Conscientious Objection in Bioethics

Yesterday's Ethics Centre Lecture, the last of the 2011 season, was given by Dr Leslie Cannold - ethicist, writer, commentator and activist. 


The theme of her talk was conscientious objection in bioethics, focussing especially on abortion. Her starting point was the principle of autonomy. For patients, it means that all people have the right to decide whether or not they should have treatment, and that they are entitled to it if they wish to receive it - no one has the right to deny them life saving treatment.  For doctors it means that they have the right to refuse to carry out certain procedures for reasons of conscience - when to do so would conflict with a deeply and sincerely held moral belief. In some cases, the two may conflict, and Cannold's focus was how this should be resolved.


She argued that when there was conflict between the two, and the life of the patient is at stake, the right to life of the patient overrides a doctor's objection to providing that treatment - for example, in the case of a woman requiring an abortion to save her life. In Europe in such instances the hospital is legally obliged to ensure that the patient receives treatment from another doctor; in the UK (I think) the doctor is legally required to find another doctor who will.


The situation is complicated by a dirth of statistical information; for obvious reasons, no research has been done about this, and so incidents are anecdotal. Women who find themselves in these situations (rare though they may be) are at the mercy of the doctor they have and whether s/he is prepared to break the rules of the Catholic hospital, risking their position, to find another hospital to perform the abortion; often time is crucial and there are several cases in the US where families are suing for death/disability as a result of the failure or delay of treatment.


In Australia the issue is, she claims, magnified by the number of Roman Catholic hospitals. 1 in 10 patients in Australia are treated in Catholic hospitals - these hospitals receive public money (as well as charitable donations) and can provide care to anyone. They are bound, however, by the Church's prohibition on abortion. However, if a pregnant woman is admitted to such a hospital, whereupon she is diagnosed with a serious condition that requires an abortion in order to save her life, the hospital cannot provide it and will not (officially at least) enable her to get it. Of course, the patient can, in theory, just take themselves off to another hospital, but this might not always be practical (especially in rural Australia given the vast distances involved).


Cannold's argument is that Roman Catholic hospitals need to be much more transparent about their position before patients are admitted (the cases she is concerned with are the ones where it is only after admission that the woman discovers the need for an abortion in order to survive - not abortion on demand). In non-religious hospitals a doctor refusing to operate on the basis of conscientious objection cannot be forced to leave the hospital as this would breach anti-discrimination laws; this stretches already overburdened hospitals and staff. She also argues that regulation is needed to enshrine the autonomy of the patient over that of the doctor, requiring the doctor to find alternative care for that patient.  It is entirely acceptable that a doctor should have the right not to perform a procedure for reasons of  conscience - but not acceptable to deny the patient their right to have a procedure that would save their life.* 


I agree entirely.




* In the USA, even if you don't have health insurance or can't afford it, any hospital is obliged to treat you in order to save your life once you are inside. However following the recently passed Protect Life Bill (Oct 2011), the staff in a Catholic hospital are entitled to allow you to die if you need an abortion in order to survive.