Yes, it can be a lot harder to exercise rights of conscience once you rise into the supervisory and administrative ranks of health care institutions that must offer abortions.
Under socialized medicine, there might be some allowance for health care professionals to conscientiously avoid killing their patients. The problem with rising to the supervisory roles is that one would be forced to oversee the health care professionals who participate in this killing.
This is the crux of the case of two midwife supervisors, Miss Mary Doogan and Mrs Connie Wood, in the UK health system who did not want to involve themselves in that aspect of health care.
The judge in the Edinburgh Court of Session ruled against the midwives, saying that their job was not covered by conscience protections in the Abortion Act.
Judge Lady Smith excluded the senior midwives of the Southern General Hospital in Glasgow from conscience protection because they were not actually performing abortions themselves.