Friday, March 4, 2011

Conscience Clause

What is the conscience clause and why should I care about it? What does this have to do with writing? Well, writing fiction is all about conflict and the conscience clause can help add that to a medical scene.

Generally, the conscience clause is a set of rules designed to protect a heathcare worker against performing any medical procedure they may find morally objectionable. For instance, not assisting in an abortion. My personal professional take on it is that I could withdraw myself from what I would personally consider a morally questionable medical procedure as long as there was "another qualified medical person" who could provide that care. Thus, the pateint's needs were met.

Let's take the case of Baby Joseph. Say, the hospital decides to go ahead and withdraw life support. Generally, it will be a nurse or respiratory therapist that "turns off the machines". In Joseph's case, I would not want to do that because I believe the family's wishes are reasonable... to place a trach and then take the baby home. I would request not to be assigned as his nurse or have someone else perform the duty.

Now, the Obama administration is rolling back some of these protections. They felt some healthcare professionals were over-using the conscience clause and certain populations of people were being denied care. You can read more about it here:

What do you think? Should a healthcare worker be "forced" to perform a procedure they find morally objectionable?


  1. I don't agree with Obama. It should be a case by case basis to prove bias. Like not saving someone's life because you don't like their skin color or the slant or no slant of their eyes.

  2. I don't believe a healthcare professional should ever be forced to violate his or her conscience. A lawyer isn't required to take every case, after all.

  3. Thanks Sharon and Paula for your comments.

    I think most health care professionals try to avoid these situations. For instance, I don't work at a clinic to provide abortion services for this reason.

    However, there seems to be some reaching into the private sector... ie Catholoic Hospitals being put in a position to provide some services they may find morally objectionable or risk losing Medicaid funding.

    I know at my hospital, Medicaid funding is somewhere near 40-50% of revenue. So you can see how, if this were cut off, it could mean the demise of the institution.

  4. As the culture continues to move away from belief that we are accountable to the living God, I expect issues of conscience will become more difficult. Given what the Bible says about the period leading up to the return of Christ, we can anticipate increased consequences for obeying God.
    Still, we've been sheltered in the United States. Our Christian brothers & sisters in many other countries have been living with the consequences of remaining true to their convictions for years. Sad, isn't it?

  5. Ava, I agree. The less we know God the less we value human life.

  6. I am a Christian respiratory therapist. I spent six years in school to attain a license to honor God through the healing and lifesaving duties of this vital profession. I work at a hospital in New York whose medical direction and critical care workers actively convice families and patients that death is a worthy choice to bring about the end of suffering. The spiritual consensus is one which holds the view that there can not possibly be any fate after death that is worse than the suffering patients experience in life with mortal illness or continuous unsconsciousness. That is to say, all patients go to heaven or nowhere.
    I believe Jesus wasn't kidding when he emphasized that there is a heaven and a hell. We also can't look at somebody lying in a hospital bed and determine for ourselves to which place that person will go after death. In a hospital that withdraws life support from several patients per week, respiratrory therapists are busy doing the dirty work of extubating ventilator-dependent patients so that they will die. I wrote to my employer a statement that I cannot conscientiously participate in any procedure that is likely to hasten the death of my patient. My department manager told me that he couldn't understand why anybody who believes what I do would ever get into the field of respiratory care, as if he thought withdrawing patients' life support were the central purpose of a respiratory therapist's career.
    The hospital has refused to fully support my request to be reassigned away from a patient when my faith prevents me from ethically carrying out the order to with draw treatment. I may once have had legal recourse through the support afforded by a conscience clause, but now, as far as I know, I have no support from the law.
    I ride a collision course with that inevitable case in which I will have to act according to the prevailing religion of my workplace, or lose my license for standing firm upon the teaching of Christ. What is the solution? It is same solution to which outnumbered Christians have resorted ever since the first century. Go underground. I have to find a new job. Then, I will lay low and hope a Christian president will emerge to reinstate the conscience clause and make it safe for Christians to work in healthcare again.

  7. Your situation Is heartbreaking to me. Have you tried going past your manager to your director or the hospital ethics committee? Maybe you should consult someone at the ACLJ-- which is different than the ACLU.

    I can't imagine your situation. I'll be praying.