Physicians, Not Conscripts - Conscientious Objection in Health Care.

“Conscience clause” legislation has proliferated in recent years, extending the legal rights of health care professionals to cite their personal religious or moral beliefs as a reason to opt out of performing specific procedures or caring for particular patients. Physicians can refuse to perform abortions or in vitro fertilization. Nurses can refuse to aid in end-of-life care. Pharmacists can refuse to fill prescriptions for contraception. More recently, state legislation has enabled counselors and therapists to refuse to treat lesbian, gay, bisexual, and transgender (LGBT) patients,1 and in December, a federal judge issued a nationwide injunction against Section 1557 of the Affordable Care Act, which forbids discrimination on the basis of gender identity or termination of a pregnancy.2 Health care conscience clauses are legislative tools that are used to insulate professionals from performing tasks that they personally deem objectionable. Legislative protection for conscientious objection in health care emerged at the height of conscientious objection to military service. Supporters of conscientious objection in health care explicitly referenced “the right of conscience which is protected in our draft laws” to justify and legitimate it.3 Yet conscientious objection in health care diverges substantially from conscientious objection to war. We highlight the differences and argue that, in most cases, professional associations should resist sanctioning conscientious objection as an acceptable practice. Unlike conscripted soldiers, health care professionals voluntarily choose their roles and thus become obligated to provide, perform, and refer patients for interventions according to the standards of the profession.