The second ACoRN Roundtable took place on 15 November 2018 at Cardiff University. In this roundtable, we moved on from the question posed at the first one (‘what is conscience?’) and looked at the ‘why?’ question; in particular, focusing on why healthcare professionals are entitled to make conscience claims in a variety of situations but other, perhaps similarly situated, professions (such as social workers or prison officers) are not. What is about healthcare professionals that entitles them to this special dispensation? Or, is it, perhaps, not healthcare professionals themselves, but the roles that they play and the jobs that they do, which means that they are entitled to such a dispensation? If this is the case, then what is about, for example, performing an abortion that makes it different from putting someone into solitary confinement or having to remove a child from their parents, such that the first is subject to conscience claims and the other two are not? Alternatively, are we incorrect and other professionals (such as social workers and prison guards) are entitled to make conscience claims in the ways that healthcare professionals can? These were the sorts of questions considered in this roundtable.

 

The roundtable was broken down into four sessions. In the first session, John Coggon (Bristol) started the discussion by focusing on evolutions in public health law and public health ethics and what they might bring to discussions of conscience and conscientious objection. This included exploring the way that conventional medical law and ethics seems to prioritise the role of doctors and lawyers over other individuals involved in health and care. John considered the direction of travel between ethics and law and public health ethics and law, in terms of conscience. Finally, he explored the prioritisation of conscientious objection as opposed to other forms of conscience claim in healthcare, and what that might mean for the questions we were answering.

 

Caroline Roberts (Bristol) followed John’s presentation, and she explored the role of the European Court of Human Rights in the protection of conscience. Specifically, she focused on the Court’s approach to Article 9 of the European Convention of Human Rights (ECHR) which protects, among other things, freedom of conscience. She outlined the developments in the jurisprudence of the court in relation to Article 9 and noted that healthcare professionals do not have special rights under that Article. This may have surprised many participants, but Caroline showed how, under the European Convention, healthcare professionals are not treated differently to other professions.

 

In the second session, Alberto Guiblini (Oxford) focused on the question of whether healthcare professionals ought be entitled to special dispensation on their basis of their moral beliefs. He first considered whether healthcare was a moral enterprise and argued that it was. This did not, he argued, mean that we ought, necessarily, to allow healthcare professionals to claim conscience. Rather, Alberto suggested that the fact that healthcare was a moral enterprise meant that we ought not to leave those types of conscientious decisions to individual professionals who might not have moral expertise. Instead, we ought to determine society’s answer to those questions because we can better account for the general moral expertise of a community, as well as take better account of other’s interests.

 

Toni Saad (Cardiff and Vale University Health Board) also considered whether medicine was a moral enterprise and he also looked at the role played by practical reason in relation to conscience. In contrast to Alberto, Toni suggested that conscience was part of practical reason and, as such, it ought to be protected because it allows individuals to make more moral decisions on the basis of their practical reason.

 

The third session explored different aspects of whether healthcare professionals ought to be a special case for conscience. Christina Lamb (Alberta) focused on her empirical research on the experiences of nurses involved in conscientious objection in Canada. She detailed some of the results of her interviews with nurses, when they discussed their experiences about conscientious objection as well as their views on the subject.[1] Christopher Cowley (Dublin) followed Christina, and he explored in more depth the comparison between healthcare and social work. He asked why it might be that we considered healthcare to be the kind of case in which conscientious objection would be appropriate but social work (and related fields) might be inappropriate. He sketched out how we might justify these distinctions and whether they were sustainable in the long term.

 

The final session of the roundtable involved small group discussions focusing on the question of whether medicine and healthcare were, in fact, special cases. Groups had lively discussions on a range of issues. Most groups felt that healthcare was a moral enterprise, but the impact of this answer varied according to the group. Additionally, while some groups agreed that conscientious objection was appropriate in healthcare even if it was not in other fields, not because of the profession of medicine but because of the ethical impact of the role and jobs that healthcare professionals play, others though that this might mean that conscience ought to be seen more broadly in other fields. In other words, for some groups the question was not why healthcare ought to be seen as different from areas such as social work, but why social workers should not be granted the same rights and privileges as healthcare professionals.

 

This roundtable was, from my perspective as the organiser, a great success, as the lively and fruitful discussions and debates initiated in roundtable 1 continued here too. These have given us much to consider and think about. It should also set us up well for the third and fourth roundtables, where we will consider how best to regulate conscientious objection (roundtable 3) and then when and where to regulate conscientious objection (the final roundtable).

 

[1]  For a discussion of these results, see: C Lamb et al, ‘Conscientious objection and nurses: Results of an interpretive phenomenological study’ (2018) Nursing Ethics 1; C Lamb et al, ‘Conscience, conscientious objection, and nursing: A concept analysis’ (2019) 26 Nursing Ethics 37; C Lamb et al, ‘Nurses’ use of conscientious objection and the implications for conscience’ (2019) 75 Journal of Advanced Nursing 594.