When Religious Freedom Clashes with Access to Care

I. Glenn Cohen, Holly Fernandez Lynch, Gregory D. Curfman

New England Journal of Medicine, NEJM
New England Journal of Medicine

Extract
At the tail end of this year’s Supreme Court term, religious freedom came into sharp conflict with the government’s interest in providing affordable access to health care. In a consolidated opinion in Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell (collectively known as Hobby Lobby) delivered on June 30, the Court sided with religious freedom, highlighting the limitations of our employment-based health insurance system.

Hobby Lobby centered on the contraceptives-coverage mandate, which derived from the Affordable Care Act (ACA) mandate that many employers offer insurance coverage of certain “essential” health benefits, including coverage of “preventive” services without patient copayments or deductibles.


Cohen IG, Lynch HF, Curfman GD. When Religious Freedom Clashes with Access to Care. N Engl J Med 2014; 371:596-599 August 14, 2014 DOI: 10.1056/NEJMp1407965

(Book Review) Conflicts of conscience in health care an institutional compromise

Dhrubajyoti Bhattacharya

Conflicts of Conscience in Health Care: An Institutional Compromise

Holly Fernandez Lynch. Conflicts of Conscience in Health Care: An Institutional Compromise. Boston: The MIT Press; 2008, 368 pp. ISBN: 9780262123051

Extract
Lynch demystifies the practice of medicine as a value-neutral panacea to remedy social ills with physicians as unwavering obligors to provide service on demand. . . . As far as the provision of services goes, protecting patient and physician interests are, as Lynch argues, not mutually exclusive propositions. In practice, physicians who check their moral apprehensions at the hospital doors may even compromise patient safety. An enlightened approach, as proposed here, encourages health professionals to embrace moral plurality to inform, rather than stymie, the provision of services in the best interests of patients—while respecting physician individuality.

Conflicts of Conscience in Health Care: An Institutional Compromise will serve as an excellent resource for educators and policymakers eager to parse the complex issues of patient wants, physician duties, and institutional prerogatives to secure individual and population health and well-being.


Bhattacharya D. (Book Review) Conflicts of conscience in health care an institutional compromise. J Leg Med. 2009;30(2):289-298.

(Book Review) Conflicts of Conscience in Health Care: An Institutional Compromise

Sean Murphy

Conflicts of Conscience in Health Care: An Institutional Compromise

Holly Fernandez Lynch. Conflicts of Conscience in Health Care: An Institutional Compromise. Boston: The MIT Press, 2008. 368 pp. ISBN: 9780262123051

Extract
Conflicts of Conscience in Health Care was published in 2008 as the 24th volume in the Basic Bioethics series from the Massachusetts Institute of Technology. It is an American book dealing with the American political and legal controversies over freedom of conscience in health care. However, the discussion of the American experience by Holly Fernandez Lynch is relevant elsewhere, since the United States has the most extensive and varied network of protection of conscience legislation in the world.

While acknowledging that freedom of conscience is of concern to all health care workers and institutions, Fernandez Lynch focuses exclusively on physicians. This carefully and deliberately restricted focus is one of the strengths of the book.

After a preface and introduction, discussion and argument occupy about 260 pages, supplemented by 53 pages of end notes, many of which offer expanded comment on the text. A good 12 page index has been included, as well as four pages of cited statutes and cases. The earliest source found in a list of 300 references is from 1951; the rest date from 1972 to 2007. . .

. . . . As the subtitle of the book indicates, she is seeking a compromise that will provide “maximal liberty for all parties.” She believes that freedom of conscience for physicians and the provision of legal medical services are both important social goals, and that they are not incompatible. Thus, she rejects “all-or-nothing” strategies that seek “total victory.” Ultimately, quoting the Protection of Conscience Project, she affirms that all legitimate concerns can be met by “dialogue, prudent planning, and the exercise of tolerance, imagination and political will.”


Murphy S. Book Review: Conflicts of Conscience in Health Care: An Institutional Compromise. Protection of Conscience Project; 2009 Dec 17.