Conscientious objection by Muslim students startling

J Med Ethics November 2013 Vol. 39 No. 11

Michelle McLean

I read Robert Card’s recent paper entitled ‘Is there no alternative? Conscientious objection by medical students’ with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five-and-a-half years (2006–2011), and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female student refuse to examine a patient of the opposite sex.

Several issues, many of which have been described by Padela and del Pozo,2 should be taken into consideration in relation to Muslim students’ conscientious objection to the cross-gender consultation on religious grounds. Although Islam prohibits touching or physical contact by the opposite gender, unless appropriate (eg,  by a spouse), in some circumstances, the ‘prohibited becomes permissible’.3 Medicine is one such circumstance. Islam does not … [Full Text]

Nursing school director opposes freedom of conscience

The Arkansas Legislature is considering HB 98, the Health Care Freedom of Conscience Act, which provides protection for freedom of conscience for individuals and institutions with respect to artificial birth control, assisted reproductive technologies, human embryonic stem-cell research; and contraceptive sterilization.  Meanwhile, Dr. Pegge Bell, Director of the Eleanor Mann School of Nursing at the University
of Arkansas, opposes the exercise of freedom of conscience as a violation of the principles of healthcare.  Dr. Bell suggests that objectors might be able to negotiate arrangements, but should otherwise change specialities, or, presumably, leave the profession. [NWA]

Twin protection of conscience bills introduced in Tennessee

Senate Bill 514 and House Bill 1185, identical bills that have been introduced in the Tennessee General Assembly, provide protection for students in post-secondary psychology, social work or counselling programmes who, by reason of religious beliefs, are unable to provide a client with the kind of counselling or therapy being sought.  The bills require objecting students to refer clients to another counsellor.

Medicine, Strasbourg, and conscientious objection

European Court of Human Rights decision

Julian Sheather*

. . .Conscientious objection is a live issue in medicine. . . Given the prevailing political pluralism—given the co-existence in our culture of different value systems—to what extent should medicine accommodate such objections? Should those whose consciences differ be treated differently? What forms of conscientious objection should be tolerated and on the basis of what criteria?
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Conscientious objection by medical students

A paper published in the Journal of Medical Ethics argues that accommodation of freedom of conscience by exempting students from performing morally contested activities is not possible in at least some circumstances.  The example given is that of male Muslim students who are unwilling to perform physical examinations on female subjects.

Card, Robert F. Is there no alternative? Conscientious objection by medical students. Med Ethics doi:10.1136/medethics-2011-100190

Medical student afraid to pursue Ob-Gyn career due to abortion pressure

 (USA: 2008)

  • | Brief examples that demonstrate the often subtle, sometimes flagrant and increasingly pervasive discrimination faced by pro-life, faith-based and conscience-driven individuals in the healthcare professions. Full Text

Medical student charged by professor with “abandonment” for no abortion referral

 (USA: 2008)

  • | Brief examples that demonstrate the often subtle, sometimes flagrant and increasingly pervasive discrimination faced by pro-life, faith-based and conscience-driven individuals in the healthcare professions. Full Text

Project Letter to the Western Standard

14 May, 2004

Sean Murphy, Administrator
Protection of Conscience Project

Should doctors be forced to abandon their faith?  by Terry O’Neill  draws attention to the problem of freedom of conscience in health care.

A bit of history is instructive. The first protection of conscience clause debated in the House of Commons was introduced by M.P. Robert McCleave as an amendment to the Omnibus Bill that legalized abortion in Canada in 1969. Mr. McCleave believed that abortion should be  legalized, but also believed that ‘freedom of choice’ should be extended to health care workers.

Compare Mr. McCleave’s notion of ‘choice’ with that espoused by Joyce  Arthur. Speaking for the “Pro-choice Action Network,” she refuses to  respect the choices of health care professionals who do not wish to participate morally controversial procedures. She seems to believe that freedom of conscience is a problem to be solved by abolishing it, at least  in the case of those who don’t agree with her. Arthur’s position is doubly ironic, since Henry Morgantaler justified his defiance of Canadian abortion law in a 1970 article titled, A Physician and His Moral Conscience.1

Referral is not a satisfactory solution for many physicians who have grave moral objections to a procedure. Objecting physicians hold  themselves morally culpable if they facilitate an abortion by referring a  patient for that purpose. Nor is this an unusual view. Consider the controversy in Canada over the deportation and torture of Maher Arar. This suggests that few believe that one can avoid moral responsibility for a wrongful act by arranging for it to be done by someone else.

Certainly, Joyce Arthur does not consider abortion to be a wrongful act. However, she has not explained why others should be forced to abide by her moral views.

Unfortunately, between the writer’s desk and publication, a couple of factual errors were introduced into the story.

In the first place, the Project followed the case from the outset, and the student was provided with the same kind of service extended to others in similar situations. His relationship with the Project has been cordial,  but it is incorrect to describe me as “a friend of the would-be doctor.” We have never met.

More important, the final paragraph attributes to me statements that I did not make. While I am, nonetheless, in agreement with a number of the points made, I did not suggest that a devout Muslim doctor might refuse to  treat women, nor make any statement to a similar effect.

It would be most unfortunate if this falsely attributed statement were  to contribute to the already adverse social pressures experienced by Muslims in North America. Muslim health care workers and students are welcome to contact the Protection of Conscience Project. One of the  Project advisors is Dr. Shahid Athar, a regent and former vice-president of the Islamic Medical Association of North America and the Chair of its       Medical Ethics Committee


1. The article appeared anonymously in The Humanist. Quoted in Pelrine, Eleanor wright, Morgantaler: The Doctor Who Couldn’t Turn Away. Canada: Gage Publishing, 1975, P. 79

Ethics Profiling in the Health Care Profession

Conscience Legislation  Needed to Stop Abuse of Authority

12 May, 2004

Will Johnston, MD President
Canadian Physicians for Life

The recent near-failing of a medical student at a Canadian university, solely because the student has pro-life convictions, shows how intolerant some people have become about choices they dislike. For years, Canadian     Physicians for Life has received anecdotal complaints from students who suspect that their medical school admission interview went badly after they truthfully answered questions which probed for pro-life beliefs. This recent case was blatant and completely documented, created undue anxiety for the student, and only ended after many months of unsuccessful appeals of the teachers’ intolerant actions. A modern democracy should have a keen interest in protecting vulnerable students from coercion by preceptors and professors who are unaware of, or insensitive to, the concept of freedom of conscience.

We don’t screen immigrants to Canada on the basis of race or religion. Why should such litmus tests be applied to citizens applying to enter key professions? Ethics profiling is no less objectionable than racial profiling.

Freedom of conscience, it seems, is now granted freely only to those whose views are acceptable to an authoritarian, secularist establishment. Others must endure the enormous costs and stress of legal challenges or implore sympathetic fellow citizens to petition those in power on their behalf. Until this situation is corrected, the Canadian experiment in pluralism will remain in a delayed adolescence.

Sincere proponents of multiculturalism and pluralism understand the importance of protection of conscience. But they must come to recognize that too many in positions of power need statutory reminders to treat fairly     those who disagree with them about the damage abortion does to women and children.

Basic conscience protection such as that provided in Bill C-276 begins to address the problems of abuse of authority and ethics profiling which lead to the kind of injustice seen in the recent case of the medical student. Such abuses must be explicitly treated in law, not left to an ad-hoc scramble by the victim and his or her friends.

The time is long overdue for the Parliament of Canada to follow the lead of countries like the United Kingdom, Australia, and New Zealand, and 46 American states to protect and clarify freedom of conscience for Canadian health care workers. In addition to necessary employment protection, the proposed Canadian legislation corrects deficiencies found in many such laws by explicitly protecting persons of conscience from exclusion from health sciences education and from discrimination by professional licensing bodies.

Canadian Physicians for Life 29 Moore Street, R.R. # 2 Richmond ON K0A 2Z0 ph/fax: 613-728-LIFE (5433)