Freedom of Conscience in Health Care: Distinctions and Limits

Abstract

The widespread emergence of innumerable technologies within health care has complicated the choices facing caregivers and their patients. The escalation of knowledge and technical innovation has been accompanied by an erosion of moral and ethical consensus among health providers that is reflected in the abandonment of the Hippocratic Oath as the immutable bedrock of medical ethics. Ethical conflicts arise when the values of health professionals collide with the expressed wishes of patients or the dictates of regulatory bodies and administrators. Increasing attempts by groups outside of the medical profession to limit freedom of conscience for health providers has raised concern and consternation among some health professionals. The personal and professional impact of health professionals surrendering freedom of conscience and participating in actions they deem malevolent or unethical has not been adequately studied and may not be inconsequential when considering the recognized impact of other circumstances of coerced complicity. We argue that the distinction between the two ways that freedom of conscience is exercised (avoiding a perceived evil and seeking a perceived good) provides a rational basis for a principled limitation of this fundamental freedom.

Civic Conscience, Selective Conscientious Objection and Lack of Choice

“…Another common view is that conscientious objection is grounded in “moral integrity” or “personal integrity”—and thus should be tolerated out of respect for the objector's moral integrity. While this view is sound, most of those who subscribe to this view wrongly emphasise the importance of respecting or tolerating people's autonomy and choices with regard to having a certain conscience and acting upon it (see Leiter , 25; Murphy and Genuis , 347; Sulmasy , 135, 138; Wicclair , 4–5).…”

Objection to Conscience: An Argument Against Conscience Exemptions in Healthcare

“…As put it by Murphy and Genuis (2014), to force people to do something they believe to be wrong is always an assault on their personal dignity and essential humanity. 18 Independence from substantial moral views regarding the content of conscience also characterizes the defence of a right to conscientious objection by some Catholic bioethicists. This is noteworthy, because in the Catholic doctrine the notion of conscience is not merely formal; rather, it implies an intimate connection with the notion of truth.…”

Ethical Diversity and the Role of Conscience in Clinical Medicine

“…Although it is not known how the symptoms of moral injury will present over time, there is concern that the consequent psychological and emotional strain may have a detrimental impact on the essence of personhood. As an individual's moral framework may constitute a fundamental component of their identity, coercion to engage in behavior that violates their moral code may represent an assault on their moral ecosystem and a violation of personal integrity that threatens their essential humanity [ 12 ]. In military situations, for example, moral injury can be associated with serious and ongoing alienation, intense shame, and sustained distress [ 107 ].…”

“…Authors exploring the notion of conscience use a variety of terms to characterize the multidimensional role of conscience in one's life [ 1 , 9 – 11 ]. Conscience has been described in its role as a means to preserve integrity or ethical wholeness (“perfective conscience”) [ 12 ], and is used to monitor how potential decisions resonate with, or “protect” one's moral framework. Other authors describe the role of conscience both retrospectively (looking back on previously made decisions or actions) and prospectively (assessing whether a proposed action would compromise one's moral integrity) [ 1 ].…”