David Earl Johnson, LICSW

4 minute read

“Conscientious Objection” by professionals seems to me to be a practice whose ethics is tied to the setting in which one practices and the nature of the limitation one wishes to set. Julian Savulescu, writing about “Conscientious Objection” by physicians in The New British Medical Journal seems to have a much narrower and blanket view. blog.bioethics.net

A doctors’ conscience has little place in the delivery of modern medical care, writes Julian Savulescu at the University of Oxford. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Imagine an intensive care doctor refusing to treat people over the age of 70 because he believes such patients have had a fair innings. Or imagine an epidemic of bird flu or other infectious disease that a specialist decided she valued her own life more than her duty to treat her patients. Such a set of values would be incompatible with being a doctor.

The argument in favour of allowing conscientious objection is that to fail to do so harms the doctor and constrains liberty. This is true, says the author, but when conscientious objection compromises the quality, efficiency, or equitable delivery of a service, it should not be tolerated. He believes that doctors who compromise the delivery of medical services to patients on conscience grounds must be punished through removal of licence to practise and other legal mechanisms.

Values are important parts of our lives. But values and conscience have different roles in public and private life, he writes. They should influence discussion on what kind of health system to deliver. But they should not influence the care an individual doctor offers to his or her patients. The door to “value-driven medicine” is a door to a Pandora’s box of idiosyncratic, bigoted, discriminatory medicine.

Public servants must act in the public interest, not their own, he concludes. Every health care worker at some point in their training becomes aware that their right to deny treatment is limited most often by the setting in which they choose to work. Each person knows when they enter a particular position that their right to deny treatment is restricted. The right to deny treatment based on political or moral values is often contrary to the mission of the setting in which the professional practices. A health care worker working for an agency would tacitly accept the mission of the agency for which they work. Health care agencies often serve the community with limitations only based on payer. Many public settings may allow an acceptable work around, such as referring to a colleague. If such accommodation is not available, the concerned health care worker should understand that when he/she accepts the job.

I’m not that familiar with the British medical practice design, but I’m hard pressed to believe that a professional in private practice has the same limitations as someone working in an agency that serves the whole community. If the desired limitation is based on a particular procedure, then it seems to me that private practice enables a professional to limit their practice. As long as the private practitioner wishing to limit his/her practice operates by fully informing the client of all treatment alternatives, regardless of any qualms and without prejudice or proselytizing his/her beliefs, and offers a good faith referral to a professional which is willing to perform the service, no harm is done. However, a limitation based on a particular client characteristic is much more complicated.

It seems likely if a professional chose to limit their practice to caucasians based on a bias towards other races, the practitioner would likely be subject to civil litigation and could correctly be censured by their licensing agency for discrimination. However, many professionals limit their practice to particular illnesses, problems, genders and age groups. One could justifiably assert a limitation in his/her cultural competency. They would be obligated to inform a client of their lack of expertise and competence and could appropriately refer them elsewhere. This a very important and complex topic and one that will surely receive more attention in the future. My opinion seems likely to evolve.

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