Are tribunals the solution to disruptive conscientious objectors?
BioEdge, 1 October, 2016
Reproduced under Creative Commons Licence
While some bioethicists believe that
conscientious objection has no place in modern
medicine, others feel that they could be
accommodated by setting up tribunals. Here are three
proposed this year in the Journal of Medical
Establish military-style tribunals.
In times of conscription, military tribunals assess whether a pleas of
conscientious objection in legitimate or not. Why not follow this model for
healthcare workers, asks Steve Clarke, of Charles Sturt University
(Australia), in the Journal of Medical Ethics. Military tribunals
used to ask whether the objector would serve in a non-combatant role. Some
agreed to support the war effort by serving in non-combatant roles; others
would only perform community service. The former were actually making an
indirect causal contribution to the war effort to which they objected.
Clarke believes that the same question should be asked of doctors:
A doctor who objects to conducting abortions, and also
objects to making an indirect causal contribution to abortion, but who
currently works for an organisation in which abortions are conducted, should
be helped to find work with a different organisation, where abortions are
not conducted. The objections of a doctor who conscientiously refuses to
conduct abortions, but who has no objection to making an indirect causal
contribution to the conduct of abortion are best dealt with by finding that
doctor other duties to perform, within the current organisation that she is
This argument will succeed in forcing objectors with very strong
convictions out of the public system and into private practice and those who
remain and perform “non-combatant” roles will be burdened with moral
Establish medical conscientious objection review boards.
Card, of the University of Rochester Medical Center (US), argues in the
JME that doctors need to give "public reasons" for conscientious objection.
This would rule out even "effective referral" for a procedure. Their reasons
need to be solidly grounded, empirically and ethically. This rules out
reasons based on prejudice (sexism or racism) or sincere moral convictions.
This leads him to propose review boards staffed by medical professionals,
bioethicists and lawyers. If a doctor establishes that there are sufficient
reasons for his objections, he would be licenced to practice medicine as an
official conscientious objector. If doctor who is not a licenced CO refuses
to do a procedure, he could be punished.
Conscientious Objection Tribunals
Earlier in the year, Jonathan A. Hughes, of Keele University (UK),
proposed the establishment of Conscientious Objection Tribunals in the JME.
Doctors would appear before a board which would assess whether their
objections were reasonable and what arrangements he would make for patients
who requested a procedure to which he objected. If approved, the tribunal
would licence them for five years at a time. No conscientious objection
would be allowed without a licence.
Keele is less specific about the composition of the tribunals. However,
they should include members of the public and potential service users. He
feels that it is important that it be a face-to-face examination
rather than a bureaucratic procedure.
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