Standards 4 Life: Right of Conscience

 

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1. What is Healthcare Right of Conscience?

 

Common Terms When Discussing Healthcare Right of Conscience

 

Conscience: the faculty of recognizing the distinction between right and wrong in regard to one’s own conduct; Conformity to one’s own sense of right conduct.¹

 

Hippocratic Oath: written during the 4th century B.C. by Hippocrates, the father of modern medicine; it is an oath stating the obligations and proper conduct of doctors, formerly taken by those beginning medical practice. Parts of the oath are still used in most medical schools.²

 

Protection of Conscience Laws (PCL’s): ensure that people cannot be forced to facilitate practices or procedures to which they object for reasons of conscience. These may include abortion, capital punishment, contraception, sterilization, artificial reproduction, euthanasia, assisted suicide, human experimentation, torture, etc. An adequate protection of conscience law should protect conscientious objectors from coercive hiring or employment practices, discrimination and other forms of punishment or pressure. It should also include protection from civil liability.³

 

Conscience Clauses: usually less comprehensive than protection of conscience laws and afford varying degrees of protection for conscientious objectors. They may appear in statutes or in the policies of organizations or institutions.⁴

 

Definition

 

Healthcare Right of Conscience (ROC) is the right of institutions and healthcare professionals to exercise their conscience and refusal to participate in or cooperate with certain medical practices or procedures they deem morally, ethically or religiously objectionable. The Christian Medical & Dental Associations’ ethics statement on healthcare right of conscience says, “The right of choice is foundational in our healthcare process, and it applies to both healthcare professionals and patients alike. Issues of conscience arise when some aspect of medical care is in conflict with the personal beliefs and values of the patient or the healthcare professional.”⁵

 

Rationale for a Right of Conscience

 

Until recently, there has been question of healthcare professionals’ right to practice according to their conscience. However, with increasing clashes on ethical issues in healthcare, the rights of physicians and other healthcare professionals are under attack. It reaches beyond doctors in an examine room to pharmacists who are unable to fulfill prescriptions for progesterone-only contraceptives or lethal doses of medications for assisted suicide due to their moral beliefs. The American Civil Liberties Union (ACLU) and many pro-abortion groups have established well-funded programs to eliminate what they call the “right of refusal.”

 

Right of Conscience and the Bible

 

Obedience to conscience is obligatory for all Christians. Here are some biblical guidelines to go by when addressing healthcare rights of conscience issues.

 

1. We must avoid every kind of evil (1 Thessalonians 5:22)
2. We must hate and oppose evil (Romans 12:9)
3. We should separate ourselves from evil (II Corinthians 6:17)
4. We should overcome evil with good (Romans 12:21)
5. We should seek wisdom (James 1:2-5)⁶

 

Hippocratic Oath

 

In the days of Hippocrates, a patient could never be certain if their physician had the intent to heal them or if they would carry out a treatment that would undoubtedly end in the patient’s death. Seeing this problem, in the 4th century B.C. a man named Hippocrates, often referred to as the “father of medicine,” wrote what is now widely known as the Hippocratic Oath. In essence, the Hippocratic Oath brought a sense of order and accountability to the field of medicine. The creation of the oath was the first step in preventing unnecessary pain to patients, which included many treatments that were inhumane and in many cases led to a patient’s death instead of their recovery. It was a call for physicians to put their patient’s wellbeing before their own agendas or rewards.

 

In order for a student to become a physician, he or she had to sign this oath as a covenant to their patients that they would uphold a number of medical ethical standards, including the infamous prohibition to “do no harm”.⁷

 

Today, most medical schools do not require a medical student to take the Hippocratic Oath upon graduation, and many of those that do require their students to take the oath have modified it or even offer their graduates the option to write their own oath. While some modifications have been made simply due to advancements in medicine (for example, in Hippocrates’ time surgery was not a recognized field so the oath was modified to allow surgical procedures), other modifications that have been made bring into question if the purpose is still to “do no harm,” such as omitting sections of the oath that originally forbade abortion and euthanasia.⁸

 

The First Amendment and ROC

 

According to James Madison, one of our founding fathers, the right of conscience is the most sacred of all property. This is clearly demonstrated in the First Amendment in the Bill of Rights, which states, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…”⁹ Before the first amendment was made more concise it read, “The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed.” It is obvious that when a healthcare professional takes a professional license, it does not mean they have to give up his or her personal morality.

 

Right of conscience does not mean discrimination because a healthcare professional doesn’t approve of a patient’s decisions or lifestyle. Healthcare professionals exercise their right of conscience when they are asked to become morally complicit by participating in an action they consider immoral. It may be prescribing birth control pills, helping an unwed couple become pregnant or dispensing the morning after pill that can cause the death of a developing embryo. For all medical professionals, as well as for non-medical professionals, what benefit does freedom of religion bring us if we cannot adhere to our deeply held beliefs? This issue pits the basic right of conscience against the patient’s frivolous right of convenience – they have to go elsewhere to get the service they desire.

 

Present Protections are Inadequate

 

The Law and Regulations

 

As far as setting the law on this controversial issue goes, one of the main concerns that is repeatedly displayed is deciding who should have the final say, healthcare providers or their patients. Each state in the United States has its own set of conscience laws. At the time of this publication, there are 45 states that have some sort of conscience laws on the issue of abortion alone.

 

While some states recognize the importance of protecting healthcare professionals’ conscience rights, there are some that are or are in the process of eliminating some of these protective measures. For example, in 2008 the state of California questioned the validity of the Weldon Amendment, which prohibits government authorities from requiring any health care professional or institution to participate in or pay for abortions.¹⁰ In that hearing, the courts ruled in favor of the healthcare professionals, but it won’t be long before the court will see another challenge to this vital protection.

2. Healthcare Right of Conscience Challenged

 

The American Medical Association’s (AMA) Statement on Healthcare Right of Conscience says this, “AMA reaffirms that neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical practice. Except in emergencies, physicians shall be free to choose whom to serve, with whom who to associate and the environment in which to provide medical care.”¹¹

 

The Christian Medical & Dental Associations’ (CMDA) Ethics Statement on Healthcare Right of Conscience states, “All healthcare professionals have the right to refuse to participate in situations or procedures that they believe to be morally wrong and/or harmful to the patient or others. In such circumstances, healthcare professionals have an obligation to ensure that the patient’s records are transferred to the healthcare professional of the patient’s choice.”¹²

 

Several pharmacist associations have also made official statements concerning the rights of pharmacists.

 

• American Pharmacists Association (APhA), Code of Ethics: “A pharmacist has a duty to tell the truth and to act with conviction of conscience.”¹³
  
  
• American Society of Health-System Pharmacists (ASHP): “…the right of pharmacists, as healthcare providers, and other pharmacy employees to decline to participate in therapies they consider to be morally, religiously or ethically troubling”¹⁴

 

However, the healthcare professional’s right of conscience is being challenged by many groups and individuals today. If the patient’s conscience should trump their doctor’s conscience, medical professionals will become nothing more than healthcare vending machines – dispensing whatever healthcare the patient demands, whether it is really in the patient’s best interest or not. To strip healthcare professionals of their conscience is reverting society back to the time before the Hippocratic Oath, when a patient did not know if they would leave the office better or worse than how they came in. The last and best protection of all patients is a health professional with conscience.

 

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