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Hastings Center News

Questions About Conscientious Objection in Health Care

In January the Department of Health and Human Services acted to increase enforcement of laws that permit doctors and other health care workers to refuse to provide services such as abortion because of moral or religious objections. A new Conscience and Religious Freedom Division in the department’s Office for Civil Rights will be in charge of enforcement.

Conscientious objection – the refusal to perform or participate in an activity associated with a professional role due to a conflicting moral or religious conviction — is a longstanding legal and ethical issue in health care, outlined in The Hastings Center’s Bioethics Briefings chapter, “Conscience Clauses, Health Care Providers, and Parents.”

Ethical questions raised by conscientious objection in health care concern the effects on patients’ access to care and their health and on the possible disruption to the delivery of health services. “At what point does a clinician’s moral objection to providing a treatment interfere with a patient’s access to treatment, and violate professional ethical standards?” states the chapter. “Laws and professional guidelines on conscientious objection in health care must balance the respect for an individual’s beliefs against the well-being of the general public.”

“Conscientious objection, by its nature, conflicts with the duty of care to which all health care professionals and institutions must adhere,” says Hastings Center research scholar Nancy Berlinger. “It is a notably well-protected right in federal and state law and in professional standards, through so-called conscience clauses. Physicians and other health care professionals have long had the right to opt out of participating in abortion, aid-in-dying, and other legally authorized health services. This right has even been described as an overprotected right, because of the focus on providers who refuse, without equivalent attention to ensuring access for patients.”

State laws that permit nonmedical exemptions from mandatory childhood vaccinations are a type of conscience clause that has become controversial on grounds of public health. Some states, notably California, have significantly tightened or eliminated this option following outbreaks of preventable disease attributed in part to parental refusal.

In its announcement last week, HHS said that abortion, sterilization, and assisted suicide were activities that could “violate the consciences of health care providers.” Its proposed rule would protect them from having to perform these activities. It has a 60-day public comment period.

Another new action that bolstered conscientious objection concerned state Medicaid programs. The Centers for Medicare & Medicaid removed restrictions on the programs’ ability to regulate abortion providers.

News reports and analysis included the concern that that the new actions could lead to discrimination against lesbian, gay, and transgender patients, in addition to reducing access to reproductive health services. “The right to opt out of a health care activity due to a conflicting moral conviction about that activity does not constitute a right to discriminate against patients or populations,” says Berlinger.