Conscience exemptions for health care providers is the subject of a guest piece at the “On Faith” column today. It’s written by Sally Steenland of the Center for American Progress, and it demonstrates nicely the approach of some elements on the left on reproductive issues:
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.
Think about that. “One conscience should never trump all others.” In other words, everybody should have to do something they consider immoral sometimes, so that nobody gets their way all the time. Imagine the possibilities:
“Well, I think doing medical experiments on Jews is wrong, but I’ll do it this one time, since I wouldn’t want to trump the conscience of Dr. Mengele, given he thinks it’s OK.”
“I don’t think it’s right to refuse to serve black people at my lunch counter, but I’ll refuse this time so that Grand Dragon Barney isn’t forced to eat lunch next to them.”
“Conscientious objectors have their rights, but the government does, too. We let them skip the last war, so they should have to give in and fight in this one.”
Obviously Ms. Steenland doesn’t have any idea what “conscience” is. Perhaps she can’t imagine anyone actually believing that there are moral absolutes, actions in which one should never engage regardless of what others think. Maybe she just can’t wrap her mind around the notion that some people really do believe on religious grounds that abortion is wrong, and that while they can’t stop someone from having one, they don’t have to be party to the immorality. I’m sure that she can’t understand why anyone would have a problem dispensing contraception, given that the only people who have any objection to it are those enslaved to the wiles of a foreign potentate. But the notion that just because we live in a “pluralistic democracy” there are no limits to what the government can and should compel people to do in order to accomodate the wishes of others is abhorrent. It may be inconvenient, or even costly, for someone to have to find another pharmacist to sell them contraception, or to find another doctor to do an abortion, but the truth is that if one wants these particular goods and services, one can always find a provider. It would be far more costly to society as a whole for us to allow the state to run roughshod over people whose conscience gets in the way.
The Reformed Pastor 
May 12, 2009 at 1:18 pm
Seems simple enough. If you can’t do the job, don’t sign up for it in the first place.
If you’re going to become an OB/GYN but have a problem with prescribing contraception then perhaps there’s another field or specialty that would be more appropriate.
And before people start complaining that isn’t fair, I’d just point out that it would be inappropriate for me to sign up for the military and then claim that I have a moral problem with killing people. Or to get a job in a brewery or a bar and then refuse to work because I think alcohol consumption is sinful. Or to get a job as a doctor and then refuse to dispense medicine or do surgery because I believe that all illness can be healed by prayer. Nor would I go to work for an abortion clinic because I think abortion is wrong.
Contraception is currently legal and it has been for some time. I have a hard time believing that doctors get into the business not knowing that. It isn’t like the expectation isn’t already there before they sign up.
(And contrary to what comfortable middle-class folks think, there aren’t always options for care.)
Anyway, if one doesn’t want to provide these completely legal goods and services, one can always find another profession. It is a simple matter of expectations. Any patient should expect to receive all available medical options that are safe and legal from any doctor, just as we expect certain services from a CPA or a mechanic. Those have always been the expectations of those professions. At the same time, any doctor should expect to have to deliver those options. That’s their job and it always has been. If they can’t do their jobs, then they should go into a different profession.
May 13, 2009 at 3:35 am
Alan seems to believe that abortion is a positive right, that it is government’s job to compel universal access to supply (or something close to it). Nobody has a positive right to get their car fixed or to have a CPA check their tax return, to say nothing of easy access to a printing press or firearms, but somehow they have a positive right to morally controversial medical procedures and products. Curious.
Furthermore, I repudiate as false on its face Alan’s claim of equivalence between the vocations of doctor and abortionist, between pharmacology and providing abortifacients. They are overlapping but non-identical sets in practice (de facto) and in law (de jure), both in the present time and historically.
May 13, 2009 at 7:59 am
Wow, Adam, your legs must be tired from all that conclusion jumping. Actually Adam, I am against abortion. I think it should be illegal.
Care to try again, kiddo? LOL Can we spell “knee-jerk”? It requires a hyphen, I believe. 😉
When I go to a doctor, I want to hear all of the available safe, effective, and legal options for treatment. I don’t want options given on the basis of anything other than the doctor’s medical expertise. I don’t want a doctor to prescribe medications because he’s getting kickbacks from a pharmaceutical company. I don’t want him refusing to discuss options because he has some sort of personal problem with them. It’s *my* job to make the decision, it’s his job to offer the safe and effective available options. If he can’t do that job, then he should find another.
Unfortunately, right now, abortion is a legal option. That should be changed, obviously. But that has nothing to do with whether or not a doctor does his/her job. You’re conflating two completely unrelated issues.
Now, if you want to end abortion as I do, then work to end abortion. These pathetic half-maneuvers and disingenuous cynical little games to try an end run around the legality of abortion does nothing but make those of us who are anti-abortion look petty, weak, and uncommitted to true change. Not to mention the fact that they needlessly open up a whole hornets nest of other issues. (eg. Where exactly do we draw a line here? 7-11 employees who refuse to sell coffee because drinking caffeine is against their religion?)
I don’t want the Government making these decisions for me, and making laws that give doctors the right to conceal medical information from their patients is wrong, stupid, and potentially injurious and beyond the scope of any reasonable (dare I say, conservative?) understanding of what our government ought to be doing.
May 13, 2009 at 10:28 pm
You’ve piled unstated suppositions and so deep it’s hard to wade through them. Since the substance of both of my previous observations has gone unanswered I have no expectation you’ll pay any more attention this time, so I’ll knock a few over for exercise and leave you be to have the last word if you feel the need.
To repeat myself, it is not definitive to a doctor’s or an OB/GYN’s “job” to counsel or perform abortions. To say so demonstrates that you do not understand what the word “job” means, and further demonstrates an abject ignorance of the history of statute law, case law, and practice of the medical profession. It is not a doctor’s job (either in employment law or in tort law) to present a patient with every legal medical option available to them, and under civil law doctors are granted significant leeway (even apart from conscience clauses) in determining which options are appropriate to present. (A doctor’s contract with their employer may impose more stringent requirements, but that is a matter of labor and contract law and is not universal to “doctors”.) That’s why “get a second opinion” has always been and will always remain good advice. You COULD argue that it is the job of a doctor who works for a hospital that has elected to offer abortive services to perform abortions, and then there might be an interesting conversation to be had, but the policy you seem to be advocating makes it the “job” of a Catholic doctor at a Catholic Church-owned hospital to perform abortions as well, a scenario in which neither the employer nor the employee has agreed with your particular personal expectation of the definition of their “job”.
It takes a great deal of nerve to say you’re being “conservative” when you call upon the government to force privately-owned hospitals and privately-owned pharmacies and their employees to perform elective abortions and supply abortifacients even when the shareholders, operators, and employees all agree that doing these things is not only morally reprehensible, but medically ill-advised. I knew “conservatism”‘s intellectual boundaries had been blurred, but not to the point of that kind of nanny-state fascism.
If you actually want to outlaw abortion, it is not a productive intermediate policy goal to force the evacuation of everyone who agrees with you from the professions in which they are perhaps best situated to influence public policy and opinion toward the end you say you want. Absolutely, fight to outlaw abortion, but don’t surrender important long-term strategic ground in the name of “not compromising”.
If refusing to recommend or perform an abortion is actually “wrong, stupid, and potentially injurious” because an abortion is “safe and effective”, you are apparently willing to argue that abortion should NOT be outlawed because outlawing it removes “safe and effective” treatment options and forces doctors to be “potentially injurious” toward their patients. Or does “safe” magically become “unsafe”, “effective” magically become “ineffective”, and “injury” magically become “soundness” simply because a law gets changed?
Enough. Have the last word if you like.
May 14, 2009 at 8:16 am
And again, you’re conflating two unrelated issues: abortion and doctor’s duties. You’ll notice I’m not talking about abortions because these sorts of laws go FAR beyond abortions. Try to keep up, eh?
(Oh, and you missed the first sentence in my response that clearly stated I am against abortion. You continue to preach as if I’m for it, which I am not. Again, try to keep up.)
I don’t think we need the nanny-state making my medical decisions for me by telling doctors that they can just refuse to give appropriate medical advice whenever they please. They’re licensed by the government to do a job. They take an oath to do that job, and when a person goes to the doctor there is a clear expectation that they’ll received *all* the medical advice that is safe and effective.
If doctors don’t like it, they can always find another job. Why we need to protect doctors more than patients is beyond me. It’s the patients that are sick.
In the meantime, I’ll continue to work to end abortion so that these stupid laws never need to be written in the first place.
I notice that you won’t address the most important point here which is where does this end? Once we get past your obsession with abortion, what other medical procedures and medications shall we begin to curtail? And why only talk about doctors? What about the 7-11 employees? Obviously we need the nanny state to step in and protect the jobs they refuse to do because they made poor career decisions. Perhaps I should inform my employer that doing any work at all is against my conscience, but of course I should continue to get paid, and the government will protect me. Sounds like a good gig to me.
May 14, 2009 at 10:52 pm
Alan, you are a hard one the figure out. I find your comments contradictory. On the one hand you say you are opposed to abortion and on the other hand you are opposed to those who would try to stop government from forcing doctors and hospitals out of the profession unless they perform them. Sorry, I just don’t think you can have it both ways. Yes abortion is legal, yes some so-called health providers perform them, but they are the antithesis of health care and I for one will fight as hard to prevent heath providers and hospitals from having to kill unborn human being as a pre-condition for providing real healthcare as I will to stop abortions. My doctor is prolife and I wouldn’t want it otherwise. After all my own life may be in his hands someday. In fact I would prefer that any doctor I must rely upon for my health and life have a great respect for life, especially mine.
May 15, 2009 at 8:14 am
I think I’m both easy to figure out and consistent, Don. 🙂 I don’t want more government regulation than is absolutely necessary. Period. I don’t want the government deciding my health-care options. And I want doctors to do their job so that patients can make the best medical decisions possible.
As I’ve said several times now, these two issues are separate. Rather than trying these cynical and lame half-measures which only protect the lives of the unborn who happen to be lucky enough to randomly end up with doctors who refuse to perform abortions, I’d rather we save the lives of *all* the unborn. (I find it even stranger that one of the arguments used in favor of these laws is that people who want abortions will be able to find doctors to perform them anyway. So why push for a law that even its supporters admit has no real force or effect on the number of abortions anyway? Dumb piled upon dumb, if you ask me.) You’re in favor of half-measures that may, but probably won’t, save a few unborn children, I’m in favor of real change that will actually save many. If folks want to go around plugging holes in the dike with their fingers, that’s their choice, but I think we need a longer term solution, and one that doesn’t cause more problems than it’s designed to prevent.
That’s neither contradictory nor hard to understand.
May 15, 2009 at 2:40 pm
[…] REFORMED PASTOR ON Negotiable Conscience …. […]
May 19, 2009 at 7:50 pm
Alan,
Just what is the “real change” that will end abortion and how is it accomplished? I see many examples of change brought about gradually by half measures which you so disdain, e.g. self government, rule of law, independance, federalism (I didn’t say I agree with them all), emancipation, expanded voter rights, desegregation, handicap access, abortion rights, gay rights. Is there now some master pro-life switch somewhere we can throw to change things without having to bother with all those wasteful and tiring half measures?
May 20, 2009 at 7:34 am
Well, I’m not sure where you think I said that I disdain self government, the rule of law, independence, federalism, emancipation, etc…
I didn’t say that, and continuing a discussion based on such blatantly obvious, silly, and false premises isn’t worthwhile.
May 20, 2009 at 10:02 pm
Alan,
I did not say you disdain any or all of the causes I list, even though I guess I could see how you might have read it that whey. The e.g. rfered to causes not half measures.
My observation was/is that it is “half measures which you so disdain” with regard to limiting abortion even though I think they have been effective in the other causes. My question was/is what is the full measure you talk about and how is it to be accomplished?
Although I enjoy some humor in these discussions, believe me when I say I would never be silly about this deadly issue. Please re-read my previous post with that as your premise.
Regards, Don