COMMENTARY

Should You Opt Out of Patient Care That Offends Your Morals?

Arthur L. Caplan, PhD

Disclosures

July 30, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I head the Division of Medical Ethics at NYU School of Medicine. President Trump's Department of Health and Human Services (HHS) issued regulations recently that permit physicians, nurses, pharmacists, and other healthcare workers to refuse to provide services to their patients if they have religious or personal reasons for a conscientious objection. I think this policy goes too far. Some counties and states are suing to try to overturn this policy.

Obviously, there are situations where a physician might say, "I have a deep moral objection to doing something." We don't demand that people be involved in providing abortions when they find it morally outside the realm of their personal beliefs. We don't demand that people get involved in the states that have legalized assisted suicide, in providing it when it violates their personal beliefs. I'm not saying that there aren't grounds to have conscientious objection.

On the other hand, if somebody shows up at a pharmacy with a legitimate prescription and the pharmacist says, "I'm against morning-after pills," that doesn't seem to be the same as asking them to provide a service that they find morally reprehensible.

A legitimate medical prescription, I think, has to be filled. Maybe you can pass that on to another pharmacist where you work or to someone down the road. However, you had better be prepared to minimally say, "I don't like to fill these prescriptions, but here's how you get it filled."

Every patient, even when it comes to physician-assisted suicide or abortion, has the right to know their options. It's basic informed consent. Unlike the HHS ruling on conscientious objection, I think you have to tell people, "I can't do this, but here's how it gets done."

I'll add another restriction. If it's an emergency—say, a woman is dying because the fetus is caught in the birth canal and the only way to save her is to perform an abortion—I think you have to do it. [Clinicians are] not in situations where some procedures are purely elective. If life and death hangs in the balance, patient welfare and patient interest dominate.

I've started to hear stories about medical students saying, "I don't want to train on this. I don't want to study this. I have a moral objection. I believe in natural foods, and I don't want to study vaccines."

If you open the door to any and all conscientious objection on the part of healthcare workers to not do what we would normally expect doctors, nurses, pharmacists, and others to do, I think you are starting to put doctors' interest ahead of patients'. That's wrong. It's not what the Hippocratic Oath says. It's not what various codes of ethics of the medical and nursing professions say. They say, "Patients first."

Only as a last resort should we allow doctors to say, "I'm not going to do X," if there are others who will, so that patients can still receive the services they need.

Conscientious objection is important. We want our physicians to have values, to think hard about what they're doing, to understand that sometimes they may not want to go along with a particular practice.

An open-ended invitation to let anybody block anything they don't like or anything they don't want to do at any time, I think, is going to lead to far more problems than it is protection of physician and healthcare worker rights.

I'm Art Caplan at the Division of Medical Ethics, NYU School of Medicine. Thanks for watching.

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