Conscientious Objection and Physician–Employees
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This article attempts to motivate a reorientation of ethical analysis of conscientious objection (CO) by physicians. First, it presents an illustrative case from a hospital emergency department for context. Then, it criticizes the standard pro- and anti-CO arguments. It proposes that the fault in standard approaches is to focus on the ethics of the physician’s behavior, and a better way forward on this issue is to ask how the party against whom the physician exercises the CO ought to respond. It connects this question with recent trends in physician employment models, which suggest that CO may become a potential source of conflict in the future. The article then develops a relational account of CO that extends James Childress’ insights about the nature of CO in “Appeals to Conscience” (1979). This relational account characterizes CO as a two-place relation between conscientious objector and expectant party, in which the conscientious objector makes a request of the expectant party, which has implications that will be welcome and unwelcome for both the pro- and anti-CO camps. Finally, the paper applies this relational account of CO to the case when the physician is an employee. This application demonstrates that it is highly context dependent whether or not an employer should accede to the CO requests of physician–employees.
KeywordsConscience Conscientious objection Physician Employee
- American Medical Association, Council of Ethical and Judicial Affairs. (2016). Code of medical ethics opinion 1.1.7: Physician exercise of conscience. AMA. Retrieved Jan 26, 2019, from https://www.ama-assn.org/delivering-care/ethics/physician-exercise-conscience.
- Associated Press. (2019). Trump administration agrees to delay health care rule. June 30. Retrieved July 9, 2019, from https://apnews.com/02344177f49b41b7aecf63c8ed1e8227.
- Bentham, J. (2002). In P. Schofield, C. Pease-Watkin, & C. Blamires (Eds.), Rights, representation, and reform nonsense upon stilts and other writings on the French revolution. New York: Oxford University Press.Google Scholar
- Cohen, J. K. (2019). HHS finalizes faith-based protections for healthcare workers. May 2. Modern Healthcare, Crain Communications. Retrieved July 9, 2019, from https://www.modernhealthcare.com/government/hhs-finalizes-faith-based-protections-healthcare-workers.
- Department of Health and Human Services. (2019). HHS announces final conscience rule protecting health care entities and individuals. May 2. Retrieved July 9, 2019, from https://www.hhs.gov/about/news/2019/05/02/hhs-announces-final-conscience-rule-protecting-health-care-entities-and-individuals.html.
- Emergency Medical Network. (2018). National emergency department inventory—USA. March 3. Retrieved Jan 26, 2019, from http://www.emnetusa.org/nedi/nedi_usa.htm.
- Flynn, C., & Wilson, R. F. (2013). Institutional conscience and access to services: Can we have both? Virtual Mentor,15(3), 226–235.Google Scholar
- Haefner, M. (2018). Hospitals employed 42% of physicians in 2016: 5 study findings. Becker’s Hospital Review. March 15. Retrieved Nov 30, 2018, from https://www.beckershospitalreview.com/hospital-physician-relationships/hospitals-employed-42-of-physicians-in-2016-5-study-findings.html.
- King, M. L., Jr. (1963). Letter from Birmingham Jail. Liberation, June.Google Scholar
- Morgan, R. E, & Truman, J. L. (2018). Criminal victimization, 2017. Bureau of Justice Statistics. Bureau of Justice. December 21. Retrieved Jan 26, 2019, from http://www.bjs.gov/index.cfm?ty=pbdetail&iid=6466.
- Orr, R. D. (2013). Autonomy, conscience, and professional obligation. Virtual Mentor,15(3), 244–248.Google Scholar
- Pellegrino, E. D. (2002a). Professionalism, profession and the virtues of the good physician. Mount Sinai Journal of Medicine,69(6), 378–384.Google Scholar
- Pellegrino, E. D. (2002b). The physician’s conscience, conscience clauses, and religious belief: A Catholic perspective. Fordham Urban Law Journal,30(1), 221–244.Google Scholar
- Russell, R. R. (1952). Development of conscientious objector recognition in the United States. George Washington Law Review,20, 409–448.Google Scholar
- Simmons-Duffin, Selena. 2019. What’s behind a rise in conscience complaints for health care workers? May 9. National Public Radio. Retrieved July 9, 2019, from https://www.npr.org/sections/health-shots/2019/05/09/721532255/whats-behind-a-rise-in-conscience-complaints-for-health-care-workers.
- Singleton, T., & Miller, P. (2015). The physician employment trend: What you need to know. Family Practice Management,22(4), 11–15.Google Scholar
- Stephens, S. (2018). The rise of hospitalists—And what comes next. April 5. Retrieved Nov 30, 2018, from https://www.healthecareers.com/article/healthcare-news/the-rise-of-hospitalists.
- Uttley, L., & Khaikan, C. (2016). Growth of Catholic hospitals and health systems: 2016 update of the miscarriage of medicine report. New York: The MergerWatch Project.Google Scholar
- Zubik, D. A. et al. v. Sylvia Burwell, Secretary of Health and Human Services, et al. (2016). 578 (The Supreme Court, May 16).Google Scholar