Do Healthcare Institutions Have Consciences and a Resultant Ethical Right to Institutional Conscientious Objection?

In healthcare, Institutional Conscientious Objection (ICO) occurs when a healthcare institution (e.g., a hospital) refuses to provide a healthcare service (e.g., abortion) on the grounds that this service contradicts its conscience. Debate rages over whether governments should allow ICO in healthcare. Currently, some do, and some don’t. Among other reasons, the debate matters because ICO can have dramatic effects on patients’ ability to access healthcare services. The debate encompasses many topics, but this paper focuses on the arguments regarding institutional conscience. This topic matters because it is legally important in many countries, and because it is central to the ICO debate; both pro-ICO arguments and anti-ICO arguments are often built on claims about the existence or nonexistence of institutional conscience, respectively. This paper’s overarching question is as follows: do healthcare institutions have consciences and a resultant ethical right to ICO? I answer this question by separating it into two sub-questions. The first is as follows: do healthcare institutions have consciences? I argue no. What I add to the literature here is in-depth critical analysis of the debates over what is necessary to satisfy the criteria for conscience, and I bring in lessons from the philosophy of group agency. Unlike the vast majority of ICO opponents, I charitably engage with the best and most recent arguments for institutional conscience (in particular, work by Xavier Symons and Reginald Mary Chua). The second question is as follows: if healthcare institutions do have consciences, does it follow that they thereby have an ethical right to ICO? Again, I argue no. I answer this question via a highly novel and highly systematic approach, which involves precisely conceptually dissecting healthcare institutions, and I bring in lessons from the philosophy of group rights.