Category: Ethics

Conscientious objection: the struggle continues

Bioedge

Reproduced with permission

Michael Cook*

The fight over conscientious objection to abortion has moved from the evening news to the academic journals. In the April issue of the American Journal of Public Health, two defenders of reproductive rights outline strategies to restrict abortion rights. They complain that “unregulated conscientious objection” seems to be growing, especially in countries where opposition to abortion is strong.

In a SSRN paper which is yet to be published, Lachlan De Crespigny, an Australian doctor writing from Oxford, and two academics from Monash University fiercely defend a recent law in the state of Victoria which forces doctors to refer for abortion. “The unregulated use of conscientious objection impedes women’s rights to access safe lawful medical procedures,” they write. “As such, we contend that a physician’s withdrawal from patient care on the basis of conscience must be limited to certain circumstances.”.

They contend that arguments in support of conscientious objection are often a smokescreen for imposing Catholic dogma. But women who conscientiously desire abortions also have rights. “The choice of abortion is in many cases the morally responsible decision that should not be overridden by the imposition of another’s conscience.”

A recent paper in the Journal of Bioethical Inquiry by two Canadians, a doctor and a lawyer, tries to make some philosophical distinctions which make conscientious objection to abortion more plausible. They distinguish between “perfective” and “preservative” freedom of conscience. The former is exercised in the pursuit of a perceived good. This must often be limited. The latter is more fundamental and cannot legitimately be coerced except in the most exceptional circumstances.

“If the state can legitimately limit perfective freedom of conscience by preventing people from doing what they believe to be good, it does not follow that it is equally free to suppress preservative freedom of conscience by forcing them to do what they believe to be wrong. There is a significant difference between preventing someone from doing the good that he/she wishes to do and forcing him/her to do the evil that he/she abhors.”

It could be argued that an ethics committee, or an institution or a government assumes the moral responsibility for a coerced decision. But this does not take into account the well-documented guilt and shame felt by concentration camp survivors who were forced to participate in heinous crimes. “When it is suppressed by coercion, the result is the kind of spiritual rape suffered by those victims of the camps who were forced to do what they believed to be wrong.”

New Zealand abortion activists complain about physician freedom of conscience

Dr. Joseph Lee, a physician in Blenheim, New Zealand, has been criticized by abortion activists because he refused to prescribe contraceptives for a 23 year old patient.  Dr. Lee practises at the Wairau Community Clinic.  A pamphlet in the reception area advises patients that some of the clinic’s physicians will not prescribe contraceptives, and staff attempt to direct patients accordingly.  The clinic leader may consider installing a sign to minimize further conflicts.

Dr. Lee identifies himself as a Catholic, but is reported to have said that he would be willing to prescribe the birth control pill to a woman who was spacing children or had had at least four children.  That is not consistent with the teaching of the Catholic Church on the subject, and it is an unusual position among health care workers who object to providing contraception.

The Abortion Law Reform Association NZ (ALRANZ) wants the General Medical Council to force objecting physicians to refer patients or otherwise assist them to obtain morally contested services.  The president of ALRANZ, Dr. Morgan Healey, claims that a High Court decision in 2010 has made the question of referral legally ambiguous. [New Zealand Herald]

However, Justice Alan MacKenzie of the High Court in Wellington, New Zealand,unambiguously ruled that New Zealand’s Contraception, Sterilisation and Abortion Act protected objecting physicians, and that the General Medical Council could not force them to refer abortion.  All that is required of a physician who objects to abortion is to decline to begin the process and inform his patient that she may obtain the procedure from another practitioner.  The protection of conscience provision states that objecting health care workers are not obliged “To fit or assist in the fitting, or supply or administer or assist in the supply or administering, of any contraceptive, or to offer or give any advice relating to contraception.”  The ruling was the result of litigation by the New Zealand Health Professionals Alliance, which, earlier this year established a website to support freedom of conscience for health care workers.

 

Personal Opinions and Ideology, Not “Science”

From Conscience and its Enemies: Confronting the Dogmas of Liberal Secularism

Robert P. George*

On September 11, 2008, the President’s Council on Bioethics heard testimony by Anne Lyerly, MD, chair of ACOG ‘s Committee on Ethics. Dr. Lyerly appeared in connection with the council’s review of her committee ‘s opinion (No. 385) entitled “Limits of Conscientious Refusal in Reproductive Medicine.” That opinion proposes that physicians in the field of women’s health be required as a matter of ethical duty to refer patients for abortions and sometimes even to perform abortions themselves .

I found the ACOG Ethics Committee ‘s opinion shocking and,  indeed, frightening. One problem was its lack of regard – bordering on contempt , really – for the sincere claims of conscience of Catholic, Evangelical Protestant , Orthodox Jewish , and other pro-life physicians and health-care workers. . .[Full text]

What role does Conscience play in Medical Ethics?

  • D. Vincent Twomey, SVD* | . . . conscience is assumed to be a purely subjective thing, a personal preference . . .that is fundamentally irrational. . . The sincerity of those who hold a subjective view of conscience is not in doubt. But is it enough? More importantly, what is wrong about that all-pervasive contemporary understanding of conscience? For the rest of this paper, I will concentrate on such a misunderstanding in the hope of clarifying what conscience in fact is. . . Full Text

Letter to General Medical Council (UK) re: conscientious objection to abortion

 Peter Saunders

When two Glasgow midwives won the right to opt out of supervising abortions last April I suggested that the General Medical Council (GMC) needed to revise its professional guidance on the matter which now seemed to be at odds with the law.

At the time Niall Dickson (pictured), the GMC’s chief executive, actually told the Guardian that the GMC would need to consider the implications of the judges’ decision on its guidance. He is quoted as saying:

We will study the outcome of this ruling, which has just come out, to see if there are any implications for our guidance. We already have clear guidance which says that doctors should be open with employers and colleagues so they can practise in accordance with their beliefs without compromising patient care.

As I have heard nothing further from the GMC about the matter, and almost two months have passed, I have today written to Mr Dickson to ask what is happening. [Full text]