The Importance of Orientation: Review of 'Health Care Providers’ Consciences and Patients’ Needs: The Quest for Balance'

Abstract

In June, 2011, as it was becoming clear that the United States was moving towards a major confrontation on freedom of conscience in health care, the Brookings Institution in Washington, D.C. convened a symposium of theologians, philosophers, legal scholars, health practitioners and advocates representing different perspectives on the subject. The proceedings informed independent research by William A. Galston, a Senior Fellow at Brookings, and Melissa Rogers, director of Wake Forest University Divinity School’s Center for Religion and Public Affairs. Drawing from the symposium when appropriate, but citing or quoting participants only with their express permission, Galston and Rogers produced Care Providers’ Consciences and Patients’ Needs: The Quest for Balance, a report that reflects their own views on freedom of conscience in health care. It is hardly surprising that the authors focus on what others (not the authors) have called “the problem of conscientious objection.” However, even if the controversy begins with conscientious objection (and that is disputed) it does not follow that the problem is conscientious objection. One could as readily describe the problem as one of intolerance for moral or religious beliefs, or of social irresponsibility: that too many American health care workers are unwilling to do what they believe to be gravely wrong. The authors’ decision to discuss conscientious objection in health care rather than intolerance of moral beliefs suggests an orientation that is suspicious of the convictions of those who challenge the dominant professional and cultural ethos. Thus, the report has an orientation subtly but decidedly adverse to the exercise of freedom of conscience in health care. However, the cool, careful, measured and even-handed approach taken by the authors is admirable and particularly welcome. The authors are seeking common ground among those who believe that protecting freedom of conscience and securing access to health care are both important goals. They hope to encourage good will on all sides so that competing claims can be accomodated to the greatest extent possible. Health Care Providers’ Consciences and Patients’ Needs: The Quest for Balance makes a good start in that direction. It is a significant contribution to the current debate in the United States about freedom of conscience in healthcare, notwithstanding the reservations and criticism offered above. The authors have indicated that the report is subject to revision. One hopes that a future revision will incorporate the broader context and change of orientation suggested here.