In good conscience? “Convictions of conscience” clauses

What if Lucy refused help to Charlie Brown? Where would he go?

You’ve probably paid a bit of attention to the national debate over birth control coverage on moral grounds for religiously-affiliated employers earlier this year (or in my case, turned off the TV in anger). Well, sort of similar things have been happening across the country in the mental health field for the past few years. Groups are pushing for “convictions of conscious” clauses that would allow counselors to both refuse services and refuse referrals on certain issues or for certain clients on moral grounds. The Ward case is just a microcosm of this debate. Let’s take a look.

I’ll keep this focused on here in Nebraska, but there is similar activity in other states. A very basic explanation: the Nebraska mental health boards are under strong pressure from some religious leaders to allow mental health practitioners to refuse to both treat AND refer clients based on a practitioner’s own religious or moral beliefs. This takes some of the issues of the Ward case one step further, since Ms. Ward at least asked if she could refer her client due to her moral objections.

Can’t figure out why this is a big deal? This practice change would deny help to huge numbers of people in need. Imagine these scenarios, if you will:

  • You are a college student and are exploring non-heterosexual relationships. You’re confused, feel you have nowhere to turn, and so contact a counselor. During your first session, you bring up sexuality and…crickets. The counselor tells you that she believes that to be morally wrong and will not see you after this session. She also won’t tell you where you can go for help.
  • You and your partner have been in a committed relationship for years, but have been having some trouble for the past few months due to financial strain. You meet with a counselor, hoping to find a new and more financially stable direction in your career, and find out he won’t work with you just because you’re in a homosexual relationship. You have to find someone else, and aren’t sure where to start.
  • You are a 16-year-old girl and find out you are pregnant. You are seriously contemplating an abortion but want to make sure that’s the right choice for you. You live in a tiny rural town and contact one of the few counselors in the area, but she won’t see you anymore because she doesn’t support abortions. She won’t refer you, and it doesn’t matter anyway because the remaining two counselors nearby won’t see you due to moral objections, either.

That’s not what counseling is all about, folks. Counseling is all about meeting the client where THEY are (not you!) and working towards solutions or goals that work for THEM (not you!).

“Convictions of conscience” clauses are a pretty clear violation of several key parts of our ethical code, including valuing diversity, avoiding values imposition, and referring when necessary, and in order to call ourselves professional counselors, we need to abide by this code. Ignoring parts of the ethical code we don’t like erodes the credibility and standards of the entire counseling profession.

When we choose a career, we must look at our values and how that career fits with our values. If the nature of the job chafes us, it’s probably not a good fit. For example, I briefly held a retail job in which I was required to ask customers if they wanted to open a store credit card. I left, in part, because this practice seemed irresponsible and customer debt was probably the reason the store could offer such deep discounts. Other people don’t have a problem with the job, feeling instead that customers have a choice in opening a credit account, so it’s a better job for them. If you’re considering becoming a professional counselor but don’t believe in working with certain groups, then perhaps it isn’t the field for you.

In the end, it’s not about us counselors and our needs, at all. It’s about our present and future clients and their needs. We aren’t missionaries, spreading our ideas about how the world should work. We are helping our clients discover what is right and true for them, and that may look very, very different than what is right and true for us. Refusing to counsel and refer someone because they are different sends a pretty clear message to that person , and further marginalizes already-marginalized groups. I have my own triggers and hot-button issues, but even if a client touched on every single one of these, I couldn’t leave that person without help, either from me or from one of my colleagues. Not in good conscience, anyway.

Do you live in a state considering similar actions? I’d love to hear more–the issue is called something a little different in each place and thus it’s kind of tricky to research.

Thanks to Dr. Julie Dinsmore for supplying me with some resources when I hit a research roadblock!


ACA Amicus Brief in Ward vs. Wilbanks et. al

ACA Code of Ethics

Mims, G., Mims, M., Dinsmore, J., & Hof, D. (2012). “The ‘convictions of conscience’ clause: Clinicians and consumers beware.” Paper based on a March 2012 presentation given at the American Counseling Association conference. (As a note, I borrowed the phrase “convictions of conscience” clauses from this paper.)

APA Practice Central (2009) article

Photo credit: Let’s skip where I found the above image and acknowledge where it really came from, A Charlie Brown Christmas, and give credit to the master cartoonist himself, Charles Schulz. The best.


3 thoughts on “In good conscience? “Convictions of conscience” clauses

  1. Pingback: And now, from the Department of Crazy… « Feet in Two Worlds

  2. You don’t get to impose your personal morals on other people. That’s not freedom and that’s not freedom of choice either and not what this country was founded upon. This bull$hit is very un-Constututional! No one should be allowed to deny others good or services based upon their own moral or religious beliefs – especially doctors! Are we progressive or regressing? WTF is this country coming to?

  3. “convictions of conscience” Pft! What kind of conscience does any doctor have to deny someone treatment and help they need based upon their disagreement of this other person’s beliefs or morals. Such bigotry! What about the hypocritic oath? (not a typo)

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