back to news Feb. 20, 2018

Center for Ethics and Human Values explores conscientious objection in medicine

Do doctors and other healthcare professionals have a right to refuse to perform certain medical procedures or to treat certain patients based on their religious or moral beliefs? Should so-called “conscience laws” enabling them to do so be passed? These questions touch on some of the most sensitive areas of contemporary medicine — including end-of-life care, abortion and in vitro fertilization, contraception, and the treatment of LGBT persons.

On Feb. 26, the Center for Ethics and Human Values will host a conversation with two leading experts who take opposing sides on the issue. The event is part of COMPAS (Conversations on Morality, Politics and Society), a series of yearlong conversation on ethical challenges that unify various projects within Ohio State’s Discovery Themes Initiative. This year, COMPAS is focusing on ethical issues intersecting with religion.

Participating as an advocate for the conscience of healthcare professionals is Abraham Nussbaum, an associate professor in the Department of Psychiatry at the University of Colorado and chief education officer at Denver Health. He is the author of The Finest Traditions of My Calling: One Physician’s Search for the Renewal of Medicine, a memoir about practicing medicine in an era of healthcare reform, recently published by Yale University Press.

Ronit Y. Stahl, taking the opposing view, is a fellow in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania. She is the author of Enlisting Faith: How the Military Chaplaincy Shaped Religion and State in Modern America, forthcoming from Harvard University Press.

The panel will be moderated by Dana Howard, a member of the Ohio State Center for Bioethics and an instructor in the Center for Bioethics at the College of Medicine. Here, Howard offers some insight into conscientious objection in medicine and the ethical considerations that will be discussed at the event.

What is conscientious objection in medicine?

Conscientious objection in medicine is the idea that physicians, nurses and health institutions can refuse treatment on the basis of their deeply held religious or moral values. There’s a long history of legislation that protects conscientious objection for practitioners. The Church Amendment was enacted in the 1970s, which was bipartisan legislation that basically confirmed that federally funded physicians, nurses and hospitals were allowed to refuse to perform abortions and sterilizations.

How has conscientious objection evolved since then?

Conscientious objection came to the forefront again in the 1990s, and there was a lot of debate. President George W. Bush’s administration ended up expanding protections offered by the Church Amendment, and then President Obama rolled some back, namely by not allowing healthcare practitioners to discriminate on the basis of gender and sexuality. Now, the Trump administration is putting protections back in place, and the Office for Civil Rights at the U.S. Department of Health and Human Services just recently announced that it will enforce existing statutory conscience protections for Americans involved in HHS-funded programs, which protects practitioners from participating in procedures that may violate their moral and religious beliefs, including abortion, sterilization or physician-assisted suicide.

What is the argument in favor of conscientious objection in medicine?

For the proponents of conscientious objection, the main pillars are that freedom of religion is an important and protected right in the U.S., and it is something our country deeply values. The idea here is that people shouldn’t have to make a decision between doing their job and doing what they morally think is the right thing to do.

What’s an argument against?

One of the interesting contrasts our panelist Ronit Stahl draws is between protected conscientious objection in the military compared to in medicine. In the military setting, individuals are objecting to state-mandated conscription, whereas in the medical setting, it’s objection to treating patients — except you’ve voluntarily entered into a profession that has specific norms. She thinks there’s an important difference between objecting to something the state is mandating you to do versus something you’ve signed on to do — especially when that profession has a specific norm that clinicians have a duty to provide the standard of care to their patients.

Why is this debate so contentious?

This debate gets to the heart of what clinicians owe their patients, but it also gets to how we deal with religious pluralism in the U.S. There’s always going to be a really difficult balance between protecting people’s religious rights and their rights of conscience against protecting people’s right not to be discriminated against. Both of these are very important civil liberties at the heart of American identity, and this case is one where people’s valid claims on both sides come to a head against each other.

Why is this forum an appropriate venue to explore this debate?

This is a timely issue, and it’s a really difficult one that can get really contentious, and people can talk past each other. What’s great about these experts is that they have deeply held convictions, but they also have educated views. We can do more than talk past each other; we can also be disagreeing in a civil way. COMPAS events are bringing people with these disparate views or perspectives together into a civil conversation.

The conversation will begin on Feb. 26 at 3:30 p.m. in Thompson Library, room 165.