Response to Article Assignment | Online Assignment

The article you will be responding to is attached along with the rubric. Do not use a “Works Cited” page, use only footnotes. Some examples of philosophical theories we have been over in class are: Cultural Relativity, Egoism, Kantianism, Utilitarianism, and Social Contract Theory

Phil 2306 Writing Assignment 5 – Term Paper (20%):
Each student is required to read the following article available from the course blackboard site:
Schuklenk, Udo and Ricardo Smalling. “Why Medical Professionals Have No Moral Claim to Conscientious Objection Accommodation in Liberal Democracies.” Journal of Medical Ethics: The Journal of the Institute of Medical Ethics, 43(4), 234-240. 7 p. APR 2017.
Each student must then offer a clear discussion of a properly formulated thesis of the student’s design in response to the article and the issues raised by its authors concerning Medical Professionals and Conscientious Objections. This will require utilizing various theories and principles drawn from the course material to argue in support the chosen thesis, recognize plausible objections to the arguments raised in support of the thesis, and responding to those objections accordingly. It will be important to recognize different interpretations of theories were different interpretations will impact the acceptability of your argument. Students should utilize relevant principles, arguments, and analogies discussed during the course wherever appropriate.
The purpose of this assignment is to provide students an opportunity to demonstrate the development of their philosophical writing abilities over the course of the semester. Students are encouraged to work on this project throughout the semester as they complete the other writing assignments during the course. Students are also encouraged to seek regular feedback from the instructor specifically on their writing by completing drafts and meeting with the instructor to discuss their writing during office hours.
• Papers MUST be typed and double spaced in 10 – 12 point Calibri or Arial font with 1 inch justified margins.
• To receive any credit for the assignment a student’s paper must be at least 1500 words in length. This is a firm minimum limit. Do not be surprised if you submit a paper that is only 1499 words and receive a ‘0’ for your submission. This word count only includes the body of the paper (the actual discussion of the material). It does not include extraneous material such as identifying information at the outset of the paper (your name, my name, the class, paper title, etc.) and it does not include footnote citations or other reference materials.
• Students should strive to submit a paper that is no less than 3000 words in length.
• Students should seek to use any available material from the course, be it readings, lecture material, discussions in class, etc.
• When utilizing such material in his/her term paper, each student should reference the material via footnote (NOT in text citation or endnote) in a way that makes clear where the material originated.
o If you are not familiar with the proper way to utilize footnotes, come to office hours for individual instruction.
o Note that a “footer” is NOT the same as footnotes. These are different features and have different names for a reason. If you do not understand, come to office hours and ask!
Students will be evaluated on the clarity of their argumentation and their ability to clearly present a critical argument in support of their chosen positions. As this is a Philosophy paper (and not an English paper) the emphasis will be on argumentation and clarity of argument (rather than imagery). Spelling/grammar/punctuation mistakes that detract from the clarity (or readability) of a student’s paper will be penalized. Students are encouraged to meet with the instructor to discuss writing style as well as content and to make use of any available resource to assist with the writing of his/her paper.
The following online guide to writing a philosophy paper is strongly recommended by the instructor for all students to utilize during the writing of the term paper:
http://www.jimpryor.net/teaching/guidelines/writing.html
This assignment must be submitted via TurnItIn on the SHSU Blackboard course site by the time specified above on the date due. Students are responsible for ensuring that their submission is compatible with the software utilized by Blackboard and that it is properly submitted. Be sure to “confirm” your submission to TurnItIn by clicking the corresponding “confirm” button when required. Students using apple products or other “non-PC” software/products are advised to submit their material as .pdf universally readable files to ensure that their submission is not penalized for lateness (an unreadable file is not submitted until a readable version of the file is submitted and accepted).
The following rubric will be in use in evaluation of each student’s submission for this assignment:
Paper Introduction 3
Thesis statement, clearly and readily identifiable 1
Thesis position (the conclusion/goal of the paper) clearly stated and readily identifiable 1
A clear statement of the conflict/issue that motivates the thesis 1
Introducing the Author/Paper/Argument under discussion 4
Reader can clearly identify what you are reporting to be Schuklenk & Smalling’s thesis 1
You accurately report Schuklenk & Smalling’s thesis 2
Accurately report the scope (context) of Schuklenk & Smalling’s argument 1
Clarity and Depth: Exposition of the Arguments/Conflicts under discussion 8
Competency of the text and the nature of the philosophical problem demonstrated using appropriate references (original article, relevant source material, textbook, etc.) 3
Efficiency (Demonstrated ability to present the relevant information accurately & completely, w/o overly long quotes or attempting to summarize every paragraph from the article) 2
Are the essential elements of the philosophical problem clearly addressed? 2
Are the finer elements of the philosophical problem clearly addressed? 1
Treatment of Plausible Objections and Defense of Thesis 12
Clear statement of objection(s) to thesis and why objection(s) is(are) problematic 6
• More credit earned for recognizing more effective objections
• More credit earned for recognizing greater number of objections
Effective discussion/response to each objection 6
Each combination of an objection and a response (or set responses to a single objection) should include the following elements:
• Clear identification of the objection to the argument and the theory/principle to be used in the objection to the argument
• Accurate representation of the theory/principle being used as the basis for the objection to the argument
• Clear, careful reflection of how the objection is a problem for the argument
• Clear identification of the response to the objection and consistent use of the same theory/principle to be used in the response to the objection
• Accurate representation of the theory/principle being used as the basis for the response to the objection (which may reflect a shift in interpretation/focus of the principle)
• Clear, careful reflection of how the response is an appropriate response to the problem created by the objection
Philosophical Consideration/Effort 7
Paper reflects a careful consideration of the topic 3
Evidence of independent thought by author (not merely regurgitation of lecture) 2
Paper analyzes the positions, is not merely a summary of the positions 2
Writing (Spelling, Grammar, Usage, Punctuation, Flow) 6
Paper is clear, well written, easy to read 2
Paper presented as a single series of objections to a single argument 1
Paper properly referenced using footnotes (NOT endnotes or in-text citations) 1
Paper properly formatted [font size/type, margins, quotations if used, etc.] 1
Irrelevant material [“fluff”] omitted from paper 1
Total Possible Points 40

EXTENDED ESSAY
Why medical professionals have no moral claim
to conscientious objection accommodation
in liberal democracies
Udo Schuklenk,1 Ricardo Smalling2
ABSTRACT
We describe a number of conscientious objection cases
in a liberal Western democracy. These cases strongly
suggest that the typical conscientious objector does not
object to unreasonable, controversial professional
services—involving torture, for instance—but to the
provision of professional services that are both
uncontroversially legal and that patients are entitled to
receive. We analyse the conflict between these patients’
access rights and the conscientious objection
accommodation demanded by monopoly providers of
such healthcare services. It is implausible that
professionals who voluntarily join a profession should be
endowed with a legal claim not to provide services that
are within the scope of the profession’s practice and that
society expects them to provide. We discuss common
counterarguments to this view and reject all of them.
INTRODUCTION
It is not unusual for students in any given bioethics
class to offer something like following defence of
conscientious objection rights: ‘Remember the Nazi
experiments and the abuse of prisoners there and
then? It is good that conscientious objection rights
exist to protect good doctors refusing to participate
in such crimes’. There are more sensible versions of
this argument, such as one published by an admittedly
not ‘very courageous’ doctor who wrote in the
British Medical Journal that he would have hoped to
object on conscience grounds to the abuse of prisoners
in Stalinist Russia, and claims that knowing that
he was ‘part of an independent medical profession
with allegiance to something higher and more enduring
than the regime of the day’ would have increased
the odds of him doing the right thing.1 We know, of
course, in bioethics, that whenever a Nazi analogy is
brought up to defend a particular normative stance,
the odds are that that stance is weakly supported, if
not outright indefensible. Unlike contemporary
liberal democracies, the Nazis and Stalin’s Soviet
Union did not respect conscientious objectors, and
neither did Pol Pot’s henchmen and henchwomen.
Well-known pacifists such as Hermann Stöhr, the
leader of the German branch of an international pacifist
organisation, perished in German concentration
camps.2 Conscientious objection typically does not
flourish in dictatorships. Toleration of conscientious
objectors in liberal democracies does little to support
conscientious objectors in North Korea. The concept
has evidently little currency there: its utility and legitimacy
cannot be defended by pointing to Nazi
Germany or Stalinist Russia. The same cannot be said
for liberal democracies where respect for both individual
as well as professional autonomy ranks highly.
The medical historian John J Michalczyk got it probably
right, when he noted that ‘those who invoke the
Nazi analogy in a broad or general fashion are pressing
the limits of valid analogy simply because the
broader the scope of their reference, the harder it
becomes to understand exactly what they think the
Holocaust was, and thus why it is of moral relevance
to the current issue’.3 We aim to take the ethical
debate about conscientious objection in medicine
back to where it currently properly belongs, namely
liberal Western democracies where some medical
doctors wish to see their private moral or religious
objections to the provision of certain professional
medical procedures accommodated by regulatory
regimes. This is invariably at a cost to patients hoping
to access medical services that they are legally entitled
to access.
Liberal democracies rightly do not take a stance
on the substance of their citizens’ moral or religious
or other convictions, what is protected in
liberal democracies’ constitutions is the citizen’s’
right to hold such beliefs and live by them—
within reason. Typically, no distinction is and
should be drawn between religious and other
moral convictions, but that is not always the
case.4 5 In the kinds of societies that we are concerned
about in this paper, the vast majority of
litigated cases are triggered by religious conscientious
objectors as opposed to secularists or atheists.
6 That in its own right is not a reason to
disregard such complaints, because the protection
of an individual’s rights to adopt significant beliefs
and live by them is at the heart of what living
one’s own life in a liberal polity is all about. For
all practical intent and purposes, we are discussing
predominantly religiously motivated conscientious
objectors in the medical profession who ask that
their objections to the delivery of particular professional
services are protected by the secular
state. There might be instances of conscientious
objection in other kinds of societies. There might
also be conscientious objection in other contexts,
for instance, in case of military conscripts. This
article will not address those contexts. We are concerned
only with conscientious objectors who
decided to join a particular profession (in this case
medicine) voluntarily and who then wish to be
exempt from providing services that are typically
expected of that profession.
234 Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560
Extended essay
To cite: Schuklenk U,
Smalling R. J Med Ethics
2017;43:234–240.
1Department of Philosophy,
Queen’s University, Kingston,
Ontario, Canada
2Department of Geography and
Planning, Queen’s University,
Kingston, Ontario, Canada
Correspondence to
Dr Udo Schuklenk, Department
of Philosophy, Queen’s
University, Watson Hall,
Kingston, Ontario, Canada, K7L
3N6; udo. schuklenk@ gmail. com
Received 23 March 2016
Revised 29 March 2016
Accepted 30 March 2016
Published Online First
22 April 2016
􀅹 http:// dx. doi. org/ 10. 1136/
medethics- 2015- 103177
􀅹 http:// dx. doi. org/ 10. 1136/
medethics- 2016- 103643
􀅹 http:// dx. doi. org/ 10. 1136/
medethics- 2016- 103670
􀅹 http:// dx. doi. org/ 10. 1136/
medethics- 2016- 103903
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CONSCIENTIOUS OBJECTION IN LIBERAL DEMOCRACIES:
WHY SHOULD WE RESPECT IT?
Let us begin by trying to understand what conscience actually is.
Daniel Sulmasy describes it as something that seems to operate
both retrospectively as well as prospectively; it impacts on particular
past actions and it impacts on how we evaluate normatively
possible future actions.7 He conceptualises conscience
both as our conviction that we should act in accordance with
our individual understanding of what morality demands of us,
and on wilfully and voluntarily acting in accordance with what
we consider to be morally good and right.8 It is uncontroversial
that asking someone to violate their conscience-based convictions
in matters that are of great importance to them is also
asking such individuals to accept a potentially fairly high psychological
cost. Typically, when we act contrary to our conscience
we will be plagued by guilt and possibly worse.
Hermann Stöhr died rather than recant his pacifist convictions.
There are others like him.
Why then should we, prima facie at least, tolerate conscientious
objectors in liberal societies? There are various reasons
that have been suggested for this. One is obvious from the
above. Prima facie no society should force conscientious objectors
to suffer the psychological cost that they would incur if
they were forced to act against their conscience. Peter
West-Oram and Alena Buyx have offered a number of other
reasons. They write, ‘the right to exempt oneself from the fulfilment
of a generally held duty is typically justified on the
grounds that such a right is vital for the preservation of freedom
of conscience. The latter is itself argued to be a core value of
pluralist, liberal-democratic states, and ‘a moral right’. Further,
the rights to freedom of conscience and conscientious objection
are argued to be constitutive of liberty and autonomy, and to be
necessary for the preservation of individual moral integrity. In
promoting these goods, the rights are argued to be vital for the
adequate toleration of different moral and philosophical perspectives
in a pluralistic society.’9 These are powerful reasons.
On this reading respect for an individual’s conscience is something
of a corollary of the principle of respect for persons.
Mark Wicclair has suggested in an influential paper that a
blanket refusal to tolerate conscientious objection would constitute
a significant threat to some doctors’ moral integrity.10
Similar views are expressed by Pellegrino.11 It is not surprising
then that there appears to be a broad consensus between religious
voices in bioethics12 and liberals13 according to whom the
failure to tolerate, protect and respect some conscientious objectors
is incompatible with what it means to live together in a
liberal multicultural society. It is also fair to say that some
bioethicists have voiced more or less strong opposition to the
view that we should accommodate medical doctors’ conscientious
objections.14–16
As mentioned in the ‘Introduction’ section, based on the
review of hundreds of legal cases reported in Brian Leiter’s
book Why Tolerate Religion?, respect for conscience in the 21st
century translates into a fairly one-sided affair: it is fought for
and demanded by religious healthcare professionals without
much regard for actual patient care and health outcomes, or
indeed respect for these patients’ moral choices. Considering
the significant power differential between patients and doctors,
this is remarkable in its own right. Whenever there is a conflict,
on this account, a doctor’s private ideological convictions generally
take precedence in the professional practice of medicine.
Various bioethicists have tried to suggest limiting criteria to
avoid the possibility that arbitrary stances taken by doctors
could pass successfully the conscience muster.17 Typically, conscientious
objections occur in the context of reproductive health
(eg, abortion, in vitro fertilisation, contraceptives), end-of-life
care (eg, assisted dying) and also affect negatively gays, lesbians
and patients with gender dysphoria.
WHY CONSCIENTIOUS OBJECTION HAS NO PLACE IN THE
PRACTICE OF MEDICINE
It is worth noting that scepticism about the importance of an
individual’s conscience claims within a community has been
expressed by influential thinkers for many years. Thomas
Hobbes had this to say in his Leviathan:
another doctrine repugnant to civil society is that whatsoever a
man does against his conscience is sin; and it dependeth on the
presumption of making himself judge of good and evil. For a
man’s conscience and his judgement is the same thing; and as the
judgement, so also the conscience may be erroneous. Therefore,
though he that is subject to no civil law sinneth in all he does
against his conscience, because he has no other rule to follow but
his own reason, yet it is not so with him that lives in a
Commonwealth, because the law is the public conscience by
which he hath already undertaken to be guided. Otherwise in
such diversity as there is of private consciences, which are but
private opinions, the Commonwealth must needs be distracted,
and no man dare to obey the sovereign power farther than it
shall seem good in his own eyes.18
Poignantly, Hobbes makes this point in a chapter on ‘those
things that weaken or tend to the dissolution of a commonwealth’.
Of course, Hobbes is not quite our archetypical
defender of liberal democracies, but the point he is making here
is valid, it applies to the case of conscientious objectors in
liberal democracies, too.
Let us begin our argument by making the general case for
why conscientious objection in medicine should not be
accommodated.
We recognise that conscientiously objecting healthcare professionals
can have various rationales to support their opposition
to the participation of doctors, in particular medical procedures.
They include typically a recourse to tradition, the Hippocratic
Oath, the Bible, the Quran and any number of other documents
that have no legitimate bearing on the practice of 21st century
medicine. It is easy to show that even the objecting doctors’
standard recourse to the Hippocratic Oath when it comes to
abortion and assisted dying is not always credible.19 20 It is evidently
the case that other ideological convictions held by particular
doctors motivate their deployment of the argument from
tradition, in the guise of the Hippocratic Oath, because only the
lines from the Oath that suit a particular objecting doctor’s
interests are typically cited, while those they disagree with are
quietly ignored. But in any case, the Oath is not a defensible
ethical guide to modern medical practice.21 Mercier might be
right in this context, when she writes that
religion is all about believing that one’s beliefs are right, but not
about having right beliefs. If first-order religious beliefs had
content, their content could be checked against the truth. It is
precisely because such beliefs lack content that one can go on
about believing that one believes them despite any and every evidence.
But the price of second-order belief in vacant first-order
beliefs is self-deception.22
On this background, it is fortunate from the conscientious
objector’s perspective that secular liberal democracies do not
typically test whether the views conscientious objectors profess
Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560 235
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to subscribe to are defensible. What matters is that they are
deeply held, or, more to the point, that the conscientious objectors
claim that they hold those convictions deeply.23 Even on
this count we are incoherent. A female Muslim doctor refusing
to see a male patient would not be granted a conscientious
objection exemption, whereas a pharmacist refusing to sell contraceptives
in some countries might. Let us assume that both of
these conscience decisions were loudly proclaimed to be genuinely
held by the professionals in question. Why should one be
respected and the other one not? It could be argued that in
liberal democracies, constitutional documents and human rights
legislation variously protect against gender-based discrimination
but may not guarantee access to contraception. While this may
be true it misses the point of the argument—that the substance
of conscience-based objections that are protected is arbitrary.
Take as an example the unfolding debates around marriage
equality. Until quite recently this was a concept alien to liberal
constitutions and human rights legislations. Those with
conscience-based objections to same sex marriage were free to
assert those beliefs against such couples. However, that is
increasingly no longer the case. Nothing has changed about the
same sex couples or the beliefs of the objectors; society has
simply decided that such objections will no longer be tolerated.
Furthermore, just as we cannot test the plausibility of the
ideological dicta that lead to conscientious objections (there is
no test for the existence of ‘God’, for instance, or truth of the
Bible), it is also impossible to ascertain whether conscientious
objectors actually hold the views they profess to hold. The US
Supreme Court writes on this issue,
What principle of law or logic can be brought to bear to contradict
a believer’’s assertion that a particular act is “central” to his personal
faith? Judging the centrality of different religious practices is
akin to the unacceptable “business of evaluating the relative merits
of differing religious claims..”.. it is not within the judicial ken to
question the centrality of particular beliefs or practices to a faith,
or the validity of particular litigants’ interpretation of those
creeds…courts must not presume to determine the place of a particular
belief in a religion or the plausibility of a religious claim.24
If that is the case, it remains unclear why untestable conscience
claims from privileged professionals who voluntarily
chose to join a particular profession, and who have been
endowed by society with a monopoly on the provision of particular
procedures, should be accommodated, given that this toleration
subverts the very objectives the profession is designed to
achieve. This does not deny anyone the right to hold any
number of private religious and moral views, as they see fit and
as they choose to hold. What we are denying is that professionals
are entitled to subvert the objectives of the professions
they voluntarily joined by prioritising their private beliefs over
the professional delivery of services to the public, especially
when they are monopoly purveyors of these services. Legal
scholar Alta Charo called it right, when she wrote, ‘claiming an
unfettered right to personal autonomy while holding monopolistic
control over a public good constitutes an abuse of the
public trust—all the worse if it is not in fact a personal act of
conscience but, rather, an attempt at cultural conquest’.25
Various authors have warned that an unqualified right to conscientious
objection in medicine would result into harmful consequences,
for instance, for women wanting to have an
abortion, who could be denied timely access to this healthcare
procedure not because of legal constraints, but because of
healthcare professionals refusing to provide such a healthcare
service on conscience grounds. Frequently, a middle-ground is
sought, as legal systems are indeed rare where conscientious
objection rights cannot be overridden by a competing stronger
right (eg, a patient’s right to access healthcare in a timely
manner). Typically, then the argument is not over whether conscience
rights are defensible, but about what kind of compromise
is reasonable for everyone affected.26 27
Unfettered versus fettered conscientious objection
accommodation
It could be objected that the argument advanced in this paper is
too simplistic as it appears to target only unfettered conscientious
accommodation stances, when the focus in today’s policy
debates is about fettered conscientious objection accommodation.
It may be argued that the question really is: where and
how could society draw reasonable lines that take into account
societal interests as well as those of individual objectors? The
preceding section explains to some extent why we have taken
this stance. The courts in various jurisdictions have already,
rightly so, conceded that it is a moot point trying to establish
the truth or even plausibility of the views purportedly held by
conscientious objectors. That is not an insignificant point,
because this concession opens the door to any number of more
or less arbitrary and random conscientious objection claims. For
policy makers aiming to establish a functioning healthcare
system with predictable service delivery and guaranteed service
levels to the people who finance the system, this constitutes an
insurmountable problem. It is nigh impossible to predict which
healthcare professional, in which part of the system will
demand accommodation for which kinds of purported or real
convictions. It is also evidently impossible to verify whether
objecting healthcare professionals even hold the views they
profess to hold. Such claims may merely be a convenient way
out of the provision of inconvenient healthcare services.
In light of this, it seems to us that whatever attempt at a principled
fettered accommodation is made, it is by necessity resulting
in arbitrary outcomes. Regardless of the accommodations
that we make today, these can and likely will be challenged time
and again by new generations of conscientious objectors. Today
it might be abortion and assisted dying, tomorrow it might be
the use of the tools of personalised medicine or something else
altogether. Limiting conscientious objection accommodation to
defensible claims seems impossible to us, unless we overcome
the two problems mentioned: demonstrate the truth of the
foundations of the conscientious objection and demonstrate evidence
that objectors actually genuinely hold the views they
claim to hold. Failing that, as we will show, the inevitably
ensuing arbitrary accommodation demands will have harmful
real-world consequences as far as healthcare outcomes and
patient access to care is concerned.
A few Canadian examples
Lobbyists for doctors usually defend the view that doctors must
never be required to provide services that they object to on conscience
grounds. Their focus is on ensuring that conscientious
objectors do not have to oblige patients asking for such healthcare
services, or even have to assist them in finding a healthcare
provider who will oblige them. A good example of this is Dr
Jeff Blackmer, the Director of the Canadian Medical
Association’s Ethics Office. Dr Blackmer writes on behalf of the
Canadian Medical Association that medical doctors are neither
obliged to provide abortion services, nor are they obliged to
transfer patients on to doctors they know will provide abortions
to women seeking one.28 Women are legally entitled to access
abortions in Canada if they so wish, and typically abortions are
236 Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560
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fully funded by provincial public healthcare systems. Canadian
doctors are the only professionals legally entitled to provide
such procedures. They are monopoly providers. Dr Blackmer’s
considered view on this subject matter is that pregnant women
who wish to have access to a medical procedure that they are
legally entitled to, and that is fully funded by the state, should
have to depend on the goodwill of volunteering doctors who
also happen to be the only licensed providers of this procedure
in the country.
A second example: At the time of writing, Canadian legislators
grapple with the question of how to implement a Supreme
Court of Canada judgement that effectively decriminalises providing
assistance in dying to competent patients suffering from
an irreversible chronic illness that renders their lives not worth
living in their own considered view.29 Dr Cindy Ford, the
current president of the Canadian Medical Association, mirrors
Dr Blackmer’s stance on the obligations of conscientious objectors.
In a statement made to the Canadian parliamentary committee
tasked with investigating possible legislative options on
assisted dying, Dr Ford reportedly stated that it is unreasonable
to require conscientious objectors to even refer such patients to
a clinician who they know will be prepared to render assistance
in dying.30 Dr Blackmer agrees with her, while at the same time
trying to assure the Canadian parliamentary committee
members of reliable professional service delivery; as he says, ‘I
can sit here…and guarantee that from simply a number perspective,
access will not be an issue’.31 Dr Blackmer’s argues that
given that 30% of Canadian doctors are willing to provide
assistance in dying, there should not be a problem for patients
wanting to access such services. If it was just a numbers game,
Dr Blackmer would certainly be correct. Given the relatively
small number of eligible patients likely to ask for assistance in
dying, there should be a sufficient number of doctors willing to
provide assistance to such patients. However, as so often, the
devil is in the detail. The problem is—we suspect this is the
reason why Dr Blackmer does not actually offer unconditionally
guaranteed access on behalf of his association—that this likely
will not help seriously sick and vulnerable patients who happen
to live in remote areas of Canada where only few doctors
happen to practice, and where all of them might be opposed to
assisted dying on conscience grounds. It is irrelevant then that
elsewhere in the country plenty of doctors would be willing to
provide assistance in dying on request, if a particular patient is
unable to travel to them. To these patients, Dr Blackmer’s ‘guarantee’
is worth very little.
We should note here that the Canadian Medical Associations
stance is not unusually radical among its peers. The British
Medical Association, too, produced a guideline stipulating that
‘whenever possible physicians who are conscientiously opposed
to forgoing treatment should be permitted to hand over care of
the patient to a colleague’, but they are not obliged to do so.32
The entitlement mentality that drives these associations’ stances
is unsurprisingly supported by the doctors they represent.33
A further example of the potential impact of conscientious
objection on patients’ access to care in Canada can be seen in
the recent application filed by various religious physicians and
associations representing them in the Ontario Superior Court.
The application challenges the College of Physicians and
Surgeons of Ontario (CPSO) Policy Statement #2-15:
Professional Obligations and Human Rights, which among other
things requires that physicians ‘provide a referral to another
appropriate health-care provider for the elements of care the
physician is unable to manage directly’.34 The applicants,
including the Christian Medical and Dental Society of Canada
and the Canadian Federation of Catholic Physicians’ Societies,
described the referral provisions of the CPSO policy statement
as ‘unconscionable’ and a violation of their freedom of conscience
and/or freedom of religion.35 This example is hardly
unique.36 These kinds of hardline positions disregard the needs
of patients.
Statements and actions of this kind strongly suggest that
Professor Charo was not attacking strawmen in her article.
Respect for private conscience choices is already limited
Regardless of the views espoused by representatives of the
Canadian Medical Association and the religious doctors’ groups
mentioned, there are already limits placed on the conscience
choices of Canadians in various settings. The Supreme Court of
Canada stated that ‘freedom of conscience and religion protects
the right to entertain beliefs, to declare them openly and to
manifest them, while at the same time guaranteeing that no
person can be compelled to adhere directly or indirectly to a
particular religion or to act in a manner contrary to his or her
beliefs’.37 In that same case, the Court went on to say that the
‘state’s duty to protect every person’s freedom of conscience
and religion means that it may not use its powers in such a way
as to promote the participation of certain believers or nonbelievers
in public life to the detriment of others’.38 These principles
are seen as cornerstones of maintaining a free and democratic
society.39
This is not to say that physicians and other medical professionals
should be denied the right to hold religious or conscience
beliefs. In liberal democracies, a diversity of beliefs and
opinions is welcomed and individuals are free to advocate for
societal acceptance of their particular worldview. It is also trite
to say that the law in liberal democratic societies may protect a
particular social or moral position espoused by a particular religion;
however, it should not do so on the basis that it is a religious
position, but on the basis that ‘in reason its merits
commend themselves’.40 Therefore, in order to maintain a
defensible balance between competing beliefs in a liberal and
democratic society, such societies have generally considered ‘the
practice of religion and the choices it implies to relate more to
individuals’ private lives or to voluntary associations’.41 To this
end, it has been recognised that within the public realm an individual’s
freedom of religion and conscience may be legitimately
burdened. In another case, the Supreme Court of Canada explicitly
acknowledged that legislative or administrative actions may
increase the cost of practising or otherwise manifesting one’s
religious beliefs.42 Further, such legislative or administrative
burdens may be justified where they prevent conduct that would
potentially cause harm to or cause interference with the rights
of others.43 The reasoning of the Court supports the view that
the conscientious belief of a physician may be legitimately
halted at the point that it interferes with the rights of patients to
access services they are entitled to receive. That interference,
however, is precisely what happens each time a conscientious
objector is accommodated and the patients are unable to access
the required service elsewhere.
Respect for private conscience choices will result in
avoidable suboptimal access to healthcare
Any society that grants medical professionals a conscientious
objection-based opt-out will have to accept suboptimal health
outcomes with regard to procedures that are considered at that
point in time part and parcel of good professional healthcare
practice in those societies. Why would toleration of conscientious
objection lead invariably to suboptimal health outcomes?
Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560 237
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Take the Canadian assisted dying example. It is apparent that
the representatives of Canadian doctors are unconcerned about
the distress they would inflict on—often—dying patients in
rural areas who cannot access easily a doctor willing to provide
assistance in dying. In many cases, doctors’ objection could be
more than an inconvenience, it could be an insurmountable
barrier to access. A case in point is the small Canadian province
of Prince Edward Island (also known as PEI). Women in that
province, at the time of writing, are required to leave the province
if they wish to have an abortion because healthcare providers
are not offering this service in the province. Empirical
evidence elsewhere suggests strongly that ‘travel is a barrier to
accessing legal abortion’.44 The situation in PEI is not unique in
the world, far from it. Minerva reported recently that some
70% of Italian gynaecologists conscientiously object to performing
abortions, which is arguably one of the reasons for staggeringly
high backstreet abortion rates in that country.45 Patient
interests come clearly last here. As we have seen, the representatives
of the monopoly providers of these healthcare services in
Canada are quite content with that outcome, as long as the association’s
members’ consciences—or, more precisely, their untestable
claims about the content of their consciences—are not
burdened or otherwise inconvenienced. This attitude is quite
the opposite of what it means to be a professional, where a
promise is made to serve the public good and to serve patient
interests first and foremost. Apparently such central features of
what it means to be a professional can readily be sacrificed
when arbitrary, untestable individual conscience claims are
mounted by professionals.
Respect for private conscience choices will result in
avoidable inequitable workloads for doctors
It seems also uncontroversially true to us that toleration of conscientious
objectors will have a detrimental impact on healthcare
practice in other respects. Because patients can expect to be
shepherded around among different healthcare professionals
choosing ‘conscientiously’ to provide different levels of healthcare,
there will be an increasing level of upheaval visited upon
healthcare systems. Worse, if the Canadian Medical Association
had its way, patients would not even be shepherded through the
system, it would be up to them to find doctors obliging them
for particular ailments that might be of concern to doctors with
any number of idiosyncratic private views of the universe and
on what may or may not be ethically acceptable. An important
consequence of such a situation would be that doctors who are
willing to provide services conscientiously refused by some or
many of their colleagues, would have to carry an inequitable
load of such work. We cannot think of a good reason for why
they ought to accept such an inequitable burden, and indeed,
why a just society should design a health delivery system that
burdens such doctors unfairly.
Respect for private conscience choices will result in
unpredictable and unfair service delivery
Because of the unpredictable nature of what it is that conscientious
objectors will object to, patients can never be quite certain
about the kinds of services that they will be able to receive from
a particular doctor, even their long-time family doctor. That is
the opposite of what can reasonably be expected of a profession
and professionals. Uniform service standards are arguably one
of the hallmarks of what constitutes a profession. Another
aspect of this has to do with the unfairness of this situation
vis-à-vis the patient. Patients, as Ruth Purtilo rightly notes, ‘can
expect to be treated fairly. Persons seeking treatment should not
be given advantage on the basis of arbitrary favouritism or be
left out on the basis of arbitrary dislike’.46 Given the intractability
of conscience claims, it is not unwarranted to characterise
them as essentially arbitrary dislikes. They might not be arbitrary
in the eyes of the objector, but we cannot even be certain
of that, given our inability to test the objector’s conscience
claims. They are arbitrary with regard to what kinds of services
particular patients can or cannot expect from particular professionals
belonging to the same profession in the same
jurisdiction.
The nature of professions is that they provide privileged services
to the public. They are quite unlike political parties,
churches, animal welfare or environmental organisations. While
the latter cater to particular sectarian audiences, professionals
must cater uniformly to everyone within the scope of professional
practice. The services professionals provide to the public
must not be subject to their private normative judgements about
individual needs of members of the public, as long as what
these members of the public require falls within the scope of
professional practice. After all, patients do not seek out doctors
for their individual convictions, but to receive professional services
that they are trained to provide.
There are other sounds reasons for refusing to tolerate conscientious
objectors in medicine. They have to do with the voluntary
choices made by those who decided to join the
profession.
Choosing to join a profession is a voluntary activity
undertaken by an autonomous adult
It seems to us that the argument from voluntariness is important
in this context. Nobody is forced to join a particular profession,
medicine included. Pace Christopher Cowley’s argument that
the practice of medicine for some is a ‘calling’—one can still
choose not to answer the ‘call’.47 The decision to join the
medical profession is quite distinct to, say, joining the military as
a conscript. Medical schools the world all over reject most applicants,
not because the applicants are unsuitable to become
doctors, but because the number of places they have available is
always much smaller than the number of people who apply.
Anyone joining a profession knows, or should know, that it is
ultimately up to society to determine the scope of professional
practice. Society can do this through professional bodies, but it
can also choose to do so by other regulatory means. Having a
monopoly on the provision of services within that scope of
practice is not something that comes cost-neutral to those who
choose voluntarily to join a particular profession. Indeed, given
the high-stakes competition to join the medical profession in the
first place, it is reasonable to suggest that doctors refusing to
provide professional services that are within the scope of practice
should be replaced by someone who is willing to undertake
the work. If at any given time a doctor is unable to continue
practicing due to their—ultimately arbitrary—conscience views,
nothing would stop them from leaving the profession and
taking up a different vocation. This happens across industries
and professions very frequently. Professionals can be expected
to take responsibility for the voluntary choices they make.
Does the nature of a particular procedure matter?
It has been suggested that not all conscientious objections fall
into the same category. The reason why it would not be acceptable
for the female Muslim doctor in our example to refuse to
see a male patient had to do with that being in violation of the
core values in medicine. Assisted dying or abortion, on the
other hand, would then be seen if not in violation of traditional
238 Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560
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medical values, but at least being sufficiently controversial to
justify the accommodation of conscientious objectors. Wicclair
argues for one possible threshold that a conscientious objection
must meet in order to be prima facie worthy of accommodation.
He proposes that a conscientious objection ‘has significant
moral weight only if the core ethical values on which it is based
correspond to one or more core values in medicine’.48 Wicclair
is, therefore, supportive of conscientious objection to abortion
or assisted dying because to his mind neither of these medical
procedures corresponds uncontroversially to these core values.
We think that he is mistaken about what he considers to be the
core values of medicine, which would be applicable in these
two instances, but we do not wish to debate the merits of this
claim here. Rather, his argument also fails, because despite his
protestations to the contrary it is essentially an argument from
tradition. What he calls core values could be more aptly
described as traditional values. However, it is in the nature of
such values that they are changing. Medicine is currently arguably
undergoing a paradigm shift from maintenance of human
life at nearly all cost to a quality-of-life focused approach.49 The
traditional core values of medical practice are in flux, and that is
one reason for why abortion is available in most liberal Western
democracies, and that is the reason why the number of jurisdictions
that are decriminalising assisted dying is steadily
increasing.
To highlight just one example of this, again from Canada, the
past president of the Canadian Medical Association, Dr Chris
Simpson, on behalf of the association, referred to assisted dying
as a ‘therapeutic service’, a mere 15 years after Wicclair suggested
that core professional values would make such a description
impossible.50 It is unlikely that the association would refer
to assisted dying as a ‘therapeutic service’, if it thought that the
provision of this service would violate Wicclair’s claimed core
values of the profession. If it is a therapeutic service, as we
agree it is, Canadian doctors wanting to go the conscientious
objector route to avoid providing this service to eligible patients
could no longer avail themselves of Wicclair’s analysis, because
the ‘moral integrity of the medical profession’ would not be
served by accommodating individual doctors who refuse to
provide therapeutic services. It is important to recognise that
medical practice is also a cultural practice that changes over
time. No democratic society, and no medical profession should
leave the scope of the provision of professional medical services
to the vagaries of its members’ personal ideological convictions.
What about our societal ability to recruit people to join the
medical profession?
An argument could be mounted that if we prevented doctors
from excusing themselves from providing professional services
that they happen to feel strongly about, we might find it difficult
to find a sufficient number of people willing to become doctors.
This seems far-fetched to us, but it is conceivable that some
people might reconsider joining the medical profession if the
accommodation of their feelings with regard to particular professional
services is not guaranteed. We indicated already that
the profession and society would likely be better off if such
people chose not to join the profession, seeing that they think
that their idiosyncratic views of the universe should be of
greater significance than the patients whose interests they promised
to further first and foremost, as professionals. The
concern about recruitment problems does not appear to be
based on real-world evidence to begin with. A recent survey
reports that countries such as Sweden, Finland and Iceland,
which do not permit their doctors to opt out of the provision of
abortion service on grounds of conscience, have not experienced
harmful consequences, as far as these countries’ healthcare
systems’ ability to train a sufficient number of doctors is
concerned.51
A somewhat related argument suggests that by preventing
doctors from refusing service based on religious or conscience
grounds, we would run the risk of losing the participation of
those kinds of individuals in the profession. However, that argument
does not hold. Those who object to particular procedures
could choose specialities that would not require that they violate
their conscience, for example, they could opt for dermatology
instead of gynaecology if they are opposed to abortion. A selfimposed
limit on one’s choice of speciality is not inherently
unfair. Individuals with certain physical limitations can also be
excluded from certain specialities in the medical profession. That
does not preclude them from joining the medical profession.
Does it matter when professionals joined a profession?
It could be argued that it matters when conscientious objectors
joined the profession. The idea here is that they agreed to join a
profession that at that time had a particular scope of practice
that these professionals agreed to work in. In a way, this scope
of practice constitutes a kind of contract between society and its
professionals. If a society wishes to change a profession’s scope
of practice it should accommodate conscientious objectors
among those who joined the profession prior to a given controversial
change, for example, by grandmothering them in. Some
of the reasons we mentioned above mitigate against granting
objectors a blanket right to such an accommodation. There is
another reason that suggests that this argument is not particularly
strong. It is surprising that doctors seem to think in large
numbers that society provided them with a monopoly on the
provision of medical services but that society at no time would
add or subtract from the range of services it considers scope of
practice of that profession. This is puzzling given the nature of
medicine as an ever-evolving scientific and cultural pursuit.
Most of us who do not work as medical professionals have
encountered employers who wish to change our scope of practice.
Many academics the world all over are suffering under
their employers’ desire and pressure to introduce online learning
programmes, despite our objections on pedagogical and other
grounds. However, nobody would think that our employers are
not well within their rights to ask us to contribute to such programmes.
Unlike doctors, we are not even entrusted with typically
well remunerated service delivery monopolies.
Having said this, we do think that we should try at least to
accommodate conscientious objectors who have practiced for
a long term under a different kind of contract than doctors
who join the profession after particular significant changes to
the scope of practice have been made. However, that is a far
cry from suggesting that doctors have a right to such
accommodation.
COULD NOT THE STATE BE THE GUARANTOR OF ACCESS?
Proponents of a fettered accommodation system might argue that
we should try to accommodate conscientiously objecting healthcare
professionals regardless of the arguments presented by us so
far. They could argue that, for instance, institutions other than
the medical profession ought to guarantee reliable access in a
healthcare system that is proactively being subverted by
accommodation-demanding conscientious objectors. Why should
not the health ministries in Canada’s provinces organise reliable
access systems based on doctors who are not conscientiously
objecting?We know from the mentioned experiences of pregnant
Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560 239
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women seeking an abortion in the province of PEI that this might
not be feasible in parts of the country. The odds are fairly high
that the more rural an assistance seeking patient is located, the
more difficult it could become to guarantee access. We have yet
to see a persuasive reason, given the arguments presented so far,
why any healthcare system should burden itself, and ultimately
patients, with these sorts of logistical problems when there is an
obvious, more efficient alternative: saying no to the consciencebased
accommodation requests of healthcare professionals. A
profession that is unable to guarantee reliable access to its services
for no other reasons than its desire to accommodate the
private ideological convictions of some or many of its monopoly
provider members is failing in its mission.
CONCLUSION
Medical professionals have no moral claim in liberal democratic
societies to the accommodation of their individual conscientious
objections. To accommodate such objections would subvert
some of the very reasons for why the medical profession was
created in the first place. To accommodate them would also
permit such medical professionals to abuse the monopoly privileges
that society endowed their profession with. Medical professionals
practicing medicine in the 21st century would be well
advised to accept professional service delivery, as defined by the
scope of professional practice, as one inevitable corollary of
their voluntary decision to join the profession. Forcing patients
to live by the conscientious objectors’ values constitutes an
unacceptable infringement on the rights of patients.
Correction notice This article has been updated since first appearing Online First.
The date of receipt and peer review statement have been updated.
Acknowledgements The authors are grateful to Drs Robert Baker and Alberto
Giubilini for their detailed and constructive comments on an earlier version of this
paper.
Contributors Both the authors meet The International Committee of Medical
Journal Editors Vancouver guideline criteria.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES
1 Smith VP. Conscientious objection in medicine: doctors’ freedom of conscience. BMJ
2006;332:425.
2 Braun H. Hermann Stöhr (1898–1940). In: Hummel K-J, Strohm C, eds. Zeugen
einer besseren Welt. Christliche Märtyrer des 20. Jahrhunderts. Evangelische
Verlagsanstalt Leipzig: Butzon & Bercker, 2000:87–105.
3 Michalczyk JJ. Medicine and ethics in the Third Reich: historical and contemporary
issues. New York: Sheed and Ward, 1994:8.
4 Weinstock D. Conscientious refusal and healthcare professionals: does religion make
a difference? Bioethics 2014;28:8–15.
5 Leiter B. Why tolerate religion? Princeton: Princeton University Press, 2013.
6 Laycock D. Regulatory exemptions of religious behavior and the original
understanding of the establishment clause. Notre Dame Law Review
2006;81:1739–842, at 1839 for the USA. Strasbourg Consortium for European
Court of Human Rights cases at http://www.strasbourgconsortium.org/. We owe
these references to Leiter B 2013, n4.
7 Sulmasy DP. What is conscience, and why is respect for it so important? Theo Med
Bioeth 2008;29:135–49.
8 Sulmasy DP 2008, at 139.
9 West-Oram P, Buyx A. Conscientious objection in health care provision: a new
dimension. Bioethics 2015. doi:10.1111/bioe.12236
10 Wicclair MR. Conscientious objection in medicine. Bioethics 2000;14:205–27.
11 Pellegrino E. The physician’s conscience, conscience clauses, and religious belief: a
catholic perspective. Fordham Urban Law J 2002;30:221–44.
12 Eg Pellegrino E 2002.
13 Eg. Weinstock D 2014.
14 LaFollette E, LaFollette H. Private conscience, public acts. J Med Ethics 2007;33:249–54.
15 Savulescu J. Conscientious objection in medicine. BMJ 2006;332:294–297.
16 Schuklenk U. Conscientious objection in medicine: private ideological convictions
must not supersede public service obligations. Bioethics 2015;29:ii–iii.
17 Eg. Wicclair MR 2000, Sulmasy DP 2008.
18 Hobbes T. Leviathan (chapter 29). London: Andrew Crooke, 1651. https://ebooks.
adelaide.edu.au/h/hobbes/thomas/h68l/chapter29.html (accessed 26 Feb 2016).
19 Donahue BS. Infant euthanasia is morally unacceptable. J Thorac Cardiovasc Surg
2015;149:1684–5.
20 Schuklenk U. The case against assisted euthanasia has not been made. J Thorac
Cardiovascr Sur 2015;149:1685–86.
21 Veatch RM. Hippocratic, religious, and secular medical ethics: the points of conflict.
Washington DC: Georgetown University Press, 2012.
22 Mercier A. Religious belief and self-deception. In: Blackford R, Schuklenk U, eds.
50 Voices of disbelief: why we are atheists. Oxford: Wiley, 2009:41–7, at 47.
23 Smith: Employment Division, Department of Human Resources of Oregon v. Smith,
[1990] 494 US 872. Amselem: Syndicat Northcrest v. Amselem, [2004] 2 SCR 551,
2004 SCC 47
24 Smith: Employment Division, Department of Human Resources of Oregon v. Smith,
[1990] 494 US 872.
25 Charo RA. The celestial fire of conscience —refusing to deliver medical care. N Engl
J Med 2005;352:2471–3.
26 Cantor J, Baum K. The limits of conscientious objection: may pharmacists refuse to
fill prescriptions for emergency contraception? N Engl J Med 2004;351:
2008–12.
27 Lynch HF. Conflicts of conscience in health care: an institutional compromise.
Cambridge: MIT Press, 2008.
28 Blackmer J. Clarification of the CMA’s position concerning induced abortion. CMAJ
2007;176:1310.
29 Carter: Carter v. Canada (Attorney General), [2015] 1 SCR 331, 2015 SCC 5.
30 Zimonjik P. Doctors with moral objections to assisted dying should be able to opt
out: committee hears. CBC January 27, 2016. http://www.cbc.ca/news/politics/
assisted-dying-committee-evidence-hearings-1.3422352 (accessed 28 Jan 2016).
31 Zimonjik P 2016.
32 As quoted in Wicclair 2000, 218.
33 Lawrence RE, Curlin FA. Physicians’ beliefs about conscience in medicine: a national
survey. Acad Med 2009;84:1276–82.
34 College of Physicians and Surgeons of Ontario (CPSO). Policy Statement #2-15:
Professional Obligations and Human Rights. March 2015. http://www.cpso.on.ca/
CPSO/media/documents/Policies/Policy-Items/Human-Rights.pdf?ext=.pdf (accessed
31 Jan 2016).
35 End-of-Life Law and Policy in Canada (EOL). Developments to Watch—Christian
Medical and Dental Society of Canada v. College of Physicians and Surgeons of
Ontario. 2015. http://eol.law.dal.ca/wp-content/uploads/2015/06/2015_03_20_
Notice_of_Application-3.pdf (accessed 31 Jan 2016).
36 Laycock D. How the Little Sisters of the Poor case puts religious liberty at risk.
Washington Post 2015, March 20. https://www.washingtonpost.com/opinions/
how-the-little-sisters-of-the-poor-put-religious-liberty-at-risk/2016/03/20/
eaaa6a34-e4b4-11e5-a6f3-21ccdbc5f74e_story.html (accessed 21 Mar 2016).
37 Saguenay: Mouvement laïque québécois v. Saguenay (City), 2015 SCC 16,
paragraph 69.
38 Saguenay, paragraph 76.
39 McFarlane: McFarlane v Relate Avon Ltd [2010] EWCA Civ 880, paragraph 21.
Saguenay paragraph 75.
40 McFarlane, paragraph 21.
41 Lafontaine: Congrégation des témoins de Jéhovah de St-Jérôme-Lafontaine
v. Lafontaine (Village), 2004 SCC 48, paragraph 67.
42 Edwards Books: R. v. Edwards Books and Art Ltd., [1986] 2 SCR 713, 1986 CanLII
12 (SCC), paragraph 97.
43 Amselem: Syndicat Northcrest v. Amselem, [2004] 2 SCR 551, 2004 SCC 47,
paragraph 62.
44 Cameron ST, Ridell J, Brown A, et al. Characteristics of women who present for
abortion towards the end of the mid-trimester in Scotland: national audit 2013–
2014. Eur J Contracept Reprod Health Care 2015;1–6. doi:10.3109/
13625187.2015.1111326
45 Minerva P. Conscientious objection in Italy. J Med Ethics 2015;41:170–3.
46 Purtilo RB. Professional-patient relationship: ethical issues. In: Jennings B,
ed. Bioethics. 4th edn. Farmington Hill, MI: Macmillan, 2014:2547–55, at 2551.
47 Cowley C. A defense of conscientious objection in medicine: a reply to Schuklenk
and Savulescu. Bioethics 2015. doi:10.1111/bioe.12233
48 Wicclair 2000, at 205.
49 Singer P. Rethinking life and death. Text: Melbourne, 1994.
50 CBC. Doctor-assisted suicide a ‘therapeutic service’, says Canadian Medical
Association. February 6, 2015. http://www.cbc.ca/news/health/
doctor-assisted-suicide-a-therapeutic-service-says-canadian-medical-association-1.
2947779 (accessed 30 Jan 2016).
51 Fiala C, Gemzell Danielsson K, Heikinheimo O, et al. Yes we can! Successful
examples of disallowing ‘conscientious objection’ in reproductive health care. Eur J
Contracept Reprod Health Care 2016;1–6. doi:10.3109/13625187.2016.1138458
240 Schuklenk U, Smalling R. J Med Ethics 2017;43:234–240. doi:10.1136/medethics-2016-103560
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accommodation in liberal democracies
claim to conscientious objection
Why medical professionals have no moral
Udo Schuklenk and Ricardo Smalling
doi: 10.1136/medethics-2016-103560
J Med Ethics 2017 43: 234-240 originally published online April 22, 2016
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