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- Freedom of conscience and religion are fundamental rights in any liberal, democratic society professing pluralism and tolerance.
- Article 18 of the U.N.’s Universal Declaration of Human Rights proclaims: ‘Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief in teaching, practice, worship and observance.’ The words of Article 18 of the International Covenant on Civil and Political Rights, and of Article 9 of the European Convention on Human Rights, are almost identical.
- In health care, conscience plays an essential role in the professional judgment – often subtle and delicate – that practitioners must exercise in their daily work. If health care workers are not to be reduced to mere functionaries (of the state, of the patient, of the legal system), they must be free to exercise their professional judgment and to allow their consciences to inform that judgment. This freedom of professional judgment informed by conscience must translate into the freedom not to be involved in certain activities or practices to which there is a conscientious objection.
- The rights of religion and conscience are, however, not absolute. Article 29 of the U.N. Declaration (with similar provisions elsewhere) states: ‘In the exercise of his rights and freedoms, everyone shall be subject only to such limitations as are determined by law solely for the purpose of securing due recognition and respect for the rights and freedoms of others and of meeting the just requirements of morality, public order and the general welfare in a democratic society.’
- We concur with the U.N. and other international bodies and conventions that freedom of conscience and religion should not violate the legally recognised rights of others and that the freedom can be limited by the just requirements of morality. This applies both to direct participation in various practices and to assistance or co-operation with them, such as facilitating them by means of referral to another practitioner.
- The rights of others, however, are not violated merely because they cannot be enforced against a person exercising their freedom of conscience and religion – for otherwise this freedom itself would be meaningless.
- Moreover, the ‘just requirements of morality’ are precisely what are in dispute in a case of conscientious objection.
- Furthermore, in a liberal, democratic society the state may not play favourites by choosing one system of morality to trump all others no matter what objections of conscience are made against it. Conscientious objectors must not be silenced or marginalised merely because of their unwillingness to participate in activities to which they object.
- In particular, the liberal, democratic state may not dictate that a secular, i.e. non-religious, system of morality trumps the rights of religious believers, or that one particular moral system trumps the rights of those with sincere, deeply held conscientious objections to some of its principles or requirements.
- Freedom of conscience and religion in a liberal society does not entail that ‘anything goes’. A health care worker should not be able to find shelter under freedom of conscience and religion merely by claiming it. For the protection to apply, a person must have a deeply held, sincere adherence to a tenet or doctrine of their code of ethics or religion that forbids – expressly or by necessary implication – the kind of act to which they object.
- Moreover, the relevant religious or ethical code must be one that has current or historic popular acceptance across some significant portion of the society in which the conscientious objector resides, or in some other society where the code is readily identifiable.
- The strong presumption in favour of conscientious objection would be rebutted if it could be shown that the act or practice in question were such that no reasonable person could object to its performance in the particular health care circumstances at hand.
- Conscience cases of recent concern nearly all involve beginning and end-of-life activities such as contraception and sterilisation, abortion, assisted suicide, and euthanasia. Reasonable people have serious disagreements over the legitimacy of some or all of these practices, and over whether participation in such activities should be compelled by law.
- That notwithstanding, it is abundantly clear that freedom of conscience and religion should not be thought of solely, or even primarily, in terms of the practices that happen to be the flashpoints of current controversies.
- Even if one disagreed with conscientious objection to some or all of the practices listed above, one should be concerned that controversies will soon also arise, as they are already beginning to, in cases such as: transgender surgery; extreme cosmetic surgery; various forms of artificial reproduction; cloning; gene editing and other forms of genetic engineering; cognitive enhancement; performance-enhancing drugs in sport and other areas; creation of chimeras; and much more.
- We will continue to see the list of controversial practices and activities increase at speed due to advances in biotechnology. If now is not the time to come out in strong support of freedom of conscience and religion in health care, we do not know when is.
- Even if you feel sanguine about the controversies either actual or on the immediate horizon, you should be seriously concerned about what is over that horizon. If you are not prepared to make a stand now, whatever your opinion about this or that particular issue, then when the time comes that your own individual conscience is under threat, it will probably be too late. Who will be there, at that time, to come to your aid?
- By adding your signature to this Declaration you affirm your support for conscientious objection in health care at a critical juncture in its development and in the evolution of attitudes towards the role of medicine in society.
Sign the Declaration in Support of Conscientious Objection in Health Care
Show your support by signing the declaration.