Conscience clauses not just about abortion anymore

WASHINGTON (RNS)—Faced with a request to give an unmarried female patient a prescription for birth control pills, Michele Phillips looked to her conscience for the answer.

“I’m not going to give any kind of medication I see as harmful,” said Phillips, a San Antonio physician. The drugs would not protect her patient from “emotional trauma from multiple partners,” Phillips reasoned, or sexually transmitted diseases. “I could not ethically give that type of medication to a single woman.”

After the evangelical Christian refused to write the prescription, she resigned her position. She now does contract work at a faith-based practice that permits her to “prescribe according to my ethical values.”

Medical technology has surged forward in recent years, leading to many life-saving and life-giving procedures. At the same time, legal and ethical remedies haven’t kept pace, and officials at the state and federal level still are working out how to address the sometimes-competing needs and values of doctors and patients.

For example, the Obama administration announced last February it plans to rescind regulations enacted at the end of President Bush’s term that permit health care workers to abstain from performing procedures they oppose for moral or religious reasons. Eight months later, the administration still has not announced new rules.

Often, experts say, the debate boils down to a question of convenience versus conscience, of personal choices affected by medical personnel.

“Do we really want co-workers deciding if our religious motivations and reasons are correct?” asked Joan Henriksen Hellyer, a postdoctoral research fellow at the Mayo Clinic in Rochester, Minn.

For example, at the recent annual meeting of the American Society for Bioethics & Humanities, a panel including Hellyer discussed the disparate dilemmas facing health care workers today, such as:

• A housekeeper who refuses to clean an embryonic stem cell lab.

• An ultrasound technologist who doesn’t want to work on Saturday.

• A respiratory tech who refuses to turn off a ventilator.

Bioethicist Holly Fernandez Lynch said consistency is crucial to prevent patients from facing discrimination based on race, religion or sexual orientation.

“A consistent objection to a service, I think, is totally appropriate as long as there is someone available to provide that service at a reasonable distance,” said Lynch, author of Conflicts of Conscience in Health Care: An Institutional Compromise.

But, she acknowledged, “the phrase ‘reasonable distance’ is really a difficult one to figure out.”

While larger communities and hospitals have the luxury of a range of practitioners, conscience quandaries are trickier in smaller communities, said Leslie LeBlanc, managing editor of The Journal of Clinical Ethics.

“It’s a very difficult question because you can’t compel someone to do something they think is morally wrong and, by the same token, clinicians make a promise to help people in need,” said LeBlanc, who attended the bioethicists’ meeting.

State legislatures have passed a plethora of legislation on the issue, with most permitting health care providers to shun abortion services, the Washington-based Guttmacher Institute reports. Some states, including Louisiana, have passed broader laws that protect health care workers who object to procedures such as cloning, stem cell research, euthanasia and physician-assisted suicide.

Rob Vischer, associate professor of law at the University of St. Thomas School of Law, argues for letting the free market determine access to all health care services.

“I think people want to have a space to live what they believe,” said Vischer, author of the forthcoming Conscience and the Common Good: Reclaiming the Space Between Person and State. “I think that’s more consistent with the common good than everybody grabbing for the reins of state power.”

Luke Vander Bleek, a Morrison, Ill., pharmacist, is fighting in court against an Illinois regulation that requires him to dispense Plan B and other emergency contraception.

“I wanted to be able to practice pharmacy in this small town that I live in where I raised my family and I wanted to be able to do it with a good, clear conscience and sleep well at night,” said Vander Bleek, a Roman Catholic. Other pharmacies within 12 miles could provide those services instead, he stressed.

Elizabeth Nash, a public policy associate at the Guttmacher Institute, counters that patients should be able to access drugs if they are legal.

“Putting barriers in their way to access those medications only hurts public health,” she said.

As the arguments continue, David Stevens, CEO of the Christian Medical Association, said physicians like Phillips are “a growing reality,” and he worries other physicians might quit permanently. In an April poll, his organization found an overwhelming percentage of faith-based physicians preferred ending their medical practice to violating their conscience.

“This is the most urgent issue for our membership,” he said. “Because they realize that if they lose this battle, they will no longer be practicing medicine.”