On the Legislation of Conscience

Among the several bills pending Alabama legislative action this spring, I am sorry to say our state has decided to extend its long arm into the realm of conscience.  There are two bills pending, SB 105 and HB 375, titled Health Care Rights of Conscience.  If you live here, you need to know about them in detail—please read for yourself. 

Conscience is no small matter—without conscience, we become sociopaths.  We’ve learned the hard way in history how blind allegiance to any authority can lead to tragedy.  The exercise of individual conscience through civil disobedience is a vital protection in democracy against a majority gone wrong.  Without bravery like that of Rosa Parks, evil laws can be hard to change by ordinary channels. 

The problem is that consciences differ between persons, sometimes wildly.  If that were not the case, we would have no need of law at all, nor police nor courts.  These are all required to protect us, by mutual consent, from the failure of individual conscience.  If Rosa Parks had done something different—if she had used her personal conscience to rob someone of money she thought they didn’t deserve to have—she would have been rightly arrested and would not have inspired social change.  That is why people who choose to perform civil disobedience must expect arrest—their acts are not meant to ignore the law but to expose it for examination.

 SB 105 and HB 375 seek to override critical citizen protections by allowing individual conscience to run amok, without the restraint of social or professional ethics.

These bills say the State must protect the right of conscience for individuals who provide health care services related to abortion, human cloning, human embryonic stem cell research and sterilization.  They say nothing whatsoever about the State’s obligation to protect patients from medical care below the established standard in our profession or to allow employers the ordinary freedom to hire people who can and will do the work required by a specific job description.

It is odd that basic science research has been mixed with regular patient services in the same bill. I can’t tell you the last time my boss ordered me to go down the hall and clone a human or do something with a stem cell, between treating children for asthma and ear infections.  If he did, I’d have no clue how to proceed.  People don’t accidentally go into training to clone humans or stem cells.  But if these bills pass, a researcher who studies human cloning will have to consider hiring a lab assistant who refuses to do the assigned work on equal footing with one who will do it. 

Under these bills, a healthcare provider is allowed to omit all types of counseling and advice for these particular services.  For cloning and stem cell research, this would imply the researchers no longer have to get consent using the IRB (Institutional Review Board) protocols meant to protect us from unethical research, as long as they say doing so would violate their conscience.  They would be free to collect our cells for these purposes without even asking us.  Bet the bill drafters didn’t realize this!

A doctor could sterilize a man or woman without getting informed consent, because the wording allows any part of a service related to sterilization to be omitted.  That’s as long as it is not because the doctor thinks the patient is less valuable due to being elderly, disabled or terminally ill.  The language leaves it open for docs to practice eugenics by sterilizing a smoker, an obese person or a conservative without consent.

A doctor could perform an abortion on a woman without getting informed consent.  That’s right—bills that were designed to limit access to abortion would allow them to be performed without counseling.  On the bright side, at least the doctor could omit the medically unneeded ultrasound and state-mandated but incorrect written information (except in abortion clinics, to which these bills don’t apply).

A doctor could refuse to tell a man with prostate cancer that removing the testicles is part of treatment in some cases, or a woman with ovarian cancer that she can have her ovaries removed.   A doctor can omit any part of a medical procedure related to abortion or sterilization, as long as it is not an immediately life-threatening situation.  This could include doing procedures like vasectomies or hysterectomies without anesthesia or pain control.  Screaming would be ok, just not dying.  Yes, it is hard to imagine that any doctor would have such a bizarre conscience—it is hard to imagine that a doctor would sexually abuse a patient too, but it happens.  With this law, we’d have no way of removing such a person from medical practice and an employer would have no way to fire him or her.

We could learn from the words of E.H. Chapin, a 19th century Christian preacher:  Let every man be free to act from his own conscience; but let him remember that other people have consciences too; and let not his liberty be so expansive that in its indulgence it jars and crashes against the liberty of others.

By licensing health care providers, the State is assuring its citizens that the license holder meets a certain professional standard of care and ethics.  To this end, Alabama has established various oversight agencies such as the Alabama Board of Medical Examiners and the Board of Nursing, boards with a long history of competent duty.  SB 105 and HB 375 would prevent them from intervening to stop malpractice related to abortion or sterilization if the perpetrator can justify such malpractice on grounds of conscience. 

When a medical provider’s personal ethics conflict with the ethics of his or her profession, the public and the profession itself have a right to be protected from harm.  Please contact your legislator and ask for a “no” vote.




Filed under Alabama legislative session 2012, Politics, women's healthcare

2 responses to “On the Legislation of Conscience

  1. lj

    Well said. Thank you. I hope it reaches the audience that needs most to hear it.

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