(2020) Beyond Money: Conscientious Objection in Medicine as a Conflict of Interest

Alberto Giubilini & Julian Savulescu

Journal of Bioethical Inquiry, Vol 17, pgs 229–243 (May 2020)


Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners’ moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs.

Relevant Excerpt (from Conclusion)

If we frame conscientious objection as the expression of a conflict of interest in health care, then it is apparent how at the moment conscientious objection is treated and managed differently from the way other conflicts of interest are treated, and for no apparent good reason. Allowing conscientious objection to certain practices means not only acknowledging that a conflict of interest exists (because we are acknowledging that the health care professional has personal goals and motivations that conflict with professional obligations) and that the conflict is ethically impermissible (because we are acknowledging the professional’s personal goals and motivations prevent them from fulfilling their professional obligations). It also means allowing the conflict of interest to take place and to affect professional conduct when we do not allow the same to happen in the case of FCOIs. This differential treatment is not ethically justified, or so we have argued.

Source: Journal of Bioethical Inquiry (open access)

leer más

(May 2020) The inequity of conscientious objection: Refusal of emergency contraception

Chelsey Yang, May 13, 2020, Nursing Ethics, 27:6; 1408-1417.


In the medical field, conscientious objection is claimed by providers and pharmacists in an attempt to forgo administering select forms of sexual and reproductive healthcare services because they state it goes against their moral integrity. Such claim of conscientious objection may include refusing to administer emergency contraception to an individual with a medical need that is time-sensitive. Conscientious objection is first defined, and then a historical context is provided on the medical field’s involvement with the issue. An explanation of emergency contraception’s physiological effects is provided along with historical context of the use on emergency contraception in terms of United States Law. A comparison is given between the United States and other developed countries in regard to conscientious objection. Once an understanding of conscientious objection and emergency contraception is presented, arguments supporting and contradicting the claim are described. Opinions supporting conscientious objection include the support of moral integrity, religious diversity, and less regulation on government involvement in state law will be offered. Finally, arguments against the effects of conscientious objection with emergency contraception are explained in terms of financial implications and other repercussions for people in lower socioeconomic status groups, especially people of color. Although every clinician has the right and responsibility to treat according to their sense of responsibility or conscience, the ethical consequences of living by one’s conscience are limiting and negatively impact underprivileged groups of people. It is the aim of this article to advocate against the use of provider’s and pharmacist’s right to claim conscientious objection due to the inequitable impact the practice has on people of color and individuals with lower incomes.

Source: Nursing Ethics

leer más

(July 2018) Religious Refusals and Reproductive Rights: Claims of Conscience as Discrimination and Shaming

By Louise Melling

Chapter 14 – Religious Refusals and Reproductive Rights, from Part IV – Conscience, Accommodation and Its Harms. Edited by Susanna Mancini, Università di Bologna, Michel Rosenfeld. Publisher: Cambridge University Press

DOI: https://doi.org/10.1017/9781316780053.015

Relevant excerpt:

The stories from Indiana and Arizona illustrate the different way in which we currently view refusals to serve LGBT people for reasons of religious beliefs versus refusals to serve women seeking reproductive health services because of religious beliefs. This chapter takes issue with this difference. It argues we need to see, question, and protest the harms that result when women seeking services related to contraception and abortion are turned away for reasons of faith as robustly as we question the harms when LGBT people are refused service because of religious beliefs.14 It asks that we see these refusals as discrimination too.

In making this call for change, this chapter first puts the current debate in the United States about religious refusals in context; second, it posits parallels between the harm to women turned away for wanting to control their fertility and to same-sex couples denied services for their weddings; third, this chapter offers an account for why refusals to provide services because of religious beliefs are treated differently in the two contexts; and finally, it argues that how we think about religious objections to serving those seeking abortion and contraception matters for women’s equality. This chapter does not purport to put forward a definitive argument; it aims instead to make a case for questioning a long-standing norm.

leer más

(July 2018) Seeking to Square the Circle: A Sustainable Conscientious Objection in Reproductive Healthcare

Emmanuelle Bribosia and Isabelle Rorive

Chapter 15 in: The Conscience Wars: Rethinking the Balance between Religion, Identity, and Equality, ed. Susanna Mancini and Michel Rosenfeld (Cambridge, UK: Cambridge University Press, 2018) pp. 392-413.

DOI: https://doi.org/10.1017/9781316780053.016

From Book Introduction:

[In this chapter, the authors] focus on the practical and conceptual difficulties in reconciling the reproductive rights of women with the conscience claims of individual health care providers. From a practical standpoint, drawing on national, international, and European measures, cases, and policy papers, they demonstrate that even the most balanced regulatory framework of conscientious objection fails to overcome the strength of the web of religious and patriarchal structures of society, in which women are still caught. This results in a distortion of religious exemption clauses to the detriment of women’s rights.

From a conceptual standpoint, Bribosia and Rorive … maintain that conscience clauses involve not only direct harm to women who wish to access abortion services but also dignitary and symbolic harm. In this light, conscientious objection places the medical doctor in the position of exercising personal power over the patient by imposing his or her beliefs, and that per se constitutes a violation of women’s dignity and equality. In the end, according to Bribosia and Rorive, access to abortion is not enough to protect women from discrimination: what is required is access to health care on an equal footing, without any moral judgment by an authority.

leer más

(July 2018) No conscientious objection without normative justification: Against conscientious objection in medicine

by Benjamin Zolf, Bioethics. DOI: 10.1111/bioe.12521  


Most proponents of conscientious objection accommodation in medicine acknowledge that not all conscientious beliefs can justify refusing service to a patient. Accordingly, they admit that constraints must be placed on the practice of conscientious objection. I argue that one such constraint must be an assessment of the reasonability of the conscientious claim in question, and that this requires normative justification of the claim. Some advocates of conscientious object protest that, since conscientious claims are a manifestation of personal beliefs, they cannot be subject to this kind of public justification. In order to preserve an element of constraint without requiring normative justification of conscientious beliefs, they shift the justificatory burden from the belief motivating the conscientious claim to the condition of the patient being refused service. This generally involves a claim along the lines that conscientious refusals should be permitted to the extent that they do not cause unwarranted harm to the patient. I argue that explaining what would constitute warranted harm requires an explanation of what it is about the conscientious claim that makes the harm warranted. ‘Warranted’ is a normative operator, and providing this explanation is the same as providing normative justification for the conscientious claim. This shows that resorting to facts about the patient’s condition does not avoid the problem of providing normative justification, and that the onus remains on advocates of conscientious objection to provide normative justification for the practice in the context of medical care.

Source: Bioethics

leer más

(June 2016) Conscientious Objection in Healthcare Provision: A New Dimension

Peter West-Oram and Alena Buyx
Bioethics 2016 Jun;30(5):336-43. doi: 10.1111/bioe.12236


The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court’s decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women’s rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.

Source: Bioethics

leer más

(2015) Objeción de conciencia en Medicina: las convicciones ideológicas privadas no deben superar las Obligaciones de Servicio Público

U. Schuklenk
Bioética ISSN 0269-9702 (imprimir); 1467-8519 (online) doi:10.1111/bioe.12167
Volume 29 Número 5 2015 pp ii–iii

El Tribunal Supremo de Canadá decidió que los derechos constitucionales se violan con la criminalización de la muerte asistida. Los políticos de Canadá están actualmente luchando para llegar a un régimen de muerte asistida dentro del período de 12 meses que la Corte Suprema les dio para solucionar el problema.

Desde entonces, la Asociación Médica Canadiense, la organización del lobby de los médicos del país, ha insistido no sólo en que los médicos no deben ser forzados a proporcionar la muerte asistida, sino también que los médicos no deben transferir a los pacientes que piden ayuda para morir a un colega que ellos saber ayudará a estos pacientes.1

En muchos países, incluyendo Canadá, las cláusulas de objeción de conciencia protegen – en su mayoría – a los profesionales de la salud de ser obligados a actuar contra sus propias convicciones ideológicas. Sospecho que no es injusto notar que estas protecciones en el mundo real no son otra cosa que protecciones para los médicos cristianos que no están dispuestos a prestar los servicios que estarían obligados a entregar a pacientes que tienen derecho legal a recibirlos, si no fuera por sus objeciones religiosas. Los profesionales de la salud seculares podrían utilizar argumentos de conciencia, pero en una democracia liberal, ¿qué causa razonable de conciencia podría implicar negarse a la prestación de servicios de salud a los pacientes? Las cláusulas de conciencia de hoy son en gran medida una concesión de derechos especiales a los profesionales sanitarios cristianos, al menos en las democracias occidentales seculares. 2
Secular healthcare professionals could arguably avail themselves of conscience clauses, but in a liberal democracy, what reasonable conscience-based cause could they have to refuse the provision of healthcare services to patients? Conscience clauses today are by and large a concession of special rights to Christian healthcare professionals, at least in secular Western democracies.

Con frecuencia se produce un compromiso incómodo consistente en que los objetores de conciencia no deben verse obligados a prestar servicios de salud a los que se oponen, sino que deben asegurarse de que los pacientes serán transferidos a personal sanitario dispuesto a prestar el servicio solicitado. Por lo general, se les prohíbe participar en actividades encaminadas a persuadir al paciente para que vea los errores de su decisión. Por lo general, también deben transferir al paciente de manera diligente a su colega más servicial.

Desde la perspectiva de un objetor de conciencia, este compromiso es todo menos un compromiso. Si me opongo al aborto porque creo que el aborto es semejante al asesinato, como creen los objetores cristianos, seguramente mi responsabilidad moral es escasamente menor si, a sabiendas, transfiero a una mujer embarazada en busca de un aborto a un colega que cometerá el acto mejor que si lo hiciera yo mismo. Los cristianos no suelen ver estas cuestiones desde una perspectiva analítica consecuencialista, pero incluso desde su perspectiva, la responsabilidad moral apenas se reduce por el compromiso. Siento simpatía por sus objeciones al compromiso, porque no es un compromiso. Para empezar, un compromiso basado circunstancias discutibles, sin duda no es factible.

Los pacientes tienen derecho a recibir del personal sanitario un servicio uniforme. No deben ser sometidos a la lotería de objeción de conciencia de hoy. La Asociación Médica Canadiense propone que Canadá debe establecer un sitio web donde los pacientes pueden confirmar donde encontrar el médico no objetor más cercano.3
Uno de los problemas de esta propuesta es que en muchas áreas rurales podría haber solamente un médico y el siguiente, más dispuesto, podría encontrarse a un vuelo de distancia. Nada nos impediría llevar esta propuesta a su absurda conclusión lógica: ¿por qué no establecer páginas web donde los pacientes pueden averiguar si su médico objeta por razones de conciencia a tratar a los homosexuales sexualmente activos, o quizás si su conciencia les prohíbe tratar a los pacientes de determinada etnia?
Los consequentialistas podrían decidir no tratar a pacientes con el virus del Ébola debido al riesgo existente, lo llaman conciencia consecuentialista. La prestación de servicios sanitarios pronto se convertiría en un acontecimiento aleatorio, basado totalmente en los caprichos de las objeciones de conciencia. Por cierto, las protecciones de la conciencia jurídica de los médicos canadienses no cubren realmente este tipo de objeciones, porque en realidad estas protecciones están diseñadas para proteger las convicciones de los médicos cristianos, a pesar de los flacos intentos débiles de aportarles neutralidad. Lo extraño de las objeciones de conciencia es que no hay manera de averiguar si son genuinas o simplemente una cuestión de conveniencia. Incluso si realmente fueran creencias ¿Por qué debería constituir una buena razón para denegar la prestación de servicios?

La misma idea de que deberíamos aceptar la objeción de conciencia en cualquier profesión es objetable.4 Nadie obliga a nadie a convertirse en un profesional. Es una elección voluntaria. Un objetor de conciencia en medicina no es diferente a un taxista que se une a una compañía de taxis que maneja una flota de automóviles de motores de mayor combustión y que objeta por motivos de conciencia conducir esos coches debido a preocupaciones ambientales. En primer lugar, ¿por qué se convirtió en taxista? Tal vez en su lugar, debería haber abierto una compañía de taxi de bicicleta. Recuerdo bien que durante una larga estancia como profesora maestra en una escuela de odontología, que en cada curso había un buen número de estudiantes de odontología que mencionaban que se habían decidido a ir a la escuela de odontología en lugar de a la escuela de medicina debido a sus objeciones al aborto. Eso parece una decisión mucho más razonable que entrar en una escuela de medicina y, a lo largo de su vida laboral, alegar objeción de conciencia por un motivo u otro, causando problemas a los pacientes que buscan atención médica a la que legalmente tiene derecho para solucionar problemas de salud. Las sociedades no deben dar prioridad a los compromisos ideológicos individuales de algunos profesionales de la salud sobre los derechos de los pacientes a recibir atención profesional a tiempo y sin complicaciones. Los pacientes moribundos que viven en zonas rurales no deben ser sometidos a una lotería de acceso a la muerte asistida causada por objetores de conciencia. Los médicos son ante todo los proveedores de servicios de atención médica. La sociedad tiene todo el derecho de determinar qué tipo de servicios deben prestar.


1 S. Kirkey. Inaceptable obligar a los médicos a participar en muerte asistida contra su conciencia: CMA. National Post 2015 5 de marzo. http://news.nationalpost.com/2015/03/05/unacceptable-to-forcedoctors- to-participate-in-assisted-dying-against-their-conscience-cmahead/ [cited 2015 March 26]
2 B. Leiter. ¿Por qué tolerar la Religión? Princeton, NJ: Universidad de Princeton Prensa; 2013.
3 S. Kirkey. Op.cit. nota 1.
4 J. Savulescu. Objeción de conciencia en medicina. BMJ 2006; 332: 294.

Fuente: www.academia.edu

leer más

(2010) Emergency Contraception and Conscientious Objection

J. Paul Kelleher
Journal of Applied Philosophy, Vol 27, No. 3, 2010.


Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists’ moral or religious objections.

Source: Journal of Applied Philosophy

leer más

(2009) Esfera de la Salud Sexual y Reproductiva

Marcelo Alegre
Fecha de Publicación: 2009
Descargar el artículo completo: [pdf]

Aunque durante siglos la objeción de conciencia fue reivindicada principalmente por aquellos que por razones religiosas o éticas se negaron a unirse a las fuerzas militares (ya fuera por un principio general o en respuesta a un conflicto violento en particular), en las últimas décadas se puede ver una ampliación significativa del concepto. En Tailandia, por ejemplo, los médicos recientemente rechazaron la atención médica a policías heridos sospechosos de haber reprimido violentamente una manifestación. En Argentina algunos abogados de oficio se han negado por razones de conciencia a representar a personas acusadas de violaciones masivas de derechos humanos. En diferentes países de todo el mundo hay médicos que se niegan a practicar la eutanasia, maestros que rechazan enseñar la teoría de la evolución, y estudiantes que se niegan a asistir a clases de biología donde se disecan ranas.

Comentarios: Documento presentado en el SELA 2009, Ley y Sexualidad, en Asunción, Paraguay, como parte del comité sobre «Los ideales fundamentales».
Cita recomendada

Alegre, Marcelo, «Opresión consciente: Objeción de conciencia en la esfera de la salud sexual y reproductiva» (2009). SELA (Seminario en Latinoamérica de Teoría Constitucional y Política). Documento 65.


leer más