A) Protection of conscience laws (PCL's)
ensure that people cannot be forced to facilitate practices or procedures to
which they object for reasons of conscience. These may include abortion,
capital punishment, contraception, sterilization, artificial reproduction,
euthanasia, assisted suicide, human experimentation, torture, etc. An
adequate protection of conscience law should protect conscientious objectors
from coercive hiring or employment practices, discrimination and other forms
of punishment or pressure. It should also include protection from civil
liability.
A) Conscience
clauses are usually less comprehensive than protection of conscience laws
and afford varying degrees of protection for conscientious objectors. They
may appear in statutes or in the policies of organizations or institutions.
A) Protection of conscience laws and
conscience clauses are needed because powerful interests are inclined to
force health care workers and others to participate, directly or indirectly,
in morally controversial procedures. Physicians, nurses, pharmacists and
others have been denied employment, dismissed, or penalized because of
objections to abortion, contraception or the morning-after pill (See
Repression of Conscience). The same pressure will almost certainly be
applied to force conscientious objectors to participate in reproductive
technology, eugenic screening, and in euthanasia and assisted suicide,
particularly where such things are legal or are tolerated.
A) That depends upon the wording of the law. A
statute can be drafted broadly so that it can be applied to any kind of
medical procedure. On the other hand, it can be written to include a class
of procedures (all those affecting life, for example). Finally, a law can
also identify specific procedures to which it is to apply. The Project website
includes examples of different kinds of legislative drafting.
A) Sometimes a law is drafted to respond to a
particular need or concern. For example: many American laws were drawn up in
direct response to the legalization of abortion by a U.S. Supreme Court
ruling about abortion. Hence, many of these laws concern only abortion.
Similarly, concerns with a certain class of
procedures (cloning and in vitro fertilization, euthanasia and assisted
suicide) may generate a law that has narrower application.
The broadest approach, which does not restrict protection
to specific procedures or classes of services, may result from a political
and social ethos that is respectful of freedom of conscience in principle.
It may also reflect an awareness that laws that are procedure-specific are
not sufficiently flexible to keep pace with changes in medical technology.
Finally, laws may be influenced by pragmatic
judgement about the political support likely to be available for different
kinds of legislation.
A) No. PCLs prevent people from being forced
to participate in medical procedures, but they do not make them illegal.
A) No. Many states provide alternatives to
active military service for conscientious objectors, but such policies have
never been understood to mean that military service is immoral. Similarly, a
protection of conscience law need have no impact on the dominant moral
outlook concerning procedures to which some people object.
A) This kind of conflict can be prevented or
resolved by identifying, in advance, the performance of certain procedures
as a bona fide requirement of a position to be filled. PCLs can be
drafted to allow for such eventualities; the
Model Statute illustrates one way of doing this.
A) They could result in some prosecutions at
first. But they should prevent litigation and prosecution by
discouraging coercive conduct. If problems arise, they are more likely to be
settled without going to court if people can refer to a single law. And
there should be fewer problems as time goes on and people learn their
limits.
A) It has actually been an issue for many
years. It was considered in the drafting of the abortion law in the United
Kingdom in 1968, which includes a protection of conscience provision. However, in recent years the issue of
freedom of conscience in health care has come increasingly to the fore
because of pressures from activists who make aggressive rights and
exaggerated rights claims, and because of ethical
problems generated by advancing medical technologies and the lobbies for euthanasia and
assisted suicide.
A) The reason usually advanced to justify
coerced participation in sterilization, contraception, or abortion is that
the health care worker's 'personal values' must give way to the choice made
by the patient. The same reasoning is used to justify coerced participation in
various kinds of reproductive technologies, in euthanasia and in assisted
suicide.
A) Yes. Following legalization of
euthanasia and assisted suicide in Canada, three medical regulators have
adopted policies demanding that physicians unwilling to kill their patients
or help them commit suicide must help them to find a colleague willing to do
so.
Q) But has anyone
said that objecting physicians should be forced to personally provide
euthanasia or assisted suicide?
A) Yes. That is now being proposed by
prominent academics like Julian Savulescu and Udo Schuklenk, who argue that
physicians have no right to refuse to do so. [Savulescu J, Schuklenk U. (2016)
Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or
Contraception. Bioethics doi:10.1111/bioe.12288]
A) Unfortunately, their record in this respect
indicates that they are unreliable. Moreover, many people are not members of
unions or professional associations.
A) Yes. But, in the first place, many workers
are not protected by collective agreements. More important, freedom of
conscience is not merely an employee benefit. It should be considered an
employee right, protected by legislation, lest unions actually bargain it
away in exchange for more vacation pay, for example, or higher overtime
rates.