This transcript has been edited for clarity.
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at New York University Grossman School of Medicine.
Oklahoma became one of the latest states to think about enacting legislation that would protect the rights of doctors to not perform actions or undertake interventions or procedures that violate their conscience. The Oklahoma statute says that the Medical Ethics Defense Act grants a medical practitioner, healthcare institution, or healthcare player (meaning a pharmacist, a nurse, or others) the ability to decline a medical procedure that a patient may need or want that violates their conscience.
I am very, very unhappy with these broad statutes. Conscience is something that ought to be respected. There are many situations where people do have obvious moral objections. There are many healthcare professionals who don't want anything to do with abortions. There are some healthcare professionals who don't want anything to do, in states that have legalized it, with medical assistance in dying, with helping terminally ill patients to die. There are certainly some medical practitioners who don't want anything to do with infertility treatments if they think embryos are going to be sacrificed.
Remember, aside from those more familiar conscience issues, there are people who say, I don't want to be vaccinated because I think it's too risky, so as a matter of conscience, I don't want to follow an employment mandate to do this. There are certainly hospitals — and we see more and more mergers these days — particularly Catholic and secular hospitals, where the hospital takes away services because they are against its policy or beliefs, sometimes on religious grounds. Maybe they're not willing to take away food and water from a dying person, seeing that as just morally unconscionable, even if delivered through artificial hydration or nutrition.
At the end of the day, conscience is important, but it's not and cannot be just blanket permission to ignore patient needs and requests for legitimate, approved standard-of-care therapies. Every person has a right to pursue their health. Patient interests in codes of ethics take precedence in the American Medical Association code, in the American College of Physicians code for internists, and in all the codes I know over healthcare professional rights.
Although you may not have to do the procedure and you may find yourself unwilling to fill the prescription for the emergency contraception as a pharmacist, the patient still has a right to know their alternatives and where they can go to receive this care. Not only do they have a right to know, I think they have a right to know this information in writing. There should be information that says, we don't do this procedure here, but because it's legal, you could go there. This is the address, this is the phone number, and this is how you make contact.
I know people would say, still, I can't facilitate or participate in something I consider immoral, but that's a place where I think individual conscience and professional rights have to yield to patient best interest.
It's one thing to say, as the Oklahoma statute does and many other state statutes do, you don't have to do this if it's a matter of conscience. It's a different thing to say that you don't have to tell people what their rights are to go elsewhere or to be informed about what their options are. That, I find, undercuts the basic medical ethics of patient interest. Patient rights come first. They trump and override professional rights.
The idea that I wouldn't vaccinate because it's against my conscience or some version of my religious belief should not exempt me from the obligation I have not to make my patients sick. That is the driver. Even there, I might say you still have to get reassigned, wear a mask, or do something that's going to protect patients.
If you really have strong conscientious objection, it may be that some parts of medicine are just not for you. If you do have conscientious objection or your institution does, you better make it clear early to somebody seeking services what those limits are.
I believe that every institution and provider has a duty of informed consent to let people know all their options, all their choices, and everything that's legally acceptable and possible, even if the provider doesn't want to do it.
I'm Art Caplan and the Division of Medical Ethics at the New York University Grossman School of Medicine. Thanks for watching.
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Cite this: Arthur L. Caplan. State Conscience Laws: Docs Should Inform Patients Early of All Options for Care, Says Ethicist - Medscape - Apr 23, 2024.
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