Conscience in Transgender Health Care: Yet Another Area Where We Should Be Prioritizing Patient Interests

Abstract

1. Setting the stage McLeod (2020) focuses her book on what she calls “typical refusals in reproductive healthcare.” She defines this at several points, describing these as primarily refusals that “target services that are standard (legal and professionally accepted) and that the objectors believe will result in the death of a human being that has the moral or religious status of a person (e.g., a fetus or embryo)” (136). Abortion is one procedure that is commonly targeted by “typical refusals.” McLeod notes that clinicians engaging in such refusals may refuse not only the procedure itself but also to make a referral for a procedure because they find this kind of indirect complicity to still be a violation of conscience (104). This rejection of referrals constitutes a rejection of attempts to find a compromise position that treats the clinician and the patient as equals. By contrast, McLeod draws our attention through the book to the irrefutable fact that, as socially-licensed gatekeepers of access to medical care, clinicians are not equal to patients. Instead, they have dramatically more power. This creates obligations of care in the exercise of that power and in particular should make us look for ways to give patients more power, or at least to protect them from the harms that clinician power, exercised in the form of refusal to provide care, can cause. This is no small part of why McLeod argues for a “patient prioritization” approach. And yet, McLeod is careful not to casually sweep aside the harms of requiring someone to act against their conscience. Please note that in substance, I do not disagree with McLeod’s patient prioritization view: When clinician conscience seems to require refusing care to a patient who is seeking that care, the power dynamic that inherently exists can only be balanced by patient prioritization. Like McLeod, I do not think the harms to clinician integrity of being compelled to do something they consider immoral can be lightly dismissed. But there is a great deal more to be said and considered, here, some of which would greatly complicate the relationship between 10.3138/ijfab-15.2.12 15 2