Protecting our rights of conscience

In reading Carolyn Schierhorn's April article titled "Death With Dignity: DOs Weigh Ethics in End-of-Life Care," I was encouraged by the thoughtful comments of like-minded physicians such as AOA President-elect Karen J. Nichols, DO, who stated, "We should not be offering a medical solution to a patient's nonmedical quest." The facts presented in the article, specifically that loss of autonomy is the most commonly cited end-of-life concern in Oregon, fully support Dr. Nichols' conclusion that the issue, and therefore the solution, is primarily social—not medical—in nature.

Regardless of one's personal view on physician-assisted suicide (PAS), this article highlights the importance of a greater, overarching issue—that of health care providers' rights of conscience—which was specifically addressed in this excerpt: "Physicians are not required to comply with 'Death with Dignity' requests or make referrals to physicians who are likely to." While the PAS acts in Oregon and Washington include specific language affirming the right of providers to opt out of participating, future legislation in other states may not do so. As the debate over right of conscience is often framed in the context of abortion, the article clearly demonstrates the need to protect these rights when it comes to end-of-life issues as well.

Many health care providers are familiar with the U.S. Department of Health and Human Services' regulation known as the "Provider Refusal Rule" and generally referred to as the "medical conscience clause," in effect since Jan. 20. While current laws, such as the Church Amendments, the Weldon Amendment and the Public Health Service Act (Section 245), specifically include conscience protections, they provide no private right of action—that is, no recourse or right to sue—when those rights are violated. With little incentive to follow these laws and ever-increasing reports of conscience rights violations, HHS deemed it necessary to put teeth into these protections by enacting them in the current regulation and providing an avenue for providers to report violations of their rights.

Citing potential access-to-care difficulties due to the medical conscience clause, the current administration has proposed rescinding the rule, and a final decision is pending. The rationale for rescission is based on a faulty assumption that health care professionals in the past have violated their consciences and now, with protections in place, will begin to deny care to their patients.

In a spring online survey conducted by The Polling Company Inc, 95% of faith-based physicians agreed that they "would rather stop practicing medicine altogether than be forced to violate my conscience." This actually suggests a far greater potential for a health care access problem if conscience protections are not upheld.

In a telephone survey, The Polling Company found that 63% of the American public favors the HHS conscience clause and 62% oppose its rescission.

While the debate continues over issues such as physician-hastened death, there is one issue that we should agree on: the right to practice medicine according to one's conscience and not be coerced, or forced, to practice in ways that violate the same. For those health care professionals who hold to the premise primum non nocere, it is of utmost importance to ensure that the autonomy of the patient does not trump that of the physician and to work for the protection of our right of conscience. The Freedom2Care coalition Web site (www.Freedom2Care.org) is a tremendous resource for learning more about the right-of-conscience issue and how physicians can help preserve it.