Sunday, September 30, 2007

On 'conscientious objection' in medicine again

'Regulars' on this blog will know that I have been railing time and again against a nebulous concept going under the guise of 'conscientious objection' in medicine. It gives doctors a license to pick and choose the types of medical services that they wish to provide, and, indeed, to whom they provide them. The 'rationale' for this sort of unprofessional conduct has always been that we should respect doctors and nurses who might be unable to provide abortions (or assist in the provision of abortions, respectively) when they believe abortion is akin to murder, as many monotheistic ideologies want to us to believe. Well, a LOT is wrong with this 'concept'. For starters there doesn't seem to be any test at all as to the truth of the conscientious objection. It seems sufficient to feel strongly enough about something (or someone) or other for a doctor or nurse to be excused. What would prevent a doctor belonging to the KKK to refuse to provide health services to black patients? Nothing much, as long as their belief is strong enough (and, as anyone will know who has had the doubtful pleasure of having to face racists, their beliefs are certainly strong). The result of legal provisions permitting 'conscientious objections' is that, for instance in South Africa women are unable to execute their legal right to have abortions in public sector hospitals because too many doctors and nurses (usually driven by strong fantasies to do with 'God') waive their hands (or slap the patient) and declare a conscientious objection. Backroom abortions remain common place, and human lives (real human lives, as opposed to cell accumulations called 'persons' by the Roman Catholic Church) are lost due to conscientious objections by medical 'professionals' who are more concerned about their private beliefs than about their professional service delivery during working hours.

The UK doctors' statutory body, the General Medical Council proposes that in future doctors should be entitled to refuse to provide any kind of professional service if their consciences tell them to do so. In a remarkable twist, the UK doctors' trade union, the British Medical Association (BMA) thinks that that goes too far, and that there must be strict limitations on the types of conscientious objections doctors are entitled to. It goes without saying that 'God' features again prominently, and abortion is the prime target. It goes also without saying that this is utterly arbitrarily a line that is drawn in the sand there. Why abortion and not PAS or IVF for lesbians? Your guess (or 'God' or 'culture') is as good as mine.

But then, in the UK today, like in the USA, religions are ever more pervasively infiltrating public life. The government is setting up ever more faith based schools to ensure an ever growing compartmentalization of, and segregation within society. If the GMC gets its way, us patients will soon need to know which religious beliefs a particular doctor or nurse subscribes to in order to ascertain which types of professional misconduct he or she is likely to get away with by means of reference (hands raised to the sky) 'conscientious objection'... - Seeing that there is no truth to the matter of religious beliefs, little should prevent a medical professional from setting up her own religion if her particular dislike of certain medical services isn't already covered by existing religious balderdash. After all, the numbers (in terms of other believers) are no indication of the truth of a religion, so a one-person religion should also work nicely. I wonder whether it soon will be OK in the country for taxi driver belonging to religion XYZ to refuse to take certain passengers to certain locations as they disapprove of such locations.

One can only hope that the GMC comes to its senses sooner rather than later.


  1. I suppose the rationale for allowing "conscientious objection" is that it would breach the separation of church and state if the state required somebody to act against his or her religious beliefs, or made a preparedness to act against certain religious doctrines a requirement to practice medicine or pharmacy.

    I assume that the people who argue in this way, if any of them do, also argue strongly that there should be no laws against abortion, stem cell research, therapeutic cloning, etc., because such laws cannot be given any rational secular basis and thus impose a specifically religious morality on people who have no moral objections to abortions, etc. They are probably also against state involvement in marriage, church influence on AIDS policy, or any government actions that adversely affect the interests of homosexuals - after all, a rigorous application of the church/state doctrine seems to imply all of this. Any other policies would enforce religious morality.

    I'm being sarcastic, of course. No religionist takes such a principled position.

    However, this does raise questions about just what is entailed in the 21st century by the political compromise that we call "separation of church and state", whether we still need this compromise, etc.

    Separation of church and state has served us quite well in the past, but it is only an historical compromise, not some kind of timeless moral principle. It's a bit shaky, foundationally, and its interpretation is constantly contested.

    I've come to think that it's important to attack the root of the problem directly, i.e. to attack religion itself. We can go on "doing" secular philosophical bioethics, but there will be no clean political answers and no relief from all these problems unless the status of religion is further weakened.

  2. A recent article from from the Times raises some of these issues, albeit in rather silly context.

    I was surprised how few people on the thread drew parallels between what the (presumably few) Muslims students are supposed to have said, and the widespread opt-out for Christians in the NHS from anything connected with terminations.


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