The Trump administration plans to modify the Health and Human Services (HHS) civil rights office to protect health care workers who have moral or religious objections to performing certain medical procedures or treating certain patients. As should be expected, the focus of concern is mainly on abortion and transgender patients. Two of the general moral issues raised by this situation are whether health workers have the moral right to refuse certain services and whether they have the right to refuse to treat certain patients based on the identity of the patients.
While some might, perhaps while thinking of abortion rights, automatically conclude that health care workers have no moral right to refuse services, this would be far to hasty. After all, entering a profession does not entail that a person surrenders their moral rights or conscience. To think otherwise would be to embrace the discredited notion that just following orders or just doing one’s job provides a blanket moral excuse for one’s professional actions. As such, since health care workers are morally accountable for their actions, they also retain the moral agency and freedom needed to ground that accountability.
But, this moral coin has another side—entering a profession, especially in the field of health, also comes with moral and professional responsibilities. These responsibilities can, like all responsibilities, can justly impose burdens. For example, doctors are not permitted to instantly abandon patients they dislike or because they want to move to a better paying position. As such, ethics of a health worker refusing to perform a procedure based on their moral or religious views requires that each procedure be reviewed to determine whether it is one that a health care worker can justly refuse or one that is a justly imposed burden.
To illustrate, consider a doctor who is asked to keep prisoners conscious and alive during torture performed by agents of the state. Most doctors, like most people, would have moral objections to being involved in torture. However, there is the question of whether this would be something they should be morally expected to do as part of their profession. On the face of it, since the purpose of the medical profession is to heal and alleviate suffering (a professional ethics that goes back to the origin of western medicine) this is not something that a doctor is obligated to do even in the face of moral objections. In fact, the ethics of the profession would dictate against engaging in this behavior.
Now, imagine a health care worker who has sincere religious or moral beliefs that when a person can no longer sustain their life on their own, they must be released to God. As such, the worker refuses to engage in procedures that violate their principles, such as keeping a patient on life support. While this could be a sincerely held belief, it seems to run counter to the ethics of the profession. As such, such a health care worker would seem to not have the right to refuse such services.
One could even imagine very extreme cases—after all there is no requirement to prove that sincerely held religious belief is true, one must only be convincing in one’s alleged sincerity. For example, imagine a health care worker who has a sincere religious belief that a patient must prove themselves worthy in the eyes of God by surviving with only the most basic care; anything beyond that is an affront to God’s will: the patient will survive if God wants them to and humans should not interfere with this. Obviously enough, such workers’ views would not be accepted as justifying their actions—they should seek another profession if they cannot do their jobs.
Turning back to services like abortion and gender transition, the issue would be whether these are more like asking a medical worker to participate in torture or more like expecting a medical worker to provide normal medical services. As should be expected, this is a central point of the dispute. Those who oppose abortion will make the moral argument that performing abortion is as bad or worse than abetting torture—it does, after all, involve killing a living entity. Those who are pro-choice will contend that it is a medical procedure like any other. I must admit that I do not have a compelling argument to change any minds on this matter.
In the case of gender transition, there can be no appeal to concerns about killing. Rather, a person must appeal to the view that people should not modify their sex and should simply accept what they were born with. This seems to be more like my imaginary case of a health care worker who believes that people must prove themselves worthy in the eyes of God than like the torture case, especially if someone takes the view that God wants people to stick with their original sex. That said, it could be argued that such modifications are wrong in the same way that non-restorative cosmetic surgery is wrong—after all, both aim to allow a person to be as they envision themselves to be. I do not, however, want to claim that the transitional process is as trivial as a face lift. Once again, I do not think I have a compelling argument here that will change any minds.
While I do not think I will change minds about abortion and such, I do think that the matter of moral objections needs to be given due consideration. It is easy to simply embrace one’s unreflecting views without considering the possibility of error. In my next essay I’ll turn to the issue of whether health workers have the moral right to refuse services based on the identity of the patient, such as their being transgender or Christian.
My dad was a surgeon in Europe during WWII; he was right in the thick of it. Their medical unit landed at Normandy a few days after D-day, and followed the front through France, Belgium, and Germany. They took all patients into their OR, regardless of allegiance. Dad told me that whenever a wounded Nazi soldier ended up on his table (which was fairly frequent), just as the anesthesiologist was about to put the patient under, he derived great pleasure from leaning in and introducing himself to the patient – “I am your surgeon,” he’d say, “And I am Jewish”. On the other hand, after his return to the States, I don’t think he should have been required to take on Nazis as private patients if he didn’t want to.
Is it really a “thing”, that healthcare workers refuse to treat some people because of their identity? Or is it just certain practices and procedures that they find morally objectionable? Not wanting to participate in sex-change surgery is quite different from not wanting to mend a transgender person’s broken leg. I’ve never heard of the latter.
(That said, there is a case where a Michigan pediatrician refused to take the child of a lesbian couple as a new patient because of the parents’ orientation – but her reasoning was sound and it was less a case of “providing care” as much as it was about developing a long-term relationship. In a letter to the parents, she said that based on her religious beliefs, she didn’t think she would be able to develop the same kind of doctor/patient relationship she normally does with her patients, and felt this would compromise the care she was able to give. The family, however, was welcomed to the practice, and invited to see a different doctor. I see nothing wrong with that. Had the child come in with an acute illness needing immediate treatment, I think it would have been a different situation.)
On the one hand, I don’t think that a healthcare worker should be required to violate their moral beliefs by participating in procedures that are, for the most part, elective. At the same time, there is probably a point at which that person should consider a different line of work, if those procedures become more frequent or commonplace. There are many ethical positions that are in opposition, here, and all sides should be considered.
For example, it does not make sense for someone who is anti-abortion to work in an abortion clinic. The clinic is under no obligation to hire or keep that employee if they will not act in accordance with policy, nor do they have the right to force an employee to act in a way that violates their moral or religious beliefs. By the same argument, though, no one is forcing that employee to work in that particular environment. If they are able to work it out, and the employee can be an economically viable asset to the clinic by doing other things, and participation in the abortions is covered by others, then fine – but as soon as it becomes a hardship for either party, a larger issue must be discussed.
Expanding this issue beyond the hot-button topics of abortion and gender transition, what about something like circumcision? Should a Christian urologist who is opposed to this practice be forced to perform the operation on someone who wanted one? What if his patient were Jewish? Would that be a case of religious discrimination?
(And why would any man of any religion, want to have this oh-so-delicate procedure done by someone who morally objects to it?)
Would you, Michael, ever consider taking a job at a university like BYU or Hillsdale College, and expect them to accommodate your liberal views in your classroom? What would happen if they told you you MUST deliver lectures in support of their religious and/or conservative beliefs? Should they be legally allowed to do this? Should you be legally allowed to make them change their views? Or should you both recognize that you’re not such a great fit for the organization? Or – like the pediatrician example above, is it possible for you to teach what you do, and for any student who doesn’t want to take your classes, can opt for different ones?
This all boils down to what was once a leftist point (and a correct one, I might note) in reference to abortion, to wit: You cannot legislate morality. You cannot make people be morally good. Attempts to do so only result in more problems than they purport to solve. Government’s job is to protect people’s natural born rights, what leftist propagandist philosophers like to refer to as “negative” rights. (This is the point where Mike, when he is so inclined, likes to drag the argument off into semantic, etymological, etc. wasteland to die…but I digress). Using laws to force people to do things against their will, be they what are perceived as “good” things or bad, is itself morally wrong. The Founders understood this. This is the fundamental basis of the First Amendment. Our First Amendment rights do not stem from the Constitution but from an understanding of reality. Morals are God’s domain, not man’s.