We are on a dangerous course with these largely unexamined changes in our society. Are we starting to assume that private morality always trumps the performance of professional duties? Where is this going to end? In the U.S. ambulance drivers have already refused to transport patients for abortions, a fertility clinic refused to assist a lesbian and a pharmacist refused to give the morning-after pill to a rape victim. The pharmacists’ refusals have become such a stampede that the government has had to intercede for the rights of patients. In 2005, Illinois Governor Rod Blogojevich filed a rule requiring Illinois pharmacies to dispense all prescriptions immediately and without question.

The language of “right of conscience” is meant to invoke the conscientious objection to war, but such is not necessarily the best analogy and it is not an exact analogy in any case. There are other and less attractive analogies that may fit. For example, many white people in U.S. history have had a “conscientious objection” to equality for African Americans, including equal access to public facilities and education, and it was only through the threat of force that public equality was enforced. The private conscience of the white supremacist could not be allowed to prevent public equality for African American citizens.

It should be noted that virtually all of the assertions of a “right of conscience” by physicians and pharmacists are directed against women and women’s exercise of their right to choice about their reproductive capacity. These physicians and pharmacists are asserting that their private conscience is superior that to that of women. Yet it should be obvious that women also have a right to exercise conscience in regard to their own private medical issues.

The “conscientious objection” to war is sometimes asserted as an analogy by these physicians and pharmacists since they regard the issue as one of “protecting life.” If this is the analogy, then let it be a complete analogy -- those physicians or pharmacists who assert a “conscientious objection” to the performance of their professional duties and the provision of impartial health care information and prescription can be assigned to other duties where their private moral objections do not interfere with the performance of their public, professional duties, exactly as "conscientious objectors" to war are assigned to other, non-combattant jobs. Perhaps a review board like the draft boards that reviewed applications for alternate military service because of “conscientious objection” to war could be set up. It is not enough for a physician or pharmacist to just opine that they have a moral objection to doing their professional work and choose as an individual to stop acting as a professional -- they at least should have to prove the basis of their objection and then in an exact analogy they could be assigned to alternative employment.

The New England Journal of Medicine (February 8, 2007) in “Religion, Conscience, and Controversial Clinical Practices” summarizes a survey of physicians as follows: “Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures.” This is unacceptable as it is the practice of medicine where the opinions of the doctor outweigh the good of the patient, including withholding medical information. I would think a physician who did so and whose patient suffered medical harm because the patient did not receive information about the full range of possible medical care would have an excellent case for medical malpractice. The good of the patient should come first, last and always.

I also think this is a case of ethical malpractice. I am making the claim that there is no absolute right to private moral conscience. A good society will find ways to try to accommodate reasonable (i.e. not based on obvious prejudice) private moral conscience but not allow private conscience to interfere with the legal equality of all citizens and the public responsibility of professionals to serve the public.

* The phrase"Not all conscience is created equal" appears in Eva LaFollette and Hugh LaFollette, "Private Conscience, Public Acts," www.jmedethics.com (30 April 2007), 249.