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03/02/2017

The ethics of conscientious objection: Caring for patients and supporting providers

Although conscientious objection arises in various
areas of medicine, notably end-of-life issues (e.g. physician assisted death), it
is ubiquitous in all aspects of reproductive medicine and women’s health care. Indeed,
it is discussed extensively in the academic bioethics literature, clinical
practice, healthcare law and policy (e.g. the Hobby Lobby Supreme Court case), and
in the popular press. Part of the reason conscientious objection is so
commonplace in reproductive medicine and women’s healthcare is because of the
controversial nature of abortion and emergency contraception.

The topic of conscientious objection forces us to
confront the boundaries of professional obligations and individual rights.
Which should be prioritized when they conflict? The common stance of most
professional medical organizations is that providers have an obligation to
refer if they oppose a practice/prescription based on personal beliefs (e.g.
providers should provide a referral if a patient requests an abortion and they
oppose abortion due to philosophical or religious reasons), but not if they
believe the practice/prescription doesn’t align with standard of care (e.g.
providers don’t have to provide a referral if a patient requests antibiotics
for the common cold).

The position of most medical organizations on
conscious objection raises some concerns. First, there are logistical and
feasibility concerns. While it may be easier to uphold providers’ conscientious
objection in densely populated areas, in rural areas where there may only be
one provider, thereby making it difficult to find someone to refer patients to.
It is burdensome for patients to travel far away to receive medical care that
they could receive locally if the provider did not have a conscientious
objection.
 

Second, there are concerns about violating the
beliefs of individual providers. Some providers may believe that a certain
medical practice/prescription, such as abortion, is so evil that even making a
referral violates their religious or philosophical beliefs by making them an “accomplice”
in what they see an immoral act. However, it may be difficult for patients to
know where to go to receive care if they don’t have a referral. Furthermore,
providers who intentionally withhold information about medically appropriate
care (e.g. not mentioning that abortion is an accepted standard of care option
for a woman carrying a fetus with a lethal abnormality) can be seen as
violating the principles of nonmaleficence and informed consent.

Although
there are some concerns with the position of most medical organizations on
conscientious objection, ultimately it does its best to protect the interests
of both patients and providers. One of the main goals of medicine is to care
for patients according to the accepted medical standard of care. When providers
have a conscience objection to a particular standard of care, they still have
an obligation to their particular patients to ensure the patients receive the
care that they need. Referring their patients to another provider safeguards
the health of the patients while preventing the provider from having to
participate in care that violates deeply held beliefs.

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI’s online graduate programs, please visit our website.

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