Institutional Conscientious Objection

by Roger Crisp

In a recent work-in-progress seminar at the Oxford Uehiro Centre, Xavier Symons, from the University of Notre Dame Australia, gave a fascinating and suggestive presentation based on some collaborative work he has been doing with Reginald Chua OP, from the Catholic Theological College, on institutional conscientious objection.

Conscientious objection is usually discussed at the individual level. Should a general practitioner, for example, be permitted not to offer any kind of advice on emergency contraception? But what about institutions, such as hospitals? Might they be permitted not to offer such advice, or indeed that service or other morally controversial services? Xavier considered three arguments to the conclusion that they should not.

The first is that, because institutions do not have a conscience, they are not entitled to any conscience protections. Against this, he argued that institutions can be seen as agents, and that their agency is often based on moral commitments. Consider for example a Catholic hospital. Even if that agency is different in various ways from that of individuals, the onus is on the objector to show why that agency is not entitled to the same sort of protection as that of individuals.

The second argument is that publicly funded hospitals should provide all healthcare services that are safe and legal. Here Xavier pointed out that a hospital might hold that services such as emergency contraception are not part of healthcare. Now it might be said that such a hospital, through accepting public funding, also enters into an implicit contract to abide by the state’s conception of healthcare. But, Xavier argued, the hospital is not concealing its own conception, so that it could not plausibly be said that the state expects such institutions to abide by the state conception.

The final argument is that institutional conscientious objection limits access to essential services — core  interventions designed to prevent serious harms. Here Xavier’s argument was that we should understand the right to conscientious objection from the deontological perspective, so that it cannot necessarily be overridden by the value of harmful consequences. Again the fact that the institutions in question are open about their policy suggests that the responsibility here for filling in any perceived gaps in healthcare provision is that of the state.

It seems to me that this final response perhaps goes further than it needs to. A deontologist might allow that there are some limits to the right to conscientious objection even in individual cases: for example, a patient with a condition such that she knows pregnancy will cause her death might be said to be entitled to emergency contraception from any doctor who finds themselves alone on duty in the hospital at the time she presents.

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