{"id":859,"date":"2009-10-26T16:12:52","date_gmt":"2009-10-26T15:12:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=859"},"modified":"2009-10-26T16:43:12","modified_gmt":"2009-10-26T15:43:12","slug":"john-coggon-can-a-conscience-dictate","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/26\/john-coggon-can-a-conscience-dictate\/","title":{"rendered":"John Coggon: Can a conscience dictate?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" style=\"float: left\" src=\"http:\/\/www.bmj.com\/channels\/icons\/john_coggon.jpg\" alt=\"john coggon\" width=\"160\" height=\"110\" \/>If I asked a physiologist to show me where her conscience is, I\u2019m fairly sure she\u2019d not be able to.\u00a0 Yet, it seems, a great many doctors appeal directly to their consciences, or at least wish to be free to do so.\u00a0 This is a little strange.\u00a0 If a patient says \u201cGod makes me do it\u201d suspicions arise.\u00a0 So why should a doctor be at liberty to appeal to something beyond the empirically demonstrable?\u00a0 I work in \u201chealth law and ethics\u201d, and see lauded the great march away from a \u201cBolamised\u201d system, wherein clinical judgement counted (officially) for pretty much everything, and values that worked against such professional opinion could be subjugated in accordance with the maxim \u201cDoctor knows best\u201d.<!--more--><\/p>\n<p>The Burke litigation clarified (thankfully, in my view, though this is something unfashionable in circles I mix in) that physicians know their craft better than the layperson: it is not for me to tell my doctor what is \u201cclinically indicated\u201d in any given situation (eg heroin and single malts might be something I think are good for me, but my GP need not therefore legitimise my opinion with a prescription).\u00a0 It is not insurmountably controversial for doctors to claim expert knowledge; to assess a patient\u2019s medical condition, and estimate the probable efficacy of various interventions.\u00a0 More controversial is a claim of knowledge of such ethereal matters as the scope and import of sanctity, dignity, and integrity.\u00a0 Why, in public healthcare anyway, should a doctor\u2019s view on abortion, bear on what their patient is entitled to?<\/p>\n<p>At a conference I\u2019ve attended today at <a href=\"www.keele-conferencemanagement.com\/conscientiousobjection09\">Keele University<\/a>, conscientious objection in public life, including but not only in healthcare, has been put under the spotlight.\u00a0 And I\u2019ve learned a lot.\u00a0 Lois Bibbings noted that historically conscientious objection has been open, to varying degrees, to people whose objection has a range of bases: religious, moral, political, and humanitarian.\u00a0 Most importantly, Bibbings made clear the importance of the socio-political context in which objection is made permissible.\u00a0 Her paper related to warfare, but if we make a case-study of the social structures that led to the \u201cconscience clauses\u201d concerning abortion and embryology, we might see that there is less about upholding deep matters of moral principle, and more about social and political compromise, in the spirit of English politics.<\/p>\n<p>In the context of healthcare, it remains contested whether a professional\u2019s conscience has a public role.\u00a0 Sheelagh McGuinness cautioned against a recurring theme in these arguments; the \u201cdemoralisation\u201d of healthcare provision, and the possibility of slipping into an amoral, consumerist model.\u00a0 Kimberley Brownlee further demonstrated how public officials can not, in good conscience, or under proper moral scrutiny, always be beholden to the apparent rules of their offices; even in the context of the criminal justice system.\u00a0 The conference covered a great deal, in fascinating and provocative detail.\u00a0 One final point of note here was Stephen Pattison\u2019s questioning of the relationship, if any, between conscientious objection and \u201cwhistle-blowing\u201d.\u00a0 Informed by references to Judaeo-Christian theology, he noted a duality \u2013 between good and bad \u2013 in moral reasoning, and asked whether whistle-blowers, and, by parity of reason, conscientious objections, are saints or sinners.<\/p>\n<p>In many ways, this felt more like the start of a debate than the end of it.\u00a0 I certainly felt there were lots of questions I\u2019d like to find answers to: What is conscience in the first place?\u00a0 Where does eccentricity or prejudice stop and moral reasoning start?\u00a0 In a political compromise (or fudge), can we expect any sort of purity on this?\u00a0 And anyway, are some groups \u2013 such as the medical profession \u2013 so powerful that they can wield their consciences regardless of the views of others?\u00a0 I remain deeply sceptical of arguments about deep-seated \u201crational consensus\u201d, and suspect it\u2019s better that physicians wear their consciences on their sleeves, than carry them deep inside and publicly legitimise their decisions through spurious rationales.<\/p>\n<p><em><strong>John Coggon<\/strong> is a British Academy postdoctoral fellow in the School of Law at the University of Manchester.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If I asked a physiologist to show me where her conscience is, I\u2019m fairly sure she\u2019d not be able to.\u00a0 Yet, it seems, a great many doctors appeal directly to [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/26\/john-coggon-can-a-conscience-dictate\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[223],"tags":[],"class_list":["post-859","post","type-post","status-publish","format-standard","hentry","category-guest-bloggers"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>John Coggon: Can a conscience dictate? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2009\/10\/26\/john-coggon-can-a-conscience-dictate\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" 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