The Progressive Conscience in Action
The Progressive Conscience in Action
The exercise of conscience that pits health care providers against their patients mandates a rule change, Susan Thistlethwaite writes.
A progressive moral vision is deeply connected to the exercise of conscience. But the interface between conscience and policymaking is poorly defined, making the concept of conscience susceptible to hijacking by conservative political forces.
This is an especially important point today given the renewed debate over what has been called the “right of conscience” of individuals and institutions to decline health care or other services that they find morally objectionable. Specifically, President Barack Obama’s proposal in March to rescind a broad conscience rule adopted by the Bush administration in January—alongside a federal call by the Obama administration for public comments on its proposed rule change by April 9—demand that Americans think carefully about what it means to be true to one’s conscience in a pluralistic democracy such as ours.
Many who support the Bush rule argue that they are defenders of conscience and portray their opponents as its enemies, but that is simplistic. What it is being played out in the public debate over this rule are different approaches to thinking about how conscience informs public policy and how public policy accommodates conscience.
For progressives, a crucial guiding principle in regard to public policy is to secure the common good while protecting individual liberty to the fullest extent possible. The progressive understanding of the “common good” is based on the conviction that not only is each individual endowed with human dignity, purpose, and worth, but also that human society as a whole should reflect these characteristics. Therefore, human beings together should strive to realize social relations based on these universal values. People can differ, of course, in their view of how to define these terms and achieve that balance. In fact, given the generally sacrosanct status of the voice of conscience—its religious and secular value—it is not surprising that conscience-based conflicts arise.
But a close look at conscience through the lens of philosophical, political, and religious history shows that it was the Bush approach, and not the Obama approach, that veered from a longstanding centrist and socially responsible position on conscience. To appreciate this perspective, progressives must understand their own roots among the many traditions on conscience, and the valuable contribution that progressivism can make as we all wrestle with the question of how conscience should be adjudicated in the public policy arena.
The roots of conscience
Conscience may or may not be a uniquely human capacity, but it appears to be most highly developed in humans—attributable, according to some, to our having been created in the image of God and, according to others, by sheer dint of our ability to reason as taught through countless lessons of evolution.
Whatever the roots of conscience, many religions emphasize its centrality to human goodness and dignity and have done so from ancient times. Increasingly, nonbelievers have also asserted the right of conscience as a central part of their value formation as well—a perspective that has prevailed in the courts. In 1970, during the height of the Vietnam War, the Supreme Court ruled in Welsh v. United States that “depth and fervency” of beliefs qualified a soldier for conscientious objector status, regardless of whether those beliefs were religious in nature. This was a long overdue recognition by the courts of the role of conscience in secular values.
Among both religious and secular traditions, conscience is often depicted as residing in the heart—an indicator of its vital role in life. In the Hebraic view, for example, it is the heart that bears witness to the moral worth of our acts and that ultimately condemns or exonerates us. Muslims also focus on the heart when engaging in ethical decision making. According to the Koran, “God lies between the human being and his heart.”
In virtually all traditions, “listening to the heart” can bring one’s own voice into harmony with that of God or Truth. And virtually all religions, as well as a number of secular traditions, have constructed mechanisms to encourage heartfelt reflection as a means of finding truth and achieving justice, among them Ramadan (the Muslim month of fasting), Yom Kippur (the Jewish holy day of atonement), Lent (the Christian period of prayer and fasting), and Buddhist meditation.
But individual reflection offers no guarantee of resolution when it comes to making social policy, and religious dictum can’t settle all conflicts in a secular society.
One approach to dealing with this reality has been to develop teachings that explicitly show how to apply religious rules to everyday life. Judaism, for example, has the Halakhah, a set of practical texts whose purpose is to resolve conflicts between the teachings of scripture and the rules of civil law.
Another approach to integrating personal conscience into the larger social agenda has involved the cultivation of the faith community—essentially a faith-bound network of diverse human hearts. According to the U.S. Conference of Catholic Bishops, for example, the Roman Catholic Church in the 20th century has increasingly emphasized a tolerance toward individual consciences that may differ from official teaching, though it should be noted that the Church deviates from its tolerance for individual conscience when it comes to abortion and has been a stalwart supporter of Bush’s exclusionary expansion of the “right to conscience.”
Protestants, especially in the 20th and 21st centuries, have found conscience not only in the individual and the community but also in social movements. The Social Gospel movement of the early part of the 20th century, which applied Christian ethics to an array of social ills and helped sow the seeds of the U.S. civil rights movement, exemplified this broader view and application of conscience.
The simultaneously individual and social natures of conscience—and the recognition that it is necessary to accommodate these equally important demands of conscience—are fundamental aspects of conscience for progressives. This balanced perspective on conscience is especially crucial in relationship to democratic policymaking, which by definition requires individuals at times to sacrifice their self-interests to the interests of others or for the larger good.
Especially relevant to the current debate over “right to conscience” is that many traditions acknowledge that individual and even communal conscience is not infallible. History has repeatedly shown that even very deeply held and age-old “obvious” truths, based on individual or societal conscience, can be mistaken. Slavery and the acceptability of torture are two examples of “rights in good conscience” that prevailed in a former era and that today are almost universally viewed as deeply flawed. The death penalty and today’s bans on gay marriage may someday be viewed in a similar light.
It may seem a small thing, but it would be a useful start to agree that even the most deeply felt conclusions of conscience can still benefit from honest discussion and from a periodic review of the fundamental goals that we, as a deeply faith-enriched but ultimately secular society, hope to achieve together.
The progressive conscience
Conscience is at the heart of progressivism because conscience is not just a feeling but a palpable urge toward improvement—a call to action or engagement. Conscience is the way our moral sense and our moral formation come together to inform our actions in the world. As a result, conscience is not fully conscientious unless one acts on that conscience. Put differently, conscience is a guide to answering not only the question, “What do I believe is right?” but also the question, “What should I do about it?”
But the progressive perspective asks more than that. It also asks, “What do we believe is right?” and “What should we do about it?” That’s because in the progressive view, conscience is not only inward and individual but is also directed toward creating a more just and equitable society. Progressives emphasize this aspect of conscience and therefore struggle with moral reflection on the question, “What is it right to do that provides the most good for the whole society?” Caring for others and not just for oneself or one’s kind is, of course, a universal value found in both religious and humanist writings.
Almost by definition, the social aspect of conscience defies unanimity. Thus there will be some tension between the individual conscience and the idea of the social good. This is a necessary tension, not only because of the predictable differences among individuals but also because of the need to allow an ongoing evolution of ideas of what constitutes the social good as social conditions change.
Indeed, one of the central differences between progressive views of conscience and other views is the willingness to change those views with time based on new information and the social needs of the day. By contrast, conservative religious or social traditions tend to focus on divine proclamation or fixed political views and teachings, irrespective of emerging crises of social justice or changing sensibilities about the nature of the common good.
To be clear, this relative stasis in conservative traditions is not the result of a lack of compassion or a failure to accept change, but comes from the belief that one’s longstanding take on conscience will best serve individuals and society in the long run. Still, the result is that new social challenges find themselves having to adapt to old and potentially outdated ideas, instead of the reverse.
In the progressive view, diverse voices of conscience come together through the democratic process and the engagement of individual and institutional values in policy debates. This is not a smooth or easy process and conflict is bound to occur. However, isn’t this precisely the test of true conscience—a willingness to test limits, to allow and even demand introspection and counterpoint?
Similarly, sound public policy in a democracy comes from adjudicating among the individual claims of conscience, protecting principled dissent, and making conscientiously vigorous policies that serve the greatest good for the whole society.
The “conscience” rule must be rescinded to protect conscience
A progressive approach to conscience in public policy must constantly hold freedom and accountability in tension. The sweeping expansion of individual rights to allow unmitigated “religious refusal” in the last-minute Bush rule destroyed this tension. It destabilized the previously balanced relationship between individual liberty of conscience and the rights of patients to safe and reliable care. It permitted doctors, nurses, pharmacists, and other health care workers to decline their participation in any procedure they found morally objectionable, including not only abortion, but contraception, artificial insemination, and potentially even nonreproductive health care services as well.
The Bush rule is so widely applicable that it extends not only to doctors and nurses but to anyone who works in and around places where such procedures are performed or products dispensed. It also protects institutional entities such as health insurance plans. The exclusive priority placed on the provider’s conscience tilted the scales radically from any notional center of moral gravity and made it impossible for patients to be able to rely on a uniform standard of care.
In short, under the Bush rule all the “conscience” protection is weighted toward those who object to certain reproductive procedures and technologies, while the right of conscience of patients, their families, and other health care providers whose consciences dictated differently is explicitly dismissed.
It is important to note that a number of protections are already in place for health care workers who might object to providing certain services. Most notably, the so-called Church Amendments—named after former Senator Frank Church of Idaho—offer conscience protections to individual health care providers. In addition, Title VII of the Civil Rights Act allows certain organizations to make employment decisions on the basis of religion and to accommodate employees’ religious-based refusals to perform services under certain circumstances. Title VII makes clear, however, that the refusers’ rights are not absolute. It assures, for example, that in a health care setting, patient care—which is, after all, the employer’s raison d’etre—has robust standing. But the law seeks a sensible assurance of balance.
In addition, some court decisions, including Catholic Charities v. Serio and Catholic Charities v. Superior Court, have affirmed the importance of not allowing refusal rules to go too far—especially when an institution invokes a right of refusal. In both cases, the courts found that laws exempting religious employers from providing coverage for contraception in their employee health benefit plans did not apply to religiously affiliated social service agencies that employed a religiously diverse workforce, did not engage in proselytization, and served the general public. These cases sent a clear legal signal that Bush decided to ignore when he promulgated his expanded conscience rule.
All members of our society deserve to know that they will be provided a professional standard of health care. Patients must be able to have confidence that health care workers will put their lives and well-being first. In the words of the American College of Obstetrics and Gynecology, a “patient’s well-being must be paramount” when conflicts arise over the moral beliefs of professionals and patients.
While providers’ preferences should certainly be respected whenever possible, it is simply wrong when, in a secular, pluralistic society, a rape victim’s legal prescription for emergency contraception goes unfilled by a pharmacist opposed to such medicines, as happened in Texas, or when a woman with a life-threatening embolism is refused a medically indicated early abortion because of the hospital’s religious affiliation, as happened to a 19-year-old in Nebraska.
It is unconscionable for health care professionals to put a patient’s life and well-being at risk. It is time to restore the balance of individual American consciences through clear rules that uphold professional standards in health care and fully serve those who are in need of care.
Susan Thistlethwaite is a Senior Fellow in the Faith and Public Policy Initiative at the Center for American Progress. To read more about this program at the Center please go to Religion and Values page of our website.
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