McLeod's Conscience in Reproductive Health Care and Its Relationship to Reproductive Freedom and Faith-Based Healthcare
- McLeod's Conscience in Reproductive Health Care and Its Relationship to Reproductive Freedom and Faith-Based Healthcare
Carolyn McLeod's book is timely and important, especially when one considers the state of conscientious objection in a country like the United States. During his presidency, Donald Trump announced an expanded "conscience rule" for healthcare workers according to which they would have the protected right to morally and religiously oppose (and refuse to perform) a variety of procedures, including abortion, sterilization, assisted suicide, and other medical procedures. In 2019, a number of states, local governments, and healthcare organizations brought lawsuits against the proposed rule, leading a federal judge to reject it. New York Attorney General Letitia James said the state of New York sued in part because the rule "was an unlawful attempt to allow health care providers to openly discriminate and refuse to provide necessary health care to patients based on providers' 'religious beliefs or moral objections'" (Abutaleb 2019). As this example indicates, conscientious objection remains a serious threat in countries like the United States and beyond, where religious liberty protections are given precedence over patient care.
I share McLeod's concerns for protecting patients' reproductive freedom and autonomy (especially that of marginalized groups), and I concur with many of the claims she makes in her book. She takes a feminist stance against provider conscientious objection and offers some compelling grounds for prioritizing patients' needs. Yet, I identify some potential problems that her argument poses when considered in the context of current practices regarding women's reproductive health and the provision of healthcare services. I will begin by considering McLeod's account of the "Dynamic View" of conscience and will follow up by putting it into the context of these concerns.
1. The Dynamic View of conscience
McLeod (2020) rejects the "Unity View" according to which "a person's integrity is at stake" (21) in adhering to our "deep moral commitments" (22). According to [End Page 153] this view, acting with conscience promotes inner unity—the very value of conscience. She rejects this view of conscience and instead presents the "Dynamic View"—that our moral values are in flux, open to revision and reinterpretation; and that a truly conscientious person would be open to reexamining what she thinks are her settled beliefs to check her commitment to them. McLeod notes that "Conscience has value potentially when it urges us to take our moral values seriously, but also when it forces us to reconsider and revise some of those values, after perhaps clarifying for us what they are" (33).
The Dynamic View of conscience is appealing in a number of ways. It reflects the realities of individual conscience—for example, that our values and beliefs are often "under construction" and that we can sometimes change course after reflection or life-changing experiences that alter our moral worldviews. To take just one example, for moral reasons an increasing number of people are switching from meat eating to vegetarianism and veganism after reading literature, watching videos on factory farming, and interacting with committed vegetarians and vegans.1 Such experiences of consciousness-raising can lead to deep changes in our values and beliefs, and we need to be open to such possibilities. As feminists have long held (going against the grain of traditional ontological accounts), the "self" is in flux, and we should approach it with an open-endedness that reflects an appreciation of this dynamism.
Other feminists have similarly argued that an individual is not characterized by a coherent, overarching, unitary self but rather a diverse self that often maintains conflicting, and sometimes incompatible, desires and commitments.2 Such inner diversity suggests that the individual is characterized not by a unitary self that rigidly makes coherent and consistent choices but by a self that attempts to make the best decisions possible despite inner conflict or misgivings. According to these feminist accounts, acting with conscience does not require unconditional precommitment to values or adherence to a consistent system of action-guiding principles but rather a commitment to "being careful and paying attention to [one's] growth process" (Davion 1991, 184). McLeod (2020) similarly notes this dynamism:
Retooling ourselves morally involves remaking our...
