Article

Assisted dying

Comment

Justice

15 October 2024

5 min read

Will clinicians and carers objecting to assisted death be treated as nuisances?

The risk and mental cost of forcing someone to act against their conscience.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

After a formal introduction to the House of Commons next Wednesday, MP’s will debate a draft Bill to change UK legislation on Assisted Dying. Previously, a draft Bill was introduced in the Scottish Parliament in March 2024, and is currently at committee stage. Meanwhile, in the House of Lords, a Private Member’s Bill was introduced by Lord Falconer in July and currently awaits its second reading. These draft Bills, though likely to be dropped and superseded by the Commons Bill in the fullness of time, give an early indication of what provision might be made on behalf of clinicians and other healthcare workers who wish to recuse themselves from carrying out a patient’s end of life wishes on grounds of Conscientious Objection.

There are various reasons why someone might want to conscientiously object. The most commonly cited are faith or religious commitments. This is not to say that all people of faith are against a change in the law – there are some high-profile religious advocates for the legalisation of Assisted Dying, including both Rabbi Dr Jonathan Romain and Lord Carey, the former Archbishop of Canterbury. Even so, there will be many adherents to various faith traditions who find themselves unable to take part in hastening the end of someone’s life because they feel it conflicts with their views on God and what it means to be human.

However, there are also Conscientious Objectors who are not religious, or not formally so. Some people, perhaps many, simply feel unsure of the rights and wrongs of the matter. The coming debates will no doubt feature discussion of how changing the law for those who are terminally ill in the Netherlands and Canada has to lead to subsequent changes in the law to include those who are not terminally, but instead chronically ill. The widening of the eligibility criteria has reached a point where, in the Netherlands, one in every 20 people now ends their life by euthanasia. This troubling statistic includes many who are neurodivergent, who suffer from depression or are disabled. It is reasonable that, even if a Conscientious Objector does not adhere to a particular religion, they can be allowed to object if they feel uneasy about the social message that Assisted Dying seems to send to vulnerable people.

“You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances”

Mehmet Ciftci

Conscientious Objection clauses can themselves send a social message. A response to the Scottish Bill produced by the Law Society of Scotland notes concern over the wording of the Conscientious Objection clause, as it appears to be more prescriptive in the draft Bill than in previous Acts such as the Abortion Act of 1967. In the case of any legal proceedings that arise from a clinician’s refusal to cooperate, the current wording places the burden of proof onto the Conscientious Objector, stating (at 18.2):

In any legal proceedings the burden of proof of conscientious objection is to rest on the person claiming to rely on it.

The Bill provides no indication of what is admissible as ‘proof’. Evidence of membership of a Church, Synagogue, Mosque or similar might be the obvious starting point. But where does that leave those described above, who object on grounds of personal conscience alone? How does one meaningfully evidence an inner sense of unease?

The wording of the Private Member’s Bill, currently awaiting its second reading in the House of Lords, provides even less clarity, stating only (at 5.0):

A person is not under any duty (whether by contract or arising from any statutory or other legal requirement) to participate in anything authorised by this Act to which that person has a conscientious objection.

Whilst this indicates that there is no duty to participate in assisting someone to end their life, there remains a wider duty of care that healthcare professionals cannot ignore. Thus, a general feature in the interpretation of such conscience clauses in medicine is that that the conscientious objector is under an obligation to refer the case to a professional who does not share the same objection. This can be seen in practice looking at abortion law, where ideas around conscientious objection are more developed and have been tried in the courts. In the case of an abortion, a clinician can refuse to take part in the procedure, but they must still find an alternative clinician who is willing to perform their role, and they must still carry out ancillary care and related administrative tasks.

Placing such obligations onto clinicians could be seen as diminishing rather than respecting their objection. Dr Mehmet Ciftci, a Researcher at the McDonald Centre for Theology, Ethics and Public Life at the University of Oxford comments:

You will often find that legislation that provides a right to conscientious objection is interpreted by judges these days in a way that seems to treat conscientious objectors as nuisances who are just preventing the efficient delivery of services. They are forced to refer patients on to those who will perform whatever procedure they are objecting to, which involves a certain cooperation or facilitation with the act.

This touches everyone, even those who (if the Bill becomes law) will still choose to conscientiously object. Therefore, it is important to consider that the human conscience is a very real phenomenon, which means that facilitating an act that feels morally wrong can give rise to feelings of guilt or shame, even if one has not been a direct participant.

Psychologists observe that when feelings of guilt are not addressed, if they are treated dismissively or internalised, this can significantly erode self-confidence and increase the likelihood of depressive symptoms. But even before modern psychology could speak to the effects of guilt, biblical writers already had much to say on the painful consequences of living with a troubled conscience. In the Psalms, more than one ancient poet pours out their heart to God, saying that living with guilt has caused their bones to feel weak, or their heart to feel heavy, or their world to feel desolate and lonely.

If the Conscientious Objection clauses of the new Bill being proposed on Wednesday are not significantly more robust than those in the draft Bills proposed thus far, then perhaps that is something to which we should all conscientiously object? There is much to discuss about the potential rights and wrongs of legalising Assisted Dying, but there is much to discuss about the rights and wrongs of forcing people to act against their consciences too.

Article

Comment

Freedom of Belief

Politics

20 October 2025

5 min read

The UN promised freedom of belief — but 80 years later, it’s still elusive

Flawed, fragile but still vital to those without a voice

Steve Dew-Jones

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Trump addresses the 80th session of the United Nations General Assembly.

The White House.

It’s been 80 years since the United Nations was founded, at the end of the Second World War, primarily in an attempt to avoid a third global conflict.

So on that score, at least, I suppose one must accept that the UN has achieved its primary objective. But why, then, does the overall feeling towards the organisation today seem negative?

The UN’s founding charter outlined three other major goals alongside maintaining “international peace and security”: developing “friendly relations” among nations; international cooperation in solving economic, social, cultural or humanitarian problems; and respect for human rights and fundamental freedoms, “without distinction as to race, sex, language or religion”.

Given that the UN is comprised of 193 countries, it is perhaps little wonder that “friendly relations” and “cooperation” between all sides have not always been forthcoming, and that instead clear cliques have formed between Western countries on the one hand, and much of the rest of the world on the other. (Perhaps the clearest such clique at the moment is the 2021-founded “Group of Friends in Defence of the UN Charter”, the identities of whose members - China, North Korea, Iran, Russia, Venezuela, et al - may lead one to wonder what exactly it is in the UN charter they wish to defend. Short answer: “sovereignty”, code for doing whatever they wish, without interference.)

As for the pursuit of “human rights” - my primary focus as an employee of an NGO - perhaps the greatest obstacle remains the lack of a truly united consensus over which rights should be included in the definition.

The closest that the nations of the world have come to an agreement on this score was the adoption in 1948, three years after the founding of the UN, of the Universal Declaration of Human Rights (UDHR), which was backed by 48 of 58 member states at the time, but which failed to secure the support of others, including apartheid South Africa, the former Soviet bloc, and Saudi Arabia.

A primary objection in the case of Saudi Arabia was to Article 18 of the declaration - the bit about religious freedom and which includes the claim that everyone should have the right to change their religion or belief, an issue that remains problematic for many of the not-so-united nations of the world today.

The UK, meanwhile, was happy to ratify the UDHR but expressed frustration at its lack of legal force, and it was nearly 20 years before another treaty, the 1966 International Covenant on Civil and Political Rights, attempted to correct this.

But while the 174 signatories to the ICCPR - including Iran, Russia, Cuba and China (though the latter two without ever ratifying the treaty) - are at least on paper legally obliged to uphold this international treaty, the challenge of enforcement remains. For example, while the signatories of the ICCPR are obliged to provide freedom of religion as defined by Article 18 of the covenant, which closely resembles the same article of the UDHR, few practical tools exist to hold to account any state that fails to meet its obligations.

In the case of persistent violators like Iran - the focus of my work - it seems the best we can currently hope for is to see a “resolution” passed by the majority of member states, outlining the ways in which the particular violator has failed to provide its citizens with the religious freedom (among other things) that should be their right according to the international treaties it has signed, and calling on them to do better.

But when pariahs like Iran can merely continue to deny that such failures exist, call them “biased” and “political”, and all the while prevent access to the country to the independent experts (“Special Rapporteurs”) best able to ascertain the veracity of the allegations, such “resolutions” can at times appear rather hollow.

At the same time, for advocates of human rights in non-compliant countries like Iran, the public shaming offered by such resolutions at least provides an opportunity for otherwise voiceless victims to be heard on the international stage. And when real change inside the country can sometimes appear nigh-on-impossible, you tend to take the small wins, such as hearing the representatives of member states mentioning the names of individual victims or groups in the public arena.

Many mentions are made, for example, about the plight of the Baha’is during every UN discussion of human rights in Iran, and while it is less common to also hear about my own area of interest - the persecution of Christians in Iran - there is usually at least one mention, which for us advocates (and we hope also the victims we represent) provides some comfort and hope for future change.

So 80 years since the establishment of the UN, it is clear the organisation has much room for improvement, but I remain persuaded by the argument that if we didn’t have the UN, we’d have to invent it.

“Friendly relations” - a helpfully loose term - between our disunited nations will always be a challenge, but increased economic ties globally over the past 80 years have also provided potential pressure points for those who fail to follow the rules. (If, for example, Iran wishes to see sanctions removed, Western countries can and should continue to demand improvements in the area of human rights.)

As for the UN’s endeavour to see increased “respect for human rights and fundamental freedoms”, the question of what such rights and freedoms should entail will continue to be debated, with persistent areas of challenge including not only religious conversion but also abortion and same-sex relations.

It is not uncommon, for example, to hear representatives of Muslim states such as Iran questioning what Western nations really mean by “human rights” and accusing them of using the term only as a “pretext” for their own “biased” agendas.

But for all its challenges, 80 years after its establishment the UN continues to offer the only forum today where countries of contrasting beliefs can come together to discuss their differences on the world stage.

Whether that is a worthwhile exercise remains a matter for debate, but to the degree that it is, the UN remains the primary channel through which such conversations can take place.

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