This is the second of Dr. Joseph Meaney’s five-part series on conscience, the third installment in HLI’s Educational Series. We invite you to read our other two series on contraception and marriage and family.
To hear Dr. Meaney’s recent short talk on conscience with HLI staff and leadership, click here.
In part one of this series I wrote a general introduction on the topic of moral conscience and its formation. In this publication I will discuss the important question of conscience and health care workers.
I agree with the late professor Edmund Pellegrino, who stated that medicine is a moral enterprise and argued that it is particularly important to respect and foster the moral integrity of those involved in the healing professions. Doctors, nurses, pharmacists, and many others are intimately involved in some of the most dramatic moments of human life, making their conscience rights of particular importance. It is also true that societies look to medicine, as well as to law and especially religion, to certify what is ethical and moral.
Everyone without exception is called to educate his/her conscience well and to follow the clear judgments of conscience. Medical workers, however, are in a profession that is especially significant because of the many grave moral dilemmas that routinely occur. Frequently, life and death decisions have to be made, and physicians are often called to help make these choices and to carry them out.
Here we will focus the most important conscience issue for medical personnel, conscientious objection. This is defined as the refusal to cooperate with or participate in an action that violates one’s conscience. These conscientious refusals are frequently protected by law through legislation with conscience clauses or the recognition of a special conscientious objector status for medical workers.
It should be noted that the most frequently cited reasons for conflicts of conscience in health care settings are abortion and euthanasia, as well as contraception and sterilization. Most laws legalizing abortion or euthanasia took into account that many health care professionals would refuse to participate in these destructive actions and recognize the right to conscientious objection in these cases. The right to freedom of conscience is an internationally recognized human right guaranteed in many international treaties starting with the International Covenant on Civil and Political Rights.
There is a disturbing modern trend, however, in many industrialized nations, in which the right of conscientious objection, especially with respect to abortion and prescribing or filling prescriptions for abortifacient drugs, is being challenged or rejected. Particularly in Scandinavia, there is little tolerance of “free thinking” when people refuse to cooperate with the Culture of Death. Thus, in some countries, persons who conscientiously object to abortion, or sterilization, etc. are persecuted and even purged from the health professions, starting as early as their medical training. Abortion advocacy groups understand that the mere fact that doctors and nurses have legal protection to keep their hands clean of participating in abortion harms their position. Health care professionals do not have or request such protections regarding almost any other surgery or procedure, and this stigmatizes abortion as something set apart from true health care.
The first recorded case of a conscience conflict involving medical workers comes from the Old Testament.
The king of Egypt told the Hebrew midwives, one of whom was called Shiphrah and the other Puah, ‘When you act as midwives for the Hebrew women, look on the birthstool: if it is a boy, kill him; but if it is a girl, she may live.’ The midwives, however, feared God; they did not do as the king of Egypt had ordered them, but let the boys live. So the king of Egypt summoned the midwives and asked them, ‘Why have you done this, allowing the boys to live?’ The midwives answered Pharaoh, ‘The Hebrew women are not like the Egyptian women. They are robust and give birth before the midwife arrives.’ Therefore God dealt well with the midwives; and the people multiplied and grew very numerous. And because the midwives feared God, God built up families for them. (Ex. 1: 15-21)
It was clear that God condemns infanticide and abortion. Sadly, midwives in several countries are now being pushed to carry out abortions.
The need to guide physicians and their consciences in medical ethics does indeed have an ancient pedigree. The Hippocratic Oath dating from the 5th century forbids doctors from committing abortion and euthanasia. Most countries have professional bodies with their own codes of medical ethics. If doctors, nurses or pharmacists violate these norms, they can be expelled from the profession, even if their unethical action did not break the law. The Nuremberg “Doctors Trials” after World War II condemned physicians for failing in their duty to refuse to obey orders that gravely violated human rights even if technically, what they did was “legal” under the laws of the Third Reich.
It is good to be reminded of the gravity of abortion in the doctrine of the Catholic Church:
Formal cooperation in an abortion constitutes a grave offense. The Church attaches the canonical penalty of excommunication to this crime against human life. ‘A person who procures a completed abortion incurs excommunication latae sententiae,’ ‘by the very commission of the offense,’ and subject to the conditions provided by Canon Law. (Catechism of the Catholic Church n. 2272)
Health care workers have a solemn duty to follow their consciences and refuse to have any cooperation with this terrible crime. If they do commit abortions, it is a tremendous perversion of the very purpose of medicine, healing or caring for human lives, so beautifully expressed in the Primum non nocere, “First do no harm,” principle of bioethics.
Recognition of the right to conscientious objection for all health care workers is essential for the good of medicine. So many immoral procedures such as abortion, euthanasia, in vitro fertilization, sterilization, prescription of “morning after pills”, and the like have been legalized. In many countries, this happens without conscience protections for the medical professions, which could soon be emptied of moral and ethical practitioners.
Interestingly, this increased risk comes while there is a diminishing risk that health workers will impose their values on others as patient autonomy rights are increasingly dominating health care delivery. Rather, at greater risk is the health worker who is often required to obey the wishes of patients, professional bodies or the institutions for whom they work, even if what is demanded violates their consciences. An important point to add here is that institutional conscience protections are the only effective safeguard preventing Catholic hospitals from being forced to shut their doors and suspend the good work they do rather than be forced to perform abortions or other immoral procedures.
Clearly, medical conscientious objection is not an unlimited right that can be invoked indiscriminately. Health workers can reasonably be required to justify why they refuse to be involved in a certain action. The unrealistic nightmare scenario of medical professionals refusing “in conscience” to perform huge numbers of procedures is simply prevented by making them explain how their “disobedience” is motivated by an objectively important basic value of medical ethics. The bedrock medical principle, of course, is not to intentionally kill a patient or harm anyone as a means of treatment. Other principles, such as the prohibition of unnecessary mutilation, explain why surgical sterilization or the increasing requests for “sex change” surgery are unethical.
It is also important to stress that a common “compromise” position regarding medical conscientious objection, requiring workers to refer persons for procedures they will not perform, is ethically unacceptable. Proximate material cooperation with evil can never be carried out in conscience. The easiest way to illustrate the absurdity of requiring this is to provide an example. What would we think of a person who said he opposes assassination and refuses to do them but is willing to give a referral to a contract killer who will “help” the petitioner with the requested murder?
Pharmacists, in particular, have faced the terrible choice of filling prescriptions for deadly drugs–such as the morning-after pill or assisted suicide pills–or losing their jobs and ability to work in their profession. HLI Ireland’s Patrick McCrystal had to leave the practice of pharmacy because he could find no work that did not require him to fill prescriptions for birth control. Other pharmacists have won legal battles to have their consciences respected.
It is clearly intolerable that such a basic human right as respect for conscience is sometimes dismissed by scholars, judges or lawmakers as a professional perk that can and should be violated for the sake of the “rights” or convenience of patients.
We are faced with a stark choice. Either protect the conscience rights of health professionals or accept that health care will be populated almost exclusively by individuals who will “follow orders,” regardless of ethics and morality. Under totalitarian regimes such as the Nazis, health workers have been required to perform unspeakable crimes such as abortions and criminal “medical experiments.” The ethical impoverishment of the health professions without conscience protections would be catastrophic. Most medical workers would either have no moral compass or would be willing to violate their most important beliefs in order to keep their jobs. Persons with the highest moral standards would be barred from the practice of medicine.
Please join HLI in standing up for the conscience rights of our brothers and sisters in the health care professions.
Portions of this text are adapted from the doctoral dissertation of Joseph Meaney: Conscience and Health Care: A Bioethical Analysis.
Resources used in this article that we recommend for further study:
The Catechism of the Catholic Church, especially n. 2270-2296
The United States Conference of Catholic Bishops (USCCB) Secretariat of Pro-Life Activities, “Life Matters: Conscience Protection in Health Care.”
 (accessed 10.05.2017, at: https://www.nlm.nih.gov/hmd/greek/greek_oath.html and https://owlspace- ccm.rice.edu/access/content/user/ecy1/Nazi%20Human%20Experimentation/Pages/Hippocratic%20Oath.html )