Saturday, May 29, 2010

Debating The Priority of Conscience.

A recent panel at Boston College included Fr. J. Bryan Hehir, secretary of health and social services for the Boston Archdiocese (and the Mongomery Professor of the Practice of Religion and Public Life at Harvard’s Kennedy School of Government), Michael F. Greene, a professor at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital, and Melissa Rogers, a lawyer who directs the Center for Religion and Public Affairs at Wake Forest University. The panel is described in an article at Boston College Magazine.

The subject of discussion was conscience exemptions, or provider refusal laws, that allow doctors to deny accepted medical procedures to patients because of religious or moral objection, including information about such available services or meaningful referrals for them. While the subject of "conscience clauses" most often arises when discussing women's reproductive services (abortion, emergency contraception), they also concern other areas of treatment including STD, pregnancy and AIDS prevention services for gays and lesbians, fertility services for lesbians, and end of life choices for terminal patients. I've long been pushing for more awareness regarding how these laws are practiced at Catholic hospitals because they are the second largest provider of health care in the country.

Because the Catholic church is a strong opponent of gay rights, end of life choice and women's reproductive rights, they have hidden behind such religious exemptions as a manner of forwarding their religious health care mission -- often refusing to comply with informed consent or referral ethics, while working to maintain their pronounced role in health care while infringing on patients' rights. In defense of such conscience clauses, "pro-life" advocates often claim that the conscience of the doctor or care-giver is morally superior to that of the patient and should be protected. Yet the web of laws that protect individuals have crept, over the years, to include the consciences of institutions. In other words, as Diogenes writes at Catholic Conscience, the church is able to use the shield of provider refusal laws to impose discriminatory care that they see as immoral. If you can't overturn Roe v Wade, the reasoning goes, limiting access to abortion and other services is the next best strategy.

Below is an excerpt from the article:

In addition to providing an overview of religious exemptions, the panelists suggested ways to move toward a societal consensus—the “fair adjudication” hoped for by Hehir—while quieting the noisy, sometimes angry debates between those who believe the state must honor any claim of conscience made by a health care provider and those who think the state should automatically deny such claims. Hehir called for “civility, attention to evidence in the arguments, making the arguments on the basis of reason, not on innuendo and ad hominem.” He also said that providers should claim exemptions “only for essential issues, not capaciously.”

Greene echoed this point when he chided doctors who won’t even refer a patient for a procedure that they refuse, on religious grounds, to perform themselves. He compared these doctors’ reasoning with that underlying a mythical court case against a farmer whose corn was made into whiskey that, in turn, fueled the misdeeds of someone the farmer never met. “There has to be a limit,” Greene asserted, “to the reach and realm of conscience.” He also cited doctors’ ethical duty to avoid situations where moral conflict might arise. “If . . . you have an objection to providing emergency contraception or abortion care services,” he quipped, “you shouldn’t volunteer” at your local Planned Parenthood office.

Rogers, too, advocated “early disclosure” by physicians of their religious objections to any procedure that they might be called on to perform. “That should not be something [the patient discovers] down the road,” she said, “in a crisis, in a conflict.” In addition, she called for a balancing of the provider’s right of conscience with the patient’s right to treatment. “We need to respect the moral autonomy of both patients and health care providers,” she said. Of pharmacists who refuse to provide morning-after contraception, she said, “If there’s [another] pharmacy close by that can provide the service . . . that would be a mere inconvenience. But it’s something else where there’s an actual lack of access, and we need to differentiate between those” situations. In the political debate over religious exemptions, “we often see a complete unwillingness to recognize” the other side’s point of view, Rogers added, and thus she called for respectful dialogue, conducted outside the political arena, between people on all sides of the issue, with a goal of finding “common ground principles” that could then be presented as model legislation.

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