Patients Need Doctors with Consciences

"Conscience clauses" define conscience as "religious beliefs" or "moral convictions," and they come up, therefore, usually in relation to women's reproductive rights. This article argues that conscience is better understood as a feeling of integrity, rightness, and self, and that we need it especially now, as huge corporations take over health care. After an illustrative story, the author reviews the history of patients' rights and also the health-care consumer movement, which introduced the idea that health care is a commodity, and the doctor, therefore, simply a tradesman, whose duty is to provide what his patient wants. The author examines where this new commercial model of medicine leads: patients demanding treatments that are bad for them and expensive for the health-care system; doctors who are forced to do what they think is wrong; a world where patients cannot trust their physicians to do their best for them. Patients need their doctors to have consciences. But in this time of expanding corporate power in health care, can the right to have a conscience also be a Trojan horse? Protecting corporate entities who legally are also entitled to have a conscience? The author proposes that the most powerful rule of conscience is the oldest, the Hippocratic oath's formulation that doctors should enter the exam room solely for the benefit of their patients. When the definition of "benefit" comes into question, then we should use the strategies developed over the past 45 years-shared decision making, ethics committees, media oversight-all of which will become ever more important as technology creates ever new dilemmas for conscience.