Protection of Conscience Project Library
Service, not Servitude
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Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.
Chervenak FA, McCullough LB. (Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics. Br Med J. 2006 Feb 18;332(7538):425.
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Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded — for example, respectively, eugenic “research” and psychiatric “treatment” of dissidents. . . . My chances of behaving honourably would have been
greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day. They would have been least if Savulescu’s opinions had prevailed . . .After 30 years of reading the BMJ, Sava-
lescu’s article was the first one to make me feel physically sick.
Smith VP. (Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience. Br Med J. 2006 Feb 18;332(425)
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Shakespeare wrote that “Conscience is but a word cowards use, devised at first to keep the strong in awe” (Richard III V.iv.1.7). Conscience, indeed, can be an excuse for vice or invoked to avoid doing one’s duty. When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors’ 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, which requires a reasonable conception of the patient’s good and the patient’s informed desires (box). If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.
Savulescu J. Conscientious objection in medicine. BMJ. 2006 February 4; 332(7536): 294–297. doi: 10.1136/bmj.332.7536.294