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Conscientious Objection and the Duty to Refer Bernard M Dickens
INTRODUCTION Conscientious objection has a long history opposing, on religious grounds, conscription into military service, and in healthcare since the late 19th century in parents opposing mandatory vaccination of their children, but objection acquired impetus after the 1960s when medical practitioners refused participation in services requested under increasingly widespread liberalized abortion laws. Some acted on their own initiative when patients took advantage of their newly recognized rights to request lawful termi nation of unwanted pregnancies, and others joined efforts orchestrated by religious and other organizations to resist requests for access to services. The conflict between patients’ requests for lawful abortion and medical service practitioners’ conscientious objections to participation might be resolved through practitioners’ ethical duties to refer patients to nonobjecting practitioners, as required by many codes of medical ethics and laws. However, some practitioners claim that complicity in others’ wrongs makes them as culpable as they would be for committing such wrongs themselves, and so invoke conscientious objection both to direct participation and to referring their patients to others for care. Attention is therefore required to ethical principles underlying rights of conscience
to object for participation in lawful medical procedures, and also to referral of patients to nonobjecting colleagues.1 In principle, conscientious objection may be made to participation in several lawful medical pro cedures, particularly regarding means of medically assisted control and promotion of fertility, including counseling or advising on means, prescribing related products and conducting related procedures. For con venience, however, the primary focus here is on abortion procedures, because they serve as reliable representative procedures that attract conscientious objection to partici pation and referral. Conscientious convictions and objec tions derived from such convictions to participation in lawful medical procedures can be based on a variety of grounds, such as personal philosophies, a sense of social justice or equity, and perceived standards of professionalism. In modern times, however, religious convictions and perceptions often underpin conscientious objection to a range of reproductive health procedures, of which induced abortion is the most prominent. In some settings, opposition to induced abortion serves as a “litmus test” of fidelity to a religious, social, political, or other commu nity. It is ethical for practitioners of medi cine and other professions to claim their rights to conscience and to conscientious