"For Love of Neighbor" is a new documentary film offering a hopeful vision for Christian engagement in politics. Click here to learn more.

Evaluating the Merit of Non-Religious Conscience Exemptions in Healthcare Policy

Renée Waller was a 2019-2020 Young Scholar Awards Program recipient. She is a graduate of Biola University where she majored in political science and history, as well as participated in the Torrey Honors Institute.

Organizations, regardless of their religiosity, are making increasingly non-religious moral and ethical arguments in the healthcare arena to combat practices such as abortion, euthanasia, and vaccines. While a lively and important discussion exists concerning the significance of religious freedom, it is pertinent to examine to what extent non-religious conscience claims may be valid, as well as their similarities to and differences from  traditional religious conscience claims. My thesis is that non-religious conscience claims can best be safeguarded within the framework of classical natural law theory. I present a case study of a requested gender reassignment surgery to test this philosophical hypothesis and then craft principles for policy-making.

In light of a rising dominant secular morality and ethical dilemmas in the healthcare system, I investigate whether there is a substantive philosophical foundation to protect non-religious conscience claims. I conclude that classical natural law theory grounds the existence of conscience as an objective phenomenon, since it explains that individuals have an innate capacity to know and experience right and wrong in the state of nature, apart from the law. It also explains how a non-religious person can know and experience this law apart from “special revelation” or a specific religious creed. Finally, natural law theory ties the conscience to a common, higher aim: the pursuit of truth or the natural good. In comparison, some philosophers or political theorists may be more inclined to defend a non-religious conscience claim via the autonomist view. The autonomist view would argue that it is the fundamental good of an individual’s autonomy that grounds morality. I believe that this method fails to provide a transcendent authority that would give a doctor’s conscience any authority over a patient’s conscience or the laws of the state.

The usefulness of natural law theory becomes apparent when I apply it to a relevant case study of a requested gender reassignment surgery. If a non-religious person objects to providing gender reassignment surgery, she is claiming to have a conscience that conflicts with the necessary actions or aim of the procedure. It may be that the person objects to the procedure itself or to providing it for certain groups of people, as it is in the case of United Kingdom Equalities Minister Liz Truss, who recently announced a ban on children under the age of 18 receiving gender reassignment surgeries. However, on the receiving end, patients requesting surgery have a conception or conviction concerning their identity that compels them to receive a surgical alteration. The question is: How can one adjudicate between these two convictions?

Natural law theory acknowledges the doctor’s right to form beliefs about the truth and her duty to act upon them. Because it is the doctor’s medical judgement that must approve of providing the procedure, natural law theory says this judgement should be respected, and that the patient should go elsewhere to obtain the procedure. In contrast, the autonomist viewpoint leaves the two autonomous beings—the doctor and the patient—and their competing wills at an impasse. Because a doctor cannot authoritatively claim to know what truly benefits the patient’s health, a doctor cannot credibly refuse the service or even receive an exemption from the law. The doctor’s conscience cannot be accepted on the basis of autonomy alone without creating a lawless society and exemption proliferation.

Finally, natural law theory informs the healthcare public policy debate by providing principles for determining the reasonability and severity of a conscience claim. It also helps us determine which fundamental goods a pluralistic society must protect. While conscience claims have strong moral claims, natural law says they can be overridden in law with the proper balancing of rights and the application of objective standards. Currently, the state is far from neutral in its handling of consciences, and some standard is necessary for adjudication between conscience claims, since all autonomous claims have moral content.

I conclude that under classical natural law, a non-religious doctor can stand on solid ground to refuse a service based on a conscience claim. Undoubtedly, it is a complex dilemma for legislators and lawyers to try to accommodate the various exemption requests in order to protect the proper rights. Nevertheless, I believe that there is adequate space to protect non-religious conscience claims in a pluralistic society that upholds fundamental human rights.