The development of patient autonomy within health care has created new challenges in the physician-patient relationship. When a patient demands a service that violates the conscience of a physician, it creates conflict within that relationship. This has become particularly problematic when a patient demands abortion or artificial contraception and the physician is morally bound to refuse. This paper argues that the integrity of the physician's conscience must be maintained in order to uphold the integrity of the patient's autonomy. If the physician is forced to violate his conscience, then the guarantee that a patient's desires and wishes will be respected will be lost because a great moral inequality will be created between the physician and the patient. To safeguard both the physician-patient relationship and the patient's autonomy, it is vital that the physician's conscience be protected.
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References
1.
“The relationship between patient and physician is based on trust and gives rise to physicians’ ethical obligations to place patients’ welfare above their own self-interest and above obligations to other groups, and to advocate for their patients’ welfare.” AMA Code of Medical Ethics, Opinion 10.015. Note the physician's obligation to the welfare of the patient, which should not be confused with the desires of the patient and must focus on the health of the patient.
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“The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.” AMA Code of Medical Ethics Opinion 10.015. The idea of medical practice being fundamentally a moral activity indicates the recognition that each physician and patient must make a value-based judgment in regards to health care. The process of doing this necessarily requires the use of the conscience.
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“Rules and Regulations: Part VI,”Federal Register73 (2008): 78072–78101, http://www.consciencelaws.org/conscience-laws-usa/Conscience-Laws-USA-07.html. Paragraph 88.1 states “The purpose of this part is to provide for the implementation and enforcement of the Church Amendments, 42 U.S.C. 300a–7, section 245, of the Public Health Service Act, 42 U.S.C. 238n, and the Weldon Amendment, Consolidated Appropriations Act, 2008, Public Law 110-161, Div. G, § 508(d), 121 Stat. 1844, 2209 (collectively referred to as the federal health-care conscience protection statutes). These statutory provisions protect the rights of health-care entities/entities, both individuals and institutions, to refuse to perform health-care services and research activities to which they may object for religious, moral, ethical, or other reasons. Consistent with this objective to protect the conscience rights of health-care entities/entities, the provisions in the Church Amendments, section 245 of the Public Health Service Act and the Weldon Amendment, and the implementing regulations contained in this part are to be interpreted and implemented broadly to effectuate their protective purposes.”
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Excerpts from Department of Health and Human Services, “Commentary on Regulation 45 CFR Part 88,” “Concern about access to care: The department is committed to its mission of expanding patient access to necessary health-care services. Americans can enjoy healthier, happier, and more productive lives through access to, and appropriate utilization of, all of the life-saving and life-improving procedures and services produced by medical innovation. The department has a long history of demonstrated success in facilitating the improvement of lives in this way. “Physician-patient relationship: A necessary element in ensuring the best possible care for patients is protecting the integrity of the doctor-patient relationship. Patients need full access to their health-care provider's best judgment as informed by practice, knowledge, and experience. This relationship requires open communication between both parties so patients can be confident that the care they seek and receive is endorsed by their health-care provider. It is one of the reasons for the common practice of patients meeting with several health-care providers in order to find the one in whom they are most confident about entrusting their care. This helps ensure patients receive the care they believe is appropriate, and that doctors provide care that they are comfortable providing.” “Rules and Regulations: Part VI,” http://www.consciencelaws.org/Examining-Conscience-Legal/Legal40a.html#II._Comments_on_the_Proposed_Rule.
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