A Matter of Conscience: Religious Exemptions and the Healthcare Debate
On April 13 the Boisi Center hosted a panel discussion on the rights and duties of conscience among healthcare providers and patients. In particular, the panel explored the implications of allowing exceptions, grounded in religious objections, to laws and regulations that would otherwise apply to everyone. The issue has been growing in importance in the medical community, even as the recent healthcare overhaul in Washington has put religious objections in the forefront of the news.Leading the discussion in front of a packed lecture hall were Rev. J. Bryan Hehir, Dr. Michael Greene, and Melissa Rogers, experts on this question in the religious, medical and legal communities.
Leading off the panel was Rev. Hehir, a professor at Harvard University’s Kennedy School of Government and Secretary for Health Care and Social Services in the Catholic Archdiocese of Boston. Conscience clauses, Hehir said, are a standard of civil law meant to help the individual citizen negotiate in his or her social context. On the one hand, conscience clauses are expected in a pluralistic society where different individuals have different moral obligations; on the the other hand, devising coherent and effective public policies that exempt certain people is challenging. Regarding the current healthcare debate, Hehir pointed to the need to protect the autonomy of individuals in the medical profession, and the profession as a whole. The law, he noted, must grant individuals a space to develop their consciences—hence the need for exemptions. If these exemptions are eroded, the law will risk driving a wedge between individuals and society.
Dr. Greene, professor of reproductive biology at Harvard Medical School and Chief of Obstetrics at Massachusetts General Hospital, spoke from his experience as a physician, identifying the goal of medicine and healthcare as the prevention of disease and care for the dying. Based on this goal, he articulated several key ethical and moral principles: respect for a patient’s autonomy; the right of patients to refuse care; and a commitment to beneficence, non-malfeasance and justice. These principles, Greene noted, are implemented through mechanisms such as informed consent and the physician licensing. While doctors should not willingly put themselves in a situation of moral uncertainty, he said, sometimes conflict is unavoidable. To illustrate his point, he recalled a recent case of a Jehovah’s Witness patient who requested a cesarean section without blood transfusion. Despite his reservations, Greene successfully performed the surgery according to her wishes. Sometimes, he said, unforeseen circumstances may arise and a physician might have to adjust to the patient’s desires.
The final speaker was Melissa Rogers, director of the Center for Religion & Public Affairs at Wake Forest University, and advisor to the White House Office of Faith-based and Neighborhood Partnerships. A lawyer and long-time advocate for religious freedom, Rogers noted that the conflict between personal and civic obligations has always been addressed in American law. While the First Amendment’s Free Exercise clause protects individuals’ rights to religious practice, the Establishment clause guards against the government’s promotion of one faith over others. Recent laws and judicial decisions have specifically linked conscience exemptions and the issue of healthcare. The recent healthcare mandate, for example, is subject to exemptions on the basis of membership in a religious group. Looking forward to the implementation of new healthcare legislation, Rogers called for acceptance of “common ground principles” for religious exemptions, including the need for greater disclosure among providers about what services they make available (and do not); the importance of distinguishing between a lack of access to care and mere inconvenience to patients (when, say, a pharmacist refuses to provide the “morning after pill”), and the need to ensure that healthcare does not become a means of coercion or proselytization.