Question

Considering the requirements for ethical (and legal) conscientious objection, in what ways are rural providers (providers who are the only option for most patients) more constrained in expressing autonomy and objection? In your own words, what is the difference between personal and professional autonomy? Should providers be allowed to exercise professional conscientious objection for personal reasons? Why or why not?

Answer 1

Conscientious objection (CO) is the professional’s refusal in performing a professional/legal obligation or responsibility due to personal beliefs. In health care, CO involves healthcare providers not providing some treatments to their patients, based on reasons of moral integrity or conscience. A CO happens when a doctor, as a result of his/her personal beliefs or values refuses to provide a legal, legitimate treatment, which is medically appropriate under professional standards. A conscientious objector is a person who has made a claim about the right to refuse to execute his/her duties on the basis of conscience or religion.

Legally, conscience clauses explicitly allow healthcare professionals to refuse certain treatment modalities, mostly reproductive and end-of-life options, on a moral or religious basis. A doctor’s right to refuse certain treatment options in a nonemergency setting, when alternative treatment options are present, is reinforced by state and federal laws and the American Medical Association’s ‘Code of Medical Ethics.’ The laws require different levels of duties from healthcare professionals, which strive towards accommodating both the vulnerable patient and the conscientious objector. The right to CO is based on human rights to act according to an individual's religious and/or other conscience. This doesn’t mean that they can invoke their rights to violate another person’s rights. Thus it states explicitly that there are legal limitations for a professional to consider CO. In the case of rural healthcare, mostly the patients are left without any other choice when the provider refuses to provide treatment on the grounds of his religious or moral integrity. Thus in such cases, it becomes a necessity that the providers should be made legally bound to their duties instead of allowing treatment refusals on basis of CO.

Considering the ethical standpoint, a healthcare worker is also a human being and not a machine, a person who fulfills his professional expectations upholding ethical or religious values which are sometimes in conflict with their professional obligations. From this perspective, the conscience or moral integrity of a healthcare professional need to be considered, as long as timely care is provided to patients and they don’t have to go in search of another facility, which is quite impractical in a rural setting and they are not being embarrassed for what someone presumes to be an immoral choice. It implies that autonomy has limitations in a rural healthcare setting where a patient is often left without any other option.

Professional autonomy is the quality of being independent and self-directing in a profession, which enables professionals to exercise judgment in decision making and execute the duties. Professional autonomy deals with one’s profession, professional decision-making etc. Personal autonomy is the quality to decide and pursue a course of action in a person’s life regardless of moral values. According to personal autonomy, each and every person has their own choices and has the right to live according to these choices.

Providers should not be allowed to exercise professional conscientious objection for personal reasons. Conscience can be considered as a vice, which is invoked to avoid performing the expected duties. When the duty is real, conscientious objection is immoral. When there is a grave duty, it should be illegal considering the gravity of error or fatality. A provider’s CO doesn’t have space in the delivery of medical care. The care given to the patients is affirmed by law and their rights are well defined considering the just distribution of finite healthcare resources, which requires a reasonable conception of the patient's welfare. If providers are not prepared to provide efficient, legally-affirmed, and beneficial care to a patient only because it conflicts with their values, they should not be providers. Providers can’t offer partial healthcare services or discharge their obligations partially for patient care.