Would denying conscientious objections by healthcare providers result in more equitable access to quality healthcare for patients? Schuklenk and Smalling argue that in liberal democracies medical professionals have no legitimate moral claim to accommodations on the grounds of conscientious objection. Schuklenk and Smalling note that while the debate currently focuses on issues like abortion and assitance in dying, they argue due to the arbitrary nature of conscientious objections means they could theoretically be applied to any medical pratice (Schuklenk and Smalling, 195). I will argue that we do need to accommodate conscientious objections, largely on the grounds that doing otherwise would exclude entire segments of the society who deserve to have healthcare providers who share similar backgrounds, identities and beliefs as them. However, I do not believe that accommodation for objections should be unlimited and I will explain why the line must be drawn on the grounds of providers’ objecting to referring a patient to another provider who will provide the service. 

 

Schuklenk and Smalling’s basic argument is that it is impossible to evaluate the legitimacy of one’s conscientious objections and thus allowing accommodations for medical duties and the ability to deny some services on the grounds of conscientiousness is nothing more than a blank check for people to choose what aspects of health care they wish to provide (Schuklenk and Smalling,194). They note that declaring some conscientious objections justified over others is just as arbitrary a process of determining if conscientious objections are deeply held (Schuklenk and Smalling,194). Thus the governing rules over what services healthcare providers must provide should be consistent and universal without exception. To further support this argument they note that conscientious objections create unequal access to services for patients, especially rural communities who may have to travel long distances to find another medical provider (Schuklenk and Smalling, 196). Therefore, they argue, it is unjust to provide suboptimal access to healthcare on the morally arbitrary grounds of conscientious objections (Schuklenk and Smalling, 196). 

 

While I agree with the authors on the arbitrary nature of conscientious objections, I think not allowing them would actually result in worse quality healthcare which is one of their main concerns. Equal access to quality medical services is important, but I believe there is a missing aspect of that discussion, that of equality and quality of care which requires diversity in providers of healthcare. Positive health outcomes require diversity in healthcare workers. It is well understood and empirically proven that healthcare and health outcomes improve when the background of providers matches those of their patients. This is due to a variety of factors including more accurate diagnosis and better treatment resulting from less bias, mutual respect, and trust between healthcare providers and patients. A policy that would not grant any conscientious objections would cut out entire religious and ethnic communities who hold strong beliefs about the permissibility of particular healthcare services and thus would be unable to serve in specific specialties in medicine. 

 

Schuklenk and Smalling note that medical professionals not only choose their profession, but also have a fair degree of autonomy over which sub-disciplines they specialize in (Schuklenk and Smalling, 197). Thus it follows that if one does not want to provide abortions then one should not specialize in the areas that may require one to do so. However, this means that entire ethnic and religious groups would effectively be banned from some occupations specifically where diversity matters the most. Cultural sensitivity is perhaps most important in communicating with marginalized groups during pregnancy and on the deathbed. The beginning and end of life is often where religious and cultural differences have the most impact on patients being respected and having quality care.  

 

With all that said, the unwillingness of providers to refer patients to another provider who can provide them with the services they object does pose a real threat to access as it is unreasonable for patients to be forced to navigate the complex healthcare system themselves. 

This, I argue, would actually result in the drop in quality and equality that Schuklenk and Smalling fear because instead of being unable to get a service in one normal location by one’s normal physician one is required to find a new provider with very little support. The barriers of travel and time are unfortunately inherent to rural life and, while they can be minimized, can never be fully equalized. However, the literal inability to get sound advice and knowledge on options available and where to obtain them would mean that patients with providers who object to referral receive a fundamentally different level of healthcare. As long as providers are willing to make referrals, then I believe that healthcare is on net more equal and accessible with some accommodation of healthcare providers. 

 

Now one can argue, as Schuklenk and Smalling do, that referrals are not always possible in a timely manner, specifically in rural communities (Schuklenk and Smalling, 196). I believe a solution to this is traveling medical professionals who specialize in commonly-objected-to practices. When healthcare providers take up a position in a rural community they can indicate what procedures they object to and arrangements can be made to have a travelling professional on call if the need arises. In the instance where having traveling professionals is not possible, I think it is not too large of an infringement to deny particular healthcare providers the ability to work in some rural areas, unlike outright bans from having specialists of some identities which would result from an outright ban on conscientious objection.  Unfortunately under no system will healthcare ever be truly equal on travel terms but I believe this comes the closest to balancing competing claims to equal access without stopping entire segments of a population from seeking specialists with a shared identity to them. As I have shown, the identity of one’s provider affects their equal access to the same quality of care. In conclusion, on the grounds of equal access to quality healthcare, conscientious objections should be permitted as long as providers are willing to refer patients to another provider.