Department of Obstetrics and Gynecology, the Section of Family Planning and Contraceptive Research, Department of Obstetrics and Gynecology, and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois.
Obstet Gynecol. 2016 Aug;128(2):391-395. doi: 10.1097/AOG.0000000000001526.
Since abortion became legal nationwide, federal and state "conscience clauses" have been established to define the context in which health professionals may decline to participate in contested services. Patients and health care providers may act according to conscience in making health care decisions and in deciding whether to abstain from or to participate in contested services. Historically, however, conscience clauses largely have equated conscience in health care with provider abstinence from such services. We propose a framework to analyze the ethical implications of conscience laws. There is a rich literature on the exercise of conscience in the clinical encounter. This essay addresses the need to ensure that policy, too, is grounded in an ethical framework. We argue that the ideal law meets three standards: it protects patients' exercise of conscience, it safeguards health care providers' rights of conscience, and it does not contradict standards of ethical conduct established by professional societies. We have chosen Illinois as a test of our framework because it has one of the nation's broadest conscience clauses and because an amendment to ensure that women receive consistent access to contested services has just passed in the state legislature. Without such an amendment, Illinois law fails all three standards of our framework. If signed by the governor, the amended law will provide protections for patients' positive claims of conscience. We recommend further protections for providers' positive claims as well. Enacting such changes would offer a model for how ethics-based analysis could be applied to similar policies nationwide.
自堕胎合法化在全国范围内实施以来，联邦和州都制定了“良心条款”，以界定卫生专业人员可以拒绝参与有争议服务的情况。患者和医疗保健提供者在做出医疗保健决策以及决定是否拒绝或参与有争议的服务时，可以根据良心行事。然而，从历史上看，良心条款在很大程度上将医疗保健中的良心等同于提供者拒绝此类服务。我们提出了一个框架来分析良心法的伦理含义。关于临床实践中行使良心的问题，有大量的文献。本文探讨了确保政策也以伦理框架为基础的必要性。我们认为，理想的法律应符合三个标准：保护患者行使良心的权利，保护医疗保健提供者的良心权利，并且不违反专业协会制定的道德行为标准。我们选择伊利诺伊州作为我们框架的测试案例，因为它有全国最广泛的良心条款之一，而且州立法机构刚刚通过了一项修正案，以确保妇女能够持续获得有争议的服务。如果没有这样的修正案，伊利诺伊州的法律将不符合我们框架的所有三个标准。如果州长签署该修正案，该法律将为患者的积极良心主张提供保护。我们还建议为提供者的积极主张提供进一步的保护。颁布这样的变革将为如何在全国范围内将基于伦理的分析应用于类似政策提供一个范例。
