What has been missing from the on-going controversy over contraception and conscience–beside the voices of women–has been a useful way of thinking through how to balance equal and competing claims. In this case, the claim to equal and quality access to health care has run into the claim that the caregiver should violate ones own conscience in providing care.
Part of the problem is that not only have Catholic Bishops have not only politicized the issue, they refuse to apply their own standards of debate within Catholic moral theology. Part of this is that they refuse to see access to contraception as a competing good, and they refuse to recognize the validity of other views–even within Catholicism. Consequently all they do is complain and criticize. They, and the politicians who have jumped on this bandwagon, have refused to recommend any solutions that can move the conversation forward, settling instead to label the President and call their opponents names.
There has to be a better way.
William A. Galston and Melissa Rogers of the Brookings Institution have written a useful guide, “Health care Providers’ Consciences and Patients’ Needs: The Quest for Balance” that walks the reader through the questions of conscience, the law and medical ethics and have suggested some principles that policy-makers, health-care providers and religious leaders might use in figuring out how to balance those who want to refrain or withhold treatment for reasons of conscience and the need to provide equal and quality access of care.
The paper is well written and provides a very good framework for ethicists, policy-makers and laypeople to begin discussion.
They know that by itself no paper will solve the problem. People have to come together and work through the hard issues together.
…These…controversies raise fundamental—and politically consequential—questions…. But they take place against a backdrop of longstanding tensions between claims of conscience and laws of broad scope and application—tensions well-known to experts but less so to public officials and most citizens. Knowing that the implementation of federal health care reform was bound to expose these tensions, the Brookings Project on Religion, Policy and Politics convened a day-long, off-the-record consultation in June 2011 (participants are quoted herein only by specific permission) involving theologians, moral philosophers, legal scholars, health practitioners, and advocates reflecting perspectives on all sides of these issues. This report is informed by that discussion as well as research the co-authors independently conducted. It is not an attempt to reflect a group consensus on these issues. The report sets forth the thoughts and conclusions of the authors.
While the co-authors are under no illusion that this or any report could settle controversies that have been raging for centuries, we hope that it can contribute to a better informed and more open-minded discussion about how to proceed. Although there is no way of resolving clashes over first principles, we believe that good will on all sides can often open a path to balanced approaches that respect and, to the greatest extent possible, accommodate competing claims.
Galston and Rogers conclude with eleven principles that can help move the conversation forward and which, if followed, could make for sensible, balanced policy and practice.
1. Don’t spend much time looking for bright-line solutions.
2. Accept the presumption of non-discrimination and equal treatment of individuals as a basis for public policy
3. Whenever possible, move the debate from principles to specifics.
4. Distinguish between what matters and what doesn’t.
5. Take the logic of institutions seriously.
6. Recognize that the right of conscience includes a right to decline to participate in the delivery of services, but it does not include a right to attempt to block a patient’s access to those services.
7. Make early and full disclosure of conscientious objections to the patient the rule, as well as complete and prompt disclosure of available alternative for service.
8. Recognize that the right to conscientious objection does not encompass a right to proselytize, condemn, or harass patients.
8. Acknowledge that defending the right of conscientious objection isn’t the same as defending the merits of the objection itself.
10. Recognize that moral diversity in the health care profession is a public good.
11. Always look for ways of including competing principles and divergent interest.