Justification for Conscience Exemptions in Health Care

Abstract

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 health care 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.In many parts of the world, physicians are free to object conscientiously to providing medical services that are legal and often deemed essential, but that they find morally offensive, such as abortions and contraception. In some

Conscientious objection in healthcare: why tribunals might be the answer

“…The idea that a justified conscientious objection must be reasonable is open to a variety of interpretations, for example that the view in question must not be based on racist or superstitious grounds, that it must be persuasive, that it must be as likely as the alternatives or that it must be responsive to new evidence 6 7 10 11. Cowley argues that these interpretations do not readily apply to moral convictions concerning abortion, where people disagree despite the fact that ‘all the possible evidence is already in’.…”

Conscientious objection and healthcare in the UK: why tribunals are not the answer

“…Marsh5 suggests that the aim of a tribunal would be to expose ‘unjustified biases,’ but this is more relevant to, for example, a civil registrar's refusal to process homosexual applicants; whereas the objecting GP is refusing to authorise abortions to anybody . Kantymir and McLeod6 worry about allowing objections that are ‘based on incorrect empirical beliefs,’ and they cite conscientious objections by parents to having their kids vaccinated based on the false belief that Measles, Mumps and Rubella (MMR) can cause autism. However, in the case of abortion the same empirical facts are accepted by both sides: they disagree only about the metaphysical and moral aspects of those facts.…”

“…Let me discuss these in turn. (Kantymir and McLeod6 also offer a third, hybrid option, but I will not discuss this).…”

“…For Kantymir and McLeod,6 the objector would have to show ‘that what grounds the objection is as likely to be true as what grounds the standard of care for patients’. But this language of truth, and greater likelihood of truth, is most at home in the empirical sciences; it cannot be so directly applied to moral enquiry and disagreement in cases such as these, where the objector holds a passionate commitment to a moral position.…”

Drugs down the drain: When nurses object

“…When nurses do act with conscience, the action has been called conscientious objection (CO), yet reviewers report that incidents of CO are under greater scrutiny as they increase in number, and demands for justification of the acts may become a healthcare industry standard. 25,26 Practice objections Wicclair 27 writes in depth about CO in healthcare, and warns that providing goods and services are considered part of a provider's professional obligations (p. 33), even when that provider has a conscience-based indication for refusing the service or product. However, the authors observe that concerns over sewering do not involve patient care or services.…”