The Obama administration is considering recension of the ‘conscience clause’ that is currently observed by the Department of Health and Human services.  The current rule allows physicians, other providers and hospitals to refuse to provide abortion services.  The HHS has allowed the providers and the public to comment on this plan until April 9.  I have provided two links to sites where persons opposed can either sign a petition in opposition to this action, or can send comments to HHS.

I understand that those of you reading this site may fall into both pro-abortion and anti-abortion camps.  I don’t want to make this post a lightning rod for that debate…not today, anyway.

What I want to explain is that individual providers should not be compelled to perform an act which they find morally unacceptable.  The ‘right’ to abortion, such as it is, does not constitute the right to force another human being to violate his or her personal ethics, which most often stem from religious faith.

The men and women who practice medicine are a remarkable group.  They are inherently concerned with human life, health and safety.  Some research has shown that they may be more concerned with spirituality than the general public.  They must follow a high moral standard in the conduct of their lives and practices.  This standard is informed first and foremost by whatever transcendent beliefs of right and wrong allowed them to commit them to the practice of medicine in the first place.  But they are also held to these standards by medical schools who teach their students the importance of ethics; by certifying specialty boards which have codes of conduct; and by state medical boards who closely investigate allegations of moral/ethical failures.

Most important, they, we, are held to a high standard by our patients, who expect us to act with love, mercy, respect and justice in the care of our patients. We are expected to maintain privacy, to preserve life as well as we can, to give comfort to even the most reprehensible patients, to avoid inappropriate relationships, to bill fairly.  Every day, in hospitals and clinics, in emergency departments and surgery suites, physicians live at the junction of science and morals; more so than any other scientific pursuit.

It seems unjust, and indeed nonsensical, to therefore ask that they suspend their ethics in a particular instance because of the desire for so-called equity, for convenience or for a pseudo-right like abortion which depends on the actions of another to exist.

To illustrate the point, I have cared for two very nice women in the last few weeks who had ectopic pregnancies; that is, tubal pregnancies.  The physician who cared for them is ardently pro-life.  But he never hesitated to provide care for these women, even to do an action which would terminate the ectopic pregnancy, because in that case the mother’s life was in danger.  His higher ethic was in no way an impedance to the care of a woman in real need.  He would not provide an abortion for convenience.  And he should never be compelled to do so.

Neither should he be compelled to refer for a service he does not provide and does not support.  That, of note, is also part of the conscience clause.  That providers would have to refer for what they do not do themselves.  But again, this is not about a neurosurgeon refusing to refer for an obscure procedure, or a cardiologist refusing to refer to a heart surgeon.  It’s about being compelled to offer someone a way to receive a procedure that one provider finds morally indefensible.
The problem, you see, is that fewer and fewer Ob/Gyn specialists are providing abortion services.  Young physicians entering practice are drawn to the specialty because of their love of life, their love of mothers and infants.  Not, generally, because of their desire to terminate pregnancies.  There’s a kind of logical and ethical disconnection between the two acts.

I am interested in this issue for many reasons; because of my faith, because I am convinced that forcing an ethic (or its abandonment) is philosophically wrong, and because I know that, like so many things in medicine, the question could ultimately land in the laps of emergency physicians like myself, who practice under the federal law EMTALA, forcing us to care for anyone who comes through our doors.

Physicians who refuse to violate their morals could find themselves fired, or could lose board certification.  Hospitals that are connected with religious groups could close.  In the end, of course, more women than those seeking abortion would lose access to care.

Again, I disagree with abortion.  I consider it wrong.  But I understand, intellectually, the thought process that leads someone to be pro-abortion.  They consider it an issue of fairness, of self-determination.

But both of those issues seem at the heart of this one; is it fair to force someone to do what they consider morally wrong? Is it fair to ask a physician to violate the freedom of self-determination in his or her practice?  Would it be fair for me to force a vegan to hunt for meat?  Would it be fair for me to force a committed atheist to become a Green Beret and kill in combat?  Would it be fair for me to force a feminist professor to become a subservient member of a polygamist cult?  No one would argue about those issues; only this one, the compulsion to do or refer for abortion, seems acceptable to the modern mind.

Finally, abortion isn’t the only issue.  Eventually we’ll be facing the ‘right to euthanasia.’  and when patients with terminal disease ask to be ‘put down’ by the doctor and the doctor refuses, that doctor will be painted as a cruel, heartless religious nut.  The medical board will investigate, the newspapers have their way and eventually that good, compassionate, ethical doctor may be forced out of work.
I wonder, if access to euthanasia and abortion is the main issue, why haven’t we seen the initiation of a new profession?  The ‘Thanatologist.’  I derived the name from the name of the Greek god of death, Thanatos.  A thanatologist would provide abortions and euthanasia for a living.  Killing is vastly easier than healing, so it wouldn’t take nearly as long to learn.  These individuals could spend their lives offering the populace the choice of death, wherever it was legal.

The problem is, it would probably become emotionally difficult, if not frankly impossible.  And I doubt it would be a career field many parents would be nudging their darlings into, however progressive they might be.

We want to mix death in with life by having physicians commit the act.   A kind of fudge-swirl of morality.

Fine; but no one should be forced into the recipe against their will!


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