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Your Morality, My Mortality

Conscientious Objection and the Standard of Care

Published online by Cambridge University Press:  26 February 2015

BEN A. RICH
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Abstract:

Recently the scope of protections afforded those healthcare professionals and institutions that refuse to provide certain interventions on the grounds of conscience have expanded, in some instances insulating providers (institutional and individual) from any liability or sanction for harms that patients experience as a result. With the exponential increase in the penetration of Catholic-affiliated healthcare across the country, physicians and nurses who are not practicing Catholics are nevertheless required to execute documents pledging to conform their patient care to the Ethical and Religious Directives for Health Care Services as a condition of employment or medical staff privileges. In some instances, doing so may result in patient morbidity or mortality or violate professional standards for respecting advance directives or surrogate decisionmaking. This article challenges the ethical propriety of such institutional mandates and argues that legal protections for conscientious refusal must provide redress for patients who are harmed by care that falls below the prevailing clinical standards.

Keywords

abortionCatholicismlawmedicineprofessional ethicsreligion
Type
Departments and Columns
Information
Cambridge Quarterly of Healthcare Ethics , Volume 24 , Issue 2 , April 2015 , pp. 214 - 230
Copyright
Copyright © Cambridge University Press 2015 

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References

Notes

1. Cantor, JD. Conscientious objection gone awry—restoring selfless professionalism in medicine. New England Journal of Medicine 2009;360:1484–5.CrossRefGoogle Scholar

2. Goodman, E. Dispensing morality. Boston Globe 2005 Apr 9:A23.Google Scholar

3. Charo, RA. The celestial fire of conscience—refusing to deliver medical care. New England Journal of Medicine 2005;352(24):2471–3.CrossRefGoogle ScholarPubMed

4. Harris, LH. Recognizing conscience in abortion provision. New England Journal of Medicine 2012;367:981–3.CrossRefGoogle ScholarPubMed

5. Hitt, J. Who will do abortions here? New York Times Magazine 1998 Jan 18; available at http://www.nytimes.com/1998/01/18/magazine/who-will-do-abortions-here.html?pagewanted=all&src=pm (last accessed 6 Jan 2014).Google Scholar

6. Means v. United States Conference of Catholic Bishops et al., U.S. District Court for the Eastern District of MI 2913; available at https://www.aclu.org/reproductive-freedom-womens-rights/tamesha-means-v-united-states-conference-catholic-bishops-0 (last accessed 18 Dec 2013).

7. United States Conference of Catholic Bishops. Ethical and Religious Directives for Catholic Health Care Services; 2009; available at http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf (last accessed 18 Dec 2013).Google Scholar

8. See note 7, USCCB 2009, at 12.

9. See note 7, USCCB 2009, at 19 (emphasis added).

10. American Civil Liberties Union Foundation, The MergerWatch Project. Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to Reproductive Health Care. New York; 2013; available at https://www.aclu.org/religion-belief-reproductive-freedom/miscarriage-medicine-growth-catholic-hospitals-and-threat (last accessed 31 Dec 2013).Google Scholar

11. Pew Research Center Polling and Analysis. Abortion Viewed in Moral Terms; 2013 Aug 15; available at http://www.pewforum.org/2013/08/15/abortion-viewed-in-moral-terms/ (last accessed 31 Dec 2013).Google Scholar

12. Annas, GJ. Transferring the ethical hot potato. Hastings Center Report 1987;17:20–1, at 21.Google ScholarPubMed

13. Simmons v. Tuomey Regional Medical Center, 533 S.E. 2d 312 (S.C. 2000).

14. Sulmasy, DP. What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics 2008;29:135–49, at 135.CrossRefGoogle ScholarPubMed

15. See note 14, Sulmasy 2008, at 138.

16. Wildes, KW. Institutional identity, integrity, and conscience. Kennedy Institute of Ethics Journal 1997;7:413–19, at 416.CrossRefGoogle ScholarPubMed

17. Wicclair, MR. Conscientious refusals by hospitals and emergency contraception. Cambridge Quarterly of Healthcare Ethics 2011;20:130–8.CrossRefGoogle ScholarPubMed

18. See note 10, ACLU 2013.

19. The Pew Forum on Religion & Public Life, 2014 The Pew Forum on Religion & Public Life. U.S. Religious Landscape Survey. Report 1: Religious Affiliation: Diverse and Dynamic; 2008 Feb; available at http://religions.pewforum.org/reports (last accessed 1 June 2014).Google Scholar

20. Wicclair, MR. Conscientious Objection in Health Care—An Ethical Analysis. New York: Cambridge University Press; 2011, at 99–100.CrossRefGoogle Scholar

21. See note 14, Sulmasy 2008, at 139.

22. Employment Division v. Smith, 494 U.S. 872 (1990).

23. Freedman, LR, Landy, U, Steinauer, J. When there’s a heartbeat: Miscarriage management in Catholic-owned hospitals. American Journal of Public Health 2008;98:1774–8.CrossRefGoogle ScholarPubMed

24. Freedman, L. Willing but Unable: Doctor’s Constraints in Abortion Care. Nashville, TN: Vanderbilt University Press; 2010.Google Scholar

25. Stulberg, DB, Lawrence, RE, Shattuck, J, Curlin, FA. Religious hospitals and primary care physicians: Conflicts over policies for patient care. Journal of General Internal Medicine 2010;25:725–30, at 726.CrossRefGoogle ScholarPubMed

26. See note 12, Annas 1987.

27. See note 24, Freedman 2010.

28. Ikemoto, LC. When a hospital becomes catholic. Mercer Law Review 1996;47:1087–134.Google ScholarPubMed

29. Catholic Health Association of America. Press Release; 2013 Dec 9; available at http://www.chausa.org/newsroom/news-releases/2013/12/09/catholic-health-association-r (last accessed 31 Dec 2013.Google Scholar

30. Statements from the Diocese of Phoenix and St. Joseph’s. The Arizona Republic 2010 May 15; available at http://www.azcentral.com/community/phoenix/articles/2010/05/14/20100514stjoseph0515bishop.html (last accessed 25 May 2014).Google Scholar

31. Pope, TM. 2010. Legal briefing: Conscience clauses and conscientious refusal. Journal of Clinical Ethics 2010;21:163–80.Google Scholar

32. Mississippi Health Care Rights of Conscience Act. Miss. Code Ann. § 41-107-3 2013.

33. Sepper, E. Taking conscience seriously. University of Virginia Law Review 2012;98:1501–75.Google Scholar

34. Swartz, MS. “Conscience clauses” or “unconscionable clauses”: Personal beliefs versus professional responsibilities. Yale Journal of Health Policy, Law, and Ethics 2006;6:269–350.Google ScholarPubMed

35. Brownfield v. Daniel Freeman Marina Hospital, 208 Cal. App. 3d 405 (1989).

36. See note 35, Brownfield 1989, at 412.

37. See note 7, USCCB 2009, at 21–22.

38. See note 35, Brownfield 1989, at 412.

39. In the Matter of Beverly Requena, 517 A. 2d 886 (1986).

40. See note 39, Requena 1986, at 480.

41. See note 39, Requena 1986, at 484.

42. See note 39, Requena 1986, at 487.

43. See note 20, Wicclair 2011, at 99–100.

44. Boozang, KM. Deciding the fate of religious hospitals in the emerging health care market. Houston Law Review 1995;31:1429–516.Google ScholarPubMed

45. See note 44, Boozang 1995, at 1515.

46. Bassett, WW. Private religious hospitals: Limitations upon autonomous moral choices in reproductive medicine. Journal of Contemporary Health Law and Policy 2001;17:455–583, at 565.Google ScholarPubMed

47. Catholic Healthcare West. Catholic Healthcare West Is Now Dignity Health; 2012 Jan 23; available athttp://www.dignityhealth.org/Dignity_Health_Information/Press_Center/223068 (last accessed 31 Dec 2013).Google Scholar

48. Pellegrino, ED. Toward a reconstruction of medical morality. The American Journal of Bioethics 2006;6:65–71, at 69.CrossRefGoogle Scholar

49. See note 48, Pellegrino 2006, at 67–8.

50. Rhodes, R. The ethical standard of care. The American Journal of Bioethics 2006;6:76–8.CrossRefGoogle ScholarPubMed

51. Lynch, HF. Conflicts of Conscience in Health Care—An Institutional Compromise. Cambridge, MA: MIT Press; 2008.CrossRefGoogle Scholar

52. See note 20, Wicclair 2011, at 91–2.