In Good Conscience? Examining the Abuse of Conscience Clauses in the US

Article excerpt

OVER THE LAST FEW YEARS those opposed to reproductive freedom have become more creative in placing hurdles in front of women seeking safe and legal reproductive healthcare services. One of the more recent tactics involves significantly expanding the concept of refusal clauses (also known as exemption clauses or conscience clauses) beyond protecting the religious and moral beliefs of healthcare providers. Instead, they use them as a means to refuse some treatments and medications to all comers. Under the guise of protecting religious freedom, antichoice activists--with the backing of some members of the Catholic hierarchy--have aggressively used the political process to increase these obstacles through the expansion of refusal clauses. These clauses and the range of people who can invoke them expanded under then--President George W. Bush, and have not been rescinded, despite promises from the Obama administration that they would be. The expansions relate to the object of refusal (for example, contraception, sterilization and abortion), but also the subject who may claim it-expanding it from individuals to healthcare institutions and insurance providers.


The Catholic hierarchy--through the United States Conference of Catholic Bishops (USCCB) and individual bishops--has collaborated with antichoice organizations across the country to expand these exemptions for entire hospitals or other healthcare facilities. These sweeping refusal clauses restrict patients' access to critical healthcare services and direct the focus away from the conscience of patients and their individual healthcare providers. The result is that women and men seeking legal reproductive healthcare services are routinely denied access to or have great difficulty in accessing these services.

The bishops use their interpretation of Catholic teachings to support the imposition of ever-more restrictive refusal clauses. However, the reality is that these clauses contravene the Catholic tradition. Most often, these refusal clauses are promoted as a means of protecting the consciences of those healthcare providers who have a religious or moral objection to providing some or all reproductive health services. The Catholic teaching on conscience--one that stretches back to the earliest days of Christianity--is however, much more nuanced than the one that is usually presented in legal and policy debates.

Catholic teaching requires due deference to the conscience of others in making decisions--meaning that healthcare providers must not dismiss the conscience of the person seeking care. Catholics practitioners can respect the rights of their clients and do so ethically and morally within the Catholic tradition. Catholic principles respect the conscience of providers and of patients. When patients seek care, especially in institutions that receive government support, the end result must be that a hospital, pharmacy or clinic provides the care patients need, regardless of the religious affiliation of the sponsoring entity.

The goal of any reasonable conscience clause must be to strike the right balance between the right of healthcare professionals to opt out of providing some services, most usually abortion, and the right of patients to have access to the medical care they need. Institutions should not seek to impose an ideology and should instead defer to the individual conscience of the patient by respecting her or his right to comprehensive healthcare.


Conscience clauses have gone through many permutations since they first appeared after the 1973 Roe v. Wade decision that permitted abortion in the US. Traditionally, these clauses sought to protect healthcare workers who refused to participate in certain healthcare practices such as the provision of contraception, sterilization or abortion, claiming that participation in these services violated their consciences. …