More Thoughts on Conscience Clauses as Way to Protect Dissenting Health Care Professionals

I have written before—and no doubt will again—that the death culture brooks no dissent. I haven’t gotten my mind totally around why this is yet, but I have developed some theories. I think issues such as assisted suicide are part of a (partially unconscious) but clearly unfolding coup de culture. Part of it too, perhaps, is that culture of death adherents are hypersensitive to the charge of supporting moral wrongdoing, and hence want all of us to be complicit in the system—a big reason in my view why the science community had a conniption over the Bush embryonic stem cell policy. Add in that many believe individuals will not be truly free to control their own lives unless virtually all impediments to abortion—and perhaps one day, assisted suicide, and other policies—are removed, and we can begin to see why refusenik medical professionals might be targeted for excommunication from their careers.

Some see conscience clauses as an answer to protect dissenting health professionals in a society that no longer agrees on fundamental issues of morality. I agree, although I don’t think the privilege should be absolute. The issue is just coming to the fore of my thinking and I have begun to reflect on it here at SHS. A few days ago, I posted some thoughts on the matter over at the First Things blog. From my FT blog entry:

How ironic that physicians and others who simply wish to adhere to the precepts of the Hippocratic Oath are declared persona non grata in medicine.

Be that as it may, those who believe in protecting medical conscience rights need to begin preparing the intellectual ground to protect dissenting professionals’ careers without also opening the door to conscience being used as a club to deny wanted life-sustaining treatments such as feeding tubes by physicians who consider it wrong to maintain patients with a “low quality of life”—a proposal already gaining stream in bioethics known as “medical futility.”

To keep from so throwing out the baby with the bathwater, I suggest that we consider at least two crucial distinctions in determining what would be a protected refusal to provide a requested medical intervention; first, between elective and non-elective procedures, and second between treatments and patients. Thus, doctors should be permitted to refuse elective procedures—that is, interventions not immediately necessary to save the patient’s life or prevent serious physical harm—if their conscience so dictates, whether it be rhinoplasty, abortion, or assisted suicide. To prevent care refusals from being a mere cover for discriminatory attitudes, the requested procedure should generally be what violates the conscience, not bias against the patient. In this way, for example, an oncologist should not be able to refuse to treat a lung-cancer patient because the patient smoked or was a member of a racial minority.

No doubt there will be nuances within nuances here, so there will be much to consider. But with the rights of conscience likely to be an explosive bioethical controversy in the coming decade, the time to begin planning for the struggle is now.

Other cultural conflicts beyond issues we generally deal with here at SHS have already become part of the conscience issue; such as the recent California Supreme Court ruling permitting a lesbian couple to sue a doctor who refused to artificially inseminate one of the partners due to a religious objection—even though the refusing doctor found another physician willing to perform the treatment for the patient, who was subsequently impregnated.

So there will be much with which to grapple. Not fun, but necessary. At stake—literally—will be whether people of certain religious and moral beliefs will be able to enter and/or remain in the health care field, and whether religiously based hospitals and other institutions will be able to keep their doors open.