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<p>Whether or not conscientious objection in medicine is justified and to what extent it ought to be accommodated is a long-standing question in the bioethical literature that has drawn its share of controversy, even more so today with the growing number of jurisdictions that have legalized the practice of physician-assisted suicide in one form or another. Recently, efforts have been made to reframe the question of whether refusal to provide certain services is justified not in terms of conscience, but in terms of an institutional right of non-participation as grounded in institutional self-governance. Doing so circumvents the moral conundrums at stake in the discussions on conscientious objection by shifting the level at which moral justification is to be located: it is in certain cases acceptable to refuse to provide services not because it interferes with a doctor's moral convictions, but because an institution, in virtue of being an institution, simply possesses an inherent right to do so. The right of self-governance grants institutions a right to exercise discretion over their internal affairs, and it is implied that decisions regarding what procedures a medical institution chooses or refuses to deliver fall within the scope of its internal affairs. Therefore, the right of self-governance grants legitimate ground for refusing to provide selected procedures, such as physician-assisted suicide. We argue that the right to self-governance ought to be limited with regard to this kind of procedure, both for public and private medical institutions. To do so, we adopt a liberal egalitarian theoretical framework and frame the issue at stake as one of competing rights between institutions and individuals. We explore cases where the unrestricted right to self-governance proves morally problematic and argue that, in order for institutions to comply with principles of justice, the right to self-governance and its derivative right to non-participation must at times be suspended and overridden by the interests of individuals.</p>

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Medical Institutions, Self-Governance, and the Right to Assisted Suicide

  • 期刊论文

  • 发表日期：

    2025年7月2日

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  • Yoann Della Croce,
  • Matteo Gianni

摘要

Whether or not conscientious objection in medicine is justified and to what extent it ought to be accommodated is a long-standing question in the bioethical literature that has drawn its share of controversy, even more so today with the growing number of jurisdictions that have legalized the practice of physician-assisted suicide in one form or another. Recently, efforts have been made to reframe the question of whether refusal to provide certain services is justified not in terms of conscience, but in terms of an institutional right of non-participation as grounded in institutional self-governance. Doing so circumvents the moral conundrums at stake in the discussions on conscientious objection by shifting the level at which moral justification is to be located: it is in certain cases acceptable to refuse to provide services not because it interferes with a doctor's moral convictions, but because an institution, in virtue of being an institution, simply possesses an inherent right to do so. The right of self-governance grants institutions a right to exercise discretion over their internal affairs, and it is implied that decisions regarding what procedures a medical institution chooses or refuses to deliver fall within the scope of its internal affairs. Therefore, the right of self-governance grants legitimate ground for refusing to provide selected procedures, such as physician-assisted suicide. We argue that the right to self-governance ought to be limited with regard to this kind of procedure, both for public and private medical institutions. To do so, we adopt a liberal egalitarian theoretical framework and frame the issue at stake as one of competing rights between institutions and individuals. We explore cases where the unrestricted right to self-governance proves morally problematic and argue that, in order for institutions to comply with principles of justice, the right to self-governance and its derivative right to non-participation must at times be suspended and overridden by the interests of individuals.