I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm

–Hippocratic Oath

Conscientious objection in health care “is the refusal to perform a legal role or responsibility because of moral or other personal beliefs.”

In February 2015, six-day-old baby Bay was refused treatment by a Michigan pediatrician, Dr. Vesa Roi, because Bay’s parents are lesbians. Roi realized she could not care for the baby after praying about it. While the family was welcome in the office generally, Roi would not be able to care for baby Bay, or “develop the personal patient-doctor relationship that I normally do with my patients” because of the sexual orientation of Bay’s parents.

PHOTO CREDIT: Pexels

In April 2016, a law passed in Mississippi, the Protecting Freedom of Conscience from Government Discrimination Act, making it legal for physicians and therapists to refuse to care for patients on religious grounds. Indeed, the Mississippi law makes it “expressly legal for doctors, psychologists, and counselors to opt out of any procedure or choose not to take on any patient if doing so would compromise their conscience.”

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Similarly, a 2016 law passed in Tennessee makes it legal for counselors to refuse to provide counseling or therapy services based on the counselor’s religious convictions. In January 2017, a federal district judge, Reed O’Connor, of Fort Worth, Texas, blocked regulations which prohibited insurers, doctors, or hospitals from discriminating against transgender patients or women who have had an abortion.

Especially in a post-Hobby Lobby climate, these laws are not out of the ordinary. In fact most states have conscience clauses. For example, in Oregon, a conscience clause permits a doctor to refuse to participate in physician-aid-in-dying, which is legal in that state, based on the physician’s personal beliefs. Some conscience clauses are specifically for pharmacists who might refuse to fill a certain prescription based on moral or religious grounds.

In 2009, the American Academy of Pediatrics Committee on Bioethics issued a statement upholding the professional right of conscience for pediatricians. Similarly, protections are upheld for physicians who will not perform sterilization or abortions due to religious convictions. And physicians who cite the right of conscience in refusing to perform a certain procedure or see a patient are rarely challenged on this particular basis. 

Conscientious objection in health care has particular effects, effects that conscientious objection in, say, education or other parts of civil society simply do not carry: “Conscientious objection in health care always affects someone else’s health or access to care because the refusal interrupts the delivery of health services. Therefore, conscientious objection in health care always has a social dimension and cannot be framed solely as an issue of individual rights or beliefs.” 

So, imagine going to see a doctor, but being denied treatment because you are gay, or black, or white, or not gay, or because you are Jewish or Christian or Muslim or atheist. Imagine allowing your doctor to pray about whether or not to care for you and that being the decision you have to accept. Imagine being asked what your sexual orientation or religious beliefs are before entering an ambulance. Or, even worse, imagine, as in the case of innocent Baby Bay, a physician refuses to see you because of your parents’ sexual orientation? Imagine having to give a detailed family history on the sexual orientation of your mom or dad before a physician will enter into a physician-patient relationship with you.

PHOTO CREDIT: Pexels

This is a very scary thought, and a slippery slope is easy to imagine. Conscience clauses for physicians allow personal values to trump professional norms and values and create a space where individual beliefs trump a professional duty of care. If physicians want to keep their status as ethical professionals, they must adhere to ethical standards of care, standards that are deep-rooted in the Hippocratic oath, an oath that calls upon them to care for all my fellow human beings, those of sound mind as well as the infirm. The AMA Code of Ethics calls upon physicians to be dedicated to providing competent medical care, with compassion and respect for human dignity and rights, regarding responsibility to the patient as paramount.

This is part of the important social contract that doctors have with their patients. Discrimination has no place in health care, and runs contrary to the special obligations that a physician has to her fellow human beings who fall under her care.  An ability to care for and work with individuals from diverse backgrounds is just as important of a skill as a physician’s ability to master anatomy and physiology. If a physician cannot ethically and compassionately work with diverse populations, she should perhaps not practice medicine and find a job where professional and ethical standards are less demanding. Conscience must not become a coverup for prejudicial, unjust, or unethical health care.

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