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A First Amendment Crisis in Health Care

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization. 

By Benjamin Kalinkowitz
February 19, 2018

Last month, the Trump Administration announced a new rule allowing health care providers to disregard evidence and researched best practices in patient care in favor of religious or moral beliefs. Rather than requiring providers to wrestle with personal ethical dilemmas to provide high quality care, the new rule will allow them to refuse to provide treatment in a wide variety of scenarios. Rather than serving the greater good by protecting the beliefs of practitioners, the new rule gives religious and moral objectors an easy way out, devaluing the role of health care providers, undermining our oaths and obligations to the public at large, and offering sub-par care to the patient in front of us.

Much has changed in medicine over the past century – and most of it for the better. In the not-too-distant past, the public imbued healthcare providers with almost god-like powers. Doctors were infallible authority figures that were to be obeyed, not merely experts in human anatomy and physiology. But health care delivery has evolved: the person sitting on the table is no longer an object to be fixed, but is a human being whose individual experiences, history and wishes the practitioner must make an effort to understand. Practitioners owe the patient the opportunity to understand the findings and their options to the best of their understanding, so that they can make an informed choice about what treatments are done or not done to their body. This therapeutic alliance gives the patient autonomy over their body. It is not only ethically important, but a path to better outcomes; when patients feel invested and in control of their course of treatment, they are more likely to feel empowered and have a more successful outcome. With the patient as partner, rather than an object of care, the health care practitioner must balance their needs with those of the patients they treat.

These shifts in health care delivery have made ethical and moral conflict a regular feature of medical practice, but not one that has been ignored. If my patient wants to pursue a course of treatment that I do not agree with or have moral issues with, I was not required to provide those services, even before this rule came into effect. However, I continued to have an obligation to the patient. Ethically, I could discuss my objections or reservations and direct them to a provider who can provide those services, allowing me to maintain my beliefs while simultaneously respecting the patient’s beliefs and autonomy. This moral and ethical calculation figures in the daily practice of many healthcare professionals. For example, when faced with parents who refuse to vaccinate their children, pediatricians face an ethical quandary. They cannot force vaccination or coerce unwilling parents, nor can they ignore the risk that unvaccinated children pose to public health and their vulnerable patients who depend on herd immunity to protect them. While many pediatricians refuse to accept unvaccinated children into their practice, they have still spent time and care to help these families find providers and receive care for their children.

And so, at best, the administration’s new rule addresses a problem where a viable solution already exists. At worst, by circumventing the need for careful thought and gentle handling of these situations, the rule damages the patient-practitioner relationship and creates the possibility of sub-standard care where it is applied. Just like public administrators, health care providers are entrusted to balance our own beliefs and rights with the rights and needs of those we serve. This delicate balance is crucial to maintaining our individual integrity, as well as the integrity of our diverse culture and democratic system.

By giving medical providers the ability to dictate which services are available based on their religious beliefs, the Trump Administration is setting a dangerous precedent: under the guise of protecting religious freedom, the new rule undermines patient autonomy and access to the health care market, and sends health care delivery on a path back to the dark ages of paternalism. We cannot afford to sacrifice Americans’ health on the altar of religious freedom.


Author: Benjamin Kalinkowitz, PT, DPT, MPA earned his Masters in Physical Therapy from Hunter College-CUNY, his Doctorate in Physical Therapy from the University of Kansas, and his MPA from the University of Nebraska at Omaha. Dr. Kalinkowitz has been a practicing physical therapist for over 10 years, having spent 8 years working at the Department of Veterans Affairs, and currently in practice at a hospital based outpatient clinic in New Jersey. All views expressed are the author’s alone, and do not necessarily represent the views of his current or former employers. Email: [email protected] Twitter @BenKalinkowitz

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