A Matter of Conscience: Religious Exemptions and the Healthcare Debate
Michael F. Greene, M.D., Massachusetts General Hospital, Harvard Medical School
Rev. J. Bryan Hehir, Harvard University and聽the Catholic Archdiocese of md传媒国产剧
Melissa Rogers, Wake Forest University
Date:聽April 13, 2010
Abstract
The vigorous religious opposition to recent healthcare reform efforts has highlighted the divisive nature of birth control, abortion and end-of-life care in American public life.聽 How should healthcare providers, from individual pharmacists and physicians to large medical institutions, balance respect for personal conscience with professional responsibility?聽 Join our distinguished panel of medical, legal and religious leaders for a robust conversation on the ethics of conscience in the healthcare debate.
Speaker Bio
Dr. Michael F. Greene聽is a Professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School and the Chief of Obstetrics at Massachusetts General Hospital.聽 His residency and fellowship training were completed at the md传媒国产剧 Hospital for Women and Brigham and Women鈥檚 Hospital respectively. Dr. Greene鈥檚 major academic interests are in medical complications of pregnancy and congenital malformations.聽 He has chaired the Committee on Obstetrical Practice for the American College of Obstetricians and Gynecologists and was an Associate Editor of the 4th edition of 鈥淕uidelines for Perinatal Care鈥.聽 He served for four years (two as Chair) on the Advisory Committee for Reproductive and Urological Drugs of the Center for Drug Evaluation and Research of the Food and Drug Administration, and continues to serve as a consultant to the FDA.聽 In those capacities, he advised the FDA regarding the conditions for final approval of Mifepristone (RU-486), and recommended changing the status of the prescription emergency contraceptive 鈥淧lan B鈥 to over-the-counter.聽 He is currently a member of the Scientific Advisory Committee of the National Children鈥檚 Study being conducted by the Eunice Kennedy Schriver National Institute of Child Health and Human Development. He is a Co-Chair of the March of Dimes Scientific Advisory Committee for preterm birth.聽 He has served as an Associate Editor of the New England Journal of Medicine since 1996.
Rev. J. Bryan Hehir聽is the Parker Gilbert Montgomery Professor of the Practice of Religion and Public Life at the Kennedy School of Government at Harvard University. He is also the Secretary for Social Services in the Archdiocese of md传媒国产剧. Prior to assuming these positions, Father Hehir served as President and C.E.O. of Catholic Charities USA from 2001-2003. Before that he served on the staff of the U.S. Catholic Conference of Bishops in Washington, D.C. and served on the faculty at Georgetown University. He also served as faculty and later Dean of Harvard Divinity School. He was named a MacArthur Fellow in 1984. His research and writing focus on issues of ethics and foreign policy, Catholic social ethics and the role of religion in world politics and in American society. Hehir鈥檚 publications include: 鈥淭he Moral Measurement of War: A Tradition of Continuity and Change鈥; 鈥淢ilitary Intervention and National Sovereignty鈥; 鈥淐atholicism and Democracy鈥; 鈥淪ocial Values and Public Policy: A Contribution from a Religious Tradition鈥; and 鈥淭he Moral Dimension in the Use of Force."
Melissa Rogers聽is the director of the Center for Religion and Public Affairs at the Wake Forest University School of Divinity. She is also a senior fellow within the Governance Program at the Brookings Institution. She received her law degree from the University of Pennsylvania. Before working at Wake Forest, she served as the executive director of the Pew Forum on Religion and Public Life in Washington, D.C. Prior to that, she served as general counsel for the Baptist Joint Committee on Religious Liberty, where she helped the organization urge greater legal protection for free exercise rights. In 2009, President Barack Obama named her to his Advisory Council on Faith-based and Neighborhood Partnerships.聽She is the co-author of a聽case book on religion and law entitled聽Religious Freedom and the Supreme Court聽(Baylor University Press, 2008).
Event Photos
Event Recap
On April 13 the Boisi Center hosted a panel discussion on the rights and duties of conscience among healthcare providers and patients. In particular, the panel explored the implications of allowing exceptions, grounded in religious objections, to laws and regulations that would otherwise apply to everyone. The issue has been growing in importance in the medical community, even as the recent healthcare overhaul in Washington has put religious objections in the forefront of the news.Leading the discussion in front of a packed lecture hall were Rev. J. Bryan Hehir, Dr. Michael Greene, and Melissa Rogers, experts on this question in the religious, medical and legal communities.
Leading off the panel was Rev. Hehir, a professor at Harvard University鈥檚 Kennedy School of Government and Secretary for Health Care and Social Services in the Catholic Archdiocese of md传媒国产剧. Conscience clauses, Hehir said, are a standard of civil law meant to help the individual citizen negotiate in his or her social context. On the one hand, conscience clauses are expected in a pluralistic society where different individuals have different moral obligations; on the the other hand, devising coherent and effective public policies that exempt certain people is challenging. Regarding the current healthcare debate, Hehir pointed to the need to protect the autonomy of individuals in the medical profession, and the profession as a whole. The law, he noted, must grant individuals a space to develop their consciences鈥攈ence the need for exemptions. If these exemptions are eroded, the law will risk driving a wedge between individuals and society.
Dr. Greene, professor of reproductive biology at Harvard Medical School and Chief of Obstetrics at Massachusetts General Hospital, spoke from his experience as a physician, identifying the goal of medicine and healthcare as the prevention of disease and care for the dying. Based on this goal, he articulated several key ethical and moral principles: respect for a patient鈥檚 autonomy; the right of patients to refuse care; and a commitment to beneficence, non-malfeasance and justice. These principles, Greene noted, are implemented through mechanisms such as informed consent and the physician licensing. While doctors should not willingly put themselves in a situation of moral uncertainty, he said, sometimes conflict is unavoidable. To illustrate his point, he recalled a recent case of a Jehovah鈥檚 Witness patient who requested a cesarean section without blood transfusion. Despite his reservations, Greene successfully performed the surgery according to her wishes. Sometimes, he said, unforeseen circumstances may arise and a physician might have to adjust to the patient鈥檚 desires.
The final speaker was Melissa Rogers, director of the Center for Religion & Public Affairs at Wake Forest University, and advisor to the White House Office of Faith-based and Neighborhood Partnerships. A lawyer and long-time advocate for religious freedom, Rogers noted that the conflict between personal and civic obligations has always been addressed in American law. While the First Amendment鈥檚 Free Exercise clause protects individuals鈥 rights to religious practice, the Establishment clause guards against the government鈥檚 promotion of one faith over others. Recent laws and judicial decisions have specifically linked conscience exemptions and the issue of healthcare. The recent healthcare mandate, for example, is subject to exemptions on the basis of membership in a religious group. Looking forward to the implementation of new healthcare legislation, Rogers called for acceptance of 鈥渃ommon ground principles鈥 for religious exemptions, including the need for greater disclosure among providers about what services they make available (and do not); the importance of distinguishing between a lack of access to care and mere inconvenience to patients (when, say, a pharmacist refuses to provide the 鈥渕orning after pill鈥), and the need to ensure that healthcare does not become a means of coercion or proselytization.
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Further Reading
鈥Religious Expression in American Public Life: A Joint Statement of Current Law.鈥澛A statement produced by the Center for Religion and Public Affairs at the Wake Forest University School of Divinity, 2010.
鈥Physicians and the First Amendment鈥 in the New England Journal of Medicine, 2008.聽An editorial on the South Dakota informed consent to abortion law, and it鈥檚 relationship to the freedom of speech as guaranteed in the First Amendment.
鈥Religious Freedom in the United States鈥 by Melissa Rogers in the International Journal, 2004.聽An overview of legal principles and the main Constitutional clauses governing church-state-relations in the United States.
External Links
"" by Ruth Braunstein聽
The Immanent Frame, 2010.聽Post overviews critiques of the first year at the White House Office of Faith-based and Neighborhood Partnerships.聽
""
signed by President Obama on March 24, 2010.聽The text of executive order signed by President Obama after the passing of the health care reform bill in March 2010.聽 The order guarantees restrictions on the use of federal funding for abortions.
""聽published by The Henry J. Kaiser Family Foundation.聽A number of online resources helpful in understanding the recent healthcare debate and the implementation of healthcare reform.