"A stampede of pharmacists" demanding the right not to provide the morning-after pill has prompted a call to rethink conscience in the latest Journal of Medical Ethics. Eva and Hugh LaFollette contend that while conscientious objection has a long and honourable history, it should not necessarily be a right enjoyed by healthcare professionals in the United States.

Conscience no longer has the prestige it had amongst baby-boomer children of the 60s. In 2005, for instance, Illinois governor Rod Blagojevich ordered pharmacists who invoked their conscience to ignore it and to fill prescriptions or face stiff penalties.

The Lafollettes’ argument seems to assume that it is impossible to determine whether a conscience is right or wrong — whether its principles are morally correct or incorrect. In that case, the only plausible standard for assessing moral judgements must be whether or not they harm someone else. Conscience is merely a private matter which cannot command the respect of society unless it mirrors society’s standards.

Hence, the LaFollettes argue that "not all conscience should be treated equally… Once [a person’s] actions significantly affect others, then we should determine whether her claims are sincere, plausible and consistent, and whether she shows reciprocal respect for others, especially if she is a member of a justified profession in a democratic and basically just society."

What appears to irritate the authors is that some pharmacists want to have their cake and eat it, too: to act according to their conscience and not to be fired for doing so. Conscience operates differently on the job and in the home, they argue: "Although my private conscience may tell me that I should not perform an act, I should not straightforwardly infer that it is also improper for me to do that act as a professional."

What the article suggests is that healthcare professionals can no longer take for granted that appeals to "my conscience" will be treated with sympathetic respect. Libertarian ethicists are busy constructing arguments which will compel them to act against it. What is not so clear is why these arguments would not have supported the behaviour of Nazi doctors in concentration camps, which are universally condemned nowadays.

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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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