Debate Desk
Should Medical Professionals Be Forced to Act Against Their Conscience?
American law has protected conscience in medicine since the Church Amendments of 1973; accommodating it harms few and honors a founding freedom.
The claim
Opponents of conscience protections say that patients should not be denied care because of a provider's beliefs, that professionals who enter medicine accept its duties and that exemptions put patients at risk.
The answer in three points
- Conscience is the oldest of rights. Madison wrote that conscience is the most sacred of all property. A person who becomes a nurse or a doctor does not give up his convictions, and the law has long respected the principle that an individual should not be compelled to take part in an act he finds morally wrong.
- Congress acted early. The Church Amendments of 1973, adopted after Roe v. Wade, protect health care providers and institutions from being required to perform or assist in abortions or sterilizations against their beliefs. Many states have similar laws, and a long record shows that systems can honor conscience while patients find care elsewhere.
- Accommodation is the rule in a free society. Other professions allow reasonable accommodation of belief, as in the case of conscientious objectors to military service. Hospitals can arrange for others to provide a service, and patients can be told where to go. This site takes no position on any medical question, only on the freedom of conscience.
A medical profession that honors conscience gives patients doctors who act from conviction.
The numbers
- The Church Amendments were enacted in 1973 and are codified at 42 U.S.C. 300a-7, according to the Department of Health and Human Services.
- Madison proposed a conscience clause for the Bill of Rights in 1789 that provided that the rights of conscience shall not be infringed, though it was not adopted in that form, according to the records of the First Congress.
- The Religious Freedom Restoration Act of 1993 requires the government to justify a substantial burden on religious exercise, according to its text.
What they will say next
"Patients can be harmed by delay." Emergency care is a different case with its own rules, and law and professional practice require emergency treatment. In ordinary cases, patients have other providers.
"Professionals should follow the standard of care." Standards of care include respect for conscience in many contexts, and the law has long drawn that line.
"Pharmacists should fill every prescription." Systems that allow referral and alternative staffing exist, and licensing boards have worked out workable rules.
"Exemptions invite abuse." Rules can be written to require notice and referral, and each case can be judged on its facts.
A country that respects conscience gives all its members room to do their jobs without betraying themselves.
"What if a patient cannot find another provider?" In remote areas that can be a real difficulty, and it calls for referral systems, telehealth and other means of access. The remedy for scarcity is more providers, not fewer professionals with convictions.