Conscientious Objectors in Healthcare

Bias, beliefs, and moral convictions live alongside the human capacity to rationalize just about anything. Some people see obesity as a moral failure. They see obesity treatment as a moral hazard. Others regard it as a non-issue. Merely a symptom of moral panic. But despite – or perhaps because of – all these conflicting views, moral concerns really do have a place in healthcare. And thus, conscientious objectors are getting attention in health policy.

At a recent seminar in Pittsburgh, bioethicist Mark Wicclair addressed this question. When should we accommodate the moral concerns of healthcare professionals?

Tricky Questions in Play

Conscientious objectors in healthcare refuse to deliver services they believe are immoral. Perhaps the most visible examples deal with abortion services. You could hardly pick a more highly charged subject.

The current administration has tried to implement a rule on this subject. It would protect the rights of some providers to refuse to participate in healthcare services that violate their moral or religious beliefs. For example, abortion, sterilization, or assisted suicide.

The problem comes when this gets in the way of delivering medically accepted care to a person who has every right to receive it. Thus, two federal courts struck down these rules. Yes, this is a contentious subject.

Finding a Balance

Wicclair suggested that neither of the extremes in this argument should carry the day. Never accommodate and you can put moral integrity at risk. Moral objections can lead to moral progress. For example, objections to eugenics led to the realization that this was a huge moral failure.

On the other hand, putting a provider’s moral beliefs above all else raises problems, too. Health professionals have special obligations. To respect patient autonomy, for example. Moreover, such an approach could create impossible burdens for other providers and organizations simply trying to deliver needed care.

So Wicclair suggests accommodating claims of conscience when it’s possible without an undue burden on others. Simple enough. But surely the devil is in the details.

Moralizing Obesity

Lest you think that this can only be about reproductive health, consider how people are wont to moralize their approach to obesity. We hear from professionals who are believers in Health At Every Size™ that they will not help a patient whose goal to lose and maintain a lower weight. They advise that bariatric surgery is “barbaric.”

At the other extreme, we have the subtle moralization of providers who will not refer a patient with obesity for evidence-based obesity care. Or maybe not so subtle. Some providers still blame and shame patients as once recommended in this AJM commentary.

In this way, conscientious objectors can be very sincere. But also very sincerely wrong. It’s one thing to take guidance from your own conscience. It’s quite another to impose it on others.

Click here for Wicclair’s presentation and here for more on the federal conscience rule. For another viewpoint on conscientious objection in healthcare, click here.

Drop Beats Not Bombs, illustration © USA Fellowship of Reconciliation / flickr

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November 19, 2019