Defending conscientious objection

By Michael Cook

One of the hottest topics in bioethics today is conscientious objection (CO). Although the clamour is loudest in the corner where the debate is over whether CO has a right to exist, most writers and legislators believe that there is some room for CO in healthcare. The question is how much room.

That’s why a special issue of The New Bioethics is a welcome addition to the rapidly growing literature on CO. The articles are part of a four-year plan of seminars in Britain organised by the Accommodating Conscience Research Network (ACoRN). Here are a few nuggets from the articles in the special issue.

David Oderberg, of the University of Reading, asks whether CO in medicine is a special case which deserves unique protection or whether CO exists in other professions as well. He answers that in principle CO in medicine is not special, but in practice, it is. Most conflicts and disputes over CO arise in this area because we all need health care.

… a serious commitment to legal protection for conscientious objection, in line with international commitments, will make medicine the driver of protections that all professions will be able to enjoy

As well, a short book by Oderberg, Opting Out: conscience and cooperation in a pluralistic society, is reviewed in the same issue by Morten Magelssen, of the University of Oslo. Opting Out can be downloaded as a free e-book.

“A main theme is that clear-headed and morally sound thinking about the ethics of cooperation is lacking in recent court decisions,” writes Magelssen. Oderberg develops a coherent theory of reasoning about cooperation inspired by the Catholic ethical tradition.

It is normally assumed in popular debates about CO that its inspiration is religious. Admittedly, that is the position taken by many healthcare workers, who describe their CO as a crisis of religious freedom. However, Toni Saad, of the Cardiff and Vale University Health Board, contends that CO is “a requirement of the moral imperative to do no harm, the right to refuse to harm in regard to health.”

This changes the discussion from unfathomable personal principles to the more objective issue of whether a course of action is harmful or not. Like Oderberg, Saad sees CO in medicine as the standard-bearer for CO in other professions. He concludes:

The high stakes and more clearly controversial possibilities of healthcare in no way imply that the rest of society operates at the level of the purely technical and mundane. All are subject to the same rules of morality, and all pursuit of the good is subject to the requirements of practical reason and conscience’s apprehension and application of practical reason to one’s given sphere, regardless of whether one’s potential to harm is great or small. Whether one is a doctor, a teacher, a butcher, baker or candlestick-maker, one should not be forced to do something which one considers harmful to another. CO, therefore, is the right to refuse to harm.

CO is at risk in Canada and other jurisdictions where the arguments of CO abolitionists like Udo Schuklenk and Julian Savulescu have taken root in the judiciary and amongst medical colleges. It is even argued that CO is associated with “idiosyncratic, bigoted, and discriminatory” ways of practicing medicine. Mary Neal, of the University of Strathclyde, and Sara Fovargue, of Lancaster University, deny this.

Taking a more holistic view of medicine, they point out that a good doctor (or nurse) must be trustworthy and compassionate. CO protects this amongst practitioners. “Trustworthiness and integrity are more fundamental to the professional-patient relationship than a willingness to perform any particular procedure. Furthermore, whereas accommodating CO supports these core professional virtues, compelling participation threatens them.”

Editor’s note. Michael Cook is editor of BioEdge where this appeared. Reposted with permission.