Extract To impose the philosophy of caveat emptor is morally inadequate, given the differences in power and class between many physicians and their patients. Physicians must not be permitted to disavow responsibility on the grounds of conscientious objection; rather, such practitioners must choose careers in which their fundamental values do not interfere with the autonomy and well-being of patients. Like conscientious objectors to military service, medical conscientious objectors must bear the consequences of their beliefs.
Extract It is unrealistic and unfair to expect patients to anticipate all conditions that may befall them, identify which ones might be problematic for their physicians, and agree either to reach a compromise or to seek care elsewhere.
Extract A health care system must establish clear criteria to allow the right balance between paternalism and the autonomy of patients in the case of medical issues that are controversial among health care professionals.
Extract Those who act conscientiously do not “disavow responsibility” and “substitute their personal values for the fundamental rights of their patients.” Rather, they are engaging in the struggle to know and do the right thing and to understand and fulfill their moral obligations in a particular situation. This task cannot be externalized or delegated. Indeed, acting conscientiously is the heart of the ethical life, and to the extent that physicians give it up, they are no longer acting as moral agents.
Extract Discussion: CMA policy states that “a physician should not be compelled to participate in the termination of a pregnancy.” In addition, “a physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician.” You should therefore advise the patient that you do not provide abortion services. You should also indicate that because of your moral beliefs, you will not initiate a referral to another physician who is willing to provide this service (unless there is an emergency). However, you should not interfere in any way with this patient’s right to obtain the abortion. At the patient’s request, you should also indicate alternative sources where she might obtain a referral. This is in keeping with the obligation spelled out in the CMA policy: “There should be no delay in the provision of abortion services.”.
Extract Media coverage of conscientious objection tends to cast the refusing health care provider in the role of Martin Luther at the Diet of Worms: Here I stand, I can do no other (emphasis on the “I”). Commentators also do this, parsing the rights and responsibilities (but mostly the rights) in a dyadic relationship: Providers versus patients. Paternalism versus autonomy. “I believe” versus “I want.” . . .
Conscientious objection in medicine is not merely a right to be invoked at the bedside, nor a problem to be held in check through a pro forma conscience clause. Rather, [David H] Smith reminds us, openly discussing the nature of providers’ moral objections, while keeping the needs of the suffering person uppermost, is a “difficult and unglamorous” communal responsibility of “morally serious people.” Amen.
Extract Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth and undoubtedly many of the health care providers who refuse to treat or refer or inform their patients do so in the sincere belief that it is in the patients’ own interests, regardless of how those patients might view the matter themselves. But the assumption that one’s own conscience is the conscience of the world is fraught with dangers. As C.S. Lewis wrote, “of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
Extract Conclusion Medical ethics and the practice of medicine as an act of conscience have become integral to this scientifically unsettled debate. Before medication is prescribed or dispensed, a prudent practitioner weighs carefully the risks of the medication with the potential benefits. 70 Laws that require a medical professional to perform an act against his or her best judgment violate the code of ethics of that profession to do no harm in the professional’s highest and best medical judgment. It ought to be alarming that a patient’s expectations may become the standard for professional action. Ought medical professionals prescribe and dispense what the patient wants even if it harms him or her, just because the patient’s autonomy allows a patient to live a risky life? 71 Family planning deserves a principled approach carried out with integrity that protects the parties, and that approach should be reflected in legal policy and lawmaking.
Should doctors and pharmacists be able to refuse to give out emergency contraceptives based on conscientious objections? Sexual freedom that was protected by the Supreme Court’s emancipation of sexuality from reproduction has allowed emergency contraceptives to be used for any purpose an individual desires, rather than for the best and most responsible medical purposes. Therefore, when a medical professional has concerns that an emergency contraceptive may harm the health of his or her patients or customers or their offspring, a conscientious objection provided by law seems more appropriate than a legal requirement to dispense despite objections, at least until a medical and legal consensus can be reached.
Extract Conclusion Conscience clauses raise many difficult issues in a pluralistic society. Health care providers have special obligations to patients that are not replicated in many other professional endeavors. Duties prescribed by law and professional codes of conduct expect health care providers to act out of respect for the patient’s welfare and dignity. While no one suggests that health professionals should abandon their religious or moral principles, patients should not suffer harm or potential harm because of a belief they do not share. It is often appropriate to accommodate individuals who wish to exercise their principles in the care of patients, but conscience clauses that promote blanket immunity for refusals to provide health care services resolve the tension between patient needs and provider autonomy in a onesided manner.
When health care providers deviate from standards of care, engage in unprofessional conduct, or unduly burden their colleagues and employers through refusals to perform services, exemptions from malpractice, disciplinary, or employment actions are not appropriate. . .Accordingly, legislators should not tie the hands of disciplinary boards in addressing such conduct.
The clamor for absolute immunity from employment actions for health care workers asserting moral refusals to treat demonstrates a myopic view of the burdens imposed by such objections on patients, employers, and coworkers. . . . Although legislators may choose to heighten the de minimis accommodation standard under Title VII, abrogation of the undue hardship test is not warranted from either a policy or legal prospective.
. . . the overriding purpose of our health care system is to protect the health and safety of patients. The expansion of refusal legislation to create immunity for health care providers who refuse any service for almost any reason is cause for alarm. Conscience clauses fail to achieve a reasonable balance when they confer a special benefit on those whose religious, moral, or ethical beliefs compel them to deny health care while absolving them of the potentially harmful consequences of their choices. . .
(Reflections regarding some texts on conscience by John Paul II and Benedict XVI)
JL Barragan
Proceedings of the Pontifical Academy for Life
Abstract
Al leer algunos textos de Juan Pablo II y de Benedicto XVI sobre la conciencia, me ha llamado la atención la manera como plantean la relación entre subjetividad y objetividad en la sociedad actual en la que fácilmente se cae en el Relativismo. Este problema se profundiza a tratar las relaciones entre Dios y la conciencia y entre la Teología y el Magisterio de la Iglesia. Mi propósito en esta intervención al inicio del trabajo de la Pontificia Academia de la Vida es aportar una modesta reflexión que pudiera contribuir a iluminar estas relaciones desde el concepto de cultura. Comienzo presentando una selección de textos de ambos Pontífices, donde resalta la problemática aludida. En una segunda parte intentaré profundizar en dicha problemática.
[Translation] Reading some texts by John Paul II and Benedict XVI on conscience has directed my attention to the way in which they present the relationship between subjectivity and objectivity in today’s society which easily falls into Relativism. This problem is deepened to deal with the relationships between God and conscience and between Theology and the Magisterium of the Church. My purpose in this intervention at the beginning of the work of the Pontifical Academy of Life is to contribute a modest reflection that could contribute to illuminate these relationships from the concept of culture. I begin by presenting a selection of texts from both Pontiffs, where they highlight the problem alluded to. In a second part I will try to delve into this problem.
