As noted in my previous essay, a person does not surrender their moral rights or conscience when they enter a profession. It should not be simply assumed that a health care worker cannot refuse to treat a person because of the worker’s values. But it should also not be assumed that the values of a health care worker automatically grant them the right to refuse treatment based on the identity of the patient.

One moral argument for the right to refuse treatment because of the patient’s identity is based on the general right to refuse to provide a good or service. A key freedom, one might argue, is this freedom from compulsion. For example, an author has the right to determine who they will and will not write for.

Another moral argument for the right to refuse is the right not to interact with people  you regard as evil or immoral. This can also be augmented by contending that serving the needs of an immoral person is to engage in an immoral action, if only by association. For example, a Jewish painter has every right to refuse to paint a mural for Nazis. But this freedom can vary from profession to profession. To illustrate, a professor does not have the right to forbid a Christian student or a transgender student from enrolling in their class, even if they have a sincerely held belief that Christians are wicked or that transgender students are unnatural.

While these arguments are appealing, especially when you agree with the refusal in question, we need to consider the implications of a right of refusal based on values. One implication is that this right could allow a health care worker to refuse to treat you.  People who support the right to refusal often believe it will be used only against other people, people they do not like. Which is often why they support specific versions of the right, such as the right to refuse gay or transgender people. The idea that it could be used to refuse Christians, straight people, or white people does not enter the imagination. This is because those crafting laws protecting a right of refusal tend to have clear targets in mind.

But moral rights should be assessed by applying a moral method I call “reversing the situation.” Parents and others often employ this method by asking “how would you like it if someone did that to you?” This method can be based on the Golden Rule: “do unto others as you would have them do unto you.” Assuming this rule is correct, if a person is unwilling to abide by their own principles when the situation is reversed, then it is reasonable to question those principles. In the case at hand, while a person might be fine with the right to refuse services to those they dislike because of their values, they would presumably not be fine with it if they were the one being refused. As noted above, laws designed to protect the right of refusal are usually aimed at people intended to be marginalized.

An obvious objection to this method is that reversing the situation would, strictly speaking, only apply to health workers. That is, the question would be whether a health care worker would be willing to be refused treatment.  Fortunately, there is a modified version of this method that applies to everyone. In this modified method, the test of a moral right, principle or rule is for a person to replace the proposed target with themselves or a group (or groups) they belong to. For example, a Christian who thinks it is morally fine to refuse services to transgender people based on religious freedom should consider their thoughts on atheists refusing services to Christians based on religious freedom. Naturally, a person could insist that the right, rule or principle should only be applied to those they do not like. But if anyone can do this, then everyone can, and the objection fails.

A reasonable reply to this method is to argue there are exceptions to its application. For example, while most Christians are fine with convicted murders being locked up, it does that follow that they are wrong because they would not want to be locked up for being Christians. In such cases, which also applies to reversing the situation, it can be argued that there is a morally relevant difference between the two people or groups that justifies the difference in treatment. For example, a murderer would usually deserve to be punished while Christians do not deserve punishment just for being Christians. And I’m not saying this just because I am an Episcopalian. So, when considering the moral right of health care workers to refuse services based on the identity of the patient the possibility of relevant differences must be given due consideration.

An obvious problem with considering relevant differences is that people tend to think there is a relevant difference between themselves and those they think should be subject to refusal. For example, a person who is anti-racist might think that being a racist is a relevant difference that warrants refusing service. One solution is to try to appeal to an objective moral judge or standard, but this creates the obvious problem of finding such a person or standard. Another solution is for the person to take special pains to be objective, but this is difficult.

A final consideration is that while entering a profession does not strip a person of their conscience or moral agency, it can impose professional ethics on the person that supersede their own values within that professional context. For example, lawyers must accept a professional ethics that requires them to keep certain secrets their client might have even when doing so might violate their personal ethics and they are expected to defend their clients even if they find them morally awful. As a second example, as a professor I (in general) cannot insist that a student be removed from my class by appealing to my religious or moral views of the student. As a professor, I am obligated to teach anyone enrolled in my class, if they do not engage in behavior that would warrant their removal. Health care workers are usually subject to professional ethics and these often include requirements to render care regardless of what the worker thinks of the morality of the person. For example, a doctor does not have the right to refuse to perform surgery on someone just because the patient committed adultery and is a convicted felon. This is not to say that there cannot be exceptions, but professional medical ethics generally forbids refusing service just because of the moral judgment of the service provider of the patient. This is distinct from refusing services because a patient or client has engaged in behavior that warrants refusal, such as attacking the service provider.