Beyond Money: Conscientious Objection in Medicine as a Conflict of Interests

Alberto Giubilini,Julian Savulescu

doi:10.1007/s11673-020-09976-9

Abstract

Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners’ moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs.

Highlights

Conflict of Interest in HealthcareHaving a personal interest that conflicts with professional obligations is not per se ethically impermissible
Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a conflict of interest (COI) occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally
In the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and should be treated in the same way, as financial COIs

Summary

Conflict of Interest in Healthcare

Having a personal interest that conflicts with professional obligations is not per se ethically impermissible. Conscientious objection clauses allow the healthcare professional to provide the patient with a medical service that is not led by the standard of best practice for that patient according to current medical and ethical guidance but by the practitioner’s own non-financial interests This is the precise situation that COI policies should be designed to prevent. As Wiersma and colleagues point out, non-financial interests, some of which may be highly personal, must be handled with discretion to avoid needlessly intruding into people’s privacy or placing them at risk of discrimination” (Wiersma et al 2018b,K1240) This consideration does not seem to apply to the case of conscientious objection: allowing conscientious objection presupposes precisely the full disclosure of personal information which might be thought of as protected by privacy rights, such as religious beliefs. If the analogy between FCOI and NFCOI holds, and we should manage NFCOIs to ensure that they do not affect professional judgement, conscientious objection, which manages NFCOIs precisely by providing a route for non-medical factors (such as the religion of the physician) to influence patient care, should not be allowed

A Few Practical Guidelines

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Conclusion