Montgomery Jonathan
Faculty of Laws, University College London, Bentham House, Endsleigh Gardens, London WC1H 0EG, UK
Med Law Rev. 2015 Spring;23(2):200-20. doi: 10.1093/medlaw/fwv013. Epub 2015 May 8.
English law expects health professionals to have, and act upon, consciences, but formal conscience clauses are not the main legal recognition of this expectation. Rather, they should be regarded as an anomaly with roots in very specific political settlements between society and health professions, whose legitimacy is historically contingent, and as an aspect of the 'price' to be paid for securing services. There are sound reasons for the protection of conscientious discretion as an aspect of professional identify, but specific rights of personal conscientious objection are difficult to reconcile with legitimate public expectations of comprehensive and non-discriminatory services. Professional identities include moral commitments, such as the privileging of patient safety over administrative convenience. These should not be permitted to be overridden by personal moralities during the course of service delivery (as opposed to debating in the abstract what the proper courses of action should be). Consequently, formal conscientious objection clauses should be reduced to a minimum and regularly revisited. It is generally more satisfactory to address clashes between the personal moralities of professionals and public expectations through more flexible means, enabling accommodation of a plurality of views where possible but acknowledging that this is a matter of striking an appropriate balance. Employment law rather than healthcare law provides the best mechanism for regulating this process.
英国法律期望医疗专业人员拥有良知并依其行事，但正式的良知条款并非对这一期望的主要法律认可。相反，它们应被视为一种异常现象，其根源在于社会与医疗行业之间非常特殊的政治和解，其合法性在历史上是偶然的，并且是为确保服务而需付出的“代价”的一个方面。将依良心行事的自由裁量权作为职业身份的一个方面加以保护有充分理由，但个人凭良心拒服的具体权利很难与公众对全面且无歧视服务的合理期望相协调。职业身份包括道德承诺，比如将患者安全置于行政便利之上。在服务提供过程中，不应允许这些承诺被个人道德观念所凌驾（这与抽象地辩论什么才是恰当的行动方针相反）。因此，正式的凭良心拒服条款应减至最少并定期重新审视。通过更灵活的方式来解决专业人员的个人道德观念与公众期望之间的冲突通常更令人满意，尽可能容纳多种观点，但也要认识到这是一个权衡适当平衡的问题。劳动法而非医疗法为规范这一过程提供了最佳机制。
