Skip to main content

Conscientious Objection and “Effective Referral”


Complicity in an immoral, and even criminal, activity, such as robbery or murder, is itself regarded as involving responsibility for those acts. What should the position be of health professionals who are expected to participate in actions that they believe are morally wrong? Professional responsibilities may clash with private conscience. Even referring a patient to someone else, when what is in question may be assisted suicide, or euthanasia, seems to involve some complicity. This is a live issue in Canada, but similar dilemmas occur elsewhere. Physicians and others should not be coerced into involvement of any kind in what they regard as wrong. Such coercion goes against the very principles of liberal democracy. Conscience matters. Reasonable accommodation should be given to those whose moral judgment may be at variance with prevailing professional norms. Moral questions should still be given weight within medicine, and disagreements respected. Dedication to the promotion of human welfare should be paramount, but it should be recognized that there may be different visions of what such welfare consists of.

Hide All


1. See News Release, March 6, 2015, College of Physicians and Surgeons of Ontario. Available at (last accessed 8 Oct 2015).

2. Huxtable, R, Mullock, A. Voices of discontent? Conscience, compromise and assisted dying. Medical Law Review 2015;23;242–63.

3. See note 2, Huxtable, Mullock 2015, at 251.

4. Carter v Canada (Attorney-General), 2015, SCCC 5.

5. See note 4, Carter v. Canada 2015, at 68.

6. See note 4, Carter v. Canada 2015, at 63.

7. For more on this see Trigg, R. Morality Matters. Oxford: Blackwell;2005.

8. Montgomery J. Conscientious objection: Personal and professional ethics in the public square. Medical Law Review 2015;23(2):200–20.

9. See note 8, Montgomery, at 220.

10. As in the case of Ladele, dealt with by the European Court of Human Rights, in Eweida and Others , v. United Kingdom , Strasbourg, No 28420/10, 2013. For more on this case, see Trigg, R. Religious Diversity: Philosophical and Political Dimensions, Cambridge: Cambridge University Press; 2014, at 182ff.

11. See note 10, Trigg 2014, at 182–3.

12. See note 8, Montgomery, at 220.

13. See note 4, Carter v. Canada 2015, at 132.

14. Downie, J, McLeod, C, Shaw, J. Moving forward with a clear conscience: A model conscientious objection policy for Canadian Colleges of Physicians and Surgeons. Health Law Review 2013; 21(2):832.

15. See note 14, Downie et al. 2013, at 31.

16. See note 14, Downie et al. 2013, at 31.

17. See note 14, Downie et al. 2013, at 31.

18. See note 14, Downie et al. 2013, at 31.

19. Weinstock, D. Conscientious refusal and professionals: Does religion make a difference? Bioethics 2014;28:815.

20. Reynolds v. United States, 98 U.S. 145 (1878).

21. United States Court of Appeals for the Ninth Circuit, Stormans, Inc v. Wiesman, No.12-35221, 2015, at 41.

22. See note 21, Stormans, Inc v. Wiesman 2015, at 23.

23. Greater Glasgow Health Board v. Doogan (Scotland), 2014 UKSC 68, at 40.

24. See note 23, Greater Glasgow Health Board 2014, at 38.

25. See Heino, A, Gissler, M, Apter, D, Fiala, C. Conscientious objection and induced abortion in Europe. The European Journal of Contraception and Reproductive Health Care 2013;18(4):231–3.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
  • URL: /core/journals/cambridge-quarterly-of-healthcare-ethics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 34
Total number of PDF views: 274 *
Loading metrics...

Abstract views

Total abstract views: 742 *
Loading metrics...

* Views captured on Cambridge Core between 9th December 2016 - 24th May 2018. This data will be updated every 24 hours.