Dr. Lauris Christopher Kaldjian
- Dr. Lauris Christopher Kaldjian is a licensed physician and professor of internal medicine at the University of Iowa.
- His views do not represent the University of Iowa.
I have been a physician and teacher of ethics at the University of Iowa’s Carver College of Medicine for 24 years. During this time it has been a privilege to teach medical ethics to thousands of medical students.
One of the courses I teach is called “Oaths and Ethics”. It helps students think about what it means to take a medical oath — to make a public promise to do some things and not to do other things, and to be a certain kind of person, a person who tries to put the medical needs of patients first. We talk about ethical challenges students experience in medical school, and about the challenges they will face as doctors. As we focus on what it means to be a medical professional, we acknowledge the need for deep individual motivation to do what we believe is good and right, especially when it may be tempting to let money, ego, or convenience get in the way.
To talk about motivation brings us to our deepest moral commitments for professional service — our ethical, moral, and religious beliefs and principles. These beliefs go to the moral roots of who we are as persons and nourish the principles that guide us through our toughest days — days when we may be tempted to do what is in our own interests, or what is profitable for a hospital, insurance company, or government. These moral roots give us our integrity. And the trust that patients want to be able to place in health care professionals depends on this integrity — a trust that health care professionals will strive to do what is good and right because that is who they are.
To talk about integrity is to talk about conscience — that deep internal reality in every human being which is our knowledge of the moral value of our actions, intentions, or character. It is an ethical or religious knowledge which grips us with a sense of obligation to do what we believe is good, and to avoid what we believe is wrong. If we let go of this sense, we lose our moral compass and are likely to experience moral distress and moral injury because we violate our sense of moral identity.
Thankfully, I believe the vast majority of health care provided in the Sstate of Iowa reflects the best moral traditions of our health care professions and reflects practices marked by integrity, compassion, and competence. As citizens of Iowa, we should be grateful for all the professionals who put patients’ needs first by promoting what is good, avoiding what is harmful, respecting shared decision making between patients and professionals, and promoting justice by caring for all patients who have medical needs, especially in emergencies.
But we need to acknowledge that we also live in a morally pluralistic society. People disagree about what is good and what is harmful in life, and this includes doctors and other health care professionals. In medicine these disagreements have direct consequences, like writing (or not writing) a prescription, or performing (or not performing) a surgical procedure. These disagreements can be very disturbing because they are about fundamental aspects of our lives: about when human life begins and deserves protection; about whether it is ever right to intentionally end a human life; about how we determine a patient is dead before organs can be removed for transplantation; and about whether a person’s gender is rooted in biological sex or is treated as a matter of internal feeling and desire that warrants the destruction of healthy tissues, organs, and hormonal systems. Competing convictions about these matters are vitally important because they reflect the deep philosophical and religious beliefs that define us as persons.
Because of these deep disagreements, as a society we need to be honest about the fact that in health care today, different health care professionals have competing perspectives about what is good for patients, about what is harmful, and even about what health is. It may sound strange to hear a doctor say that health care professionals don’t always agree on what health is, but it’s true. Morally controversial practices are now simply part of the landscape of health care.
To navigate this landscape, medical practitioners, trainees, and students need legal protections to ensure their consciences are protected, so they are not forced to participate in practices they believe are wrong. As a society, if we want to respect moral diversity and moral freedom in our communities, we need to protect health care professionals and institutions from being forced into moral compromises that cut against the core of who they are.
When professionals are forced to go against their conscience, their integrity suffers, and the source of their professional motivation is weakened. This is bad for them, it’s bad for their patients, and it’s bad for society. Medicine depends on ethics, and ethics depends on the philosophical and religious convictions which form our conscience. Over the course of nearly 30 years of medical practice, I have seen these convictions motivate the care of all patients with medical needs, whether in university hospitals, private hospitals, VA hospitals, Indian Health Service hospitals, prisons, or mission hospitals overseas. Healthcare needs clinicians of conscience.
More:Iowa bill creates ‘conscience’ clause allowing health care groups to opt out of services
The Iowa Legislature is considering legislation to protect the conscience of health care professionals and institutions. We should support these protections. This legislation respects every person’s conscience, regardless of political party, philosophical viewpoint, or religious affiliation. To vote for conscience in health care is to respect the moral integrity of health professionals who are the hands, feet, and faces that make the healing professions flourish. Health care professionals need space to practice with conscience, space where we will not be forced to conform our actions to fit beliefs and belief systems we cannot endorse.
As we participate in debates surrounding the protection of conscience in the face of morally controversial practices, we need to remember that freedom of conscience in health care is not about who we are willing to care for. Women and men of good conscience want to care for all patients with medical needs. The real debate is not about whether to provide health care, but about what health care is and which medical practices promote it. Conscience protections are not about whether to care, but how to care and how to navigate ethical disagreements respectfully in a pluralistic society.
Dr. Lauris Christopher Kaldjian is a licensed physician and professor of internal medicine at the University of Iowa. He serves as a clinical ethicist at the University of Iowa Hospitals and Clinics and directs the Bioethics and Humanities program at the Carver College of Medicine. His views do not represent the University of Iowa.
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