Conscientious objection: a global health perspective

Abstract

Conscientious objection is a critical topic that has been sparsely discussed from a global health perspective, despite its special relevance to our inherently diverse field. In this Analysis paper, we argue that blanket prohibitions of a specific type of non-discriminatory conscientious objection are unjustified in the global health context. We begin both by introducing a nuanced account of conscience that is grounded in moral psychology and by providing an overview of discriminatory and non-discriminatory forms of objection. Next, we point to the frequently neglected but ubiquitous presence of moral uncertainty, which entails a need for epistemic humility-that is, an attitude that acknowledges the possibility one might be wrong. We build two arguments on moral uncertainty. First, if epistemic humility is necessary when dealing with values in theory (as appears to be the consensus in bioethics), then it will be even more necessary when these values are applied in the real world. Second, the emergence of global health from its colonial past requires special awareness of, and resistance to, moral imperialism. Absolutist attitudes towards disagreement are thus incompatible with global health's dual aims of reducing inequity and emerging from colonialism. Indeed, the possibility of global bioethics (which balances respect for plurality with the goal of collective moral progress) hinges on appropriately acknowledging moral uncertainty when faced with inevitable disagreement. This is incompatible with blanket prohibitions of conscientious objection. As a brief final note, we distinguish conscientious objection from the problem of equitable access to care. We note that conflating the two may actually lead to a less equitable picture on the whole. We conclude by recommending that international consensus documents, such as the Universal Declaration on Bioethics and Human Rights, be amended to include nuanced guidelines regarding conscientious objection that can then be used as a template by regional and national policymaking bodies.

Keywords: Global Health; Health policy.

Figure 1. The possibility of global bioethics hinges on reconciling different value priorities with an objective project of collective ethical progress. In this figure we use differences in prioritisation of communitarian and individualistic societies (prioritisations that do not necessarily exclude each other—see reference #⁷¹) to illustrate how such an endeavour might be possible. Each value-vector (blue and red) has a magnitude and a direction, the sum of which (purple) reflects general priorities for that society. It is the business of ethics to identify the relevant value-vectors, as well as the direction and weight they carry in a given argument. Although magnitudes and directions ascribed by societies may differ, these differences are intelligible to us because we ultimately rely on the same laws of reason (analogous to the laws of physics in our example of vectors). We credit the vector analogy to a talk given by Julian Savulescu at the Oxford Uehiro Centre for Practical Ethics on 10 June 2023.