Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Q)  Why should health care workers be able to impose their beliefs on patients?

A)  Those who refuse to do what they believe to be wrong are defending their own integrity, not "imposing beliefs."  This is well understood in other contexts.  For example: people who refuse to help others cheat, steal or commit adultery are not accused of "imposing their beliefs."

Q)  Why should health care workers be allowed to let their personal beliefs affect their work?

A)  All beliefs are personal, since one who believes something holds that belief "personally" or is personally committed to that belief.  Someone who refuses a bribe because he believes bribery is wrong is acting on his beliefs.  Health care workers who suggest some forms of treatment or care rather than others may also be acting on their beliefs.  It is normal for people to act on their beliefs, at the workplace or elsewhere.

Q)  What about acting on religious beliefs? 

A)  Beliefs -and believers - can be religious or non-religious.  For example: people may believe in the equality of all people for religious reasons, for for political, ideological, or philosophical reasons.  If one can reasonably act on a non-religious belief, one can reasonably act on a religious belief.  There is no reason - apart from anti-religious bigotry - to prevent people from acting on religious beliefs. [See There are No Secular Unbelievers.]

Q)  Why should objecting health care workers be allowed to violate a consensus that certain procedures and services are ethically acceptable?

A)  With respect to morally contested procedures and services, a so-called  'consensus' that they are "ethical" is typically achieved by excluding from consideration opinions that are at odds with the ethical, moral or religious presuppositions shared by a dominant elite. The resulting 'consensus' is, in reality, simply the majority opinion of like-minded individuals, achieved by excluding those who think differently.  It is not a genuine ethical synthesis reflecting common ground.

Q)  Why should objecting health care workers be allowed to act on personal or private beliefs instead of the ethics of their professions?

A)  To identify beliefs as 'private' or 'personal' does not help to resolve a question about the exercise of freedom of conscience. The beliefs of many conscientious objectors, while certainly personal in one sense, are actually shared with tens of thousands, or even hundreds of thousands or hundreds of millions of people, living and dead, who form part of great religious, philosophical and moral traditions. If their beliefs are 'private,' those of the members of a particular professional group are not less so. Disputes about what counts as 'private' or 'public' thus end in a stalemate.  Further: the "ethics of the profession" have too often supported conduct now considered to be unethical, such as the operation of eugenics boards in North America until late in the twentieth century.

Q)  Do objecting health care workers violate the social contract between society and health care professionals? 

  • Society has given medical professionals a monopoly on the delivery of health care.  In return for the power, prestige and wealth that this monopoly provides, they ought to provide the services sought by society.

A)  Social contract theory is a tool developed to explore different aspects of human relationships.  It remains a theory that fails to address the actual historical development of the practice of medicine, and is itself contested for other reasons.  Moreover, even if there could be said to be some kind of 'contract,' the content of the contract is disputed.

Q)  Society has invested in the education of health care professionals.  Do they not owe society a return on that investment by providing the services society expects them to provide?

A)   "Society" does not expect them to provide the services and procedures because "society" includes people who share the beliefs of objecting health care workers.  They have invested in the education of medical professionals no less than those who disagree with them.  Only by denying that these people are a part of society is it possible to maintain the fiction that "society" expects objectors to do what they believe to be wrong.

Q)  Why not compromise?  Allow conscientious objectors to refuse to provide a service, as long a they refer the patient to someone who will do so.

A)  Some health care workers who refuse to provide procedures for reasons of consience are willing to refer patients to others who will.  However, other health care workers will not refer patients because they believe that referral or other forms of facilitation make them morally responsible for the act that follows. 

Q)  How can a health care worker be morally responsible for something that somebody else actually does?

A)  In the same way that someone who provides a gun and a getaway car for a bank robbery shares in the moral responsibility for the robbery and all of the harms that come from it, even if someone else actually commits the robbery.

Q)  But bank robbery is illegal.  Why should health care workers be allowed to refuse legal services?

A)  The concern is not legal, but moral and ethical.  Capital punishment is legal in a number of jurisdictions, but most professional medical associations insist that their members must not participate in executions, even when the law requires the involvement of a medical practitioner.  And by "participation" they mean both direct and indirect involvement.  (See, for example, American Medical Association Policy E-2.06: Capital Punishment.)  This is exactly the same kind of moral reasoning applied by conscientious objectors who refuse to facilitate procedures by referral or other means.

Q)  Is mandatory referral not justified as a reasonable limitation of freedom of conscience?

A)  No.  This amounts to a claim that a health care worker can be compelled to do what some other person believes is a lesser wrong, or what some other person thinks is not "really" a wrong at all.  In short, it means that health care workers can be compelled to practise according to the conscientious convictions of someone else, to serve ends chosen by someone else even if he finds them abhorrent. This is a form of servitude, not service.  It does not merely limit freedom of conscience.  It suppresses it.

Q)  Are there no limits to freedom of conscience? 

A)  There are limits to freedom of concience.  However, the limits may be determined by reference to the nature of the human person, human freedom and moral responsibility, not by reference to laws of supply and demand, convenience or delivery of public services.