When we think about harm, we typically think of physical or psychological suffering. But ethicists point out that we can also suffer “moral injury” when forced to do something at odds with our deeply held values.

Moral injury is often associated with military veterans. It can also occur in health care, however, when providers are coerced to offer care that violates their conscience. In fact, moral injury plays an important role in a case now before the Supreme Court, in which doctors opposed to abortion argue that the availability of mifepristone, a drug used to induce abortion, could force them to participate in the procedure.

As a sociologist who works in bioethics, I am interested in the ways conscience influences caregiver decisions about whether to take part in certain services. There are legal protections for “conscientious objection,” but the role of conscience in health care is much richer and more complicated than these laws allow. In medicine there are both conscientious objectors and conscientious providers.

In March 2024, the Supreme Court heard oral arguments challenging the Food and Drug Administration’s decisions that expanded access to mifepristone.

First approved by the FDA in 2000, the drug has been widely used with few side effects. In 2016, the agency lowered the recommended dose, extended the weeks of pregnancy when it could be used, and allowed nurse practitioners and physician assistants to prescribe it. Further changes in 2021 made it possible to dispense the medicine by mail.

In 2022, the Supreme Court overruled Roe v. Wade, deciding that the Constitution did not protect the right to abortion. Soon after, a number of medical associations opposed to abortion rights challenged the FDA’s 2016 and 2021 decisions.

The case eventually made its way to the Supreme Court, where the first step was to decide whether the plaintiffs had the right to sue, which could be granted only if they had been harmed by the FDA decisions.

The plaintiffs claimed the FDA’s new guidelines put them at risk of “conscience injury.” They argued that mifepristone might result in complications that would send a woman to an emergency room where, as the only nurse or doctor on duty, they might be forced to take part in terminating a pregnancy.

Much of the oral argument focused on the fact that mifepristone rarely causes complications and that, in any case, federal “conscience clause” laws allow medical personnel to decline to participate in care they find morally troubling.

The first U.S. law allowing medical personnel to refuse to provide care that offends their beliefs was passed in 1973, shortly after the Supreme Court affirmed the right to abortion. Known as the Church Amendments, the law prohibits institutions that receive federal funds from requiring employees to participate in sterilizations or abortions, if doing so would go against their religious or moral convictions.

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