• conscientious objection
• abortion
• euthanasia

In his paper ‘The truth behind conscientious objection’ Nir Ben-Moshe develops a new approach aimed at justifying conscientious objection (CO) without relying on respect of moral integrity of the conscientious objector or tolerance towards her moral views.1 According to Ben-Moshe, the problem with justifications of CO based on moral integrity and tolerance is that ‘truth of conscience’s claims is irrelevant to their justification’. He argues, to the contrary, that whether the claims of the conscientious objector are true or false makes a difference in assessing whether their objection is justifiable or not. He goes on explaining that someone’s CO can be justified if it can be proved that ‘conscience can express true moral claims’.

Ben-Moshe then proceeds to explain how one can determine true moral claims. He develops an account of conscience that is modelled on that of Adam Smith. In particular, he uses the idea of the ‘impartial spectator’ to show how a true claim of conscience can emerge after careful thinking from the point of view of an impartial perspective. So, if the healthcare practitioner wants to object to a certain medical procedure after considering the issue at hand from the moral standpoint of such impartial spectator, then her claims of conscience are true (or ‘approximate moral truth to the greatest degree possible for creature likes us’) and, as such, should be respected.

Ben-Moshe then applies this new framework to some cases of CO that are relevant to medical ethics, such as CO to abortion and euthanasia. In the case of abortion, the job of the impartial spectator is particularly difficult: since it’s not possible to determine whether the fetus has moral status and whether it should be considered one of the relevant parties (whose preferences should be taken into account), then the best that can be done is to invoke epistemic humility. Moreover, both in the case of abortion and in that of euthanasia, the impartial spectator could invoke epistemic humility when considering whether killing in these cases is ‘justified killing’ or not. The conclusion is that, both in the case of abortion and in that of euthanasia, the healthcare practitioner’s claim of conscience is justified and should be respected.

According to Ben-Moshe, his paper provides ‘a novel justification for CO in medicine by appealing to the simple idea that a conscientiously objecting agent might be getting things right, whereas society is getting it wrong, and it does so by utilising a standard of correctness that we can all share and is, thus, fitting to liberal democracies.’

I agree with Ben-Moshe that arguments based on moral integrity and tolerance fail to justify CO of healthcare practitioners, though for different reasons than the ones provided in his paper. I also agree that taking the standpoint of an impartial observer can provide a good framework for developing a (more) impartial understanding of moral issues. However, I am not convinced by the author’s claim that such framework provides a justification of CO of healthcare practitioners. It is possible that such approach could perhaps work in other cases, but here I am focussing on CO of healthcare practitioners working in countries where the procedure they object to is legal.

The duty to perform a treatment considered beneficial by the patient and legal (within a country) is not based on the assumption that the healthcare practitioner willing to perform it is morally right, or that her claims of conscience are true. Professional duties of healthcare practitioners are based on respect of patients’ autonomy, together with a commitment to respect the principles of beneficence, non-maleficence and justice.

It’s not unreasonable to ask healthcare practitioners to perform any medical procedure that is legal and beneficial to the patient irrespectively of the moral beliefs they might hold about it. For example, I think it’s reasonable to say that a doctor has a professional duty to perform euthanasia even if she believes that euthanasia is not a form of a justified killing, and even if an impartial spectator could invoke epistemic humility about this matter. I also think that it’s reasonable to ask healthcare practitioners to put aside their claims of conscience and provide the vaccinations their patients ask for, or attend a patient of the opposite sex, or one who is under the influence of alcohol and/or drugs. People often hold very different moral views, but an efficient healthcare system has to make sure that patients’ needs are met, and that they obtain the treatments they are entitled to (and need) regardless of moral disagreements between patients and doctors or between society and doctors.

In sum, I don’t think there is any argument that can provide a moral justification of CO of people who enter a profession knowing that they will be required to perform a procedure they find morally impermissible, such as abortion or vaccination, for instance.

However, I have argued elsewhere that it is possible to find practical solutions to make CO compatible with safeguarding patients’ well-being and with respecting the moral integrity of (at least some) healthcare practitioners.2 For instance, we can make sure that the number of conscientious objectors in a certain geographic area is not so large to make it difficult for patients to find someone willing to perform a certain procedure on them.

On the other hand, in order to prevent conscientious objectors from being accomplices in wrongdoing, we should not force them to inform and refer patients (as it currently happens). Patients should be clearly told that a certain doctor is a conscientious objector and that she might withhold relevant information with respect to specific medical procedures. Patients should also be given the option of choosing a different healthcare practitioner and of accessing the treatment they need without delay.

To conclude, although I found Ben-Mosher’s approach to CO very interesting, I don’t think it provides a useful theoretical or practical solution to the problem of CO of healthcare practitioners. However, I think it would be interesting to find out if it could be applied more successfully to other forms of CO.