According to Holroyd (1971: 628), in March 1916 the author Lytton Strachey attended a tribunal, seeking exemption from conscription on the grounds of conscientious objection (CO). He was asked by a tribunal member, ‘…what would you do if you saw a German soldier attempting to rape your sister?’ Strachey replied: ‘I should try and come between them.’ The tribunal rejected his CO, but he was deemed medically unfit for service.
At first glance, the story of how a great author, and greater snob, avoided military service a century ago has little resonance with modern health care. But with rape a common weapon of contemporary war, a modern-day Strachey might argue that if his sister were raped by a soldier, he would recommend emergency hormonal contraception, which has been available without prescription since 2002 in the UK and 2011 in Ireland (Gallagher et al, 2013).
Strachey's CO is relevant to the ethics of some health-care providers who withhold emergency contraception from patients, and justify their inaction by describing themselves as conscientious objectors. Just as CO to military service opposes the taking of human life through combat, some people object to emergency contraception as they see it as the taking of human life through medical intervention. But is the principle behind CO to military service applicable to non-provision of emergency contraception? A conscientious objector who objects to killing in war will be against all wars, and accepts the consequences. Similarly, a conscientious objector to emergency contraception because it kills a zygote will oppose all medicines that might kill a zygote, and accept the sanction(s) of their regulating authority.
But there's a complication. Opposition to both emergency contraception provision and any other medicine that might kill a zygote entails opposition to the provision of, for example, certain medicines that influence lactation. This is because some women who breastfeed experience lactational amenorrhoea, the post-fertilisation effect of which could prevent implantation, killing a potential zygote. COs to breastfeeding are absurd, no matter the threat to a zygote, so it is the principle of selective CO to emergency contra ception provision that is invoked by a conscientious objector. This places a ‘selective’ conscientious objector on shakier moral ground than a ‘conventional’ one, the former asserting a strongly held belief in one case but a less strong belief in another.
Conscientious objectors are particularly strident in relation to abortion. In December 2014, the UK Supreme Court ruled that two Catholic midwives, employed as labour ward coordinators at the Southern General Hospital, Glasgow, had no right to avoid supervising other staff involved in abortion procedures (BBC News, 2014). The midwives highlighted the provision in the Abortion Act 1967 which states that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection.’ But the Supreme Court judged this provision inapplicable to the midwives' work as labour ward coordinators.
To what extent is CO to abortion accepted in other countries? Heino et al (2013) explain that of the EU member states where induced abortion has been legalised, the law allows the assertion of CO in 21 countries; in addition, it is permitted in the non-EU countries Norway and Switzerland. However, CO is denied in Sweden, Finland, Bulgaria, the Czech Republic and Iceland. The authors consider that CO reinforces the stigma associated with abortion, and recommend that if CO is to be granted, it ‘should be overseen by competent national or regional authorities that guarantee equal access to abortion for all women regardless of their place of residence or financial situation’ (Heino et al, 2013: 233). They also make the sensible suggestion that disclosing one's position on CO should be part of the recruitment process when applying for positions where it might be invoked.
But Cowley (2015), in addressing doctors' objections to abortion in the UK, argues that such individuals should not be formally required to defend their beliefs. He was responding to a suggestion that conscientious objectors in health care settings should give their reasons for CO to a tribunal, essentially modelled along the military one which Strachey attended a century ago.
Hughes (2016), however, takes the opposite view. He cites Cowley's admission that ‘access to a non-objecting doctor “might be an issue in some remote rural parts of the UK, and it might become an issue in the future if there are too many objecting doctors.”’ This, according to Hughes, is an important concession, since denial of access to abortion services may expose a pregnant woman to a range of unwanted medical, psychological, social and economic risks.
It seems reasonable to expect that the delivery of appropriate treatment to women who ask for help—whether in the form of legally approved emergency contraception or abortion—should not be impeded by the religious views and moral judgments of health-care providers such as (or, perhaps, especially) midwives.