Protection of Conscience: Yesterday, Today and Tomorrow
Presented at the Comox Valley Pro-Life Society AGM
British Columbia, Canada: 14 March, 2004
My talk this afternoon is called Protection of
Conscience: Yesterday, Today and Tomorrow. I
will be referring to developments in Britain and the
United States, but my focus today is Canada.
Under the heading Yesterday I will discuss
protection of conscience as it relates to early
abortion legislation and subsequent developments.
When we come to the situation Today, I
will explain that there is much more to be concerned
about than abortion, and introduce you to the
Protection of Conscience Project.
For Tomorrow, I will not play the prophet,
but I will suggest some key issues that need study.
I will conclude with some general remarks, and
take questions from the audience.
This is merely an overview. There are also gaps
in my information. The Protection of Conscience
Project is very much a work in progress.
Conflicts of conscience in medicine are not new.
However, the potential for conflicts of conscience
increased exponentially with the legalization of
abortion in the 1960's.
In 1968, Britain enacted the first liberalized
abortion law in the English speaking world. The
problem of conflict of conscience was recognized
there from the beginning.
The Abortion Act provided that no person
should be under any duty to participate in abortion,
except when necessary to save the life of the
mother, or to prevent grave permanent injury to the
health of a pregnant woman.
With those exceptions, health care workers could
not be made to participate in abortions, by
contract, statute "or other legal requirement".
Conscientious objectors were thus protected from
civil liability (they could not be sued) and from
criminal responsibility (they could not be
But the law - did not - and does not - prohibit
discrimination. As we shall see presently, this was
a significant weakness in the law.
Developments in North America mirrored those in
In 1967, Colorado became the first American state
to liberalize its abortion law, followed two weeks
later by North Carolina. Laws in both states
included protection of conscience exemptions.
In Colorado, hospitals were not required to admit
for abortion, nor were they required to appoint
abortion committees. This provided some
institutional protection, but, unlike the British Abortion Act, no protection for individuals. In
North Carolina there were exemptions to protect both
physicians and hospitals.
In later years most states would adopt some kind
of protection of conscience law, most of them
In the mid-1960's, Canada was also moving toward
liberalization of its abortion law. Remarkably,
given subsequent developments, abortion reform
advocates frequently portrayed themselves as
champions of freedom of conscience.
The Globe and Mail, for example, in 1965,
demanded liberalization of the law "to enable
doctors to perform their duties according to their
conscience and their calling."2
Two years later, in 1967, an editorial in the Globe and Mail stated that the Government had
decided "that where religious moralities conflict,
the State should support none, but leave the choice
to individual conscience. It is a policy that should
also be followed with abortion."3
Two Private Members Bills on abortion were
introduced in1967, and referred to the House
Standing Committee on Health and Welfare. One of
these, Mr. Herridge's bill, had a conscience clause
almost identical to British Abortion Act.4
And M.P. Grace MacInnis, sponsor of the other bill,
assured the committee in its fall hearings that
"nobody would be forcing abortion procedures on
anybody else", suggesting that abortions should be
up to the individual conscience.5
In December, 1967, the Omnibus Bill was
introduced in the House of Commons. This included
what later became Canada's new abortion law. It did
not include a protection of conscience
clause, but its absence did not set off any alarms.
For example, the Canadian Welfare Council,
considering new abortion law, stated:
At the risk of labouring the obvious, no woman
will be required to undergo an abortion, no hospital
will be required to provide the facilities for
abortion, no doctor or nurse will be required to
participate in abortion.6
Nor was the Catholic Hospital Association
We note that there is no question of [our
hospitals] being obliged to change their present
norms of conduct. On the contrary, proponents of a
'liberalized' abortion law admit that it should
exempt those who object to being involved in
The progress of Omnibus bill was interrupted by
the election of 1968, but returned to the Commons
the following year, with Pierre Trudeau as Prime
Minister, and John Turner as Minister of Justice.
The abortion debate began in April, 1969. The
Progressive Conservatives and Creditistes had put
forward almost fifty amendments. Seven of these were
intended to guarantee the right of conscientious
objection to individuals or institutions. It was
agreed that debate on one of the amendments would
dispose of all seven. What was then debated was to
the following effect:
Nothing in the new law shall be construed as
obliging any hospital to establish a therapeutic
abortion committee, or any qualified medical
practitioner to procure an abortion, or any member
of a hospital staff to assist in abortion.8
This conscience clause, by the way, was proposed
by Robert McCleave, an M.P. who was in favour
John Turner responded that the proposed law
imposed no duty on hospitals to set up committees,
imposed no duty on doctors to perform abortions, and
did not even impose a duty on doctors to initiate an
application for an abortion.10
I will not go into the details of the debate today.
The protection of conscience clause was rejected.
One of those voting against it was Liberal MP
Stanley Hadaisz, whose name some of you may
By the early 1970's, then, Britain, Canada and
many of the United States had liberalized their
abortion laws. Britain and the U.S. had protection
of conscience legislation, but Canada had none.
Let's see what happened.
Looking back over first year of the operation of
the new law, some thought that the 'conscience
clause' needed strengthening, while others
complained that its operation was interfering with
the provision of abortions.12
A survey of Obstetrician Gynaecologists noted
that 77% had encountered reluctance from nursing
staff - "the principal problem being nurses'
religious views" - and 41 % had encountered
reluctance from medical and other staff, most
commonly with anaesthetists.13
Despite these levels of reluctance, correspondent
C.K. Varton, writing in the British Medical
Journal in 1971 - only three years after law was
enacted - stated that those who are not prepared to
perform abortions should train in some other branch
In 1972, only four years after the Abortion
Act was passed, the Lane Committee, reviewing
its operation, received a report of extensive
discrimination against Catholic applicants for
obstetrical and gynaecological positions. The
evidence presented included a letter from a 33 year
old Catholic, with five years postgraduate training
in obstetrics and gynaecology, who had applied for
the position of Registrar at three university
teaching hospitals. At each interview he was quizzed
on his abortion views, and each time stated his
conscientious objection to abortion on demand. He
was unsuccessful on all three occasions.
After last interview, a Catholic member of panel
took him aside:
. . . although I was the most senior and
well-qualified of the group shortlisted I was not
given the job as I was a Catholic. It was considered
that to give me the job would be doing me a
long-term disservice and I was directly told that
"there is now no place for a Catholic obstetrician
and gynaecologist in the United Kingdom...I was
advised to cut my losses and get out of England as
soon as I could, or, if not, change my specialty.
Recent advice from consultants in a teaching
hospital not far from the House of Commons was in
the same vein.15
Of course, this applied not only to Catholics,
but anyone with principled objections to abortion.
Dr. Robert Walley, the applicant, took the advice
he was given. We will return to Dr. Walley's
experience in Canada. He is now a professor of
Obstetrics and Gynaecology at Memorial University in
St. John's, Newfoundland, and a founder and medical
director of MaterCare International.16
From 1967, states began legalizing abortion, and
there was a parallel development of protection of
conscience laws, particularly in the aftermath of Roe vs. Wade. These laws were better than
nothing, but improvements are still needed.
The American laws were reviewed in 1993 by
Professor Lynn Wardle, a law professor at Brigham
Young University. Professor Wardle is an advisor to
the Project. He stated that reported cases of
discrimination against conscientious objectors were
"only the tip of the iceberg", and that "significant
numbers of health care providers are subject to
direct and indirect coercion and mistreatment". He
described U.S. protection of conscience laws as
"obviously and profoundly inadequate", since they
addressed only a few procedures (chiefly abortion),
often provided protection to only some individuals
or classes of persons (some protected only doctors,
some doctors and nurses, and so forth), and failed
to include mechanisms for remedy or redress.
Professor Wardle observed, with some irony, that
"[t]he greatest opposition to laws protecting the
rights of conscience of health care institutions has
come from advocates of absolute reproductive
Remember what the Canadian Welfare Council said
about the new abortion law in 1968?
No hospital will be required to provide the
facilities for abortion.
There were repeated calls and suggestions from
1970 to1974 that all publicly funded hospitals- or
all hospitals - must be made to perform abortions.18
In 1974, the Globe and Mail (that erstwhile
champion of freedom of conscience) stated:
. . . hospital boards should never have been
allowed a choice in the matter. The Government
should . . . require hospitals which receive public
grants to establish abortion committees.19
This kind of pressure has continued. In 1992, for
example, Elizabeth Cull ordered 33 British Columbia
hospitals to perform abortions.
What else did the Canadian Welfare Council say
about the new law? Remember?
. . . no doctor or nurse will be required to
participate in abortion
Tell that to nurse Frances Martin, who, in 1971,
refused to assist at abortions, and was demoted from
head nurse in the labour-delivery unit.20
Or tell it to nurse Linda Bradley, who, between
1977 and 1984, was denied employment at Langley
Memorial, Peace Arch Hospital, Delta Hospital and
Vancouver General Hospital because she did not want
to assist with abortions. Desperate, she sacrificed
her convictions to get a job at the Richmond General
Hospital. She lost it after she refused to assist at
the hysterotomy of a mother, five and a half months
pregnant. She was told that assisting at abortions
was a condition of employment. Bradley took the
advice of the Registered Nurses Association of BC,
resigned, and went to the BC Human Rights Tribunal.
The Tribunal refused her case, telling her that she
was not not eligible for protection because her
refusal was for moral and not religious reasons.21
. . . no doctor or nurse will be required to
participate in abortion? What was this assurance
worth to Catholic nurses in Thunder Bay? In 1997
they were transferred from St. Joseph's Catholic
Hospital to a public hospital, where they were
forced to participate in abortions.22
And over thirty years after that promise was made,
postpartum nurses at Foothills Hospital in Calgary
were told that they would have to be involved with
late term abortions, regardless of their moral
Do you remember M.P. Grace MacInnis promise to
the committee in 1968?
. . . nobody would be forcing abortion
procedures on anybody else
Well, between 1985 and1988, BC welfare worker
Cecilia Moore was fired for refusing to pay for an
abortion that would have been illegal under the law
as it then stood.,24
Constable David Packer was forced out of the
Metropolitan Toronto Police for refusing to guard
what was then an illegal abortion facility, and
three transition house workers in Ontario were fired
- with the government's approval - for refusing to
refer for abortions.25
And when Memorial University's medical school
discovered Dr. Robert Walley's views on abortion,
influential people tried to get rid of him. He got
no support from the Catholic community, but retained
his position with the help of Dr. David Charles, a
Welshman - and a pro-abortionist who came up from
Boston to help. Dr. Charles was a remarkable man,
one of the few self-identified pro-choicers who
really believe in freedom of choice.26
What about that last comment by the Canadian
Welfare Council in 1968?
. . . no woman will be required to undergo an
Surely nothing has happened that contradicts
But it has. In 1999, a Quebec Court ordered the
abortion and sterilization of a mentally ill woman
who was not capable of requesting or consenting to
Canadian politicians generally demonstrate very
little concern for freedom of conscience in health
care. Perhaps their understanding of the issue is
dulled in a political system that considers 'voting
according to conscience' a rare privilege that can
only be granted by the party leader. In any event,
only a handful of Canadian politicians have
attempted to address the problems created by the
broken promises of their predecessors.
In the Senate, Stanley Haidasz - who, as an M.P.,
had voted against the conscience clause -
realized the need for protection of conscience
legislation and put forward a bill before he
retired. It was carried forward by Senator Raymond
Perrault, but has long since died.28
In the House of Commons, Liberal M.P. Don Boudria
introduced a private member's bill in 1994, but it
Alliance M.P. Maurice Vellacott has twice introduced
a Commons version of the Haidasz/Perrault Senate
bill. Vellacott's bill has been opposed by the
government and has not progressed.30
Alberta M.L.A. Julius Yankowsky proposed an
amendment to the provincial human rights act to
protect those who are unwilling to participate in
medical procedures that offend their convictions
about the sanctity of life. The bill died when an
election was called and has not been resurrected.31
In Ontario, a draft protection of conscience bill
never reached the floor of the legislature.32
You can find the texts of these bills on the
Thus far I have talked exclusively about
protection of conscience and abortion. However, it
would be a serious mistake to suggest that
conscientious objection concerns only abortion. That
connection exists for purely historical reasons.
Abortion was just the first morally
controversial medical procedure to have been widely
mandated by state and medical authorities.
There are more coming. Some are already here.
Lets look at some of them.
There is chemical
abortion, induced by drugs like mifepristone
(formerly RU486), misoprostol or prostaglandin gel.
I'll introduce this topic with a history lesson.
Dr. Bernard Nathanson discovered that about 2/3
of the poor women who came to his clinic at Woman's
Hospital in New York with 'spontaneous miscarriages'
had actually had illegal abortions started by a
physician, midwife, friend or relative; they had
come to the hospital to have them completed. That
was in 1957, and this problem was one of the reasons
given for legalizing abortion.33
Fast forward to South Africa in the 21st
century. Women are arriving at hospitals with
incomplete abortions induced by drugs like
mifepristone, prescribed by physicians who have not
made arrangements for continuing care of their
patients. It is assumed that hospital physicians
will complete the abortions and deal with
complications. If the infant in utero is
already dead a D & C is required, which presents no
moral conflict for a physician. However, if the
infant is still alive, a significant conflict may
arise if a patient demands that the abortion be
completed by a pro-life physician. This is not a new
problem; it was noted in a
done in 1997 in the Western Cape.34
The 'morning after
pill' deserves special notice. It can sometimes
prevent implantation, thus causing the death of the
early embryo. For this reason some pharmacists and
other health care workers refuse to prescribe or
dispense it. Three pharmacists in Texas who would
not do so were fired last month. The patient had the
prescription filled across the street, so there was
no problem with access to the drug. Closer to home,
the College of Pharmacists of British Columbia
demands that conscientious objectors dispense or
refer for such drugs. Its attitude toward freedom of
conscience was illustrated by
an instruction published in the College newsletter,
which implied that conscientious objectors are
dishonest in dealing with patients. The College had
no evidence to support the statements, but has
refused to retract or apologize.35
We have heard about
reproduction; I won't count the ways. Listen to
John Harris, Professor of Philosophy at the
Institute of Medicine, Law and Bioethics of the
University of Manchester:
. . .the liberty to reproduce any way one wishes
is a freedom of the human being that must be
defended; it is a right.36
"The liberty to reproduce any way one wishes.
. . is a right." Think about what that
means if you are a health care worker.
But we are also encountering the claim that one
should not only be able to reproduce any way
one wishes, but should be able to reproduce what
one wishes: a deaf child to suit deaf parents,37
a genetically matched sibling to use as a donor for
a girl or a boy, as the parents prefer.39
Or as the parent prefers. One does not need two
parents, we are told,40
nor parents of the opposite sex.41
In fact, in December, 2001 it was reported that a 16
year old boy in Birmingham, England, planned to have
his sperm frozen before a sex change operation so
that he could become both the mother and father of a
The point here is that even someone who does not
object to artificial reproduction in principle may,
nonetheless, encounter conflicts of conscience in
The University of Pennsylvania had what it called
an "Assisted Suicide
Consensus Panel". It decided that nurses, social
workers and clergy should participate in
assisted suicide. And the clergy were not there to
give the last rites, but to help patients work
through the decision to kill themselves.43
Assisted suicide is legal in Switzerland, but until
recently the service was provided by private groups.
Now the Swiss Academy of Medical Sciences is drawing
up guidelines for physician assisted suicide.44
Pressure to legalize the procedure continues in
other parts of the world.
Lawsuits and bills
are appearing in many parts of the United States to
force employers to provide insurance coverage for
contraceptives. Catholic Charities of Sacramento,
for example, has just been ordered to provide its
employees with such coverage.45
And when Dr. Stephen Dawson of Barrie, Ontario,
refused to prescribe contraceptives for unmarried
patients, Dr. James Robert Brown, professor of
science and religion at the University of Toronto,
referred to him as "scum", adding that he should
"resign from medicine and find another job."46
Charged for professional misconduct, Dr. Brown and
the College of Physicians and Surgeons of Ontario
managed to work out an acceptable agreement.47But
it has cost tens of thousands of dollars in legal
bills for pharmacist Maria Bizecki of Calgary to
achieve a settlement of sorts with the Alberta
College of Pharmacists.48
People for the
Ethical Treatment of Animals have a journal called
the Animal Times. It's winter, 1999, number
announced the group's grants to companies that were
developing human embryo testing as one of the
alternatives to the use of lab rats or other
In eugenics, you are
familiar with "wrongful birth" lawsuits for birth of
imperfect children, who would have been aborted had
their parents known about their defects. Consider
what Professor Greg Stock of the University of
California has to say:
Eventually it will be thought as reckless to have
a child without genetic screening as to have a child
without pre-natal screening, as happens today.50
Euthanasia advocates are
very active in the United Kingdom and elsewhere, and
euthanasia is now legal in both Belgium and Holland.
Two Belgian Catholic Universities and the
Association of General Practitioners of Belgium have
issued a policy statement on end of life decisions
that asserts that physicians who object to
euthanasia should not be required to perform it.
However, they state that objecting physicians have
an obligation to help the patient find a willing
physician - something that most conscientious
objectors would be unwilling to do - and recommend
that euthanasia be considered part of palliative
care - a marked departure from the current
understanding that palliative care excludes
euthanasia and assisted suicide. Such policies would
have a significant impact on all health care
practitioners involved in end-of-life care.51
There is human
experimentation. Dr. Ron James of Glasgow has
suggested that genetically modified pig organs
should be transplanted into brain-dead human
patients to see if they are safe.52And
American surgeons have carried out sham operations,
which involved drilling holes in patients' skulls,
as placebo surgery designed to test the
effectiveness of a new treatment for Parkinson's
Finally, we have
organ harvesting or tissue trafficking. A senior
transplant surgeon in the United Kingdom has
suggested that the law should be allow brain dead
patients to be kept alive for the purpose of organ
So, remember the broken promises of1968 - John
Turner, Grace MacInnis, the Canadian Welfare
Council. Remember the complacency of the Catholic
Hospital Association in its response to the new
abortion law. And when they say,
"No one will be obligated to perform
"The law imposes no duty to assist with
"No hospital will be required to
participate in cloning..."
"No one will be experimented on against
Remember the promises that were made about
abortion, and say, "Good. I'm glad that no one is
going to be forced to assist with euthanasia."
"Good. It's great to hear that no will be forced
to help with assisted suicide or cloning."
"Good. Put it in writing!"
"Put it in writing!"
"Put it in law!"
The Protection of Conscience Project is trying
to help those who are trying to put protection of
conscience in writing. It is a non-denominational,
non-profit initiative - not an organization or
association - supported by a project team and
advisory board. The Project website received almost
75,000 visits in 2003. On the site you will find
texts of protection of conscience laws from
text of protection of conscience policies, position
background information about practice,
cases of repression of conscience
project reports (similar to Amnesty International)
project submissions, media
documents, resources , and
a model statute
The Project does not direct or manage protection
of conscience initiatives. It is not
'conscience central control'. It respects principle
of subsidiarity: people directly involved are the
ones best placed to deal with a problem.
For their benefit, the Project provides
information, offers suggestions, encourages
co-operation and facilitates communication. Advocacy
thus far has included writing letters to
professional associations, organizations, companies,
and letters to editors.
Submissions have been made to the Irish
parliamentary committee studying the abortion law in
and the BC Civil Liberties Association.56
As a result of stonewalling by the Alberta
College of Pharmacists, a submission to an Alberta
legislative committee recommended that
self-governing professions be subject to the
province's freedom of information law.57
Reports, like those done by Amnesty International,
have been prepared on the conduct of the ethics
advisory committee of the College of Pharmacists of
and the risks posed to conscientious objectors by
BC's Access to Abortion Services Act.59Amendments
were proposed a model code of ethics for Canadian
A brief submission was made concerning the Assisted
Human Reproduction Act.61
Over 1,500 .pdf documents of this type were
downloaded during 2003.
Information pamphlets like those you see here
today can be downloaded and printed anywhere. Over
2600 pamphlets were downloaded in 2003.
Project Team consists of an
Administrator, myself, and
Michael Markwick, a Human Rights Specialist.
Michael was formerly executive assistant to the
Chief Commissioner of the Ontario Human Rights
Commission, and past President of the British
Columbia Chapter of the Catholic Civil Rights League
The Advisory Board has seven members.
Janet Ajzenstat is Associate Professor,
Department of Political Science, McMaster
University, Hamilton, Ontario. She teaches public
law and political philosophy, and is associated to
the Centre for Cultural Renewal and the Dominion
Dr. Shahid Athar
is Clinical Associate Professor
of Internal Medicine and Endocrinology, Indiana
School of Medicine, Indianapolis, Indiana, a regent
of the Islamic Medical Association of North America,
and the Chair of its Medical Ethics Committee.
J. Budziszewski is Professor, Departments of
Government and Philosophy, University of Texas. He
is a specialist in ethical and political philosophy.
Dr. John Fleming has been the Director of the
Southern Cross Bioethics Institute in Adelaide,
Australia, since 1987. He is a bioethicist, and a
Corresponding Member of the Pontifical Academy for
Henk Jochemsen is Director of the Prof.dr. G.A.
Lindeboom Institute, Amsterdam, Netherlands. The
Institute is a private centre for medical ethics. He
is also an Advisory Board member of the Center for
Bioethics and Human Dignity.
David Novak is the J. Richard
and Dorothy Shiff Chair of Jewish Studies,
University of Toronto. He is Professor of the Study
of Religion at the University, and a Professor of
Philosophy, with appointments in University College,
the Faculty of Law, the Joint Centre for Bioethics,
and the Institute of Medical Science.
Lynn D. Wardle is a professor of law at Brigham
Young University, Salt Lake City, Utah. He has
taught and written extensively about biomedical
ethics and law.
One person not listed, who is actually
indispensable, is my wife, Evelyn. I am able to be
here because she is at home, looking after things.
One of the pharmacists I know has described her as a
'prisoner of conscience'
One note: not all pro-lifers are comfortable with
the approach taken by the Project. The Project is
silent on morality of the procedures. It does not
admit they are moral, but it does not assert that
they are immoral. This silence is construed by some
as giving consent, as implicitly admitting that the
procedures are moral.
For this reason, I usually recommend that this
work and pro-life work be kept separate, to avoid
I've talked about yesterday and today. What about
Before talking about tomorrow, we should
understand the rules of the game that GK Chesterton
called 'Cheat the Prophet':
The players listen very carefully and
respectfully to all that the clever men have to say
about what is to happen in the next generation. The
players then wait until all the clever men are dead,
and bury them nicely. They then go and do something
So I will not prophesy, but I will propose to you
three issues that are of continuing interest to
advocates for protection of conscience.
First: the relationship between man and ethics.
Second: the cult of personal autonomy.
Third: the dynamic of expectation.
First: man and
ethics. Reasoning from different beliefs about
what man is leads to different ideas about what is
good for him, to different notions of right and
wrong, and ultimately to different ethical
Consider the idea of man as a 'genetic machine'.
Compare that, then, to the idea of man as the image
of God, thus the image of love, so that love is
central to his existence and vocation. Man, the
genetic machine, can be treated very differently
from man, the image of God.
Our society no longer has a common understanding
of what man is. Even my inclusive use of the term
'man' will create problems for some people, for
example. The absence of that common understanding is
at the root of the problems encountered by
How does this happen?
Many state and regulatory authorities adhere to
an ethical theory that attempts to apply 'principles
of biomedical ethics':
Non-maleficence: interpreted as, "do no harm"
Beneficence: interpreted as, "do good"
Justice: interpreted as, "be fair"
Autonomy: interpreted as, "respect patient
Nothing strange here. But what is meant by
harm, by good, and by fairness? Is causing the death
of the patient "doing good"? Is prolonging life
"doing no harm"? Must one respect the choice of a
patient who wants a healthy limb amputated?
Answers to such questions depend primarily upon
beliefs: beliefs about the nature of the human
person, and the nature of human relationships.
Problems arise when the hidden faith of
establishment elites yield answers that are
substantially different from those of a
conscientious objector, as, for example, when the
establishment ethicist believes that the early
embryo is not a human person, but the but the
objector believes that it is. Note well that the personhood of the embryo is not a matter for
science, but for philosophy.
The problems become worse when establishment
elites believe that they do not believe: that they
Especially when they believe (for they cannot
know) that theirs is that special kind of knowledge
required for the just ordering of society.
And that only people who believe what they
believe can be trusted to manage public affairs, or
sit on ethics committees.
Anybody else should get out of the way, get out
of the profession, get out of politics, get out of
the country. And I have heard all of these
things said over the last few years.
To summarize this first point: ethical conflicts
often begin because of fundamental disagreement
about the nature of man, and this disagreement is
Second: the cult of personal autonomy.
I am not talking
about legitimate autonomy, that freedom necessary
for performance of moral acts. I am talking about
the cult that sees autonomy as the defining
characteristic of the human person, essential for
human happiness, and inseparable from personal
Achievement of personal autonomy is therefore the
most important goal of personal development.
Enhancement of personal autonomy then becomes one of
the most important functions of law, medicine and
Taken to its logical conclusion, this can
transform the traditional obligation to meet the
needs of a patient into an obligation to fulfil the
patient's wishes: amputating a healthy limb
is an expression of respect for personal autonomy.
The cult of personal autonomy understands all
human relationships in terms of function and
power. One gains personal autonomy by gaining
personal power, the ability to get what one wants,
or to do what one wants. The watchword is empowerment. All social interactions are
interpreted as products of power-based
Conflicts that are actually conflicts of faith
(for example, the hidden faith that the end
justifies the means vs. the explicit faith
that they do not) are often recast as disputes about
power, to be resolved by applying notions of
equality to achieve a balance of power.
Take the case of the pharmacist-patient
relationship. This is described as imbalance of
power, to be corrected by giving patient the power
to command the pharmacist, thus balancing their
power and 'levelling the playing field'. The
expected result is fairness.
Personal autonomy is not violated so long as
parties to social interaction consent to what is
done. It is violated when something is done without
consent, or when consent is improperly obtained.
Thus, consent will suffice to justify any action
which might otherwise violate personal autonomy.
In law and in bioethics, the axiom of the
autonomous person and the corollary of justification
by consent are used to support mercy killing and
assisted suicide. Logically, this can be extended to
support any other morally controversial procedure.
Concluding this second point: conflicts of
conscience will not be resolved by adjudicating
claims of autonomy but by respecting the needs of
humanity- the full humanity of the parties involved.
Finally, what happens when the state assumes
primary responsibility for the delivery of health
care? First comes the assumption - reasonable in
itself - that citizens are entitled to demand from
health care providers what they have paid for
through taxes. Next, health care providers come to
be perceived to be state employees, expected to
implement state policy. And, as the guarantor of a
de facto social contract for health care, the
state is expected to enforce the terms of the
contract against reluctant employees.
The legalization of a procedure in these
circumstances creates a
dynamic of expectation: tremendous pressure on
health care workers to provide every legal service,
regardless of their conscientious convictions.
I emphasize that I am not attacking socialized
medicine. I am not against Medicare. But I want to
point out that this aspect of it deserves more
I will close with a plea for freedom of
But what is freedom, first of all?
Our society is driven by an understanding of
freedom primarily as 'freedom from': freedom
from restraint, from rules, from direction, from
immutable principles. People are encouraged to
determine the course of their lives, to assert who
they are, by breaking away from moral imperatives,
which are perceived to impose constraints and limit
one's freedom of choice.
This is not the freedom sought by Project.
What is sought is 'freedom for': for
discerning the good that needs to be done, for
choosing the good, for doing good. Such freedom is
onerous, for it implies an obligation to distinguish
true goods from false, higher goods from lesser. It
demands that one form convictions about what is
truly good, and live accordingly.
Certainly, this can generate conflict among
people pursuing different notions of 'the good'. But
the remedy for this is not to have governing elites
or a governing majority impose a hidden faith that
'the good' does not exist, or that 'the good' cannot
be identified or, perhaps, that 'the good' consists
of the pursuit of power in order to maximize
Instead, we are called to develop the charity,
the patience, and the skills necessary to live
together peacefully. Above all, we must learn to
talk to each other about faith -all faith -
hidden, explicit, religious, and non-religious.63
This is the kind of dialogue encouraged by the
Protection of conscience laws provide an
opportunity for it to develop.