Your conscience, my health: the right to refuse?

Saturday 30 October, 12.15pm until 1.15pm, Henry Moore Gallery Lunchtime Debates

The right of doctors and nurses to refuse to perform procedures like abortion on grounds of conscience is well established in Europe and the US. Particularly in America, however, there is concern that there has been a proliferation of healthcare refusals based on ‘ideological and political justifications’. It has been widely noted that the concept of ‘conscientious objection’ has expanded beyond its original intention. ‘Conscience’ has been appropriated by entire institutions, such as Catholic hospitals, and applied to a wider range of healthcare procedures, for example doctors refusing to give fertility treatment. In the UK too there have been concerns about pharmacists refusing to issue patients with medication prescribed by their doctors, and questions about whether professionals’ religious beliefs are accorded too much protection at the expense of patients who do not share those beliefs and simply want treatment. In Britain, however, some religious people suggest it is secularists who are driven by ideology, refusing to accommodate healthcare professionals’ moral qualms even when patients could easily receive treatment by alternative means.

It is argued that the expansion of refusal clauses could seriously limit access to healthcare. Consequently, some suggest prioritising women’s ‘right to health’ over and above healthcare professionals’ conscience. But does this risk compromising a doctor’s personal sense of integrity? What might be lost by pushing health professionals to practise against their beliefs? And is it acceptable in a free society to require institutions to conduct procedures that run counter to their values? If it’s unreasonable to expect an abortion clinic to employ a priest as an abortion counsellor, why is it reasonable to expect a Catholic hospital to perform abortions? But then, given that abortion is established as a legal right, should physicians be allowed to opt out at all?

We are familiar with increasing employment controversies in the UK where people cite their religion when refusing to do aspects of their job, whether conducting civil partnerships or serving alcohol at supermarket check-outs. Lord Justice Laws, rejecting Christian Gary Macfarlane’s challenge against his sacking for refusing to give sex therapy to homosexuals, said legislation to protect views held purely on religious grounds could not be justified, noting it was not only an irrational idea, ‘but it is also divisive, capricious and arbitrary’. Former Archbishop of Canterbury Lord Carey angrily replied that, ‘It is…but a short step from the dismissal of a sincere Christian from employment to a religious bar to any employment by Christians’. What does conscience mean anyway, and what are its limits in public provision of services and employment?

Listen to session audio:


Dr Christian Fiala
medical director, abortion and family planning clinic; founder and director, Museum of Contraception and Abortion

David J. Nolan
director of communications, Catholics for Choice, Washington DC

John Wyatt
professor of ethics and perinatology and honorary consultant neonatologist, University College London

Ann Furedi
chief executive, British Pregnancy Advisory Service; author, The Moral Case for Abortion

Produced by
Jennie Bristow senior lecturer in sociology, Canterbury Christ Church University; author, The Sociology of Generations: New directions and challenges and Baby Boomers and Generational Conflict; co-author, Parenting Culture Studies
Recommended readings
Abortion, Ethics, Conscience and Choice

Papers from the bpas conference, London, 25 - 26 June 2008

Various, Abortion Review, August 2010

Should women’s healthcare needs take priority over doctors’ beliefs?

The use of refusal clauses, or ‘conscience clauses’, to limit women’s access to reproductive healthcare is a problem that has gained increasing attention over the past few years.

Jennie Bristow, Abortion Review, 8 June 2010

Should women’s healthcare needs take priority over doctors’ beliefs?

The use of refusal clauses, or ‘conscience clauses’, to limit women’s access to reproductive healthcare is a problem that has gained increasing attention over the past few years.

Jennie Bristow, Abortion Review, 8 June 2010

Health Care Refusals: Undermining Quality Care for Women

Unlike structural defects in the health care system, ideological restrictions are not being addressed in the current health care debate; they will not be resolved by current reform proposals; and, in fact, there is a serious risk that these restrictions will be institutionalized without careful evaluation of their public health impact.

National Health Law Program, 24 May 2010

Conscientious Objection in Medicine: A Moral Dilemma

Where are the boundaries between professional obligations and personal morality? Can personal morality override professional duty when it comes to patient care?

Ishmeal Bradley, Clinical Correlations, 29 May 2009

Conscientious objection in medicine

Deeply held religious beliefs may conflict with some aspects of medical practice. But doctors cannot make moral judgments on behalf of patients

Julian Savulescu, BMJ, 7 February 2006

Religious Freedom & Catholic Health Care

Over the last decade, there have been attempts to turn the meaning of religious freedom on its head. These attempts have occurred in the arena of health care, specifically over legislative efforts to counteract out-of-date regulatory policies and unethical and questionable religious restrictions on some services at Catholic and Catholic-controlled hospitals.

Catholics for Choice

Session partners