Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human.

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances”

Mehmet Ciftci

Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0):

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by this Act to which that person has a conscientious objection.

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act.

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.

Interview

Culture

Education

Justice

S&U interviews

17 February 2025

8 min read

How justice shaped a world of rights

Historian John Coffey talks about his contribution to a new book: Justice & Rights.

Nick Jones

Nick is the senior editor of Seen & Unseen.

A statue of a woman holding a spear in one hand a lightening bolt in the others that reads: 'Droits de l'homme'.

A French statute celebrating Human Rights.

DDP on Unsplash.

In our networked world old problems, and new ideas to solve them, flash across our minds and screens. It can be a hectic and dis-orientating feeling that occurs when we try to make sense of it all. Whether it's the global order changing or yet another injustice occurring.

Seeking insights on all this means crossing boundaries, and that’s what over 160 scholars do by sharing with each other. The members of the Global Faculty Initiative (GFI), drawn from all faculties usual in great universities, integrate faith and scholarship through dialogues. They examine the themes of justice, order, flourishing and beauty - mixing subject matter expertise in everything from physics to public policy.

The GFI has just published the results of one such dialogue in a book Justice and Rights. Among the contributors is Professor John Coffey. His work explores the history of religion and the big ideas like justice and rights. Recently he talked with GFI coordinator Bethan Willis, on its Justice podcast series. Here’s an extract of the discussion that looks at the ‘genealogy of rights.’

Bethan Willis So, shifting focus now to the question of rights, particularly. So, you talk in your Brief about the genealogy of rights, and in his Theology Brief, Nicholas Wolterstorff makes a case for placing rights at the centre of our understanding of justice, but that's obviously not an uncontested move. And some people would see a focus on rights as problematic, and part of the debate about the legitimacy or the value of rights can sometimes centre around the question of where rights actually come from. So which period in history, which philosophy and vision of human life and justice gives rise to this language. So can you tell us a little bit about that kind of trajectory that you've set out in your Brief , the different points at which people might identify rights as coming to the fore and why that happens and the various interests at play in these discussions of where rights come from?

John Coffey So it can be very confusing if you read the scholarship on this subject because if you listen to someone like Samuel Moyne, he will argue that the human rights revolution of the 1970s really invents human rights or maybe grudgingly the 1940s and the conservative statesmen who created the UN declaration of human rights in that period. Others, of course, would root it in the enlightenment. And I guess this is a classic answer. It's the enlightenment and the French Revolution with its Declaration of Rights of Man and Citizen, which is really at the heart of the story of rights. But then early modernists and medievalists pushback, they see natural rights language, the idea of individual subjective rights that one has simply on the basis of one's humanity. These are distinct from legal rights, but they're individual natural rights that they would see this concept emerging in the Middle Ages with canon lawyers and Juris and so on, and then being embraced by various 17th, 16th, 17th century groups up to Locke.

And I think there are different things going on here. One, of course, is that there are turf wars between historians in different periods who want to draw attention to their period as being really seminal in various ways. People have talked about the revenge of the medievalists, the early modernists and the Renaissance specialists who made so much emphasis on this being a radical break from the dark mediaeval past that mediaevalists have always been keen to push back against that and to point to the mediaeval roots of a lot of modern concepts. But I think there's also more going on here. I think in some ways it's part of a bigger argument about political and to some extent economic liberalism as well, because rights language has been so important for liberals, whether they're talking about politics or talking about economics. So, you have an example of rival genealogies being used for political purposes, if you like, to both problematize and legitimize, right?

BW Your work is focused on the contributions that religious groups have made to politics and ideas. And you particularly reference the Levellers in the 17th century and the abolitionists at the turn of the 18th, 19th century. Can you tell us a bit about the contribution that Christians may have made to the development of rights and particularly to the rights of freedom of conscious thought and belief in particular?

JC Yeah, yeah. I think it's important to emphasize this because there's also been a long tradition of suspicion of rights language among Christians, especially in the wake of the Enlightenment and the French Revolution. I mean, this has obviously been true in the Catholic church in the 19th century where there was deep suspicion of liberalism and the individualism associated with it and rights language was regarded with a great deal of suspicion by many traditionalist Catholics. But it's also true in Protestant circles as well, among some high Anglicans. But you could see it in the Dutch Calvinist tradition, they founded an anti-revolutionary party after the French Revolution, which is very critical of the political language which emerges from that event. So, it's interesting to see how historians and intellectual historians in recent decades have recovered what you might call the theological origins of rights talk. And that's true of people like Brian Tierney writing about the mediaeval era and showing the kind of seminal influence of various mediaeval theorists of natural law, but also natural rights.

And certainly, when you get to the period I'm most familiar with from the 17th century onwards, groups like the Levellers are not just talking about native rights or legal rights that they have as Freeborn Englishmen. They're also talking about universal natural human rights that individuals have on the basis of their humanity. And it's in that period in the 17th century that people begin really for the first time to talk about freedom of religion as a natural right. I mean, you don't see that in the Middle Ages. It's a development that emerges within particularly radical Protestantism in the 17th century. Though interestingly, it's also tied to the idea of duties. So because we have a duty to worship God according to our conscience, consciences must be left free and the individual must have a natural right to worship God according to their conscience, because otherwise they wouldn't be able to please God if they just follow the dictates of the state or the state church that they wouldn't be able to worship in a way that's pleasing to God. So, it is interesting the way the argument works. It's theistic grounded in a sense, but it applies not just to Christians, it applies to other kinds of religious worship, to Jews, to Muslims, to heathens and so on.

And you can see more widely a theological grounding for rights in figures like Locke. And that's encapsulated, obviously famously in the Declaration of Independence, Thomas Jefferson drafted in 1776, that ‘all men are created equal and endowed by their creator with certain inalienable rights’. So, this idea that we have certain rights that we cannot transfer over to the state, that we can alienate them over to the state, they're inalienable, and we have a solemn responsibility before God to protect them. So yeah, I mean, it's certainly by the 18th century, this rights language is absolutely flourishing within Protestant circles, and you can see it being taken up quite significantly in the abolitionist movement in the 1780s, though people are also shying away from it in the 1790s because of the French Revolution and Tom Payne's rights of man and so on. But if you read 19th century American religious abolitionists, people like Frederick Douglas or William Lloyd Garrison or others, they're using the language of natural rights, pretty insistently.

BC And it's often to articulate the kind of victim's perspective, isn't it, to defend the weak against the mighty and to say there's a bigger kind of justice that is beyond the state or the law. Is that right? Can you tell us a bit about how that works?

JC Yeah, no, I think that's absolutely right, and it's one reason why we should be wary about just tossing, tossing rights language out as some kind of secular poisoning of the, well, a, it does have some deep roots in Christian thought, but it also, rights language is also designed as one of the weapons of the weak, if you like. It's a way to defend those whose claims are often ignored and to assert their human dignity. So, it's why it gets taken up so much by religious minorities, by those who are pushing for widening the vote and suffrage maybe to all men, maybe eventually to women. The anti-slavery movement is using it, and of course, by the 20th century, the Civil Rights movement.

BC But as you said, Wilberforce himself doesn't really use this language much, partly because the arenas he's speaking in and partly because of these associations with the French Revolution. Is that right?

JC Yeah, and if you look in the 1790s, it's interesting because it's from that period really the language of left and right starts to emerge, and those on the right are very much concerned about law and order. They look across at France and they see disorder and the guillotine and regicide and Civil War and the exile of Catholic priests and so on, and it's extremely alarming for them. So, the emphasis very much shown law and order, and they become extremely alarmed by the way that rights language has been used to undermine order. So, it's classically articulated at that divide between Edmund Burke on the one side and Tom Payne on the other. What's interesting in the British context, is you'll find sort of devout Protestant Christians on both sides of that. So, Wilberforce would be very much on Burke's side in this argument, but the founder of the London corresponding society in the 1790s, a man called Thomas Hardy, he's actually a devout Scottish Calvinist, and he's absolutely on board with this rights language. And so different religious groups will be divided over this.

Follow the rest of John and Bethan's conversation on the GFI podcast.

John Coffey on Justice.