Blog: Concientious Objections from Healthcare Professionals

Posted by ab98 at Dec 22, 2015 12:00 AM |
Highlights of Dr Mary Neal’s recent paper given to the research cluster in November.

by Katerina Aikaterini Kazou (PhD student Leicester Law School)

Her thought provoking paper  raised the important issue of conscientious objection in the context of healthcare. She sought to defend the right of healthcare professionals to opt out of particular procedures because of their personal values and beliefs. Dr Neal conceptualised conscience as an aspect of moral agency and as integrity. Her paper was divided in two main parts. The first part analysed the ‘incompatibility thesis’ approach to conscientious objection in health care, and the second suggested three limits to the application of conscience-based exceptions.

What is the ‘incompatibility thesis’?

This approach refers to the tension between professional obligations and personal values. This means healthcare professionals cannot refuse to provide services within the scope of their competence on the basis of conscience, as this would be incompatible with their professional obligations. Two different rationales were noted, namely medicine’s internal values and value-neutrality. Medicine’s internal values refers to the ends of medicine and particularly the obligations to respect patient dignity and patient autonomy, refrain from discrimination, and promote patient health and well-being. Dr Neal questioned however whether healthcare professionals should subordinate their deeply held personal values and sign up to professional ethics. Value-neutrality refers to the duty of healthcare professionals to act in a value-neutral way. A number of points were raised by Dr Neal in regard to that rationale. It was argued that value-neutrality is not neutral, as it in fact imposes secular values. Furthermore, it was noted that healthcare professionals also have a duty to exercise moral agency and that they make moral assessments as well. It was finally mentioned that participation in procedures actually embodies a value choice.

Dr Neal suggested three limits to the application of conscience-based exemptions. First, they should only apply to liminal cases of ‘proper medical treatment’, such as abortion, IVF and assisted dying (if it were to become lawful). Second, they should only apply if certain criteria are met, namely that the position must be sincere, it must not disrespect the conscientious position of others, the belief must be fundamental so that its violation poses a serious risk to the healthcare professional’s moral integrity, and finally that the healthcare professional must be able to articulate his/her position. Third, conscience-based exceptions should only apply if certain duties are fulfilled, including the duty to behave respectfully, to avoid unnecessary burdens on patients and colleagues, and to treat in emergencies.

Moral Responsibility?

One point that I personally found particularly interesting, however, was that the healthcare professionals’ participation in certain procedures embodies a value choice. It made me consider why a person who merely assists another person to make his/her own - value - choice would be seen as adopting that other person’s choice. Simply assisting patients to fulfill their wishes, especially doing so as part of their professional duties and not as a freely made decision (although having freely chosen their profession and therefore to be bound by the relevant duties), does not seem to necessarily mean that healthcare professionals have the same wishes as their patients or share their values. Even in considering a seemingly similar situation within the criminal law context, an accomplice’s common intent is a required, rather than implied, condition. I would therefore think that it is the patient who is morally responsible for the action; the healthcare professional shall not take ownership of that action or be morally responsible for the patient’s own choice.

Katerina Aikaterini Kazou – PhD student Leicester Law School

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