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Medical Martyrdom? How to Defend Your Right of Conscience

by David Stevens, MD, MA (Ethics)
Today's Christian Doctor - Fall 2007

If some have their way, you may soon have to either amputate your conscience or fall on your professional sword and abandon your career.

The Washington State Pharmacy Board, after Governor Chris Gregoire threatened to replace them, unanimously ruled in April 2007 that pharmacists must stock and dispense all legally prescribed medications regardless of any moral or religious objections they may have. The regulation states that the patient’s “right to a prescription” supersedes their individual right of conscience. If you don’t comply – you lose your license.

In April, 2005, Governor Rod Blagojevich issued an executive order stripping Illinois pharmacists of their right of conscience protection in dispensing potential abortafacients.

In California, a Christian physicians group is being sued for discrimination for refusing to perform in vitro fertilization on a lesbian even though they disclosed, before she was accepted as a patient, that they did not perform IVF on unmarried women. CMDA has filed an amicus brief with the Christian Legal Society in this case that is headed for the California Supreme Court.

NARAL, Planned Parenthood, the ACLU and other groups have mounted an all out, take no prisoners assault on the right of conscience, which they in disdain refer to as the “right of refusal.” Planned Parenthood’s website claims, “Health-related decisions made between a provider and patient should be made on the personal welfare and health-care needs of the patient - not the morals or beliefs of the caregivers. . . . While we firmly believe that all people have a right to their own opinions and moral beliefs, it is unethical for health care providers to stand in the way of a woman’s access to safe, effective, legal, and professional health care.”

The ACLU publishes an advocacy kit teaching members how to coerce hospitals, including Catholic ones, to provide abortion services. The Pro-Choice Resource Center’s “Spotlight Project’s” goal is to build a network of opposition to “conscience” or patient abandonment clauses that allow doctors, pharmacists, and entire hospital systems to deny women access to services like abortion.

These and other efforts are racking up success after success – forcing a private community hospital to do late term abortions, preventing mergers, requiring Catholic insurance companies to cover contraceptives, and much more.

Of all the issues Christian doctor’s face, this is the one I’m most concerned about. If we do not have the freedom to practice healthcare in accordance with our deeply held religious and moral convictions, all the other ethical issues we face will be lost for the simple reason there will be no Christians in healthcare.

That is not just my conclusion. Recently, I was debating one of Planned Parenthood’s lawyers on an hour-long coast-to-coast NPR radio show when she stated, “If a doctor is not willing to do a legal procedure, they shouldn’t be in healthcare!”

Right of conscience issues involve much more than just the ones surrounding abortion. They include contraception, sterilization, physician-assisted suicide, and participating in executions. Many more loom on the horizon – human cloning, therapies derived from human embryonic stem cells, genetic enhancement, euthanasia, trait selection, trans-humanism, and others.

This is not a new issue. The right of conscience was a moral debate over 2,500 years ago when a group of physicians decided there were certain things which, even though permitted, they would not do. They agreed, among other things, that it was a violation of their conscience to give a deadly drug to anybody if asked for it or to give to a woman an abortive remedy. Before Hippocrates, patients did not know if their physician would cure them or kill them, heal them or take sexual advantage of them or would share the intimate details of their medical history with others. He and his followers started a dramatically different form of medicine based on their consciences and patients voted with their feet.

So how do you and I defend our right of conscience? Here are the key points I make:

  1. The right of conscience is one of the most fundamental and precious rights that our country was founded upon. The First Amendment to the Bill of Rights says, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.” It is informative to look at the different versions of the First Amendment to understand the intent of the Congress as they polished and shortened it to its final version on September 24, 1789. James Madison’s first draft on June 7th: “The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed. No state shall violate the equal rights of conscience or the freedom of the press, or the trial by jury in criminal cases.” The House Select Committee’s revision, July 28th: “No religion shall be established by law, nor shall the equal rights of conscience be infringed.” Thomas Jefferson later said, “The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.”
  2. There are already clearly established rights that govern the doctor-patient relationship. Patients have the right to autonomy, to choose what will be done to their body, but they can’t compel a doctor to do something outside their training or established norms. The doctor may prospectively limit the extent and scope of his or her obligation to treat or even refuse to enter into a doctor-patient relationship in a non-emergent situation. Doctors are not healthcare vending machines, but professionals who understand the difference between negative rights such as the right to refuse treatment or be left alone and positive rights, including entitlement to treatment. In terms of the latter, the physician holds the “trump card” in that he or she can decline to provide requested treatment that he or she feels is not medically indicated or may be outside the standard of care.
  3. The AMA, which is on record advocating that pharmacists be required to dispense potential abortafacients, states that neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical practice.
  4. The Health Services, Medicare and Medicaid Acts all have protections to prevent physicians from being compelled to do sterilizations or abortions. The Weldon Amendment of 2001 provides that no federal, state, or local government agency or program that receives federal health and human services funds may discriminate against healthcare professionals because they refuse to provide, pay for, provide coverage of, or refer for abortion. This federal law has been repeatedly challenged in court by pro-abortion groups and by the Attorney General of California in his state. CMDA has filed amicus curiae briefs in each of these cases. Forty-five states have some sort of conscience laws on abortion. (See your state’s laws at: www.consciencelaws.org.)
  5. There is also international right of conscience protection. Article 9 of the European Convention on Human Rights states that everyone has the right to “. . . freedom of thought, conscience and religion. This includes . . . freedom . . . to manifest his religion or belief in worship, teaching, practice and observance. . . .”

With all this protection, what is the problem? Most conscience protection deals with performing abortions and mainly covers doctors and nurses. Therapeutic modalities, such as Plan B, that inflict a postfertilization effect before implantation, destroy human life, but since that is not defined as an abortion, there is no protection of the right of conscience. There is spotty protection on issues like sterilization and contraception. There is little or no protection from being forced to participate in or refer for present or future morally objectionable therapies including embryonic stem cell therapies, preimplantation genetic diagnosis, genetic enhancements, euthanasia, or other interventions that could become the “standard of care.”

Laws are needed to insure that no healthcare professional is forced to violate his or her conscience and become complicit in an immoral act. In some situations, like referring for an abortion, it comes down to the issue of moral complicity, which is (as described in CMDA’s statement on moral complicity):

“. . . a culpable association with or participation in wrongful acts by - use of information, technology, or materials obtained through immoral means.

  • using, rewarding, profiting, perpetuating, justifying, or ignoring past or present evil.
  • enabling or facilitating future immoral acts.

We must strive to never commit evil ourselves, nor should we participate in or encourage evil by others.”

Linda Rankin, a bioethicist at the University of Tennessee summed it up well in a 2004 Christian Science Monitor article when she said, “If we don’t protect personal integrity, we would go down a dangerous avenue. By taking a professional license, you do not in fact step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person.”

I encourage you to get into this fight. We dare not lose this war.

SOUND BITES YOU CAN USE WHEN DISCUSSING THIS ISSUE:

1. Is our healthcare system in need of more conscience-driven doctors or more “ethically neutered” doctors?

2. Do we want medical schools to systematically strip our future doctors from any and all religious and ethical convictions that have not been approved?

3. Your doctor’s conscience may some day be the last line of protection between you and those who would profit from your early death.

4. Some pharmacists don’t want to dispense the morning after pill for the same reason they don’t want to drive drunk — they don’t want to kill another human being.

5. I’m not trying to mandate Planned Parenthood staff to work in a crisis pregnancy center in violation of their conscience.

6. Denying the constitutional freedoms of one group is a threat to the constitutional freedoms of every one of us.

7. The irony of trampling individual liberties and conscience rights while marching under the banner of “choice” will not be lost on the American public.


ABOUT THE AUTHOR

David Stevens, MD, MA (Ethics)

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