The conscience clause and liberty
by John
Stanley Fish has a luciid discussion of the question of whether health care professionals should be allowed to refuse to perform or recommend certain treatments that offend their conscience, the so-called “conscience clause.” The occasion is uncertainty of whether Obama will overturn this directive, enacted by George W. Bush. As usual, Fish takes the reader through a few competing perspectives including, as always, the perspective of the US Supreme court as well as questioning the meaning of conscience, citing Hobbes.
Fish’s last word makes the liberal argument:
This sequestering of religion in a private space is a cornerstone of enlightenment liberalism which only works as a political system if everyone agrees to comport himself or herself as a citizen and not as a sectarian, at least for the purposes of public transactions.
However, the traditional liberal argument is weaker here than Fish might imagine. [One caveat -- all of this assumes that the physician is refusing to undertake a procedure, not giving advice. The situation is quite different if the doctor is, from his or her own moral base, giving controversial or sub-optimal advice to patients who are ill-equipped to know when their doctor does not have their best interests at heart. The obvious example is a "pro-life" doctor advising women against abortion in every instance and without providing all alternatives.]
First, there are lines to be drawn as to what the preservation of the liberal order can compel one to do. The liberal case is much stronger when it’s claim is that the citizen must refrain from acting, or, stronger still, when all that is compelled is a basic tolerance for the lives of others. The arguement is weaker when, as Fish seems to claim, the rules of the liberal order compel voluntary action in ways that violate the conscience.
Secondly, Fish gives a great deal of credence to the obligations of the profession (medicine), but I do not believe these obligations are as strong or compelling as he thinks. The doctor is bound by certain rules and codes of behavior (certainly the Hippocratic oath) but the doctor does not affirm that he will complete every procedure requested by the patient. Further, the development of new procedures which shock the conscience would be a serious threat to the profession, as each new development would require each physician to re-examine their oath.
Finally, in brief, Fish seems to place a great deal of weight in the inconvenience to the patient in finding a new physician, which seems to be slight for those of us who have gotten many referrels without incident.
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- Untramelled Liberty = Community?
- Friends can be statesmen, but can statesmen be friends?
- Yes, we are glad Tim Tebow is here
- Paying people to be healthy
- Fish on the First, Continued
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John,
Where do you think the line is drawn between a physicians obligation to act and their right to their own conscience? For example if a pediatrician believed that childhood immunizations were too risky would they be allowed to deny them to children whose parents requested them. I use this example because they are so commonly accepted as a reasonable medical procedure while also remaining somewhat controversial. In a similar way abortions, though controversial, seem to be a commonly accepted medical procedure within that medical field. The two examples seem related to me and are separated mostly by the scale of the controversy. Does the amount of public outcry matter? Or is a physician always allowed to deny treatment on moral grounds?