Conscience and proper medical treatment

A controversy that cuts across medical practice and law is the question of the proper reach and role of conscience in medical practice. This is a particularly acute issue in the context of a publicly funded healthcare system where comprehensive access to treatment is supposed to be guaranteed. This special issue brings together papers that were developed from two conferences which looked at this overarching issue. The first, held in Manchester and funded by a grant from the Wellcome Trust, explored how certain treatments, procedures, and practices come to be viewed as ‘proper medical treatment’.1 The second, held in Birmingham and funded by the AHRC as part of a seminar series on faith and religion in health care,2 examined the role of conscience in medical care. We are grateful to both funders for their support, and to participants at these seminars for their valuable discussions and insights. The papers in this issue critically assess the role of conscience in clinical practice and explore how we understand notions of proper medical treatment. Ethically contentious medical interventions such as abortion, withdrawing life-sustaining treatment, and assisted dying continue to spark debates about the role of the law in legitimising and/or regulating such practices. Indeed, important contributions to these debates have featured in this journal.3 The papers in this special issue seek to develop these debates by linking the concept of proper medical treatment and ideas about medical conscience, as we see these as fundamental to medicine. These matters are particularly significant to treatments which invite polarised views and moral confusion. The question of whether such treatments are legitimate (proper medical treatment) and whether doctors and other health professionals are willing to provide them (conscience), are central to establishing the legal and ethical parameters of medical practice. The papers in this issue highlight the way in which we come to understand the boundaries of acceptability for non-clinical concerns to bear on health professionals' decision-making.