Compromise in the Clash of Absolutes

Despite the First Amendment of the U.S. Constitution’s declaration that “Congress shall make no law respecting an establishment of religion,” religion plays a major role in influencing American laws and policy [1]. Indeed, religion is inextricably linked to contemporary debates over evolution, same-sex marriage, contraception, and abortion. However, a recent Pew Research Center poll showed that for the first time in American history, the United States is no longer a majority Protestant nation. About one-in-five Americans identify with no religion [2]. As a result, significantly higher numbers of Americans now advocate for the restriction of religion to private life only. Advocates of lifestyles guided by religion and proponents of secularization often engage each other in “clashes of absolutes,” where each side views compromise as a threat to their fundamental beliefs.

Allowing for religious liberty exemptions in policy legislation is an effective form of compromise in the clash of absolutes. These exemptions permit individuals to legally abstain from specific aspects of laws with which they have profound religious or philosophical objections. Religious liberty exemptions are designed to help individuals avoid serious moral dilemmas between their personal beliefs and their legal obligations.

Given the diversity of viewpoints on health among the world’s religions and philosophical traditions, it is inevitable that physicians may disagree with each other on the morality of certain medical practices. Many religions disagree on the moment at which life begins; for Catholics, the fetus is considered “alive” at conception, while for Muslims, life begins approximately 120 days after conception [3]. Followers of Eastern religions such as Buddhism and Hinduism also disagree as to whether abortion constitutes a breach in the practice of non-violence, or can be permissible as the “least harmful act” if it would preserve the mother’s life or prevent undue suffering by the fetus [3].

Conflicts arise because virtually every major religion forbids the taking of innocent life, and many physicians are unwilling to abort a fetus that they consider to be “alive” [3]. To complicate matters further, US law states that the government cannot place an “undue burden on a woman’s right to obtain an abortion “before the fetus is viable” [4]. This language is intentionally vague, and thus what constitutes an “undue burden” is usually decided on a case-by-case basis. However, precedents are relative, as modern medical advances have enabled fetuses to be viable at different points in pregnancy. When Roe v. Wade was decided in 1973, premature infants with fewer than 30 weeks of gestation were unlikely to survive because their lungs had not fully developed sufficient lung surfactant, a substance which enables appropriate lung expansion [5]. However, the introduction of artificial surfactant during the late 1980’s decreased the odds of death by 67%, and in recent years, research in surfactant therapy for premature infants continues to improve likelihoods of survival [6].

The question of whether or not a fetus is viable often becomes a difficult and subjective assessment. However, since abortion before fetal viability is still a guaranteed right based on Roe v. Wade, doctors may be legally compelled to perform abortions in situations that contradict their own religious, moral, or medical opinions.

One compromise is conscientious objection (CO). CO is often associated with military conscription, where members of traditions who completely oppose violence are exempt from required military service. In medicine, a CO allows a doctor to opt out of a medical procedure that would threaten his/her moral integrity, making it a viable option for many morally-driven doctors [7]. CO recognizes the growing diversity of Americans who often identify as “spiritual but not religious,” suggesting that their ethical beliefs are influenced by a wide range of factors which may or may not include religion, and eensures that people who are strongly conscious of morality will still practice medicine, as if there were no provision for CO, it is likely medicine would be dominated by physicians who do not value medical ethics [7].

However, CO raises other concerns: physicians may be able to opt out of almost any procedure by claiming CO, and so allowing unrestricted CO is also unsustainable in that it could be applied to seemingly mundane procedures such as blood transfusions [8]. Critics of CO claim that doctors will subtly influence patient behavior by objecting to certain procedures. For example, if a woman requires an abortion to save her life but is being treated by a Catholic doctor who demands a CO, the woman may change her mind and believe that the procedure is not in her best interests. Advocates against CO believe that physicians should prioritize their patient’s well-being over all other considerations, and suggest strict conformation to a legal framework.

Despite these potential issues with CO, there is another potential compromise that could assuage both sides’ concerns known as “CO with referral.” This means that doctors are allowed to conscientiously object to legal medical procedures as long as they refer patients to another health provider that would not object. In a 2007 survey, physicians were generally supportive of this approach: 86% of respondents said that physicians should “present patients with ALL treatment options” and 71% supported conscientious objection as long as the patient was referred to a non-objecting health provider [9].

Religious physicians will not be forced to choose between respecting US law and upholding their own beliefs, since they can opt out of procedures through CO. On the other hand, patient care will not necessarily be compromised because objecting physicians will be required to refer their patients to other doctors. While doctors could potentially object to a wide variety of procedures, patients will still eventually receive necessary care through the referral process, and become more informed about treatment options and potential ethical dilemmas.

As evidenced by demographic changes and survey responses, it is clear that the U.S. is moving towards a more secular society. Religious arguments no longer carry the same moral weight as in the past. Given this trend, allowing for religious liberty is absolutely essential towards preventing a “tyranny of the majority.” We must acknowledge that our nation contains an extraordinary diversity of viewpoints while allowing each person to stay true to their own beliefs.

1. U.S. Constitution. Amendment I.
2. Pew Research Center, “The Pew Forum on Religion and Public Life.” Last modified 2012. Accessed November 13, 2012.
3. BBC Religions – Ethics, “Abortion.” Last modified 2012. Accessed November 17, 2012.
4. Planned Parenthood of Southern Pennsylvania v. Casey. 505 U.S. 833, 112 S. Ct. 2791, 120 L. Ed. 2d 674, 1992 U.S. 4751.
5. Sylvia Wrobel, “Bubbles, Babies, and Biology: The Story of Surfactant.” Journal of the Federation of American Societies for Experimental Biology. 18 no. 13 (2004): 1624e.
6. March of Dimes Foundation, “Research and Treatment: Prematurity.” Last modified 2013. Accessed March 23, 2013.
7. Douglas White, and Baruch Brody, “Would Accommodating Some Conscientious Objections by Physicians Promote Quality Healthcare?,” Journal of the American Medical Association, 305, no. 17 (2011): 1804-1805.
8. Julia Cantor, “Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine,” Massachusetts Medical Society (2009).
9. Farr Curlin, Ryan Lawrence, Marshall Chin, and John Lantos, “Religion, Conscience, and Controversial Clinical Practices,” New England Journal of Medicine, 356, no. 6 (2007): 593-600
10. Planned Parenthood of Southern Pennsylvania v. Casey. 505 U.S. 833, 112 S. Ct. 2791, 120 L. Ed. 2d 674, 1992 U.S. 4751.
11. Winter, Michael. “N.D. Lawmakers define start of life, outlaw abortion.” USA Today, sec. News, March 22, 2013.

Aamir Hussein is a senior at Georgetown University studying the Biology of Global Health. He is the co-president of the Georgetown Student Interfaith Council and an EMT-B on the Georgetown Emergency Response Medical Service (GERMS). Follow The Triple Helix Online on Twitter and join us on Facebook.