Opinion: Federal “Conscience” Policy Threatens Right to Health

October 12, 2018

A Trump Administration policy would shield federally-funded health providers from the consequences of refusing to provide certain medical treatments on the grounds of religious belief or conscience. In an editorial in the American Journal of Public Health, Wendy Chavkin at the Columbia University Mailman School of Public Health and co-authors argue that this policy threatens to abridge equitable access to health care. Furthermore, “conscientious objector” requests should only be accommodated if they are not discriminatory and harms can be mitigated.

In January, the Trump Administration created a Conscience and Religious Freedom Division within the U.S. Department of Health and Human Services Office for Civil Rights. HHS then created a rule to shield conscientious objectors that flags objections related to abortion, sterilization, medical aid in dying, advanced directives for end-of-life care, as well as comprehensive approaches to HIV care, occupational health screening, vaccination, hearing screening, and suicide prevention for children.

“We are a group of scholars and activists from medicine, public health, ethics, law, theology, and the social sciences who believe that it is possible—and necessary—to honor individual integrity and moral beliefs without harming those with different beliefs and values,” write lead author Wendy Chavkin, MD, MPH, Professor Emerita in Population and Family Health and Clinical Obstetrics and Gynecology, and her co-authors. “We believe that this new division and rule give a green light to those who invoke claims of conscience as a way to oppose social and political changes. Privileging these claims infringes on the conscience and rights of those holding different beliefs.”

Chavkin and colleagues argue that denying care would also undermine public trust in medicine. “Patients must be able to trust that the physician will put their needs first,” they write. 

Co-authors are Desiree Abu-Odeh, Columbia Mailman School; Catherine Clune-Taylor, Princeton University; Sara Dubow, Williams College; Michael Ferber, University of New Hampshire; and Ilan H. Meyer, UCLA School of Law.

Read the Perspective, “Balancing Freedom of Conscience and Equitable Access.”