Crossing the Line: When Doctors’ Beliefs Endanger Patients’ Autonomy and Health


Craig Klugman

Publish date

January 9, 2017

by Craig M. Klugman, Ph.D.

In 2016 the Illinois legislature passed and Governor Bruce Rauner signed into law Public Act 099-690 (SB 1564), an amendment to the Health Care Right of Conscience Act. This change states “It is also the public policy of the State of Illinois to ensure that patients receive timely access to information and medically appropriate care.” The change requires physicians to inform patients about legal treatment options including their factual risks and benefits, but does not require the physician to perform such services. If the hospital or physician has a conscientious objection to performing a procedure, then the patient must be referred to or transferred to someone or some facility that will.

For this effort, state officers have been sued in both state and federal courts by the Alliance Defending Freedom on behalf of a group of “pregnancy centers,” a doctor and her medical practice in Rockford, IL. Their complaint is that this law “forces them to promote abortion regardless of their ethical of moral views.” In other words, because the law requires doctors to allow patients to know all of their legal options indicated under standard of care and to be transferred elsewhere for services a physician or facility will not perform, this violates their religious freedom. The plaintiffs want it to be legal to lie, obfuscate, and keep information from patients and to keep patients away from legal and safe, medically indicated procedures. Specifically, this suit cites abortion.

Most surprisingly, a judge in a rural county has issued an injunction against the law going into effect (only) for the named plaintiffs. These few clinics and single doctor now have the right to lie to patients and to keep information and services from them. If a woman comes to one of these centers with an ectopic pregnancy, they do not have to let her know that an abortion may be necessary to save her life.

The idea behind a moral conscience clause is to allow a professional to perform her or his duties but not violate personal values, often based in religious belief. This case is not arguing that the state is requiring these individuals to perform acts that they find to be immoral. Rather, the law requires them to let women know their options. The plaintiffs argue that even talking about these procedures violates their beliefs. They become “guilty of sin” for referring to another provider or talking about the procedure. Here is where they cross the line from personal belief affecting their actions, to their belief harming others. There is no right for a care provider to withhold knowledge of and access to legal, safe, medically indicated procedures from patients. There is a limit to moral conscience actions and this is it.

Many years ago, I conducted a study about moral conscience clauses in pharmacists in Nevada. This is a state where physicians are required to fill all valid and legal prescriptions. We asked how many would enact a moral conscience clause. About 48% felt they should have a right to refuse to fill on moral grounds. Six percent said they would refuse to dispense or to transfer. Others were unaware that they were required to fill. Our analysis found that religious affiliation was the main variable that determined a person’s position. Evangelical Protestants, Catholics, and other Christian believed in and would use a moral conscience rejection. While all other Protestants, Jews, Muslims, and Atheists would not use them.

What this comes down to is whether doctors have a right to impose their moral standards on patient choices? Should a patient who accepts an abortion and perhaps in terms of an ectopic pregnancy needs one to save her life, die because her doctor doesn’t want to be associated with referring or even mentioning this option? Or a young girl is forced to give birth to her stepfather’s child?

I suggest that when you are violating your duty to patients then you have stepped over a line. And keeping information and access to legal, safe, and medically indicated procedures is over that line. If your personal beliefs do not permit you to perform certain aspects of your job, then perhaps you should not be doing that job. Religious practice is a private matter, being a doctor is a public matter. One of the tenets of being a professional is altruism, that you put the needs of your patient before your own.

This simple law upholds patient’s rights to make their own informed choices. The court should find against the plaintiffs and reinstate the reasonable requirements of the law in order to protect patient’s health and liberty. When a provider’s religious liberty and a patient’s rights collide, the patient wins, every time.

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