Conscience Claims

Conscience claims can arise in many contexts. Perhaps the most famous is conscientious objection to military service, which has a history going back to the beginning of the nation when Quakers objected to military service on religious grounds. Of course the most famous conscientious objection cases occurred during the Vietnam War, when the issue came to the fore in public discourse. Several court cases arose from conscientious objector claims during that era. Yet it is in the healthcare context that conscience claims have been most prevalent in recent years. In this context, even the term “conscience claim” is controversial. This is the language often used by those advocating for conscience based exemptions to healthcare requirements. Opponents refer to them as “refusal claims”, because they allow healthcare providers to refuse to provide services that they would otherwise be legally required to provide. I understand that the terminology one chooses to use is not just a matter of semantics, but I decided to use the term “conscience” rather than “refusal.” Although I agree with those who focus on the significant concerns that arise for women's healthcare when certain forms of conscience claims are protected without consideration of the impact on third parties, the simple fact is that these “refusals” are indeed based on religious or moral “conscience.” Therefore the term “conscience” is the better representation of the reasons why we have these exemptions, even if it is not the better representation of the effects that these exemptions may have when they are written in a way that does not consider patients’ rights. By choosing to use the term “conscience,” I am not picking sides on the broader issues relating to reproductive rights – as will be seen clearly in this chapter; rather, I am acknowledging that despite the power of words to define the nature of a phenomenon such as conscience or refusal, there are ways to protect interests on both sides regardless of which term one uses. So, to those of you who prefer the term “refusal,” please do not assume that your position will be ignored or undervalued because I have chosen to use the term “conscience.”