Do medical professionals have a right not to perform services with which they disagree morally? If so, is that right absolute? If not, what are the parameters and what criteria should we utilize in deciding the question?

Usually, the rights of medical conscience arise in the context of physicians not wanting to participate or be complicit in abortion by referring to an abortionist (as they are in Victoria, Australia), or more commonly here, of pharmacists who object to dispensing contraceptives or abortifacients.

Now, the Journal of Medical Ethics has published an article discussing a recent phenomenon in the UK in which some male Muslim medical students are claiming the right not to learn how to examine females because of their faith’s requirement of modesty between the sexes. I discuss over at my biweekly First Things “On the Square” column:

The article argues — persuasively in my view — that medical conscience should not extend this far because it would result in future physicians lacking an “essential competency”:

By refusing to perform examinations on members of the opposite sex, such students are failing to engage the question of what constitutes a touch that is professional and non-sexual — one that exemplifies a ‘cool intimacy’ that is still compatible with closeness to a patient. The matter here is not mechanics of touch; it is instead an emotional and psychological investigation whereby one learns how to cognitively distinguish clinical touching from touch that might otherwise signify erotic or romantic affection. This reasoning suggests that an inherent part of learning how to perform physical examinations involves a deep core competency . . . [and thus] gaining knowledge necessarily involves participation in the objected-to activity.

That seems indisputable to me. One simply can’t receive a thorough medical education by learning to practice exclusively on one’s own sex.

So, if medical gender segregation is a bridge too far, how do we decide where to draw the lines?

I strongly believe in a robust — but limited — right of medical conscience. A few years ago, I wrote an article in First Things proposing some criteria, among which were:

  • Conscience clauses should be legally binding.
  • The rights of conscience should apply to medical facilities such as hospitals and nursing homes as well as to individuals.
  • Except in rare and compelling circumstances in which a patient’s life is at stake, no medical professional should be compelled to perform or participate in procedures or treatments that take human life.
  • The rights of conscience should apply most strongly in elective procedures, that is, medical treatments not required to extend the life of, or prevent serious harm to, the patient.
  • It should be the procedure that is objectionable, not the patient. In this way, for example, physicians could not refuse to treat a lung-cancer patient because the patient smoked or to maintain the life of a patient in a vegetative state because the physician believed that people with profound impairments do not have a life worth living. [And, doctors would not be able to refuse to treat based on gender.]
  • No medical professional should ever be forced to participate in a medical procedure intended primarily to facilitate the patient’s lifestyle preferences or desires (in contrast to maintaining life or treating a disease or injury).

Of course, there is much more to be pondered. But ponder them we must. As I note in today’s column, the provocative question of medical conscience is an inescapable consequence of multiculturalism.

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Wesley J. Smith, J.D., Special Consultant to the CBC
Wesley J. Smith, J.D., Special Consultant to the CBC