Health Care Workers and Moral Objections II: Patients/Clients

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As noted in an earlier essay, the Trump administration plans to modify the Health and Human Services (HHS) civil rights office to protect health care workers who have moral or religious objections to performing certain medical procedures or treating certain patients.  In that essay I addressed the general moral issue of  whether health workers have the moral right to refuse certain services. I now turn to the general issue of whether they have the moral right to refuse to treat certain patients (or clients) based on the identity of the patients (or clients). The legal matter, of course, is something for the courts to settle.

As noted in the earlier essay, a person does not surrender their moral rights or conscience when they enter a profession. As such, it should not simply be assumed that a health care worker cannot refuse to treat a person because of the worker’s values. But, of course, it should also not be assumed that the moral or religious values of a health care worker grant them the right to refuse treatment based on the identity of the patient.

One moral argument for the right to refuse treatment because of the patient’s identity is based on the general right to refuse to provide a good or service. A key freedom, one might argue, is this freedom from compulsion. For example, an author has every right to determine who they will and will not write for.

Another moral argument for the right to refuse is a general one about the right to not be forced to interact with people whom one regards as evil or at least immoral. This can also be augmented by contending that serving the needs of an immoral person is to engage in an immoral action, if only by association. For example, a Jewish painter has every right to refuse to paint a mural for Nazis.

While these arguments have considerable appeal, especially in cases in which the refusal is directed at the sorts of people one dislikes, it is important to consider the implications of a right of refusal based on values. One obvious implication is that such a right could warrant a health care worker to refuse to treat you if they regarded you as immoral. In general terms, moral rights need to be assessed by applying a moral method I call reversing the situation. Parents and others often employ this method informally by asking questions such as “how would you feel if someone did that to you?”

Somewhat more formally, this method is based on the Golden Rule: “do unto others as you would have them do unto you.” Assuming this rule is correct, if a person is unwilling to abide by his own principles when the situation is reversed, then it is reasonable to question those principles. In the case at hand, while a person might be fine with the right to refuse services to those they dislike because of their values, they would presumably not be fine with it if the situation were reversed.

An obvious objection is that reversing the situation would, strictly speaking, only apply to health workers themselves. Fortunately, there is a modified version of this method that would apply to everyone. In this method one test of a moral right, principle or rule is for a person to replace the proposed target of the right, principle or rule with themselves or a group (or groups) they belong to. For example, a Christian who thinks it is morally fine to refuse services to transgender people based on religious freedom should consider their thoughts on atheists refusing services to Christians based on religious freedom. Naturally, a person could insist that the right, rule or principle should only be applied to those they do not like—but if anyone can take this out, then it would seem everyone could as well, thus the objection would fail.

One reasonable reply to this method is to point out that there are clear exceptions to its application. For example, while most Christians are fine with convicted murders being locked up, it does that follow that they are wrong about this because they would not want to be locked up for being Christians. In such cases, which also applies to reversing the situation, it can be argued that there is a morally relevant difference between the two people or groups that justifies the difference in treatment. For example, convicted murders generally deserve to be punished for being murders while Christians obviously do not merit punishment just for being Christians. As such, when considering the moral right of health care workers to refuse services based on the identity of the patient (or client) the possibility of relevant differences must be given due consideration.

The obvious problem with relevant difference considerations is that people will tend to think there is a relevant difference between themselves and those they want to apply the right of refusal. For example, a person who is a social justice warrior might regard a member of the alt-right as an evil racist and see this as a relevant difference that warrants refusing service to such a person. One solution is to appeal to an objective moral judge—but this creates the obvious problem of finding such a person. Another solution is for the person to take special pains to be objective—but this is rather difficult and especially so in cases in which objectivity is often most needed.

A final relevant consideration is the fact that while entering a profession does not strip a person of their conscience or moral agency, it often imposes professional ethics on the person that supersede their own values within the professional context. For example, lawyers must accept a professional ethics that requires them to keep certain secrets their client might have (the most obvious being when they did the crime) even when doing so might violate their personal ethics. As another example, lawyers (especially public defenders) are expected to defend their clients even if they find their clients morally awful. As a third example, as a professor I (in general) cannot insist that a student be removed from my class by appealing to my religious or moral values regarding the identity of the student. As a professor, I am obligated to teach anyone enrolled in my class, if they do not engage in behavior that would warrant their removal (such as assaulting other students). Health care workers generally fall under professional ethics as well and these typically include requirements to render care to people regardless of what the worker things of the morality of the person. For example, a doctor does not have the right to refuse to perform surgery on someone just because they committed adultery, are a compulsive liar, have engaged in shady and even illegal business practices or expressed their proclivity to grab people by a certain part of their anatomy. This is not to say that there cannot be exceptions, but professional medical ethics would seem to forbid refusing service just because of the moral judgment by the service provider of the patient (or client). This, obviously enough, is distinct from refusing services because a patient or client has engaged in behavior that warrants refusal, such as attacking the service provider.

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