A young woman needs an abortion and the reasons, while urgent, are not medical. A defiant detainee on hunger strike is ordered to be force-fed by a United States Navy nurse at Guantánamo Bay. These very different real-life cases have one connecting thread: the question of whether a health professional can conscientiously object to carrying out a patient’s request.
Conscience freedom is frequently regarded as a noble ideal. However, when it is used to deny health care, it indicates that a single individual’s beliefs are determining what is best for another person’s physical and mental health, which can result in devastation or even death. Colleagues and I came to the conclusion in our most recent book, Rethinking Conscientious Objection in Healthcare, that doctors shouldn’t be allowed to make medical decisions based on their personal beliefs. Refusing to provide care is not noble. International human rights law protects freedom of conscience, but not completely. The Universal Declaration of Human Rights includes it. This principle has often been used for moral purposes: for example, to resist orders to torture or kill.But after researching use of conscientious objection by health professionals, I have concluded it is seriously flawed when used to deny patients health services. This is especially so when particular doctors have a monopoly on service provision, as is the case with abortion and assisted dying in many rural and regional areas of Australia.
Although nearly all states require a referral to other service providers or information about how to access the relevant service, doctors in Australia are permitted to conscientiously object to abortion. In practice, these laws are not enforced and sometimes disregarded.
Patients may be denied the standard of care they require—or even any care at all—if a doctor refuses. Professionals in the health care field are not like pacifists who oppose being compelled to serve in the military by refusing conscription. They are free to choose careers in health care, which come with responsibilities and ethical stances that have already been established by professional codes of conduct. Though people are free to hold any beliefs they want, those beliefs will unavoidably limit some of their options. A vegetarian, for instance, cannot work in an abattoir. That holds true for all of us. However, a doctor’s personal beliefs shouldn’t prevent their patient from having legitimate options. Four key questions Instead of personal values, there are four key secular principles we propose that doctors should rely on when deciding how to advise patients about sensitive procedures:
is it legal?
is it a just and fair use of any resources that might be limited?
is it in the interests of the patient’s wellbeing?
is it what the patient has themselves decided they want?
Naturally, there will be times when some of these principles conflict; when this occurs, it is critical to adhere to the most important ones—the patient’s well-being and their own wishes. In 2012, a young woman by the name of Savita Halappanavar sought treatment for her miscarriage at an Irish hospital. For fear of violating Ireland’s anti-abortion laws, doctors refused to evacuate her uterus while there was still a fetal heartbeat despite knowing there was no chance the pregnancy would survive. As a result, Savita passed away at 31 from septicemia. If doctors had put the patient’s wellbeing first, they would have given her that termination, despite the law, and it would have saved her life.
These principles ought to have been applied to the aforementioned scenarios, such as the nurse refusing to force-feed prisoners or the woman seeking an abortion for professional reasons. The nurse or doctor ought to inquire: Is it what the patient has independently determined they want? Will it result in the best possible outcome for their mental and physical health? If abortion will promote a woman’s wellbeing, it is in her interests. Hunger strikers should not be force-fed because it violates their autonomy.
An unfair burden
While doctors’ personal values are important, they should not dictate care at the bedside. Not only does this put the patient at risk, but it also places an unfair burden on coworkers who accept such work, forcing them to carry a disproportionate amount of procedures that they may find unpleasant and financially unsatisfying. It also creates injustice. It is already easier for patients who are educated, wealthy, and well-connected to get health care. Because it further restricts options, conscientious objection exacerbates this unfairness across substantial portions of the nation. Two countries with excellent health-care systems, Sweden and Finland, do not permit conscientious objection by medical professionals.
In Australia, it is time we do the same and strongly limit conscientious objection as a legal right for health professionals. We should also make sure that people entering the field are ready to handle all procedures related to their field.
