HEC Forum

pp 1–22 | Cite as

Conscientious Objection and Physician–Employees

  • Paul J. CumminsEmail author


This article attempts to motivate a reorientation of ethical analysis of conscientious objection (CO) by physicians. First, it presents an illustrative case from a hospital emergency department for context. Then, it criticizes the standard pro- and anti-CO arguments. It proposes that the fault in standard approaches is to focus on the ethics of the physician’s behavior, and a better way forward on this issue is to ask how the party against whom the physician exercises the CO ought to respond. It connects this question with recent trends in physician employment models, which suggest that CO may become a potential source of conflict in the future. The article then develops a relational account of CO that extends James Childress’ insights about the nature of CO in “Appeals to Conscience” (1979). This relational account characterizes CO as a two-place relation between conscientious objector and expectant party, in which the conscientious objector makes a request of the expectant party, which has implications that will be welcome and unwelcome for both the pro- and anti-CO camps. Finally, the paper applies this relational account of CO to the case when the physician is an employee. This application demonstrates that it is highly context dependent whether or not an employer should accede to the CO requests of physician–employees.


Conscience Conscientious objection Physician Employee 



  1. American Medical Association, Council of Ethical and Judicial Affairs. (2016). Code of medical ethics opinion 1.1.7: Physician exercise of conscience. AMA. Retrieved Jan 26, 2019, from
  2. Associated Press. (2019). Trump administration agrees to delay health care rule. June 30. Retrieved July 9, 2019, from
  3. Bentham, J. (2002). In P. Schofield, C. Pease-Watkin, & C. Blamires (Eds.), Rights, representation, and reform nonsense upon stilts and other writings on the French revolution. New York: Oxford University Press.Google Scholar
  4. Cantor, J. D. (2009). Conscientious objection gone awry—Restoring selfless professionalism in medicine. New England Journal of Medicine,360(15), 1484–1485.CrossRefGoogle Scholar
  5. Childress, J. F. (1979). Appeals to conscience. Ethics,89(4), 315–335.CrossRefGoogle Scholar
  6. Childress, J. F. (1985). Civil disobedience, conscientious objection, and evasive noncompliance: A framework for the analysis and assessment of illegal actions in health care. The Journal of Medicine and Philosophy,10(1), 63–83.CrossRefGoogle Scholar
  7. Cohen, J. K. (2019). HHS finalizes faith-based protections for healthcare workers. May 2. Modern Healthcare, Crain Communications. Retrieved July 9, 2019, from
  8. Cowley, C. (2016). A defence of conscientious objection in medicine: A reply to Schuklenk and Savulescu. Bioethics,30(5), 358–364.CrossRefGoogle Scholar
  9. Department of Health and Human Services. (2019). HHS announces final conscience rule protecting health care entities and individuals. May 2. Retrieved July 9, 2019, from
  10. Emergency Medical Network. (2018). National emergency department inventoryUSA. March 3. Retrieved Jan 26, 2019, from
  11. Flynn, C., & Wilson, R. F. (2013). Institutional conscience and access to services: Can we have both? Virtual Mentor,15(3), 226–235.Google Scholar
  12. Giubilini, A. (2014). The paradox of conscientious objection and the anemic concept of ‘conscience’: Downplaying the role of moral integrity in health care. Kennedy Insitute of Ethics Journal,24(2), 159–185.CrossRefGoogle Scholar
  13. Haefner, M. (2018). Hospitals employed 42% of physicians in 2016: 5 study findings. Becker’s Hospital Review. March 15. Retrieved Nov 30, 2018, from
  14. Hughes, J. A. (2017). Conscientious objection in healthcare: Why tribunals might be the answer. Journal of Medical Ethics,43(4), 213–217.CrossRefGoogle Scholar
  15. King, M. L., Jr. (1963). Letter from Birmingham Jail. Liberation, June.Google Scholar
  16. LaFollette, H. (2017). My conscience may be my guide, but you may not need to honor it. Cambridge Quarterly of Healthcare Ethics,26(1), 44–58.CrossRefGoogle Scholar
  17. Lamb, C. (2016). Conscientious objection: Understanding the right of conscience in health and healthcare practice. The New Bioethics,22(1), 33–44.CrossRefGoogle Scholar
  18. Magelssen, M. (2012). When should conscientious objection be accepted? Journal of Medical Ethics,38(1), 18–21.CrossRefGoogle Scholar
  19. Meyers, C., & Wood, R. D. (2007). Conscientious objection? Yes, but make sure it is genuine. American Journal of Bioethics,7(6), 19–20.CrossRefGoogle Scholar
  20. Minerva, F. (2015). Conscientious objection in Italy. Journal of Medical Ethics,41(2), 170–173.CrossRefGoogle Scholar
  21. Morgan, R. E, & Truman, J. L. (2018). Criminal victimization, 2017. Bureau of Justice Statistics. Bureau of Justice. December 21. Retrieved Jan 26, 2019, from
  22. Orr, R. D. (2013). Autonomy, conscience, and professional obligation. Virtual Mentor,15(3), 244–248.Google Scholar
  23. Pellegrino, E. D. (2002a). Professionalism, profession and the virtues of the good physician. Mount Sinai Journal of Medicine,69(6), 378–384.Google Scholar
  24. Pellegrino, E. D. (2002b). The physician’s conscience, conscience clauses, and religious belief: A Catholic perspective. Fordham Urban Law Journal,30(1), 221–244.Google Scholar
  25. Rhodes, R. (2006). The ethical standard of care. American Journal of Bioethics,6(2), 76–78.CrossRefGoogle Scholar
  26. Rhodes, R., & Danzinger, M. (2018). Being a doctor and being a hospital. American Journal of Bioethics,18(7), 51–53.CrossRefGoogle Scholar
  27. Russell, R. R. (1952). Development of conscientious objector recognition in the United States. George Washington Law Review,20, 409–448.Google Scholar
  28. Savulescu, J. (2006). Conscientious objection in medicine. BMJ,332, 294–297.CrossRefGoogle Scholar
  29. Sawicki, N. N. (2018). Disentangling conscience protections. Hastings Center Report,48(5), 14–22.CrossRefGoogle Scholar
  30. Schuklenk, U. (2018). Conscientious objection in medicine: Accommodation versus professionalism and the public good. British Medical Bulletin,126(1), 47–56.CrossRefGoogle Scholar
  31. Schuklenk, U., & Smalling, R. (2017). Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies. Journal of Medical Ethics,43(4), 234–240.CrossRefGoogle Scholar
  32. Simmons-Duffin, Selena. 2019. What’s behind a rise in conscience complaints for health care workers? May 9. National Public Radio. Retrieved July 9, 2019, from
  33. Singleton, T., & Miller, P. (2015). The physician employment trend: What you need to know. Family Practice Management,22(4), 11–15.Google Scholar
  34. Smalling, R., & Schuklenk, U. (2017). Against the accommodation of subjective healthcare provider beliefs in medicine: Counteracting supporters of conscientious objector accommodation arguments. Journal of Medical Ethics,43(4), 253–256.CrossRefGoogle Scholar
  35. Stahl, R. Y., & Emanuel, E. J. (2017). Physicians, not conscripts—Conscientious objection in health care. New England Journal of Medicine,376(14), 1380–1385.CrossRefGoogle Scholar
  36. Stephens, S. (2018). The rise of hospitalistsAnd what comes next. April 5. Retrieved Nov 30, 2018, from
  37. Sulmasy, D. P. (2008). What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics,29(3), 135–149.CrossRefGoogle Scholar
  38. Uttley, L., & Khaikan, C. (2016). Growth of Catholic hospitals and health systems: 2016 update of the miscarriage of medicine report. New York: The MergerWatch Project.Google Scholar
  39. Wicclair, M. R. (2000). Conscientious objection in medicine. Bioethics,14(3), 205–227.CrossRefGoogle Scholar
  40. Zubik, D. A. et al. v. Sylvia Burwell, Secretary of Health and Human Services, et al. (2016). 578 (The Supreme Court, May 16).Google Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Medical Education, Bioethics ProgramIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations