EthicsWalk addresses spiritual care as an ethical enterprise. It explores why relationships between spiritual care providers and those they serve need protection, and examines what that protection entails. PlainViews invites
our readers to share their responses
to each EthicsWalk column,
which will be published in the
following issue.
If you’d like to respond to EthicsWalk,
please send a comment of no more
than 100 words. You can use the
e-form below (click on "hearing from you," link) or submit your
commentary to the editors in
the body of an e-mail (or as
a Microsoft Word attachment) sent to Info@PlainViews.org.
Please put the phrase “EthicsWalk”
in your subject line.
We look forward to hearing
from you.
Conscience Clauses: Who Benefits?
Pharmacist Neil Rosen’s assertion that conscience forbids his filling birth control prescriptions or transferring them to another pharmacist has provoked national debate and a flurry of legislation concerning “conscience clauses.” [1]
What ethical values and moral dilemmas are implicated in the conscience clause debate? Can spiritual care providers’ experiences inform the discussion in hospitals or state legislatures?
Frequently conscience clauses are triggered by reproductive rights issues. For example: a hypertensive, diabetic 45-year-old Jewish woman seeks to abort a ten week pregnancy. Her GYN confirms its medical desirability but neither he nor the local hospital provide abortions citing their religious objections. The nearest clinic is 250 miles. There is no public transportation, the patient has no one in whom she is comfortable confiding and is medically prohibited from driving.
Four fundamental ethical values are implicated: autonomy, nonmaleficence, beneficence, and distributive justice. Depending on interpretation, each value conflicts with the religious freedom, guaranteed by the United States constitution, [2] of either provider or patient. Conflicting values create ethical dilemmas. However, conscience clause debates are often less conflicts between values than conflicts of values interpretation and application.
The woman is competent with capacity to choose. She chooses a legal procedure which is unavailable because of personal conscience objections by her providers. Advocates for the woman would argue that respecting her autonomy requires providing her the legal, medically indicated procedure she chooses. Distributive justice calls for access to skilled professionals in a safe environment convenient to her. Her religion places a premium on saving the life in front of one (hers in this case); the denial interferes with her exercise of religious freedom.
Advocates for the health care providers would argue that requiring participation offends their decision making autonomy and violates their religious freedom. For them, abortion is an act of malficence which abrogates any possibility of beneficence to the fetus.
Reasonable people make both arguments.
The first EthicsWalk column (7/04) suggested that for care providers, the first ethical question is, “What should I do in relation to the patient’s rights and/or well being?” The focus when applying ethical principles to the patient’s situation is the patient’s perspective. If the patient’s choices are legal and within good practice standards, the patient’s perspective prevails over the professional’s. [3] From the woman’s perspective, an abortion is the beneficent act.
Spiritual care providers minister daily to people whose religious convictions and moral interpretations differ from their own. Their expertise respectfully navigating the religious traditions of others while remaining grounded in their own, is embodied in a new Common Code of Ethics for Spiritual Care Professionals. [4] It sheds light on how they reconcile situations when interpretations of moral values collide. Pertinent standards confirm that they:
1.3 Demonstrate respect for the cultural and religious values of those they serve and refrain from imposing their own values and beliefs on those served.
1.4 Are mindful of the imbalance of power in the professional/client relationship and refrain from exploitation of that imbalance.
4.5 Seek advice and counsel of other professionals whenever it is in the best interest of those being served and make referrals when appropriate.
Spiritual care providers could help medical colleagues adapt these standards to diverse interpretations of ethical principles and diminish the conscience clause clamor.
Do you agree that as a spiritual care provider you must abide by the code of ethics that has been adopted by the six major cognate groups? What might be situations where your conscience would cause you to opt for a different standard of practice than the code endorses?
[1] Conscience clauses are enacted by state or federal legislation to allow entities or individuals, without penalty, to deny funds or services for medical procedures contrary to the provider’s moral or religious beliefs.
[2] The First Amendment reads, Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof… Federal and/or state monies (through the Fourteenth Amendment) import constitutional standards to virtually all health care entities.
[3] Some argue that abrogating a provider’s option to deny a procedure on his or her moral grounds is the slippery slope to Nazi medical atrocities. In the latter case, practices violating providers’ consciences were forced as the will of “the state.” In the present example, the legal procedure, medically indicated, is the informed choice of the patient.
[4] The constituent boards of six organizations of spiritual care professionals affirmed this document in November 2004. More information is available at www.professionalchaplains.org.
Anne Underwood
has an undergraduate degree in
religious studies, a master’s degree
in rural sociology and a mid-life
law degree obtained after working
over a decade as a college administrator.
She has mediated for the Maine
family courts since 1983. Currently
she serves as an advisor to the
ethics commissions of ACPE, APC,
the CCAR (Central Conference of
American Rabbis), and NAJC, and
consults with a variety of Protestant
faith communities on issues of
power, fair process, and congregational
conflict management. Her articles
on mediation and restorative justice
have appeared in the ACPE News,
The APC News and on the ACPE web
site. Articles on clergy accountability
and judicatory processes are published
by the Alban Institute and The
Journal on Religion and Abuse.
A chapter, “Clergy Sexual Misconduct:
A Justice Issue,” appears in Body
and Soul: Rethinking Sexuality
as Justice-Love
, Marvin Ellison
and Sylvia Thorson-Smith, editors,
The Pilgrim Press, 2003.
.gif){kind=spacer}
.gif){kind=spacer}
.gif){kind=spacer}