A) Protection of conscience laws (PCL's)
ensure that people cannot be forced to facilitate practices or procedures to
which they object for reasons of conscience. These may include abortion,
capital punishment, contraception, sterilization, artificial reproduction,
euthanasia, assisted suicide, human experimentation, torture, etc. An
adequate protection of conscience law should protect conscientious objectors
from coercive hiring or employment practices, discrimination and other forms
of punishment or pressure. It should also include protection from civil
clauses are usually less comprehensive than protection of conscience laws
and afford varying degrees of protection for conscientious objectors. They
may appear in statutes or in the policies of organizations or institutions.
A) Protection of conscience laws and
conscience clauses are needed because powerful interests are inclined to
force health care workers and others to participate, directly or indirectly,
in morally controversial procedures. Physicians, nurses, pharmacists and
others have been denied employment, dismissed, or penalized because of
objections to abortion, contraception or the morning-after pill (See
Repression of Conscience). The same pressure will almost certainly be
applied to force conscientious objectors to participate in reproductive
technology, eugenic screening, and in euthanasia and assisted suicide,
particularly where such things are legal or are tolerated.
A) Those who refuse to do what
they believe to be wrong are defending their own integrity, not "imposing
beliefs." This is well understood in other contexts. For
example: people who refuse to help others cheat, steal or commit adultery
are not accused of "imposing their beliefs."
A) All beliefs are personal,
since one who believes something holds that belief "personally" or is
personally committed to that belief. Someone who refuses a bribe
because he believes bribery is wrong is acting on his beliefs. Health
care workers who suggest some forms of treatment or care rather than others
may also be acting on their beliefs. It is normal for people to act on
their beliefs, at the workplace or elsewhere.
A) Beliefs -and believers -
can be religious or non-religious. For example: people may believe in
the equality of all people for religious reasons, for for political,
ideological, or philosophical reasons. If one can reasonably act on a
non-religious belief, one can reasonably act on a religious belief.
There is no reason - apart from anti-religious bigotry - to prevent people
from acting on religious beliefs. [See
There are No Secular Unbelievers.]
A) That depends upon the wording of the law. A
statute can be drafted broadly so that it can be applied to any kind of
medical procedure. On the other hand, it can be written to include a class
of procedures (all those affecting life, for example). Finally, a law can
also identify specific procedures to which it is to apply. The Project website
includes examples of different kinds of legislative drafting.
A) Sometimes a law is drafted to respond to a
particular need or concern. For example: many American laws were drawn up in
direct response to the legalization of abortion by a U.S. Supreme Court
ruling about abortion. Hence, many of these laws concern only abortion.
Similarly, concerns with a certain class of
procedures (cloning and in vitro fertilization, euthanasia and assisted
suicide) may generate a law that has narrower application.
The broadest approach, which does not restrict protection
to specific procedures or classes of services, may result from a political
and social ethos that is respectful of freedom of conscience in principle.
It may also reflect an awareness that laws that are procedure-specific are
not sufficiently flexible to keep pace with changes in medical technology.
Finally, laws may be influenced by pragmatic
judgement about the political support likely to be available for different
kinds of legislation.
A) No. PCLs prevent people from being forced
to participate in medical procedures, but they do not make them illegal.
A) No. Many states provide alternatives to
active military service for conscientious objectors, but such policies have
never been understood to mean that military service is immoral. Similarly, a
protection of conscience law need have no impact on the dominant moral
outlook concerning procedures to which some people object.
A) Unfortunately, their record in this respect
indicates that they are unreliable. (See
Repression of Conscience). Moreover, many people are not members of
unions or professional associations.
A) Yes. But, in the first place, many workers
are not protected by collective agreements. More important, freedom of
conscience is not merely an employee benefit. It should be considered an
employee right, protected by legislation, lest unions actually bargain it
away in exchange for more vacation pay, for example, or higher overtime
A) They could result in some prosecutions at
first. But they should prevent litigation and prosecution by
discouraging coercive conduct. If problems arise, they are more likely to be
settled without going to court if people can refer to a single law. And
there should be fewer problems as time goes on and people learn their
A) This could only occur if large numbers of health
care workers refused to participate. In that case, it would be
appropriate to re-examine the nature of the procedure. A re-examination
might suggest, for example, that the procedure should be done only by
medical specialists, or only in certain facilities, or by specialists
outside traditional health care professions.
In fact, it is extremely unlikely that large numbers
of health care workers would refuse to participate in morally
non-controversial procedures that are actually beneficial for the patient.
That has not occurred in jurisdictions like the state of Illinois, U.S.A.,
which has a broadly worded protection of conscience statute. [See the
Health Care Right of Conscience Act.]
A) There are many medical services that
cannot, for economic reasons, be routinely provided in rural areas, and even
in small towns or cities. Such difficulties are usually resolved by visiting
specialists or by sending the patient for treatment at a central location.
What is done for reasons of economy could also be done for reasons of
conscience - if conscience is valued as highly as economics.
A) This kind of conflict can be prevented or
resolved by identifying, in advance, the performance of certain procedures
as a bona fide requirement of a position to be filled. PCLs can be
drafted to allow for such eventualities; the
Model Statute illustrates one way of doing this.
A) It has actually been an issue for many
years. It was considered in the drafting of the abortion law in the United
Kingdom in 1968, which includes a protection of conscience provision. However, in recent years the issue of
freedom of conscience in health care has come increasingly to the fore
because of pressures from activists who make aggressive rights and
exaggerated rights claims, and because of ethical
problems generated by advancing medical technologies and the lobbies for euthanasia and
A) The reason usually advanced to justify
coerced participation in sterilization, contraception, or abortion is that
the health care worker's 'personal values' must give way to the choice made
by the patient. The same reasoning is used to justify coerced participation in
various kinds of reproductive technologies, in euthanasia and in assisted
A) Yes. Two universities
in Belgium joined the Flemish Association and General in 2003 in a statement
asserting that physicians unwilling to provide euthanasis should help
patients find someone willing to provide the service. Since then, a
panel of the Royal Society of Canada and a legislative committee in the
province of Quebec, Canada have issued reports recommending legalization of
assisted suicide/euthanasia, and compulsory referral by objecting
Belgium: Mandatory Referral for Euthanasia]