Amongst the paradoxes of contemporary bioethics are simultaneous appeals to individual conscience as the arbiter of murky moral issues and disdain for conscientious objection by doctors. Oxford bioethicist Julian Savulescu is squarely in the second camp. In a controversial recent article in the BMJ, he contends that “a doctor’s conscience has little place in the delivery of modern medical care”.

What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources… If people are not prepared to offer legally permitted, efficient, and beneficial care to a patients because it conflicts with their values, they should not be doctors.”

Most of the decisions which Professor Savulescu has in mind revolve around reproductive issues, such as doctors refusing to do abortions, especially late-term abortions, refusing to give reproductive advice to gay couples, or refusing to prescribe emergency contraception. He gives four reasons to support his stand:

• By forcing patients to “shop around” for their doctors, conscientious objection creates inequity and inefficiency.
• It gives a special, unwarranted status to religious scruples. Doctors who believe that elderly sick should not be treated cannot appeal to their consciences to protect themselves from censure.
• Some skills are “a part of being a doctor”. Refusing to exercise those skills “corrupt[s] the delivery of the just and legal delivery of health services”.
• It privileges religious values above secular values and thereby constitutes unfair discrimination.

Professor Savulescu’s blast against the “Pandora’s box of idiosyncratic, bigoted, discriminatory medicine” which results from conscientious objection rendered many BMJ readers apoplectic. The response of Professor Shimon M. Glick, of Ben Gurion Hospital in Israel, was representative. He asked: “What is one to do in countries where torture is legal and physicians are asked to participate as loyal citizens? Again are we to leave our consciences behind?” He called upon Savulescu to retract his position “which has great potential for harm to young medical students and physicians, who may take him too seriously”.

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Michael Cook

Michael Cook edits BioEdge, a bioethics newsletter, and MercatorNet, an on-line magazine whose focus is human dignity. He writes from Sydney, Australia.

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