Conscience & Religious Freedom

Objection

in Healthcare

By: Cara Shiller

PHIL-2306 Introduction to Ethics

Tarrant County College Northeast Campus

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• Introduce the Leadsuature that was set forth to be applied.
• Detail what has happened since it was originally set forth until present.
• Explain what the Conscientious rule encompasses.
• Expound on the arguments from U.S. Government oversight.
• Outline the basic elements within Medical Ethics and Principles, Principles of Health Care Ethics, Principles of Patient Centered Care.
• Define Bioethics and its Principles.
• Summarize the basis of Medical Ethics and Bioethics origins.

Objectives:

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• The Protecting Statutory Conscience Rights in Health Care (Conscience Rule) put forth by President Trump and the U. S. Department of Health and Human Services (HHS) to protect “conscience rights” in healthcare.

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• In January, 2018 the Conscience and Religious Freedom Division (CRFD) within the HHS was created, shortly thereafter, the Conscience Rule was published on May 21, 2019 with a Original Commencement of July 22, 2019.

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parentalrights.org

(“CNN 6 Nov. 2019.”) (“Democratic 1 Aug. 2019.”)

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• Due to significant contention over the rule, the effective date was delayed until November 22, 2019.

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• On November 6, 2019 The Conscience Rule was vacated by Judge George B. Daniels of the U.S. District Court for the Southern District of Manhattan, New York.

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• Sited were violations of the Constitution and the Administrative Procedure Act, which regulates and governs government agency procedures. Trump’s administration attempted to circumvent close to 30 federal statutory provisions without applying to proper channels set by the U.S. Government.

(“CNN 6 Nov. 2019.”) (“Democratic 1 Aug. 2019.”)

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tneagleforum.org

What Would the Rule Allow:

• Broaden the term healthcare workers beyond doctors, nurses, emergency personnel, and hospice workers who already have similar rights, to include indirect involvement, receptionist, hospitals, pharmacies, teachers, students, faith-based charities

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• Cite their religious beliefs or moral grounds as justification to treat or not treat indiscriminately.

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• Ability to refuse to perform, accommodate, referring for, assisting, paying for, provide coverage of, or provide certain services workers the capability to refuse to provide basic health care coverage.

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• Waives requirements under Medicare and Medicaid for religious, nonmedical, health care providers and their patients from having to concede to the standards of medical treatment that intercedes with their religious practices.

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• Extends the current rule from three consciences statues, issued in 2011, to 25 provisions.

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• Enables the U. S. Department of Health and Human Services to enforce these changes to policy.

(“Conscience 22 Mar. 2019.”) (“Protecting 21 May 2019.”) (“Democratic 1 Aug. 2019.”)

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• Abortion

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• Providing/Receiving Training in Abortion

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• Treat of Women Who Have Had Past Abortions

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• Sterilization Male/Female

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• Birth Control in all Forms

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• Assisted Suicide

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• Performance of Advanced Directives

Objectionable care includes, but is not limited to:

thefangirlinitiative.com

(“Conscience 22 Mar. 2019.”) (“Protecting 21 May 2019.”) (“Democratic 1 Aug. 2019.”)

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• Vaccination

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• Referrals for Services

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• Hearing Screening/ Device Implants

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• Occupational Illness Testing

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• Mental Health Treatment/Counseling

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• Mental Health Treatment/Screenings of Children

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• Lawful/Medically Necessary Treatment, Services, Information, Critical or Life Saving Care to Patients

askideas.com

We Have A Lot of Ground to Cover...

(“Conscience 22 Mar. 2019.”) (“Protecting 21 May 2019.”) (“Democratic 1 Aug. 2019.”)

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• Care to LBGQTIA+ Individuals, Families, and Children

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• Preventative Care for AIDS/HIV

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• Hormone Therapy Treatment for Any Reason

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• Transition-Related Care

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• In Vitro Fertilization (IVF) for Single Women

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• In a Lesbian Relationship

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• Persons in Interfaith/Race Relationships

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• Global Health Programs

etsy.com

Stay with me...

(“Conscience 22 Mar. 2019.”) (“Protecting 21 May 2019.”) (“Democratic 1 Aug. 2019.”)

• Solicitation of complaints, coordination or communication with external entities for proper issuing of the rule.

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• Communications between HHS personnel, which includes 11 operating divisions of Public Health and Human Services, any non-governmental organization, entity, or individuals with regards to submission or inquiry of complaints to the Office of Civil Rights.

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• Conduct or consult any internal and/or external analyses of the potential impact of the refusal of care rule on patient access to health care services.

ifrl-blog.blogspot.com

U.S. Government Oversight

(“Democratic 1 Aug. 2019.”)

Protections for U.S. Citizens

• Discrimination of patients in health care settings

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• Discrimination against patients that face multiple forms of discrimination

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• Effort to ensure patients in rural areas or with limited access to health care providers,are able to access medical services

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• What impact will the rule will have on patients who are already facing disproportionate discrimination.

• i.e., women, LBGTQIA+, people of color, people living in rural areas, and other historically underserved groups

(“Democratic 1 Aug. 2019.”)

pymnts.com

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Who is really in charge?

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• Medicine has become more bureaucratic and legalistic.

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• Insurance companies now decide what is medically necessary and can deny coverage.

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• Private entities pinch every penny they can from patients.

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• Regulations that are suppose to protect patients do more harm than good.

hoover.org

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Maybe?

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Does the Conscience Rule Violate a Doctor’s Duty?

journalofethics.ama-assn.org

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American Medical Association

(AMA)

Limits on conscientious objection

religiously-based objections to providing medical care

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AMA@Twitter

AMA@Twitter

(“Kuře 23 Oct. 2018.”) (“Groenhout 21 Jan. 2018.”)

AMA@Twitter

American Medical Association

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The AMA wrote to Secretary Alex Azar with the Health and Human Services on March 27, 2018 stating opposition to the proposed rule.

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The AMA stated the rule would be a“shield for people asserting objections on religious or moral grounds and could permit them to withhold care from already vulnerable groups and create confusion in health care institutions”. Thus, “underimindingf patients access to information and care.”

(“HHS 6 Apr. 2018”)

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• Emergency treatment cannot be refused on the basis of conscience. During an emergency,The Emergency Medical Treatment and Labor Act (EMTALA) requires clinicians to triage and stabilize a patient of any life-threatening injuries or illnesses.

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• If they person is the only available professional, either rural or present, they must provide treatment within expectations of their job.

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• The professional cannot make it impossible for the client to access the requested treatment,therefore, they may be required to dispense care despite of religious or moral beliefs.

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• The healthcare profession is set foundationally in a commitment to patient health first and formost.

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• Professionals unwilling to accept these conditions do have a choice to leave the profession or work in an area of medicine that does not conflict with their beliefs.

What the AMA’s Stance is to Emergency Care:

(“June 3 June 2019.”) (“Savulescu 4 Feb. 2006.”) (“Kuře 23 Oct. 2018.”) (“Groenhout 21 Jan. 2018.”)

Response to Rule:

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” it does not reflect nor allow for our moral and legal duty as emergency physicians to treat everyone who comes through our doors. Both by law and by oath, emergency physicians care for all patients seeking emergency medical treatment. Denial of emergency care or delay in providing emergency services on the basis of race, religion, sexual orientation, gender identity, ethnic background, social status, type of illness, or ability to pay, is unethical”

American College of Emergency Physicians (ACEP)

(“Kivela.”)

isc.ac.uk

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Denying access to care to a patient on religious, ethical or moral grounds is in direct conflict with AAFP policy:

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“The proposed rule forces family physicians to omit important and accurate medical information necessary for our patients to make timely, fully informed decisions. This encroaches on physicians’ codes of ethics and responsibilities to our patients. When our government restricts the information that can be given to women, women will receive substandard medical care and their health will suffer.”

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American Academy of Family Physicians (AAFP)

alamy.com

(“Sykora 3 June 2019.”)

phgd.com

“those who ‘freely choose their field’ to evaluate their beliefs in relation to their specialties and whether they are able to provide all legal options for care. ‘As gatekeepers to medicine, physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. … Conscience is a burden that belongs to that individual professional; patients should not have to shoulder it.”

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(“aamc.”)

“Focused on the moral conduct and principles that govern members of the medical profession. Regardless of gender, religion or race, medical ethics ensures guaranteed quality and principled care for people”.

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ed2go.com

(“ Eight 4 June 2019.”)

slideshare.com

(”Dictionary 3 Oct. 2019.”)

• Specifically explains the moral principles related to human clinical medicine.

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• Field that focuses on the application of ethics, religion, and the social sciences to the analysis of health care issues.

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themedicportal.com

Medical ethic is a branch of bioethics since it mainly focuses on ethics of medicine.

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wordpress.com

• Explains the multidisciplinary moral principles of all biomedical science areas including biotechnology, medicine, history with medicine, healthcare and nursing, politics, law, philosophy etc.

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• A broader study which touches the philosophy of science and biotechnology as well.

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(”Dictionary 3 Oct. 2019.”)

Bioethical Considerations

of

Conscience Claims

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collegehippo.com

Consequentialism & Utilitarianism

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Views:

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• This ethical theory is concerned with the most good.

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• Under this ethical theory we have utilitarianism.

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Fallacy Argument:

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• Utilitarian line of reasoning that advises against certain social innovations by predicting that allowing them will have very bad results whose badness will go unnoticed in the future.

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• Consequentialist will find that the best way forward resides in the best outcome or consequences.

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• Attention is focused on the end product as opposed to what means is used to achieve this end.

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• One could consider the burden of treatment against the end result in order to reach a decision.

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(“Mandal 2016.”)

Deontology

• Concerned with our actions, with rules and principles.

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• "intention" matters.

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• Contrary to utilitarianism .

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Fallacy Argument:

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• Could sometimes yield wrong or unfair results. It focused on doing the right thing which might have other negative effects.

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• No room for diplomacy.

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• Applied In the practical clinical situation: Moral acts of the doctors are to be judged in terms of their conformity to rules, duties and/or obligations. They have the responsibility to apply the same rules to everyone without considering unique individual needs.

healthimpactnews.com

(“Mandal 2016.”)

Four cardinal (moral) virtues:

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• Prudence-right reason applied to action;key virtue in good ethical decision making.

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• Justice-giving each person (patient) their due.

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• Fortitude-moral courage in the face of death.

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• Temperance-leads the person away from things which seduce the appetite from obeying reason;free from self-interest.

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healthimpactnews.com

VIRTUE ETHICS

(“Mandal 2016.”)

Questions for thought:

“Ought Christians to see conscientious refusals of this sort as central to their faith and moral life?”

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“Many health care systems indicate their religious origins in their names (St Mary’s, Lutheran General) and were founded to provide care to all those in need as a reflection of their Christian mission. “

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“So it seems the refusal of treatment as essential to their personal conception of morality

One would expect that serious followers of Christ would demonstrate their Christian faith by assisting the sick and providing service to those with whom they disagree. and the like.”

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“With the assumption that one’s own moral purity depends on distancing oneself from with others one considers immoral, and if providing care or assistance for such individuals is seen as polluting, then the primary moral duty one has is that of remaining free from contamination. “

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“It is well within the bounds of standard Christian belief to recognize that while individual may need to refuse to participate in specific procedures as a matter of individual conscience (the right to refuse to participate in either abortion or physician assisted suicide) they also have a moral duty to provide necessary health care to all individuals, regardless of whether or not those individuals comply with one’s own moral beliefs.”

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(“Groenhout 21 Jan. 2018.”)