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  • Conscientious Objection in Health Care: An Ethical Analysis by Mark Wicclair
  • Lori Kantymir
Conscientious Objection in Health Care: An Ethical Analysis, by Mark Wicclair. Cambridge, UK: Cambridge University Press, 2011.

Should medical professionals be permitted to object conscientiously to providing legal, standard health services? Mark Wicclair’s Conscientious Objection in Health Care: An Ethical Analysis, his latest book, is dedicated to addressing this difficult question. He criticizes views that are either overly permissive or restrictive of objections, and defends a compromise approach that allows for some conscientious objections within specified ethical constraints. I will analyze Wicclair’s book from a feminist perspective, and argue that his view perpetuates unfair harms to women in conscientious refusals.

In the first chapter, Wicclair argues that conscientious refusals are worth protecting, at least to some degree, because of their connection to moral integrity. Conscientious refusals are based on core moral beliefs, and to act contrary to one’s deepest convictions threatens moral integrity and can result in a loss of self-respect. This impact makes it undesirable to require health-care professionals to act against their consciences. The first chapter lays the groundwork for Wicclair’s rejection of views about conscientious refusals that are overly restrictive: since refusals are worth protecting, they cannot simply be banned from the health-care context.

The stated purpose of chapter 2 is to introduce three approaches to conscientious objection in health care: conscience absolutism, the incompatibility thesis, and compromise. Wicclair briefly outlines these views: according to conscience absolutism, health-care professionals should be exempted from [End Page 253] performing any action that goes against the dictates of their consciences, including giving information and referrals. The incompatibility view claims that all objections by medical professionals are contrary to their professional obligations and should be denied. Last, a compromise approach contends that conscientious refusals can be compatible with professional obligations as long as the refusals meet specified ethical constraints. However, the chapter is misleadingly titled, as Wicclair spends most of his time examining various accounts of professional obligations rather than explaining any of the three views in detail. He argues that a compromise approach to refusals is more compatible with common accounts of professional obligations than the absolutist or incompatibility views.

For example, consider the essentialist view of medicine according to which professional obligations follow from the inherent healing nature of medicine. Conscience absolutism would not respect professional obligations to promote healing, since it would allow exemptions even when doing so would impede healing. The opposite view—that conscientious refusals are always incompatible with professional duties—is also problematic. A health-care worker can be committed to healing and still not provide all healing-related services, and, also, not every health-care service (such as emergency birth control) unambiguously promotes healing. Wicclair argues that conscience-based objections are neither ruled out nor supported wholesale by (among others) the essentialist view of professional obligations; rather, whether a conscientious refusal is compatible with these obligations is context-dependent. Since context is important, Wicclair proposes that a compromise approach—one that uses a set of ethical constraints to limit the exercise of conscience in the health-care context—is best. The extensive discussion of the various accounts of professional obligations is a rather roundabout way of introducing his own version of a compromise approach, and repeats Wicclair’s previous work (2008).

The third chapter is the heart of the book, where Wicclair defends his compromise approach to conscientious objections in health care. He identifies three core professional obligations toward patients common to medicine, nursing, and pharmacy: the obligation to respect patient dignity and refrain from discrimination, to promote patient health and well-being, and to respect patient autonomy. Since no one is required to enter or remain in any particular healthcare profession, these core obligations do not require anyone to act against her conscience; rather, they provide guidelines for career choices within the medical profession. Furthermore, Wicclair claims that these obligations justify five [End Page 254] ethical limitations on the exercise of conscience: regarding discrimination, patient harms and burdens, disclosing options, referral and/or facilitating a transfer, and advance notification. Wicclair clarifies that the constraint on harm is really on excessive...

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