Wednesday, February 8, 2012

Conscience Check

The recent announcement by Katherine Sibelius of HHS created a dilemma for faith-based organizations and providers.   The context of the dilemma is the provision of contraceptive services to women as a part preventive services without additional charges or co-pay.  This final rule provides for a grace period of one year to “allow these organizations more time and flexibility to adapt to this new rule.”  This rule is a response to the Institute of Medicine’s report,  Clinical Preventive Services for Women: Closing the Gaps.

There is no question that the administration is aware of tension between religious liberty and the scientific basis of the recommendation.  The last sentence of the release is particularly revealing...”And this final rule will have no impact on the protections that existing conscience laws and regulations give to health care providers.”
There are a multitude of state rules/regulations as well as a long history of federal rules that support the idea of not forcing health care providers to participate in any procedure or service that they find morally objectionable.  The concern is that these protections are  “slipping away” given the demands of “access” and “control of health care costs”.
This issue is an opportunity to revisit prior “posts” addressing the purpose and nature of why and what we do.(1)   What seems likely to happen is that this will be seen in political terms particularly at this time in our history and ultimately as a legal question.  So what should be our conscientious response?
We can say that there is “a significant minority” of physicians who object to participation in procedures or recommendations that are morally objectionable.(2)  The other data is the impact of oaths and professional codes.  One example has been the refusal of physicians to participate in capital punishment.(3)  The anesthesiology board prohibits participation and sights a “Hippocratic” reason and support of the AMA.   Their policy is informative in that it does not argue the laws but addresses their professional response. It is a clear response that physicians are not agents of the state.
In summary, rules and regulations are important to consider in our actions as individuals and organizations but are not the definition of our mission either as a profession or as a vocation.  We have been confused in the past and should try and avoid this error as we are confronted with changes in the framework or context of our practice.


(1) 12/24/2010 - The "Telos" for Christian Healing Agents
07/23/2011 - Power, Politics and Healing
01/6/2012 - Burdens and Benefits

(2) Lawrence RECurlin FA. Physicians' beliefs about conscience in medicine: a national survey.  Acad Med. 2009 Sep;84(9):1276-82.


(4)  Genuis SJ. (2006). Dismembering the ethical physician.  Postgraduate Medical Journal, 82(966), 233-8

1 comment:

  1. Thanks for a reasoned response to this issue, Marv. I won't expect to hear any of this on the evening news.