Opposing Medical Conscience with a Soft Touch

National Review
Reproduced with permission

Wesley J. Smith

When the Department of Health and Human Services announced its intention to create a new office to emphasize the protection of medical conscience, the screaming from the usual suspects was so loud one would have thought Roe v. Wade had been overturned.

Now, The New England Journal of Medicine has published an abstruse opinion piece by one Lisa Harris, a professor concerned with “issues along the reproductive justice continuum,” whatever that means.

I bring this up because medical conscience is a burning issue for pro-life medical professionals and those who believe in Hippocratic medicine. The issue is whether doctors, nurses, pharmacists, and others can be forced to participate in requested interventions with which they have a strong religious or moral objection — such as abortion, assisted suicide, and suppressing normal puberty in children with gender dysphoria.

But reading Harris, you would think it was just about “partisans” not understanding the gray areas and nuances of contentious social issues. From, “Divisions Old and New–Conscience and Religious Freedom at HHS”:

I feel an angry argument building in response to HHS’s one-sided framing. But I resist it. Because my challenge these days is to avoid further entrenching polarized positions and to reject the divisiveness that poisons contemporary life. Is it possible, once again, to hold in tension seemingly opposite ideas about abortion? Can we understand abortion as both something that “stops a beating heart” and a fundamental right, rather than insisting it’s only one or the other?

But the conscience issue isn’t about whether we can all just get along and understand people have differences of opinion. It isn’t about “holding in tension seemingly opposite ideas.” It is about protecting doctors from being forced to take a human life or engage in another act in the clinical setting that is violative of their faith or moral beliefs.

Harris just doesn’t get it — or doesn’t want to:

Abortion and parenthood are not mutually exclusive; loving children and ending pregnancies are compatible in patients’ lived experience.

So is loving abortion work and questioning it: abortion providers might express an enormous sense of pride, purpose, and fulfillment in their work, and also say they felt weak-kneed the first time they saw a second-trimester abortion. Some feel sad that in different circumstances, many women would continue their pregnancies, in particular if poverty and economic strain were not issues. There is sometimes a point at which, when pressed, ardently pro-choice caregivers become uncomfortable with abortion. For some, it is a matter of pregnancy duration; for others, the circumstances of an abortion, such as sex selection.

Conversely, some caregivers whose religious beliefs lead them to strongly oppose abortion nevertheless offer assistance. Some religious nurses give medications and offer comfort, compassion, and care during an abortion because they see these tasks as shared purposes of nursing and religion. Sometimes doing so requires “sitting with discomfort in real time” and holding “the tension of two contradictory positions simultaneously.”

To which I respond, bully for them, but so what?

Harris should read Ezekiel Emanuel’s article in the NEJM from not too long ago advocating that doctors who refuse to participate in a legal procedures requested by the patient should be kicked out of medicine. No balancing of “tensions” and “sitting with discomfort in real time” for him!

And there is nothing in Harris’s piece to make me think she isn’t just as opposed to medical-conscience rights as Emanuel. She just says it indirectly, in a passive-aggressive manner, and with a softer touch.

I believe the real reason the medical establishment, the secular Left, and bioethicists like Emanuel and (I believe) Harris oppose strong legal conscience protections is precisely due to the powerful moral message sent when a respected doctor or nurse says to a patient: “No. I can’t do this thing you request. It is wrong.”

There is an old saying in pro-abortion advocacy: “If you don’t believe in abortion, don’t have one.”

To which I add a medical-conscience corollary: If you want an abortion, don’t force a doctor to give you one.

Sometimes comity requires living with unambiguity too.

‘Medical Conscience’ Is Becoming a Partisan Controversy

National Review
Reproduced with permission

Wesley J. Smith

Should doctors and nurses be forced to participate in interventions they find morally abhorrent or unwarranted? As one example, should ethical rules require pediatricians to medically inhibit normal puberty as demanded by parents to “treat” their child’s gender dysphoria — even if they are morally opposed to the concept and/or the supposed treatment?

Some say yes. Thus, influential bioethicist Ezekiel Emanuel argues that medical professionals are obligated to accede to the patient’s right to receive legal interventions if they are generally accepted within the medical community — specifically including abortion. Emanuel stated doctors who are morally or religiously opposed, should do the procedure anyway or procure a doctor they know will accede to the patient’s demands. Either that, or get out of medicine.

Supporters of “medical conscience” argue that forcing doctors to participate in interventions they find morally abhorrent would be involuntary medical servitude. They want to strengthen existing laws that protect doctors, nurses, and pharmacists’ who refuse participation in legal interventions to which they are morally or religiously opposed.

Now, medical conscience looks to become another battlefront in our bitter partisan divide. After the Trump administration announced rules that will place greater emphasis on enforcing federal laws protecting medical conscience, Democratic state attorneys general promised to seek a court order invalidating the new rule. From the New York Law Journal story:

But 19 state attorneys general, led by New York’s Eric Schneiderman, argue that it is the patients who will be discriminated against under the proposed rule. This is particularly true, they argue, in the cases of marginalized patients who already face discrimination in trying to obtain health care, such as lesbian, gay, bisexual and transgender patients and male patients seeking HIV/AIDS preventative medications, according to the comments filed in opposition to the rule.

“If adopted, the proposed rule … will needlessly and carelessly upset the balance that has long been struck in federal and state law to protect the religious freedom of providers, the business needs of employers, and the health care needs of patients,” they state.

The stakes can only increase as moral controversies in health care intensify in coming years. As just two examples, some bioethicists are lobbying to enact laws that would give dementia patients the right to sign an advance directive requiring nursing homes to starve them to death once they reach a specified level of cognitive decline. There are also increasing calls to do away with the dead-donor rule in transplant medicine so that PVS patients can be organ-harvested while still alive

If these acts become legal, should doctor and nurses who practice in these fields be forced to participate? If Emanuel’s opinion prevails, the answer could be yes. If medical professionals are protected by medical conscience legal protections, the answer would be no.

Medical conscience is not just important to personally affected professionals. All of us have a stake. Think about the potential talent drain we could face if we force health-care professionals to violate their moral beliefs. Experienced doctors and nurses might well take Emanuel’s advice and get out of medicine — while talented young people who could add so much to the field may avoid entering health-care professions altogether.

Comity is essential to societal cohesion in our moral polyglot age. Medical conscience allows patients to obtain morally contentious procedures, while permitting dissenting medical professionals to stay true to their own moral and religious beliefs. I hope the Democrats’ lawsuits are thrown out of court.

The “Medical Conscience” Civil Rights Movement

First Things

Wesley J. Smith*

Until recently, healthcare was not culturally controversial. Medicine was seen as primarily concerned with extending lives, curing diseases, healing injuries, palliating symptoms, birthing babies, and promoting wellness – and hence, as a sphere in which people of all political and social beliefs were generally able to get along.

That consensus has been shattered. Doctors today may be asked to provide legal but morally contentious medical interventions such as sex selection abortion, assisted suicide, preimplantation genetic diagnosis of IVF embryos, even medications that inhibit the onset of puberty for minors diagnosed with gender dysphoria. As a consequence, medical practice has become embroiled in political and cultural conflict. . .
Full Text

Assisted-Suicide Pushers Want Forced MD Participation

National Review
Reproduced with permission

Wesley J. Smith*

Assisted-suicide advocates pretend they want assisted suicide limited to the terminally ill.

They pretend that they favor strict guidelines.

And they pretend they would never want doctors forced to participate in intentionally ending the life of a patient. Indeed, the laws they have passed all contain conscience protections.

Except, sometimes they show their true hands. For example, when the Canadian Supreme Court imposed a broad right to lethal-injection euthanasia — certainly not limited to the dying — Compassion and Choices (formerly the Hemlock Society) issued a laudatory press release — later scrubbed because it told the truth about the movement’s true goals.

And now, Compassion and Choices — again, which has included conscience protections in laws it sponsored as a necessary predicate to passage — has come out strongly against a proposed Trump-administration office in HHS to protect medical professionals from forced participation in procedures against their consciences and/or religious beliefs. From an email sent to its supporters (my emphasis):

The new division marks one of the greatest threats we’re facing to the future of the end-of-life choice movement and patient-centered care.

Under the HHS proposed rules, providers who object to various procedures could impose their own religious beliefs on their patients by withholding vital information about treatment options from them — including options such as voluntarily stopping eating and drinking, palliative sedation or medical aid in dying. And your federal tax dollars will be used to protect physicians who make the unconscionable decision to willfully hold back information from a patient and abandon them when they are at their most vulnerable.

This is unacceptable and needs to be stopped.

Note the warning that conscience protections threaten “the future” of the assisted-suicide movement. It is abundantly clear that these suicide advocates believe forcing doctors to participate in suicide is essential to implementing their lethal agenda.

C & C already tried to impose such a duty on doctors in Vermont in support of a regulation that sought to force doctors to share information on assisted suicide with patients. That violated the assisted-suicide law’s conscience protections. Dissenting doctors sued and forced the bureaucrats to retreat. C & C tried to intervene legally to (unsuccessfully) thwart that settlement.

So, this is the truth: If C & C prevails in legalizing assisted suicide (and eventually, euthanasia) across the country, pressure will soon begin to force dissenting MDs, nurses, and pharmacists to either get on the death train or get out of medicine.

For those with eyes to see, let them see.

 

Accessed 2018-03-28

 

The War on the Hippocratic Oath

First Things

Wesley J. Smith

The screaming was so loud, you would have thought that the Trump administration had overturned Roe v. Wade. It hadn’t, of course. But it had directed needed attention at the existing legal protection that allows doctors and nurses to refuse to participate in abortions without fear of firing or other job sanctions. This protection is sometimes called “medical conscience rights.”

The occasion for the uproar? The Department of Health and Human Services announced its intention to create a new office of Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR) to enforce medical conscience. It is worth noting that this proposed action will not change the law. But it will revitalize enforcement efforts after years of the Obama administration’s hostility toward religious liberty generally and medical conscience rights specifically. Indeed, the newly created enforcement office will put medical employers on notice that the current administration considers medical conscience rights to be fundamental. As the HHS press release put it:

The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.

In a country with a long and venerable history of honoring conscientious objection and protecting the free exercise of religion, one would think this step would be met by applause. But for some, it was akin to a declaration of social war. The Massachusetts Medical Society sniffed in opposition:

As physicians, we have an obligation to ensure patients are treated with dignity while accessing and receiving the best possible care to meet their clinical needs. We will not and cannot, in good conscience, compromise our responsibility to heal the sick based upon a patient’s racial identification, national or ethnic origin, sexual orientation, gender identity, religious affiliation, disability, immigration status, or economic status.

The New York Times was equally condemning. In an editorial titled, “The White House Puts the Bible Before the Hippocratic Oath,” the editorialists warned hyperbolically:

The decisions may make it more difficult for teenagers wanting to get tested for sexually transmitted diseases, for gay men looking to prevent HIV and even for women seeking breast exams or pap smears.

Please. No one who supports a robust protection of medical conscience advocates compromising the physician’s responsibility to “heal the sick.” No one wants to prevent women from obtaining cancer screenings. Nor do supporters of medical conscience seek to authorize doctors and nurses to discriminate against individuals.

Rather, medical conscience prevents doctors and nurses from being forced to act in opposition either to their religious beliefs – e.g., commit a grievous sin – or to their moral consciences by being forced to participate in morally objectionable procedures, such as taking innocent human life in abortion, assisted suicide, or lethal injection euthanasia. It could also protect medical professionals from being required to administer hormones to inhibit puberty in adolescents experiencing gender dysphoria – a controversial recent innovation that the American College of Pediatricians has called “mass experimentation.” That opinion is becoming heterodox in the field, but surely no doctor should be forced in an elective procedure to act in a way that he believes actively harms the patient. The same goes for physicians who object to participating in sex-change surgeries based on the belief that sex is biologically determined or that it is wrong to remove healthy organs. Conscious protections should also apply to a doctor or nurse who objects to participating in infant circumcision based on a moral objection. And surely no doctor should be forced to participate in an execution, not even the administrative act of declaring the condemned prisoner dead after the execution.

People of good will can hold radically divergent moral beliefs, including about legal medical services and procedures. The stakes in this controversy are very high. As I have written here before, there is a concerted effort underway to drive pro-life and Hippocratic Oath-believing doctors, nurses, and other professionals out of medicine – a lamentable potentiality. We need increased comity and tolerance for those medical professionals who object to reigning moral paradigms and hold to sanctity-of-life ethics. The new HHS office represents a positive step toward achieving that end.

Post Script: The best and most efficient way to protect medical conscience would be for the states and the federal government to allow medical conscience rights to be enforced via private causes of action in civil court, which is not currently allowed generally. I will discuss that idea in a future column.

 

Medical Establishment Opposes Conscience Rights

Evolution News & Science Today
Reproduced with permission

Wesley J. Smith

The laws and regulations of the United States protect medical professionals from being forced to participate in abortion and sterilization and other procedures against their religious beliefs by prohibiting discrimination in employment.

The medical establishment thus responds to the creation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR). How awful, they yell. We want our pro-life colleagues, and those who believe in the Hippocratic Oath, to be forced to violate their religious and moral beliefs in their professional lives.

For example, the Massachusetts Medical Society doesn’t want a division formed to protect their colleagues. From the Society’s statement:

As physicians, we have an obligation to ensure patients are treated with dignity while accessing and receiving the best possible care to meet their clinical needs. We will not and cannot, in good conscience, compromise our responsibility to heal the sick based upon a patient’s racial identification, national or ethnic origin, sexual orientation, gender identity, religious affiliation, disability, immigration status, or economic status.

Baloney. It won’t “compromise” anything. Doctors are not “on demand” technocrats who fill patient’s orders, particularly with regard to non-life-threatening and elective procedures, which are the real subjects here.

It could, however, protect employees from being forced by their employers to choose between their faith or moral beliefs, and their careers.

In a society as profoundly rent as ours is about fundamental moral beliefs around the sanctity of human life and the proper role of medicine in fulfilling lifestyle and other personal desires, basic comity requires such focused enforcement of legal conscience protections.

Otherwise, pro-lifers will be driven entirely out of medicine — an outcome, I assume, that the the leaders of the Massachusetts Medical Society would heartily applaud.

https://evolutionnews.org/2018/01/the-medical-establishment-opposes-conscience-rights/

On Medical Conscience and Assisted Suicide, Good News from Vermont and Maine

Evolution News & Science Today

Wesley J. Smith

With the attacks on medical conscience increasing, here’s some fine news. Alliance Defending Freedom has successfully obtained a consent decree that protects doctors in Vermont from having to counsel about assisted suicide to legally qualified patients if they are morally or religiously opposed. From the decree:

Plaintiffs and similarly situated medical providers do not have a legal or professional obligation to counsel and refer patients for the Patient Choice at End of Life process [e.g., assisted suicide].

That’s good. . . [Full text]

 

Pro-life medics being forced to choose between career or conscience

Christian Institute

Pro-life medics in the US are ‘under attack’, an academic has warned.

Author and bioethicist, Wesley J. Smith, said medics who are morally opposed to abortion and assisted suicide may soon be forced to choose between “their careers and their convictions”.

He made the comments in an article for First Things, an influential journal of religion and public life.

‘Morally opposed’

In support of his case, he highlighted work published in the New England Journal of Medicine which described abortion as “a standard obstetrical practice” and “not medically controversial”.

Smith said: “The authors take an absolutist position, claiming that personal morality has no place in medical practice.”

He went on to highlight several examples where doctors are being forced to refer patients for abortion and assisted suicide “even if they are morally opposed”. . . . [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]