Self-exempting conciliationism is the view that it is rational to give weight to the opinions of peers in disagreement, except in disagreements about how to respond to disagreement. The special treatment of disagreements about disagreement, which is important to avoid self-undermining, seems arbitrary. Two arguments against this objection were put forward. Elga [3] aims to show that there is an independent motivation for conciliationism to be self-exempting. Pittard [5] argues that the special treatment is not arbitrary because the concern for (...) epistemic deference motivates conciliatory responses only in ordinary disagreements, but not in disagreements aboutdisagreement. I will argue that both replies fail—none of them can provide a consistent justification for why one ought to be conciliatory in disagreements except in cases of disagreement about disagreement. (shrink)

Philosophers traditionally distinguish between excuses and exemptions. We can excuse someone and still see them as a participant in normal human relationships, but when we exempt someone, we see them as something to be managed and handled: we take an objective attitude to them. Madness is typically assumed to ground exemptions, not excuses. So far, the standard philosophical picture. Seeing other people as objects to be managed and handled rather than as persons with whom one can have relationships (...) is, however, ethically problematic. If I am mad myself, consistently seeing myself this way becomes downright unsustainable. A better option, I will argue, is to fully appreciate my own difficulties and learn to show myself compassion and understanding. I, then, can excuse myself on those grounds. Furthermore, a compassionate self-excusing attitude leaves room for both nuance and improvement in a way that total exemption does not. Finally, I will argue that many mad actions ought to be considered justifiable and justified rather than in need of exemption or excuse. (shrink)

Distinguishing between excuses and exemptions advances our understanding of a standard range of problem cases in debates about epistemic norms. But it leaves open a problem of accounting for blameless norm violation in ‘prospective agents’. By shifting focus in our theory of excuses from rational excellence to norms governing the dispositions of agents, we can account for a fuller range of normative phenomena at play in debates about epistemic norms.

This paper provides an interpretation of the licensing provisions envisaged under the Human Fertilisation and Embryology Act 1990 as a model for a rule and exemption-based procedural strategy for the adjudication of potential ethical controversies, and it offers an account of the liberal-democratic legitimacy of the procedure’s outcomes as well as of the legal procedure itself. Drawing on a novel articulation of the distinction between exceptions and exemptions, the paper argues that such a rule and exemption mechanism, while not (...) devoid of attractions, is not immune from the criticisms often levied against procedural approaches to the management of pluralism: it either has to fall back on substantive justification in ways that are not helpful when trying to arbitrate a moral controversy, or it appears justificatorily groundless. (shrink)

Religious exemptions have a long history in American law, but have become especially controversial over the last several years. The essays in this volume address the moral and philosophical issues that the legal practice of religious exemptions often raises.

The Moral Conscience principle claims that a conflict between the demands of a law and the demands of an individual’s sincere moral conscience provides her with a defeasible moral entitlement to an exemption. This chapter argues that this principle is vulnerable to an unfairness objection. There is nothing special about moral conscience that would justify granting an exemption, it claims, that is not shared by a variety of non-moral projects. Thus, there is no principled moral reason for a defeasible entitlement (...) to moral conscience-based exemptions that is not an equally good reason for a defeasible entitlement to non-moral project-based exemptions. Since the chapter assumes that people are not defeasibly entitled to such project-based exemptions, it advocates scepticism about the Moral Conscience principle. (shrink)

Without taking a position on the overall justification of anti-doping regulations, I analyse the possible justification of Therapeutic Use Exemptions from such rules. TUEs are a creative way to prevent the unfair exclusion of athletes with a chronic condition, and they have the potential to be the least bad option. But they cannot be competitively neutral. Their justification must rest, instead, on the relevance of intentions to permissibility. I illustrate this by means of a set of thought experiments in (...) which only an athlete’s intentions vary. I argue that the Doctrine of Double Effect sheds some light on TUEs and illustrate this by applying different readings of the DDE to the thought experiment. This underpins a justification of anti-doping exemptions very different from the approach adopted by the World Anti-Doping Agency. I argue for three changes to bring TUEs in line with this understanding: rewriting of the regulations, transparency, and a greater role for athletes in determining what exemptions are allowed, and when. (shrink)

Exemptions from laws of general application are sometimes granted on the basis of an individual’s unwillingness to comply with the law. Most such volitional exemptions involve a conflict between the law and the demands of an individual’s religious or secular moral convictions. I argue here that a limited number of volitional exemptions can be justified on the basis of a futility principle. When otherwise morally permissible penalties for violating the law cannot be expected to induce the compliance (...) of an intransigent minority, the penalties are futile, and the state has some principled reason to exempt the minority from the law’s requirements. Since the futility principle only applies to some cases of conscientious objection, it differs in important ways from justifications grounded in a general entitlement to religious or moral exemptions. (shrink)

Granting differential treatment is often considered a way of placing some groups in a better position in order to maintain or improve their cultural, economic, health-related or other conditions, and to address persistent inequalities. Critics of multiculturalism have pointed out the tension between protection for groups and protection for group members. The ‘rule-and-exemption’ approach has generally been conceived as more resistant to such criticism insofar as exemptions are not conceded to minorities or ethical and religious groups as such, but (...) to individuals who are part of those groups. However, I show that when a government grants an exemption, it inevitably provides a definition of the relevant group in question, and the tendency is to take cultural membership as ‘given’ or as defined by group spokespersons. I discuss some problems related to these definitions and defend instead a definition based on shared group interests. (shrink)

To what extent does the case for exemptions from laws to accommodate religious commitments rest specifically on egalitarian arguments? To what extent should specifically egalitarian or anti-discrimination concerns be used to determine when such exemptions should be granted? This Article considers both of these questions. It argues that while egalitarian considerations have a role to play in both the general justification and case-by-case evaluation of exemption claims, neither the justification, nor the evaluation of exemptions, properly rests solely (...) on specifically egalitarian considerations. At the level of justification, there is an important, independent role for something akin to the principle of respect for conscience recently put forward by Martha Nussbaum; and, when citizens come to evaluate particular claims for exemptions, the anti-discrimination approach put forward by Christopher Eisgruber and Lawrence Sager in the context of the U.S. and its constitutional tradition is more plausibly seen as a complement to the “balancing test” which has been used historically rather than as an alternative to it. (shrink)

Mental retardation is an invented bureaucratic category, currently undergoing radical rethinking and likely renaming, that includes many who have biologically based brain disorders, but is itself determined on functional criteria that are purely arbitrary. People with MR are socially vulnerable and thus are more likely to be "naíve confessors," "naíve defendants," and "naíve offenders." That is most likely the rationale and justification for the Supreme Court's decision, in Atkins v. Virginia, to exempt the class from execution. Although the decision is (...) to be applauded as a step in a more humane direction, it is problematic to use an indirect, artificial, and insufficiently inclusive category to determine who should or should not be executed. Limited social intelligence is a characteristic of a wide range of brainbased syndromes and disorders, including many who fall above the upper IQ limit and, thus, are ineligible for the MR label and the legal protections associated with it. A more equitable, and logical, policy would be to extend execution exemption to all who demonstrate the same kinds of vulnerabilities, especially if they can be linked to some brain-based medical condition, regardless of whether one qualifies for the label of MR. (shrink)

The paper aims to make sense of the reproach to adherents of conspiracy theories (and other bad beliefs) that they should not exempt themselves too easily from knowing better. I propose that a significant factor contributing to this exemption might be their epistemic laziness. To define this vice, I consider its normative context. I argue that epistemic laziness can be addressed without adopting a normative contextualist if it is integrated into the Aristotelian triad of virtue and two opposing vices: epistemic: (...) diligence, laziness, and overzealousness. I emphasize the need for a comprehensive analysis that includes both motivational and phronetic dimensions. For that reason, epistemic laziness cannot be reduced to akrasia alone. On the other hand, epistemic diligence demands an intrinsic motivation of love for knowledge, coupled with proper engagement and refraining from further inquiry. This expanded account offers some novel approaches to addressing epistemic laziness and combating conspiracy theories. (shrink)

ABSTRACT Because Pastafarianism – or the Church of the Flying Spaghetti Monster – is a parodic religion, common sense suggests its ‘adherents’ should not receive exemptions. However, the prima facie case for excluding Pastafarians is complicated by the fact that many assert their religion is as legitimate as any other religion and that their beliefs are genuine. Indeed, Pastafarians have already obtained exemptions in various countries. Taking the dominant liberal egalitarian, integrity‐based approach to exemptions, this article investigates (...) whether there is a principled, objective basis for excluding Pastafarians that accounts for their assertions. To that end, I examine four tests: a religion, seriousness, obligation, and sincerity test. I assess whether each test can actually exclude Pastafarians, and if it could, can it do so in a way that is consistent with liberal egalitarian commitments. I argue that only a sincerity test – based on consistent behaviour and a willingness to bear the costs of one's beliefs – satisfies both of these conditions, but, on a weak and contingent basis. (shrink)

abstract The most well‐known liberal‐egalitarian defence of cultural rights, provided by Will Kymlicka, presents culture as a primary good, and thus a resource that ought to be distributed according to some fair egalitarian criteria. Kymlicka relies on the intuition that inequalities between persons that are the result of brute luck rather than personal choice are unjust in making the case for various multicultural rights. This article makes two main claims. First, the standard luck egalitarian intuition on which Kymlicka's argument relies (...) cannot justify what he calls ‘polyethnic rights,’ in particular cultural and religious exemptions from generally applicable laws. Second, I argue that such exemptions are justifiable by appealing to the public value of fair equality of opportunity, properly construed. (shrink)

Justifying religious exemptions is a complicated matter. Citizens ask to not be subject to laws that everyone else must follow, raising worries about equal treatment. They ask to be exempted on a religious basis, a basis that secular citizens do not share, raising worries about the equal treatment of secular and religious citizens. And they ask governmental structures to create exceptions in the government’s own laws, raising worries about procedural fairness and stability. We nonetheless think some religious exemptions (...) are appropriate, and in some cases, that exemptions are morally required. So how are we to determine when religious exemptions are justified? This article employs a public reason framework to provide an answer. I show how to publicly justify religious exemptions. My thesis is that a citizen merits a religious exemption under four conditions: if she has sufficient intelligible reason to oppose the law, if the law imposes unique and substantial burdens on the integrity of those exempted that are not off-set by comparable benefits, if the large majority of citizens have sufficient reason to endorse the law, and if the exempted group does not impose significant costs on other parties that require redress. If these conditions are met, then legislative and/or judicial bodies should carve out an exemption for those requesting them. (shrink)

Religious Sovereignty and Group Exemptions This response concurs with Cohen’s critique of the Hobby Lobby and Hosanna-Tabor cases but investigates whether religious accommodation might sometimes be justified in the case of institutions and groups (not just individuals). It suggests that exemptions for associations that are recruited to advance state purposes (e.g., in welfare or education) may be more justifiable than where private associations seek to maintain illiberal – for example, discriminatory – rules in line with their religious ethos. (...) Non-democratic associations with a strong religious ethos might in principle enjoy permissible accommodation on the grounds that its members acquiesced to that ethos by joining the association, but only if other conditions are met. Democratic associations with a religious ethos have in principle a stronger claim for accommodation; in practice, however, few religious associations are internally democratic, especially where they seek to preserve illiberal internal rules. (shrink)

Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. (...) would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed. (shrink)

All of the 50 states of the United States have laws governing childhood vaccinations; 48 allow for religious exemptions, while 19 also offer exemptions based on some sort of personal philosophy. Recent disease outbreaks have caused these states to reconsider philosophical exemptions. However, we cannot, consistent with the U.S. Constitution, give preference to religion by creating religious exemptions only. The Constitution requires states to put religious and nonreligious claims on equal footing. Given the ubiquity of nonreligious (...) objections to vaccination, I conclude that the best response is to remove all exemptions, as two states have already done. But removing exemptions should not end our concern for children. Removing exemptions only bars children from public schools; it still leaves them unvaccinated, a danger to others, and reliant on whatever nonpublic schooling is available. If public school attendance is not enough of an incentive for vaccine reluctant parents, perhaps we should look into stronger measures. (shrink)

In February 1997, the Committee on Bioethics of the American Academy of Pediatrics updated its position on religious exemptions to medical care. In its earlier statement, the committee noted that forty-four states have religious exemptions to the child abuse and neglect statutes, and they argued for the repeal of these exemptions. The committee did not indude in its statement a position on religious exemptions to childhood immunization requirements that exist in forty-eight states, although this issue was (...) discussed in committee meetings. In its revised statement, the committee concluded that “The AAP does not support the stringent application of medical neglect laws when children do not receive recommended immunizations.” In this paper, we consider whether failure to immunize one's child is a form of medical neglect and, if so, whether states should repeal their religious exemptions to the immunization statutes. We argue that failure to vaccinate a child properly is medical neglect. (shrink)

When generally applicable rules clash with one’s cultural, religious or moral commitments, should exemptions be granted? The debate on exemptions raises the question both of what it means to treat people equally and of what it means to protect diversity adequately. The objective of this paper is to defend the no-exemption argument and to make it a more attractive position for liberals. I first argue that exemptions violate the principle of equal treatment because they rely on distinctions (...) that cannot be neutrally justified. I then argue that diversity can be adequately accommodated if we use a more demanding interpretation of the justification of generally applicable rules. There should be no exemption to fully justified rules, but rules are only fully justified when the particular demands that they impose on individuals are justified, i.e. when they are either neutral or pass both a Necessity Test and a Sufficiency Test. When rules are not fully justified, they should be repealed or modified. Based on this focus on the demands of rules, equality can be reconciled with an adequate accommodation of diversity. (shrink)

Mandatory reporting laws are one of the main tools that governments in the US use to curb abuse. While clergy have historically been exempted from these laws, this privilege has increasingly come under fire. This essay argues a certain degree of clergy privilege is warranted. Specifically, it argues three main points. First, laws that require every adult to report credible evidence of abuse are problematic and ought to be repealed. Second, if religion is special, there should be widespread exemptions (...) for clergy from mandatory reporting laws. Third, if religion is not special, confessors should still be exempt from mandatory reporting laws. One of the upshots of this essay is that, regardless of whether religion is special, confessors should not be obligated to report abuse heard in the confessional. (shrink)

While supporters argue that exemptions are needed to equalize opportunities, critics claim they are unwarranted in principle and discriminatory in practice: equal treatment requires only facial neutrality whereas exemptions treat citizens unequally insofar as individuals with idiosyncratic commitments similarly burdened by general rules are rarely given an exemption.The upshot of this critique is that the burdens of cultural and religious commitments ought to be treated as expensive tastes. I argue that religious and cultural commitments cannot be reduced to (...) expensive tastes that can be revised in the face of resource expectations and that, for this reason, opportunities are not equal when minorities must choose between adherence to such commitments and availing of valuable opportunities, when members of more dominant communities need not. I also explain why treating religious and cultural commitments in this way does not entail the adoption of a primordial view of culture that puts these commitments beyond revision and choice. (shrink)

Background: While employers are increasingly considering and implementing COVID-19 vaccination requirements, little is known about the reasons offered by employees seeking religious exemptions.Methods: We conducted a mixed methods analysis of all the requests for religious exemptions submitted during the initial implementation of a COVID-19 vaccination requirement at a single academic medical center in the United States.Results: Five hundred sixty-five (3.4%) employees requested religious exemptions. At least 305 (54.0%) requesters had job titles suggesting that they had direct patient (...) contact. Four hundred ninety-nine (88.3%) of requesters self-identified as Christian, of whom 120 (21.2%) identified as Roman Catholic. Requesters offered 0 to 8 (mean 2.7) categories of reasons for their request. The most frequently stated reasons pertained to the use of fetal cell lines in vaccine development and manufacturing (382, 67.6%), interest in maintaining purity (221, 39.1%), or belief in divine healing (172, 30.4%). Some requesters also volunteered evidence of the sincerity of their beliefs including examples of their religious practices (116, 20.5%), other practices (66, 11.7%), and emotional states (32, 5.7%). One hundred fifty-two applications (26.9%) contained text copied without attribution, primarily from sample religious exemption request letters available on the Internet.Conclusions: Most requesters focused on the use of fetal cell lines in the development or manufacturing of the vaccines as the justification for their request. The development of vaccines that are not reliant on fetal cell lines may increase vaccination rates. Understanding reasons for religious exemption requests may inform vaccine education and vaccination policies. (shrink)

Several possible approaches can be applied by the state when it responds to religious conscientious objections. These approaches compare the response to religious-conscientious objections with that to non-religious objections. If the content of the objector’s conscience is significant when deciding to grant conscientious exemptions, three approaches to the practice of granting conscientious exemptions are possible: First, a non-neutral liberal approach that takes into consideration the content of the conscience but not its religiosity as such; second, a pro-religious approach; (...) and third, an anti-religious approach. This paper contends that the non-neutral liberal approach and the pro-religious approach should be rejected in favor of an anti-religious approach to granting conscientious exemptions. The proposed anti-religious approach is as follows: (1) unjustified intolerance should not be tolerated; (2) empirical evidence links religion and intolerance – that is, people’s responses to measures of religion and intolerance are closely related; (3) theoretical evidence links (some) religions and intolerance; and (4) the religiosity of conscience gives the state a reason to refuse to grant conscientious exemptions. (shrink)

Exemption claims remain a tangled and divisive moral and legal issue both in academia and in the public sphere. In his book Exemptions: Necessary, Justified, or Misguided?, the constitutional scholar Kent Greenawalt zeros in on the vexed question of whether exemptions from rules of general applicability based on the conscientious convictions of individuals or groups are sometimes justified or prudent by discussing a wide range of cases drawn from the American jurisprudence. Although he does not engage in a (...) significant way with political and legal philosophy and comparative law, his contextualist and pragmatic approach is a powerful antidote against oversimplification and dogmatism with regard to exemption claims. Unsurprisingly, Greenawalt’s approach comes at times dangerously close to casuistry, and some of his analyses and normative recommendations would benefit from a firmer footing in moral principles and rational argumentation. In this review, I flesh out some of the strengths and limits of Greenawalt’s valuable book. (shrink)

According to the standard liberal egalitarian approach, religious exemptions from generally applicable laws can be justified on the grounds of equal respect for each citizen’s conscience. I contend that claims of conscience cannot justify demands for exemptions, since they do not meet even the most inclusive standards of public justification. Arguments of the form ‘My conscience says so’ do not explicate the rationale behind the practices that the claimants seek to protect. Therefore, such arguments do not constitute even (...) pro tanto reasons for exemptions. Rather, they are what Francis Bacon called idola fori – ‘idols of the marketplace’– conventional justifications that are deemed rational and even self- evident, while in fact they are not. (shrink)

Within the health care industry, the move from regulatory cost controls to market competition has generated rapid and dramatic restructuring of providers. To enhance their competitive positions in the evolving market, many health care organizations are pursuing the ownership and integration of all elements and stages of health care delivery and payment, with the goal of increasing access to capital and lowering costs through administrative efficiencies and economies of scale. As of July 1994, 24 percent of hospitals were members of (...) an integrated delivery system, and 47 percent were involved in IDS development.IDSs pose a singular challenge to the Internal Revenue Service. The IRS recognizes that its traditional policies for granting tax exempt status are not flexible enough for the competitive and rapidly changing health care market. In recent years, the IRS has taken a more active role in scrutinizing emerging health care institutions seeking taxexempt status. (shrink)

In this article, I defend the view that conscience exemption clauses for medical practitioners (doctors, nurses, technicians, pharmacists) should be limited by patient protection clauses. This view was also defended by Mark Wicclair, in his book on conscience exemptions in medicine (Cambridge UP, 2011). In this article, I defend Wicclair’s view by supplementing it with Hegelian ethical theory and feminist critical theory. Conscience exemptions are important to support as a matter of human rights. They support an individual’s right (...) to protect their deepest value-commitments. A true understanding of conscience is dialectical, however, and it requires patient protection clauses because they, too, protect individuals in their deepest value-commitments. In this article, I show that the defense of patient protection clauses is historically supported by the theory of “conscience [Gewissen]” developed by G.W.F. Hegel in the nineteenth century (mostly in the Phenomenology of Spirit (1807)). (shrink)

Research on the nutrition transition often treats dietary changes as an outcome of increased trade and urban living. The Northern Food Crisis presents a puzzle since it involves hunger and changing diets, but coincides with a European ban on trade in seal products. I look to insights from economic sociology and decolonizing scholarship to make sense of the ban on seal products and its impacts. I examine how trade arrangements enact power imbalances in ways that are not always obvious. I (...) explain how the ban’s exemption for Inuit-produced seal goods explicitly aims to protect Inuit from the harshness of capitalism and preserve their traditions. In this respect, the Northern Food Crisis is an embodiment of European visions of who Inuit are expected to be and how they are supposed to act in the global economy. (shrink)

Religious exemptions present an anomaly in American law. Under the power of religious exemptions, individuals and organizations whose actions violate civil and criminal laws are exempt from those l...

Nagappan, Kalokairinou, and Wexler (2021) raised a serious ethical question: Are off-label practices or direct-to-consumer medical devices offered to public exempted from clinical or research gover...

Volume 25, Issue 3, September 2019, Page 290-292.

Legal and philosophical theories of religious exemptions have primarily understood them as a means toward one or more moral ends: protecting rights and securing equality, primarily. But exemptions also serve an under-theorized stabilizing function in resolving conflicts between law and belief. In this paper, I argue that these conflicts pose a challenge to public justification, and ipso facto to political stability. I then show how religious exemptions can support stability by ameliorating these conflicts, and elaborate parameters for (...) identifying those exemptions most likely to achieve this stability-enhancing effect. (shrink)

The Japanese Medical Act section 21 states that doctors must report unnatural deaths to the police, even though the term “unnatural death” is not defined by law. However, many doctors are reluctant to report potential therapeutic deaths . The Japanese Society of Legal Medicine has submitted guidelines for unnatural death, including PTD. These define a PTD as an unexpected death, the cause of which is unknown, but which is potentially related to medical practice. Such deaths are “reportable” to the coroner (...) in the UK. In this study, we addressed the question of whether physicians would report each of eight hypothetical PTDs. Although the clinical societies declare that doctors must report deaths due to gross negligence, 60% of the participants said that they would not report gross negligence involving an overdose in cases where they had obtained informed consent or had provided an explanation after the death occurred. This can be accounted for by the mistaken belief on the part of the participants that obtaining informed consent exempts Japanese physicians from the duty of reporting PTDs. The attitude of Japanese physicians is caused by the death investigation system, which is designed to discover whether a crime has been committed rather than focusing on the cause of death. Accordingly, the Japanese Government has decided to commission a pilot study from an independent organisation in which medical specialists will investigate PTDs in order to prevent deaths occurring as a result of gross negligence. (shrink)

American bankruptcy law has offered a "fresh start" in every state for over one hundred years. As a result, econometric studies of consumer bankruptcy often focus on one of the few aspects of the law that has varied significantly across time and across states: exemptions. Professors Gropp, Scholz and White published the first article to test the effect of exemptions on credit markets. Consistent with theory, they found that residents of states with larger exemptions pay higher interest (...) rates than those in states with lower exemptions and face an increased probability that they will be denied credit. These effects were most pronounced for poor households. This result is surprising because exemptions only allow a household to keep what it has. The difference between a $100,000 exemption and an exemption with no dollar limit should not matter if the household has little or no assets to exempt. This essay examines alternative explanations for why exemptions appear to have a disproportionate impact on the poor. Unfortunately, however, none of these alternative explanations proves entirely satisfactory. (shrink)

I address the long-standing problem of toleration in diverse liberal societies in light of the progress of same-sex marriage and continued vehement opposition to it from a significant portion of the population. I advance a view that contrasts with recent discussions by Teresa Bejan, Mere Civility, and especially Cecile Laborde, Liberalism’s Religion. Laborde emphasizes the importance of state sovereignty in fixing the boundaries of church and state, emphasizing the priority of public authority and constitutional supremacy. I argue that emphasis on (...) priority needs to be complemented by a recognition of the importance of forms of reconciliation that go beyond ‘mere civility’. Reflections on toleration in the liberal and democratic traditions – including in the canonical discussions of Locke, Rousseau, Smith and Tocqueville, and in more recent political science – have recognized that the health of liberal democracy benefits enormously from the educative and morally formative resources furnished by religious c... (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2016 Heft: 209 Seiten: 77-97.

Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might prompt requests for (...) conscience-based exemptions. In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety. (shrink)

I focus on some controversial features of Peter Balint’s stimulating and provocative reassessment of the place of toleration in contemporary diverse societies. First, I question his argument that we must enlarge the concept of toleration to include indifference and approval if toleration is to be compatible with state neutrality. Secondly, I suggest that his idea of active neutrality of intent risks encountering the same difficulties as neutrality of outcome, although these will be mitigated the more the state’s neutrality takes a (...) ‘hands-off’ form. Thirdly, while accepting his claim that exemptions depart from neutrality insofar as they attribute a significance to religious and conscientious convictions that they deny to mere preferences, I argue that that departure is not arbitrary and remains within the spirit of neutrality of intent. (shrink)

Exemption from blameworthiness is often bound to implicit or explicit claims of diminished agency, or even non-agency. This poses a dilemma in navigating moral relationships affected by mental illness. While it is crucial for assessments of responsibility to be responsive to the significance of mental illness, must this responsiveness come at a cost to symmetrical moral relations? In this paper we argue, contra recent critiques, that Strawsonian accounts of responsibility are able to navigate this dilemma, and can accommodate significant exculpation (...) on the basis of mental illness while maintaining symmetrical relations. We understand this to be part of the larger recognition that while we have certain fundamental entitlements within our moral relationships, it is also possible to be over-entitled, and to expect too much of others. Our account draws, in particular, on the moral significance of difficulty. Difficulty is inherently scalar, and in drawing on this explanatory framework we explicate a theory of both excuse and exemption by degree. We argue for a significant realm of excuse on the basis of mental illness that is fully compatible with symmetrical relations. However, we also acknowledge the limits of this accommodation on Strawsonian grounds, and argue that these limits are justified and appropriate. (shrink)

This study examines the procedural ethical considerations surrounding religious exemptions to Covid vaccine mandates, specifically focusing on immigrant healthcare personnel (HCP) and HCPs of color. It emphasizes communication issues with applicants by investigating exemption applications and their accompanying guidelines. While there is extensive literature on the ethical implications of religious exemptions, a notable gap remains in addressing the procedural aspects of religious exemption applications and their reviewing processes. The study scrutinized religious exemption application forms and accompanying guidelines from (...) 32 selected non-teaching and teaching hospitals for the years 2022–2023. The findings highlight significant variability in exemption application criteria and processes across institutions. Importantly, many application forms lacked comprehensive procedural information, which may result in subjective evaluations and potential misinterpretations of non-Western and non-mainstream religious beliefs, especially those of immigrant HCPs and HCPs of color. The study proposes various strategies to advocate for more equitable and transparent procedures, underlining the significance of diversity, equity, and inclusion in the religious exemption review process for vaccine mandates. (shrink)

In a recent commentary, Kim and colleagues argued that minimal-risk research should be deregulated so that such studies do not require review by an institutional review board. They claim that regulation of minimal-risk studies provides no adequate counterbalancing good and instead leads to a costly human subjects oversight system. We argue that the counterbalancing good of regulating minimal-risk studies is that oversight exists to ensure that respect for persons and justice requirements are satisfied when they otherwise might not be.