A study in the Journal of Medical Ethics published yesterday showed that nearly 50% of medical students support the doctor’s right to conscientiously object to treatments and procedures to which she or he has ethical, moral or religious concerns.
Surveying some 733 UK medical students at Cardiff University, King’s College London, Leeds University and St George’s University of London, researcher Dr Sophie Strickland found that 45.2% believed doctors should have the right to refuse to treat someone when doing so clashed with their personal beliefs.
What was even more interesting was that while there was a strong religious component to this, the reasons for conscientious objection were not exclusively, or even primarily religious. 19.7% of the objections raised were for religious reasons, 44.1% were for non religious reasons and 36.2% for both religious and non religious reasons. The highest percentage of students in favour of conscientious objections are Muslims (76.2%), followed by Jewish students (54.5%), Protestants (51.2%) and Roman Catholics (46.3%), while just 35.5% of atheists or non religious students said that they were in favour of conscientious objection.
The area where most objections were raised was, unsurprisingly that of abortion, and this has raised serious concerns amongst abortion advocates. Abortion is the one area where legislation actually gives a health professional the right to conscientiously object to carry out a procedure. Dr Strickland appears to believe that this strong expression of conscience is a threat to the practice of medicine, and suggests this is a good reason to limit it: ‘Once qualified as doctors, if all these respondents acted on their conscience and refused to perform certain procedures, it may become impossible for conscientious objectors to be accommodated in medicine’.
Another blogger put it even more starkly ‘ What is the point of investing public money and resources to provide a degree in medicine for people who put their moral or religious concerns before the wellbeing of the people they are supposed to cure?’
Julian Savulescu, a prominent Oxford medical ethicist quoted Shakespeare in a 2006 BMJ article ‘Conscience is but a word that cowards use, devised at first to keep the strong in awe’ (Richard III, Act V, scene iii). Last autumn, Christine McCafferty sought to introduce a resolution to the Council of Europe calling on a severe limitation of the right to conscientious objection by health professionals, particularly in the area of abortion. This was overturned and reversed by the Council, which strongly defended the right of freedom of conscience.
But make no mistake, the fact that doctors, nurses and other health professionals have a conscience, and choose on occasion to limit the areas in which they will work in order not to be ethically compromised is under assault from many sides.
And we should take this threat very seriously – for while it is mainly activists wanting to maintain abortion services that are mounting this assault, the consequences will go far beyond that if freedom of conscience is eroded or outlawed. There are notorious examples of the moral corruption of a medical profession where freedom of conscience was ignored or forbidden, and which subsequently failed to oppose state-sanctioned abuses of patients: forced sterilisations in many countries in the 20th century; euthanasia and horrific experimentation in Nazi Germany and Japan; the Tuskegee syphilis experiments on black people in the USA which only stopped in 1972; organ transplants from prisoners in China.
More topically, what of the right of doctors to refuse to be involved in capital punishment, or in assessing prisoners as fit for ‘enhanced interrogation’ (water boarding and other forms of torture)? Closer to home, many would want the right to opt out of performing non-medically indicated circumcisions. Where does the line get drawn once the state tells the individual doctor or nurse they no longer have the right to object to a procedure that the state requires them to perform?
Savulescu failed to put his quotation of Richard III into context – the full quote reads as follows (emphases mine):
‘Let not our babbling dreams affright our souls: conscience is but a word that cowards use, devised at first to keep the strong in awe: our strong arms be our conscience, swords our law. March on, join bravely, let us to’t pell-mell. If not to heaven, then hand in hand to hell.’