The Right Of Conscience

David Stevens, M.D,M.A. (Ethics)CEO

Christian Medical Association

DefinitionHealthcare

Right of Conscience

DefinitionHealthcare

Right of Conscience

The freedom to practice healthcare The freedom to practice healthcare in accordance with your deeply held in accordance with your deeply held religious, moral or ethical religious, moral or ethical convictions.convictions.

Martin Luther KingMartin Luther King

"On some positions cowardice asks the question, 'Is it safe?' Expediency asks the question, 'Is it politic?' Vanity asks the question, 'Is it popular?' But conscience asks the question, 'Is it right?' And there comes a time when one must take a

position that is neither safe, nor politic, nor popular. But ... because it is right."

Harper LeeTo Kill a Mockingbird, 1960

Harper LeeTo Kill a Mockingbird, 1960

"The one thing that doesn't abide by majority rule is a person's conscience."

The Issue The Issue

Alaska (1997) - Valley Hospital Assoc.

California (2003) - Benitez v. North

Coast Women's Medical Care

Illinois (2005) - Governor Rod

Blagojevich

Washington (2007) - Pharmacy Regs

Overt: Mandatory Abortion Training in NYC 2002: Mayor Bloomberg orders

abortion training in All NYC medical schools

NY guidelines make it very difficult to conscientiously object

Covert: Pro-life students denied admission (Duquesne Law Review)

ACOG Committee Opinion # 385, 11/07

ACOG Committee Opinion # 385, 11/07

Patient autonomy final arbitrator for Rx Right to Demand Rx = Right to Refuse Rx ROC is just a personal opinion Moral obligation to pt. over rides ROC Inconvenience imposes providers beliefs

on pts. Patient’s concept of well-being trumps Must refer for abortion If can’t timely refer, must provide Those who refuse to provide abortions

should only practice in areas where abortion services can be provided.

American Board of Obstetrics and Gynecology

American Board of Obstetrics and Gynecology

New policy issued in January 2008: certification contingent on compliance with ACOG ethical principles. Under pressure reversed in 1/09.

Two OpinionsTwo Opinions

“the right to abortion, artificial means of contraception, assisted reproductive technology, physician-assisted suicide, or other legally permissible procedures or medications becomes meaningless without physicians who are willing to provide such services.”

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

This is Not a New IssueThis is Not a New Issue

Moral Debate 2500 Years Ago I will neither give a deadly drug to

anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy.

Hippocratic Oath

Another Perspective - “The Right of Refusal”

Another Perspective - “The Right of Refusal”

“A threat to reproductive rights”

“Health related decisions made between a provider and patient should be made on the personal welfare and healthcare needs of the patient - not the morals or belief of the caregivers.”

“While we firmly believe that all people have a right to their own opinions and moral beliefs, it is unethical for healthcare providers to stand in the way of a woman’s access to safe, legal and professional healthcare.”

Refusal ClausesPlanned Parenthood Website

What Right?What Right?

"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof…"

(Bill of Rights, First Amendment)

What does Freedom of Religion mean if you can’t follow your conscience?

Writing the First AmendmentWriting the First Amendment James Madison, 1789-JUN-7 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.

House Select Committee, JUL-28 No religion shall be established by law, nor shall the equal rights of conscience be infringed,

Livermore, AUG-15 Congress shall make no laws touching religion, or infringing the rights of conscience.

House Version, AUG-20 Congress shall make no law establishing religion, or to prevent the free exercise thereof, or to infringe the rights of conscience.

Conference Committee SEPT 24 Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.

Founding FathersFounding Fathers

The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.

I consider the government of the U.S. as interdicted by the Constitution from intermeddling with religious institutions, their doctrines, discipline, or exercises.

Thomas Jefferson

James MadisonJames Madison

Conscience is the most sacred of all property.

The Religion of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate.

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.

Linda Rankin, Bioethicist, U.of TN Christian Science Monitor - 4/26/04

Conscience & HealthcareConscience & Healthcare

Is our healthcare system in need of more conscience-driven doctors or more "ethically neutered" doctors?

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

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

AMA StatementAMA Statement

AMA reaffirms 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.

Except in emergencies, physicians shall be free to choose whom to serve, with whom who to associate and the environment in which to provide medical care.

World Medical Association

World Medical Association

The physician should be free to make clinical and ethical judgments without inappropriate outside interference.

Other Countries/CodesOther Countries/Codes

European Convention on Human Rights Everyone has the right to freedom of thought,

conscience and religion; this right includes… freedom …to manifest his religion or belief in worship, teaching, practice and observance.

Canadian Medical Association Physicians who object to abortion for reasons of

conscience are advised to inform their patients of their objections so that the patient can consult another physician. The CMA stresses that physicians who decline to participate in abortion should not be discriminated against, and emphasizes the need to respect the rights of conscientious objectors, especially those in training for obstetrics and gynecology, and anesthesia.

PharmacistAssociation Statements

PharmacistAssociation Statements

“Pharmacist have a duty to act with conviction of conscience.” Code of Ethics, APhA“APhA

recognizes the individual pharmacist’s right to exercise conscientious refusal”

Pharmacist Conscience Clause, APhA

“the right of pharmacists… to decline to participate in therapies they consider to be morally, religiously or ethically troubling.

American Society of Health-System Pharmacists

Federal LawFederal Law Church Amendment Public Health Services Act Medicare/Medicaid 42 U.S.C. §238n Weldon Amendment

Limited to federally funded programs.

State LawsState Laws

45 states have some sort of conscience laws on abortion

Illinois 45 ILCS 70/1- “Healthcare right of Conscience Act” “It is the public policy of the State of

Illinois to respect and protect the right of conscience of all persons.”

State by State Law http://www.consciencelaws.org

Problem ContinuesCMDA Member Survey

Problem ContinuesCMDA Member Survey

40% of member report being pressured to compromised convictions

>43% know someone else who was pressured

>24% have lost position, promotion or compensation as a result

>88% think it is getting worse

CMDA Public PollCMDA Public Poll

September 2008 CMDA commissioned the polling company TM, inc to conduct a nationwide telephone poll +/- 3.1% at 95% confidence level 42% think law obligates doctors to

perform/refer abortion 38%, no obligation 11% unsure 5%, depends

Protecting a right does not mean endorsement

of the position

Protecting a right does not mean endorsement

of the position Protection of someone’s right to

object does not mean be equated with support for their position

Indeed, we must pay special attention to protecting the rights of others when we do not support the position.*

*(Claims of conscience rights can be abused)

Efforts to Abolish LawsEfforts to Abolish Laws Abortion Access Project ACLU - Reproductive Freedom Project PCRC -Pro-Choice Resource Center

Spotlight Campaign Merger Watch

Maryland NARAL Hospital Provider Project

Planned Parenthood

Why Not Refer?Why Not Refer?

Referral means: I endorse the competency, judgment

and ethics of the doctor I’m referring too.

I enter into a professional relationship with them. I will receive a report back from him.

I believe they will “do no harm.”

Current EventsCurrent Events January 20: HHS policy goes into effect

protecting right of conscience Discriminate in the employment, promotion,

termination, or the extension of staff or other privileges to any physician or other health care personnel because he performed, assisted in the performance, refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.

Anaphylactic reaction by pro-abortions groups and some media False claims, e.g., women will not be

allowed contraception Media blitz Legal action taken

1/15/09 - PP, ACLU, 7 State Attorney Generals filed suit in CT to overturn

Overturning HHS Regulations

Overturning HHS Regulations

Overturning HHS Regulations

Overturning HHS Regulations

February 2009 Obama announces will rescind

regulation

30 Day Public Comment Period ends April 9th.

Comments reviewed and Rules Eliminated

"[W]hat will convince them? This, and this only: cease to call slavery(abortion) wrong, and join them in calling it right. And this must be done thoroughly - done in acts as well as in words. Silence will not be tolerated - we must place ourselves avowedly with them…..The whole atmosphere must be disinfected from all taint of opposition to slavery (abortion), before they will cease to believe that all their troubles proceed from us."

Abraham Lincoln

Cooper Union address of 1860

What would truly satisfy the pro-slavery (abortion)

faction

The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last.

Crispin Sartwell

Los Angeles Times

Self Described “Pro-Choice Atheist”

The “Right” of Convenience

versus Right of Conscience

Martin Niemoller (1892 - 1984)

Martin Niemoller (1892 - 1984)

"First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me."