Conscientious objection
Gonzalo Herranz, department of Bioethics, University of Navarra.
lecture Delivered at the Course on Health Law.
Royal Academy of Medicine of Eastern Andalusia.
Granada, 2 May 2007, 12:30 pm.
What is conscientious objection?
2. The basics of professional ethics in dentistry and the dental profession.
3. Some sociological aspects of odec
The reason for choosing topic: to bring up a problem that has not yet been removed from the list of unresolved issues. As the years go by, despite the jurisprudence that has been produced, there is a lack of positive legislation on the extent, intensity and methods of conscientious objection (CO) in the health sector.
Lacking legal and medico-legal credentials, I will limit myself to some ethical and deontological considerations on the theory and the internship of odec. I will try to do so,
First, describe what awareness is behind genuine odec in the health field.
Second, remember the basics of dental deontology; and
Third, to refer to some sociological aspects of odec, in particular the ambiguity with which odec is viewed in society and within the profession.
What is conscientious objection? 
Odec is, alongside civil disobedience or evasive insubordination, an attitude of social dissidence by which one rejects, for moral, professional or religious reasons, what is ordered by authority or the law. What distinguishes odec is its peaceful character, never violent; its moral and religious rather than political basis; and its ultimate intention is to abstain from conduct which, although socially permitted or administratively enforced, is judged by the objector to be inadmissible.
It seems to me very important to retain these specific features of conscientious objection in report and in action. The objector as such does not intend with his action to subvert or change the prevailing political, legal or social status , as the civil disobedience activist does with his outward manifestations, or the insubordinate with his spectacular or aggressive protest actions. The objector is only trying to peacefully exempt himself from certain actions, without having to suffer discrimination or reduction of his rights as a consequence.
odec constitutes, in my opinion, one of the most considerable advances in the field of social ethics in our time. In contrast to what happened in the past, and beyond the horizontal plane of human relations between equals, odec has extended the possibility of living peacefully the vertical disagreements of subjects with those who lead, command or legislate, framing them within the confines of ethical respect for people and their freedom.
odec has also been a step forward in the ethics of the health professions. I often repeat that one of the main advances, perhaps the most significant, in contemporary medical ethics has consisted in making explicit and operational the idea that patients, doctors and nurses are moral agents alike, all of them people of conscience, free, responsible, who enter into a reciprocal relationship to act with knowledge, skill and deliberation; capable of making decisions and agreements on the basis of rational and sincere principles. But it can and does happen occasionally that the faithful following of one's own convictions collides with certain legal mandates, with orders from the institutional hierarchy, with wishes that patients interpret as rights. It may then happen that, after the obligatory consideration of all those involved, the conclusion is reached that the disagreement is firm and on subject serious: that the doctor cannot comply with the legal mandate, the order from the head of the institution, the patient's wish without denying his own moral identity. It is then that the sincere, serious opinion of one's own conscience and the mature exercise of one's own freedom demand that the odec be invoked.
In my view, the conscience at work in odec is the minimal but strong core of our moral existence, the solid centre of convictions that inform our ethical character, something we can do without if not at the cost of falling apart as moral individuals.
The concept can be better understood with an example. In the preface to his drama about Sir Thomas More, Robert Bolt confesses:
"As I wrote about him, Thomas More became to me a man with a diamond sense of his own self. He knew where to begin and where to end, what part of himself he could abandon to the lures of his enemies, and what part submit to the demands of those who loved him [...] Being a clever man and a great lawyer, he was able to withdraw from dangerous areas, and he did so in perfect order. But, in the end, they demanded that he also give up the corner of his soul where he had placed his own self. And then that flexible, good-humoured, simple yet sophisticated character became as hard as metal, he took on an absolute, unyielding rigidity that no one could relax.
As Bolt's words make clear, true objection has nothing to do with whim, stubborn obstinacy, visceral self-assertion. It is result of a serious and deliberate process of rational decision. It is about a few, very few, central and profound issues, on which one stakes one's soul; never about negotiable matters that admit of several decent solutions.
The objecting conscience is therefore an identifying conscience, which does not limit itself to judging what acts are or are not morally right and proper. It simply tries to define what subject moral being I am, what I make of myself. This core conscience of my person, built up through study and reflection, is planted at the centre of my being.
Odec is not necessarily linked to a religious attitude. It is obvious that he who believes in God must form his conscience, not with his back turned to Him, but in His presence, with the financial aid of prayer and living faith. But also those who do not believe in God must be very careful and diligent in seeking and fixing the cardinal points of their professional conscience. The agnostic Declaration of Geneva calls on the physician, when entering the practice of medicine, to make his human honour the guarantor of his fidelity to the basic promises of the profession. As Pellegrino stated twenty years ago, real medical ethics involves the coexistence of strongly held and often divergent spiritual, philosophical, political and social convictions. Today's dominant medical ethics seems to have given up on promulgating an objective and universal rules and regulations . Instead, it relies on physicians, and individual physicians, to be guided creatively and responsibly by pluralistic conclusions consistent with the principles of respect for persons, tolerance for diversity, non-paternalism, fidelity to promises. This ethic gives greater prominence to the professional conscience of the physician: it makes him or her freer, but requires that he or she must always be able to give an ethically acceptable justification for his or her actions. After all, as someone has rightly stated, the degree scroll doctor of medicine today represents both an academic Degree and a moral Degree .
Finally, I would like to point out that odec is a social treasure. At a time when we are all dependent to a greater or lesser extent on a national health service, patients want and need to be cared for by free, conscientious doctors who know how to guard their independence wisely. And if people want such doctors, they also want the governance of the health system to be entrusted to men of conscience who know how to respect, and hold in high esteem, the legitimate freedoms and rights of conscience of their subordinates.
odec is ultimately a social institution that manifests in special circumstances the respect due to each and every citizen, to all citizens equally. It is striking how, in recent years, American physicians and ethicists, faced with the overwhelming power of health maintenance organisations, are considering the role of odec in the field of service delivery, and are exploring what means, outside the rules and contracts and even against the law, physicians should use to resolve situations of grave injustice that appeal to their conscience. It is basically a way of responding to the demands of that basic core of medical ethics which is respect for the life and health of patients.
In conclusion, odec awareness is the central element in an identifying ethic of respect, which deserves the robust protection of professional ethics.
2. The basics of professional ethics in dentistry and the dental profession.
The deontology of dentistry in Spain does not differ appreciably from that in force in other countries on the European continent or in those of the Anglo-Saxon area , although it must be acknowledged that the treatment given to dentistry by the American Medical Association association is somewhat lukewarm. The codes of ethics and deontology, with rare exceptions, recognise the physician's right to object to certain interventions on grounds of conscience; moreover, many of them suggest to the physician the conduct to be followed in such circumstances.
The current CEDM in Spain (September 1999) retains to a large extent the norms of the 1990 CEDM, as interpreted by the Central Commission of Deontology in its Declaration on Medical Ethics of 1997. area In essence, the Code states, in its article 26.1, that it is a doctor's right to abstain, for reasons of conscience, from medical acts related to human reproduction (regulation or attendance to reproduction, sterilisation, termination of pregnancy); and that this right implies the doctor's duties to inform his patient without delay of this conduct, to offer him the alternative treatments he considers appropriate, and to always respect the patient's freedom to seek the opinion of other doctors. Finally, it reminds the physician that those with whom he collaborates also have their own rights and duties at subject.
It should be emphasised that the deontological rules and regulations protects the physician's freedom of conscience with the same intensity as it protects the patient's freedom of choice. Since the physician is obliged to state to the patient that his or her conduct is based on reasons of conscience, he or she may not omit to state them in a clear, reasoned and simple manner. Deontologically, objection cannot be, nor can it be expressed as, a whim. It would be repugnant as tool for hypocritical, changeable, opportunistic behaviour. It must be, and be presented as, a decision based on ethical reasons and on confessable and defensible professional criteria.
odec must conform to the high standards of human and scientific quality that all medical care must have, in accordance with Art. 18.1 of the CEDM.
With regard to human quality, the objector is deontologically obliged to treat with the utmost respect the patient whom he or she refuses care for reasons of conscience. As the CCD Declaration states, "odec refers to the refusal of certain actions, it has nothing to do with the refusal of persons". The peaceful context of odec repels moral insult, humiliation, self-righteous contempt. The objected status is an occasional event to be regretted, a situation of force majeure, an exception in a relationship that one wishes to preserve, which, on the part of the doctor, cannot end in an irrevocable disagreement, but in an offer to remain at the disposal of his patient if the latter so desires. The doctor's door must also be open to those who have asked for a service that the doctor could not in good conscience provide. Obviously, odec does not exclude, as the CCD Declaration itself specifies, the duty to provide any other medical care, antecedent or subsequent, to the person who is to undergo or has undergone the objected intervention, but who does not form part, not cooperate, morally with that specific intervention.
The same peaceful tone of quality human relations must be preserved and strengthened when odec occurs in the context of hierarchical or professional relations. Refusal to comply with an order or request should not disturb the respectful and fraternal quality of relations between colleagues, relations that go back before and must continue afterwards, without undermining the due deference, respect and loyalty that doctors owe to each other.
With regard to scientific quality, the objector's action can never be counter-rational; it cannot clash with serious, evidence-based medicine. It must be supported by positive scientific arguments, not simply by administrative expediency. Ultimately, abortion is not a superior medical solution to the other alternatives that the abortion-averse physician may offer. The decision to treat the woman's illness without resorting to the destruction of the unborn human being represents a profoundly professional attitude, which is at the origin of the most remarkable progress in pregnancy care. Faced with the mother-fetus dyad, the physician feels obliged to serve equally the life and health of his two patients: the pregnant woman and the unborn child. Today, in view of the advances in clinical attendance , the notion that abortion is the treatment of choice for any illness of the mother, so superior to other therapeutic alternatives that not to perform it is a serious breach of the medical precept of do no harm, is refutable.
Abortion cannot be defined as an ethically obligatory treatment of a sick foetus. The eugenicist idea that human beings must be free of imperfections is alien to medicine. It is not in keeping with the healing vocation of the physician to be an agent of the "tyranny of normality": all his patients must be treated with the same diligence and application, without discrimination. For him, all lives are equally worthy of respect. The sick person, before or after birth, is presented to him as someone who, however plagued by illness, always deserves his human appreciation and care based on current scientific knowledge. Scientific medicine does not care for perfect biological organisms, with a flourishing quality of life, but for beings of flesh and blood, marked by both dignity and frailty, sometimes too much frailty.
There is a deontological problem that deserves to be referred to in some detail. Following the guideline set by the Oslo Declaration on Therapeutic Abortion, since the WMA promulgated it in 1970, many Codes include the duty of the physician to refer his patient to a colleague who is not reluctant to have an abortion.
The Declaration, in its recent version of October 2006, after reaffirming from entrance that the WMA requires physicians to respect human life, notes that the physician, when the interests of the mother and those of the unborn child seriously conflict, may be faced with the dilemma of terminating a pregnancy. Oslo cautions that different responses to such a dilemma are possible status, since the value placed on the life of the unborn depends on the convictions and conscience of the individual physician, which must be respected. It further recalls that, while it is not for the profession to determine the laws of the political community in which it operates subject, the profession must ensure the protection of patients and safeguard the rights of physicians. If the law of the land permits therapeutic abortion, it must be performed by a competent physician in establishments approved by the authority. If the physician's convictions do not allow him or her to advise or perform the abortion, he or she may withdraw from the case - and herein lies the problem - "provided that he or she ensures that a qualified colleague is made position responsible for the medical care".
I pointed out earlier that the CEDM in force here does not impose an obligation on the physician to guide the patient to a colleague who does not object. It obliges the CEDM to respect the patient's freedom to seek the opinion of other physicians. But does he have an obligation to transfer the case to a colleague so that the colleague will perform the action to which he objects?
This is a complex question, as such an abstract status may arise in very different real circumstances.
For example, there is a typical one, which occurs in our neighbouring countries (Italy, France, Germany) where abortion legislation follows the patron saint of a time limit law. At outline, the law requires a woman seeking an elective abortion to go to a general practitioner for a prior enquiry , in order to fulfil certain information (requirements legal, alternatives to abortion, social assistance) and administrative formalities (recording the date of the beginning of the reflection period, submit to the woman a notification of the formalities completed), without which the abortion cannot proceed to internship . It is logical that a doctor who is reluctant to have an abortion would consider the submission of this notification as an act of cooperation with the evil of abortion, an act that is repugnant to his conscience. This is not the case here, as Spanish law does not provide for it.
In reality, in our country and as a consequence of Constitutional Court Ruling 53/1985, legal abortions, apart from extremely urgent ones, do not usually give rise to objection conflicts. Legal abortions performed in private clinics do not seem to be affected by objection conflicts: nobody there objects to abortion. The significant question is this, in my opinion: Do cases of extreme obstetric urgency, which cannot be postponed, with a living foetus, for which there is no other therapeutic option than abortion, occur in public hospitals, and which must necessarily be attended by a reluctant doctor, because at that very moment only that objecting doctor is present in the hospital? No one knows how many such cases may occur in Spain each year. From the most recent data published by the Ministry of Health, one can guess that very few, perhaps none. Taking the most recent statistics, those for 2005, we have the following figures:
Abortions performed in public hospitals: 2896.
Abortions performed for foetal indication: 2667.
Abortions performed at 21 weeks or later: 1814.
It is worth pausing for a brief consideration of these figures. The Ministry of Health has acknowledged that abortions of high risk for the mother and those motivated by serious foetal alterations are practically only carried out in public hospitals, as these are abortions that require diagnostic methodologies only available in hospitals. It can be assumed that the majority of abortions in public hospitals are carried out for foetal indications. On the other hand, abortions for serious gestational causes, if they occur, and because of their high risk, are programmed, in an advanced obstetric internship , outside the context of extreme urgency, according to a regulated procedure, which is likely to respect odec. If we take into account that many cases of obstetric emergencies correspond to situations in which the foetus is dead, we have very few cases left to assign to the hypothetical status to which I alluded in my question.
Fortunately, the dramatic situations of subject "or the life of the mother or the life of the foetus", "urgent interventions to prevent serious permanent injury to the pregnant woman" are, in advanced countries with a diligent gestational and obstetric attendance , somewhat exceptional. Catastrophic situations due to intercurrent diseases are not remedied by abortion. This clause is maintained in the Oslo Declaration because of the universal character of the WMA, which must make no distinction between advanced and developing countries development.
The problem of replacing the objecting doctor by the qualified colleague has today, in my view, more to do with issues of scheduling work, on-call shifts, even with the training of the young doctor, than with the responsibility staff of a given doctor. As someone has observed, "a prudent government should consider how it will be able to find health professionals who in good conscience are willing to carry out its policies (including abortion). They have made laws permitting abortion and obliging professionals to comply with them, but they have not paid attention to the basic principle of respecting, in the social framework , odec".
Particularly within health care institutions, odec can be a source of serious conflict. The relationship between ideologically indifferent or pro-abortion health managers and objectors is very complex. Managers are often fascinated by two aspirations: the machine-like efficiency of their management and the servile desire to please their superiors.
Fascinated by efficiency, they can never look with sympathy on those who break the regular rhythm of the uniform and programmed work . All the more so since hospital or health area managers, obsessed with reducing the economic cost of health care, have been invested with extensive organisational powers to keep the health care machine running at maximum performance level. This makes it necessary to consider any exception or exemption as a disturbing drawback of the supposedly homogeneous response.
It is a problem of institutional organisation and ethics. A final deontological aspect refers to it: corporate protection of the objector. Deontologically, odec is not only a private, individual problem of the objecting physician. It is a matter of concern to the entire medical profession, since it is the responsibility of the medical profession to guarantee, to the best of its ability, the legitimate independence of its members, which is an essential condition for the proper practice of the profession.
article 26.2 of the CEDM states that "A physician may inform high school of his or her status as a conscientious objector for whatever purposes he or she deems appropriate, especially if this status causes him or her conflicts of subject administrative or in his or her professional practice. The high school will provide the necessary advice and financial aid ".
Thus, the medical profession must protect its members from actions that diminish their freedom or discriminate against them because of their fidelity to ethical standards and to ethical principles that they have seriously matured and sincerely lived. It does so not only because the medical profession must contribute to a social life in freedom, but also to fulfil the statutory duty to defend the independence and dignity of doctors and to respond to the right of members to be defended by the high school or by the committee General. In the Central Commission's 1997 statement, the Colleges are invited to open a voluntary register in which members can register to record their odec.
To be registered and to merit institutional support requires that the objector's conduct, as such, be of a piece, committed, commensurate with the ethical dignity of the objection.
3. Some sociological aspects of odec
Since its origins, odec has been viewed with ambiguity. One cannot read without being struck by Thoreau's radical expressions, when he proposed in his Civil Disobedience, the rejection of military service, minimal government and respect for consciences. His demands for the moral maturity of the common citizen, his rhetoric on the need to be men first and only then subjects, his denunciations of the alienated life of his contemporaries, who for the most part serve the state not as free men but as machines, with their bodies, absent conscience, met with an ambiguous response of enthusiasm and rejection. More than a century and a half later, odec is greeted with the same mixture of admiration and annoyance.
odec is indeed annoying, for everyone. It is burdensome behaviour. Doctors and nurses who shrink from complying with legal standards or regulatory mandates cannot ignore it. As Rawls said: "We have to pay a certain price to convince others that our actions have, in our considered and mature view, a sufficient moral basis".
On the one hand, there is no shortage of reasons that make odec unpopular and unpopular. Like strikes, dissident behaviour does not always attract admiration and respect. Sometimes justifiably so, for odec is not always exercised righteously. It is possible and real, though I prefer to assume infrequent, to use odec opportunistically or perversely, to use it to avoid work obligations, to sabotage the system or to gratify one's ego.
There is recurrent talk, in political circles and in the media, of some doctors who object in their work hours in public services, but do not object in their internship private hours. This is an extremely serious accusation, which has never, it seems, materialised in formal complaints to the medical profession or the administration of justice. Those who follow such conduct would be subject to a very severe disciplinary transcript , since, as the CCD Declaration of 1997 states, such an attitude, in addition to abusing the objection, would be motivated by an illicit profit motive.
There is no shortage of data to suggest that odec is not only expensive and manipulable, but that it does not have a good press. It is presented to society in an unfavourable light.
At discussion , the disadvantages of odec outweigh its advantages. After all, those who do not object and are willing to carry out assignments and orders without restriction seem to have the ideal conditions for sociability and integration into the work team. This makes it easier to entrance on group and qualifies one to move up the organisational ladder. Whoever declares certain moral scruples or a selective conscience puts himself at a disadvantage in competition. He will encounter more obstacles in his professional degree program , some specifically established by legal rules. In France, and in some regions of Germany, for example, only candidates who do not object in conscience are eligible to head the obstetrics and gynaecology services of large public university hospitals. This is a highly dissuasive policy that puts ethical integrity at test staff by imposing a heroic choice between moral coherence and professional expectations.
For years, in England, Scotland and Wales, declaring one's reluctance to internship abortion de facto disqualified a student from admission to medical school, or a doctor from a gynaecology post in an NHS hospital. For almost 15 years the doors were closed to him, not by virtue of the law, but for reasons of mere intra-professional logistics. The Abortion Act 1967 states in section 4 that no person shall be compelled, whether by contract or by any other statutory or legal requirement, to participate in any treatment authorised by this Act. But it so happened that, within a few years of the Act coming into force, the workload of abortion had become unbearable for non-reluctant doctors. And it was these same doctors who made a stand: they made the continuation of their work conditional on only those doctors who did not resist abortion being admitted to work in the NHS in the future. In fact, qualifying boards openly, and illegally, questioned candidates about their attitude to abortion. Reluctant doctors were automatically excluded. By 1990, discrimination against objectors was so blatant that it prompted the intervention of the House of Commons Social Services Committee. Although many of the Commission's recommendations went unheeded, the tension that threatened to divide the medical profession was eased and partial solutions were enabled. In some hospitals, reluctant doctors were forced to practice a peculiar substitute service subject : they had to work as orderlies or clinic assistants one afternoon every other weekend.
Freedom was more costly and delayed for nurses, because according to an erroneous judicial interpretation of section 4 of the Abortion Act, which took years to rectify, nurses, as well as staff clinic assistants and secretaries, could not invoke odec.
Almost everywhere, however, it is difficult to maintain a sufficient number of doctors issue who do not resist the demand for abortions. Crises occur periodically, as it is a recurring experience in different countries and under different medical demographic conditions that doctors abandon internship abortion as soon as they can. On the occasion of a critical decrease of issue of these doctors in the British NHS, the causes of the phenomenon were reviewed. Vocational factors seem to play a decisive role. On the one hand, performing abortions lacks a technical perspective, it is a repetitive internship that leaves little room for improvement. On the other hand, the relationship between doctor and patient is poor: it does not provide a human contact , they do not see each other's faces, nobody smiles there, it does not leave in the conscience the idea of having done something good and great for someone else. It only gives relief at the end of the workshop. In other fields of the specialization program the doctor can say: "I cure cancer, I save children, I make women happy. That gives a rosy aura to work. In abortion he cannot say anything like that".
association The decline of issue of non-objecting physicians in the USA led, in 1999, the American Medical Association, the American College of Obstetricians and Gynecologists, the Joint Commission of accreditation of Hospitals and other organisations to prepare standards to make abortion education and internship abortion a prerequisite for the training of future specialists in Obstetrics and Gynecology. The initiative met with very strong resistance and, in the face of threats of a split within these organisations, had to be abandoned.
Some aspects of intra-professional sociology are also of great interest. A review of the writings of doctors who are supporters and opponents of odec shows that, on the intra-professional discussion , they invoke almost identical reasons for their respective points of view: protection of the law, the same professional ideals, ethical requirements, acceptance of a fair and equitable distribution of the workload.
Therefore, it does not seem easy to comply with Art. 33.3 of the CEDM, which imposes a special duty on the leaders of hierarchically organised groups of work to ensure that an ethical atmosphere of tolerance for the diversity of professional opinions exists among colleagues. Such harmony in diversity is not easy to achieve. Objecting behaviour breaks routines. It causes inconveniences, which should not have a negative connotation. Apart from having to be balanced by compensatory or substitute benefits, they should be regarded as the price to be paid so that everyone can live peacefully in ethical pluralism and thus contribute to the moral maturation of society.
In my opinion, peaceful coexistence cannot be achieved through the ethical abdication of strong convictions, which have to be surrendered prisoner to the minimum legal imperative. It seems to me that it is to be achieved through the friendly coexistence of people who respect each other in their inevitable diversity. The deontological mandate that rejects discrimination against patients on ideological or any other grounds subject also applies to interprofessional relations. The ethics of collegiality prohibits the constitution of groups in which any of its members could be exploited by others (art. 33.4). And I think that we are not dealing with mere wage or labour exploitation: more worthy of rejection is the exploitation, the expropriation, of freedom of conscience and freedom of prescription.
It would be foolish not to take into account that odec, due to the moral immaturity of those who profess it or those who do not adopt it, can be taken by third parties, actively or passively, as a moral reproach. Odec is a defence of one's own integrity, which must be exercised with humility, as it is exclusively about surviving in freedom and without harm. It can never be raised haughtily or aggressively. Therefore, odec cannot be received by patients or colleagues as a low blow, a moral insult, or a lesson in harsh morality. It can be a setback. In a modern society, we all have to pay tribute to the ethically justified demands of others. We have all suffered the consequences of a transport strike. Many sick people have been inconvenienced by a hospital strike. I think that travellers and patients, even in the midst of these setbacks, have not been able to deny a modicum of distant understanding for those who aspire to fairer wages or more humane conditions at work .
In today's society, the relationship between consumers and suppliers is very complex. The associative movement of users has brought about clear improvements in the quality and uniformity of the industrial products that are purchased, the food that is consumed, the services that are used, the attention that is received. The doctor-patient relationship has also been affected by the awareness of consumer rights.
Moreover, the influence of consumerism induces immediate satisfaction of aspirations for a more rewarding lifestyle, while the blandishments of advertising convince people not to be content with little, that they can have it all. It is not surprising, therefore, that a doctor's refusal to consent to an abortion can be received as a hurtful slight. This is all the more so because it is not simply a matter of the displeasure of not receiving immediately what one asks for, or the inconvenience of having to go elsewhere to get what one is looking for.
The objector's rejection of abortion is sometimes taken as a moral insult. Never does the customer who goes to a shop in search of a certain brand of product react as if he were morally assaulted by the shopkeeper's reply that he does not have that product because, for example, he has decided, in response to his political convictions, to boycott American products until the Washington government withdraws its soldiers from Iraq. The customer, more or less disgruntled, if he wants exactly that product, will go to other establishments: he knows that the satisfaction of his specific desire has a cost. And he also knows that sometimes he will have to resort to a substitute because the product of his choice is no longer marketed, not even on the Internet. It is no longer available. Our man will regret it, he will miss the good old days: he will neither be indignant nor cry out for revenge. Nor does it occur to him to report the case to the Department of Trade.
Conclusion
The odec of health professionals will continue to be the subject of discussion in society and within the professions.
It is still far from being a peaceful social achievement, an established individual right. Public opinion is divided on odec. Some believe that once certain actions, such as abortion or sterilisation, have been decriminalised, it is unfair for doctors to refuse them to those who request them, especially if they are among the health services offered or subsidised by the public health services. In this view, doctors and nurses are salaried technicians whose moral values must be subjected to legal dynamism. Others argue that, in an advanced society of free and responsible men, and caring for the rights and freedoms of its citizens, no one can legitimately be compelled to perform an action that is seriously repugnant to his or her moral conscience, as this would be tantamount to inflicting moral torture on that person.
The odec hides many professional values: respect for life, the considered freedom to prescribe, individual independence. It is therefore more than a survival mechanism in an ethically fractured society. It forces the development and fine-tuning of new critical attitudes and the fine-tuning of the mechanisms of negotiation - of learning how to stand at agreement and to live in disagreement - between doctors, patients and administrators. It uncovers the specific risk of commercialist corruption of the private internship . It advocates fair legislation, to prevent the risk that the objector may suffer moral damage and financial harm for bearing witness to the value of human life.
For their part, objectors are obliged to offer a social image of odec that is consistent with its ethical dignity. They will never abuse it or exploit it to their own advantage. They will not seek privileges, but neither should they resign themselves to being victims.
odec is an ethical treasure, a very excellent part of the moral heritage of people and humanity.