Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests

Abstract

Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners’ moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs.

Reply to: Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests

“…For example, a solicitor should not engage in or encourage blackmail or physically threaten another party in order to achieve a better result for their client. Assuming Giubilini and Savulescu's (2020) claim about the non-relativist nature of ethics, blackmailing and threatening are always unethical, and would be so even if lawful and permissible under professional codes of ethics. Solicitors should act in their clients' interest but must also be mindful of other parties' rights.…”

“…Part of Giubilini and Savulescu's argument is that professional ethics standards are set by relevant governing bodies. Yet, they acknowledge in their paper (Giubilini and Savulescu 2020), that many governing bodies acknowledge a right to CO. Moreover, a right to CO is what most ethicists advocate for (Neal, Fovargue, and Smith 2019), though not in an unconditional manner.…”

“…In their recent Journal of Bioethical Inquiry symposium article, Giubilini and Savulescu (2020) open an important discussion on the role of non-financial conflicts of interest. However, their argument that conscientious objection (CO) should be regarded as a conflict of interest (COI), and so abolished, is problematic.…”

Symposium Lead Essay—Conflict of Interest: Opening Up New Territories

“…In sharp contrast, Giubilini and Savulescu reject the notion that financial COIs are more ethically problematic than non-financial COIs and use a number of hypothetical case scenarios to demonstrate how non-financial COIs may adversely influence health practitioners' decision-making (Giubilini and Savulescu 2020). They focus on clinicians' moral and religious beliefs as a type of non-financial interest that may at times generate a COI.…”

Life Goes On

“…So it is not that this is itself problematic, as freedom of conscience is indeed an agreed fundamental human right, but, per Mill, not when the exercise of CO infringes the rights of others in a democracy, who do not share the same beliefs. Giubilini and Savulescu (2020) shows us an expanded view of interests that deserves our attention and that CO is a key contributor to conflicts between them.…”