What is a Conscience Clause and why is it unconscionable?

A Conscience Clause is a clause in law or code of professional conduct that permits pharmacists, physicians, and other providers of health care not to provide certain medical services for reasons of religion or conscience. Those who choose not to provide services may not be disciplined or discriminated against. The provision is most frequently enacted in connection with issues relating to reproduction, such as abortion, sterilization, and contraception, (hence the term provider conscience is used) but may include any phase of patient care.

From the BBC comes an example of just how such a conscience clause can affect health care, with a tip to Misunderstoodranter who provided the link:

Pharmacists across the UK, for example, have been told they can continue to refuse to prescribe items that may clash with their religious beliefs. A revised code of conduct from the new industry regulator will allow staff to opt out of providing items such as the morning-after pill and contraception. But they may in future have to give customers details of alternative shops. The National Secular Society wanted the General Pharmaceutical Council to scrap the so-called conscience clause.

The General Pharmaceutical Council (GPhC) is to take over the regulation of pharmacists, pharmacy technicians and the registration of pharmacy premises from the Royal Pharmaceutical Society later this year. Under its new code, pharmacists with strong religious principles will still be able to continue to refuse to sell or prescribe products if they feel that doing so would contradict their beliefs. But the GPhC says pharmacists who refuse services could be obliged to tell patients where they can access them and it plans to consult more widely on the issue.

Terry Sanderson, president of the National Secular Society, said he was disappointed by the code.

“This was a perfect opportunity to severely restrict the exercise of this supposed conscience clause which has caused a great deal of embarrassment and inconvenience to people recently. “It seems incredible that pharmacists can arbitrarily tell people that they won’t serve them with medication that has been prescribed by a doctor.” The issue was highlighted recently by a woman denied the pill by a Sheffield chemist. She was told to return to the shop the following day when another staff member would be on duty.

To help us see what is so unconscionable about this clause, imagine a police officer arriving at a domestic dispute but, rather than intervene and enforce the law, decides to arbitrarily  respect his conscionable religious beliefs about the respective roles of  ‘allowable’ conduct of husband and wife. What might be the problem here?

Imagine if operating room staff decided to respect conscionable adherence to proper religious clothing ahead of professional sterilization procedures. What might be the problem here?

Imagine a teacher in a language class insisting that all those of an opposite gender had to leave the room to suit one student’s religious sensibilities that agrees with the teacher’s. What might be the problem here?

When we allow professions to suspend and subvert their professional codes of conduct in place of and out of a misguided respect for personal religious beliefs held by individual practitioners, we are prostituting the profession. We undermine the ethical framework that describes the role each member of the profession is to uphold and allow religious belief to take its place out some misguided and unjustified sense of tolerance and reasonable accommodation. This subversion is unconscionable.

If someone decides that personal religious beliefs rather than professional standards should be the measure of conduct while acting as a representative of that profession, then the confused individual must either voluntarily resign or be stripped of professional status. One cannot have it both ways: if one wishes to act only as an individual with various beliefs and preferences, then that’s fine. Act as an individual by being an individual. But if one wishes to act as a representative of a profession, then one must be willing to put aside the personal while acting as a professional of that profession.

For example, it doesn’t matter what laws an individual may think deserves more respect than others: when acting as a police officer, one acts as a representative of the law and not a representative of the individual with preferences. The higher allegiance a police officer must have to be an ethical professional is not a greater respect for his or her individual preferences and beliefs but to the professional code of conduct under which he or she acts as a police officer. If one wishes to act as a representative of the profession of pharmacists, then one must put aside one’s personal preferences and beliefs and act according to the professional code of conduct of a health care provider.

When professional codes of conduct are perverted, abused, and manipulated to protect individuals exercising their personal preferences while acting as a representative of various professions, then each professional body that goes along with this abuse under a Conscience Clause has subverted its very reason for being.

In the same way, if enforcing the law is dependent on each individual police officer determining which laws he or she will enforce according to some personal preference, then we have subverted law enforcement. If we allow dispensing prescribed medication to be dependent on each individual pharmacist determining which drugs he or she will dispense according to some personal preference, then we have subverted health care. And to subvert what it means to be a professional – to act as a representative of that profession with recognized rights and privileges based on guidelines and rules and areas of specialized knowledge and expertise – to suit the unjustified religious beliefs of certain individuals within professional bodies does not serve either the interests of the profession as a whole or the public trust in that profession… it undermines our confidence in both the profession and the professional.

I think that to support this willing sacrifice of what it means to be a professional by professional bodies of oversight on the alter of religious belief under the fictitious banner of tolerance and accommodation is unconscionable stupidity and ethical capitulation.