Conscience Laws Detrimental to Medicine: Ethicist
Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at NYU Grossman School of Medicine.
Of all things these days, conscience and the right to have conscientious objection has become a huge and divisive issue in medicine. As I'm sure many of you watching are aware, a number of states have passed conscience laws trying to grant rights to doctors to refuse to do things that they don't agree with morally.
That's because many federal laws, such as the EMTALA law, which requires treatment in emergency rooms, have said that you have to do things that will stabilize a patient, and that might involve in some instances, an abortion, let's say, because the woman's life is in danger.
Conscience laws that some states — red states — have put through basically say, no, you don't have to do that , a nd your conscience should take precedence both over that federal law and over what the patient might need. What's best is you do what is moral for you, and we're going back that decision up, particularly if it agrees with what we, as the state legislature in conservative red states, want to see happen.
There are also blue state efforts to say that my state has banned something by law, and I don't want to see somebody put in a conscience statute so that I can do things that the legislature has said they're not going to allow, such as transgender surgery.
Conscience has become a strange battleground because people are using it to try to evade laws thatthey deem either too restrictive when there are approved medical treatments but doctors don't want to do them, or at the other end are way too liberal, forcing somebody to do something by law that, as a matter of their values as a physician, they don't want to do.
How do we sort all this out and where does conscienceleave us, as a physician or as a nurse, when dealing with patients? My view is very simple. I don't believe that state legislature should be telling doctors what to do or not to do when existing, approved medical treatments are out there.
If physician associations and groups agree that there are instances in which abortion is indicated, if there are situations in whichphysician groups agree that it is appropriate to remove a feeding tube from a dying person, if physician groups have consensus and say that the data show day-after pills are safe and they can be administered in a doctor's office or even by telemedicine, then I think it should be doctors who decide what's going to happen with their patients.
I think we've seen way too much push, both from the left and the right, to intervene with doctor-patient relationships. You may recall Florida once had a law proposed that said you can't discuss gun safety with your patients. That seems ludicrous to me. The legislature shouldn't be interfering in a public health matter like that.
Idaho and some other states are considering laws that say they're going to ban the use of messenger RNA (mRNA vaccines). That means they don't like COVID vaccination, but mRNA vaccines are the future of cancer treatment.
To put it another way, I'd rather have a doctor deciding what's appropriate for their patient than a person who's a real estate agent, has worked in farming, or has been a lawyer deciding, as a state legislator, what they think appropriate and medically useful care is going to be.
Conscience is important. There is no doubt that we want to respect what doctors and nurses think is right and wrong, but what ought to come before conscience is the patient's best interest. If something controversial is still in the patient's best interest, that's what I think physicians, nurses, and medical associations all ought to be fighting for.
Let's try to keep the state legislator out of the waiting room. Let's try to minimize the impact of politics on the practice of medicine, as it's going too far under the banner of conscience. Let's restore the integrity and, if you will, the sanctity of the doctor-patient relationship.
I'm Art Caplan. I'm at NYU Grossman School of Medicine.Thanks for watching.
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