Opinion Piece on Conscientious Objection in Medicine

By Rachel Walden — March 30, 2009

We’ve covered the topic of provider conscience a number of times here previously. The New England Journal of Medicine has just published a perspective piece on the issue, Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine, by Julie D. Cantor, which offers a clear and concise explanation of concerns about the Bush Administration’s last minute “conscience” rule – including the broad definitions of who is included, effects on employment law, and the lack of an “emergency exception for patient care.”

The author argues that the current “conscience” debate is “not really about moral or religious freedom writ large,” asserting that,

“If it were, then the medical profession would allow a broad range of beliefs to hinder patient care. Would we tolerate a surgeon who holds moral objections to transfusions and refuses to order them? An internist who refuses to discuss treatment for diabetes in overweight patients because of moral opposition to gluttony? If the overriding consideration were individual conscience, then these objections should be valid. They are not (although they might well be permitted under the new rule). We allow the current conscience-based exceptions because abortion remains controversial in the United States. As is often the case with laws touching on reproductive freedom, the debate is polarized and shrill. But there comes a point at which tolerance breaches the standard of care.”

She also points out the burden such rules place on patients – “Patients need information, referrals, and treatment. They need all legal choices presented to them in a way that is true to the evidence, not the randomness of individual morality. They need predictability.”

Cantor concludes: “Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it. Because the Bush administration’s rule moves us in the opposite direction, it should be rescinded.”

The piece includes an appendix that will allow you to download both the existing “conscience” rule and the proposed rule to rescind it.

You have slightly less than two more weeks to submit your public comments (due April 9) on rescinding the last minute “conscience” rule – go here to submit!

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