Conscientious Objection

Question 1

Which declarations of human rights affirm freedom of conscience?

Answer 1

• UDHR
• European convention on HRs
• Human Rights Act 2004 (ACT)

All affirm freedom of thought, religion or lack of religion

Question 2

Define conscientious objection as defined as AMA

Answer 2

A conscientious objection occurs when a doctor, as a result of a conflict with his or her own personal beliefs or values [sincerely-held beliefs and moral concerns not self-interest or discrimination], refuses to provide or participate in a legal legitimate treatment or procedure which would be deemed medically appropriate in the circumstances under professional standards.

Doctors have a moral obligation to minimise disruption to patient care.

A refusal to provide or participate in a treatment or procedure for legitimate medical or legal reasons does not constitute a conscientious objection

Question 3

List the areas in which a right to conscientious objection has been recognised

Answer 3

In Medicine:
- Termination of Pregnancy
- Reproductive Medicine: IVF & Contraception
- Euthanasia (VAD, MAID)
- Electroconvulsive therapy* *
Elsewhere:
- War
- Dissection in Biology Class
Who can lay claim to CO in Healthcare?
- Medical Doctors
- Professions Allied to Medicine: Midwifery, Nursing, Pharmacy

Not so much:
- Those who work within Healthcare? Administrators, Porters, Interpreters
- Institutions? (Calvery H/care Group)

Question 4

Describe the argument against conscientious objection

Answer 4

Some, Savulescu among them, think we should reject all claims to conscientious objection.
Others are concerned with distinguishing between claims we should recognize or accommodate and those we should not. Furthermore, they are interested in how such claims should be circumscribed.
In the latter case, some think that virtually all claims of conscience should be recognized or accommodated, others think that more narrow criteria should apply.

Question 5

Provide examples of moral objections that do not count

Answer 5

• Objections to War per se: e.g. Pacifism
• Not Objections to this War: e.g. Vietnam
• Objections to Abortion per se
• Not Abortion in this, that or the other circumstance.
• Similarly for Euthanasia
• Objections to IVF as opposed to IVF for single mothers, surrogacy, or same-sex parents

Question 6

Discuss ethics issues related to referral

Answer 6

Individuals who conscientiously object to a particular intervention such as abortion or VAD are required to refer patients seeking these services to a non-objecting provider. Some argue that we should not require individuals to act in this way as doing so would amount to transgressing one’s own moral beliefs, precisely what COs are seeking to avoid.

Question 7

Why does conscientious objection exist?

Answer 7

The underlying purpose or raison d’être of medicine is health. Thus, we evaluate different treatments and interventions in terms of their contribution to this goal; all other things being equal, acting so as to restore the patient to good health is the better option.

Some take this idea and explore what is and is not properly thought of as part of medicine or healthcare. They argue that if something is not in the interests of health, it need not form part of medical practice.

For example, some consider abortion or VAD illegitimate because simply being pregnant cannot be construed as a ‘state of ill health,’ and death neither ‘cures’ nor ‘palliates.’ Thus, they argue that while some medical doctors may agree to provide such services, others should not be compelled to do so.
Few make the same point regarding infertility; failure to become pregnant may be distressing but not being pregnant does not amount to ‘a state of ill health,’ at least not in itself.

Moral objections are not uncommon but recognizing or accommodating them as Conscientious Objections is relatively unusual.

Broadly, the decline of moral authority (notably religion or, perhaps more accurately, the hegemony of state-religion), the emergence of secularism, processes of individualization and detraditionalization, the normalization of (religious) diversity, and the advent of moral pluralism has created a context in which conscientious objection has become a useful idea.

Introduction of specific changes:
- legalization of abortion;
- developments in reproductive medicine;
- changing opinions on euthanasia.
- Facilitated by an ethico-political settlement.

MORAL ACCOMMODATION CUTS BOTH WAYS

Question 8

DOES IT HAVE TO BE A SECULAR MORAL OBJECTION?

Answer 8

Briefly yes.

Many who defend CO limit it to moral concerns that can be expressed and defended in secular terms or within the limits of ‘public reason.’ However, it is clear that many COs are historically and personally rooted in beliefs of a religious nature, even if they can be defended in secular terms.