“Conscience Rules” Ignore Patient

By Sally Steenlandsenior policy adviser, Center for American Progress What happens when consciences collide? In the field of health care, … Continued

By Sally Steenland
senior policy adviser, Center for American Progress

What happens when consciences collide? In the field of health care, the provider’s conscience is given great consideration. For over 30 years, we’ve had federal and state laws that allow health care providers to refuse to provide certain treatments that they object to on religious or moral grounds. In fact, the public debate is usually framed as one of provider conscience vs. patient access. The problem is that this frame ignores the conscience of the patient.

Let’s say a patient needs a prescription for contraception. She is a mother of two and takes birth control pills in order to be a spiritually and emotionally responsible parent. Her decision is one of conscience. When a pharmacist refuses to fill her prescription for religious reasons, he or she is defying the patient’s conscience in favor of his or her own. That is wrong.

In a pluralistic democracy where people hold different beliefs and values, one conscience should never trump all others. Instead, we must find ways to negotiate conflicting consciences so that religious liberty is respected and health care is safeguarded.

The conflict over conscience refusals has been in the news lately because the Obama administration is rescinding a harmful Bush rule that took effect his last day in office. The Bush rule, which is currently in effect, goes too far in expanding provider refusals.

The rule jeopardizes patient health and well-being, and allows the religious beliefs of the provider to be imposed on the conscience of the patient. And not just that. The rule is also unnecessary because there are existing laws on the books to protect the religious beliefs of health care providers. The good news is that the new rule, soon to be issued by the Obama administration, should set a fairer balance between the rights, needs and responsibilities of providers and patients.

In some areas, this is not overly difficult to do. In large pharmacies, medical practices, and hospitals, for instance, provisions can be made to meet the needs of the patient and of the health care provider. However, in areas where there are fewer providers, those who refuse to provide treatment place a great burden on patients. One could also argue that they place a burden on their own professional conscience and ethical responsibility because of their chosen profession.

It must be said that most of the “conscience” issues being debated involve women’s reproductive health, such as abortion, sterilization and contraception. It must also be said that one rarely hears in public debates a clear argument supporting women’s moral agency, or conscience, as they make a difficult decision. For some women, the moral decision is to continue their pregnancy. For others, the moral decision is to have an abortion.

It is important to acknowledge this reality if we want to move forward and find real solutions and common ground. It is also important to look beyond reproductive health issues regarding conscience clauses, since other issues, such as end-of-life care and genetic technologies, increasingly present difficult moral choices.

As we debate and decide these issues, it is important not to demonize opposing views or claim a monopoly on morality. It is also important to put systems in place so that cases are not decided on an ad-hoc basis which can jeopardize patient care. Finally, it is important to be persistent in our search for solutions and common ground, no matter how difficult it may be. Though it may sometimes seem as if clashing core values can never be resolved, in fact, policymakers, bio-ethicists, advocates and others are diligently exploring ways to find real solutions–ones that insure quality care while respecting the conscience of the provider and the patient.

Sally Steenland is the senior policy adviser to the Faith and Progressive Policy Initiative at the Center for American Progress.

  • vrajavala

    it seems to me that patients can find another practitioner to fulfill their needs. Also, you forgot to mention that if Catholic hospitals do not perform abortions, they will lose their federal funding.

  • Paganplace

    “it seems to me that patients can find another practitioner to fulfill their needs.”This is simply not always true, …especially when these ‘conscience clauses’ are mostly designed to restrict access to emergency contraception as long as a pharmacist can be misinformed about what emergency contraception even *does* and think their religious/political beliefs suddenly give them the right to overrule someone’s *doctor.*It’s not about ‘finding another practitioner:’ the patients already have. ” Also, you forgot to mention that if Catholic hospitals do not perform abortions, they will lose their federal funding.”Not entirely true, but.. Why should the government pay religious institutions to *not* practice medicine?Why should queer peoples’ tax dollars go to paying religious institutions to discriminate against us? Should people not-religiously-correct have to take two ambulance rides for someone else’s sense of ‘religious correctness?’ Why stop there? Maybe you can start having emergency rooms demand Christian prayers before anyone gets treated. Seriously, you want us to *pay* you to treat us like second-class citizens? No way.

  • CCNL

    Looking beyond the local problems of conscience/conscious objections:According to Drs. Lanza and Berman in their new book, An excerpt:”However, the Grand Canyon or Taj Mahal are only real when you get there.” p. 160.”Third Principle of Biocentrism:The behavior of subatomic particles- indeed all particles and objects- is inextricably linked to the presence of an observer. Without the presence of a conscious observer, they at best exist in an undetermined state of probability waves.” p. 93. “So the table has been set in the public mind for biocentrism’s jump to the reality that its all only in the mind, that the universe exists nowhere else. “p. 167 p. 167.

  • arosscpa

    Ms. Streisand’s definition of pluralism is outside of the common understanding of that word. A pluralist society is one in which its members can live according to their own cultural, religious, ethnic, and political frameworks in ways that do not infringe on others’ right to do the same. Steisand’s definition of pluralism demands that a patient’s failure to control her reproductive abilities trumps the right of a health practitioner not to perform an act that according to his/her world view is cold blooded murder. That is not pluralism; it’s fascism and evil.

  • gladerunner

    “Let’s say a patient needs a prescription for contraception”NEEDS? Contraception is almost always a choice, not a need. Unlike heart medicine, psychtropics, pain medicine and antibiotics, contraceptives are not required to sustain immediate essential health needs. Are pharmacies currently required to carry certain medications? I really don’t like the idea of forced inventory for commercial businesses. If a Pharmacy chooses not to carry birth control, or second chance drugs, fine. I’m sure that there are other stores that will. As has been pointed out, contraception is not immediate or life threatening. “When a pharmacist refuses to fill her prescription for religious reasons, he or she is defying the patient’s conscience in favor of his or her own.”Lets change one thing…When a pharmacist refuses to sell soft-core pornography for religious reasons, he or she is defying the customer’s conscience in favor of his or her own.Lets not leap from the noble fight for contraceptive choice to contraceptive mandate.

  • kjohnson3

    “I really don’t like the idea of forced inventory for commercial businesses. If a Pharmacy chooses not to carry birth control, or second chance drugs, fine.”Gladerunner,Actually, a pharmacy is not merely a commercial business; it is a business tightly regulated by the federal government. As such, it doesn’t have the same “free market” protections that other for-profit businesses enjoy.Furthermore, when a business is regulated for the sale of pharmaceuticals, taxpayer dollars are involved. Consequently, any product that can legally be purchased — and is customarily dispensed by such a business — should be available to consumers.Again, the onus is on the individual with the “conscience problem” to avoid employment wherein his/her personal values may be compromised.

  • Athena4

    “Contraception is almost always a choice, not a need. Unlike heart medicine, psychtropics, pain medicine and antibiotics, contraceptives are not required to sustain immediate essential health needs.”You obviously have never been a woman with endometriosis or dysfunctional bleeding. Oral contraceptives are used to alleviate those problems as well. Is the burden of proof on the woman to tell her pharmacist if she’s using The Pill for contraceptives or to keep her endometriosis from giving her killer cramps? That’s none of his business. And yes, this has happened to a friend of mine. She’s single, never married, and had dysfunctional bleeding. A pharmacist refused to fill her presecription for BC pills because she was unmarried. She was pissed as he11, and reported the pharmacist to his manager.

  • Athena4

    Let’s take this out of the reproductive cycle for a moment. You are a customer with a prescription for antidepressants. The only pharmacist available is a Scientologist, who refuses to fill any prescription written by a psychiatrist, or even to stock psychiatric drugs. Is this a proper use of the conscience clause?

  • nunivek

    It seems to me every job that you could work in is likely to contain actions that are morally objectionable. If you work in any customer service industry you have likely supported unfair labour practices if not outright slavery. Even in the services sector of our economy companies regularly do business with questionable clients and engage in practices that are detrimental to society and/or the environment. Even the system itself can be considered to be morally bankrupt as it glorifies consumption and personal gratification above all else to the point of objectification and the dehumanization of all others.

  • arosscpa

    I choose to patronize a fellow Catholic pharmacist who offers those products and services consistent with teaching of the Church. Others can patronize chain pharmacies or others that choose to offer these other products. It seems to me that if Planned Parenthood and others were solely interested in guaranteeing access to birth control and abortion services, they could construct a database of those who offers those services in every county and state, and make it available on the internet. This respects professionals with real conflicts of conscience, and increases the access to women that want these services.

  • arosscpa

    One of the commentors claimed that conscience clauses were the result of strategies to resist Roe v. Wade. This is patent ignorance.Conscience clauses in the US predate the first world war. Catholic medical institutions in that era were establishing list of services that could not be performed, and a list of doctors and nurses that could not practice in Catholic institutions. A contemporary reminder of this is the Georgetown University Hospital’s sale to Medstar. As part of the contract, the Archdiocese retained control of the pastoral and ethical oversight of the hospital administration. I do not suggest that illicit services have never been performed in the intervening years, but that Archdiocese has pursued recourse in some cases. The termination of a researcher that was performing stem cell research on campus is one example.Doctors, nurses, and pharmacists are not technicians whop execute a series of steps unreflectively at the request of a patient. A large part of what they do requires thought, judgment, ad intuition. Those activities are formed by the one’s ethical worldview. I suggest that it would not serve anyone well to abandon that model.

  • arosscpa

    We are speaking of two constitutional rights: one is the enumerated right to practice one’s faith freely and without government restraint. The other is a unwritten right to birth control and abortion which seems to appear in an penumbra discovered by 5 justices two centuries after the founding of the republic. Let us assume for the moment that Roe is good law that will not be overturned. The substance of Ms Streetland’s essay and many of the commentors suggests that where a conflict between the two rights exists, it should be resolved in favor of the right to privacy. Why? If anything, religious right has a longer tradition, a broader judicial development, and a more significant place in US history.Even granting that a certain percentage of rape claims are based in fact, the right to privacy is almost always appealed to in those cases where a woman has failed to take responsibility for her reproductive abilities. That another person needs to violate his/her conscience to accommodate another’s mistake or error is not pluralism; it is fascism and evil.

  • Alex511

    fr athena4:>…And yes, this has happened to a friend of mine. She’s single, never married, and had dysfunctional bleeding. A pharmacist refused to fill her presecription for BC pills because she was unmarried. She was pissed as he11, and reported the pharmacist to his manager. I’d also be reporting the pharmacist to the Board of Pharmacy in your state. That clown needs to find a different job, where the only question he needs to ask is “do you want fries with that?”

  • greyhound1

    Courtesy of AROSSCPA: and: “…a patient’s failure to control her reproductive abilities… “‘GRANTING’ that a certain percentage of rape cases are based in fact? I am so horrified by the implications of this one statement that I don’t even know where to begin. Are you implying that women who accuse men of rape are lying? Lying for the sole purpose of getting birth control? Secondly, it bothers me that you’re blaming women entirely for not taking responsibility for their reproductive abilities. While some of my lesbian friends wait impatiently for female-only reproduction, at the moment the rest of us still require a donor; it’s those donors who notoriously refuse to take responsibility for *their* reproductive abilities because they are not biologically required to live with the consequences – they get girlfriends pregnant and then dump them, run out on their families, etc.; women end up dealing with those consequences on their own. Unfortunately, this will continue to be a problem until Neanderthals like AROSSCPA finally decide to crawl out from under their rock.

  • walter-in-fallschurch

    the idea of a pharmacist being able to turn a patient away is the kind of thing that might happen in an islamic theocracy. imagine the storeowner saying, “but no, i won’t sell you this because it violates the state religion.”

  • arosscpa

    Greyhound1 wrote.’GRANTING’ that a certain percentage of rape cases are based in fact? I am so horrified by the implications of this one statement that I don’t even know where to begin. Are you implying that women who accuse men of rape are lying? Lying for the sole purpose of getting birth control?This is sarcasm or irony, right? The history of male-female relationships is littered with both the use of sexual violence of men against women, which is in every case an evil act of the first order, and the lies of women about men for the sake of revenge, to hide an illicit sexual encounter, or to advance the woman’s own agenda. Because it destroy the reputation, and often the liberty and life, of the man falsely accused, it is no less evil that the act of rape itself. I would guess 30-40% of rape claims have no factual basis.We now have a new reason to cry rape: to obtain emergency contraception at public expense.

  • greyhound1

    Actually, rape is a crime that is highly – and tragically – under-reported, mostly because women fear that they won’t be believed. I wonder where they got such an idea. AROSSCPA, maybe you can enlighten us?

  • wiccan

    Wasn’t there a kerfuffle in Detroit when Muslim cabdrivers were instructed by their imam not to transport passengers if the cabdriver thought the passenger was carrying alcohol? What say you, Arosscpa? Should these cabdrivers have that right?

  • arosscpa

    Greyhound1: The under-reporting of actual incidents of rape, and the presentation of false claims are not mutually exclusive. Both can exist, and both do exist according to the data, and they describe fundamentally different types of women.Wiccan: Wow, are you just out of the loop or what? In the Washington DC area, never mind Detroit, cab drivers decline rides for a number of reasons: safety concerns about the customer or his destination, the trip is inconvenient, the drive has pre-contracted rides whose schedule does not allow accommodation of the passenger, or the passenger is clearly high, drunk, or has bad body odor. Anglo-American law does not permit any party to force a contractual obligation or transaction upon another unwilling party. Get a life. A total stranger has no obligation to assist someone just because she has placed herself in a pickle.BTW, Unless it’s truly rape, the woman has ultimate and final responsibility for her reproductive capacities. That’s what Griswald, Roe, and the women’s movement was all about. Period.

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