Conscientious objection is the refusal to perform a legal role or responsibility because of personal beliefs. In health care, this involves practitioners not providing certain treatments to their patients based on reasons of morality or “conscience.” While there may be good reasons to accommodate conscientious objections of clinical providers, the exercise of rights and beliefs of the provider has an impact on a patient’s health and/or their access to care. The traditional contexts of conscientious objection are abortion, sterilization, emergency contraception and physician-assisted suicide. Conscientious objection negatively impacts the deliverance of healthcare in the LGBTQ+ community because providers may refuse to deliver care to a community that they do not support.
While there have been significant advancements in public policy in recent years, the LGBTQ+ community still faces discrimination in healthcare. Research conducted by the U.S. National Library of Medicine suggests that LGBTQ individuals face health disparities linked to societal stigma, discrimination and denial of their civil and human rights. This discrimination has been associated with high rates of psychiatric disorders, substance abuse and suicide. If conscientious objection language is protected under public policy, a medical provider could refuse to prescribe PrEP to an LGBTQ patient looking to reduce their risk of contracting HIV, refuse to provide gender-affirming care to trans and nonbinary patients or puberty blockers to transgender minors.
One commonly held view by bioethicists is that the health care system depends on physicians having the space to act on their conscience, and they hold that a tolerant society should not compel health care workers to perform practices in violation of their conscience. The ethical dilemma around conscientious objection is that health care providers can refuse to provide services to underrepresented communities because the procedure does not align with their values.
Conscientious objection continues to spark debate in federal law. According to The Miami Herald, Florida GOP lawmakers want to strengthen healthcare conscience legislation. In January 2022, the Florida Legislature began moving forward with a bill that would allow healthcare providers to act on their conscience when deciding whether to provide certain treatments for patients. The measure would provide protections for a healthcare provider or insurer to avoid non-emergency procedures that they believe go against their religious, moral or ethical beliefs. Religiously affiliated healthcare companies would be cleared to make staffing, employment and contracting decisions in accordance with those beliefs under the bill, House Bill 747. Given the bill’s language, many lawmakers wonder, what’s to stop a drug user from being refused treatment by a doctor morally opposed to illegal drugs? Or an anti-war doctor from treating a veteran? With these questions in mind, there has been talk of amending the legislation to make it clear that federal statutes act as an appropriate guardrail for his bill.
Conscientious objection may be acceptable when carried out with sensitivity towards the vulnerable patient, but it should not be used to prevent the care of an already underrepresented community. As someone who wants to work in health care, I believe it is time to combat the ways health care providers complicate healthcare for patients, particularly those who are the most vulnerable and historically excluded from receiving equitable care.