The VA has made an impressive commitment to end health care disparities for veteran LGBT patients, but much less is known about the health care quality gaps for ADSMs. In both cases, legislation like that enacted in Tennessee only places additional obstacles on that steep climb to health care equity.
Not even the most impassioned advocate of social justice would likely say that a counselor or a nurse is not entitled to have personal beliefs and values. Codes of ethics, hospital policies, and state and federal laws often contain “conscience clauses” allowing persons to decline to participate in procedures that violate their religious and moral beliefs—we will explore this further in a later editorial. But a procedure, for example, prescribing a medication or doing a surgery is different from refusing to serve an entire group of persons on the basis of a characteristic that is neither chosen nor changeable.
A conscience clause summoned to defend or disguise clearly discriminatory actions is invalidated and self-contradictory because it violates the most essential ethical principle, that all human beings are worthy of respect and dignity. Conscientious objection on the grounds of personal religion or morality in health care ends where discrimination against a class of persons denying clinically indicated treatment begins.9
There are multiple clinically concerning implications of this legislation for federal practice. We are only too aware that our organizations historically have failed to safeguard the rights and dignity of ADSMs or veterans who belong to many types of minority groups. But recently we have made progress in addressing these health care disparities especially for the VA LGBT community.10 Legislation like that passed in Tennessee and proposed in other states threatens to undermine these gains for those who served honorably and those who still put their life on the line to defend “liberty and justice for all.”
Even if we continue to uphold high moral and legal principles in regards to the patients we treat in our institutions, millions of ADSM and veterans receive their care in the community, especially with the advent of the Choice Act. Our duty to care must begin within our federal auspices to ensure that all those we treat receive health care with dignity, but it must extend outside the walls of our institutions to protect those who have been or are now in uniform against discrimination in health care.