When doctors say No
A law professor defends physicians' right to
18 May, 2017
Reproduced under Creative Commons Licence
As abortion, euthanasia and other controversial
procedures become more widespread, conscientious objection
for healthcare workers is becoming a flashpoint for
controversy throughout the Western world. Some doctors and
ethicists have argued that conscientious objection itself is
unethical because doctors are required to fulfil any legal
request that their patients make.
MercatorNet interviewed Professor Michael Quinlan,
dean of the law school at the Sydney campus of the
University of Notre Dame Australia, about this contentious
issue. He has just published an article on the situation in
MercatorNet: Opponents of conscientious objection
complain that patients could suffer if doctors refuse to
provide a service. But how about doctors? Do they suffer if
they cannot live consistently with their consciences?
Michael Quinlan: Yes, they do and in a
number of ways. Some doctors faced with provisions which
prevent them from living consistently with their conscience
will retire or move to a State which does respect
conscience. Not all doctors will be in a financial position
to take those steps, so some will comply with the law –
after all generally speaking we expect citizens, and
especially professionals, to comply with the law.
Just as there is growing evidence of what is called
"moral distress" being experienced by ex-servicemen and
women, so there is growing evidence that health
practitioners who act against their conscience can suffer
from "moral distress."
This is not just a bad feeling. Moral distress can
adversely impact on self-respect, self-esteem, patient care
and job satisfaction. Feelings of helplessness, frustration,
guilt, sorrow and anxiety can manifest in physical and
mental illness. Moral distress can cause burnout and early
retirement from the profession. It can also lead to
desensitising of one's conscience and to increased risk of
doctors developing indifference to patients and a weakening
of their ability make ethical decisions.
Most discussions of conscientious objection to
abortion frame it as a moral judgement on the procedure. But
isn't it also possible to see it as bad medicine – the wrong
answer to a woman's distress?
There is certainly evidence that some women do suffer
adversely from induced abortions. Symptoms can include
depression, low self-esteem, self-destructive behaviours,
relationship difficulties, substance abuse, suicidal
ideation and anxiety. Such symptoms are not confined to
women who undergo late term terminations and emerge after
short or long periods of time have elapsed.
Reardon, Coleman and Short's study of medical evidence
from half a million women in Denmark found significantly
higher mortality rates within one to ten years of woman who
have had early or late abortions. Women should be informed
of these medical risks but they should also be given real
alternatives to consider and those alternatives – material
and medical – should be real.
Nobody likes "conscience clauses". Those who
appeal to them resent being treated as an exception; those
who oppose them think they are unfair. Do conscience clauses
have a future or will they become narrower and narrower and
I don't know that it is true to say that nobody likes
"conscience clauses." Conscience protections are actually
not all that uncommon in Australia. Parliamentarians in the
major political parties at least enjoy conscience votes in
issues such as abortion. Federal law and the laws of most
states and territories provide privilege from disclosure of
confidential religious confessions. Conscientious objectors
to military service are protected from conscription in the
Commonwealth Defence Act.
The law protects those whose religious beliefs prevent
them from voting at all or from voting in an election if it
is held on a particular day of the week from fines for
failing to vote. The Australian Cricket Board was able to
accommodate the religious objections of a Muslim player to
having to wear a uniform promoting alcohol. The
Canterbury-Bankstown Rugby League club was willing (at least
until recently) to accommodate the religious objections of
one of its star players to playing football on a Sunday.
Medical professionals of conscience need to be clear on
their position and make their voices heard – in their
professional organisations – but also in the public square.
Conscientious objection must have some limits.
Can a Jehovah Witness doctor refuse to do blood tranfusions?
Or a Muslim doctor refuse to examine women?
In a multi-faith, multi-racial and multi-cultural
pluralist country like Australia I think that it is
generally reasonable to accommodate positions held by
medical professionals – and other citizens – as much as
possible. Some issues may be able to be accommodated in some
but not other circumstances.
Perhaps in a large public hospital with sufficient staff
it might be possible for patients to be well cared for
without requiring a doctor who has a conscientious objection
to blood transfusions or to examining particular patients to
be accommodated. Of course there do need to be some limits
on conscientious objection. As Professor Iain Benson has
observed "[a]ny legal regime is necessarily involved in line
drawing and there is nothing inherently offensive about
Some have argued that if doctors object to
performing legal procedures, they should find another job as
a plumber or child care worker? How would you respond?
Those who make this argument tend to ignore the fact that
we do live in a multi-faith, multi-racial and pluralist
society. Just as there are some doctors who have a
conscientious objection to abortion, so too are there
patients who have such an objection. Patients have a right
to obtain medical treatment from doctors who understand
their religious worldview and who share that viewpoint.
Policies and legislative provisions that discourage
"pro-life" doctors from joining or remaining in the
profession may deprive patients from access to the services
of health practitioners who share their views about the
value of embryonic human life. Some patients would never
countenance the termination of a pregnancy no matter the
risks to their own physical health or no matter the physical
or other challenges that their child might face. Such women
who do not want to feel pressured into termination because
their unborn child might be a Downs syndrome child or be
pressured into a "selective reduction" if they are carrying
Such patients want their doctors to support them in their
decisions and to give them and their children whole hearted
and supportive medical care. Provisions which force doctors
out of the profession act to reduce – not to increase –
What are the weak points in the armour of
resolutely secular thinkers who argue that doctors should
perform all legally requested procedures?
This sort of argument actually tends only to be made in
relation to abortion services. Elective surgery is not
normally something that doctors must do. So, for example,
many paediatric doctors refuse to perform circumcisions on
baby boys. Essentially these arguments seek to put patient
autonomy as a governing principle and to assert that doctors
owe obligations to society because society gives them
something of a monopoly.
When you think about it, though, no one seems to argue
that doctors must subjugate their own interests entirely to
those of their patients. No one argues that doctors must
carry out every legal operation a patient requests or that
they must provide every legal medication that a patient
We expect – we want – we need - doctors to be ethical
people who are not driven solely by profit. We need doctors
to refuse to carry out medical procedures which might earn
them money but which they think would not be best for their
patient's health and wellbeing. We don't expect and we don't
actually want our doctors to give us antibiotics that we
don't actually need. We want them to tell us what they think
is actually in our best interests even though our Google
inspired medical view conflicts with theirs.
We don't expect doctors to subordinate their interests to
those of their patients generally. We don't expect them to
work for free or to make house calls or never to take
holidays at their patient's request. Those who want all
doctors to provide abortion services must be honest in their
arguments. If they want to argue that all doctors must
provide abortion services – but not other medical services –
they must explain what exactly makes abortion different and
overcome the powerful arguments against such compulsion.
This article is published by Michael Quinlan and
MercatorNet under a Creative Commons licence. You may
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