Service or Servitude: Reflections on Freedom of Conscience for Health Care Workers

Sean Murphy

Protection of Conscience Project
Protection of Conscience Project

Abstract
The authors suggestion that patients should be able to access morally controversial services without compromising health care workers’ freedom of conscience is most welcome, as is their acknowledgment that “other options exist” when pharmacists decline to fill prescriptions.

However, the conflicting interests of patients and health care providers may be accommodated but cannot be balanced because they concern fundamentally different goods. Neither the concept of autonomy nor an appeal to the “needs” of the patient help to resolve conflicts in these situations, while fiduciary obligations cannot necessarily be invoked because they are not governed by fixed rules, and there can be no obligation to participate in wrongdoing.

The fact that post-coital interceptives can cause the death of an early embryo is at the heart of the controversy over the drugs. The authors’ advocacy of mandatory referral follows from their belief this is not wrong. Those with different beliefs do not share their conclusions. Conscientious objection does not prevent patients from obtaining post-coital interceptives from other sources. As the exercise of freedom of speech does not force others to agree with the speaker, the exercise of freedom of conscience does not force others to agree with an objector. Concerns about access to legal services or products can be addressed by dialogue, prudent planning, and the exercise of tolerance, imagination and political will. A proportionate investment in freedom of conscience for health care workers is surely not an unreasonable expectation.


Murphy S. Service or Servitude: Reflections on Freedom of Conscience for Health Care Workers (2004 Dec 20) Protection of Conscience Project (website).

The Limits of Conscientious Objection-May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?

Julie Cantor, K Baum

New England Journal of Medicine, NEJM
New England Journal of Medicine

Abstract
Several reports have detailed cases in which pharmacists have refused to fill prescriptions for emergency contraception. Should pharmacists have the right to refuse access to these medications? This Sounding Board article discusses arguments for and against the right to refuse and proposes a balanced solution to the problem.


Cantor JD, Baum K. The Limits of Conscientious Objection-May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?. N Engl J Med. 2004 Nov 04;351(19):2008-212.