Is conscientious objection incompatible with healthcare professionalism?

Mary Neal, Sara Fovargue

The New Bioethics

Abstract
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.

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

Mary Neal, Sara Fovargue

Abstract

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