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Conscience Regulation Unconscionable March 1, 2009

Posted by Dwight Furrow in Current Events, Dwight Furrow's Posts, Ethics.
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On Friday, Obama rescinded a last minute Bush Administration rule which gave legal protection to health workers who do not want to perform or assist with abortions, sterilizations, or other procedures they find morally objectionable. Dubbed the “provider conscience regulation”, the rule was breath-takingly broad in scope. Opponents argued that it would void state laws that require insurance plans to cover contraceptives and require hospitals to offer emergency contraception to rape victims; and would allow drugstore employees to refuse to fill prescriptions for contraceptives.

Should health-care workers be forced to perform tasks for which they have moral objections?

The most troubling consequence of allowing health-care workers (including pharmacists) to refuse to treat patients on moral grounds is that in rural areas of the country patients often have very limited options. If the sole pharmacist in your small town refuses to provide contraceptives, you will be out of luck.

In most situations, there are informal ways of handling moral objections. In most cases, I imagine hospital administrators and other supervisors will arrange to have abortions performed only by surgeons with no moral objections to the procedure. By contrast, it is likely that in conservative rural areas health-care providers would come under enormous pressure from local churches and opponents of abortion to stop providing abortions, contraceptives and information on reproductive rights. Again, the victims of the policy would have no recourse.

Carried to its logical conclusion, a general conscience exception for workers would lead to all sorts of absurdities. Should vegetarian truck drivers be able to refuse to deliver meat products to the supermarket? Should employees of pharmaceutical companies be legally permitted to refuse to work on the production line when drugs they oppose are being manufactured?

But beyond the empirical issues, there is an important conceptual issue at stake. Professionals have a duty to the people they serve. In most professional relationships—especially the doctor/patient relationship—there is a power asymmetry. The patient goes to the doctor for help and the doctor uses her authority to persuade the patient to take care of her health issue. Patients tend to believe what doctors say; their words have authority.

If a doctor tells a women (especially a very young woman) seeking an abortion that she would be committing murder, the patient is being coerced by the doctor to believe it. Refusing to perform an abortion may be an act of conscience, but encouraging a patient not to have one (assuming the procedure would be medically justified) is an attempt at coercive persuasion as well. The professional duty of a physician is to give medical advice, not moral advice.

Doctors must take up the needs of their patients, and up to a point this means subordinating their own values to that end. If they cannot do that, they belong in another line of work.




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