Dangers of belief-based workplace opt-outs

By Savi Hensman
August 6, 2011

The case of a Christian midwife who refused to wear trousers has again drawn attention to debates over faith in the workplace. She had been asked to leave a high dependency unit when she came in wearing her own dress rather than the scrub uniform.

In early August 2011, Hannah Adewole lost her bid for £7,000 compensation when an employment tribunal ruled that the uniform policy at Queen’s Hospital, Romford, was "legitimate and proportionate for infection control".

The Trust had argued that her religious needs had later been met because she has been given two scrub dresses. NHS trusts in the UK have become increasingly strict with measures to reduce the risk of patient infection, a major cause of preventable suffering and sometimes death.

Though the law forbids direct and indirect discrimination on the grounds of religion and belief, staff are generally expected not to let their faith – or lack of it – interfere with their work duties. This may change if the Equality and Human Rights Commission gets its way. It has applied to intervene at the European Court of Human Rights in four cases in which Christians allege they have been unfairly treated, and called for the law to permit ‘reasonable accommodations’.

Adewole had reportedly claimed that “I believe that the Bible is truth and that its words should be followed wholeheartedly”, and told the tribunal that she considered wearing dresses rather than trousers “a mandatory requirement in order to adhere to the scriptures”, a reference to Deuteronomy 22.5.

Though this may well have been her sincere belief, to many Christians it will seem strange. Paul strongly warned against legalistically following such laws: “if righteousness were through the law, then Christ died for no purpose” (Galatians 2.21; see also Romans 4.14). And, while Deuteronomy 22 contains some valuable principles (e.g. verses 1-3), many Christian and Jewish people today would have profound moral objections to taking the whole of it literally (e.g. verses 23-24).

She also claimed that her treatment was unfair because Muslims were allowed to wear hijabs (headscarves) and their own tops under scrub tops. But concessions to Muslims are strictly limited: for health and safety reasons, I doubt that any hospital would allow a nurse or midwife to wear a jilbab (loose full body garment).

Findings from a survey of UK medical students, published in the Journal of Medical Ethics in July, demonstrate the potential dangers of changing the law to make it easier to opt out of professional responsibilities on grounds of belief. Students were invited to complete an anonymous online questionnaire about conscientious objection, including whether they would object to carrying out certain medical procedures.

Many of the students – of various faiths and none – were ready to carry out any of these. Some objected to carrying out abortions, but this is an area where doctors are already allowed to opt out for reasons of conscience. More disturbingly, a sizeable minority of the Muslim students objected to examining or treating patients intoxicated with alcohol or recreational drugs, and to carrying out intimate examinations of patients of the opposite sex.

A much smaller proportion say they would not perform such procedures – but this might rise if opting out were allowed. At present, those entering the medical profession are expected to act on the basis that, in the words of the World Medical Association’s Medical Ethics Manual, “all patients are deserving of respect and equal treatment”.

Of course, anyone has the right to avoid taking substances, but refusing to care for someone who has made different choices (or is addicted) is another matter. And it bad enough that patients sometimes feel embarrassed to seek help at an early stage of conditions such as testicular cancer: if some doctors will not carry out intimate examinations on sizeable numbers of patients, the dangers are all the greater.

If the law is changed to force employers to make ‘reasonable accommodations’, there is a serious risk that sizeable numbers of staff in the NHS and other essential public services will demand the right to opt out of important duties.

Managers and professional bodies may insist that some types of adjustment are not reasonable. But they will then have to prove that those whose requests to be excused from certain duties are turned down are not being treated less favourably than colleagues of other beliefs to whom concessions have been made. There is also the risk that, in the midst of an emergency, a staff member might feel entitled to refuse to do what is expected of them, with potentially deadly consequences.


© Savi Hensman work in the equalities and care sector. She is an Ekklesia associate and a widely respected Christian commentator on social and ecclesial issues.

Although the views expressed in this article do not necessarily represent the views of Ekklesia, the article may reflect Ekklesia's values. If you use Ekklesia's news briefings please consider making a donation to sponsor Ekklesia's work here.