Conscience in Medicine

This should prove interesting:

Los Angeles TimesReporting from Washington — The outgoing Bush administration is planning to announce a broad new "right of conscience" rule permitting medical facilities, doctors, nurses, pharmacists and other healthcare workers to refuse to participate in any procedure they find morally objectionable, including abortion and possibly even artificial insemination and birth control.

Some examples of refusal to provide medication or procedures based on the conscientious objection of the provider are given.  No details in the newspaper report, and I have about 20 questions for each presented, which boil down to ‘were there really no other viable alternatives but to insist one person go against their strongly held beliefs’?

I’ll now go out on a limb and say I don’t understand why medical professionals are not allowed to act, or refuse to act, based on their own beliefs, providing it results in no harm to the patient.  (I am not advocating prostylitizing or any other unprofessional behavior). The argument ‘you’re allowed to believe anything you want but must do whatever the patient wants even if it goes directly against your beliefs’ I can buy, but it would have to be under very very rigorous conditions (a true emergency or unavoidable time limitations coupled with a lack of viable alternatives).  We’re people, not automatons, with as much right to our own beliefs, and to have those beliefs respected, as anyone else.

To argue otherwise says you must jettison your own values and do whatever is asked.  Medicine demands a lot; it shouldn’t include your soul. 


  1. A hearty AMEN to that!

  2. There’s a spectrum here that you seem to be ignoring, and I can’t tell if it’s intentional or not.

    It’s the difference between refusing to prescribe Plan B to a rape victim because you believe it causes abortion and that abortion is murder at one end, and being forced to prescribe narcotics to frequent flyers against your medical judgment (implied by your statement “[you] must do whatever the patient wants even if it goes directly against your beliefs.”) I get the impression that you are using the second scenario to express your support for these “conscience clauses,” whereas it is the first that causes the most mischief.

  3. I don’t see a distinction here, as while your first example is terrifically emotionally charged and the second is routine, they devolve to the same question: should the medical person have to go against their beliefs?

    My answer to the first is: if you’re the only doctor able to see this patient and write for the Plan B (which is going OTC), then tag, you’re it. However, if there is another physician with different beliefs, that physician should be able to see the patient for the problem.

    The “mischief” can be avoided (usually) without having to cross a line that forces the medical treatment team to leave their conscience at the door.

  4. The mischief can only be avoided if their is another MD or pharmacy in town AND if they are willing to direct the patient to that MD/pharmacy without feeling they (the objector) is compromising their beliefs.

  5. there is (rather than their is)

  6. Disgruntled Internist says:

    You know when I feel the most bullied into doing something against my conscience? When misinformed, angry and misguided family members threaten to sue me (don’t think I’m exaggerating here) if I don’t do “everything” for Mama–and Mama is 95 years old, has a GFR of 20, severe emphysema, severe dementia such that she doesn’t even recognize the demanding relative, CHF, etc., and comes in with something that will take her peacefully, such as pneumonia.

    So, instead of allowing Mama to have a peaceful, easy death at home with her family, Mama ends up dying in the ICU after receiving:

    1) Subclavian triple lumen catheter, screaming in agony during its placement.

    2) Foley catheter

    3) Intubation after Bipap fails

    4) arterial line placement

    5) Kidney dialysis

    6) Cardioversion.

    And she’s lucky she didn’t get surgery, a rectal tube or a chest tube before she died.

    This is why I’m am now and forever out of the hospitalist and geriatrics business. People forced me one too many times to cause great suffering by providing futile care. I want to die peacefully at home, not in the ICU. Surveys show that almost everybody feels the same way, yet most of us die under ghastly circumstances in the hospital.

    Any law that allows anti-abortion or anti-contraception doctors to exercise “right of conscience” MUST also allow doctors who don’t believe in TORTURING DYING OLD PEOPLE to exercise the same “right of conscience” when confronted with end of life issues.

  7. Although I agree that no person should ever be forced to do something that they find morally objectionable, I don’t completely agree with “Disgruntled Internist” and his idea of “right of conscience” when dealing with end of life issues …

    When the family stands behind their 95 year old loved one, and demands that everything be done to keep the relative alive, it could be that they are carrying out the wishes of the elderly patient. Also, when it’s over, they may need to be able to say: “Well, she’s gone, but we did everything we could to keep her alive.” It may actually help them through their grieving process … since they wouldn’t be feeling overwhelmed by misplaced guilt.

    I think that “right of conscience” on the physician’s part in this case might be exercised by trying to reason with the family, ensuring that they understand that the elderly loved one will spend the last few hours of her life in pain and unnecessary distress. If that doesn’t work, then the physician has done what he can to keep the patient from suffering any longer, and he should have the option to pass the entire issue off to someone else who can deal with it.

    End of life decisions should come the patient, if possible, and if not the patient, then those who are closest to the patient, such as family. If this really upsets you, then perhaps you could consider making sure your thoughts on the matter are known from the outset, thus giving the patient/family a chance to turn to someone more sympathetic to their own desires.

    I agree that the elderly should be allowed to pass away in dignity and peace, and with whatever they need in order to be as free from pain and discomfort as possible. Still … I feel that a doctor’s “right of conscience” shouldn’t trump the patient or family’s right to ask that their end of life wishes be respected. If the doctor’s conscience doesn’t allow him to continue, another person should be able to take over.