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Thursday, December 25th 2008

Right of Conscience

President Bush’s second term has been rife with discussion over the rights of health care providers to refuse care if such challenges their religious and moral beliefs. Such debate often centers around abortions and contraception. Last year the Bush Administration “reenforced” the right to refuse to provide contraception.

Now, in a rule sure to be killed within Obama’s first 100 days in office, the Bush Administration has provided a further expansive definition of health care worker’s right of conscience.

[Secretary Mike] Leavitt initially said the regulation was intended primarily to protect workers who object to abortion. The final rule, however, affects a far broader array of services, protecting workers who do not wish to dispense birth control pills, Plan B emergency contraceptives and other forms of contraception they consider equivalent to abortion, or to inform patients where they might obtain such care. The rule could also protect workers who object to certain types of end-of-life care or to withdrawing care, or even perhaps providing care to unmarried people or gay men and lesbians.

While primarily aimed at doctors and nurses, it offers protection to anyone with a “reasonable” connection to objectionable care — including ultrasound technicians, nurses aides, secretaries and even janitors who might have to clean equipment used in procedures they deem objectionable.

The order denies federal funding to any health care delivery entity who either doesn’t document their steps to protect provider’s right of conscience or who violates such a right. The right of conscience is far from a new idea but these new broad federal rules bring the ethical debate back into the forefront. After the Roe v. Wade decision many states jumped to conscience laws. Indeed, the vast majority of states now protect some form of right of objection to care based on a provider’s beliefs. But the new federal rule seems exceptionally broad.

I admit that I support the move. Opponents of the move see health care as a political right; something that providers are obligated to provide. I’ve obviously never been a fan of positive rights. I’ve obviously never been a fan of a right to health care. But I’ve devoted thousands of words to that point of view through this blog.

What I really want to discuss here is the simplistic place public discourse over this issue is taking place at. The framework proper framework for a debate is over the weight of a right of conscience versus a right to health care. Take some of the ideas from a discussion the Washington Post hosted with readers,

Thanks for these eye-opening articles. This is scary stuff. We rightly expect “professionals” in whatever field to perform their duties in a “professional” manner, perhaps more so when they are licensed by the government. If there are duties that conflict with your religious beliefs, DON’T go into that field.


Our right to religious freedom is absolute. What is not absolute, however, is any “right” to be a physician or a pharmacist or to engage in any licensed profession when one’s religious beliefs interfere with his or her ability to practice that profession. My question is, what under our laws, constitution, or traditions permits a licensed professional to retain his or her license to practice in the face of any inability to discharge the duties of that profession faithfully, whether the impediment is religious, physical, or some other factor?


When did a professional’s religious beliefs become more important than a state’s licensing board? All of the professionals described in the article are governed by state regulations (and were trained/educated to meet standards); how can they ‘cry’ discrimination on the basis of religion if they knew beforehand what the position entailed?

These opinions are scary because they assume much and take the debate away from more fundamental points. The social construct of a profession is so far from inherent. We have a very simplistic view of the situation from most health care consumers. They place obligations on providers and are really unable to defend them; they simply know they exist because physicians or pharmacists or nurses chose to go into that profession and because of that patients are owed something. Weird, non sequitur causality.

I’m Proud of the Social Status of American Medicine

I’m proud of medicine’s status as a profession. I’m proud of the respect it is granted in society. I’m proud of the self governance it is left to. But the idea the being a member of such a profession places an obligation to provide whatever the patient or family wants, which is what the expectation has arisen to, is ludicrous. Now medicine isn’t, at all times, completely about merely healing the body. I admit. But, one key, pragmatic point I would like to make is that the issues at hand here often do not involve curing a pathology. The major ethical issues this rule tries to protect health care providers from having to participate in are things like: contraception, abortions, sterilizations, withdrawal of care, etc.

I suppose we shouldn’t worry too much. We’ll see how long these expansive rules survive once the new administration come into the Oval Office.