By Adam Sonfield
Senior Policy Manager
Guttmacher Institute
- Social conservatives have used the specter of religious discrimination against doctors and nurses as cover for powerful institutions to claim religious and moral exemptions from providing a wide array of services.
- Institutional refusals pose particularly serious dangers for society, because institutions have more power and reach than individuals, often have captive audiences or few or no competitors, and can use their power to undermine public programs and policies.
- Policymakers and advocates must take steps to mitigate the scope and abuse of institutional refusals and to ensure that they are appropriately balanced against the rights and needs of individuals and society.
The issue of religious and moral exemptions—often referred to as conscience clauses or religious refusals—has reclaimed a central political stage over the past decade, with high-profile disputes over insurance coverage of contraceptives and abortion, same-sex marriage, transgender rights and more. In pressing for expanded refusal rights, social conservatives often put forward the threat of doctors or nurses being required to perform abortions, even though that has been barred by federal law and laws in almost every state since the early 1970s. There are serious harms that can come when doctors, pharmacists or other health care professionals discriminate against the patients they serve or violate legal and ethical standards of care. Therefore, there are strong reasons to limit those refusal rights, and balance them against the rights and needs of patients.
Yet, behind these persistent debates over individual refusal have been long-simmering and in many ways considerably more dangerous attempts to expand refusal rights for institutions. In some cases, social conservatives have worked to expand the scope of laws designed to provide refusal rights to individuals by insisting that owners or CEOs of an institution should be able to refuse on behalf of the entire institution. In other cases, they have used individual refusal rights as political cover for pushing for new refusal policies that expand rights for institutions. Either way, the result is the same: Giving new power to already powerful health care, educational and social services institutions to impose their values and agenda on society.
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