Conscientious Objection--to Do, or Not to Do

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The previous Tip of the Week mentioned a term called ‘conscientious objection’. The term actually has significant foundation in, if not its entire origins in a definition by the U.S. Department of Defense when describing someone objecting to military service during mandatory drafts for World War II on the grounds of freedom of thought, religion, or conscience. Conscience clauses are legal clauses attached to laws in some states which permit pharmacists, physicians, and/or other health providers not to provide certain medical services for reasons of religion or conscience. In some cases, the clauses permit providers to refuse to refer patients to unopposed providers, and those who choose not to do so may not be disciplined or discriminated against. The provision is most frequently concerned with issues relating to reproduction, such as abortion, sterilization, contraception, and stem cell-based treatments but may include other forms of care.   

In a statement published by the New England Journal of Medicine, Stahl and Emanuel sound off on conscientious objection in health care.1 They state that unlike conscripted soldiers, health care professionals voluntarily choose their roles and thus become obligated to provide, perform, and refer patients to the standards of the profession. They discuss various conscience clauses adopted over the years by various entities including the right in some areas for student physicians not to undergo training in abortion services, the Balanced Budget Act which allowed insurers to plan sponsors to deny coverage based upon religious or moral convictions, and the 2009 Provider Conscience regulations that provided protection against persons unwilling to participate in rendering care or engaging in research to which they objected. They point out inconsistencies within the medical profession and American Medical Association in regards to conscientious objection. They observed similar with regard to the American Pharmacists Association which in 1994 stated that the well-being of the patient was at the center of practice, but in 1998 approved the right of pharmacists to exercise conscientious refusal. They assert that proponents of conscientious objection point toward emerging issues like assisted suicide and use of marijuana for treatment, but that these latter issues concern medical value, not cultural acceptance. They thus claim that as a health professional, religious beliefs are secondary.

This Management Tip will not argue for or against conscientious objection, including all of its potential nuance (eg, refusal to treat but referral to others who do). It will, however, affirm the need for ethical judgment that recognizes the need for altruistic practice. Pharmacy managers must be clear on and effectively communicate state law and company policy to provide employees with what they are required to do (or not do) and the repercussions for doing, or failing to do so.

Additional information about Ethical Decision Making and Compliance with Regulations and Regulatory Bodies can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

1Stahl RY, Manuel EJ. Physicians, not conscripts—Conscientious objection in health care. New Engl J Med. 2017;376:1380-1385.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California