An Examination of the State of Conscientious Objection in Healthcare in 2024

Conscientious Objection in Healthcare (COIH) remains a complex and divisive issue, with evolving debates that reflect broader sociocultural and ethical dilemmas in medical practice. This paper examines the current state of COIH in North America, with a comparative analysis focusing on Canada and the United States. Through a review of contemporary cases, policy frameworks, and legal interpretations, we analyze COIH as it pertains to critical healthcare practices, including euthanasia and assisted suicide, abortion, in-vitro fertilization (IVF), and other women’s health issues.

The acceptance and regulation of COIH are deeply influenced by national and regional policies, as well as by underlying ethical and religious values. In both Canada and the United States, healthcare professionals who refuse participation in procedures like euthanasia or assisted suicide often cite personal moral or religious beliefs, challenging healthcare systems that aim to ensure comprehensive patient care. In Canada, where Medical Assistance in Dying (MAID) has been legal since 2016, this debate is particularly heated as the federal government continues to refine related regulations. Meanwhile, the United States maintains varied state-level policies that create an inconsistent landscape for patients and healthcare providers alike.

Our study also addresses the application of COIH in reproductive healthcare, particularly in relation to abortion and IVF, as well as women’s health services. In these areas, conscientious objection often intersects with patient access, posing ethical questions regarding healthcare equity. Additionally, we explore COIH within the context of end-of-life care and organ donation, where definitions of death and autonomy become pivotal.

This paper offers a critical assessment of the potential implications for patient rights, professional responsibilities, and policy development in North America. We conclude by exploring ways to reconcile individual conscience with public health needs, seeking to contribute to the ongoing discourse on COIH.

Authors: Hasan Shanawani, VA; Natalie Delia Deckard, University of Windsor