The "Medical Conscience" Civil Rights Movement

Wesley J. Smith*

Until recently, healthcare was not culturally controversial. Medicine was seen as primarily concerned with extending lives, curing diseases, healing injuries, palliating symptoms, birthing babies, and promoting wellness - and hence, as a sphere in which people of all political and social beliefs were generally able to get along.

That consensus has been shattered. Doctors today may be asked to provide legal but morally contentious medical interventions such as sex selection abortion, assisted suicide, preimplantation genetic diagnosis of IVF embryos, even medications that inhibit the onset of puberty for minors diagnosed with gender dysphoria. As a consequence, medical practice has become embroiled in political and cultural conflict.

On one side, a coalition of establishment medical associations, pro-choice activists, gay rights organizations, the ACLU, the Democratic party, and mainstream bioethicists promotes a "patient-centered" medical paradigm. Under this view, patients have the right to obtain any legal and effectual medical intervention they desire (and can pay for). In the interest of avoiding discrimination, whatever religious or moral qualms medical professionals may have will take a back seat to satisfaction of the patient’s desire. Many advocates argue that if doctors can’t leave their own morality at the clinic door, they should get out of medicine.

Against such healthcare conscription, "medical conscience" advocates—doctors, nurses, and other professionals who believe in the sanctity of life, plus their supporters, such as conservatives and the pro-life movement—insist that as a matter of basic civil rights, medical professionals should be allowed to refuse participation in procedures and interventions to which they have a religious or moral objection (subject to certain limitations, such as when the patient’s life is at stake). This view is already supported to a limited extent in federal law regarding abortion and sterilization, as well as in most state-assisted suicide legalization statutes. The Trump Administration recently raised the stakes when it announced the creation of a special office in the Department of Health and Human Services to enforce existing federal laws protecting medical conscience. The secular left was not amused.

Now David S. Oderberg, a philosophy professor at the University of Reading in the U.K., has produced a "Declaration in Support of Conscientious Objection in Healthcare." As the Declaration notes, Article 18 of the U.N.’s Universal Declaration of Human Rights reads: "Everyone has the right to freedom of thought, conscience and religion," a statement that should not exclude healthcare professionals in the performance of their callings. From Oderberg’s Declaration:

If health care workers are not to be reduced to mere functionaries (of the state, of the patient, of the legal system), they must be free to exercise their professional judgment and to allow their consciences to inform that judgment. This freedom of professional judgment informed by conscience must translate into the freedom not to be involved in certain activities or practices to which there is a conscientious objection.

The Declaration acknowledges that people are free to access legal medical procedures from willing professionals. But their rights to do so "are not violated merely because they cannot be enforced against a person exercising their freedom of conscience and religion—for otherwise this freedom itself would be meaningless." In other words, liberty is a two-way street. Patients may obtain medical care from consenting professionals, but they may not dragoon the unwilling into acting against their own moral views.

Oderberg’s Declaration also asserts that democratic societies "should not play favorites by choosing one system of morality to trump all others." I would state it even more strongly: Civil liberties are most needed when protecting minority perspectives. This means that medical conscience rights are more crucial to liberty now—as Western societies are secularizing and faith is becoming a heterodox perspective—than when religious belief was society’s default setting.

Oderberg is aware that some might make ludicrous claims for protection—either as a wild hypothetical to disparage the right of medical conscience, or as a result of religious beliefs that society need not countenance. Hence the Declaration states:

Freedom of conscience and religion in a liberal society does not entail that "anything goes." … For the protection to apply, a person must have a deeply held, sincere adherence to a tenet or doctrine of their code of ethics or religion that forbids—expressly or by necessary implication—the kind of act to which they object. Moreover, the relevant religious or ethical code must be one that has current or historic popular acceptance across some significant portion of the society in which the conscientious objector resides, or in some other society where the code is readily identifiable.

The Declaration warns that new fields of medical research and bioethical advocacy could lead to even greater conscience controversies within the healthcare sphere than are currently being experienced. These are not enumerated, but let me suggest a few examples to indicate the stakes:

• Some of the world’s most influential bioethicists advocate changing the law to permit organ harvesting from people diagnosed as persistently unconscious.
• Biotechnologists hope to develop treatments made from embryonic stem cells derived from human cloned embryos.
• New gene-editing technologies could allow the engineering of human gametes and human embryos in order to enable eugenic modifications of progeny.
• Advocacy has commenced to allow healthy limbs to be amputated or spinal cords severed as a "treatment" for people suffering from "body identity integrity disorder"—a mental illness in which able-bodied people identify as being disabled.
• There is even a growing movement to require the intentional starvation of dementia patients who willingly take food and water—if they have previously asked to die upon reaching a certain milestone of cognitive decline.

Do we really want to require doctors, nurses, pharmacists, and others to participate in such acts if they consider them to be immoral or grievously sinful? Should healthcare public policy declare lived faith to be non grata in the medical professions? I say emphatically, no!

There is also a practical consideration. If we force healthcare professionals to violate their moral beliefs, we could see a mass exodus from the medical professions. Older doctors and nurses will retire, taking their experience and knowledge with them. Talented young people who would make splendid doctors, nurses, or pharmacists may avoid the field altogether.

If you agree that protecting medical conscience is an important civil rights issue, I hope you will join me in supporting the Declaration in Support of Conscientious Objection in Health Care. For information on signing and to read the entire Declaration, hit this link.