Protecting health care professionals who act based on their conscience

by Child of the Ocean

I recently came across an interesting article titled “Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine” by Julie D. Cantor, M.D., J.D., in the New England Journal of Medicine.

This article argues against a rule, the Provider Refusal Rule, from the United States Department of Health and Human Services (DHHS) that legally protects health care professionals who act based on their conscience when treating patients.  For example, if a doctor is morally opposed to euthanasia then, according to the rule, he or she can legally refuse to perform that procedure.  This is undoubtedly a delicate issue, however, the argument presented by Dr. Cantor does not convince me entirely.

The article attempts to make the case that, if health care professionals were allowed to act on their conscience then “everyone connected to health care may opt out of a wide range of activities, from discussions about birth control to referrals for vaccinations … Taken to its logical extreme, the rule could cause health care to grind to a halt.”

Meaning of conscience

Firstly, the article exhibits a misunderstanding of the concept of conscience.  It suggests that “[w]hen broadly defined, conscience is a poor touchstone; it can result in a rule that knows no bounds”.  This conveys the idea that conscience is a matter of personal whim and inherently baseless.  However, conscience does not exist meaningfully without an absolute moral reality underpinning it.  In other words, meaningful conscience is not about whimsically deciding that something is right or wrong.  Instead it is a way of being in touch with the knowledge of what is factually right or wrong.  Knowledge of this moral reality is revealed by the Supreme Lord, and mere opinion does not change this reality.  For example, a person’s opinion of whether fire burns or not does not alter what would happen if that person were to put their hand in fire – they would get burned regardless of their opinion on the matter.  In this case, that fire burns is a factual reality.

Role of conscience in society and specifically health care

Secondly, the author does not seem to understand the magnitude of the positive impact that conscience has had in human societies and in health care.  It is conscience that keeps people from committing murders, not the laws criminalizing the act.  When the recent tragedy in Haiti struck, the many thousands who helped the recovery efforts did so because of their conscience.  When Gandhi urged millions to choose non-violent methods in their struggle for freedom against only a few thousand oppressors it was because of his conscience.  Even Einstein once said, “Never do anything against conscience, even if the state demands it.”

Regarding the health care professions, it cannot be denied that many are drawn to these professions because of their fundamental belief that helping those in need is a good thing; that is their conscience speaking.  The innumerable doctors who have made immense sacrifices to help others did so because of their conscience – this is real “selfless professionalism”.  At this point it must be acknowledged that there have been many atrocities that have been committed by people who kill purportedly because of their conscience.  In such cases, their so-called conscience is not in line with the absolute moral reality, and they will be punished by that same absolute moral reality; just like the person thinking that it is good to put their hand in fire is inevitably burned despite their opinion.

(On a side note, vilifying medical professionals that act on their conscience as possibly having “religious beliefs [that] demand suffering at the end of life” seems unprofessional of the author at best.)

A fundamental right

Finally, being able to think, speak, and act freely according to your conscience (but not criminally) is a fundamental human right.  It is a basic expectation in a free society.  And health care professionals are rightful members of society.  So when an individual who is both a doctor and a lawyer advocates for the suppression of health care professionals’ basic right to exercise their conscience it makes for a rather worrying contradiction.

“Child of the Ocean” is a medical student who blogs at the self-titled site, Child of the Ocean.

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