Ask the Expert: Sally Steenland on the Conscience Clause

What is a conscience clause?

It refers to federal and state rules that allow health care providers and institutions to refuse to provide certain medical treatments on the basis of religious or moral grounds. ThatÕs why its also called a refusal clause. We think that the term conscience clause is a little bit problematic because its limited, it refers only to the conscience of healthcare providers and institutions who refuse services not to institutions who do provide services to patients on the basis of conscience, nor does it apply to the consciences of patients whose belief systems might be very different from that of their providers. Lets say for instance thereÕs a woman who needs contraception because sheÕs already a mother of two and thatÕs her ethical and spiritual responsibility and limits but her pharmacist says ÒIÕm not going to give you this contraception because its against my conscience.Ó Well what about the conscience of that mother or her doctor who as a medical provider gave her that prescription. And for reasons like that we think its important to include and consider more than one conscience, the consciences of all the folks who are involved in these dilemmas.

How is the Obama administration rescinding the Bush administrationÕs midnight conscience clause rule?

Well for one thing, the Bush rule was adopted on his last day in office, it was a pretty political rule and it goes way too far. It goes beyond abortion and sterilization to allow people to refuse contraception, fertility treatments, even end of life care. It goes beyond direct services so you donÕt have to provide information to patients, referrals, counseling, treatment or any thing. In addition to that the extensions are way too broad, it refers not only to healthcare providers but to just about anybody in healthcare, that could be volunteers, candy stripers, ambulance drivers, its way too vague. And the rule is unnecessary. Before the Bush rule there was a compromise in place that worked, balanced consciences and it was clear and not vague. One more thing is the Bush rule applies unnecessary restrictions on health care institutions that are already economically strapped, and for low income patients who have very few options when they are refused treatment its very very hard for them to get health care.

How should the government address questions on conflicting conscience in the future?

These are not easy questions but itÕs very important to get them right. Of course we should always respect matters of conscience but weÕre also talking about the health of patients, their wellbeing and even their lives. What that means is that the health of patients and their lives must always be paramount. There are a couple of principles we can refer to that help guild us in these types of situations. So one, in an emergency situation even if someone objects to providing health care if no one else is available, the health care provider does have to step in and serve the patient. Another principle is that objections need to be known in advance and that means healthcare providers should inform their employers, their institutions and their patients about what services they refuse to provide so that if a patient wants to go elsewhere he or she can. And institutions like hospitals should tell patients this information as well so that theyÕll know in advance.

A third principle is that systems should be in place so that the patient gets seamless and quality care, so if for instance an objector says I canÕt provide this service there is a system in place for someone else to step in so that the patients needs will be served. And one other thing, its one thing to not provide services to a patient but you should never obstruct that patient from finding treatment somewhere else and that means you might provide information and treatment in a very unbiased way, again because the patients conscience and belief might be very different from your own. We live in a diverse democracy and worldviews and belief systems are very different from each other. So the important thing is not to have one conscious trump all others but to negotiate them in a way that respects all those involved.