The risk in a Biden reversal of medical conscience protections

President Biden.
President Biden. Illustrated | Getty Images, iStock

"The Biden administration is preparing to scrap a Trump-era rule that allows medical workers to refuse to provide services that conflict with their religious or moral beliefs," Politico reported Tuesday, citing "three people familiar with the deliberations." The exact scope of the prospective update isn't clear, but the Department of Health and Human Services confirmed it's coming.

In one sense, the change is irrelevant. Introduced in 2019, the rule in question would have denied federal funding to health-care organizations that don't allow staff to opt out of participation in abortions, procedures related to gender transition, assisted suicide, and the like. But it was blocked in federal court before it took effect and so has never been implemented. The Biden administration's "change" would merely confirm the status quo. Moreover, cases where health-care workers are forced to perform services they believe to be immoral (or fired for refusing to do so) seem to be relatively rare. They do happen, but most states already have laws on the books providing at least some conscience protections for medical professionals.

Still, the federal reversal is a step in the wrong direction on two counts. One is a matter of principle: The government technically isn't forcing doctors who believe abortion is murder to perform abortions. This isn't a straightforward mandate, because the doctors can, of course, quit their jobs instead. But federal endorsement of organizational policies that require employees to choose between conscience and livelihood does not exactly evince a civil libertarian spirit. It isn't a clear-cut state violation of freedom of conscience or religious liberty, yet it does give the government's blessing (and dollars) to private rejection of very serious claims of conscience.

Then there's the practical side of things. Politico quotes Jacqueline Ayers of Planned Parenthood, who says the change would "help ensure people can access the health care and information they need when they need it." If this revocation — of a rule, again, that never took effect and is already broadly echoed at the state level — changes anything, I suspect the opposite would be true.

Were medical professionals widely required to work in violation of their consciences, many would leave their fields, change their specialties, or outright refuse to take on certain patients — something doctors, in particular, will always be able to do by citing facially neutral concerns like workload. In the worst case, I can imagine situations where a medical worker forced to act against conscience would deliberately misdiagnose or mistreat a patient, rationalizing that this is the lesser sin.

Compelling any violation of conscience is a very grave proposal. Compelling it of medical staff is uniquely risky, too.

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