They need to give reasons for their refusals

While some bioethicists believe that conscientious objection has no place in modern medicine, others feel that they could be accommodated by setting up tribunals. Here are three proposed this year in the Journal of Medical Ethics.

Establish military-style tribunals. In times of conscription, military tribunals assess whether a pleas of conscientious objection in legitimate or not. Why not follow this model for healthcare workers, asks Steve Clarke, of Charles Sturt University (Australia), in the Journal of Medical Ethics.

Military tribunals used to ask whether the objector would serve in a non-combatant role. Some agreed to support the war effort by serving in non-combatant roles; others would only perform community service. The former were actually making an indirect causal contribution to the war effort to which they objected. Clarke believes that the same question should be asked of doctors:

“A doctor who objects to conducting abortions, and also objects to making an indirect causal contribution to abortion, but who currently works for an organisation in which abortions are conducted, should be helped to find work with a different organisation, where abortions are not conducted. The objections of a doctor who conscientiously refuses to conduct abortions, but who has no objection to making an indirect causal contribution to the conduct of abortion are best dealt with by finding that doctor other duties to perform, within the current organisation that she is employed in.”

This argument will succeed in forcing objectors with very strong convictions out of the public system and into private practice and those who remain and perform “non-combatant” roles will be burdened with moral complicity.

Establish medical conscientious objection review boards. Robert Card, of the University of Rochester Medical Center (US), argues in the JME that doctors need to give “public reasons” for conscientious objection. This would rule out even “effective referral” for a procedure. Their reasons need to be solidly grounded, empirically and ethically. This rules out reasons based on prejudice (sexism or racism) or sincere moral convictions.

This leads him to propose review boards staffed by medical professionals, bioethicists and lawyers. If a doctor establishes that there are sufficient reasons for his objections, he would be licenced to practice medicine as an official conscientious objector. If doctor who is not a licenced CO refuses to do a procedure, he could be punished.

Earlier in the year, Jonathan A. Hughes, of Keele University (UK), proposed the establishment of Conscientious Objection Tribunals in the JME. Doctors would appear before a board which would assess whether their objections were reasonable and what arrangements he would make for patients who requested a procedure to which he objected. If approved, the tribunal would licence them for five years at a time. No conscientious objection would be allowed without a licence.

Keele is less specific about the composition of the tribunals. However, they should include members of the public and potential service users. He feels that it is important that it be a face-to-face examination  rather than a bureaucratic procedure. 

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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