Conflicts of Conscience in Health Care: An Institutional Compromise

Overview

Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by "conscience clauses." These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access ...

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Overview

Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by "conscience clauses." These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access to care, argue that professional refusals should be tolerated only when they are based on valid medical grounds. In
Conflicts of Conscience in Health Care, Holly Fernandez Lynch finds a way around the polarizing rhetoric associated with this issue by proposing a compromise that protects both a patient's access to care and a physician's ability to refuse. This focus on compromise is crucial, as new uses of medical technology expand the controversy beyond abortion and contraception to reach an increasing number of doctors and patients. Lynch argues that doctor-patient matching on the basis of personal moral values would eliminate, or at least minimize, many conflicts of conscience, and suggests that state licensing boards facilitate this goal. Licensing boards would be responsible for balancing the interests of doctors and patients by ensuring a sufficient number of willing physicians such that no physician's refusal leaves a patient entirely without access to desired medical services. This proposed solution, Lynch argues, accommodates patients' freedoms while leaving important room in the profession for individuals who find some of the capabilities of medical technology to be ethically objectionable.

The MIT Press

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Editorial Reviews

From the Publisher

"[Lynch's] pragmatic approach is also innovative and refreshing in a policy arena that is often fraught with an overabundance of criticism with little substance on reform." Dhrubajyoti Bhattacharya The
Journal of Legal Medicine

The MIT Press

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Product Details

  • ISBN-13: 9780262515054
  • Publisher: MIT Press
  • Publication date: 8/13/2010
  • Series: Basic Bioethics
  • Pages: 368
  • Product dimensions: 5.90 (w) x 8.90 (h) x 0.70 (d)

Meet the Author

Holly Fernandez Lynch is Executive Director of the Petrie-Flom Center for Health
Law Policy, Biotechnology, and Bioethics and author of Conflicts of
Conscience in Health Care: An Institutional Compromise
(MIT Press).
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Table of Contents

I Conscience clauses and professionalism 17

1 A primer on conscience clauses 19

2 Defining medical professionalism 43

II Protecting doctors and patients : an institutional solution 77

3 Moral diversity in medicine and the ideal of doctor-patient matching 79

4 Which institution? : licensing boards bearing the burdens of conscience and access 99

III The details of the institutional solution 115

5 Measuring patient demand and determining which demands to meet 117

6 Measuring physician supply and limiting the grounds for physician refusal 145

7 Calibrating supply and demand 165

8 The "hard" cases : when the institutional solution fails 195

9 Physician obligations and sacrifices 215

10 Addressing skeptics, a model statute, and conclusions 241

App Statutes, regulations, and case law 259

Notes 263

References 317

Index 335

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