COMMENTARY

Can a Company Dictate Employees' Contraception Efforts?

Arthur L. Caplan, PhD

Disclosures

April 25, 2014

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Hi. I'm Art Caplan, from the NYU Langone Medical Center's Division of Medical Ethics.

Should a company have the right of conscience when it comes to medical matters? We certainly recognize the right of individual healthcare practitioners to exercise conscience when they are asked to do something that they are morally opposed to. If they don't want to do it, they select a substitute -- someone else who will.

Obviously, that policy has come up again and again when an individual doctor is asked to perform an abortion or when a doctor is asked to prescribe a medicine or contraceptive that they are morally opposed to. If you can find someone else to do it, I think the patient has the right to know that they have all options. However, an individual physician, nurse, or pharmacist doesn't have to carry out something that is against their values, as long as the immediate health of the patient is not jeopardized.

But what about companies? We all know that there has been a lot of litigation around the healthcare mandate in the Affordable Care Act, or Obamacare, about requiring the coverage of contraception. In a recent case, an arts and crafts company, Hobby Lobby, went all the way up to the Supreme Court arguing that the company should not be forced to cover contraception.

I happen to think that that position is wrong, because if you hire individuals off the street, their healthcare benefits should not depend on whether or not their employer has particular moral views. If you go to work for a church, if you go to work for a mosque, or if you go to work for an explicitly religious organization, then I think you have to be ready to go along with some of the restrictions or values that the organization holds. However, I would not say that that applies to a private employer.

So that battle has gone back and forth about the rights of a private company to exercise conscience if its leaders don't want to cover contraception, but I think what has been missing in this debate are the facts. The company is particularly concerned about contraception that is given after someone has sexual intercourse. A woman fearing that she might be pregnant may take some of the medicines available now: day-after contraception or emergency contraception. What the company has said in court again and again is that they don't want to be complicit in an abortion.

What the facts are, however, is that that type of contraception doesn't kill an embryo; it prevents a fertilized egg from implanting. That may sound like dancing around the head of a pin, but in science, nothing is an embryo until it has implanted into the uterus of the woman. It's simply a fertilized egg up until that point. Many of those leave the woman's body naturally, sadly. Maybe 50% of all fertilized eggs fail to implant, owing to problems -- genetic defects or biological issues that they have -- so we don't recognize embryo status until a pregnancy has begun, and we don't recognize a pregnancy until there has been implantation. That's the science.

The only way that Hobby Lobby could make its case against that form of contraception is to bring a theological point of view rather than a scientific point of view, but when it comes to public policy and making decisions about such things as medical coverage, I think science trumps theology.

I'm Art Caplan at the NYU Langone Division of Medical Ethics. Thank you for watching.

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