Skip to main content
Log in

Speak No Evil? Conscience and the Duty to Inform, Refer or Transfer Care

HEC Forum Aims and scope Submit manuscript

Abstract

This paper argues that the type of conscience claims made in last decade’s spate of cases involving pharmacists’ objections to filling birth control prescriptions and cases such as Ms. Means and Mercy Health Partners of Michigan, and even the Affordable Care Act and the Little Sisters of the Poor, as different as they appear to be from each other, share a common element that ties them together and makes them fundamentally different in kind from traditional claims of conscience about which a practical consensus emerged in the 1980s and 1990s. This difference in kind is profoundly significant; so much so, we contend, that it puts them at odds with the normative basis for protecting conscience claims in United States health care settings in the first place, making them illegitimate. Finally, we argue that, given the illegitimacy of these contemporary claims of conscience, physicians and other health professionals must honor their well-established standing obligations to provide informed consent and refer or transfer care even if the service requested or needed is at odds with their own core moral beliefs—a requirement that is in line with the aforementioned practical consensus on traditional claims of conscience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. http://www.nytimes.com/2013/12/03/us/lawsuit-challenges-anti-abortion-policies-at-catholic-hospitals.html.

  2. http://www.nytimes.com/2014/01/25/us/justices-extend-order-blocking-contraception-mandate-for-nuns.html.

  3. https://www.aclu.org/reproductive-freedom-womens-rights/tamesha-means-v-united-states-conference-catholic-bishops.

References

  • American Academy of Pediatrics. (2009). Physician refusal to provide information or treatment on the basis of claims of conscience. Pediatrics, 124, 1692.

    Article  Google Scholar 

  • Antommaria, A. H. M. (2010). Conscientious objection in clinical practice: Notice, informed consent, referral, and emergency treatment. Ave Maria Law Review, 9, 84–97.

    Google Scholar 

  • Aulisio, M. P. (2003). Meeting the need: ethics consultation in health care today. In M. P. Aulisio, R. M. Arnold, & S. J. Youngner (Eds.), Ethics consultation: from theory to practice. Baltimore: Johns Hopkins University Press.

  • Aulisio, M. P. (2014). Clinical ethics: I. Development, role & methodologies. In B. Jennings (Ed.) Encyclopedia of Bioethics, 4th edition. New York: Macmillan Reference.

  • Aulisio, M. P., Arnold, R. M., & Youngner, S. J. (2000). Health care ethics consultation: Nature, goals, and competencies. A position paper from the Society for Health and Human Values-Society for Bioethics Consultation Task Force on Standards for Bioethics Consultation. [In Eng]. Annals of Internal Medicine 133(1), 59–69.

  • Brock, D. W. (2008). Conscientious refusal by physicians and pharmacists: who is obligated to do what, and why? Theoretical Medicine and Bioethics, 29, 194–198.

    Article  Google Scholar 

  • Frader, J., & Bosk, C. L. (2009). The personal is political, the professional is not: Conscientious objection to obtaining/providing/acting on genetic information. American Journal of Medical Genetics C Seminars in Medical Genetics, 151C(1), 62–67.

    Article  Google Scholar 

  • May, T. (2002). Bioethics in a liberal society: The political framework for bioethics decision making. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • May, T., & Aulisio, M. P. (2009). Personal morality and professional obligations: Rights of conscience and informed consent. Perspectives in Biology and Medicine, 52(1), 30–38.

    Google Scholar 

  • Savulescu, J. (2006). Conscientious objection in medicine. BMJ: British Medical Journal, 332, 294–296.

    Article  Google Scholar 

  • Sonfield, A. (2004). New refusal clauses shatter balance between provider “conscience,” patient needs. Guttmacher Report on Public Policy, 7(3). http://www.guttmacher.org/pubs/tgr/07/3/gr070301.html. Accessed 25 June 2014.

  • Sulmasy, D. P. (2008). What is conscience and why is respect for it so important? Theoretical Medicine and Bioethics, 29, 135–149.

    Article  Google Scholar 

  • Wicclair, M. R. (2011). Conscientious objection in health care: An ethical analysis. Cambridge: Cambridge University Press.

    Book  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark P. Aulisio.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aulisio, M.P., Arora, K.S. Speak No Evil? Conscience and the Duty to Inform, Refer or Transfer Care. HEC Forum 26, 257–266 (2014). https://doi.org/10.1007/s10730-014-9242-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10730-014-9242-8

Keywords

Navigation