Obliged to Kill

The Assault on Medical Conscience

The Weekly Standard
Reproduced with permission

Wesley J. Smith*

A court in Ontario, Canada, has ruled that a patient’s desire to be euthanized trumps a doctor’s conscientious objection. Doctors there now face the cruel choice between complicity in what they consider a grievous wrong – killing a sick or disabled patient – and the very real prospect of legal or professional sanction.

A little background: In 2015, the Supreme Court of Canada conjured a right to lethal-injection euthanasia for anyone with a medically diagnosable condition that causes irremediable suffering – as defined by the patient. No matter if palliative interventions could significantly reduce painful symptoms, if the patient would rather die, it’s the patient’s right to be killed. Parliament then kowtowed to the court and legalized euthanasia across Canada. Since each province administers the country’s socialized single-payer health-care system within its bounds, each provincial parliament also passed laws to accommodate euthanasia’s legalization.

Not surprisingly, that raised the thorny question of what is often called “medical conscience,” most acutely for Christian doctors as well as those who take seriously the Hippocratic oath, which prohibits doctors from participating in a patient’s suicide. These conscientious objectors demanded the right not to kill patients or to be obliged to “refer” patients to a doctor who will. Most provinces accommodated dissenting doctors by creating lists of practitioners willing to participate in what is euphemistically termed MAID (medical assistance in dying).

But Ontario refused that accommodation. Instead, its euthanasia law requires physicians asked by a legally qualified patient either to do the deed personally or make an “effective referral” to a “non-objecting available and accessible physician, nurse practitioner, or agency .  .  . in a timely manner.”

A group of physicians sued to be exempted from the requirement, arguing rightly that the euthanize-or-refer requirement is a violation of their Charter-protected right (akin to a constitutional right) to “freedom of conscience and religion.”

Unfortunately, the reviewing court acknowledged that while forced referral does indeed “infringe the rights of religious freedom .  .  . guaranteed under the Charter,” this enumerated right must nonetheless take a back seat to the court-invented right of “equitable access to such medical services as are legally available in Ontario,” which the court deemed a “natural corollary of the right of each individual to life, liberty, and the security of the person.” Penumbras, meet emanations.

And if physicians don’t want to commit what they consider a cardinal sin, being complicit in a homicide? The court bluntly ruled: “It would appear that, for these [objecting] physicians, the principal, if not the only, means of addressing their concerns would be a change in the nature of their practice if they intend to continue practicing medicine in Ontario.” In other words, a Catholic oncologist with years of advanced training and experience should stop treating cancer patients and become a podiatrist. (An appeal is expected.)

This isn’t just about Canada. Powerful political and professional forces are pushing to impose the same policy here. The ACLU has repeatedly sued Catholic hospitals for refusing to violate the church’s moral teaching around issues such as abortion and sterilization. Prominent bioethicists have argued in the world’s most prestigious medical and bioethical professional journals that doctors have no right to refuse to provide lawful but morally contentious medical procedures unless they procure another doctor willing to do as requested. Indeed, the eminent doctor and ethicist Ezekiel Emanuel argued in a coauthored piece published by the New England Journal of Medicine that every physician is ethically required to participate in a patient’s legal medical request if the service is not controversial among the professional establishment—explicitly including abortion. If doctors don’t like it? Ezekiel was as blunt as the Canadian court:

Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.

For now, federal law generally supports medical conscience by prohibiting medical employers from discriminating against professionals who refuse to participate in abortion and other controversial medical services. But the law requires administrative enforcement in disputes rather than permitting an individual cause of action in civil court. That has been a problem in recent years. The Obama administration, clearly hostile to the free exercise of religion in the context of health care, was not viewed by pro-life and orthodox Christian doctors as a reliable or enthusiastic upholder of medical conscience.

The Trump administration has been changing course to actively support medical conscience. The Department of Health and Human Services recently announced the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights, which would shift emphasis toward rigorous defense of medical conscience rights.

Critics have objected belligerently. The New York Times editorialized that the new emphasis could lead to “grim consequences” for patients—including, ludicrously, the denial by religious doctors of “breast exams or pap smears.”

The American College of Obstetricians and Gynecologists joined the Physicians for Reproductive Health to decry the creation of the new office – which, remember, is merely dedicated to improving the enforcement of existing law – warning darkly that the proposal “could embolden some providers and institutions to discriminate against patients based on the patient’s health care decisions.”

The Massachusetts Medical Society joined the fearmongering chorus, opining that the new office could allow doctors to shirk their “responsibility to heal the sick.” Not to be outdone in the paranoia department, People for the American Way worried the new office might mean that “other staff like translators also refuse to serve patients, which could heighten disparities in health care for non-English-speaking patients.”

The Ontario court ruling is a harbinger of our public policy future. Judging by the apocalyptic reaction against the formation of the Conscience and Religious Freedom Division, powerful domestic social and political forces want to do here what the Ontario court ruling – if it sticks on appeal – could do in that province: drive pro-life, orthodox Christian, and other conscience-driven doctors, nurses, and medical professionals from their current positions in our health-care system.

Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism and a consultant to the Patients Rights Council.

No, Politico, Conscience Protections Are Neither ‘So-Called’ Nor ‘Controversial’

There is simply no historical ground upon which Politico can claim that protecting the right of medical professionals not to participate in abortion has been ‘controversial’ since Roe v. Wade.

The Federalist
Reproduced with permission

Casey Mattox

Government shouldn’t force people to violate their consciences. Until recently, that opinion hasn’t been particularly controversial, even where actual controversial issues like abortion were involved. One can support abortion and still think government shouldn’t discriminate against medical professionals who don’t perform abortions.

But if you want to gin up opposition to something, it presumably helps to pretend that it’s your opponent who is the extremist. You can’t very well admit that it’s your own opinion that is historically extreme and your opponent who has history on his side. That’s a much harder sell.

Perhaps this is why, in a story yesterday about the new U.S. Department of Health and Human Services office to address conscience and religious freedom for medical professionals and institutions, Politico casually dropped this nugget: “So-called conscience protections have been politically controversial since shortly after Roe v. Wade legalized abortion in 1973.”

This claim may be politically useful, but it is demonstrably false. At the risk of appearing to repeatedly bludgeon this false narrative to death, it’s important to understand just how inexcusably wrong this instance of fake news is, and how these sorts of so-called “mistakes” drive narratives that create today’s politics.

Shortly after Roe v. Wade

Weeks after the Supreme Court released its decision in Roe v. Wade, Congress enacted the first of the federal laws aimed at protecting conscience in light of this newly minted “right” to abortion. The Church Amendment, named for its sponsor, Idaho’s longtime Democratic Senator Frank Church, ensured that Catholic hospitals could continue to provide health care to millions of Medicaid patients without being forced to also perform abortions.

That provision passed 372-1 in the House and 92-1 in the Senate. Noted right-winger Sen. Ted Kennedy spoke in favor of the law on the floor of the Senate, calling it necessary “to give full protection to the religious freedom of physicians and others.”

A Democrat-controlled Congress added additional “so-called conscience protections” to the Church Amendment for these individual medical professionals and in federally funded programs over the next few years. The idea that these laws were controversial would have been a surprise to the bipartisan coalitions in Congress voting for them.

In 1992, Nadine Strossen, president of the American Civil Liberties Union, testified in favor of the Religious Freedom Restoration Act (yep, you read that correctly), saying RFRA would protect “such familiar practices as . . . permitting religiously sponsored hospitals to decline to provide abortion or contraception services.” The ACLU didn’t think conscience was either “so-called” or “controversial” in 1992.

In 1996, a bipartisan Congress again defended conscience rights, enacting the Coats-Snowe Amendment to the Public Health Services Act with President Bill Clinton’s signature. This law prohibits the federal government and any state or local government receiving federal funds (i.e., all of them) from discriminating against physicians or health-training programs or their participants on the basis that they don’t provide or undergo abortion training or perform or refer for abortions.

Forty-seven states have enacted laws protecting medical professionals from being discriminated against because of their objection to participating in abortion, most of those becoming law in the years immediately following Roe.

But everything above is just icing on the cake. Politico could have confirmed its narrative was false just by reading Roe. Addressing the concern that this new right to an abortion might result in attempts to force medical professionals to perform them, the Supreme Court explained this wouldn’t happen because the American Medical Association’s House of Delegates had already broadly defended the exercise of religious and moral conscience in the abortion context, quoting it in Roe:

Be it … resolved that no physician or other professional personnel shall be compelled to perform any act which violates his good medical judgment. 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 personnel withdraw from the case so long as the withdrawal is consistent with good medical practice.

In the companion case Doe v. Bolton, the Supreme Court called a state law allowing hospitals not to admit patients for abortions and prohibiting them from requiring medical professionals to assist in them an “appropriate protection to the individual and to the denominational hospital.”

There is simply no historical ground upon which Politico can claim that protecting the right of medical professionals not to participate in abortion was “controversial” at the time of Roe or in the decades thereafter. It has only become “controversial” to defend the right of people to think differently and to live according to their own moral compass when the political left recently abandoned this classically liberal principle in favor of government compulsion.

The whole article reads like a horror movie in search of a villain. Its writers and interviewees know that HHS committing resources to safeguard the conscience of medical professionals and institutions that deliver health services to Americans is an evil plot. They just don’t know how. So the authors introduce the reader to none of these laws (available on the HHS Office of Civil Rights website with handy links), vaguely assert that all of this is really about LGBT issues (it’s not), and try to make boogey-men of those in this new office.

What Politico doesn’t do is inform readers that those advocating for government to compel medical professionals to perform abortions are actually the ones advocating for a departure from our historical common ground of respecting one another’s conscience. That, apparently, would complicate the narrative.

Casey Mattox is senior counsel with Alliance Defending Freedom. You can follow him on Twitter at @CaseyMattox_.


Washington State mother sues employer for denying insurance coverage to transgender son

Lawsuit claims Catholic health care organization is breaking law by denying coverage for all transgender services

Metro Weekly

John Riley

The ACLU of Washington has filed a civil rights lawsuit against a Catholic health care organization for refusing to cover the medically necessary surgery required by a transgender son of one of their employees.

The ACLU is suing on behalf of Cheryl Enstad, a medical social worker at PeaceHealth St. Joseph Medical Center in Bellingham, Wash. Enstad decided to file a lawsuit after PeaceHealth refused to cover the medical expenses of her transgender son, Pax, even though the treatments that were denied were recommended to treat his gender dysphoria.

Because PeaceHealth is a Catholic health care organization, it tries to abide by the teachings of the Catholic Church when it comes to issues surrounding sexual orientation or gender identity. It used that as justification for refusing to provide coverage for a recommended chest reconstruction surgery and other treatments for gender dysphoria under its medical benefits plan. . . [Full text]


Let’s Expand the Scope of Conscience Protection

Evolution News and Science Today

 Wesley J. Smith

As I have written here and elsewhere, attacks on medical conscience are proliferating, and the ground is being prepared to strip doctors, nurses, pharmacists, and others of the ability to practice their professions under the principles of Hippocratic ideals.

I suspect that if the Left ever again takes control of the government, conscience rights will come under even more concerted attack than is currently happening. I mean, they tried to force nuns to provide contraception in the order’s health insurance.

A bill was introduced in Congress to strengthen existing conscience protections. Called the Conscience Protection Act of 2017, . . . but the legislation, as written, is far too narrowly drawn. The pending crisis of medical conscience extends far beyond abortion. . . [Full text]


New England Journal of Medicine publishes “attack on medical conscience”

Pro-Lifers: Get Out of Medicine!

First Things

Wesley J. Smith

Doctors in the United States cannot be forced to perform abortions or assist suicides. But that may soon change. Bioethicists and other medical elites have launched a frontal assault against doctors seeking to practice their professions under the values established by the Hippocratic Oath. The campaign’s goal? To force doctors, nurses, pharmacists, and others in the health field who hold pro-life or orthodox religious views to choose between their careers and their convictions.

Ethics opinions, legislation, and court filings seeking to deny “medical conscience” have proliferated as journals, legislative bodies, and the courts have taken up the cause. In the last year, these efforts have moved from the relative hinterlands of professional discussions into the center of establishment medical discourse. Most recently, preeminent bioethicist Ezekiel Emanuel—one of Obamacare’s principal architects—coauthored with Ronit Y. Stahl an attack on medical conscience in the New England Journal of Medicine, perhaps the world’s most prestigious medical journal. When advocacy of this kind is published by the NEJM, it is time to sound the air raid sirens. . . [Full text]


Health indignity: A Carmichael hospital denied a trans man his hysterectomy. Now he’s suing.

Dignity Health moves patient’s surgery to another hospital over Catholic directives


Dave Kempa

Two days before Evan Minton’s scheduled hysterectomy last September at Dignity Health Mercy San Juan Medical Center, a nurse called to discuss pre- and post-operation care. Toward the end of the call, Minton had a request.

“‘I just want to let you know that I’m transgender and my pronouns mean a great deal to me,'” he recalled saying.

According to Minton, the nurse was affirming. He hung up with a positive feeling. But the next day his doctor called with bad news. The hospital had canceled the procedure. He was terrified that the cancellation would add months or years to his physical transition.

Now, seven months later, the 35-year-old is teaming up with the American Civil Liberties Union to sue Dignity Health for denying care to a transgender patient. . . [Full text]


Woman Who Identifies as Man Sues Catholic Hospital for Disallowing Uterus Removal at Facility

Christian News

Heather Clark

SAN FRANCISCO, Calif. — A California woman who identifies as a man has filed a lawsuit against a Catholic hospital and its parent company for prohibiting her surgeon from performing a sex change-related hysterectomy at the facility because of the organization’s religious convictions.

The 35-year-old woman, who goes by the name Evan Minton, had been scheduled to undergo a complete hysterectomy at Mercy San Juan Medical Center in Carmichael last August. She believed the procedure was necessary to comport with her preferred identity.

However, the day before her appointment, after she noted to a nurse that she identifies as “transgender,” the surgery was canceled.

“In general, it is our practice not to provide sterilization services at Dignity Health’s Catholic facilities,” said spokeswoman Melissa Jue in a statement at the time. . . [Full text]

ACLU renews attack on Catholic hospitals over abortion

Baptist Press

Samantha Gobba

ASHEVILLE, N.C.(BP) — The American Civil Liberties Union is launching a renewed attack against religious hospitals, claiming they should not be allowed to base the care they provide on the dictates of their sincerely held beliefs.

In a report released in May, titled “Health Care Denied,” the ACLU targets Catholic hospitals, saying they jeopardize women’s lives because they “prohibit a range of reproductive health services,” including abortion, when something goes wrong during pregnancy.

Grazie Pozo Christie, a Miami-area radiologist and a Catholic, said claims of care being denied are false.

“When a woman’s life is in danger, any treatment that a woman needs will be provided to her, even if it endangers the child,” Christie told WORLD News Service. “So there is no point in a Catholic hospital at which a woman’s life becomes really in danger.” . . .[Full Text]


ACLU loses case to force Catholic hospital to perform abortions

LifeSite News

Ben Johnson

DETROIT, April 11, 2016 (LifeSiteNews) – A Michigan judge has thrown out the ACLU’s lawsuit attempting to force a nationwide chain of Catholic hospitals to perform abortions.

The U.S. District Court for the Eastern District of Michigan, Southern Division dismissed the case, saying the liberal legal organization lacks standing to sue.

The ACLU filed suit against Trinity Health Corporation, which operates 86 health care facilities in 21 states nationwide, last October because Trinity – a Catholic institution – abides by the U.S. Bishops’ Ethical and Religious Directives (ERDs), which bar physicians from taking unborn human life. . . [Full text]


Court allows doctors to support hospitals, staff in ACLU suit that seeks to force them to commit abortions

Court grants ADF motion to allow pro-life physician groups to intervene in defense of Catholic hospital network

News Release

American Center for Law and Justice

American Civil Liberties Union v. Trinity Health Corporation: Several pro-life doctor groups have intervened in defense of a Catholic hospital system which the American Civil Liberties Union sued. Alliance Defending Freedom attorneys represent the Catholic Medical Association, the Christian Medical and Dental Association, and the American Association of Pro-Life Obstetricians and Gynecologists. The ACLU’s lawsuit seeks to force Trinity Health Corporation and its staff to commit abortions regardless of their religious and pro-life objections. Trinity Health operates 86 facilities in 21 states.

Attorney sound bites:  Kevin Theriot | Matt Bowman

DETROIT – A federal court agreed Thursday to allow several pro-life doctor groups to intervene in defense of a Catholic hospital system which the American Civil Liberties Union sued last year. In December, Alliance Defending Freedom attorneys representing the Catholic Medical Association, the Christian Medical and Dental Associations, and the American Association of Pro-Life Obstetricians and Gynecologists asked the court to allow the groups to intervene.

On March 23, the court will hear arguments on whether to dismiss the ACLU’s lawsuit, which seeks to force Trinity Health and its staff to commit abortions regardless of their religious and pro-life objections. Trinity Health operates 86 facilities in 21 states.

“No American should be forced to commit an abortion,” said ADF Senior Counsel Kevin Theriot. “No law requires faith-based hospitals and medical personnel to commit abortions against their faith and conscience, and, in fact, federal law directly prohibits the government from engaging in any such coercion. In addition, the government can’t tie any funding to a requirement that hospitals and health care workers give up their constitutionally protected freedoms. We look forward to defending those freedoms in this case.”

“Those who doubt that anyone would ever try to force someone to commit an abortion need only look at this case,” explained ADF Senior Counsel Matt Bowman. “This is precisely what the ACLU is seeking to do. But forcing Catholic hospitals to perform abortions is not only against the law, it makes no sense at all. Patients should always have the freedom to choose a health care facility that respects life and to choose doctors who do not commit abortions.”

“Forcing health care workers to act contrary to the very faith and ethical convictions that led them into the medical profession—to serve, help, and bring healing to people—is counterproductive, unnecessary, and against the law,” Bowman added.

“Here, the Medical Applicants represent members that are affected by the policy directives of the Defendants’ hospitals on a daily basis,” wrote the U.S. District Court for the Eastern District of Michigan, Southern Division, in its order in American Civil Liberties Union v. Trinity Health Corporation. “The outcome of the litigation could have an effect on the day-to-day aspect of their duties as healthcare professionals. Accordingly, finding that the Medical Applicants are regulated by the policy directives at issue, the Medical Applicants are able to intervene as of right.”

  • Pronunciation guide: Theriot (TAIR’-ee-oh), Bowman, (BOH’-min)

Alliance Defending Freedom is an alliance-building, non-profit legal organization that advocates for the right of people to freely live out their faith.

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