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6. Rights of Conscience in the Physician-Patient Relationship
- Johns Hopkins University Press
- Chapter
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6 RIGHTS OF CONSCIENCE IN THE PHYSICIAN-PATIENT RELATIONSHIP Professional life in a liberal constitutional society involves a balancing of values between professional and client. This is commonly accomplished through negotiation, but in some areas of life the values in question are so fundamental and important that negotiated compromise is difficult, if not impossible. This is especially true in health care, where the values at stake involve issues of life and death and the basic capacities and abilities that give meaning to people’s lives. Because health care touches on profound issues of life, death, and the quality of life, its practice can at times call for participation in activities that some health care professionals might find morally inappropriate. Requests for physician-assisted suicide, abortion, euthanasia , and the withdrawal or withholding of life support are just a few examples of controversial issues that leave little room for compromise. As recognition of the rights of patient self-determination becomes more pervasive and patient values assume a more prominent role in formulating health care treatment plans, it is inevitable that conflicts between the values of patients and those of health care providers will increase. Much attention has been paid to patients’ right to refuse treatment and to choose among various treatment options. It is also important to reflect on how to protect appropriately the health care provider’s values when these conflict with the patient’s. In protecting a patient’s right to choose a course of treatment, we must be careful not to hold the health care professional “hostage” to the patient ’s values by forcing the provision of services that would not otherwise be offered, simply because the patient holds certain beliefs or values. If we do not recognize this concern, we risk forcing a health care professional—only because she has undertaken a certain profession—to engage in activities that she finds morally reprehensible. Protection is also required for a professional’s value system in our understanding of her professional role. By “professional role,” I mean the conception of the activities in which the professional engages as a health care professional. Below, when I discuss allowing room for the professional to frame her role, I am concerned to let that professional’s values influence the range of her work activities. We must account for how obligations attached to a professional role can be consistent with individuals within that profession holding different fundamental values and beliefs. To motivate our examination of rights of conscience, let us consider the following case: A Jehovah’s Witness needs a surgical procedure or he will die. He is willing to undergo the procedure if he can be assured that blood products will not be used. In nine out of ten cases, the procedure does not require blood products, but the surgeon refuses to perform the procedure unless she has the option of using blood products. The surgeon acknowledges that although she could perform the procedure without blood products, she believes the additional risk to the patient imposed by removing the option of their use is great. A common approach in this scenario is to allow the professional to “transfer care” of a patient when she has moral problems concerning treatment choices. I find it acceptable, in principle, to have such a policy as an ideal, to be employed after settling questions about when a right of conscience may be exercised and to be used to outline procedures for when a right of conscience is exercised. Before addressing these procedural questions, we must turn to questions of the nature and scope of such rights and of the types of issues over which such rights may be exercised, matters that have been largely ignored in the literature on rights of conscience in health care It is not clear that a policy of transfer of care is always acceptable, for example , because it fails to consider adequately when a right of conscience may appropriately be exercised and the effect of the transfer of care on a The Physician-Patient Relationship 99 [44.200.49.193] Project MUSE (2024-03-29 10:47 GMT) patient’s access to care. Allowing “unlimited” transfer of care leaves open the possibility of discriminatory practices and a transfer that may be contrary to the patient’s best interests. Even though a transfer leaves the patient with access to care, it is not access to the same care he would have had were he to hold different values...