Presentation Transcript

1. Conscience, Health Care and the CMA

   John Brehany, Ph.D., S.T.L. Catholic Conscience Formation: Truth and Freedom April 20-21, 2012
2. Introduction Review status quo on respect for conscience rights, with a focus on trends in medical profession Discuss responses; what the CMA is doing and why, and what more we can do Brehany, Catholic Medical Association, 2012
3. Introduction Getting older Seeing changes 1967 . . . Brehany, Catholic Medical Association, 2012
4. Brehany, Catholic Medical Association, 2012
5. Growing Hostility to Conscience and Religious Freedom Culture Academe Government – Federal and State Church Amendments (1970s) Public Health Services Act (1996) Hyde-Weldon Amendment (2004) Brehany, Catholic Medical Association, 2012

6. Recent Trends re Conscience Protection in Medicine

7. Redefining Nature and Role of Conscience in Medical Profession American College of Obstetrics & Gynecology (ACOG) Ethics Committee, “The Limits of Conscientious Refusal in Reproductive Medicine” (Nov. 2007) Julie Cantor, M.D., J.D. R. Alta Charo, J.D., U. Wisconsin Madison “Health Care Provider Refusals to Treat, Prescribe, Refer or Inform: Professionalism and Conscience” – Speech, American Constitution Society for Law and Policy, Feb. 2007 Brehany, Catholic Medical Association, 2011
8. ACOG, Limits of Conscientious Refusal Defines Conscience Pejoratively “[the] privately, ethically attuned part of the human character. It operates as an internal sanction. . . An appeal to conscience would express a sentiment such as ‘if I were to do x, I could not live with myself/I would hate myself/I wouldn’t be able to sleep at night’.” Deflects Conscience Challenges to medical integrity “can result in considerable moral distress for providers [but are] best met through organized advocacy on the part of professional organizations.” Brehany, Catholic Medical Association, 2008
9. Julie Cantor, M.D., J.D. “Conscientious Objection Gone Awry — Restoring Selfless Professionalism in Medicine,” 360 N.E.J.M. 15 (Apr. 9, 2009) “Conscience is a burden that belongs to the individual professional; patients should not have to shoulder it.” “Patients rely on health care professionals for their expertise; they should be able expect those professionals to be neutral arbiters of medical care.” “Federal laws may make room for the rights of conscience, but health care providers . . . should cast off the cloak of conscience when patients’ needs demand it.” Brehany, Catholic Medical Association, 2008
10. Charo, “Health Care Provider Refusals to Treat . . .” Health Care as a “Public Good” “Disparate Impact” Reframe the Relationship between the Government, Physicians, and the Medical Profession Brehany, Catholic Medical Association, 2008
11. Charo, “Health Care Provider Refusals to Treat . . .” Physicians as State Agents Licensure creates a “state-created and maintained collective monopoly on these products and services.” “What might otherwise be an issue of life-style choices is transferred by state action into an issue of medical choice, in which patient and provider stand . . . as petitioner and provider in a regulated relationship.” Brehany, Catholic Medical Association, 2008
12. Charo, “Health Care Provider Refusals to Treat . . .” Because State licensure grants physicians/pharmacists “monopoly” on medical services . . . Physicians can be considered agents of state State must ensure monopoly power is not abused Medical societies should establish standards to help patients get what they want and the state to do its job Brehany, Catholic Medical Association, 2008
13. Charo, “Health Care Provider Refusals to Treat . . .” To deal with “refusing physicians,” societies could “articulate their own ethical standards and, in this way, lay the groundwork both for individual health care providers to see their way clear to serving patients even in ways that violate their own preferences and beliefs as well as to assist courts in determining the customary and standard practice in medical malpractice cases based on refusal of service or medical abandonment.” Brehany, Catholic Medical Association, 2011
14. Charo, “Health Care Provider Refusals to Treat . . .” Argues for an Affirmative Duty “The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice.” —American Medical Association — “Pediatricians should not impose their values on the decision-making process and should be prepared to support the adolescent in her decision or refer her to a physician who can. . . . Should a pediatrician choose not to counsel the adolescent patient about sexual matters such as pregnancy and abortion, the patient should be referred to other experienced professionals.”—American Academy of Pediatrics — “A [physician assistant] has an ethical duty to offer each patient the full range of information on relevant options for their health care. If personal moral, religious, or ethical beliefs prevent a PA from offering the full range of treatments available or care the patient desires, the PA has an ethical duty to refer [and to responsibly transfer] an established patient to another qualified provider.” —American Academy of Physician Assistants, — By failing to abide by the standards set by their own professions, those practicing refusal without the necessary accompanying assistance of informing patients of their options and providing referrals or other alternatives are not merely denying a discretionary benefit to the consumer but rather are affirmatively violating a duty to their patients. Brehany, Catholic Medical Association, 2012
15. Template for Enacting?: ACOG Ethics Committee, “The Limits of Conscientious Refusal in Reproductive Medicine” (Nov. 2007) All physicians must provide referrals In some cases physicians must provide services “in an emergency in which a referral is not possible or might negatively impact a patient’s physical or mental health, providers have the obligation to provide medically indicated and requested care regardless of the provider’s personal moral objections” (emphasis added) Brehany, Catholic Medical Association, 2011
16. ACOG + ABOG Maintenance of Certification Guidelines (Dec. 2007) – Cause for denial or revocation of certification Was – grossly immoral behavior or violating ACOG Code of Professional Ethics Now –“violation of . . . ACOGrules and/orethics principles” Brehany, Catholic Medical Association, 2011
17. A Looming Burning Issue: Religious Freedom . . . R. Alta Charo, NEJM, July 2005 “the surge in legislative activity surrounding conscience clauses represents the latest struggle with regard to religion in America. Should the public square be a place for the unfettered expression of religious beliefs, even when such expression creates an oppressive atmosphere for minority groups? Or should it be a place for religious expression only if and when that does not in any way impinge on minority beliefs and practices?” Brehany, Catholic Medical Association, 2012

18. Responses: CMA and You

19. Witness to 3 Fundamental Goods The True Nature and Role of Conscience The True Nature of the Medical Profession and the Goods It Serves and Protects Oath of Hippocrates – L. Kass; J. Patrick The Significance of Religious Liberty In the depths of his conscience, man detects a law which he does not impose upon himself, but which holds him to obedience. Always summoning him to love good and avoid evil, the voice of conscience when necessary speaks to his heart: do this, shun that. For man has in his heart a law written by God; to obey it is the very dignity of man; according to it he will be judged.(9) Conscience is the most secret core and sanctuary of a man. There he is alone with God, Whose voice echoes in his depths. Vatican II, Gaudium et spes, #16 Brehany, Catholic Medical Association, 2012
20. Engage 3 Key Audiences Government and the Public (Citizens and Patients) Members of the Medical Profession Students – Medical and other A Physician should not only be ever ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mission, and the responsibility he habitually incurs in its discharge. Those obligations are the more deep and enduring, because there is no tribunal other than his own conscience, to adjudge penalties for carelessness or neglect. AMA Code of 1847 “When a man takes an oath, Meg, he's holding his own self in his own hands. Like water (cups hands) if he opens his fingers then – he needn't hope to find himself again.” A Man for All Seasons Brehany, Catholic Medical Association, 2012
21. CMA – Founded in 1932 To uphold the principles of the Catholic faith in the science and practice of medicine To assist the Church in the work of communicating Catholic medical ethics to the medical profession and society at large To support Catholic hospitals in faithfully applying Catholic moral principles in health care delivery. To enable Catholic physicians to know one another better and to work together with deeper mutual support and understanding
22. History and Activities Growth in Guilds and Members 1932-1968 1968-2000 Traditional Activities White Mass Linacre Quarterly Annual Educational Conferences
23. Relationships We come together in the Catholic Medical Association in order to grow in the spirit of Christ in our personal and professional lives, to bring His Spirit to all that is touched by our science and art . . . Service Education Witness Growth & Development EthicalIssues
24. How Are We Doing?
25. How Are We Doing?
26. Engaging Government & Public Helping to Amend Obamacare H.R. 358, Protect Life Act H.R. 3, No Taxpayer Funding for Abortion Act H.R. 361, the Abortion Non-Discrimination Act Respect for Rights of Conscience Act (Fortenberry, R. Neb.) Responding to the HHS Mandate Brehany, Catholic Medical Association, 2012
27. Medical School Students Student Section and Support Boot Camp(s) Ongoing Support and Mentoring through Guilds
28. Practicing Physicians Goal –Renew Catholic physicians as individuals; for Catholic Health Care Ministry, and for the profession of medicine Means – Program of formation Accessible – Online and weekend instruction Foundational– Theology; Ethics; Leadership Compelling – Certificate and/or E-MBA program; CME Outcomes Leaders and Mentors Wisdom Communities and Networks
29. Advice – Pope Benedict XVI 2006 interview prior to trip to Germany Christianity, Catholicism, is not a collection of prohibitions: it is a positive option . . . We have heard so much about what is not allowed that now it is time to say: we have a positive idea to offer . . . Brehany, Catholic Medical Association, 2012

30. Concluding Thoughts