Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights

Katherine A White

Stanford Law Review
Stanford Law Review

Abstract
In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.


White KA. Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights. Stanford Law Rev. 1999 Jul;51(6)1703-1749.

(Thesis) Conscientious objectors to a medical treatment: What are the rules?

Andre Carebonneau

Abstract
Patients who refuse a specific medical treatment for religious reasons must often overcome strongly entrenched presumptions held by physicians and judges, presumptions frequently based on personal values. A case in point is the refusal of blood transfusion therapy by Jehovah’s Witnesses. This paper rests on the following theory: The sanctity of life principle is not necessarily violated by respecting the autonomous decision of a patient who, for religious or moral reasons, chooses one therapy over another that may be favored by the treating physician. Where a patient has decided for conscientious reasons against a certain treatment in any given medical situation, the need to be informed will shift from the patient to the physician. The physician must understand the nature of the religious or moral conviction as well as his own moral and legal obligation to respect the patient’s wishes by providing the best Medical care under the circumstances.


Carebonneau A. (Thesis) Conscientious objectors to a medical treatment: What are the rules [masters thesis]. [Montreal, PQ]: McGill Univesity; 1999 Jul. 122 p.

The Common Good and the Duty to Represent: Must the Last Lawyer in Town Take Any Case?

Teresa Stanton Collett

South Texas Law Review
South Texas Law Review

Extract
More specifically, this article explores the question: Is it morally permissible for a lawyer to decline representation of a prospective client who seeks to obtain a legal but immoral objective, if the lawyer reasonably believes that the prospective client will be otherwise unable to obtain legal representation?


Collett TS. The Common Good and the Duty to Represent: Must the Last Lawyer in Town Take Any Case? South Texas Law Review. 1999;40(137-179)

The Americans’ higher-law thinking behind higher lawmaking

Joyce Appleby

Yale Law Journal
The Yale Law Journal

Extract
Bruce Ackerman’s “We The People: Transformations” is elegantly conceived, theoretically clever, rhetorically inventive, and empirically convincing, but it remains ideologically inadequate. . . . In the absence of attention to how people in the United States have come to think about a higher law, Ackerman has fallen back on a Whiggish view where love of liberty and justice is assumed to be part of the human endowment, at least of American humans. Fused convictions about democratic governance and liberal aspirations motivate Ackerman’s We the People. . . . This Whiggish overlay upon the argument of Transformations appears most strikingly in the discussion of Reconstruction, in which all acts are optimized-whether those of intransigent Radical Republicans or white supremacist Southern Redeemers. Some higher force is orchestrating this partisan cacophony into a melodious resolution. . . . I will pose the proposition that two higher law concepts have polarized American politics from Alexander Hamilton through Ronald Reagan, and that they need to be put into the picture of Ackerman’s grand transformative moments.


Appleby J. The Americans’ higher-law thinking behind higher lawmaking. Yale Law J. 1999;108(8):1995-2001.

Human rights and abortion laws

Rebecca J Cook, Bernard M Dickens

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.


Cook RJ, Dickens BM. Human rights and abortion laws. Int J Gynecol Obstet. 1999 Apr 22;65(81-87.

The Moral Reasoning of HEC* Members (*Hospital Ethics Committee)

Donnie J Self, Joy D Skeel

HEC Forum
HEC Forum

Extract
It appears that on many characteristics there are significant differences among members and non-members of HECs. Whether it be a self-selection bias or some other factor, whatever is at work on the composition of HECs seems to have a profound effect pulling toward homogeneity of the membership. This is not necessarily bad if it leads to the best ethical thinking in the institution. It does, however, give pause for thought considering the current widespread emphasis on cultural diversity in society. If diversity is thought to be desirable, is such homogeneity within HECs appropriate?


Self DJ, Skeel JD. The Moral Reasoning of HEC* Members (*Hospital Ethics Committee). HEC Forum. 1998 Mar;10(1):43-54.

Insider Trading: Conscience and Critique in Bioethics

Laurie Zoloth-Dorfman, Susan B Rubin

HEC Forum
HEC Forum

Extract
The problem of conscience in ethics consultation is a central part of the creation and selection of the particular standards to which we hold ourselves accountable and the very process by which we come to know,choose, and act on what is right. Finding such standards and agreeing on how to maintain personal and professional integrity forces each of us to regard in the most serious terms the core issues of our work and its meaning. And though external sources such as our profession, religion, or community may all at times influence our sense of appropriate and inappropriate behavior, on some level, each of us must also face these questions personally. At a certain point, we face a confrontation with what we are culturally shaped by modernity to “see” as our own privatized internal guide – our conscience. Turning towards conscience is turning towards a particular kind of confrontation with ourselves.


Zoloth-Dorfman L, Rubin SB. Insider Trading: Conscience and Critique in Bioethics. HEC Forum. 1998 March;10(1):24-33.

There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey

John F Crosby

Christian Bioethics
Christian Bioethics

Abstract
Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.


Crosby JF. There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey. Christ Bioet. 1998 Jan 01;4(1):63-82.

Institutional identity, integrity, and conscience

Keven Wm Wildes

Kennedy Institute of Ethics Journal
Kennedy Institute of Ethics Journal

Abstract
Bioethics has focused on the areas of individual ethical choices — patient care — or public policy and law. There are however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.


Wildes KW. Institutional identity, integrity, and conscience. Kennedy Inst Ethics J. 1997 Dec;7(4):413-419.

Conscience and Conscientious Actions in the Context of MCOs

James F Childress

Kennedy Institute of Ethics Journal
Kennedy Institute of Ethics Journal

Abstract
Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.


Childress JF. Conscience and Conscientious Actions in the Context of MCOs. Kennedy Inst Ethics J. 1997 Dec;7(4):403-411.