What I think I find most problematic about Conscientious Objection, or at least what lays the groundwork of my distaste for it, is its unique context. To put it more straightforwardly, Conscientious Objection can, but does not always, involve genuine cases of life and death.
Rather than considering one-off examples, let’s try a cluster approach.
i. A woman is in dire medical need of an abortion; if she does not receive an abortion, she will inevitably die during childbirth. If she lives, the fetus will die and vice versa.
ii. A woman is in significant medical need of an abortion; if she does not receive an abortion, she will inevitably suffer permanent physiological damage. If the fetus lives, she will live but in immense pain for the rest of her life. If she lives (i.e. has an abortion), the fetus will die.
iii. A woman is not in any medical need of an abortion; she elects to abort the fetus within the federally and state regulated timelines allowed to do so.
Now, let’s consider a few more examples where Conscientious Objection has been defended; these examples will take place outside of a medical context, however, in order to draw a more complete picture of the concept and its usage.
iv. A baker refuses to make a wedding cake for a homosexual couple’s marriage; he bases this refusal on his religious beliefs that homosexuality is a sin and punishable by hellfire in the hereafter.
v. A hotel denies a request for a venue reservation to a group of professionals and advocates supportive of Transsexuals’ rights; the hotel’s owner bases this denial on her moral beliefs that a person’s gender is equivalent to, or identical with, their sexual orientation/lifestyle and believes that both are static and permanent from birth until death.
It is clear from these two sets (or clusters) of examples that there is a major difference between these types of cases. In the latter, it seems like there are numerous potential alternatives available.
As unjust and unbecoming as the baker’s behavior was, the homosexual couple can still find another baker to bake their wedding cake. Just how available, accessible, and convenient it is to get to that other baker is contextually dependent on a variety of things. But in the abstract, if the couple is merely inconvenienced, all other things equal, then they must simply ‘suck it up’ and deal with the reality that they will not be able to get their wedding cake from their original selection.
The same goes for the venue reservation request. Though the Transsexuals’ rights group has definitely been mistreated and turned away inappropriately, they still, presumably, have alternative meeting places that they could utilize. It may not be their first choice and it may not have all of their ideal features, but they could still manage (or so the argument goes). The key for proponents of CO is that there exists an alternative selection or option that is functionally equivalent to their desired choice.
Proponents of CO may say something like: “CO is justified so long as there exists an alternative source of the desired good/service which can provide that particular good/service to the party whose request was/has been denied.”
In the former cases (i.e. the medical ones), it simply may not be (and likely is not) feasible for a woman in need of a medical procedure, such as an abortion, to travel to another healthcare facility or find another doctor within that same facility who is willing to perform the procedure. Perhaps in case (iii.), that is certainly possible. That much can and should be conceded.
But look at (i.) and (ii.): the kind of deliberative choice and sheer ability to wait before acting in (iii.) are luxuries not afforded to the women in scenarios (i.) and (ii.). One of these key reasons is resource distribution. While it is easier/faster to find alternative sources for certain goods/services, it is when these goods/services take on life and death importance (i.e. they are medical goods/services, not merely economic ones) that the Libertarian’s argument from available alternatives fails.
The women in (i.) and (ii.) cannot be reasonably expected to respond to a claim of conscientious objection by (1) researching exactly what facilities and physicians would be willing and capable of performing the procedure, (2) transporting themselves to that location (with or without assistance), and (3) being able to take time off of work, school, and one’s social life to accomplish all of that. It’s unrealistic. It’s unreasonable.
This leads me to my main idea on the topic: when matters involve life or death, one doctor’s individual psychological suffering is outweighed by the patient’s potential fatality. While I acknowledge that this utilitarian kind of calculus is controversial, I do not believe it is problematic. Let’s think of the most intense mental discomfort possible. Conceivable. Even that, whatever it may be, is nothing compared to one’s non-existence or the loss of existence. In short, one individual’s mental discomfort is not a legitimate or valid ground on which to base CO at least in cases involving possible, but especially probable, fatal consequences.
But also, as a final word, note how concisely I specified with the examples. It has to be a genuine case of life-and-death on the line, but when it is, (at least in my view) doctors and physicians are still being morally respected even if they are expected (or even coerced whether it be the government, their employer, or the general public) to provide certain procedures to patients who need them.