Is conscientious objection incompatible with healthcare professionalism?

Mary Neal, Sara Fovargue

The New Bioethics

Is conscientious objection (CO) necessarily incompatible with the role and duties of a healthcare professional? An influential minority of writers on the subject think that it is. Here, we outline the positive case for accommodating CO and examine one particular type of incompatibility claim, namely that CO is fundamentally incompatible with proper healthcare professionalism because the attitude of the conscientious objector exists in opposition to the disposition (attitudes and underlying character) that we should expect from a ‘good’ healthcare professional. We ask first whether this claim is true in principle: what is the disposition of a ‘good’ healthcare professional, and how does CO align with or contradict it? Then, we consider practical compatibility, acknowledging the need to identify appropriate limits on the exercise of CO and considering what those limits might be. We conclude that CO is not fundamentally incompatible – either in principle or in practice – with good healthcare professionalism.

Neal M, Fovargue S.  Is conscientious objection incompatible with healthcare professionalism? New Bioethics 2019 Sep; 25(3): 221-235, DOI:10.1080/20502877.2019.1651935.

Guest editorial re: conscience in health care

Special edition of The New Bioethics

Mary Neal, Sara Fovargue & Stephen W. Smith

The New Bioethics

It is probably fair to say that academic interest in the role of conscience in healthcare (and specifically, in the phenomenon of conscientious objection (CO)) has never been more intense, as evidenced by the volume of articles (and indeed, special issues) devoted to the topic in recent years. The three of us have contributed to this burgeoning literature, writing separately and together.

This special issue of The New Bioethics marks the mid-point of a project devised and co-managed by us and funded by the Royal Society of Edinburgh’s Research Networks scheme: the Accommodating Conscience Research Network (ACoRN).  Our aim in developing this multidisciplinary network (including academics from arange of disciplines, practitioners, and representatives of professional bodies) is to carve out intellectual space within which to begin exploring conscience/CO inhealthcare from a broadly supportive perspective. Our sense, as participants in academic debates about conscience, is that although the literature contains many rich insights and fascinating discussions, some of the most interesting questions about conscience are being overshadowed by the loudest and most polarized disagreement over whether there is any legitimate role for CO in healthcare at all. This is despite the fact that it seems to us that most contributors adopt positions that are hospitableto the accommodation of CO, at least to some extent and in some circumstances. . . [Full text]

Neal M, Fovargue S, Smith SW. Guest editorial. The New Bioethics. 2019 Sep;25(3): 203-206, DOI:10.1080/20502877.2019.1659485.

Protection of Conscience Project welcomes new advisor from Scotland

News Release
For immediate release

Protection of Conscience Project

The Protection of Conscience Project welcomes Dr. Mary Neal, PhD, LLB Honours, LLM to the Project Advisory Board. Dr. Neal is Senior Lecturer in Law, University of Strathclyde, Glasgow.  She researches, writes, and teaches in the fields of Healthcare Law and Bioethics, focusing on beginning and end-of-life issues.  In 2014-15, she was Adviser to the Scottish Parliamentary Committee scrutinising the Assisted Suicide (Scotland) Bill, and she is a current member [2018] of the British Medical Association’s Medical Ethics Committee. She has published a wide range of academic articles and blogs on a range of topics including, most recently, conscientious objection by healthcare professionals; the nature of ‘proper medical treatment’; the role of the emotions in end-of-life decision-making; and the conceptual structure and content of human dignity.

Dr. Neal was a co-editor of and contributor to the recent volume Ethical Judgments: Re-writing Medical Law (Hart, 2017). Her works-in-progress include articles and book chapters on conscientious objection; the idea of ‘vulnerability’ in healthcare; physician-assisted suicide; and the role of dignity in human rights discourse. Among other research activities, Dr. Neal is currently leading two funded projects relevant to the issue of conscientious objection in healthcare. One is a British Academy/Leverhulme-funded project exploring conflicts between personal values and professional expectations in pharmacy practice. The other is a multi-disciplinary network of academics and healthcare professionals (the ‘Accommodating Conscience Research Network’, or ‘ACoRN’), funded by the Royal Society of Edinburgh, and beginning with a series of roundtables exploring various aspects of conscientious objection in healthcare. Dr Neal is also a spokesperson for the Free Conscience campaign supporting the Conscientious Objection (Medical Activities) Bill currently before the UK Parliament.[Faculty Profile]

Sean Murphy, Administrator
Protection of Conscience Project

The Protection of Conscience Project is a non-profit, non-denominational initiative that advocates for freedom of conscience in health care. The Project does not take a position on the morality or acceptability of morally contested procedures. Since 1999, the Project has been supporting health care workers who want to provide the best care  for their patients without violating their own personal and professional integrity. 

Conscientious objection and withdrawal of life support


Xavier Symons

Are British doctors obliged to withdraw life support if requested by a patient?

This question was raised by Iain Brassington of the University of Manchester, in response to the introduction of the Conscientious Objection (Medical Activities) Bill in the British parliament.

The bill would protect health care professionals who conscientiously object to a range of controversial medical procedures.

Brassington suggested that certain clauses of the proposed legislation may conflict with extant civil and criminal law, under which it is unlawful to fail to withdraw treatment (including life-sustaining treatment) from a competent patient who no longer consents to it, or from a patient who lacks capacity if treatment is no longer in her best interests.

Yet in a response post to Brassington, University of Strathclyde law lecturer Mary Neal said that there was no tension between the proposed bill and existing law.

First, Neal observed that existing GMC guidance permits a conscientious objection to withdrawal of life-sustaining treatment. Paragraph 79 of the GMC’s guidance Treatment and care towards the end of life: good practice in decision making (2014) states that doctors can object to withdrawing treatment if their “religious, moral or other personal beliefs” lead them to do so.

“Doctors, at least, are already subject to guidance that tells them they can opt out of involvement in the withdrawal of life-sustaining treatment”, Neal writes.

Second, Neal observes that extant case law requiring the withdrawal of treatment of consenting patients applies to Trusts rather than to individual doctors:

When a competent patient indicates that she no longer consents to life-sustaining treatment […]continued treatment is unlawful…But this obligation belongs to the Trust…If an individual professional notifies her employer that she has a belief that forbids her from performing the act of withdrawal (switching off a life support machine, or disconnecting a feeding tube, for example), it is incumbent upon those with management responsibility to assign the task to someone else who has no such objection.

The Conscientious Objection (Medical Activities) Bill has progressed passed a second reading in the House of Lords, and will now go before a committee.

This article is published by Xavier Symons and BioEdge under a Creative Commons licence. You may republish it or translate it free of charge with attribution for non-commercial purposes following these guidelines. If you teach at a university we ask that your department make a donation to BioEdge. Commercial media must contact BioEdge for permission and fees.

Church calls for Scottish Bill to back medics’ conscience rights

Scottish Catholic Observer

Amanda Connelly

The Catholic Church in Scotland has called for a bill that gives medical professionals the right to conscientiously object to medical procedures such as abortion.

The comments come after Baroness O’Loan’s new Conscientious Objection (Medical Activities) Bill for England and Wales, which looks to ensure conscience rights for medical professionals, had a second hearing in the House of Lords on Friday January 26.

“While the bill only applies to England and Wales, its progress should be of interest to people in Scotland, where hopefully a similar bill could be presented to the Scottish Parliament,” director of the Catholic Parliamentary Office Anthony Horan said. . . . [Full text]


Changes to abortion provision means NHS staff need more legal protection

The Herald

Dr. Mary Neal

FREEDOM of conscience is an important fundamental freedom recognised in international treaties but current protection for conscientious objection by health professionals in UK domestic law is inadequate.

Some professionals have statutory ‘protection’ that is so narrow. This was exposed by the UK Supreme Court’s judgment in the Glasgow midwives’ case. The court held that ‘hands off’ involvement in terminations was not covered by the statutory conscience right in the Abortion Act 1967, so that individuals had no right to refuse to enable and support the process in indirect ways. . . [Full Text]

Conscientious Objection: A Quick(ish) Answer

Journal of Medical Ethics

Mary Neal

The Conscientious Objection (Medical Activities) [HL] Bill, introduced by the crossbench peer Baroness O’Loan, received its second reading in the House of Lords on Friday 26th January and successfully proceeded to the committee stage.  In a post on this blog the following day, Iain posed a very reasonable question about clause 1(1)(a) of the Bill.  That clause would allow health professionals to refuse to be involved in “the withdrawal of life-sustaining treatment”, and Iain asks how this can be compatible with existing civil and criminal law, under which it is unlawful to fail to withdraw treatment (including life-sustaining treatment) from a competent patient who no longer consents to it, or from a patient who lacks capacity if treatment is no longer in her best interests.

Before responding, I should declare an interest: I’m a spokesperson for the Free Conscience campaign, which supports the Bill.  I endorse the Bill’s premise that healthcare professionals should, in key areas of practice, benefit from statutory conscience rights that are both meaningful and effective. . . [Full Text]

Abortion decriminalisation and statutory rights of conscience

BMJ Opinion

Mary Neal

On 13 March 2017, the House of Commons voted by 172 to 142 in favour of a second reading for the Reproductive Health (Access to Terminations) Bill. The bill, introduced by Diana Johnson MP, would decriminalise abortion until the end of the 24th week of pregnancy, meaning that abortion could be performed until the end of the 24th week of pregnancy without the need to satisfy any statutory grounds, or to obtain two doctors’ authorisation. Many campaigners see this bill as a first step toward the longer-term goal of fully decriminalising abortion. [1]

The prospect of decriminalisation raises a number of interesting and important issues, including an issue which has been neglected in the debates over decriminalisation so far, namely what any change in the law might mean for the right of health professionals to withdraw from participation in abortion on grounds of conscience, under section 4 of the Abortion Act 1967. . . .[Full text]


Conscience and Agent-Integrity: A Defence of Conscience-Based Exemptions in the Health Care Context

Mary Neal, Sara Fovargue


The issue of conscientious refusal by health care practitioners continues to attract attention from academics, and was the subject of a recent UK Supreme Court decision. Activism aimed at changing abortion law and the decision to devolve governance of abortion law to the Scottish Parliament both raise the prospect of altered provision for conscience in domestic law. In this article, building on earlier work, we argue that conscience is fundamentally connected to moral integrity and essential to the proper functioning of moral agency. We examine recent attempts to undermine the view of conscience as a matter of integrity and argue that these have been unsuccessful. With our view of conscience as a prerequisite for moral integrity and agency established and defended, we then take issue with the ‘incompatibility thesis’ (the claim that protection for conscience is incompatible with the professional obligations of health care practitioners). We reject each of the alternative premises on which the incompatibility thesis might rest, and challenge the assumption of a public/private divide which is entailed by all versions of the thesis. Finally, we raise concerns about the apparent blindness of the thesis to issues of power and privilege, and conclude that conscience merits robust protection.

Neal M, Fovargue S. Conscience and Agent-Integrity: A Defence of Conscience-Based Exemptions in the Health Care Context. Med Law Rev. 2016 Nov 1;24(4):544-570. doi: 10.1093/medlaw/fww023