Conscientious objection in healthcare
Authors: Clarke Steve 
Published: February 2023

When healthcare professionals ask for a conscientious objection to be accommodated, they are requesting an exemption from a work role they object to, on moral or religious grounds. The word ‘conscience’ is sometimes taken to suggest a distinct mental faculty which generates moral responses. It would be a mistake to associate conscientious objections in healthcare too closely with the deliverances of conscience, however. Conscientious objections do not always involve the input of an objector’s conscience. But, they always involve moral or religious considerations.

Conscientious objection was rarely discussed in healthcare contexts before the 1960s. Until then healthcare was permeated by a culture of medical paternalism, under which the values of doctors were effectively imposed on patients. Under the modern ethos of patient autonomy there is scope for patients to request, and to receive, forms of healthcare that healthcare professionals might find objectionable. So, they may want exemptions from some of the ordinary duties expected of them. If the healthcare institutions in which they work are to accommodate their wishes then either an arrangement needs to be made to ensure that other healthcare professionals undertake those duties, or some of the services that society licenses healthcare institutions to provide will not be provided.

The 1973 Church Amendment exempted healthcare professionals in the United States from having to provide abortion or sterilisation services if doing so was inconsistent with their religious beliefs or moral convictions. Since then the scope of legal entitlement to conscientious accommodation has steadily expanded, in the United States and elsewhere. This expansion has begun to impact on healthcare provision, especially in respect of abortion. Unsurprisingly some commentators have started to think of ways to restrict conscientious accommodation.

To what extent should conscientious objections be accommodated in healthcare? There is a plethora of answers to this question. Wicclair (2011) provides a helpful taxonomy of the different positions, recognising three different sorts. These are: (a) Conscience absolutism: the view that healthcare professionals should never be professionally obliged to act in any way they regard as violating of their consciences, (b) the incompatibility thesis, according to which no conscientious objection should be accommodated in the healthcare professions; and (c) compromise. Advocates of compromise hold that only some conscientious objections should be accommodated in the healthcare professions.

In many public healthcare institutions, a healthcare professional who refuses to perform a medical procedure, on conscientious grounds, is expected to refer a patient requesting that procedure to another healthcare professional who is qualified, willing, and available to perform it. Referral is controversial because if a healthcare professional is convinced that a particular form of healthcare service is wrongful, then, were they to refer a patient, they would be complicit in an activity they regard as wrongful. The case for insisting on referral is that public healthcare systems have a duty to provide legal and safe forms of healthcare to patients.