a post not long ago, by my Canadian bioethics colleague Udo Schuklenk on his Ethx Blog, on the topic of conscientious objection in health care. The reason why I have started to think about this is that my country's rapidly shrinking Christian Democrat party has just elected itself a new leader – Ebba Busch Thor (see image to the left) – and the echo of the affirmative acclamation at the party's national congress had barely silenced before she made her first move to plug the many leaks of voters, members and sympathisers by declaring that health care staff should be given the legal right to conscientiously object to participate in the performance of legal abortion. This follows attempts in two public health care counties earlier this and the last year, initiated by single midwifes backed up by "pro-life" lobby organisations, to have the counties grant them such a legal right. Busch's Thor's move is obviously tagging onto these initiatives in an attempt to stop the flight of fundamentalist Christians from the party and mark a shift from the former party leaders more liberal and secular version of Christian Democrat ideology (whatever that is). At the same time, in both of the cases, the motions on behalf of the midwifes were denied by the county councils, albeit in one of them after some brief shuffling. In addition health care professional organisations (including the union of midwifes) have publicly stood up strongly against this sort of idea (see here, here, here), among these the Delegation for medical ethics of the Swedish Society of Medicine, of which I am an appointed member. More precisely, this delegation dismissed generally the notion of a right to conscientious objection for health care staff, no matter the procedure or background motivation. On top of that, given the very strong support of the liberal-feminist Swedish abortion legislation (in place since 1975 and giving all pregnant women a positive right to have an abortion performed by public health care, at barely no cost, up to the end of the 18th week of gestation, no questions asked), while Busch Thor's move might lure some of the lost fundamentalists back into the Christian Democrat pen, it will probably scare off even more of the more liberal and secular minded of the party's supporters. So far so good.
However, when discussing this issue with people in general and colleagues within both ethics and health care, and both in Sweden and internationally, I have encountered five very common confusions, which I will set out briefly in this post. If you feel yourself attracted to the notion of a legal right to conscientious objection, you may want to consider these before settling on a more precise opinion on the matter.
went public to declare that he would henceforth refuse to treat religious people. Perhaps a bit ham-handed, this provocative move still illustrates one of the most basic problems with the idea of a legal right to conscientious objection: such a right cannot be restricted to any particular conscience. While it may provide a legal right for doctors and nurses honouring their professional ethos to refuse, e.g., participating in torture – should this have been made legal – or the right of those who find that objectionable to refuse participating in legalised assisted dying procedures or abortions, at the other end of the scale it would equally protect the rights of the vile, hateful racists or misogynist to refuse to assist in, e.g., the care of Jews or Roma people or "immigrants", or disabled, or others that such a person's conscience may tell him or her should not be included in public health care services. By implication, we may also imagine a hateful anti-religious doctor, who would be convinced that religious people should be denied privileges extended to others, and this person's right to execute this denial would then be protected by law – as would an imagined Josef Mengele leaving disabled babies to perish and die in the maternity ward where he works. So, while there is an often repeated rhetoric suggesting that a lack of a legal right to conscientious objection will open the door for Nazis and similar horrid figures to reign freely (dealt with above in confusion no. 3), it is in fact the very existence of such a legal right that opens this door – if there is a "Nazi argument" on this topic, it speaks against, not for, legal conscientious objection rights. On a grander scale, this illustrates, of course, that the upshot of a legal right to conscientious objection is nothing less than potential anarchy and arbitrariness – again the very opposite of what is required of the basic principles of the rule of law and legal security.
Luckily, for anyone conscientiously objecting to whatever task included in his or her work description, there are many easy solutions: Talk to your employer about changing role and, if that doesn't help, find a job where the task you object to is not on the menu. But first of all, do not take jobs where there are tasks to which you conscientiously object!