The truth behind conscientious objection in medicine

Abstract

Answers to the questions of what justifies conscientious objection in medicine in general and which specific objections should be respected have proven to be elusive. In this paper, I develop a new framework for conscientious objection in medicine that is based on the idea that conscience can express true moral claims. I draw on one of the historical roots, found in Adam Smith’s impartial spectator account, of the idea that an agent’s conscience can determine the correct moral norms, even if the agent’s society has endorsed different norms. In particular, I argue that when a medical professional is reasoning from the standpoint of an impartial spectator, his or her claims of conscience are true, or at least approximate moral truth to the greatest degree possible for creatures like us, and should thus be respected. In addition to providing a justification for conscientious objection in medicine by appealing to the potential truth of the objection, the account advances the debate regarding the integrity and toleration justifications for conscientious objection, since the standard of the impartial spectator specifies the boundaries of legitimate appeals to moral integrity and toleration. The impartial spectator also provides a standpoint of shared deliberation and public reasons, from which a conscientious objector can make their case in terms that other people who adopt this standpoint can and should accept, thus offering a standard fitting to liberal democracies.

Junior doctors and conscientious objection to voluntary assisted dying: ethical complexity in practice

“…Broadly, conscientious objection clauses are designed to protect the moral integrity of doctors, by making it clear that doctors are allowed to decline to provide a particular service, if providing that service would cause them moral distress. 24 There are many areas of debate in the ethical and legal literature about conscientious objection provisions in health law, including: whether conscientious objection provisions should exist at all, 25 26 what counts as a conscientious objection, 27 28 whether health professionals should be expected to register or report their conscientious objection, 29 the relationship between institutions and conscientious objection 30 31 and the impact of conscientious objection on equitable access to services. 32–34 …”

Conscientious objection and the referral requirement as morally permissible moral mistakes

“…While the preponderance of authors do not endorse the notion, that the demands of the referral requirement might represent an unacceptable compromise to the moral integrity of the conscientious objector is not uncommon in discussion of the issue in healthcare ethics 8 10 11 13 17 24–27. The argument is that if we respect the right of individuals to opt-out of providing certain services or interventions that they consider to be morally objectionable, then it would seem contradictory to nevertheless require them to direct patients to someone who will provide those same services or interventions.…”

“…One of the primary concerns such accounts address is the need to balance between the interests of healthcare professionals and their moral integrity with the patient’s right to access legal services without undue restriction. The competing rights of providers and patients mean that it is permissible to demand that the claims made by those who would conscientiously object meet a particular standard or that their scope and boundaries can be delimited in some way 5–8. Thus, commentators variously suggest that such claims must be expressed in secular terms or that they must meet a certain standard of reasonability 5 8.…”

“…The competing rights of providers and patients mean that it is permissible to demand that the claims made by those who would conscientiously object meet a particular standard or that their scope and boundaries can be delimited in some way 5–8. Thus, commentators variously suggest that such claims must be expressed in secular terms or that they must meet a certain standard of reasonability 5 8. Elsewhere, pragmatic conditions for exercising a right of non-participation have been outlined, the most common of which is the referral requirement: the idea that healthcare professionals who exercise their right to conscientiously object to an intervention—commonly the Termination of Pregnancy (ToP) or Voluntary Assistance in Dying (VAD)ii—should refer patients enquiring about such services to another provider who does not object to providing the relevant service 9–11…”

Ought Conscientious Refusals to Implement Reverse Triage Decisions be Accommodated?

“…In contrast to conscientious refusals, conscientious objections are formally established rights that relate to certain acts, practices, or issues. Whilst some argue that they require reasonable justification (Ben-Moshe 2019 ; Kantymir and McLeod 2014 ; Card 2017 ), conscientious objections can be seen as political devices that are deployed to facilitate and manage changes to—or revolutions in (Baker 2019 )—established ethical positions regarding specific practices such as medical assistance in dying (MAiD), abortion, and contraception (Emmerich 2019 ; Montgomery 2015 ). Indeed, as Montgomery points out, “conscience clauses are historically situated and part of the ebb and flow of professional boundary work by which professional identities are constituted and reconstituted” (Montgomery 2015 , 213).…”