Intended for healthcare professionals


Conscientious objection in medicine: Author did not meet standards of argument based ethics

BMJ 2006; 332 doi: (Published 16 February 2006) Cite this as: BMJ 2006;332:425
  1. Frank A Chervenak, chairman of obstetrics and gynaecology,
  2. Laurence B McCullough, professor of medicine and medical ethics (mccullou{at}
  1. Weill Medical College of Cornell University, New York, NY 10021, USA
  2. Center for Medical Ethics and Health Policy, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA

    EDITOR—Savulescu's account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary.1 Unfortunately, he violates the standards of argument based ethics.2 3

    He claims that professional commitments, what should be provided to patients, are based on law and the just management of resources. To say the least, this is a contentious claim in contemporary medical ethics and therefore must to be argued. Having claimed law and responsible resource management as the ethically authoritative sources of doctors' professional obligations, Savulescu is methodologically obligated to provide an account of relevant law and an ethical justification for why and how it should guide doctors' clinical judgment, decision making, and behaviour.4 He is also methodologically obligated to provide a rigorous ethical analysis of the very slippery concept of inefficiency in the management of resources to show why it is always, as he puts it, an inequity that is unjustifiable.3

    He does neither. In all cases of conflict with the principles of individual conscience of “would-be conscientious objectors,” the professional commitments of doctors, Savulescu concludes, should control clinical judgment, decision making, and behaviour. The intellectual and moral authority of this sweeping conclusion is a function of the argument given to explain and justify the commitments of the profession. No such argument is provided.

    Savulescu's failure to meet the standards of argument based ethics means that the five constraints that are necessary to ensure the legal, equitable, and efficient delivery of health care spring fully armoured from the head of Savulescu. Readers timorous enough to expect argument should, instead, genuflect and accept these constraints, simply on Savulescu's unargued, albeit vigorous and witty, assertion of them. After all, initium sapientiae timor domini. Thus is medical ethics reduced to saying it is so.


    • Competing interests None declared.


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