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diggNew-look Inquisitions want to call doctors in for a little chat
In a world without objective truth, why should governments recognise a right to conscientious objection?
This summer, Canada’s
well-known doctor shortage almost got worse. A portion of doctors in
Canada’s largest province started scouting for jobs elsewhere,
expecting that Ontario would soon require them to violate their
conscience. The College of Physicians and Surgeons of Ontario, the
licensing body for Ontario doctors, had drafted a policy that
required doctors to refer for procedures with which they disagreed on
moral or religious grounds.
The public reaction was loud and furious. Religious groups and opinion writers were quick to point out the authoritarian nature of such a policy. But the decisive blow came from within the profession itself: the Ontario Medical Association, the professional organization of Ontario’s doctors, released a scathing condemnation of the policy and openly urged the College to abandon it. The OMA said: “We believe that it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious or moral beliefs.”
In the
end, the College gave in and enacted a vague and watered-down version
of the original draft. The storm passed over. But in the ensuing
calm, Ontario doctors still have grave reason for concern. The public
debate revealed that the College of Physicians had produced the
policy in response to suggestions by the Ontario Human Rights
Commission. This notorious organ had indeed provided the College with
two detailed submissions which asked the College to adopt the OHRC’s
troubled understanding of doctors’ rights and duties.
The OHRC clearly expects doctors to inform patients about all legal treatments, and to refer for these treatments regardless of their moral or religious objections. In their view, a doctor’s “denial of services or refusal to provide a woman with information relating to contraception or abortion… would be discriminatory”. In fact, the OHRC has entirely reconstructed the doctor’s role. It says: “It is the Commission’s position that doctors, as providers of services that are not religious in nature, must essentially ‘check their personal views at the door’ in providing medical care.” So much for conscientious objection.
Any citizen can bring a human rights complaint against any doctor in Ontario, at public expense – and the doctor, who must pay out of pocket for his own defense, can brace for judgment by the OHRC’s new standard. Ontario doctors are not out of the woods. And the fire is spreading. The doctors’ college of Manitoba has indicated plans to model its own policy after the Ontario College’s first draft, and the doctors’ college of Alberta is circulating a new draft policy that may indicate a duty to refer.
Things aren’t heating up only in Canada. In the United States, a fierce debate is being waged about proposed federal regulations that would protect doctors who work in federally funded medical facilities from being forced to violate their conscience. The “Provider Conscience Regulation” issued by the US Department of Health and Human Services is intended to protect doctors who object to abortion or sterilization – some also believe the language could extend to contraception.
Many see this bill as a needed response to the tightening anti-conscience stands of prominent medical organizations like the American College of Obstetricians and Gynecologists. It is also a response to the emergency contraceptive laws that have been passed in 16 states, which require hospitals to provide sexual assault victims with information about emergency contraception and in some cases, to dispense it on demand. In the words of HHS Secretary Mike Leavitt, “Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience.”
The
government of the state of Victoria in Australia may not agree.
There, the lower house of parliament has just passed a bill that
would require doctors to refer for abortion regardless of their
religious or moral objections. If the bill gets through the upper
house later this month, Victorian doctors could be stripped of their
freedom of conscience by Christmas. Catholic hospitals are
considering shutting down their maternity and emergency departments
rather than comply with this law.
Like in Canada, the Australian medical profession is split on this issue. The Royal Australian and New Zealand College of Obstetricians and Gynecologists supports the bill, but the Australian Medical Association has taken a stand against it. In a letter to Victoria’s premier the AMA Victoria president said: “Respect for a conscientious objection is a fundamental principle in our democratic country, and doctors expect that their rights in this regard will be respected, as for any other citizen.”
What
are the intellectual roots of this assault on the conscience rights
of physicians? Until only a few years ago, the popular opinion of
conscience seemed to be favourable. Many proudly appealed to their
conscience in using the Pill to prevent overpopulation or to avoid
the Vietnam War; while theologians cited their conscience as they
developed dissenting teachings. But these days, when conscience comes
up in the media, the debate is mostly about whether its exercise
should be suppressed. Why has the conscience become unpopular?
One reason may be that objective truth and morality are weakening their foothold on our society. In a world where conscience is believed to reflect only a subjective personal ethics, where an individual’s right and wrong is considered to have no truth value beyond the individual’s own mind, it makes supreme sense to suppress the capricious exercise of arbitrary personal values. Anything else would sink such a radically autonomous world into chaotic anarchy. Social order, in this kind of world, can only be achieved by the uniform enforcement of legally recognized rights.
In the
medical field specifically, conscience may also have become more
inconvenient because over the past few decades, courts and
governments have legalized procedures that many doctors believe to be
deeply unethical. The result: an exponential escalation of conflict
between the law and doctors’ consciences, and so between patients
and doctors. If the only doctor in a small town refuses to prescribe
emergency contraception, a woman may well lose her window of
opportunity to use it. The law says this contraception is her legal
and human right – while from the doctor’s perspective, to
prescribe or refer would be to participate in the killing of an
innocent human being. This is a zero-sum game: there is no good
compromise. Someone’s got to lose – today, it is the doctor (and
the embryo).
Finally, doctors may be facing more pressure to comply because their role in society has quietly but dramatically shifted. With the advent of the Pill, abortion and reproductive technologies, doctors have come to play a crucial role in helping millions of people plan and direct their reproductive lives. This is not the traditional role of doctors, who have always been concerned with sickness and disease. The state has now made them the exclusive providers of elective services that are based not on medical need but on personal preferences.
These
reproductive services are self-prescribed, meaning that it is the
patient who decides whether they are “needed”. The doctor’s
expected role is that of a mere technician who administers these
services on demand. Since doctors are the only people with a license
to provide these services, legal scholars like R. Alta Charo now
argue that the medical profession is “a kind of public utility
obligated to provide service to all who seek it”. This is not the
kind of medicine that many doctors signed up for when they entered
medical school.
The irony is that doctors are being subjected to a viewpoint Inquisition by the very society that constantly pays homage to tolerance. That comes as no surprise to many who have already experienced the intolerance of some parts of our society for truly divergent views, especially those that challenge today’s reproductive freedoms. There is still some lip service to the importance of conscience – but in the end it is bulldozed as a necessary sacrifice for the new social agenda.
So
much is obvious even from many of the various opinions expressed last
week before the President’s College on Bioethics in Washington.
This eminent body is now considering the conscience issue, and has
just published a number of fascinating presentations on its website.
Last week, Dr Ann Lyerly, Chair of the Ethics Committee of the
American College of Obstetrics and Gynecology, began her presentation
by acknowledging that many people believe in the critical value of a
doctor’s conscience, “independent judgment” and “moral
integrity” for good medicine, and in the importance of conscience
for “democracy, bioethics, humanity”.
But then she went on to address what to her are clearly more important concerns. The first was the health and welfare of the patient. Non-controversial? She described how women’s welfare was reduced when they were denied sterilization during a C-section, or denied emergency contraception after rape. Lyerly’s second concern was “fairness”, which to her meant not placing a “disproportionate burden on disenfranchised women”. Her example: lesbians should not be refused artificial insemination. Lyerly’s final concern was “respect for autonomy”, which she defines as respecting the “bodily dominion” of women by not refusing them certain treatments such as abortion. In her opinion, the freedom of conscience of doctors needs to be “balanced” (read: limited) by these considerations.
The
desire to limit doctors’ conscience rights in order to ensure easy
access to reproductive services for patients appears to be gaining
traction. Even if their conscience rights do not end up limited by
law, a number of physicians’ professional and regulatory bodies are
being attracted to such policies. Might things get worse before they
get better?
One thing is clear: doctors are not the only ones who will have to fight for their conscience rights. We’ve already seen some of the same arguments made about pharmacists, with regard to their right to refuse dispensing the morning-after pill. In Canada, the Ontario Human Rights Commission has also stated that marriage commissioners must “check their personal views at the door” – they are expected to perform gay marriages regardless of personal views about homosexuality. In fact, the Commission seems to believe that all providers of “secular services” have this duty to leave their morality at the doorstep of their workplace.
Secular services… like say, medicine, education, law, and most other areas of ordinary work. If medicine falls, these might just be the next dominoes.
Lea Singh graduated from Harvard Law School in 2003. She works for a nonprofit organization in Ottawa, Canada.
It’s time that Christians realize that secular extremists are attempting to display us from the Public Square. They believe that religion should not be expressed publicly which runs contrary to Christian teachings. Jesus said that if we were ashamed of him in this life, we would be rejected by him in the next. Christian doctors can not participate in murder. Christian teaches can’t teach the lie of homosexuality. Lot’s of other public servants can’t go along with the culture of death that secularism creates.
It is time that Christians understand that at the root of all of this is a secularist attempt to eliminate Christianities grand narrative from any significant human expression. This is all about doing away with Christianity.
Who would have thought in predominantly Christian countries that within a couple decades, doctors might not be able to practices their faith. It think a time is coming when Churches will be made illegal. It is time that Christians become much more militant (non-violently) in protecting their right to express their faith. If we don’t the feminists and gay activists will get their way and destroy our narrative (which is to destroy Christianity).
I don’t completely agree with Nike that in our country it is worst. Abortion is still a criminal act although with the Reproductive Health Bill 5043 under proposal, we are going in that direction, indirectly as of yet. Also, people seem to forget that a lot of these contraceptives have abortifacient mechanisms of action (i.e. preventing the implantation of an embryo when IUD’s or pills alter the uterine lining)and thus is unconstitutional. We are also conditioning people into not wanting to raise children for one reason or another and eventually lead into the direction of abortion on demand in order to accomplish it.
As a medical student then, I had to object to assisting sterilization procedures based on my beliefs, but eventually, it turned me off from pursuing Obstetrics and Gynecology as a specialty.. i.e. What if they require me to perform a certain number of bilateral tubal ligations to complete the traning program? I wonder if they train OB-gyne’s to teach NFP as much as they teach them to dispense contraceptives or insert IUD’s. I hardly learned anything about NFP in medical school. I got to learn about the Billings method by reading on my own.
Its worse in the Philippines. The Reproductive Health Bill 5043 being proposed now, also includes in its provisions; penalties and fines to parents and employers for discriminating against artificial contraceptives for their children and employees. With bills like this in our congress we are surely going to be backwards.
Hi Mario
Thanks for your informative comments.
I think you will find though, that most people will stamp their feet and insist that they have the absolute right to bodily autonomy and who the heck are you to deny them their right to such?
They do not care for your reasoning - they want what they want.
They also will counter that the “harm” of BC pills, abortion etc are not scientifically proven. It seems that it matters not which studies are cited, they simply REFUSE to accept that any reasonable person would consider denying patients these “services” based on unproven or what they (as experts) consider flawed studies.
In the end it comes down to ideology which is being rammed down everyone’s throat - pharmacists, doctors and others. I fear we have the beginnings of a global totalitarianism setting in.....
Peace to you,
Patricia
Indeed, God bless YOU, Mario!
Part 5
Embryonic stem cell research: From the argument above, given that life begins at fertilization it is not right to destroy a human person in order to perform research. Specially when the research is not likely to yield a cure for diseases. Two facts of embryonic stem cell research are seldom mentioned. First embryonic stem cell research is not effective. There has not been a single human (or experimental animal) that has been completely cured by embryonic stem cell therapy, despite billions of dollars spent on this type of research. Not only have these experiments failed because of the failure of the method, but they also fail because the fate of most tissue derived from embryos and transplanted to a recipient is ultimately destroyed by the hosts immune system. Second: Embryonic stem cell therapy is not safe. The majority of experimental animals that received embryonic stem cell tissue have to be euthanized because of the development of tumors called teratomas that develop from the embryonic tissue. In the pharmaceutical industry any therapy intended for human use as a first step has to prove to be safe and effective in animals before being tested in humans. So it is a major violation of a medical and scientific principle to test therapies in humans before proving safety and efficacy in animals.
Do note that up to now, I have not given a single moral argument to oppose abortion, contraception and embryonic stem cell research. While these arguments are important. I have concentrated on scientific and medical principles, because these principles are objective and apply to all cases, irrespective of the moral (subjective) arguments. So in reality the physicians should not resort to becoming a conscientious objector to an intervention for which the scientific and medical evidence provides sufficient objection to their use
God bless you
Part 4
Emergency contraception: The argument is that a medication or high dose birth control pill will prevent fertilization if given after the sexual intercourse. While this may occur. The scientific fact is that the by time between the sexual intercourse and the woman seeking emergency contraception fertilization has occurred, so the real mechanism of action of emergency contraception is to prevent the implantation of the tiny human called an embryo. So again this “medical treatment” is the killing of a human person. Regardless of the claim or the mechanism of action, the concept is also a violation of a medical principle, where an artificial intervention is applied to a healthy woman in order to prevent a normal event. Also high doses of the synthetic hormones used in emergency contraception and the morning after pill result in significant and potentially live-threatening complications. They are not safe. So again the principle of first do no harm is violated.(see part 5)
Part 3
Abortion is another example: The scientific evidence is overwhelming. Human life begins at fertilization (conception). This is when an incomplete cell, a haploid cell (sperm) fertilizes another haploid cell (ovum) to form a new person, whose characteristics are defined by the combination of the DNA of both cells. In general this genetic information does not change through out life. So providing an abortion a physician is indeed killing a human person. Unfortunately, utilitarian morality has been so much ingrained in the medical profession to the point where physicians try to provide quasi-explanations as to why a fetus is not a human person. When the reality is that a human person has to go through several stages in early life first an embryo, than a fetus, who for a while (9 months) lives inside a woman’s fallopian tubes and uterus and is dependent on her. It is common for abortion advocates to support late-term abortion in order to protect the life of the mother. One thing they do not admit is that in the rare cases of a life-threatening disease, where medical technology is not able to cure the condition, BOTH lives can be saved. Since a child in the third trimester of pregnancy is viable. The baby can be delivered, he or she may require the expertise of the neonatal intensive care team, but can also survive. So the solution is to save BOTH lives. In conclusion, with regards to abortion the medically correct position is not to perform it. (see part 4)
Part 2
Contraception is a perfect example of utilitarian morality guiding medicine. Here are the true scientific facts of hormonal contraception (the pill): The female menstrual cycle is a favorite of endocrinologists (like me) to teach principles of endocrinology. It is a physiologic (NORMAL) cycle, that requires the interaction of three glands through at east 5 hormones. The physiologic purpose of this cycle is ovulation and preparation of the uterus to have a nurturing environment for the implantation of the young human (embryo) if fertilization occurred in order to allow the new human to develop in its first stages. Pregnancy is a physiologic (NORMAL) condition. It is not a disease. The birth control pill is made up of a combination of synthetic hormones that are given to the woman to disrupt the normal cycle and prevent ovulation and if it does not prevent ovulation, to prevent implantation. So a woman has her healthy normal condition artificially converted into a an abnormal one of anovulation (no ovulation) or oligoovulation (less ovulation). In order to prevent normal physiologic condition (pregnancy). To aggravate the situation the use of the pill results in life-threatening complications: Cervical cancer, breast cancer, pulmonary embolism, heart attacks (Just to name a few of the most serious ones). So the pill is not safe. So is it medically correct to use the pill? No. It is true that almost all medications have side effects. But when we decide to prescribe a medication to treat a disease we place in the balance the risks and benefits of the medication, and if the ratio is favorable (the benefits outweigh the risks) the medication is prescribed because not treating the disease is detrimental to the patient. Now consider that the pill has risks but the so called benefit is to prevent a normal condition in a healthy person. this does not make medical sense. (see part 3)
Part 1:
This is a very important issue. As a physician I am obligated to provide medical care to patients. The key to providing medical care is in the first place to have a true compassion towards your patients and second to have an evidence-based approach. Being compassionate requires that you always apply the first and most important rule of medical therapeutics: First do no harm. The evidence-based approach requires the use of scientifically proven therapies.
These two pillars of medical care are being lost (and in some cases have been lost) when it comes to “reproductive health” issues. Rather than applying scientific evidence utilitarian morality has become the rule and guiding force for the research done in this area. (See next part)
Shameful? Yes i suppose coherency in one’s standards or principles both publicly and privately is something we should deem “shameful.” I mean , it might make others feel uncomfortable after all. Please—most of these ‘services’ (emergency contraception, abortion, insemination etc) are able to be provided (unfortunately) by practitioners who have no conscientious objection to it! If someone is not told or prescribed what they want from those who do—it is not as though they haven’t got any other options! It is shameful that any ‘democracy’ would force or impose practices on those who were never educated in the first place for it! Worse still if these doctors were then forced to leave their professions because there was no chance of working without having to compromise their beliefs! And all because (at least in most cases) individuals are engaging in sex, the consequences of which they are not prepared to handle. Yes, lets make hard working, moral professionals suffer for the irresponsibility of others!
thanks for the article!
Say the doctor has never encountered a woman who regretted continuing her pregnancy. What if the doctor was even aware of research that indicated a protective psychological effect (generally) of bearing a child. Suppose the doctor has found no evidence showing any benefits of abortion. (There is none)
If that doctor, valuing the woman’s wellbeing, refused to refer for abortion, is that a shameful exercise of conscience or an imposition of religious beliefs?
What about the doctor who is perhaps not necessarily always opposed to abortion, but who has studied risk factors for adverse outcomes. Perhaps the woman has previous depression. She is obviously ambivalent and is being pressured by her boyfriend. Her mother is being treated for breast cancer. ( Continuance of first pregnancy is strongly protective for breast cancer). If the doctor refuses to refer her for abortion because his ethical system “religious or just traditional” guides him to want to protect her from a course of action the doctor judges to be highly risky, is that a shameful exercise of freedom of conscience and imposition of religious beliefs?
If grandma wants to keep driving but is as slow as a wet week and blind as a bat, should doctor just sign her forms because she demands it. Yes, curtailing her driving is harsh but she and the rest of the community will be safer for the doctor’s conscientious exercise of clinical judgement.
If I want sleeping pills or antibiotics, should doctor just give them to me, or should there be a conscientious exercise of clinical judgment.
Attacking conscience in medicine is attacking medicine.
If it succeeds, we may as well just retrain the doctors as dispensers of drugs and surgical referrals to be doled out on demand, like a simple clerk. You want plastic surgery to your perfectly lovely 16 year old face? Here is the referral to your nearest surgeon. You want open heart surgery despite being 85 and a pack a day smoker.? ok
Alan-Just what is a ‘personal religious belief”. If a religious person values ethical behaviour, integrity, commitment to others’ well-being because of the influence of their religious faith is that a bad thing? One engineer thinks near enough is good enough as he works on a bridge and cuts corners for his own convenience and builds a sub-standard bridge that would not be ok. If an engineer who had strong ethical principles (because he was religious or just strongly committed to an ethical system that assumed right and wrong, the goodness of honesty and integrity and working hard to ensure a safe bridge for the community), would you object? Would you object if in doing so this ethical engineer was a pain in the neck for his bosses who wanted to keep costs down, for some in the community who wanted the bridge built sooner etc?
A doctor has studied his biology and knows that from the moment of conception, a new human life has formed. He holds to a coherent and rational system of ethics of long standing in the medical profession and dating back to pagan ancient Greece, that has as its first principle, do no harm, and that holds that human life is never to be intentionally destroyed in the practice of medicine. He takes that ethical code and applies it to his knowledge of human development. He concludes that abortion is unethical.
Is that a shameful exercise in medical decision-making. Is it, necessarily based on religious beliefs? If the doctor making that decision is religious, does that render his decision shameful?
What about if the doctor has studied the research on abortion’s risks and knows that most women suffer at least some psychological difficulty after an abortion. What if he knows that a conservative estimate is that between 10-20% of women suffer severe psychiatric illness following abortion. He knows psychiatrists and psychologists who privately tell him of abortion’s role in many patient’s distress. cont.
On the contrary, it would be shameful for any physician to do what s/he thought to be morally wrong. “First do no harm”: don’t make the patient worse, in attempting to make him/her better. The physician should “make the patient’s needs his/her first concern”; but surely that pre-supposes the doctor’s moral integrity. Would you want physicians to lie to patients, if some patients said they wanted it?
I think it would be very bad if doctors in some counties were to do operations for ‘inoperable’ cancer (i.e. when surgical opinion is that operation is not in the patient’s best interest) for fear of litigation. If put under pressure so to do, I think they should stand together, in the name of the truth, and say “we all agree that this is wrong, and we won’t do it”; precisely because it’s bad for the patient.
In the case of abortion, I think that the doctor is dealing with two patients. S/he must do the best possible for both. I think morally wrong actions, very often, produce deleterious effects: e.g. the psychological suffering caused to many women, after abortion. Honesty and integrity are essential for good medicine and all professions.
We must all respect genuinely held conscientious objections.
To force physicians to go against their consciences risks producing all sorts of evils
Alan: Did you actually read the article? Doctors are supposed to provide for patients’ NEEDS, not give them whatever they want. And there are many non-religious reasons to condemn abortion, artificial insemination, euthanasia, and other controversial but legal (in some places) medical procedures. This kind of thinking takes away their right to ANY belief, not just religious belief.
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