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Two years ago, a group of philosophers and bioethicists published what they called a 'Consensus Statement on Conscientious Objection in Healthcare'.1 The statement, called the Brocher Statement because the group met at a foundation of that name in Geneva, sets out ten points that should 'inform, at the level of legislations and institutional policies, the way that conscientious objections in healthcare is regulated'. The statement proposes a very low threshold for compelling the performance of a practice in violation of conscience, whether of an individual or of an institution, in healthcare. In so doing, it reflects the position advanced ten years earlier by the influential Australian philosopher, Julian Savulescu. Himself one of the group who proposed this 'Consensus Statement', Savulescu had claimed that '[a] doctor's conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient's good and the patient's informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors' .2 Such a policy would, I submit, fail to accommodate the legitimate scope for conscientious decision-making, which is at the heart of medical professionalism.
In the first part of this article I identify the main elements of the 'Consensus Statement' espoused in the Brocher Statement and defended by Savulescu. In the second, I set out those key features of conscience and medicine that provide a necessary background for an evaluation of this proposal. In the third, I argue that the position found in the statement would be bad public policy: it misconstrues both conscience (and morality more generally) and medical professionalism. In the fourth, I respond to Savulescu's additional arguments in support of the view embodied in the statement. I finish by recommending a different and more reasonable view of the proper scope and limits of respect for conscientious judgment in healthcare, which is found in the works of Daniel Sulmasy.3
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The first of the ten points in the Brocher Statement is key: 'Healthcare practitioners' primary obligations are towards their patients, not towards their own personal...