Friday, August 10, 2007

God week continued: No to conscientious objection in medicine or elsewhere

Usually in the context of the abortion controversy, religiously motivated health care professionals claim the moral (and often legal) right to conscientious objection to the provision of certain health care services. The basic idea is that if, say, Christian doctors and nurses object for religious (conscience) reasons to abortion they should not be forced to provide such services. On the face of it this seems uncontroversial. I think both accepting such conscience based refusals to provide health care services as well as assuming that such decisions are uncontroversial is mistaken. Let me explain why.

First things first: health care professionals such as doctors and nurses are first and foremost called upon by us as members of society as professionals and not as members of the Communist Party, the Klu Klux Clan, the local chess club, or a particular church. They provide a public service. In return for this we as society grant them a monopoly on the provision of such services (eg doctors have a monopoly on the provision of many health delivery services, including the prescription of drugs). We as society also invest substantial amounts of public funds into their training.

In many countries abortion is legal to some extent or other. In other words, societies have decided that it is ethically acceptable for women to make such choices (usually within certain well-defined limits). In societies providing public health care, women are entitled to receive abortion services through health care professionals that are publicly funded. These professionals are seen by pregnant women for the purpose of having an abortion. They are sought out as professionals and not at all as private individuals with their own private views on the morality or otherwise of abortion. I think it is preposterous to suggest that such professionals could kind of opt-out of the provision of some services because they feel strongly about such services.

Religious provisions are more or less arbitrary. Some make sense, others don't, and among religions there is little consensus on what is and isn't ethical. To permit the delivery of health care to be controlled by what amounts essentially to a lottery is unacceptable. Patients treated by a public sector doctor belonging to Jehova's Witnesses wouldn't get blood transfusions, those falling into the hands of an adherent to the Scientology Church won't receive antidepressants, the list is endless. It's easily imagineable that a racist doctor belonging to a suitably racist church could refuse to provide life-preserving services to patients from ethnicities other than her own. The conscientious objection to abortion crowd might not like to hear this, but there is no in-principle difference between their objection and that of the medic belonging to the Aryan Nation Church of Jesus Christ Christian. They will, of course, claim that they have 'better' reasons and that the competing church (ie the smallish racist outfit) is either not a 'real' church or that the racists are 'wrong' etc. The thing is, strictly speaking, none of this can be shown to be true, because, as it happens all monotheistic religions depend on untestable claims about the existence of 'God'.

A reliable delivery of health services (and this include equitable access) depends on guaranteeing timely access based on health need. Conscientious objections are a serious threat to precisely that. If you are a pregnant woman living in a rural area with a limited number of predominantly conservative Christian or Muslim doctors you might well not be able to execute your legal right to have an abortion at a certain point in time, if respect for conscientious objections was considered to be of greater importance than your access to services. This argument is very powerful indeed, when you consider the dearth of health care professionals serving the public sector in developing countries.

So, the sooner we get rid of the right to conscientious objection, the better for us, the public. And to be clear, if health care professionals feel strongly enough about this matter, they should be invited to leave the profession and do something else with their lives. We cannot reasonably permit a pick-and-choose type interpretation of professionalism to become the norm.

As someone who has taught for many years in medical schools, I can testify to quite a number of people who have chosen dentistry over medicine, for instance, because they did not wish to ever have to face the moral conflicts that come into play in the abortion controversy or end-of-life decision-making. In all honesty, these professionals deserve our respect for what I think is a grown-up understanding of what it means to be a professional.

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