Institutional conscientious objection may sound like an arcane bioethical issue, but it will be at the centre of fierce political debates in coming years. As more and more jurisdictions legalise procedures like abortion and euthanasia, some hospitals and clinics, mostly Catholic, will refuse to provide facilities. Governments will try to force them to participate – and there will be fireworks. This is already happening on a small scale in Canada and Australia. 

The idea that an institution can have a conscience is roundly denied by many bioethicists. The ability to discriminate between right and wrong is a property of individuals, not institutions, they believe. Therefore hospitals which refuse to provide, say, abortions should be forced to do so and doctors who refuse to participate should be sacked. After all, abortion is legal and socially acceptable.

Up to now, arguments for and against institutional conscientious objection have been relatively unsophisticated. One side says, “do what I say or else”; the other side responds, “we have a time-honoured right to our beliefs”. These are vulnerable to the exercise of raw political power. 

However, bioethicists are beginning to examine this issue more carefully. In the Journal of Medicine & Philosophy, two Australians, Xavier Symons and Reginald Chua, defend a right to institutional conscientious objection by parsing the terms of the debate more carefully. (Full disclosure: Symons is a former deputy editor of BioEdge, who is currently working at Harvard.) They sketch three familiar arguments against institutional conscientious objection: 

• People have consciences; institutions don’t have consciences.
• Institutions that receive public funding should provide legally sanctioned services. 
• Institutions must not deny legal services to people in desperate need, especially when they have nowhere else to go. 

Symons and Chua contend that these objections fail to take into account the metaphysics of institutions. While institutions are not individual persons, we often speak of them as if they had moral responsibility. For instance, Israel should not bomb Gaza or Iran should not fund Hamas. This is hardly a knock-out blow to opponents of ICO, but it should give us pause. It is an approach which is supported recent philosophical research. 

Their critique of the government funding argument deploys another simple distinction: 

Catholic facilities are not funded by governments with an implicit expectation of providing abortion or euthanasia. They are funded with the expectation that they act in accord with their foundational ethos. If anything, Catholic hospitals are honoring the expectation that the State has of them by acting in accord with their basic values and not providing terminations and assistance in dying.

Forcing these institutions to provide “immoral” services causes them moral harm. 

Finally, they discern in the argument about denying essential services a strong streak of consequentialism: “that the life and health of women is of greater importance than respecting an institution’s mission and values”. But this is a matter of reasonable, if vehement, disagreement. 

They note that the European Court of Human Rights ruled in 2012 that “States are obliged to organize their health service system . . . to ensure that the effective exercise of freedom of conscience by health professionals . . . does not prevent patients from obtaining access to services to which they are entitled.”

Without demolishing the arguments against institutional conscientious objection, they contend that much more depth, nuance, and tolerance are needed in a conflict which is sure to become more heated in coming years.