Conscientious Objection in NSW Healthcare: A Guide

Conscience in the Clinic: What Happens When NSW Doctors and Nurses Say No to Abortion or Assisted Dying?

Imagine you’ve spent years training as a nurse or doctor because you wanted to care for people. Then, one day, you’re asked to take part in something your conscience tells you is wrong. You can say no, but you may pay a price.

That’s the picture painted by Liberal MLC Susan Carter at a recent seminar in Sydney, as reported by Michael Cook in The Catholic Weekly and republished on The Daily Declaration. She warned that New South Wales healthcare workers who object to participating in abortion or voluntary assisted dying (VAD) are increasingly under pressure, and she and three panellists raised a new idea for protecting them: treating forced participation as a workplace safety risk called “moral injury.”

This post looks at what Carter said, what NSW law actually provides, how other jurisdictions handle the question, the best arguments on each side, and how Christians can think about it with both conviction and care. It’s a topic on which sincere people disagree, and we’ve tried to represent that honestly.

What Was Said

The seminar was held at Club York in Sydney’s CBD and attended by about 40 people. It was the first joint event of the St Thomas More Society and the NSW Catholic Medical Association. According to the report:

• Carter’s warning. She said she has detected hostility towards conscientious objection, and a growing endorsement of what she called “authoritarian majoritarianism” among both constituents and parliamentary colleagues. In her view, health bureaucrats often speak of anyone who declines to take part in care as an obstruction to be removed.
• Examples cited. She pointed to Greens MLC Dr Amanda Cohn, who has told Parliament that conscientious objection must not be weaponised to restrict access to care by whole departments or institutions. She also cited a statement last year by the CEO of Murrumbidgee Health District to a budget estimates committee that they would prefer to employ people in key roles depending on whether they object to abortion.
• Her conclusion. Objectors, she argued, are increasingly treated as obstacles to be “designed around,” with employment structured so that they become unemployable.

Three panellists responded:

• Professor Megan Best of the University of Notre Dame Australia said that objection can be very hard in practice, particularly for junior staff working under supervisors who don’t share the objection. She also argued that there need to be limits, to prevent “conscience” being used arbitrarily, for example to refuse treatment to certain classes of patients. She floated ideas such as external verification or limiting the number of issues covered, while acknowledging that the lines are hard to draw.
• Emeritus Professor Michael Quinlan, also of Notre Dame, noted that many people besides doctors and nurses are involved: students, pharmacists, pastoral care workers, aged-care staff, administrators and interpreters. He argued that freedom of thought, conscience and religion belongs to everyone, not just registered practitioners.
• Dr Xavier Symons of the Plunkett Centre at Australian Catholic University, author of Why Conscience Matters: A Defence of Conscientious Objection, argued that health professionals can suffer moral injury if pressured to act against deeply held beliefs.

What Does NSW Law Currently Say?

It’s worth looking at the actual legal provisions, since much of the debate turns on them.

Abortion

Under the Abortion Law Reform Act 2019 (NSW), a registered health practitioner who has a conscientious objection to performing a termination must disclose the objection to the person asking, as soon as practicable. They must also refer or transfer the person to another practitioner, or to a health service provider, whom they reasonably believe can provide the service and who does not object. The Act also contains other provisions, including a requirement for medical care for a child born alive after a termination, and an offence of coercing someone into an abortion.

Critics of this model, including bioethicists at Notre Dame, argued during the 2019 debate that it forces objectors into a role they see as complicity, and that Victoria’s later VAD law, which didn’t require objectors to provide information, was a better model. A commentary reported in Quadrant has also claimed that proposed amendments in 2025 would move from “disclose and indicate how to find a provider” to requiring a specific, direct referral. That’s an assertion in an opinion piece, and anyone planning to rely on it should check the current text of the law.

Voluntary assisted dying

Under the Voluntary Assisted Dying Act 2022 (NSW), which commenced in late 2023:

• A registered health practitioner with a conscientious objection has the right to refuse to take part in specified actions, including prescribing, supplying or administering a VAD substance.
• Health care workers are not allowed to initiate a discussion about VAD with a patient or suggest it. That restriction is designed to protect patients from pressure, and it applies to everyone.
• NSW Health guidance states that all healthcare workers have obligations under the Act, including objectors. If a practitioner is unable to accept a formal first request, they should refer the patient to the NSW VAD Care Navigator Service or an authorised practitioner.

So conscientious objection is formally recognised in both areas, but with obligations attached, and the debate is about how far those obligations extend and how they work in practice.

How Other Places Handle It

• Ontario, Canada. In 2019, the Ontario Court of Appeal upheld a regulatory policy requiring doctors who object to MAID or other procedures to provide an “effective referral.” The court accepted that this limited religious freedom but found it justified to protect patient access.
• The United Kingdom. In Greater Glasgow Health Board v Doogan (2014), the Supreme Court held that the right to conscientious objection to abortion covers actually taking part in the treatment, not supervisory or administrative tasks around it. It shows how much turns on the definition of “participate.”
• Victoria. The VAD law there states that practitioners have no obligation to provide information about VAD or to take part in the request and assessment process. NSW is more demanding by comparison.

Different jurisdictions have drawn the line in different places, which shows that the question isn’t settled and can be answered in more than one way.

The Moral Injury Idea

The most novel part of the seminar was the suggestion that conscience protection could be reframed as a work health and safety issue.

The term “moral injury” comes originally from work with military veterans. Researchers use it to describe the lasting psychological, spiritual and social harm that can follow actions, or witnessing events, that violate a person’s deeply held moral beliefs. Carter, Quinlan and Symons argue that health professionals who are pressured to take part in procedures they believe are wrong could suffer something similar.

In Australia, workplace safety regulators in recent years have treated psychological harm, including bullying, trauma and work-related stress, as hazards that employers must manage. The argument is that if employers have a legal obligation to prevent psychosocial injury, forcing someone to violate their conscience, or bullying them for objecting, could fall within that duty.

It’s an interesting and untested legal argument. Quinlan himself said more research is critical. Supporters hope it could offer a practical route for protection that doesn’t depend on winning the political argument over abortion or VAD. Critics might say that stretching safety law this way is novel, and that the evidence for moral injury in this context needs to be established, not assumed. Notably, health workers who support abortion or VAD can also experience moral distress in restrictive environments, and the concept cuts in several directions.

The Christian Case for Conscience

Scripture treats conscience as serious.

• The Hebrew midwives. In Exodus 1:15–21, Shiphrah and Puah refuse Pharaoh’s order to kill newborn Hebrew boys, because they feared God. They’re remembered and blessed for it.
• Daniel and his friends. Daniel resolved not to defile himself (Daniel 1:8), and later Shadrach, Meshach and Abednego refused to bow to the king’s image (Daniel 3). They acted respectfully and without rebellion, and accepted the consequences.
• The apostles. When ordered to stop speaking about Jesus, Peter and John answered that they could not help speaking about what they had seen and heard (Acts 4:19–20). Later, they said they must obey God rather than human beings (Acts 5:29).
• Conscience and faith. Paul says that whatever does not come from faith is sin (Romans 14:23), and he urges Timothy to hold on to faith and a good conscience (1 Timothy 1:19).
• Defending the vulnerable. Proverbs 24:11 calls on us to rescue those being led to death. Many Christians see opposition to abortion and euthanasia as rooted in this and in the sanctity of human life made in God’s image (Genesis 1:27).

But the Bible also describes service. Jesus’ story of the Good Samaritan (Luke 10) shows love for a neighbour in need, whoever they are. Philippians 2:3–4 calls us to look to the interests of others, not only our own. Christians who object to certain procedures are called to be gracious, transparent and as helpful to patients as conscience allows, including in being honest about what they can’t do so patients can seek care elsewhere.

Our Take

Here’s where we’d like to add some commentary.

1. Conscience protection is part of a free society.

People shouldn’t be forced to choose between their livelihoods and their deepest convictions without very good reason. That principle applies whatever one thinks of abortion or VAD, and it protects people of many beliefs, including those who might object to other practices in the future.

2. Patients’ access matters too.

A woman seeking a lawful termination, or a dying patient seeking VAD, shouldn’t be left without options because of where they live or who they happen to meet. In regional areas, where there may be only a single hospital, that concern is real. A good system must ensure access without conscripting objectors.

3. The hard questions are about the lines.

Who counts as an objector? Which tasks count as participation? Should objections be limited to certain issues? Must objectors refer, or only inform? Professor Best’s point that unlimited “conscience” could be abused is a fair one, and so is Professor Quinlan’s point that protection shouldn’t be limited to registered practitioners. Serious answers require careful drafting.

4. Beware of motivated language.

Terms like “authoritarian majoritarianism” and “weaponised” are both persuasive labels. They capture real concerns, but they can also close down listening. We’d encourage both sides to describe each other’s positions in terms their holders would recognise.

5. Objectors have responsibilities as well as rights.

Transparency, early disclosure, professionalism and compassion for patients are part of a credible conscience claim. Objectors who act with grace and avoid obstruction strengthen the case for protection.

6. The moral injury argument deserves proper study.

It’s an interesting idea and may prove helpful. But it will need real evidence, careful legal analysis and, ideally, a broad hearing that includes people on both sides of the underlying issues.

The Other Side of the Argument

In fairness, here’s how supporters of abortion access and VAD, and some ethicists, would respond:

• Patient-centred care. Healthcare is provided for patients, not practitioners. Where a legal service is available, patients have a right to access it, and professionals who can’t provide it have an obligation to make sure they aren’t blocked. Ontario’s courts took this view.
• Professional role. Some ethicists, such as Julian Savulescu, have argued that doctors who are unwilling to provide lawful, standard care should not practise in the relevant areas at all, or should place the needs of patients above their own values.
• Institutional access. The comment attributed to Dr Cohn reflects a concern that departments or entire facilities could use conscience to restrict services, leaving patients with nowhere to go. Supporters of access argue that this isn’t a matter of individual conscience but institutional policy.
• Staffing. Health administrators say they must run services that comply with the law and meet community needs, and that having objectors in key roles can create gaps. That’s a management challenge, not necessarily hostility.
• VAD safeguards. The ban on health workers initiating VAD, and the existence of the Care Navigator Service, are designed to balance conscience and access.
• Moral injury cuts both ways. Clinicians who believe patients deserve these services may also experience distress if barriers prevent them from providing care.

These perspectives deserve a fair hearing. The question isn’t whether conscience or access matters, but how to protect both.

What Can Be Done?

• Health workers: Know your employer’s policies and the relevant law, document objections properly, and seek advice from your professional body, union or a lawyer if you’re under pressure.
• Employers and health districts: Be transparent about hiring and conditions, and respect the legal protections that exist. Develop clear rostering and referral processes that respect both patients and staff.
• Churches: Pray for Christians in healthcare, offer support and mentoring, and be a place where they can talk about the pressures they face.
• Citizens: Ask your MPs where they stand on explicit conscience protections, and whether they would extend them to pharmacists, students and aged-care workers.
• Researchers and lawyers: Study the moral injury argument and the practical impact of current rules.

Questions to Reflect On

• Where would I draw the line between conscience and obstruction?
• How should a health system balance access to lawful services with respect for those who object?
• What would it cost me to hold to my convictions at work?
• Do I know any Christian nurses, doctors or pharmacists, and how could I support them?
• How can I talk about this issue in a way that honours both patients and objectors?

A Short Prayer

Lord, you give wisdom to those who ask. We pray for every doctor, nurse, pharmacist and carer who works long hours to care for the sick and dying. Protect those who face hard choices and the pressure to compromise their conscience. Give courage to the faithful, compassion to those who disagree, and wisdom to legislators and administrators. Keep the vulnerable safe, and let our health system be marked by justice, mercy and truth. Amen.

Further Reading

This post was prompted by Michael Cook’s report, Conscientious Objection for Healthcare Workers Endangered in New South Wales, published by The Daily Declaration and republished with thanks to The Catholic Weekly.

Tags: conscientious objection, NSW, abortion, voluntary assisted dying, moral injury, religious freedom, healthcare, Christian commentary

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How to Spot Media Bias: A Case Study From the Howe Controversy

Meta description (138 characters): How to spot media bias using the Howe controversy as a case study: loaded language, missing context, story choice and fair-minded reading.

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Most of us sense when a news story is leaning on us. A word feels a little too strong. A quote seems to be missing something. The headline promises one thing and the article delivers another. But few of us can say exactly how it’s done.

A recent commentary on The Daily Declaration by Kurt Mahlburg, republished from Flipped Media, sets out to explain the mechanics. Using coverage of the controversy over comments by James and Joanna Howe as a case study, he walks through a series of techniques that journalists, he argues, use to tilt a story while presenting it as neutral news.

This post draws on his argument and adds some background, some context he doesn’t provide, and a few cautions about applying the same tests fairly to everything we read, including commentary from writers we agree with. The subject matter here is sensitive, since it concerns sexual consent and marriage, so we’ve tried to be careful about what’s known and what’s disputed.

What Happened

According to news reports:

• On 9 September 2026, Dr Joanna Howe, a law professor at Adelaide University and prominent anti-abortion campaigner, published an episode of her YouTube show, The Dr Jo Show, with her husband James. The episode discussed Chanel Contos and her Teach Us Consent program and was titled with a reference to “the radical feminist” behind the government’s social media measures.
• In the episode, James Howe is reported to have said, among other things, “I just don’t do consent,” “we don’t do consent, I do marriage man,” and “Consent is not even a freaking thing for me.” He also criticised what he described as teaching small children about consent.
• The comments went viral and drew strong criticism, including from South Australia’s Attorney-General, Kyam Maher, and from consent education advocates. A petition calling for Adelaide University to dismiss Joanna Howe gathered thousands of signatures, and the university issued a statement clarifying its position on consent.
• Joanna Howe said the criticism “fundamentally misses the point.” James Howe said the claims were falsehoods spread by ideological opponents, and, according to reports, launched a fundraiser of around $95,000 for legal action over defamation.
• The couple also took part in a rally outside the New South Wales Parliament that week, on abortion-related legislation.

Mahlburg’s argument is that the way this was reported misrepresented what the Howes actually said and meant. That claim is contested, and legal proceedings are reportedly in prospect, so it’s important to keep to what’s documented and to avoid prejudging.

The Toolkit: Sixteen Ways a Story Can Lean

Mahlburg draws on a guide from AllSides, an organisation that rates the political bias of news outlets and publishes a list of techniques reporters can use to tilt coverage. The ones he highlights are worth knowing, whatever one thinks of the particular case:

• Spin. Using vivid verbs to colour what someone did: a person “declared,” “claimed” or “snapped,” rather than “said.”
• Unsubstantiated claims. Asserting things like “widespread fury” or “alarming levels” without naming a source, a post or a number.
• Subjective qualifying adjectives. Words such as “controversial,” “wild,” “strong” or “hugely irresponsible,” which tell you how to feel before telling you what happened.
• Word choice. Choosing labels that carry a judgement, such as “anti-abortion activist” or “pro-life,” or whether someone is called “Mrs” or “Dr.”
• Negativity bias. Dwelling on outrage, damage and controversy, while leaving out what the person was trying to say.
• Flawed logic. Mixing up two related issues, such as an argument about a school program and an argument about the law.
• Slant and viewpoint placement. Giving more space or prominence to one side, or putting a critic’s reaction right after the quote so it frames how you read it.
• Bias by omission. Leaving out the lines that explain what a speaker meant.
• Sensationalism. Crafting headlines that provoke emotion, often with a striking quote lifted out of its setting.
• Story choice. Deciding which stories to tell, and which to ignore.

Most of these are subtle, and most journalists use some of them at least occasionally, often without noticing. That’s why learning to see them is useful.

Mahlburg’s Case Against the Article

Mahlburg applies this toolkit to a news.com.au article published on 15 September, headlined with a quote from the podcast and the phrase “wild consent claim.” His main points, as he presents them:

1. The format signals “news.” The article was filed under a news section, without an opinion tag, and followed the usual shape of a news report.
2. Loaded language and unsubstantiated claims. He points to the words “declared,” “claim,” “fury” and “come under fire,” and says no critics are named to support the “widespread fury.”
3. A selective source. The article quoted a single critic, who he says is a long-time opponent of Joanna Howe, and placed her reaction immediately after the summary.
4. Omitted context. He says the podcast was criticising Contos’s school program, not “consent laws,” as the article said. He also says the article left out two lines in which James explained that he was talking about marriage, and the meaning of the “I don’t give a f***” quote used in the headline, which Mahlburg says was about critics who would misrepresent him, not about his wife’s consent.
5. Story choice. He notes that the Howes were also preparing for a major rally the same day, which wasn’t the focus of the coverage.

Some of these points can be checked by anyone willing to read the article and watch the episode, and they’re worth checking, because that’s the point of media literacy.

Where the Critique Is Strong, and Where It’s Incomplete

Where it’s strong. Whenever a headline takes a phrase out of its setting, or an article omits context that explains it, readers should be told, and it’s reasonable to push back on that. Loaded language, anonymous “fury” and one-sided sourcing are well-known problems in journalism, and they apply to coverage of people on every side of politics. Conservative Christians are not the only ones who feel they receive unfair treatment, and it’s reasonable to want fair coverage for everyone.

Where it’s incomplete. There are several points that a fair reader should also weigh:

• The quoted words were widely reported. Several outlets quoted similar remarks, and the reported phrases, such as “I just don’t do consent” and “consent is not even a freaking thing for me,” came from the episode itself. The strong reaction wasn’t invented by a single article.
• Context may explain, but it doesn’t always excuse. Even if James’s meaning was that marriage, not a classroom script, is the proper framework for sexual relationships, critics argue that dismissing the word “consent” is harmful, because sexual coercion within marriage is real. Whether the omitted lines soften the remarks or make them more worrying is exactly what people disagree on.
• The same toolkit applies to Mahlburg’s piece. His commentary uses vivid language of its own, including “hoodwink,” “slimy tactics,” “skulduggery” and “how the news sausage is made.” That’s normal in opinion writing, but it means his article also needs to be read with the same critical eye.
• A critique of coverage isn’t a defence of the remarks. It’s possible for an article to be unfair and for the remarks it reported to be unwise, or both could be true to different degrees. They are separate questions.

Consent and Marriage: What the Law and Scripture Say

Because this debate involves sexual consent in marriage, it’s worth stating some basics clearly, whatever one’s view of the media coverage.

The law. In Australia, consent is required for sexual activity, and that applies within marriage. The old legal exemption for rape in marriage was abolished across the country, with every state and territory having removed it by the early 1990s. Several states have also adopted “affirmative consent” laws, which require a person to have said or done something to communicate agreement, rather than assuming consent from silence.

The Christian view. Scripture portrays marriage as a relationship of mutual self-giving, not demand. Paul writes in 1 Corinthians 7:3–5 that husband and wife each have a duty to the other, that each has authority over the other’s body, and that abstaining should be by mutual agreement. Ephesians 5:25 calls husbands to love their wives as Christ loved the church and gave himself up for her, and Colossians 3:19 says husbands must not be harsh with their wives. First Corinthians 13:5 says love “does not insist on its own way.”

Taken together, these passages leave no room for coercion within marriage. A good Christian marriage is one in which each spouse freely and joyfully gives themselves to the other. It’s also true that some Christian communities have a painful history of failing victims of domestic and sexual violence, sometimes by treating a wife’s consent as irrelevant. For that reason, Christians have extra reason to speak carefully on this subject, and to make it plain that consent matters.

The debate about consent education. There’s also a separate policy debate: how, when and at what age consent and respectful relationships should be taught in schools, and how the programs are framed. Some parents and commentators worry about age-appropriateness. Supporters, including many educators, say that teaching about boundaries and respect from an early age helps protect children and reduces later harm. That discussion deserves to be heard without being merged with the question of what was said in one podcast.

What the Bible Says About Truthful Reporting

Scripture has a lot to say about how we speak about one another:

• Exodus 23:1 commands, “Do not spread false reports.”
• Leviticus 19:16 warns against slander.
• Proverbs 18:13 says that giving an answer before listening is folly and shame, and Proverbs 18:17 says the first to state a case seems right until the other comes and examines him.
• Matthew 7:1–5 reminds us to take the plank out of our own eye before pointing at the speck in someone else’s, which applies to media critics as much as to journalists.
• Luke 6:31 gives the golden rule: do to others as you would have them do to you. We should want others to describe us fairly, and describe them the same way.
• 1 Thessalonians 5:21 tells us to test everything and hold on to what is good.
• Ephesians 4:25 urges us to put away falsehood and speak truthfully to our neighbour.

These principles apply to newsrooms, to commentators, to social media posts and to those of us who share them.

Our Take

Here’s where we’d like to add some commentary.

1. Media literacy is a good skill, and it’s a Christian one.

Learning to spot spin, omission and selective sourcing helps us avoid being manipulated, and it fits the biblical call to test what we hear.

2. Use the same tests on everything.

The honest way to use this toolkit is to apply it to writers we like as well as those we don’t. Opinion pieces, Christian media and our own social media posts all use framing, emphasis and word choice, and we should hold them to the same standard.

3. Go to the primary source.

Whenever possible, watch the full episode, read the full document and compare more than one account. It takes time, but it’s the only reliable way to judge whether a quote has been fairly used.

4. Separate the questions.

“Was the coverage fair?” and “Were the remarks wise or right?” are different questions. A critique of the first doesn’t answer the second, and vice versa.

5. Be careful with pending legal matters.

Because defamation action has been foreshadowed, readers should avoid treating allegations on any side as settled. Courts, not commentators, are the place to determine questions of fact and law.

6. Speak carefully on sensitive subjects.

Whatever the intent, phrases that sound dismissive of consent will be heard by people who have experienced harm. Christians in public life have particular reason to choose words that make clear they stand for the safety and dignity of every person, including within marriage.

7. Remember the people involved.

Behind these controversies are families, children and communities, as well as professional reputations. Pray for everyone involved, including the Howes, those who have felt hurt by the remarks, and those who have been on the receiving end of anger online.

The Other Side of the Conversation

In fairness, here’s how others would see it:

• Critics of the Howes would say that public figures are responsible for what they say, that the quoted words were clear and widely reported, and that a sexual consent message matters too much to be treated lightly. They’d add that complaints about “media bias” can become a way to deflect from the substance.
• Supporters of the Howes would say that the remarks were taken out of context, that the family has been subjected to an unfair campaign, and that this is part of a pattern of hostility towards pro-life Christians in public life.
• Journalists would say that headlines compress, that quoting a controversial remark is part of reporting, and that they’ve sought comment from relevant voices. Some would point out that people who go public with strong views should expect scrutiny.
• Consent educators would say the episode shows why consent education matters, and that dismissing it as “creepy” misses what the programs aim to do.
• Media-literacy experts would add that every news organisation and commentator makes editorial choices, and that the best response is a diverse reading diet, not trust in one source.

None of these positions cancels out the others. A fair-minded reader can take what’s right in each.

A Practical Checklist for Reading the News

1. Check the label. Is this news, analysis or opinion?
2. Read the headline last. Then ask whether the article actually supports it.
3. Look at the verbs and adjectives. Do they describe, or do they judge?
4. Count the sources. Who is quoted, and who isn’t? Are critics and subjects both heard?
5. Look for numbers. When an article says “widespread,” “alarming” or “growing,” ask for evidence.
6. Find the full quote. What came before and after the excerpt?
7. Read a second account from a different perspective.
8. Ask what’s missing. What story is not being told?
9. Notice your own reaction. Strong emotion is a prompt to slow down.
10. Apply the same standards to sources you agree with.

Questions to Reflect On

• When I feel outraged by a story, have I checked the primary source?
• Do I give the same scrutiny to media I trust as to media I distrust?
• Have I ever shared something about someone without being sure it was fair?
• How can I speak about sensitive topics in ways that protect the vulnerable and honour truth?
• Who might need prayer and kindness in a controversy like this?

A Short Prayer

Lord of truth, you hate false witness and love honest speech. Give us discernment to test what we read and hear, humility to examine our own biases, and courage to speak plainly and kindly. Protect the vulnerable from harm, and give wisdom to those who teach, report and lead. Bring healing to families caught up in public controversy, and make us people whose words build up and do not tear down. Amen.