Conscientious provision and the problem of state legitimacy in bioethics, Guest Lecture A/Prof Richard Matthews (Bond)
Conscientious refusal is concerned with the rights of healthcare workers to refuse, on the grounds of conscience, to provide specific healthcare – such as abortion, emergency contraception, or sterilization - that is otherwise safe, legal and professionally permissible. Conscientious provision is an apparently similar concept where healthcare workers provide, on the grounds of conscience, safe and beneficial healthcare to patients in spite of legal prohibition, denial of resources, policy formation or informal pressure. It can include abortion provision or euthanasia in states that prohibit them. In recent years, a debate has emerged about the claimed symmetry of conscientious refusal and conscientious provision, that a right to the one entails a right to the other. This is incorrect – no state will provide a conscientious provision right. It fails to recognize that conscientious provisions not uncommonly involve law violations and that they are concerned with allyship with those marginalized by state law, policy and resource allocation decisions. Conscientious provision is important, but it requires a critical engagement with the violence of the state – in this context the liberal state – and the ways that privilege and oppression function to unjustly shape access to important healthcare goods. This paper has the following goals:
- to distinguish conscientious refusal and conscientious provision
- to situate the moral dilemmas of conscientious providers in the privilege and oppression relations that mark liberal states
- to use some recent Canadian cases to capture the moral ambiguities of professional boards, healthcare institutions and state laws, and their underpinning violence
- to conclude that bioethicists need to adopt a politically and morally critical attitude towards liberal states in their provision of health care