The Question of Conscience

“Conscience clauses were significantly expanded last December when the Bush administration issued rules that tipped the balance toward refusal, and in our view neglected the rights, needs and conscience of patients,” said Sally Steenland, Senior Policy Advisor for the Faith and Progressive Policy Initiative at CAP. Steenland spoke at “When Consciences Collide,” an event CAP hosted Tuesday.

Steenland moderated the discussion with a panel of experts that included Holly Fernandez Lynch, Author of Conflicts of Conscience in Health Care: An Institutional Compromise; Willie J. Parker, an Obstetrician/Gynecologist and Director of Family Planning for Washington Hospital Center; Susan Brooks Thistlethwaite, Professor of Theology at Chicago Theological Seminary and CAP Senior Fellow; and Melissa Rogers, Director of the Center for Religion and Public Affairs at the Wake Forest University Divinity School.

Conscience clauses are state and federal regulations that allow health care workers to refuse to be involved with certain services that they object to on the basis of ‘conscience.’ However, the conscience of the patient must also be considered, especially when it conflicts with the conscience of the provider.

Definitions of “conscience” vary. Holly Fernandez Lynch encouraged a broad definition based on normative judgments about what people should or should not do. Willie Parker’s definition was personal: conscience is his personal gyroscope, oriented to what constitutes good.

“It’s the human capacity to tell right from wrong,” said Susan Thistlethwaite. “But what makes conscience so contested is it has so many emotional sources.” She said there was tremendous risk in assuming the infallibility of conscience and that “people of good conscience can disagree.” “The beauty of conscience is that we protect all of those understandings,” said Rogers. “We recognize that people come to spiritual understandings in different ways.”

The current debate over conscience clauses too often stands at a stalemate, pitting the religious liberty of health care providers against the needs of patients. Lynch said that rather than framing the debate solely in terms of rights, we should focus on duties and obligations, both of individual providers and of the health care profession as a whole.

Parker described his transformation from an ob-gyn who didn’t provide abortion services to one who did as a journey of conscience. He grew up in a fundamentalist community in Birmingham, AL, and religion informed his initial decision to not provide abortion services. Yet in his many years of practice, he saw the limited access many women had to abortion and the dangerous alternatives that resulted, and his views changed. Parker felt a moral obligation to serve his patients, so he trained and began to provide abortion care services. He described this decision as reconciling his conscience with the reality of the world.

Permitting religious refusals and providing access to medical services are both a matter of conscience, said Thistlethwaite. “The problem is that the conscience label is only given to refusal clauses and not applied to those who ensure access to medical services like abortion.”

Lynch described one possible solution to the dilemma of religious refusals versus the patient’s need for care: State licensing boards could bear the responsibility of ensuring adequate access for patients. She emphasized the need to create incentives for doctors who provide services, rather than punish those who refuse them. Rogers, too, noted the importance of both sides engaging in an effort to find common ground.

Ultimately, said Thistlethwaite, “This is not an issue that is standing still. It is a struggle and in my view it is being played out in the lives of poor women. There are important issues of conscience relating to poor women that we haven’t even gotten to yet… we are just beginning to try to have a conversation about how complex these issues really are.”

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