This week’s quote-of-the-week post (though it’s only Thursday) sheds light on how the relatively recent deployment in bioethics of the term conscientious objection enables (neo)liberal eugenic goals.

As a philosopher whose thinking has been formatively influenced by Foucault, my philosophical motivations derive in large part from a desire to problematize (in Foucault’s sense) what is taken for granted as self-evident, assumed to be value neutral, represented as politically innocent, or passes as progressive. In my quote-of-the-week post two weeks ago, for instance, I aimed to show how arguments against paternalism (in medicine and bioethics itself) obscure the ways in which the allegedly autonomous choices of disabled people to undergo assisted suicide/euthanasia are the products of subjectivities constituted within the apparatus of disability, that is, are choices constituted through a filter of internalized ableism.

This week’s quote-of-the-week post highlights remarks that disabled policy analyst and activist Gabrielle Peters has articulated in a discussion of assisted suicide/euthanasia/MAiD. The post aims to problematize another shibboleth of bioethics and bioethicists—namely, the bioethicist’s critique of “conscientious objection.” In particular, the post is designed to counter the ways that bioethicists and other proponents of MAiD manipulate and mobilize the notion of conscientious objection as means to: (1) demand the institutionalization of mandatory, universal delivery of MAiD; (2) represent the practice of MAiD as threatened by reactionary zealots; and (3) cast the “autonomy” of disabled people, which MAiD allegedly upholds, as endangered by these alleged threats.

Historically, the term conscientious objection has been associated with the refusal—based on one’s political, moral, or religious convictions—to engage in military combat and service. Thus, conscientious objection has been traced back to at least AD 295 when Maximilian Tebessa, who refused to serve in the Roman army due to his Christian religious beliefs, was consequently beheaded, and thus martyred. In the 16th century, the conviction was developed into a doctrine by Mennonites and, beginning in the 18th century, was authoritatively recognized by the British government in response to unsuccessful attempts to conscript Quakers (for instance, see here). Due to the predominance of the American empire and hence widespread media coverage of events in the United States, many people nowadays are likely to associate the terms conscientious objection and conscientious objector with resistance to the Vietnam War in the mid twentieth century and the refusal of young American men (pejoratively dubbed as “draft dodgers”) to serve in the American military during that war. In other words, the term conscientious objection has historically been regarded as signifying a principled, idealistic anti-government position, a position not necessarily associated with religious belief.

In recent years, bioethicists have worked diligently to overturn this understanding of the term conscientious objection, arguing that the term signifies a regressive, orthodox, sectarian, and outdated stance that poses a threat to secular moral and political values such as individual autonomy and rights and therefore ought to be condemned. A primary target of these bioethical critiques (but by no means the only target) is “conscience clauses” that, following their adoption in various countries, permit doctors, pharmacists, and other medical personnel to refuse to provide a certain service, treatment, drug, etc. on the basis of their religious or moral convictions. For example, feminist and other bioethicists who oppose conscience clauses and conscientious objections in health-care settings more generally have been concerned to argue against their use in various countries that permit providers to (on the basis of the moral, political, and religious views that they hold) refuse to perform abortions, distribute contraception, and deliver health care to trans people.

These bioethical arguments against “conscientious objections” cast the objections as value-laden, uninformed, and ideological departures from standard medical practice which, by contrast, is represented as impartial, grounded in scientific inquiry, and therefore objective, guided by professional doctrine and stringent norms rather than by external influences such as structural biases or the subjective moral and political values and views of individuals. Yet this distinction should not be accepted. Nor should we abide this strategy to, in effect, individualize and discredit resistance to euthanasia/assisted suicide.

In Canada, applications for the meagre financial and other benefits that the provincial and federal governments distribute to disabled people presuppose a medicalized conception of disability and thus approval of an application requires the imprimatur of a medical authority. As a disabled person whose physician repeatedly denied her requests to be approved for these benefits—“Surely you can get some job. You aren’t that disabled.”—I want to underscore that this example of physician denial/refusal (which is a common occurrence) is nowhere on the radar of the bioethicist’s critique of conscientious objection.

In other words, not all physician refusals and denials that rely on the moral and political values of physicians—which, in essence, all of them do—fall into the class of (“conscientious”) refusals/objections to which bioethicists, in a word, object. Rather bioethicists are quite selective about which refusals/denials on the part of medical professionals that they deem worthy of their critical attention and count as “conscientious objections,” that is, count as objections of the appropriate kind to concertedly oppose. Which refusals/denials count in this regard? The refusals and denials with which bioethicists can reproduce the (dated) juridical conception of autonomy and other individualistic liberal values on which the field of bioethics depends.

Since 2015, Udo Schüklenk, the co-editor of Bioethics, has published several articles in this journal that critique resistance (“conscientious objection”) to assisted suicide/euthanasia/MAiD and several additional critiques of resistance (“conscientious objection”) to assisted suicide/euthanasia/MAiD in other bioethics journals and edited collections, including in Journal of Medical Ethics, Journal of Clinical Ethics, and The Rowman and Littlefield Handbook of Bioethics. In 2019, the APA Committee on Philosophy and Medicine organized a panel at the Pacific APA called “Justifying Conscientious Objection in Medicine,” in which Schüklenk gave a presentation entitled “Conscientious Refusal and Medical Professionalism are Incompatible: An Argument Against Accommodation.”

These efforts by Schüklenk to undermine resistance to euthanasia/assisted suicide/MAiD, in addition to Schüklenk’s other articles to promote MAiD, bring together his ableist utilitarian stances on atheism, academic freedom, professionalism, and euthanasia/assisted suicide, and have helped to establish him as a leading proponent of euthanasia/assisted suicide/MAiD worldwide. Claims about the requirements of medical professionalism are in fact central to Schüklenk’s arguments for why the Canadian government and the medical profession must stipulate that “adherence” to regulations about MAiD is mandatory and universal for medical workers in Canada.

Schüklenk’s arguments for the professional adherence (compliance) with respect to MAiD that is required of doctors, pharmacists, and other medical personnel formatively influence the demands that the profession of bioethics itself places on bioethicists themselves, given both (1) the coercive nature of the professional norms of bioethics to which individual bioethicists—as members of the profession—feel compelled to comply to obtain jobs and advance their careers; and (2) Schüklenk’s own status within the profession. To date, for example, no disability bioethicist or feminist bioethicist has so much as intimated that a challenge to Schüklenk’s dossier is demanded if philosophy is to promote justice for disabled people. Indeed, this tacit acceptance of the individualizing critique of “conscientious objection” to MAiD, which these arguments about professionalism are intended to bolster, puts into further relief the complicity of disability bioethicists and feminist bioethicists in the eugenic agenda of the field of bioethics.

Nevertheless, as I have pointed out on BIOPOLITICAL PHILOSOPHY and in other contexts (including here and here), a growing number of disabled people are watching, that is, they/we are paying attention to what bioethicists and other philosophers say/fail to say about them/us. Of particular note is Gabrielle Peters, who watches what bioethicists and other proponents of euthanasia say/don’t say about MAiD and disabled people and other marginalized populations. Indeed, Peters’s remarks in “Reality, Not Religion, Is the Reason People Need MAiD-Free Health Care,” her recent article in Policy Options, bear directly on my problematization of arguments against conscientious objections in the literature and practice of bioethics. As Peters writes:

Disabled people often talk about being made invisible. This feeling is particularly striking around issues that are specific to us like MAiD, medical assistance in dying. The lobbyists and proponents for Canada’s MAiD regime routinely mischaracterize or, more often, omit mention of disabled people or our reasons for opposition entirely.

Consistent with this, Jocelyn Downie and Daphne Gilbert ridiculed B.C. Health Minister Adrian Dix’s plan for a clinical space for MAiD to be created next to a MAiD-free hospital in Vancouver. In their recent Policy Options article, they call the planned connecting hallway a “corridor of sin” and accuse the minister of making a plan that is church-centred, not patient-centred.

Some health-care providers see MAiD-free spaces as working environments that allow them to respect their conscience and adhere to their professional understanding of doing no harm. Disabled patients, however, have expressed different reasons for wanting MAiD-free health-care settings. To start with, we should have the right to receive medical care in places and from people who do not contemplate or participate in killing disabled people as part of a care plan.

Who wants to look up at a doctor from a hospital bed and wonder if they have just deliberately ended the life of someone with a similar condition? Or to overhear conversations in hallways, waiting rooms, nursing stations or on the other side of a curtain, about how a lethal injection preserved a relative’s dignity before she – gasp – became incontinent, like me[?]

As Peters points out, the only remaining MAiD-free hospital settings in Canada exist in faith-based facilities, thanks in large part to vigorous lobbying by well-funded groups such as Dying with Dignity Canada and the epistemic authority conferred upon privileged (nondisabled) individuals such as Schüklenk and Downie. Although Peters notes that many, if not most, disabled people would likely opt for secular MAiD-free spaces if these were available, she cites renowned disability studies scholar Catherine Frazee who remarks that she and her lesbian partner would tolerate the presence of religious artifacts in a treatment room if doing so ensured their safety from MAiD. In short, as Peters puts it: “Canada has made disabled people a killable class, and hardly anyone has considered the impact this would have on us. This country must maintain MAiD-free health-care spaces.”

Bioethicists argue that the refusal of medical personnel to provide MAiD violates both their professional responsibilities and the norms of the profession at large. Yet I contend that these refusals should rather be regarded as life-saving acts of/in solidarity with disabled people. These refusals, rather than violations of autonomy imposed upon disabled people, confer value and esteem upon them and, simultaneously, resist the (eugenic) liberal agenda of the apparatus of disability that generated the practices of MAiD and the field of bioethics in the first place, an agenda that the professional norms of bioethics effectively reconsolidate, deepen, safeguard, and extend.