Conscience is a fundamental aspect of what it is to be human. Conscience is the ability to distinguish between good and bad action and strive to live in conformity with the virtue of integrity. The formation of conscience and its role in human actions is perhaps the most critical aspect of a person’s character. Many religious and secular authorities agree that the protection of conscience is a fundamental human right. However, in an age of increasing moral relativism, conscience is relegated to a secondary status in the discussion of human rights. Instead, primary importance is placed on transitory cultural trends that are often disassociated from true moral goodness and the pursuit of the common good.
Conflicts between professional ethics and patient autonomy represent the height of this modern dilemma. Patients often request medical procedures that violate the sanctity of human life, the goodness of the created order, bodily integrity, and the protection of the vulnerable. Physicians, in the name of compassion, frequently are asked to facilitate acts of abortion, assisted suicide, euthanasia, sterilization, sexual promiscuity, transsexual surgery, assisted fertility procedures, etc. A robust argument against all these acts is articulated by the natural law, human experience and in the Catholic tradition—divine revelation. If a physician’s conscience dictates not to participate in these requests, he or she ought to be defended by standards of practice, medical societies, and legislative action. Moreover, not only should physicians be exempt from participating in immoral practices, their rights to educate and exhort their patients and others as to the reasons for their ethical principles and positions also must be protected. Conscience protection is only the bare minimum expectation in a healthy society, and the right to convince others of the truth of one’s moral insight should also be enshrined in a similar fashion. By its very nature, truth attracts. Therefore, the Catholic Medical Association supports conscience protection for all health care workers and facilities without compromise. Nothing less is acceptable.
If the patient, an employer or supervisor, or the law, insists on a referral/consultation for an immoral action or procedure, Catholic healthcare workers must not formally cooperate with such requests. They also may not participate in immediate material cooperation in which the assistance they provide is essential to the completion of the act. To avoid claims of patient abandonment, a physician may express an objection to the physician’s supervisor for a change of assignment.If the patient is insistent on pursuing an immoral choice, the physician may be unable to prevent this, thus, necessitating a transfer of the patient to another health care provider chosen by the patient or the physician’s supervisor. Ultimately, the patient is an independent moral agent who is free to decide where and from whom he or she will seek care. The physician is to make his or her objections known to the patient and must not indicate where the patient might go to receive the immoral procedure or otherwise direct the patient to it A general list of other providers or institutions based on geographic vicinity or even area of specialty might be provided; however, the list may not be developed based on the criterion of whether they are known or believed to offer the immoral procedure. In practice, this means that the list must include any providers or institutions that fit the chosen criterion (geography, specialty, both, or other) and also oppose the immoral practice. In the case of objections to contraception, for example, a list of local gynecologists should include those who offer only natural family planning.
The physician should release all medical records in accordance with statutory regulations. Ideally, health care institutions and the law should favor norms assuring morally questionable or objectionable consults can be arranged solely by patient request, exempting the objecting physician from any entanglement in the process of referral. The rights of the objecting physician should also apply to any health care worker with deeply held ethical or religious beliefs.
It must be stated emphatically that Catholic Medical Association stands by these principles not only to protect the rights of medical and other health care practitioners and Catholic facilities, but also because it believes immoral and unethical procedures are not in the patient’s best interest and hurt patients physically, psychologically, and spiritually. This vision is holistic and fundamental to the entire tradition of Western medicine. Physicians are called to serve and love their patients by adhering to their well-formed conscience in the practice of medicine. Following their conscience is the sole guarantee of fulfilling that calling.
Approved by the Board – October 6, 2021