Book Review: Alberto Giubilini et al., “Rethinking Conscientious Objection in Health Care”

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Rethinking Conscientious Objection in Health Care

Alberto Giubilini, Udo Schuklenk, Francesca Minerva, and Julian Savulescu, Oxford University Press, 2025
ISBN 978-0-1977-8653-6, 272 pages, Hardback, $40.25

In recent years, amid the increasing availability and social acceptability of controversial medical procedures, the role of conscientious objection in healthcare has come under renewed scrutiny. In Rethinking Conscientious Objection in Health Care, Giubilini et al. present a case against the right of healthcare practitioners to exercise conscientious objection according to their moral convictions. Concerned with the widening use (and abuse) of conscientious objection, the authors insist that objections in medical practice ought to be grounded on professional standards and clinical judgment—and not on what they deem as “personal conscience” (p. 3, emphasis original).

Organised into four main chapters, this monograph argues that, although there can be reasonable disagreement regarding the ethics of contentious yet legally accessible medical procedures, “it is not a health professional’s responsibility or prerogative to assess whether a certain legal provision is ethically right or wrong, particularly at the bedside” (p. 4). Accordingly, it is contended that, since health practitioners voluntarily enter professions that render them into “state-sanctioned monopoly providers of medical services” (p. 6), they ought to act in ways that do not deviate from existing professional standards, notwithstanding their moral beliefs. As the authors declare, “conscientious objection contravenes professional responsibilities, and professional responsibilities take priority over personal moral views” (p. 18).

In Chapter 1, Giubilini et al. explore the concept of conscience as it relates to conscientious objection. While acknowledging that conscience appertains to one’s core moral beliefs and identity, the authors question the notion of conscientious objection as a fundamental right. Seizing on the notorious complexity of defining conscience, the authors claim that cases of conscientious objection commonly applaud a mere appeal to the vague notion of “conscience,” irrespective of the rationale for the objection. That is, “it does not depend on the actual content of one’s core moral beliefs” (p. 22). Thus, it is the role of professional standards, social norms, and legal obligations to balance claims of conscientious objection in healthcare. However, even though “conscience and moral integrity do matter,” according to Giubilini et al., “other considerations matter as well, maybe even more” (p. 25).

Furthermore, the authors propose that conscience “is primarily a matter of strongly felt inward conviction” (p. 26, emphasis original). In tracing the concept of conscience through history and philosophy, the authors note what they perceive as an inconsistency in how religious institutions—namely, the Catholic Church—handle conscientious objection. They write, “the [Catholic] Church is not a known defender of conscientious objectors who wish to provide abortion or euthanasia” (p. 29). Indeed, Giubilini et al. divorce the principle of freedom of conscience from its substantive content—that is, the ethics concerning a concrete matter (e.g., abortion). Therefore, the authors contend that advocates of conscientious objection must “bite the bullet” (p. 33): either accepting that their claims are based on idiosyncratic moral views or conceding that conscientious objection should be applied to every and any case.

In Chapter 2, Giubilini et al. present their core arguments against consciousness objection in healthcare. Predicated on the notion that the mere allowance of conscientious objection, at a minimum, entails a risk of harm to patients, the authors focus on the concept of professionalism and professional obligation as the main pillars of their case against conscientious objection. First, the authors stress that health practitioners, by virtue of their professional status, “act as fiduciaries for their patients” (p. 50). This, in turn, establishes the basis for professional obligations, given the presumption that the best interest of patients must be prioritised ahead of self-interest. For Giubilini et al., this all but proves the “incompatibility thesis”—that is, that conscientious objection is incompatible with carrying out professional duties. Thus, the authors contend that “given that the goal of the medical profession is to put the public good, and patients’ interests, first, it is at least arguable that such permissions and exemptions [i.e., conscientious objection] are not appropriate for the profession” (p. 60).

Second, the authors shift their focus to the “objection” involved in a consciousness objection. They argue that, unlike lay members of society who can exercise their freedom of conscience without the need to object, health practitioners, as professionals with professional obligations, do not have this same freedom. In the case of professionals, the authors suggest, “there is at least a presumption against freedom of conscience, from which those putting forward an objection claim an exemption” (p. 69). Therefore, the prospective conscientious objector has the onus to demonstrate why an objection—implying a deviation from professional standards—should be granted. As Giubilini et al. put it, “an argument needs to be provided in support of an objection. We cannot simply assume that for people to invoke their own conscience is itself a reason to shift the burden of proof on to those who want to deny a right to conscientious objection” (p. 81).

But what if certain professional standards are ethically wrong? Would this be a ground for claiming conscientious objection? According to Giubilini et al., the answer is “no.” Instead, the authors propose that “challenging professional standards falls within the realm of political action, not the realm of clinical practice” (p. 84). To be sure, the authors concede that a corollary from their rejection of conscientious objection is that it reduces health practitioners to mere technicians. They write, “there is only so much space for discretion that a professional can exercise, and in some circumstances that space is very narrow, and following a procedure is all a professional can be expected to do” (p. 99).

In Chapter 3, the authors attempt to disprove certain arguments in favour of consciousness objection. Their major point in rebutting such arguments is that individuals enter professions voluntarily. As they put it, “Failing to respect a person’s conscience would occur if that person were forced into a profession that requires them to act against their conscience. . . . But people are not conscripted to be doctors” (p. 118).

In Chapter 4, Giubilini et al. explore several specific cases of conscientious objection claims, both negative (or, as they call it, “conscientious objection as omission”) and positive (or “conscientious objection as action”). These cases include abortion, medical assisted dying, in-vitro fertilisation for same-sex couples, bioenhancement, and genome editing. In their Conclusion, the authors underscore that “medicine and health care as professions must be fundamentally guided by standards of professionalism, and not by the personal values of professionals” (p. 242).

While Rethinking Conscientious Objection in Health Care is well written, Giubilini et al. offer a case against conscientious objection that mostly recycles common arguments. The authors are right to be concerned with abuses in claims of conscientious objection, particularly within healthcare. The authors are also right in pointing out that claims of conscientious objection ought to be supported by sound ethical arguments. However, they are wrong to reject conscientious objection, notably with arguments that amount to “so what.” Conscience, core moral beliefs, and identity are important, but so what? Yet, healthcare professionals are more than mere practitioners or providers. Moreover, Giubilini et al.’s description of conscience as personal and inward “feelings” is not merely a simplistic caricature but a misrepresentation of the true depth of moral conscience. In any case, this book is a reminder of the importance of having a well-formed and informed conscience. To paraphrase 1 Peter 3:15: “Always be ready to make your defence to anyone who demands from you an accounting for the hope—or conscience—that is in you.”

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