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How to Protect Medical Conscience


Over at First Things, I have a piece up about the ongoing and accelerating campaign — most recently furthered by Ezekiel Emanuel — to drive pro-life and orthodox religious believers out of medicine by forcing their participation or complicity in acts in the medical sphere with which they have strong moral or religious objections.

There are currently some conscience protections in the law, but as the piece notes, they are under assault here and are already collapsing in other countries. From “Pro-Lifers Get Out of Medicine”:

The government of Ontario, Canada is on the verge of requiring doctors either to euthanize or to refer all legally qualified patients. In Victoria, Australia, all physicians must either perform an abortion when asked or find an abortionist for the patient.

One doctor has been disciplined under the law for refusing to refer for a sex-selective abortion. In Washington, a small pharmacy chain owned by a Christian family failed in its attempt to be excused from a regulation requiring all legal prescriptions to be dispensed, with a specific provision precluding conscience exemptions. The chain now faces a requirement to fill prescriptions for the morning-after pill, against the owners’ religious beliefs.

In Vermont, a regulation obligates all doctors to discuss assisted suicide with their terminally ill patients as an end-of-life option, even if they are morally opposed. Litigation to stay this forced speech has, so far, been unavailing.

The ACLU recently commenced a campaign of litigation against Catholic hospitals that adhere to the Church’s moral teaching.

Here, I would like to share some ideas about how to shore up existing protections to best protect medical professionals from being forced into committing what they consider sinful or immoral acts. I suggest that the following general principles apply in crafting such ­protections:

  • Conscience protections should be legally binding.
  • The rights of conscience should apply to medical facilities such as hospitals and nursing homes as well as to individuals.
  • Except in the very rare and compelling circumstance in which a patient’s life is at stake, no medical professional should be compelled to perform or participate in procedures or treatments that take human life. 
  • The rights of conscience should apply most strongly in elective procedures, that is, medical treatments not required to extend the life of, or prevent serious harm to, the patient.
  • It should be the procedure that is objectionable, not the patient. In this way, for example, physicians could not refuse to treat a lung-cancer patient because the patient smoked or to maintain the life of a patient in a vegetative state because the physician believed that people with profound impairments do not have a life worth living.
  • No medical professional should ever be forced to participate in a medical procedure intended primarily to facilitate the patient’s lifestyle preferences or desires (in contrast to maintaining life or treating a disease or injury).
  • To avoid conflicts and respect patient autonomy, patients should be advised, whenever feasible, in advance of a professional’s or facility’s conscientious objection to performing or participating in legal medical procedures or treatments.
  • The rights of conscience should be limited to bona fide medical facilities such as hospitals, skilled nursing centers, and hospices and to licensed medical professionals such as physicians, nurses, and pharmacists.

I am interested in other ideas on this subject, which I predict will become a firestorm issue in coming years.

Photo credit: Unsplash, via Pixabay.

Cross-posted at The Corner.

Wesley J. Smith

Chair and Senior Fellow, Center on Human Exceptionalism
Wesley J. Smith is Chair and Senior Fellow at the Discovery Institute’s Center on Human Exceptionalism. Wesley is a contributor to National Review and is the author of 14 books, in recent years focusing on human dignity, liberty, and equality. Wesley has been recognized as one of America’s premier public intellectuals on bioethics by National Journal and has been honored by the Human Life Foundation as a “Great Defender of Life” for his work against suicide and euthanasia. Wesley’s most recent book is Culture of Death: The Age of “Do Harm” Medicine, a warning about the dangers to patients of the modern bioethics movement.



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