Religious-employee opt-out rights in health care

This topic, which I mentioned in passing last week, is back in the news with the announcement of an executive order by President Bush extending and entrenching the asserted right of hospital, clinic and pharmacy employees to defy their supervisors and disrupt the operation of their workplaces by announcing that they will not dispense prescriptions or participate in medical procedures that violate their religious beliefs.  At NRO’s “Corner”, we are instructed by Tyranny of Reason author Yuval Levin that it’s totally illegitimate to use quote-marks around the word “conscience”, as if to suggest that the employees in question could have spared themselves a crisis of conscience by not accepting jobs that might present them with such duties in the first place. Levin also seems to find it illegitimate for the New York Times’s story to mention the Roman Catholic hierarchy in tones that suggest that the issue has anything to do with churches’ influence on public policy. Speaking of which, a post by Radley Balko at Reason “Hit and Run” reminds me just how broad the Vatican’s opposition to assisted reproductive technology is: I mentioned in vitro fertilization for unmarried women last time, but of course the Church prohibits the use of in vitro techniques for married couples as well.

The rules are likely to cause trouble — maybe even are intended to cause trouble — for clinics offering in vitro and other assisted reproductive services. And yet the Bush people would be unlikely to succeed in mustering the votes for an outright ban on such services, no matter how much encouragement they got from the Corner or Levin’s Ethics and Public Policy Center.

P.S. Some further thoughts from Rick Garnett at Prawfsblawg on the question — which seems in some ways the cutting edge of contention — of whether backers of the measure should be conceded the positively-charged word conscience without the distancing or irony of quotation marks. In part this is a battle over who gets to use language with favorable connotations, but it is also influenced by the sense that there’s a time and place for everything, even crises of conscience, and that the time to announce one’s conscientious objections to warmaking, if one doesn’t want people to start using air quotes about them, is before one is shipped to the battlefield.

About Walter Olson

Fellow at a think tank in the Northeast specializing in law. Websites include overlawyered.com. Former columnist for Reason and Times Online (U.K.), contributor to National Review, etc.
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32 Responses to Religious-employee opt-out rights in health care

  1. kurt9 says:

    People are entitled to their own beliefs. I don’t see why people who believe in these kinds of limitations on reproductive issues cannot go into other areas of medicine that have nothing to do with reproduction or, alternatively, establish themselves as “christian” clinics. Obviously they do not want to serve a clientele seeking various reproductive and contraceptive services. So, why don’t they establish their own clinics that cater to a more “Christian” clientele?

  2. Grant Canyon says:

    kurt9,
    What use is it to have personal religious convictions if you aren’t permitted to force them on other people?

  3. Anthony says:

    “to defy their supervisors”

    Gasp! How terrible!

  4. A-Bax says:

    As far as I am concerned this issue is on the same level as the Muslim cabbies who refuse to transport passengers if they are carrying alcohol.

    The correct response to the Muslim-cabbies is: We respect your religious beliefs, however, this society is not bound by them. If you cannot transport passengers with alcohol, then, unfortunately, you don’t meet the requirements for the job of cab-driver (which include a willingness to so transport people).

    It’s the same response to Catholic pharmacists: Basically, if your religion prevents you from performing this job, then you have a choice to make.

  5. Pingback: GWB as regulator: new opt-out “conscience” rules for health workers

  6. Xyz says:

    Using the threat of reduced public funding to protect those who object to certain medical procedures on religious/moral grounds seriously undermines the separation of church and state, especially if the people trying to get those procedures aren’t in a position where they can get another provider.

    Any other articles I read on this say it’s entirely about abortion, but I can’t seem to find the actual text of the rule — just a figure that said it’s 127 pages long, which gives me reason to doubt we’ll ever know what’s actually in it.

  7. Andrew M says:

    I’m with A-Bax here. This was one reason, albeit a minor one, why I did not go into medicine. While I do agree with the moral objections, I also agree that if that precludes them doing their job and their employer decides that it’s not worth it to keep them on in the limited capacity, then they have no reason to keep them on staff.

  8. Sean O'Hara says:

    I wish I could defy my superiors with impunity. Damn my lack of religious belief.

  9. mieoux says:

    There are already jobs that indicate the applicant needs to meet certain requirements necessary for performing certain tasks in the job description in order to be eligible for employment, maybe this kind of thing can apply here too.

  10. Tim of Angle says:

    Well, I guess “clinics offering in vitro and other assisted reproductive services” will have to put a statement on their job applications to the effect that they offer these kinds of services and the employee acknowledges as a condition of employment that said employee will be obliged to provide them. Problem solved in a free-contract, free market way. Don’t see what the uproar is all about.

  11. Rollory says:

    I am curious how many of the people who insist that people should be free to follow their religious beliefs when dispensing medicine would react with horror to the idea of people following their religious beliefs when choosing who to accept as a taxi fare or choosing whether to ring up a customer’s purchase of ham at a cash register.

  12. Jackson says:

    Don’t follow.

  13. vic says:

    Maybe I am dense and thus missing something
    1. what is inconsistent with being an atheist and thinking that abortion is murder. In my proffession ( I run a neonatal ICU)- that conclusion is hard not to come to.

    2. So even if you are tolerant enough to live and let die ( in amnner of speaking); would you not draw the line if asked perform a procedure that you consider ” a problem”.

    3. So an atheist who has a problem w abortion cannot go into OBGYN– as kurt9 seems to be suggesting

    what utter poppycock!!!

    ??????

  14. vic says:

    and there is a difference between taking a taxi fare and aborting a semiviable fetus
    what about an person doing aresidency in an obgyn program who has a problem w abortion…. should the person be forced to do this procedure as a requisite for certification… or should all people who have a problem a abortion not plan on being an obgyn or an Family practioner for that matter, or perhaps be precluded from becoming aphysician, because you may have to ascrub and assist in a pregnacy termination as a med student rotating through obgyn

    sometimes I think that this pc bullshit about reproductive rights etc has addled many a good brain’s capability to reason

  15. vic says:

    I have sent many many 22 and 23 week fetuses home in intact condition

    will someone please explain to me how killing this kid while he is inside the uterus is ok, but 15 minutes later when he is in the incubator is murder.

    must be some shit god does right— passing through the vagina somehow gives this little human being a soul

    now I am live and let live kinda guy, so that if YOU want to delude yourself with some brinless idiocy and kill your child – feel free to do so- but DO not limit my or anyone elses career preferences because you want to force me to do a procedure that I find to be a problem

    and please please do not compare this to a taxi fae or selling ham
    or i will be forced to conclude that your brin lies a few inches superior and medial to your hams.

  16. bmb says:

    I just want to second what vic is saying, people seem to think this is some big religious debate, personally my feelings on abortion have nothing to do with any religious beliefs or lack thereof, but instead on my scientific understanding of the development process. That said, why should a doctor, who believes an action is unethical, be required to perform said act. That is not to say the physician should use his position to preach to the patient but, assuming this is not a case that requires immediate action which presents in an ED with single coverage at 3am in a hospital devoid of other qualified individuals in the middle of a giant snow storm, they should be able to refer the patient to another physician and not perform the procedure.

  17. Walter Olson says:

    Again, the question is not whether it’s an admirable idea for a hospital to accommodate the wishes of anti-abortion (or anti-vasectomy, anti-contraception, etc.) personnel when it finds that feasible. It’s whether the government should force the issue when the hospital doesn’t think accommodation works well. The training process, I am aware, raises different issues, and I sympathize with the suggestion of setting up multiple training paths if the organized specialty (such as ob/gyn) agrees that that can be done consistently with patient interests.

    The whole set of issues becomes much easier to handle if the authorities permit a natural diversity of institutions, with hospitals A, B and C choosing one path while D and E go the other. Then Vic’s concern for not limiting “my or anyone else’s career preferences” will be met since people’s “career preferences” will tend naturally to sort them out to the institution that is right for them.

  18. vic says:

    But the reality of the marketplace is that 90-95 % of academic OBGYNs think of abortion as their religious duty at the alter of todays new age religions (I define religion a liitle more broadly than christianity islam etc, – any persistent set of irrational beliefs not amenable to reason or empericism – which places current PC culture and gaia worship/ tree-hugging squarely in the category of religions – more pernecious perhaps than even evangelical christianity simply because accolytes of new religions tend to be more devout and fervent).

    In that context, a med student or resident who has a problem w the ethics of abortion will probabely have a problem without laws to protect his or her ethical position. The problem may persist even with laws as the accolytes at the religion of abortion ( believe me there are plenty of these around too ) may still victimise him/ her.

    I work at a hospital which is puportedly faith based. All abortions have to be approved via committee to adhere to certain guidelines pertaining to health of mom/ condition of baby. I am co chair of this committee. As a secret atheist on this committee it is quite amusing to see the parallels between how some some of the more ” progressive” obgyn’s request abortions ( at times actually encourage abortions) as a -perhaps blood sacrifice to propiate the pagan gods. There I am, saying that with the condition under discussion we have a emperic 50 % chance of survival and the non survivors die quickly ( ie not producing undue burden on system resources or families), so far in the 7 years I have been on the committee we have not refused a single abortion request. Cowardice on my part perhaps – I am not willing to jeopardize my life and career -to take a prinicipled battle aginst these blithering idiots. Coz if perchance I get labeled as anti abortion, it will effectively end my career.

    So yes protections are necessary

  19. Grant Canyon says:

    The point at which this “ethical accommodation” becomes a problem is when the person seeking to exercise her right to abortion or contraception or what have you, is effectively prohibited from exercising that right by virtue of the limitations in the market or the specific circumstances of the place the person lives.

    I have no problem with an “opt out” option, so long as, as a condition precedent to the exercise of that option, the person opting out fulfills what would be his burden to ensure that the person seeking the contraception, abortion, whatever, is provided with the services they require and request. So if a pharmacist doesn’t want to dispense the morning-after pill, that’s fine, so long as that pharmacist arranges, on his dime, for the person to receive the prescription in a full and timely manner from another source.

  20. Grant Canyon says:

    “But the reality of the marketplace is that 90-95 % of academic OBGYNs think of abortion as their religious duty at the alter of todays new age religions (I define religion a liitle more broadly than christianity islam etc, – any persistent set of irrational beliefs not amenable to reason or empericism – which places current PC culture and gaia worship/ tree-hugging squarely in the category of religions – more pernecious perhaps than even evangelical christianity simply because accolytes of new religions tend to be more devout and fervent).”

    You should just say, “I like to label things I don’t like as a ‘religion’ so that I can mock them with religious-based imagery. For example, it lets me describe ‘abortion’ as ‘a -perhaps blood sacrifice to propiate the pagan gods.'”

  21. vic says:

    Grant Canyon

    You dont like my definition of religion ?

    You may not like my examples – I can give you that. But you do not think that in the secular west we are right now witnessing a phenomenon where some/many avowedly secular individuals are replacing the void in there lives absent a traditional belief system by a new idolatory?

    I think the phenomena has not reached its full manifestation as yet, I am just waiting for a messiah to appear who will canonise it. I am not anti environmentalism, however I see in some aspects of the current fervor, the same branding and vilification of contrary opinions, and suppression of rational debate, that I have hitherto seen in adherents of religion. ergo….

    Blood sacrifice….. Yes I am guilty of, perhaps, hyperbole. But in my personal experience I see abortion being pushed… and yes i say pushed as the only viable option.

    2 cases in point :
    1. prenatal diagnosis of hypoplastic left heart: surgical options available success rate variable.
    2. prenatal diagnosis of oligohydramnios/ hypoplastic lung sequence: in our hands we have a 50 % success rate of kids going home healthy.

    When the obstrical provider in unwilling to even offer the option to the pregnant mother (and this is cases where this was a desired pregnacy) of talking to the cardiovascular surgeon wih experience or the neonatologist the experience with these conditions and wants to solely push for termination.
    What conclusion should I come to.

    The pharmacist who refuses to dispense a morning after pill…. no good answerss there from me. However I see a difference there between terminating a 12 -22 wk fetus where organogenesis is basically complete. While I havent honestly thought this true, at the very least i might conjecture a difference between a zygote that has either not implanted yet or is in the process of implanting whose mother takes a pill to prevent implantation, and a even a late first trimestor fetus in whome a rudimentary heart is beating and whose cranial part of the neurotube is in the process of closing. who by now has discernible arms legs chest abdomen and head, in whom the physician is putting a surgical instrument inside the uterus to essentially pulverize his body and extract the pulverized remnants. I think the differnce while quantitative, has enough diverbence in quantitativeness to qualify as a qualitative difference.

    And someone please explain to me the difference in rights between the 23 week fetus in the uterus and 15 minutes later in the NICU.

    If a woman delivers a live born and proceeds to put it in plastic bag and throw it in the bushes, we prosecute her. So please someone explain to me in a reasoned disspassinate way what magical properties does the same child get by virtue of passage through the birth canal, which he/she didnt posses a half hour earlier when he was still in utero ?

  22. Caledonian says:

    “So if a pharmacist doesn’t want to dispense the morning-after pill, that’s fine, so long as that pharmacist arranges, on his dime, for the person to receive the prescription in a full and timely manner from another source.”

    We have to make a distinction between pharmacists who own their own businesses and ones who act on the behalf of some other owner.

    Owners are free to refuse to offer certain services if they so choose. They are even free to refuse service to specific people or types of people, although the law currently limits that freedom depending on the reasons for refusal and type of person.

    But if the pharmacy is owned by someone else, and the pharmacist is just an employee, the pharmacist is not free to refuse services the owner has decided to offer. If they’re not willing to offer those services, they are unwilling to perform their jobs and are free to look for employment elsewhere.

    Owners have no burden to ensure that people can get what they’re looking for.

  23. SmokeVanThorn says:

    I am not going to question Mr. Olson’s consistency on the issue of government interference with an employer’s right to exercise discretion over what is required of employees; I believe that he has been similarly critical of liberal/PC interference. I know, however, that many of those who denounce this policy have supported equally egregious government interference with employer rights when it suited their purposes.

  24. Anonymous Coward says:

    What about the conscience of someone who refuses to participate in the end-of-life intubating, respirators, and the rest of the death-prolonging and futile things for brain-dead patients?

    I’m Buddhist. My religion says that minimizing suffering is a good thing. Inflicting some short-term suffering for long-term survival is OK, but when nothing is to be gained by it … don’t do it.

  25. Grant Canyon says:

    @ vic,

    “You dont like my definition of religion ?”

    No, it’s nonsensical.

    “But you do not think that in the secular west we are right now witnessing a phenomenon where some/many avowedly secular individuals are replacing the void in there lives absent a traditional belief system by a new idolatory?”

    First, your premise is sheer speculation that secular individuals have such a void. From the way that religious people are constantly expending energy looking for “answers,” I would presume that it is they who have a void in their lives that they are seeking to fill, making them victim to every kind of charlatan that comes down the pike.

    Further, I think it is nonsensical to state that something like environmentalism is “idolatry.” First, because it, you know, isn’t. And second, because simply being passionate about a thing doesn’t make it religious simply because religious people tend to be passionate. Moreover, even if one is, in your view, being irrational, that does not make them religious, merely irrational.

    “I see in some aspects of the current fervor, the same branding and vilification of contrary opinions, and suppression of rational debate, that I have hitherto seen in adherents of religion. ergo….”

    Well, you would have to be more specific as to what you consider “branding”, “vilification”, etc. For example, James Inhofe is an idiot. That’s not a brand, that’s a fact.

    One thing that the evolution argument has in common with the environmental argument, in my opinion, is that the “anti’s” in both cases oppose the science because their mindsets or their pre-existing ideology simply won’t let them consider whether the science says what it says. So they rationalize and exercise selection bias, and claim that the other side is shutting down rational debate. Well, there are certain things in both sciences that are simply beyond rational debate.

    “Blood sacrifice….. Yes I am guilty of, perhaps, hyperbole.”

    Actually, there is no “perhaps” about it, given the definitions of the words involved.

    And I understand you feel passionately about abortion; that much is clear. As for me, I do not share that passion. I have no doubt that there is a point in fetal development where abortion should not be permitted, except to protect the life and physical health of the mother. However, I also believe that there is a point before which a woman should have no limitations on her exercise of her right to an abortion. I have never defined those points, but there you are.

  26. Grant Canyon says:

    @Caledonian
    We have to make a distinction between pharmacists who own their own businesses and ones who act on the behalf of some other owner.”

    I understand that you would make such a distinction. I wouldn’t. It makes no difference to me that the person is the owner or an employee. By becoming a licensed professional, the owner has, in my opinion, waived the right to exercise the type of choice for which you argue. If he does not like it, and does not want to stock contraception and morning-after pills, he should either ensure that those he serves can obtain them (at his own cost if necessary) or he can find another line of work.

  27. vic says:

    grant

    actually i dont feel particularly pasionately about abortion
    i think i have some valid questions re the issue
    which the prochoice crowd ignores
    not that the pro lifers are by and large any better
    in any event
    just dont ask me to perform it

    most common everyday adherents of environmentalism are clueless about the nature of the debate and the valid questions being asked
    for most of the prius driving greens that i have encounterd the whole thing is a matter of fashion and social status – not a rational examination of the issues and questions raised. For a small but increasing minority it is religion with all the attendant rituals

    recntly i was reading something about a municipality where their recycle program has been abandoned for cost reasons etc. however that faithful are still sorting out their garbage in various recyclable piles.

    i just feel that there is certain mindlessness to it as in suppression of debate and attacking strawmen

    maybe you should educate yourself about the impulses in us that make us seek religion. just the mere the fact that there has basically been no culture/ society in the history of mankind that has been devoid of religion, should necessarily pose the question why?

    scott atran and others try to examine the question- i suggest a quick education.

    it sure loks like you have some voids that are getting filled up by some belief-sets that are beyond questioning.

    who is James Inhofe

    and next time you want to refute my arguments come up with some logic and reason not just “First, your premise is sheer speculation that secular individuals have such a void. From the way that religious people are constantly expending energy looking for “answers,” I would presume that it is they who have a void in their lives that they are seeking to fill, making them victim to every kind of charlatan that comes down the pike.

    Further, I think it is nonsensical to state that something like environmentalism is “idolatry.” First, because it, you know, isn’t. And second, because simply being passionate about a thing doesn’t make it religious simply because religious people tend to be passionate. Moreover, even if one is, in your view, being irrational, that does not make them religious, merely irrational.”

    what exactly is your point other than you dont like what i say

    more of this and i will conclude you are an erudite idiot

  28. vic says:

    and grant

    secular is a rather broad term
    what variety of secular are you

    atheist, agnostic or just someone who likes separation of church and state. just so i can categorize your brand of logic a little better.

  29. secularagenda says:

    @vic… try to keep up, will ya?

    Do you honestly not see the man’s point, or were you just in the mood for a juvenile tirade?

    You:
    “But you do not think that in the secular west we are right now witnessing a phenomenon where some/many avowedly secular individuals are replacing the void in there lives absent a traditional belief system by a new idolatory?”

    Grant:
    “First, your premise is sheer speculation that secular individuals have such a void.”

    Run that through your “erudite idiot decoder ring” if you must, but I’d bet that it requires no further clarification for many/most of the readers here.

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