There has been a lot of news lately about a person’s right to decline to provide a service to another for reasons of conscience.  For example, after the U.S. Supreme Court decision regarding marriage equality, the N.C. General Assembly passed legislation granting magistrates the right to decline to perform marriages for same sex couples.  Do health care providers have any similar rights of conscience in North Carolina? In several discrete circumstances, the answer is yes.

End-of-Life Care

North Carolina law allows for a living will, i.e., a declaration of a desire for a natural death.  However, any physician may decline to honor such a declaration if stopping “life-prolonging measures...would violate that physician’s conscience or the conscience-based policy of the facility” where the patient is being treated. However, the physician must cooperate with efforts to find a physician or facility that will honor the living will. The N.C. Medical Board’s position statement on  Advance Care Directives is consistent with this statute.

Lawful Abortions

Abortion is legal in North Carolina during the first 20 weeks of pregnancy and also thereafter “if there is substantial risk that continuance of the pregnancy would threaten the life or gravely impair the health of the woman.”  However, no hospital or institutional provider is required to provide abortion services, and a physician, nurse, or other health care provider who states an objection to abortion on moral, ethical, or religious grounds may refuse to perform or participate in medical procedures which result in an abortion.  Moreover, the provider cannot be sued or disciplined for refusing to participate in the abortion.

Pharmacists

The North Carolina Board of Pharmacy says that compassionate care and conscientious objection are not mutually exclusive. Pharmacists may object to providing a particular medication for moral or ethical reasons, but those who do have no right to obstruct proper dispensing or delivery, and they should take proactive measures so as not to obstruct a patient’s right to obtain such medication. In the specific case of emergency contraception, a pharmacist who objects to the medication on ethical grounds has an obligation to get the patient and the prescription to a pharmacist who will dispense that prescription in a timely manner. N.C. Board of Pharmacy, “Conscience Concerns in Pharmacist Decisions” (Revised, April 2005).

Lessons to Be Drawn

Clinicians in hospitals need to understand in advance what their facilities expect of them and plan to address issues of conscience before they arise.  Since these questions often arise when patients are vulnerable, a clinician who cannot conscientiously provide a lawful, medically acceptable procedure upon request must take action to ensure the patient’s seamless transfer to a provider who can furnish such treatment.