The Right Of Conscience

1. The Right Of Conscience David Stevens, M.D,M.A. (Ethics) CEO Christian Medical Association

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

3. Martin 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."

4. Harper LeeTo Kill a Mockingbird, 1960 "The one thing that doesn't abide by majority rule is a person's conscience."

5. 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

6. 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)

7. 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.

8. 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.

9. Two 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.”

10. This 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

11. 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 Clauses Planned Parenthood Website

12. 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?

13. Writing the First Amendment • James Madison, 1789-JUN-7The 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-28No religion shall be established by law, nor shall the equal rights of conscience be infringed, • Livermore, AUG-15Congress 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 24Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.

14. Founding 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

15. James 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.

16. 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

17. Conscience & 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.

18. AMA 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.

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

20. Other 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.

21. 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

22. Federal Law • Church Amendment • Public Health Services Act • Medicare/Medicaid • 42 U.S.C. §238n • Weldon Amendment Limited to federally funded programs.

23. State 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

24. 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

25. CMDA 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

26. 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)

27. Efforts 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

28. 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.”

29. Current 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.

30. Overturning HHS Regulations • 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

31. Overturning HHS Regulations • February 2009 • Obama announces will rescind regulation • 30 Day Public Comment Period ends April 9th. • Comments reviewed and Rules Eliminated

32. What would truly satisfy the pro-slavery (abortion) faction "[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

33. 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”

34. The “Right” of Convenience versus Right of Conscience

35. 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."