May 24, 2024

“I object”: leading academic responds to criticisms of CO in health care

And so the debate continues.

Earlier this month, BioEdge drew readers’ attention to the “Declaration in Support of Conscientious Objection in Health Care” published by University of Reading philosophy professor David Oderberg. We also discussed a lengthy reply to Oderberg’s declaration written by Oxford ethicists Alberto Giubilini and Julian Savulescu (published on the blog Practical Ethics).

Professor Oderberg has this week written his own reply to Giubilini and Savulescu, addressing several criticisms made of his Declaration. While interested readers can read the full post here, we’ve selected a few key quotes that summarise some Oderberg’s clarifications and rejoinders.

Giubilini and Savulescu have stressed that doctors are not be forced to be doctors; if an individual chooses to enter the medical profession, he should be prepared to accept all the professional obligations that come with their role. Yet Oderberg challenges the notion that membership of the medical profession implies a commitment to providing all the services that medicine currently provides:

Freely choosing a profession does not entail that you ‘sign up’ to every requirement laid down by that profession’s current standards, or that you must obey every law governing that profession no matter how unjust you believe it to be. To think otherwise is to concoct a veritable recipe for professional corruption. …The idea that civil rights are somehow extinguished or superseded by dint of membership of a professional body, however, cannot be accepted. 

Savulescu and Giubilini also criticised Oderberg’s heavy reliance on a concept of “reasonableness” to arbitrate between legitimate and illegitimate forms of conscience-based refusal. Yet as Oderberg notes, “reasonableness tests” are ubiquitous in the common law system. They are certainly vague at the level of legislation, yet they are given precise meaning through judicial processes and the establishment of precedent:

As for that catch-all term ‘reasonable’, the simple fact is that common law is replete with ‘terms of art’ such as ‘negligent’, ‘cause’, ‘foreseeable’, ‘reasonable’, and the like. What the law calls ‘reasonableness tests’ are found everywhere. Rarely if ever do legislators try to define such terms, partly because they are so broad and generic that any definition would, for legal purposes, be itself so wide in scope as to be of little practical use. In addition, the breadth of the terms means that they crop up all over the common law, in just about any kind of tort case you could think of, as well as contract, property, and other areas. If we were to eliminate all ‘reasonableness tests’ from the law, the legal system would collapse. I am happy for the ‘reasonableness’ buck to stop with the courts.

Giubilini and Savulescu have accused Oderberg of moral relativism. And, indeed, his Declaration states that, “in a liberal, democratic society the state may not play favourites by choosing one system of morality to trump all others no matter what objections of conscience are made against it”.

Yet Oderberg stresses that he is by no means a moral relativist, but rather is simply trying to present a persuasive case for broad conscience protections given the assumptions that are fundamental to a liberal democratic society:

What is reasonable has to be settled by parliament and the courts, with plenty of room for lobbying and argument on all sides. If the appeal is reasonable, no liberal state can play favourites and compel obedience contrary to conscience…Lest there be any misapprehension, I am no moral relativist. But as far as I am concerned, in a liberal and pluralistic society one seeks to effect changes in the law through the usual means of lobbying and persuasion, and of course the ballot box. One does not do it by trampling on freedom of conscience. This no more implies moral relativism than freedom of speech in a liberal society implies that all things spoken are equally plausible.

“I object”: leading academic responds to criticisms of CO in health care
Xavier Symons
Creative commons
conscientious objection