A matter of conscience?

Categories: Hacking Life, The Juggle


The economy is impacting us in myriad ways, but one of the most shocking, to me, is the way it’s had an effect in the bedroom. People are trying to figure out if they have enough money to have another child; a heartbreaking number of people have decided that they do not, and are putting their family plans on hold, choosing sterilization, or deciding to have an abortion.

It’s a terrible decision to have to make, and there’s another layer of difficulty that’s being discussed often these days: Doctors and nurses faced with having to decide between their faith and their jobs. 

There have been laws — often called “Conscience Clauses” — on the books protecting the right of healthcare workers to refuse to perform abortions or other procedures that violate their personal beliefs for more than 30 years, but on Dec. 19, 2008, the outgoing Bush administration passed a regulation expanding the existing federal law and allowing healthcare workers to refuse to provide services, information, and advice based on moral or religious objections.

The new regulation went into effect on January 20 — hours before President Obama took office — and the current administration is seeking to overturn the expanded version.  (Seven states — Connecticut, California, Illinois, Massachusetts, New Jersey, and Oregon – sued the Bush administration to block the regulation in January). The Obama administration is seeking public opinion on their decision to rescind the regulation; you have until April 9 to weigh in on the matter.

So, why seek to overturn something intended to protect people?

Those in favor of overturning the expanded Conscience Clause argue that the regulation as passed by the Bush administration is so broad as to allow a pharmacist to prevent a married woman from filling a prescription for birth control pills if contraception is against that pharmacist’s personal beliefs; he or she could also refuse to transfer the prescription to another pharmacy (this isn’t hypothetical, it actually happened in Wisconcin in 2005). Some say it could easily apply to non-reproductive health scenarios as well – dispensing anti-depressant medication, giving blood transfusions, undergoing genetic testing, for example — and that the expanded regulation ultimately undermines patients’ access to healthcare services.

Those seeking to uphold the expanded version argue that it accurately relflects other laws already passed by Congress, as well as those in several states, and was meant to protect healthcare workers who did not want to perform abortions, not to interfere with anyone’s access to healthcare. “If the administration overturns the regulation, future tax dollars and the government could discriminate against doctors, nurses and other health specialists who choose not to perform medical procedures that conflict with their ethical convictions such as abortion,” Dr. Donna Harrison, president of AAPLOG, a pro-life OB-GYN group, said in a press release.

Though most of the debate has focused on abortion, the Conscience Clause issue also sheds light on some tricky topics: Which is more important, the rights of the patient or the rights of the healthcare provider? Is it discrimination to fire a healthcare worker who refuses to do something that’s clearly part of the job, like dispensing contraception? To whom does “pro-choice” apply? Is it ethical to impose your morals or religious beliefs on your patient?

Where do you draw the line?

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20 comments so far...

  • I draw the line at pharmacies. If you are not going to do the job, change professions. I take birth control for a condition UNRELATED to birth control. My body doesn’t manufacture all the hormones it needs, and birth control pills are the easiest and cheapest method of getting the hormones I need. Do I really have to explain my medical history to get the medication my physician and I have decided I need? But I also don’t think a physician should be required to do abortions. It’s a slippery slope either way…

    Jen  |  April 6th, 2009 at 2:23 pm

  • Jen: I hear you. I think a narrowly defined conscience clause could be a very good thing — I can’t remember where I read it, but someone likened it to being a conscientious objector during wartime. If you truly believe abortion to be the taking of a life, then you should not be required to participate in one. That said, I don’t think it’s right to be able to refuse to direct the patient to someone or someplace would be able to treat him or her for a procedure you find objectionable — and that includes everything from blood transfusions to vaccinations to sterilizations. The healthcare worker’s moral or religious objections should not prevent the patient from receiving care elsewhere, IMO.

    Lylah  |  April 6th, 2009 at 2:41 pm

  • I believe that if it’s in the normal job description when the person takes the job, he/she ought to be fired if he/she doesn’t do the job. But, what if something happens after they already have a job that creates a new requirement?

    Liberal politicians and lobbyists have been pushing for laws that would require existing hospitals / doctors to change their policies. This includes requiring doctors to perform abortions among other things. They feel the “access to abortion” is more important than a doctor’s right to not be involved. Depending on your definition of abortion, this would include certain drugs as well.

    There was also an action not long ago to require all medical students to have experience with doing abortions - regardless of whether their specialty would foreseeably place them in a position to perform an abortion. If you’re going to be forced to perform an abortion in order to get your medical license, pro-life students aren’t going to go to medical school, and that’s a big loss. The majority of Americans are personally opposed to abortion and certainly would not want to perform one.

    The “freedom of choice act” would chip away at rights of pro-life doctors as well as parents. It was well known before Obama was elected that he intended to expand abortion “rights” and has a history of opposing even the most unpopular abortion practices such as late-term abortion and allowing live babies born in failed abortions to be brutally killed after birth. Most likely Bush’s late action was to underscore the extreme position of Obama and give Americans a chance to question his plans before they have a chance to go into effect.

    SKL  |  April 6th, 2009 at 3:15 pm

  • Missing words in my previous post, needed to clarify - Obama has a history of opposing LAWS AGAINST even the most unpopular abortion practices such as late-term abortion and infanticide after failed abortions.

    SKL  |  April 6th, 2009 at 3:18 pm

  • SKL: Good point — especially the part about medical school (though, I do wonder… do they differentiate between teaching a student to do a post-naturally-occurring miscarriage D&C and an abortion? Or is the D&C also objectionable, since the mechanics of the procedure is similar to an abortion, even though the circumstances are very different?).

    My issue with the expanded version is that it seems to extend the protection to too many people. If it was limited to the people who would otherwise be forced to perform abortions, then that’s one thing — but the drug store example, or to say a Christian scientist janitor doesn’t have to mop the floor in operating room because a blood transfusion took place, takes things too far, I think.

    I guess the question that I need to research then is: Would rescinding the Bush’s version of the Conscience Clause and reverting to the pre-existing version be harmful to pro-life health providers?

    Lylah  |  April 6th, 2009 at 3:34 pm

  • Change professions. Keep your bias at home or find a job that will not contradict with your beliefs. This is why I didnt join the armed forces. Im against killing people.

    portland  |  April 6th, 2009 at 5:35 pm

  • I agree 100% with portland.

    spacegeek  |  April 7th, 2009 at 8:46 am

  • We live in such a parallel world today. We say one thing and live another ….sometimes in the same breath.

    When medical students apply to prospective medical schools, they are aware of the curriculum and it’s in the junior year is when they have to make steadfast decisions regarding policies, oaths and convictions. They either go or don’t go. They made a choice. Not only have they made a choice, but the accepting school has also made it’’s choice of who to accept.

    It seems as if the Conscience Clause was geared to discriminate against certain ethnic groups, but stats show that white American women have the most abortions…..they can afford to travel outside the Bible Belt states. The Conservatives, who mostly live in the southern and Midwestern United States, have means of securing info either from relatives or friends,regarding who and where an abortion can be performed. It’s like going to the corner drug store to buy condoms and paying the clerk, who just might be a choir member!

    Statistics show that during the recessions of 1980 and 1990, there were more abortions performed during those years. There will be just as many this time, So, the ” majority” pro-life statistics go down….the freedom of choice and the freedom to survive with dignity rises.

    Barb  |  April 7th, 2009 at 12:05 pm

  • Barb, I’m not clear - are you saying you’re OK with the idea that students who don’t want to perform abortions have no choice other than to give up on medical school? You’re OK with the only people able to, in good conscience, become doctors being those who are comfortable with personally performing abortions?

    SKL  |  April 7th, 2009 at 12:49 pm

  • Another point for Barb - on the racial discrimination issue. It is common knowledge that (a) the earliest pro-abortion advocates were advocating it as a way to reduce the surplus minority populations; the pro-abortion stance started out as a blatantly racist position; and (b) partly for that reason, people of color are more likely to be “pro-life” than whites. Making it easier for professionals to opt out of furthering abortions is more likely to protect white fetuses than black fetuses - but not because of racist intent.

    SKL  |  April 7th, 2009 at 1:38 pm

  • SKL-Prospective medical students have the ability to “flip-flop” their convictions, if they want to become doctors. Their main goal is to pass the boards in all required courses and get their license….whether they become good doctors or bad doctors. Those students who are truly convicted to pro-life, should think about another profession….before good time and money is spent. A good doctor should not pass on any guilt feelings to a patient…..only the bill!

    Education is a wonderful occurrence. It allows a person to become enhanced and again…..the ability to make choices, deal with circumstances and be productive in society. Could this be one of the reasons why our new government wants to rescind the expansion of the “Conscience Clauses”?

    Barb  |  April 7th, 2009 at 10:13 pm

  • Healthcare providers are not ignorant or stupid. They know what the job entails before they go into it. If someone doesn’t want to dispense birth control pills, antidepressants, or emergency contraception, don’t become a pharmacist. If you don’t believe in antidepressants, don’t become a psychiatrist. If you don’t believe in blood transfusions, don’t be a surgeon.

    As far as I know, there has never been a case of a doctor being forced to perform an abortion, so I don’t understand why this clause is even necessary at all.

    My opinion is: if a healthcare procedure is legal, and a doctor agrees with the patient that it is appropriate, no one should be able to block it.

    Robyn  |  April 8th, 2009 at 9:16 am

  • http://www.acog.org/from_home/publications/press_releases/nr09-25-08.cfm

    According to this statement, physicians are not required to perform abortions to be board certified as obstetricians and gynecologists.


    Here’s another interesting article from the Wasthington Post.

    At this point in time, it is my understanding that abortion education is part of most medical schools’ programs, but the actual performing of an abortion is NOT required for completion of the program. Does anyone know differently?

    Robyn  |  April 8th, 2009 at 9:30 am

  • Robyn, I only know that there was an attempt to require med students to perform abortions in order to get certified, and there was an outcry about it. It may have been limited to ob-gyn specialists - the folks who plan to spent 10 years and $X00,000 preparing to assist live births / preserve lives. I am not surprised if the protest succeeded in stopping it this time; but there is an ongoing attempt to encroach on doctors’ basic conscience rights, and this will come up again if we are too complacent. Most people would not agree that a person has to be willing to perform abortions (other than emergency ones to save the mother) in order to be licensed allowed to birth babies. But requirements like this can be strategically couched in benign language and slip in by the back door.

    I feel doctors have just as much right to act in accordance with their conscience as anyone else. What if this were a discussion about circumcision? If a doctor believes it harms more than it helps, would it be right to fire him or take away his license for not doing it? What are the bigger implications here - is the doctor no longer allowed to use his judgment in determining what’s best for his patient’s health? Are politicians more qualified to make medical decisions than doctors?

    The same is true for pharmacists up to a point. They are professionals who are supposed to actually care that the medicines they dispense are used in the right way by the right people, etc. They are not just cashiers. On the other hand, unless a pharmacist is pretty old, he has to be used to the idea that the job normally includes dispensing contraception and other reproduction-related substances. With the exception of the stuff that actually causes a micarriage (what is it, IU 480 or whatever), it’s hard to respect a “conscientious objection” to such things in an ordinary drugstore. But, they should still be allowed to keep it out of a faith-based medical establishment/pharmacy. Nobody is forced to go there for care.

    I also don’t believe the government has a responsibility to ensure everyone has access to abortion. It especially irks me that some politicians care more about access to abortion than access to delivery rooms. I come from a county where some people have to drive well over an hour to the nearest delivery room, because the nearby hospitals stopped delivering babies due to the high cost of malpractice insurance. Where’s the public outcry about that?

    SKL  |  April 8th, 2009 at 10:07 am

  • What I’m wondering is if requiring that med student learn how to perform certain procedures is the same as requiring them to be willing to perform them when they’re out on their own? The procedure used in an early-stage abortion and a non-abortive but medically necessary D&C are similar… is requiring that a med student learn it wrong because the procedure can also be used for abortions?

    SKL: You also wrote, of pharmacies and Rxs: “it’s hard to respect a “conscientious objection” to such things in an ordinary drugstore. But, they should still be allowed to keep it out of a faith-based medical establishment/pharmacy.” I think that makes sense, as long as the faith-based establishment isn’t the only option available in the area (which can be the case in some rural areas). My issue with the revised and expanded regulation that went into effect in January is that it is far too broad, allowing for “conscientious objections” to standard physical and chemical contraceptions and even to medications that have nothing to do with reproduction, as long as the person who works there (not necessarily the person dispensing it!) objects.

    You also wrote: “I come from a county where some people have to drive well over an hour to the nearest delivery room, because the nearby hospitals stopped delivering babies due to the high cost of malpractice insurance.” That’s awful. Why are malpractice cases there so focused on OB-GYN procedures that they need to stop delivering babies? What else don’t those hospitals do? You’re right… there should be more of an outrage over that.

    Lylah  |  April 8th, 2009 at 10:39 am

  • Lylah, to clarify, the rule was that the med students must actually perform an abortion in med school in order to pass. Although that particular rule didn’t relate to what the doctor will do after receiving his license, he/she would have to actually kill a homo sapiens during med school, usually in an elective situation since there aren’t that many emergency therapeutic abortions to practice on.

    If they just had to read about it in a book and pass a test or whatever, or even do it on a dummy, that would still be a restriction of freedom and a waste of time and money, but at least they wouldn’t be carrying the ghost of a child with them. Many med students simply would not be able to carry out this requirement. “Just this once” doesn’t cut it.

    SKL  |  April 8th, 2009 at 11:29 am

  • Thanks, SKL, I see what you’re saying.

    Barb, I totally missed your comments, I’m sorry! The last part of one of them just struck me: “Education is a wonderful occurrence. It allows a person to become enhanced and again…..the ability to make choices, deal with circumstances and be productive in society. Could this be one of the reasons why our new government wants to rescind the expansion of the “Conscience Clauses”?” It sounds like you’re wondering if a deliberate side effect of rescinding the expanded regulation could be that fewer people would persue higher education in order to avoid having to be in those fields… that’s interesting, I hadn’t thought about it that way.

    Lylah  |  April 8th, 2009 at 11:51 am

  • Since I am a professional, a teacher with a graduate degree and post-graduate education, does that mean I get to use my own judgement and discretion regarding what my students need to know and how to teach it to them? HAHAHAHAHAHA! Nope. I have to follow the state academic standards and graduation requirements. Sometimes I am required to use specific pedagogies, even if I believe they are ineffective. All of this I knew and accepted (though I don’t agree with it) when I chose my profession. I work from inside to try to improve the education that my students receive (micro level) as well as participating in research and policy-making to try to change the system (macro level).

    Lawyers who are public defenders or defense attorneys are required to defend people they know are guilty without disclosing that fact. Priests are required to keep all confessions confidential, even from law enforcement, even if someone confesses to committing a crime.

    Doctors (and nurses, and pharmacists, and other healthcare professionals) should also know the legal guidelines and requirements for their professions, the extent to which they are allowed to exercise their discretion and act “according to their consciences” before they pursue the profession.

    Robyn  |  April 8th, 2009 at 12:51 pm

  • Robyn, your last paragraph doesn’t address the fact that the changes we’re talking about came about / will come about after the existing docs / med students have already chosen their profession.

    Also, it doesn’t address the bigger issue of whether it’s right for the government to discriminate against people who don’t want to perform abortions or participate in them. I think it’s wrong, regardless of whether or not it was in the job description on day one. The only exception (for doctors) would be if the individual went to work for an abortion clinic.

    Again, guaranteeing access to abortion should not be a role of the government, and using discrimination / taking away freedoms to pursue this goal should be illegal.

    SKL  |  April 8th, 2009 at 1:03 pm

  • True. I am addressing only the current state of affairs. Of course, future or proposed changes should be the subject of vigorous debate.

    As it seems to be.

    I, personally, don’t believe that doctors should be required to perform abortions. Honestly, I can’t see that ever becoming a requirement for the profession that would be enforced by law. Abortion is just such a divided topic in this country, I can’t see Congress ever making that law or the Supreme Court ever upholding it. Maybe that is naive.

    But this seems to be about more than abortion, to include various other medications and treatments. My last paragraph of my last comment probably is more applicable to those other areas.

    Robyn  |  April 8th, 2009 at 1:16 pm