Recently introduced legislation in Michigan permits a health-care provider to deny any care to which he or she objects "as a matter of conscience" based on the provider's "ethical, moral or religious" beliefs. A companion bill extends this right of conscientious objection to health insurers. A similar Wisconsin statute identifies specific procedures that a provider may refuse to perform, ranging from abortion to in vitro fertilization.
Supporters of this legislation emphasize that they are simply protecting the moral and religious rights of health-care providers. These statutes, however, severely inhibit patients' ability to get care for - or even advice about - a range of serious health conditions.
These proposed statutes are based on two serious misunderstandings: first, a misunderstanding of the nature of religious and moral accommodation, and second, a misunderstanding of the role of the health-care provider.
In this country, we have a long tradition of accommodating religious and moral dissenters. This tradition has prevailed even with regard to the most important aspects of citizenship and even in times of crisis. We have exempted religious objectors from military service, the Supreme Court has accommodated civilian religious objectors such as the Amish and Jehovah's Witnesses, and most states have adopted broad statutes exempting religious objectors from the effects of many general regulations.
Religious accommodation in these contexts is intended to free individuals from the coercive pressure of the political majority's religious and moral values. We believe that religious and moral values should be determined by every individual, not the government. This principle sometimes produces anomalous results, however. Consider, for example, the plight of devout individuals who work for the government. Even the most pious public school teacher may not pray aloud during class time. Likewise, a fundamentalist employee of a state department of motor vehicles may not deny a female applicant a driver's license, even if the employee believes that women have a religious duty to stay home and refrain from driving. Because of the nature of their jobs, these employees are forced to bend their religious and moral beliefs to the demands of serving a diverse public. Accommodating the religious inclinations of these employees would, in effect, impose their views on other citizens - a result contrary to the principle of individual religious liberty that provides the motivation for the accommodation mandate in the first place.
While health-care providers, unlike public employees, do not necessarily work for the government, they are more like government workers than like individual conscientious objectors because they serve an indispensable role in providing a crucial public benefit to a diverse society. Health-care providers are the unavoidable gatekeepers to medical care for the entire population. It is irresponsible for them to impose their own religious and moral views on patients whom they are professionally obligated to serve.
The proposed Michigan and Wisconsin statutes are ill-advised because they misjudge where the interest of liberty truly lies and grant to health-care providers a power of moral omniscience that is inconsistent with the proper exercise of their professional duties. Legislators and health-care providers in the two states should heed the principles embodied in the Hippocratic Oath. The modern version of that oath cautions doctors to "tread with care in matters of life and death." It continues, "This awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God." The patient's care - not the provider's views - should be everyone's primary concern.
