Conscience clauses are clauses in laws in some parts of the United States which permit 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, contraception, and stem cell based treatments, but may include any phase of patient care.[1]
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Health care providers opposed to abortion or contraception support the clauses because they believe that disciplinary or legal action for refusing to perform services obliges providers to supply services which their moral or religious principles forbid.
Reproductive rights organizations, such as Planned Parenthood and NARAL Pro-Choice America, oppose the provision because they maintain that pharmacists, doctors, and hospitals have a professional duty to fulfill patients' legal medical needs, regardless of their own ethical stances. Opponents see conscience clauses as an attempt to limit reproductive rights in lieu of bans struck down by Supreme Court rulings such as Roe v. Wade.[2]
The earliest national conscience clause law in the United States, which was enacted immediately following the Supreme Court's decision in Roe v. Wade, applied only to abortion and sterilization. It was sponsored by Senator Frank Church of Idaho. The Church Amendment, passed by the Senate on a vote of 92-1, exempted private hospitals receiving federal funds under the Hill-Burton Act, Medicare and Medicaid from any requirement to provide abortions or sterilizations when they objected on “the basis of religious beliefs or moral convictions.” Nearly every state enacted similar legislation by the end of the decade—often with the support of legislators who otherwise supported abortion rights. Supreme Court Justice Harry Blackmun, the author of Roe vs. Wade, endorsed such clauses “appropriate protection” for individual physicians and denominational hospital.[3]
Conscience clauses have been adopted by a number of U.S. states. including Arkansas, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Pennsylvania, and South Dakota. There are some recent comprehensive reviews of federal and state conscience clause laws across the United States and in select other countries.[4]
The Obama administration has proposed reversing recent additions to the conscience clause enacted by the Bush administration.[5]
An informed consent clause, although allowing medical professionals not to perform procedures against their conscience, does not allow professionals to give fraudulent information to deter a patient from obtaining such a procedure (such as lying about the risks involved in an abortion to deter one from obtaining one) in order to impose one's belief using deception. These principles were reaffirmed in the Utah Supreme Court's decision in Wood v. University of Utah Medical Center (2002). Commenting on the case, bioethicst Jacob Appel of New York University wrote that "if only a small number of physicians intentionally or negligently withhold information from their patients significant damage is done to the medical profession as a whole" because "pregnant women will no longer know whether to trust their doctors."[6]
Some pharmacies in U.S. jurisdictions with conscience clauses, including CVS and Target, allow pharmacists to choose, without penalty, not to dispense birth control pills. Target requires the objecting pharmacist to recommend another Target location that will dispense the medication.
The conscience clause is widely invoked in Catholic hospitals in order to maintain a pro-life policy. Opponents of related FOCA legislation have interpreted the possible end of the conscience clause as a demand to either "do abortions or close."[7] However, such clauses are sometimes interpreted differently and their use will often depend on the given context.[8]