Conscience and the Practice of Medicine

John Lantos, MD
April 17, 2009

What are we, as a nation, going to do with the pesky issue of conscience clauses? Or, more interestingly, how are we going to think about the more profound issue of conscience itself and its role in the practice of medicine?

When should professional obligations override individual moral qualms? Do we risk turning doctors into moral automatons if we insist that there is no role for individual conscience in clinical decisions?

Controversies about conscience raise more questions than answers, generate more heat than light, and like debates about medical futility or universal coverage, lead to stable stalemates between protagonists who held relatively well-defined positions. And, like those other long-standing controversies, there is a relatively broad middle ground about which most people actually do agree.

In some situations, conscience clauses are widely accepted. No doctor or nurse has to participate in an abortion procedure. That has been true for thirty years. In other situations, conscience clauses would be intolerable. A Jehovah’s Witness trauma surgeon could not withhold blood transfusions. The real question is where to draw the boundaries between conscience claims that are acceptable and those that are intolerable.

Two solutions for many conscience problems would solve many problems. One is full disclosure. If a health professional has an uncompromising, conscience-based limitation on his or her practice, he must disclose that to each and every patient at the outset of their doctor patient relationship.

Second, medical interventions that could be provided without the complicity of a health professional should be.

Links:

Medical pros seek freedom to follow their consciences, Detroit News, April 13, 2009

Conscience vs. Conscience, Stanley Fish, New York Times, April 12, 2009

Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine, New England Journal of Medicine, April 10, 2009