CONSENSUS STATEMENT ON CONSCIENTIOUS OBJECTION IN HEALTHCARE
On the 7th, 8th, and 9th of June 2016 a group of philosophers and bioethicists gathered at the Brocher Foundation in Geneva, Switzerland, to participate in a workshop on healthcare practitioners’ conscience and conscientious objection in healthcare. Conscientious objection is the refusal by a healthcare practitioner to provide a certain medical service, for example an abortion or medical assistance in dying, because it conflicts with the practitioner’s moral views. Aim of the workshop was to discuss the ethical and legal aspects of conscientious objection in healthcare, in view of proposing some guidelines for the regulation of conscientious objection in healthcare in the future.
At the end of the workshop, the participants formulated a consensus statement of 10 points, which are here proposed as ethical guidelines that should inform, at the level of legislations and institutional policies, the way conscientious objections in healthcare is regulated. The 10 points are the following:
- Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience. When the patient’s wellbeing (or best interest, or health) is at stake, healthcare practitioners’ professional obligations should normally take priority over their personal moral or religious views.
- In the event of a conflict between practitioners’ conscience and a patient’s desire for a legal, professionally sanctioned medical service, healthcare practitioners should always ensure that patients receive timely medical care. When they have a conscientious objection, they ought to refer their patients to another practitioner who is willing to perform the treatment. In emergency situations, when referral is not possible, or when it poses too great a burden on patients or on the healthcare system, health practitioners should perform the treatment themselves.
- Healthcare practitioners who wish to conscientiously object to providing medical treatment should be required to explain the rationale for their decision.
- The status quo regarding conscientious objection in healthcare in the UK and several other modern Western countries is indefensible. Healthcare practitioners can conscientiously refuse access to legally available, societally accepted, medically indicated and safe services requested by patients in practice for any reason. This is in part due to the cost-free environment in which practitioner choice of service occurs, and in which the practitioner bears no substantive burden of proof. The burden of proof to demonstrate the reasonability and the sincerity of the objection should be on the healthcare practitioners.
- Accordingly, in such countries, the reasons healthcare practitioners offer for their conscientious objection could be assessed by tribunals, which could test the sincerity, strength and the reasonability of healthcare practitioners’ moral objections to certain medical services.
- Policy makers should ensure that in any geographical region there is a sufficient number of non-conscientious objectors for patients to obtain the medical services they need in a timely manner even if some healthcare practitioners conscientiously object to providing that service. This implies that regional authorities, in order to be able to provide medical services in a timely manner, should be allowed to make hiring decisions on the basis of whether possible employees are willing to perform medical procedures to which other healthcare practitioners have a conscientious objection.
- Healthcare practitioners who are exempted from performing certain medical procedures on conscientious grounds should be required to compensate society and the health system for their failure to fulfil their professional obligations by providing public-benefitting services.
- Medical students should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong. Even if they become conscientious objectors, they will still be required to perform the procedure to which they object in emergency situations or when referral is not possible or poses too great a burden on patients or on the healthcare system.
- Healthcare practitioners should be educated to use a framework of decision-making incorporating legal, ethical and professional arguments to identify the basis of their objection.
- Healthcare practitioners should also be educated to reflect on the influence of cognitive bias in their objections.
Angela Ballantyne (Otago University), Robert Card (State University of New York, Oswego and University of Rochester Medical Center), Steve Clarke (Charles Sturt University), Katrien Devolder (University of Oxford), Thomas Douglas (University of Oxford), Alberto Giubilini (University of Oxford), Jeanette Kennett (Macquarie University), Sharyn Milnes (Deakin University), Francesca Minerva (University of Ghent), Maurizio Mori (University of Turin), Christian Munthe (University of Gothenburg), Justin Oakley (Monash University), Ingmar Persson (University of Gothenburg), Julian Savulescu (University of Oxford), Dominic Wilkinson (University of Oxford).