Abstract
Most arguments about conscientious objections in medicine fail to capture the full scope and complexity of the concept before drawing conclusions about their permissibility in practice. Arguments favoring and disfavoring the accommodation of conscientious objections in practice tend to focus too narrowly on prima facie morally contentious treatments and religious claims of conscience, while further failing to address the possibility of moral perspectives changing over time. In this paper, I argue that standard reasons against permitting conscientious objections in practice—that their permission may result in harm to patients, the idea that medical providers willingly enter into the medical field, and that conscientious objections stand contrary to medical professionalism—do not apply in all cases and that the medical field and health systems in which many physicians now practice should continue to tolerate conscientious objections in practice.
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Notes
For the sake of linguistic and conceptual readability and continuity, the term “treatment” is used throughout this paper when referring to conscientious objections. “Treatment” should be understood by readers to mean any standard activity of medical care that not only includes the administration of various treatments such as mechanical ventilation or feeding tubes, but also to include the administration, use, or implementation of therapies (e.g., psychotherapy for depression), procedures (e.g., surgery), imagining (e.g., x-rays), pharmaceuticals, treatment modalities/philosophies (e.g., Hospice care), as well as general patient management (e.g., care in ambulatory/clinic settings), treatment requests (e.g., use of fertility specialists), or referrals (e.g., consultation with specialists for new diagnoses).
If “abandonment” were conceptualized broadly not only to mean the withdrawal from a relationship, but also to cease attempts at engaging in a relationship, failure of a medical provider to establish care with a new patient based on a conscientious objection by the provider—for example, an oncologist refusing to see a person in the hospital with a new finding of cancer because the patient is transgendered—may also constitute a form of abandonment. However, fully developing an argument around the different kinds of abandonment that can occur as a result of a provider’s conscientious objection falls outside the scope of this paper. For the sake of this paper, it is sufficient merely to establish that conscientious objections are problematic when they prevent persons from obtaining needed medical care.
This example—as well as the overall argument in this sub-section—is also a challenge to arguments favoring the public disclosure of conscientious objections as a path toward the accommodation of conscientious objections in practice. However, whether developing a new conscientious objection would be incommensurable with a public disclosure argument would depend on both the argument for public disclosure and the mechanism or policies for when disclosures should happen. For example, the argument I previously articulated (Harter 2015) favoring public disclosure should be able to account for this possibility by making it a requirement that each new objection is disclosed when the provider has it, and not necessarily just at the beginning of one’s employment.
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Acknowledgements
I would like to thank Tyler Whatley, MTS, of Divine Savior Healthcare and Sarah Brown, MD, of Gundersen Health System for their helpful thoughts and comments on the ideas presented in this paper, particularly regarding some of the case examples.
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Harter, T.D. Why Tolerate Conscientious Objections in Medicine. HEC Forum 33, 175–188 (2021). https://doi.org/10.1007/s10730-019-09381-9
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DOI: https://doi.org/10.1007/s10730-019-09381-9