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03/03/2013

Do Medical "Conscience Clauses" Mean Being Unconscious to Patient Care?

“Conscience Clauses” either proposed or actually written into governmental legislation of medical practice have stirred controversy on both sides of the issue. A “conscience clause” would permit physicians freedom from any legal retribution, discipline or discrimination to reject performing or otherwise carrying out an action or service which would go against the physician’s “conscience”, conscience being the physician’s belief of right vs wrong, good vs bad based on the physician’s own ethical or religious  principles as applied to the patient care. In rejecting, the physician may be required to attempt to refer the patient to another physician who would agree to perform the service. On the other hand, this responsibility may not be required since some might find such a referral to be facilitating an act which was already deemed suspect. It should be noted that the “conscience clause” is supported by the First Amendment to the U.S. Constitution: “Congress shall make no law respecting an establishment of  religion, or prohibiting the free exercise thereof..” Apparently the Amendment applies to physicians and other medical care providers as well as their patients.

An example of a “conscience clause” written into a United States state law, which is one about which I am familiar, is that of the California Probate Code.Within the California state Probate Code is the following:

“4734.  (a) A health care provider may decline to comply with an
individual health care instruction or health care decision for
reasons of conscience.
   (b) A health care institution may decline to comply with an
individual health care instruction or health care decision if the
instruction or decision is contrary to a policy of the institution
that is expressly based on reasons of conscience and if the policy
was timely communicated to the patient or to a person then authorized
to make health care decisions for the patient.”

If the provider or institution declines, then:

“4736.  A health care provider or health care institution that
declines to comply with an individual health care instruction or
health care decision shall do all of the following:
   (a) Promptly so inform the patient, if possible, and any person
then authorized to make health care decisions for the patient.
   (b) Unless the patient or person then authorized to make health
care decisions for the patient refuses assistance, immediately make
all reasonable efforts to assist in the transfer of the patient to
another health care provider or institution that is willing to comply
with the instruction or decision.
   (c) Provide continuing care to the patient until a transfer can be
accomplished or until it appears that a transfer cannot be
accomplished.” 

The “conscience clause” may be applied to legislation that could deal with various aspects of medical care but is more often related to issues of reproduction such as sterilization,abortion,contraception and stem cell procurement and use.

But the issue I want to discuss here is with regard to what is the impact of the “conscience clause” on the professional duties of physicians and other providers in the medical system. Should we look at it as an impediment, within the law, to proper patient care? Irrespective of the permission of the “clause”, should physicians, nevertheless, divest themselves of their personal moral decisions when they take on
professional responsibilities? Should  responsibilities be only directed toward attending to the request and the best care of the needy patient and not, in some circumstances, directed toward the caregiver themselves? And what do you think about physicians or other healthcare providers who find situations where, to maintain
self-directed responsibilities and conscience intact, the duty even to transfer the patient to another provider who would follow the patient’s request is unacceptable?

If you are a doctor how would you look at the permission offered by the “conscience clauses”? If you disagreed with the patient’s request because of your moral or religious values, would you reject the request? ..Maurice.

Graphic: From Google Images modified by me with ArtRage and Picasa3







  

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