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.