A conscience vote is meaningless unless it is a two-way street

Such questions may not be front of mind for our state MPs, but they should be. Before the year is out, Victoria's MPs will cast a conscience vote on bills about physician-assisted suicide, abortion and assisted reproductive technologies. Conscience clauses will be contained in each of these bills.

Our understanding of the proper role of conscience in politics and health remains murky. What is conscience, why are we pledged to honour it, and what responsibilities do those who claim the right to follow theirs have to others?

The right to act according to the dictates of our conscience is founded in the value of autonomy. Autonomy means self-rule. An autonomous person is one who is free to direct her life according to her own values. It would be hard to overestimate the role autonomy, and therefore conscience, plays in the value systems of contemporary Australian society. Our political and legal structures are grounded in the belief, to paraphrase High Court Justice McHugh, that autonomous individuals are entitled to make, and are consequently responsible for, their own choices. And our health system, in line with that of others in the Western world, has shifted in the past few decades from the paternalistic idea that doctors know best, to the view that patients have a right to make their own informed choices about their care.

All this suggests what is true: that most learned discussions of conscience focus on the duties lawmakers and medicos have to protect the autonomy of citizens and patients. This is for good reason. Both our elected representatives and health care staff are professionals: trusted and respected members of society with a duty of care to those they are sworn to serve and heal.

Despite this, some professionals in Victoria seem primarily concerned with their rights when it comes to conscience, not their obligations. Some MPs, understandably pleased at the rare opportunity to shrug off party discipline, see a conscience vote as a chance to register their own value positions on the issues at hand. In the same way, conscience clauses in bills on euthanasia, abortion and ARTs tend to spell out the entitlements of medical professionals to refuse treatment they deem morally objectionable, but are silent on their obligations to ensure patients get timely, appropriate care.

We need to get the balance right. Yes, the entitlements of MPs and medical professionals to follow the dictates of their consciences are part of the autonomy story. But if mutual obligation means anything, then political and medical professionals who assert their right to vote or to refuse care on grounds of conscience must take their responsibilities to foster the autonomy of those they are bound to serve - we citizens and patients - just as seriously.

They can do this by recognising that it is unconscionable for someone to defend the right to follow his conscience, then deny that very same right to someone else. Such moral hypocrisy is compounded when those denying the autonomy of others are professionals, and those they are denying are the citizens or patients they are sworn to serve.

For politicians, this means thinking twice about using a conscience vote to pass a law that denies citizens the right to act on their consciences when terminally ill, facing an unplanned pregnancy or seeking to conceive using ARTs.

For medical professionals, it means ensuring that all conscience clauses in legislation include an obligation to refer. That is, where the law articulates the right of doctors, nurses and pharmacists to refuse treatment on grounds of conscience, it must also spell out the obligations of professionals to ensure their patients' needs are met elsewhere.

Pro-life groups continue to resist such basic demands, though medicos tend to be on board. A recent letter to all Victorian MPs signed by a number of religious leaders spent paragraphs detailing the extensive rights of health-care workers to refuse treatment on grounds of conscience, and just one sentence tartly rejecting the idea that these providers had any obligation to refer.

In contrast, the ethical practice guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists instructs its members to "offer or arrange a further opinion and/or ongoing care with another suitable practitioner if the therapy required is in conflict with (your) personal belief/value system."

With all rights come obligations, and the freedom to follow one's conscience is no exception. As members of our community, politicians and health-care workers are as entitled as the rest of us to live their lives according to their values. But because they are professionals, these rights come with significant responsibilities, responsibilities that come down to a requirement that those who act from conscience live by the golden rule: do to others as you would have them do to you.