Introduction

Though physicians are committed to their professional obligations, there are times when those professional obligations might entail actions that conflict with their moral beliefs, either secular or religious. When such a conflict arises, physicians might object to acting against their personal beliefs. In bioethics, this is often referred to as making a conscience-based objection (CBO) or refusal (CBR). CBRs are particularly relevant when discussing abortion, physician assisted death, sterilization, and palliative sedation to unconsciousness.

Moral Dimensions of CBR Graphic

Consequentialist arguments

Generally, consequentialists arguments are those that say that a we should act in a certain way because the outcomes of acting in that way are better than the outcomes of acting in other ways. There are arguments for and against honoring CBRs on the grounds that it would promote better outcomes. Those in favor of accommodating CBRs argue that doing so might decrease physician moral distress and promote physician diversity in the medical space by accommodating minority beliefs. Those against accommodating CBRs note that they disproportionately affect women and minorities (e.g., reproductive rights, gender affirming treatments).

Deontological arguments

Generally, deontological arguments are those that say we should act in accordance with some set of rules. Defenders of CBRs argue that accommodating certain CBRs is an important part of respecting the moral integrity of physicians. Other defenders argue that forcing physicians to act in ways that violate their personal beliefs would impermissibly harm them. Some have objected that these sort of arguments in defense of CBRs are too weak. Additionally, it seems that respect for physician moral integrity may be at odds of respecting patient’s beliefs

Assigned Readings

Seminar participants were asked to read the following papers prior to meeting for discussion.

White DB, Brody B. (2011). Would Accommodating Some Conscientious Objections by Physicians Promote Quality in Medical Care? JAMA. 305(17),1804–1805. doi:10.1001/jama.2011.575

  • Thesis: “Policies that allow some Conscientious-Based Refusals while also ensuring patients’ access to the requested services may yield better overall medical quality by fostering a diverse workforce that possesses integrity, sensitivity to patients’ needs, and respect for diversity” (1805).

Giubilini A. (2014). The paradox of conscientious objection and the anemic concept of ‘conscience’: downplaying the role of moral integrity in health care. Kennedy Institute of Ethics journal, 24(2), 159–185. https://doi.org/10.1353/ken.2014.0011

  • Thesis: Arguments in defense of conscientious objections based on respect for physician’s moral integrity are weak. The best arguments defending conscientious objections rely on some form of moral relativism or subjectivism, which defenders of conscientious objections seemingly do not endorse.

Reflection Points

In discussion, seminar participants reflected on the following points.

  1. What is the moral significance of a cost-benefit analysis in the context of CBRs? Might such analyses suggest that we should accommodate all CBRs (including more problematic cases)? How should we treat costs that are seemingly unquantifiable?
  2. If an applied theory relies on moral relativism, is this a sufficient reason to reject it?
  3. There is little empirical data showing the outcomes of accommodating CBRs in the medical space.
  4. Who can legitimately claim a CBR (e.g., ambulance driver, administrators)? Which medical procedures would be subject to CBRs?
  5. How would accommodating CBRs impact the power dynamic between physician and patient?

References and Additional Resources

Cowley C. (2016). A Defence of Conscientious Objection in Medicine: A Reply to Schuklenk and Savulescu. Bioethics, 30(5), 358–364. https://doi.org/10.1111/bioe.12233

Savulescu J. (2006). Conscientious objection in medicine. BMJ (Clinical research ed.), 332(7536), 294–297. https://doi.org/10.1136/bmj.332.7536.294

Schuklenk, U., & Smalling, R. (2017). Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. Journal of medical ethics, 43(4), 234–240. https://doi.org/10.1136/medethics-2016-103560

Nordberg, E. M., Skirbekk, H., & Magelssen, M. (2014). Conscientious objection to referrals for abortion: pragmatic solution or threat to women’s rights?. BMC medical ethics, 15, 15. https://doi.org/10.1186/1472-6939-15-15