Conscientious objection—the morality of opting out of responsibility

At a recent meeting of a hospital ethics committee of which I am a member, there was a discussion about conscientious objection on the part of pharmacists and physicians. Here are some of my thoughts about the role of individual conscience and responsibilities to the larger group:

In 1965, the Met Opera Orchestra put Wagner’s Die Walküre on its program list. At that time, the German composer’s music was still pungent with memories of his anti-Semitism and of Hitler’s great fondness for the composer’s music and philosophy. At that time, Wagner’s music was still under an unofficial ban in Israel. No matter how great the music might be, for many the composer’s life and the uses to which the music was put couldn’t be dismissed or forgotten. Art couldn’t be separated from the artist; the music itself was contaminated.

At that time, the Met Opera Orchestra had three members who were Holocaust survivors. One refused to play the scheduled Die Walküre. The orchestra’s managing director honored the musician’s conscientious objection. To its credit, the orchestra didn’t force to musician to choose his conscience and his job. Unlike many in Germany just a few years before, this musician didn’t have to submit himself to the group’s will.

In 1982, Amnesty International USA Group #74, which I co-founded, had been given the case of George Boviastos, a young Jehovah Witness in Greece who, on religious grounds, refused military service. He was one of over 100 Greeks serving four-year time prisoner terms for refusing military conscription. Greek law provided for non-combatant roles in the army, but the Jehovah Witness said that service in the military under any condition was morally unacceptable. When Boviastos was released, he was drafted again, refused one more time and was sentenced to another four-year term.

Last year, nine nurses in Nassau County refused to assist in an abortion when a woman’s water broke after 14 weeks. The attending physician said that the fetus could not survive outside the womb at such an early stage. However, the nurses on duty said that the fetus still had a heartbeat and the mother’s life wasn’t in danger. As a matter of conscientious objection, they wouldn’t follow the doctor’s directions. At first the hospital suspended the nurses, then rescinded its decision and apologized to the nurses saying that it had mistakenly believed that the mother’s life was in danger. Under federal law, health care workers can opt out of a procedure for moral reasons, except in a life-threatening situation.

Finding the right balance between duty (to play in the orchestra, obey the law, carry out medical responsibilities) and personal morals can be difficult. In many of the podcasts I have recorded that are on this blog ( people struggle between following directions from supervisors, adhering to rules, regulations and the law, or following their own consciences.

There is a problem when one person’s conscience causes harm to another. If the musician doesn’t play, there may be no program. This harms other orchestra members and those who came to hear the concert. If a citizen refuses military conscription, someone else will have to take his place. And if nurses refuse to assist in an abortion, the doctor’s professional judgment is undermined.

No one should be forced to act against his most fundamental ethical values. But that doesn’t mean that the individual has the final word. The musician can refuse to play but cannot expect to do so with impunity. It would be callous for the Met Opera Orchestra to have fired the protesting musician because his reasons were understandable to any thoughtful person. And it was relatively easy to find a substitute for the one-time performance. If, however, the Met had scheduled many Wagner operas, then it would be time for the musician to take a sabbatical or find a new orchestra.

Greece fell short in providing for conscientious objection by not offering civilian alternative service. Until the law was changed, Boviastos and others were punished for their non-compliance. If they believed that the law was unjust and they had the moral obligation to resist it, they also could rightly expect to be punished. Gandhi, Martin Luther King and other conscientious objector didn’t plead for immunity from the law but that the unjust law changes.

As for the nurses: professionals assume moral duties. Their professional responsibilities are expected to carry more weight than personal feelings. Part of a professional’s obligation is to serve without judgment. A firefighter needs to put out a fire even in a crack house; a defense attorney is expected to mount the best defense even if the client is reprehensible. Medical professionals are expected to treat patients even if the patients have lung cancer because they are chain smokers.

So should the Nassau nurses’ conscientious objection to abortion have been respected? Yes, provided there was backup for their decision. If the physician ordered the abortion and needed nurses to assist, then substitute nurses need to be available. Medical personnel have a professional obligation to serve patients. If their conscience won’t allow them to do this (as in abortions), they need to find work in a setting in which they can reasonable expect not to be put in conflictual situations (a Catholic hospital, for example).

Everyone has a right to conscientious objection, but that right isn’t absolute. Good laws need to make room for reasonable accommodations for personal beliefs while at the same time ensuring that the public’s right to be served isn’t violated.


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