Ethics of conscientious objection
In the February 4th British Medical Journal, one Julian Savulescu, director of the Oxford Uehiro Centre for Practical Ethics argues that there is little if any room for autonomy by physicians in deciding not to provide certian kinds of care
A doctors' conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient's good and the patient's informed desires. If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.Certainly once can't accuse Savulescu of pulling punches.
I see a number of problems with this sort of reasoning, not least that the pool of potential physicians might be signficantly limitied if every medical school applicant had to be prepared to offer any medical service that was currently legal or might be legal in the future. I don't think breast augmentation should be illegal, but I don't see any problem with not doing them myself.
Now, in a letter responding to the original article, Vaughan Smith, powerfully points out the flaws in Sauvescu's "public servants must act in the public interest, not their own" line of reasoning:
Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded—for example, respectively, eugenic "research" and psychiatric "treatment" of dissidents.which puts it more eloquently than I ever could. And points our the obvious problem that what is "legal" can vary immensely from time to time and society to society. One can of course object that conscientious objection by physicians hasn't been very effective, but that is an entirely different issue. I suspect that Savulescu wouldn't be impressed with US physicians who participated in mistreatment and torture of prisoners at Abu Ghraib and Guantanomo because it was "legal."
I hope, but not being a very courageous person, I'm not at all sure. My chances of behaving honourably would have been greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day.
Note that I'm pro-choice, although not necessarily pro-abortion. I don't currently face the issue commonly, but would refer any pregnant patient who desired an elective abortion to a qualified provider. So it's Savulescu's reasoning I object too.