The last several years have seen a dramatic attack on respect for individual conscience when one’s conscience is based upon theistic principles. The attacks upon Catholic health care organizations and health care providers have become more frequent and persistent. This trend should be of grave concern to all who desire to maintain a democratic society and particularly for people of faith. We should take heed of the warning sounds and spread the message, reminding all of the importance of conscience rights.
Death of Conscience in the Public Sphere?
It should not come as a revelation to anyone that our society is not friendly to Catholic values. Yet, the level of animosity has grown so great that we stand on the precipitous of the loss of any conception of conscience and one’s ability to act as one wishes – at least when one’s desires are theistically-based.
One need not look far for evidence of this erosion. In Canada, some involved in the crafting of national guidelines on physician-assisted suicide have opined that physicians have no right to object to prescribe lethal medications to their patients under the law based upon their religious beliefs. In the United States, the Supreme Court recently heard oral arguments in Little Sisters of the Poor Home for the Aged, Denver Colorado, et al. v. Burwell, et al., a case which has, at its core, the question of how far one’s refusal to cooperate in perceived moral evil may extend.
These examples, unfortunately, point to a strange turn in our society’s seemingly free-for-all attitude where anything goes. Take for example Facebook’s gender listing. In 2014, Facebook listed 58 options for gender in the United States (including gender fluid, gender nonconforming, bigender, pangender, trans* person, and two-spirit). These options, however, were deemed too restrictive, forcing people to pigeon-hole themselves. As a result, a year later, Facebook allowed “custom” genders, a literal fill-in-the-blank to describe one’s gender. In this same environment where people are free to declare their gender and act in accord with their perceived gender identity, choosing to act on theistic principles is shunned.
The Attack on Conscience in Medicine
While there is admittedly an attack on conscience throughout society, it is most acutely felt in the health care industry. Scholarly opinion is leaving less and less room for conscientious objection where a physician chooses, for example, to have a contraceptive-free practice or refuse to euthanize a patient.
Take for example an article by Julian Savulescu, director of the Oxford Uehiro Center for Practical Ethics, published in the British Medical Journal in 2006. Savulescu writes “A doctors’ [sic] conscience has little place in the delivery of modern medical care…if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.”
In a similar vein, Peter West-Oram and Alena Buyx argued in a 2015 article that health care providers have a duty to provide medical services (specifically contraception and abortion). They argue that allowing health care providers to refuse to provide certain services based upon their conscience is an improper attempt to expand their private sphere of conscience into the public arena, resulting in certain health care providers being required to make up for the shortfall of other providers.
Sadly, these opinions are shared by influential voices. For example, Dr. Udo Schuklenk is co-editor of Bioethics, one of the leading journals in the field and one of the authors of the white paper which eventually led to legalization of euthanasia in Canada.
In a March 2016 article, Dr. Schuklenk and Ricardo Smalling, professors at Queen’s University in Kingston, Ontario, which states “…it remains unclear why untestable conscience claims from privileged professionals who voluntarily chose to join a particular profession, and who have been endowed by society with a monopoly on the provision of particular procedures, should be accommodated, given that this toleration subverts the very objectives the profession is designed to achieve.” They go on to argue that respecting private consciences of medical professionals will result in sub-optimal access to healthcare as, in many cases, the objecting professional is the only reasonably accessible provider for the patient.
These are just a tiny sampling of the opposition to conscience clauses in the area of medical practice and signals a shift in attitude against allowing medical professionals the freedom to act based on their religious beliefs.
The Practical Concern
At a very basic level, concern should be raised on behalf of our Catholic brothers and sisters in the health care profession. The Catholic Church has had a long history of providing health care, particularly to those least able to afford such care. Numerous religious orders have formed based on that very particular apostolate. The very roots of America’s health care system is in Catholic health care. Many health care providers are Catholic and wish to be able to practice their profession in accord with their faith.
Imagine the state of health care without Catholic health care providers because they choose not to go into this “voluntary” profession. The very fear envisioned by Schuklenk and Smalling of sub-optimal access to health care would become a reality if Catholics were forced out of the medical profession.
This fear is happening already. For example, Canadian general practitioner Dr. Nancy Naylor has publicly declared that she is leaving the profession after legalization of euthanasia in the country, potentially without an option for conscientious objection. Dr. Naylor had practiced family medicine and palliative care for 40 years. Writing in the Canadian Family Physician, Dr. Naylor stated: “I have no wish to stop [practicing medicine]. But I will not be told that I must go against my moral conscience to provide standard of care.”
The loss of Catholic health care providers not only impacts the availability and accessibility of medical care generally, it would have a disproportionate impact on Catholics seeking a health care provider who will respect their treatment preferences. Right now, there are many places in America where it is impossible to find an OB/GYN who is willing to support a patient’s decision to practice natural family planning or a young female’s decision not to utilize contraceptives. The problem would be exacerbated if an OB/GYN could not state up-front that he or she will not prescribe contraceptives, and, instead, would be required to prescribe contraceptives if the patient asked for them.
While a health care provider should respect a patient’s reasonable decision regarding his or her medical treatment, including the decision of a patient to seek treatment elsewhere, mandating the health care provider participate in actions contrary to the provider’s conscience will have the same negative consequences for health care access as eliminating conscience protection.
A Grave Concern for All
Beyond the practical effects of the overriding of personal conscience on health care access, there is an even greater threat to our freedom of religion. America was founded upon the desire for religious liberty. Interference by the government in people’s practice of the faith requires meeting an extremely compelling interest. Allowing people to lead lives in accord with their religious and moral duties, while respecting the rights of others to do the same, has been fundamental to American society.
The attack on conscientious objection is an attack on religious liberty because it limits the arenas in which people are allowed to live a life integrated with their moral beliefs. The law becomes the moral arbitrator; “it’s legal so therefore it must be okay” becomes the mantra. As the late Francis Cardinal George stated in 2009, “Respect for our personal conscience and freedom of religion as such ensures our basic freedom from government oppression. No government should come between an individual person and God – that’s what America is supposed to be about.” We should all take heed, not just for the freedom to live an authentic Catholic life, but also for preservation of all of our freedoms.
Even above the necessity of respecting individuals’ consciences for maintaining a free society, it is a fundamental right of all human persons. Humans are the only creatures capable of reasoning and free will. As is stated in the Catechism of the Catholic Church, number 1704, “by free will, [the human person] is capable of directing himself toward his true good.” We are obligated to follow our conscience in seeking to do good and avoiding evil. (CCC 1713)
By preventing one from following one’s conscience and exercising one’s free will, the fundamental nature of the human person is impeded. It is absolutely contrary to promoting the good of all people to permit government to encourage and promulgate such laws.
Take Action to Protect Conscience Rights
An awakening is needed now. We, particularly as Catholics, need to renew our enthusiasm for our conscience rights. This right is essential to being able to live a truly integrated Catholic life, for the preservation of our democratic society, and for the recognition of who we are fundamentally as human beings.
We need to not be afraid to speak openly about the threat to our freedom to act in accord with our consciences. We have a duty to proclaim the truth on this matter. Talk to family and friends. Contact your elected representatives. Learn about pending legislation and court cases that touch upon this important right.
There is great power in people willing to act on their informed consciences. In fact, in his 1995 encyclical, Evangelium vitae, paragraph 95, Pope St. John Paul II called on “a general mobilization of consciences” as a means for building a culture of life. Let us preserve this powerful and essential right.