The influential New England Journal of Medicine appears to be backing moves to curtail conscientious objection to medical procedures like providing contraception or participating in abortions. Bioethicist R. Alto Charo contends in the current issue that some American health professionals are putting their religious beliefs ahead of the welfare of patients by refusing to treat them or refusing to refer them to other doctors or pharmacists. Due honour should be paid to conscience, she says, but conscientious objectors should also be prepared to suffer the consequences.

Society has given health professionals a monopoly on providing health services, she writes. Consequently they are a public service which is “obligated to provide service to all who seek it”. Claiming an unfettered right to personal autonomy while holding monopolistic control over a public good constitutes an abuse of the public trust — all the worse it if is not in fact a personal act of conscience but, rather, an attempt at cultural conquest.”

Throughout her treatment of the inflammatory issue of conscientious objection, Ms Charo assumes that refusal to provide a particular medicine or service is essentially a matter of religious faith, and not of philosophy or appropriate medical care.