The fundamental right to refuse

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Iam a pro-choice atheist. But I support a regulation, recently promulgated by the Bush administration, that would cut federal funding to nearly 600,000 hospitals, clinics, health plans, doctors’ offices and other entities if they do not allow their employees to opt out of providing certain types of care -- including abortion services -- on grounds of conscience and personal belief.

Ask yourself: What are some of the bad things that have happened because people refused, on conscientious grounds, to do what the institutions in which they were embedded demanded? Now ask yourself: What are some of the bad things that have happened because people overcame serious qualms and did what they were ordered to do?

The idea that we must respect individual conscience as a moral arbiter is a fundamental insight of the Protestant Reformation and of the American individualism of such figures as Emerson and Thoreau. It is at the core of our traditions and our freedoms. This idea means nothing if we respect it when we agree with its results and not when we don’t.


For example, many people who favor abortion rights defended the right of healthcare providers to dispense abortion services when it was illegal to do so. Their argument was that women had a right to control their own reproduction. It was, at least in some respects, an individualist and a conscientious argument. But if we respect the right of women to control their bodies, we ought to respect the rights of doctors to control their own actions. And if we respect the decision to perform abortions, we ought to respect the refusal to do so.

One measure of the decency and democracy inherent in an institution is the degree to which it can allow scope for individual conscience -- the degree to which it allows people autonomy in fundamental matters. The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian -- and dangerous.

Thoreau, in “Civil Disobedience,” said this: “Must the citizen ever for a moment, or in the least degree, resign his conscience to the legislator? Why has every man a conscience, then? I think that we should be men first, and subjects afterward.”

And he argued that although I am under no obligation to try to fix all injustices, I am under something like an absolute obligation to not push forward things that I regard as unjust, to not participate in things I regard as wrong or gratuitously hurtful. Some doctors and nurses regard abortion in precisely this way, taught so by their religion or by their experiences. I don’t happen to agree with them, but the objection is clear and principled, and it ought to be respected.

The idea that, in assuming some function -- some career, for instance -- I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last. It is the first -- the only -- defense in any crimes-against-humanity trial: I was just doing my job; I was just obeying orders.

Mobilizing a whole nation into a killing machine for war, the Holocaust, the spasm of ethnic cleansing, requires the idea of the supremacy of the group and the institution over the individual. If history teaches us nothing else, it is that this attitude brings us face to face with the void, nudges us into the abyss.


What will make us all essentially evil and perhaps end life on Earth is the bland bureaucracy with its regulations, and the willingness of people to capitulate to it. Of course, people can refuse to participate by quitting, fleeing and so on. But a decent society would not require extraordinary moral heroism; it would respect people’s fundamental moral commitments. It would keep its doctors healing, and stop trying to force them to do what they think is wrong.

Crispin Sartwell teaches philosophy at Dickinson College in Carlisle, Pa.