Conscientious objection under fire

Conscientious objection to abortion and euthanasia is a hot topic wherever these procedures have been legalised. Politicians hesitate to penalise people who appeal to a higher authority. But supporters argue that doctors have a duty of care to provide legal healthcare services.

The target article in the latest issue of the American Journal of Bioethics tackles this controversy. Kyle G. Fritz, of the University of Mississippi, lives in a state whose legal code declares: “A health-care provider may decline to comply with an individual instruction or health-care decision for reasons of conscience”.

He argues that what is good for the goose is good for the gander. If some doctors are permitted to withhold their services on the grounds of conscientious objection, why can’t other doctors provide the services for the same reason? He regards the current situation as ethically “asymmetrical”.

Supporters of what he terms “negative conscience clauses” sometimes argue that being forced to do something against one’s conscience hurts one’s integrity, resulting in guilt, shame, a loss of self-respect and a decline of moral character. But isn’t this true as well for people whose desire to perform an action, say, an abortion, is thwarted? He writes:

… one’s integrity can be damaged not only by performing an action contrary to one’s conscience, but also by not performing an action that one’s conscience requires. So, if we should protect negative conscience clauses to protect integrity, we should also protect positive ones for the same reason.

Fritz’s argument is long and complex. But he points out that he has not proved that conscientious objection should exist at all.

As far back as 2006 Julian Savulescu made a strong case for the immorality of conscientious objection: “When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors' conscience has little place in the delivery of modern medical care.”

So, as Fritz points out, there are two ways forward: to grant a right to conscientious objection to doctors who refuse to do abortions and also to doctors who want to do abortions. This, of course, makes the whole notion conscientious objection incoherent, if not a joke. So the other option is to abolish conscientious objection altogether.

Michael Cook is editor of BioEdge


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