So I’m reading “Generation Roe” (Seven Stories Press, 2013, and highly recommended thus far), and I’m on the chapter about conscience clauses, and I’m so inflamed that I had to take a time out and write about it because the whole thing just pisses me off so much. Like, I could be sitting on my nice sunny porch reading a book in my pajamas1, which is what I was doing five minutes ago, but instead I am here typing about how angry I am.
Anyway, let me get back on track here. Conscience clauses, for those who don’t know about them, allow health care providers to refuse to perform or be involved in certain procedures and treatments. Which really boils down to, of course, abortion and contraception.
These laws protect the right to refuse service, allowing pharmacists to withhold Plan B and contraceptives, while nurses, doctors, and other medical personnel can refuse to provide care to patients who want contraceptive (including sterilization) or abortion services. Entire medical facilities can, in fact, refuse to provide care, which is why Catholic hospitals are allowed to turn patients away when they need abortions, even in cases like those of patients who are actively miscarrying and need immediate medical treatment.
If there’s a heartbeat, the hospital can tell the patient she has to wait it out. Hang out on a gurney with your dying baby, lady, because we don’t do that kind of thing here.
You might guess, from my tone, that I am not a fan of conscience clauses. I am going to make a possibly radical statement here: I think conscience clauses in this context are ridiculous2, and I hate them, and I think they shouldn’t exist. But, more than that, I think that if you want to become a medical provider, you need to be prepared to perform all aspects of your job without judgment.
If you don’t want to do your fucking job like a grownup, do not become a doctor, or a nurse, or a pharmacist, or a radiology technician, or an anesthesiologist, or anything else. If the idea of working with women who need contraceptives, abortion care, or other reproductive health services is ethically repugnant to you, okay, that’s your choice. More power to you or whatever.
But you do not get to be a medical provider. You do not get to dare impose your beliefs on the patients you interact with, because that’s an ethical violation of its own, and it’s a shitty thing to do, and it’s wrong.
The right is fond of raising the specter of “forced abortions” and what have you, painting a picture of a world where people will be forced into abortion if access to safe, compassionate, legal abortion continues to be made available. That would be unethical, I think (hope) we can all agree; no one should be compelled to have an abortion, or take birth control, or be sterilized. By the same token, no one should be compelled not to do any of these things, which is what happens when medical providers invoke conscience clauses to walk away from their jobs.
You don’t just get to pick and choose which medical services you provide, beyond the choosing that goes into selecting a medical specialty. Like, if you don’t enjoy working with children, you might go into geriatrics, or another field where child patients are relatively unusual. Or if you’re really grossed out by surgery, you could choose, you know, psychiatry as a specialty.
Over the course of medical education, you get lets of opportunities to learn not just how to practice medicine, but what’s entailed in different kinds of medical practice. If you work as a pharmacist, OB/GYN, or medical-surgical nurse, there’s a chance you’ll be involved in abortion or contraceptive care. And you need to deal with that. If you don’t want to deal with it, pick another medical specialty, because you do not get to decide what kinds of health care patients can and cannot access by your own personal rubric.
If you don’t like abortion, don’t have one. And by all means, don’t participate in performing one, or caring for patients pre-and post treatment. If you’re opposed to birth control, sure, don’t provide it to people. But don’t go into a career where these tasks are expected as part of your job.
I’m aware that people go into the practice of medicine for a lot of different reasons, but many of those reasons are rooted in the idea that you want to help patients. That you believe it’s important to provide access to medical care for people who need it. What kind of monster do you have to be in order to decide that your personal value system is more important than that of your patients?
It’s not like providing abortion care or participating in it is a surprise that gets sprung on you after you finish medical school and residency -- “Hey, by the way, now that you’re a board certified OB/GYN, you’ll have to perform abortions!” And you can’t claim you don’t know that part of the job for people like Registered Nurses and pharmacists is reproductive health counseling and the dispensing of birth control.
So, like, you, personally, Medical Provider, have a choice very early in your training about the kind of care you want to provide. And like I say, if you don’t want to be involved in reproductive health care, that’s cool, but don’t select a specialty that will bring you into direct conflict with reproductive health issues. Be an orthopedic surgeon and set bones. Go into physical therapy and help people recover from severe injuries. Specialize in ophthalmology and treat people with vision problems and eye injuries.
There are so many fields in medicine, which is kind of amazing and terrifying and wonderful. So many options to choose from, and all of them are important and result in helping tons of people in a lot of different ways. So choose the one you’re comfortable with, the one that provides the kind of care you find morally acceptable, rather than deliberately choosing a career path that will inevitably lead to a situation where you’re asked to do something you don’t believe in doing.
Because this whole conscience clause thing is like taking a job as a repo man and then acting horrified when you’re told to go repossess a car.
1. Exhibit A:
2. However, conscience clauses do have a place in medicine when they involve care providers being forced to provide services they believe are unethical because they compromise a patient's autonomy and choice. Which is why hospitals have ethics boards, and why physicians should be permitted to refuse to perform procedures on patients with compromised decision-making capacities if they feel these procedures are not in the best interest of the patient. For example, a gynecological surgeon might refuse to sterilize a disabled patient if a parent or guardian demanded it on the grounds that the patient is the one to make that decision. Return