In medicine, so-called “conscientious objection” occurs when a healthcare professional refuses to provide a legal medical service based on their personal or religious beliefs. This happens mostly for abortion and contraceptive care.
I propose a more accurate term: Belief-based care denial. This phrase makes it clear that treatment is being refused due to ideological reasons and not clinical considerations. Further, care denials are not conscientious because they cause harms to patients and create barriers to care. The new term also illuminates the contradiction of a doctor elevating their personal interests above their duty to provide healthcare, even though doctors are bound by regulations and ethical codes that prioritize patient interests.
Belief-based care denial is a relatively new phenomenon that began when abortion was legalized in the UK in 1967 and the United States in 1973. Around the world today, almost all care denials are still exercised mostly for abortion, also other reproductive healthcare like contraception and sterilization, and increasingly for medical assistance in dying as it is legalized.
How did the term “conscientious objection” get adopted?
In the UK around 1960, Glanville Williams drafted the earliest known example of a “conscience clause”, which aimed to protect doctors from liability if they refused to provide legal abortions. Williams was a legal scholar and president of the Abortion Law Reform Association that worked to legalize abortion, but he was also a conscientious objector during World War II. So it’s likely that he simply adopted the term on the assumption that refusing to provide abortions could be equated to refusing to fight in a war. But can it?
Military conscientious objection (CO) is nothing like healthcare “conscientious objection” (“CO”)
- Soldiers are drafted into compulsory service in a subordinate position, while doctors who deny care based on personal beliefs enjoy a position of power and authority, and voluntarily entered their occupation.
- Soldiers must justify their stance before a tribunal and accept punishment or alternate service in exchange for exercising their CO, while healthcare professionals usually have no obligation to justify their “CO,” rarely face consequences for denying care, often retain their positions and salaries, and may escape stigma or harassment by avoiding abortion provision. It is patients who bear the burdens of “CO,” not doctors.
- Soldiers are conscripted to kill others for the economic or political benefit of those in power, while doctors have a duty to help patients and preserve their health and lives.
Calling the denial of healthcare “conscientious objection” is therefore dishonest — also because it frames abortion as inherently immoral. In fact, safe and legal abortion reduces maternal mortality, improves lives, and furthers gender equality. Objections to providing abortions are based on a denial of that evidence and the known harms of criminalizing abortion. The provision of abortion is a vital public interest that negates the grounds for belief-based care denial.
Other factors point to the illegitimacy of “CO” in healthcare
The problem is not just with the term, but the entire practice of belief-based care denial and how it arose. First is the undue influence of religion.
The UK legalized abortion in 1967 and its new Abortion Act included a “conscience clause” very similar to Glanville Williams’ original draft. But the addition was fundamentally rooted in moral and religious disapproval of abortion. Williams said in the 1960 book Law for the Rich that his clause was intended to protect any individuals with “conscientious objections” to abortion, specifically Roman Catholic practitioners.
A concern at the time was that if abortion was legalized, doctors would be obligated to provide them or face legal punishment. Many doctors as well as Members of Parliament were Catholic, and their alarm was shared by the British Medical Association, which strove to protect doctors’ decisional authority over patients. The MP who introduced the bill, David Steel, cited the influence of priests at a Catholic parish in his constituency as the main reason he added a “conscience clause” to his bill. Steel was also pressured to include the clause by MP Norman St John-Stevas, whose chief loyalty was to the Catholic Church.
Belief-based care denial is inextricably linked to religious beliefs, which drive abortion stigma and political action against abortion rights. From the start, the Catholic Church and Christian right have sought to ensure that healthcare professionals and religious hospitals could deny abortion provision under the guise of “conscience.” Further, religious and anti-choice organizations have tried to expand belief-based care denials to a wide array of services.
READ MORE: Conservatives amplify anti-choice rhetoric in the House of Commons
Abortion remains stigmatized in part because the Catholic Church is still powerful enough to enforce traditional sexist beliefs about women, who are expected to fulfil a motherhood role and may face disapproval or hostility when requesting abortion. Belief-based care denial becomes a paternalistic initiative to compel women to give birth. More seriously, it represents a repudiation of their autonomy and civil rights.
Second, medicine is a scientific pursuit that relies on evidence, not religious faith. Doctors are part of a regulated profession — their work fulfills a public trust and they owe a fiduciary duty to patients. Belief-based care denial turns this duty upside down and creates a conflict of interest. Care deniers are abusing their position of trust and authority by imposing their personal views on patients.
Doctors are in a privileged position and have willingly entered their profession knowing that it entails a duty to care for patients. For example, the specialty of Obstetrics/Gynecology should obligate doctors to help people with unplanned pregnancies, and family doctors should be expected to write prescriptions for contraception.
Third, patients’ rights and health have been deprioritized in the debate over “CO.” Refusals to provide healthcare must not be based on a patient’s gender, race, religion, disability, or medical condition. But belief-based care denial is rooted in gender discrimination because reproductive healthcare and gender-affirming care are largely delivered to women and 2S/LGBTQ+ people. Denials of medical assistance in dying are discriminatory on grounds of age or disability as well as medical condition.
Care denials cannot be an issue of “competing rights” between the healthcare professional and the patient because there is no “balance” when an authority figure is allowed to impose their beliefs on a dependent person. A patient’s right to life and health has no moral equivalency with a doctor’s supposed right to refuse them care — especially since doctors exercise a monopoly on healthcare that can leave patients at risk of going without care.
Let’s call it “belief-based care denial” and stop the harms
After the UK’s 1967 Abortion Act, belief-based care denial spread to almost every country in the world (only four explicitly disallow it). Virtually no monitoring or enforcement occurs anywhere, giving care deniers impunity when they too often withhold referrals or other required actions to assist the patient. This can result in serious harm to patients.
I’ve collected about 80 stories from global media and NGO reports where women have suffered serious harm or injustice after being denied legal abortion by “objectors,” including death in several cases. These stories are the tip of the iceberg, as only a few cases ever become public.
Why should society allow belief-based care denial in the 21st century when we have clear evidence of the harms it causes, and of the necessity of access to safe and legal abortion? Supporting it just cedes ground to the anti-choice movement and weakens the causes of reproductive rights and gender equality. We cannot have religion and patriarchy dictating who gets what medical care. Support rabble today!
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Nick Seebruch, editor
Over time, it may be possible to reduce or eliminate belief-based care denial by following some common-sense steps (which do not involve forcing doctors to do abortions). Let’s start by ditching the misleading phrase “conscientious objection,” which has become nothing more than an anti-choice propaganda term. I urge everyone — medical professionals, advocates, NGOs, academics, and governments — to adopt the term belief-based care denial.
