Why conscience matters: a defence of conscientious objection in healthcare

Why conscience matters is a landmark in the literature on conscientious objection in healthcare. In it, Xavier Symons, bioethicist and postdoctoral research fellow at Harvard University, makes the case for the fundamental role of conscience in healthcare, and rebuts the arguments of those who, over the last two decades, have attempted to undermine rights to conscientious objection. This book now succeeds Mark Wicclair’s Conscientious objection in health care: an ethical analysis (2011) as the required reading on the subject. Daniel Sulmasy makes a point in his forward whose correctness is clear to those following the debates around conscientious objection: ‘it may just be that conscience is not the issue’ (p. vii). He means that the debate hinges not on questions of the nature of conscience and the purposes of medicine but on questions of pluralism and tolerance – politics rather than ethics. Opponents of conscientious objection tend to elide the substantive philosophical questions, and view it solely as a hindrance to medical services, before proposing management solutions filtered through an authoritarian cultural lens. Although Symons’ work is not one of political philosophy, his account of the substantive philosophical questions is illuminating. Chapter 1, Introduction, sets out the book’s purpose and direction. Symons says of conscience: