By Trevor Stammers, Catholic Medical Quarterly
As an academic who teaches bioethics and medical law, it is my privilege also to learn from my students – undergraduate and postgraduate alike. Just recently one of my MA students based in Australia, posted the following contribution on our online discussion board – “ The politics of abortion make it incredibly difficult for those who are critical of current practices to be heard in the public square. In the case of conscientious objection, what should be a straightforward moral appeal for freedom to perform acts that are not morally objectionable to the individual (and not to perform acts which are morally objectionable), becomes a question of the rights of women in general. This becomes doubly difficult if, as a critic, one is also a man. Nevertheless, the notion that such conscientious objection can be called into question is a spurious idea that betrays a bizarrely modern commitment to autonomy”.
The autonomy referred to here is of course that of the patient (as the student rightly goes on to comment), but one wonders from recent events in the UK, what place will remain in a few years time for the autonomy of health care professional to be exercised in expressing conscientious objection ?
The United Kingdom’s National Health Service (NHS) is the largest, publicly-funded health service in the world. Serving a population of over sixty million people, every year the NHS receives over £100 billion of tax-payers’ money. Furthermore, it employs more than 1.7 million people, including 120,000 hospital doctors, 40,000 GPs, 400,000 nurses, and 25,000 ambulance staff. Given the NHS’s social, political, and economic importance, the large numbers of people it both serves and employs, and the gravity of the matters with which it deals, it is not surprising that the place of moral concerns within it have been subject to considerable, and often heated, discussion and argument. Not surprisingly, secularist voices have been prominent here — and nowhere more so, than on the question of conscience in healthcare provision.
There is good evidence that a doctor’s beliefs influence patient care. This is especially true with regard to for example sexual health and end-of-life issues. A carefully designed study of the influence of doctors’ religious beliefs (or lack of them) on their care of the dying, for example, showed that ‘doctors who described themselves as non-religious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life.’ [1, p. 677] Conscience is not, of course, the sole preserve of religious people — there are a great many doctors who identify with secular spiritual traditions, or who have no religious or spiritual tradition at all, who would equally refuse to authorize or participate in particular (legal) medical procedures on the grounds of conscience. Nevertheless, such objections are indeed frequently influenced and justified on the basis of specifically religious convictions.