Reproductive health services and the law and ethics of conscientious objection

Bernard M. Dickens

Medicine and Law

Abstract: Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation, in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians’ conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses’ claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health-related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.


Dickens BM. Reproductive health services and the law and ethics of conscientious objection. Med Law. 2001;20(2):283-93.

The scope and limits of conscientious objection

Bernard M. Dickens, Rebecca J. Cook

International Journal of Gynecology & Obstetrics

Abstract: Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses’ conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.


Dickens BM, Cook RJ. The scope and limits of conscientious objection. Int J Gynaecol Obstet. 2000 Oct;71(1):71-7.

Freedom of conscience, professional responsibility, and access to abortion

Rebecca S. Dresser

The Journal of Law, Medicine & Ethics

Acess to abortion is becoming increasingly restricted for many women in the United States.  Besides the longstanding financial barriers facing low-income women in most states, a newer source of scar­ city has emerged. The relatively small  number of physicians willing to perform the procedure is compromising the ability of women in  certain parts of the country to obtain an abortion. Do physicians have a duty to respond to this situation? Do they have a professional responsibility  to ensure that abortions are reasonably available to the women who want to terminate their  pregnancies? Or, is abortion so morally and socially controversial as to remove any professional  obligation to provide reasonable access?


Dresser RS. Freedom of conscience, professional responsibility, and access to abortion. J Law Med Ethics 1994 Fall;22(3):280-5.