The Role of Conscience in Medicine Essay Example

Appeals to conscience do not hide unspoken prejudices because they are based on the physician’s moral objection to a certain medical treatment, not based on a judgement of the patient’s identity. A physician can refuse to provide medical interventions that contradict their moral code while still respecting a patient’s intersectional identity.  

Conscientious objection in medicine is a physician’s refusal to give a patient some medical treatment based on their own moral beliefs about performing the intervention. Allowing conscientious objection ensures that physicians remain active participants in medicine rather than becoming medical machines. It also ensures that patients know their physicians are using their conscience and are committed to their patients’ good (Curlin and Tollefsen, 2019). Legitimate conscientious refusals are based on the medical intervention and not based on any characteristic of the patient. As Curlin and Tollefsen state in their essay on the conscientious objection, it is possible to “coherently condemn refusals that involve invidious discrimination without abandoning either the notion of conscience or the physician’s commitment to the patient’s health” (2019). Refusals to provide medical intervention based on a patient’s identity such as their race, gender, or sexual orientation are not conscientious objections at all; rather, these are examples of bias. For example, a doctor who refuses to provide physician-assisted suicide is conscientiously objecting because they think providing such an action would be immoral. A doctor who refuses to give reproductive advice to a gay couple, on the other hand, has a bias based on the patients’ identities. Biases always hold unspoken prejudices, but legitimate conscientious objections do not.  

Opponents of conscientious objection state that allowing such refusals results in medical disparities. In his essay against conscientious objection, Savulescu says these it “introduces inequity and inefficiency” (2006). He goes on to explain that the poor do not have the time or money to “shop” for a doctor who will fulfill their medical needs, while affluent people can (Savulescu, 2006). However, banning moral objections could create the same issues on a more extreme level. If becoming a medical professional required one to abandon their morality, the profession would become much less appealing, and the pool of physicians would decline. The result could be overwhelmed hospitals with people waiting days for an available physician. In other words, this would lower access to medical care for everyone, especially the poor, who have less time to spare. Furthermore, Savulescu bases what is medically acceptable on what is legal, arguing that doctors have a “responsibility to provide all legal and beneficial care” (2006). However, history has shown us that laws can be extremely unethical and prejudiced against people based on their race, gender, class, etc., therefore laws should not be the undisputed deciding factor for what is medically good.  

Some might argue that conscientious refusals end the open conversation between doctor and patient and therefore hinder the ability of the physician to understand the patient’s intersectionality. The intersectionality of a patient is a convergence of all the identities they hold and the unique forms of systemic oppression they face because of those identities (Wilson, 2019). However, as Curlin and Tellefsen state, when a disagreement comes up in the hospital, “physician and patients do their best to negotiate an accommodation that does not require either to do what they believe is unethical” (2019). In other words, whenever a doctor and physician disagree, they should have an open negotiation until the doctor fully understands all the factors that have led the patient to seek treatment. The doctor should always be willing to listen, reflect on the patient’s background, and even change their mind after negotiation. On the reverse side, the patient should be willing to respect the intersectional identities of the physician as well. The doctor might not be willing to offer certain medical interventions because of their culture or religion, which is why they should have the option to refuse to offer a procedure or to refer the patient to another professional.  

In conclusion, the ability of medical professionals to use their conscience when deciding what medical interventions to offer is essential to health care and does not provide an opportunity for physicians to bring biases and prejudice into their work. 

References: 

Curlin, A. & Tollefsen, C. (2019). Conscience and the Way of Medicine. John Hopskins University Press. Retrieved February 11, 2022, from https://muse.jhu.edu/article/732240 

Savulescu, J. (2006, February 2). Conscientious objection in medicine. The BMJ. Retrieved February 11, 2022, from https://www.bmj.com/content/332/7536/294 

Wilson, Y., White, A., Jefferson, A., & Danis, M. (2019, October 3). Intersectionality in Clinical Medicine: The Need for a Conceptual Framework. The American Journal of Bioethics. Retrieved February 11, 2022, from https://www.tandfonline.com/doi/full/10.1080/15265161.2018.1557275