Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Re: The Limits of Conscientious Refusal in Reproductive Medicine

ACOG Committee on Ethics Opinion No. 385: November, 2007

Sean Murphy*

In October, 2005 the President of the American College of Obstetricians and Gynecologists (ACOG) asked U.S. Senators to force conscientious objectors to refer patients for abortion.

Perhaps recognizing that the President had failed to make an ethical case for mandatory referral, the ACOG Committee on Ethics released an opinion in November, 2007 that purported to do so. The opinion [The Limits of Conscientious Refusal in Reproductive Medicine], particularly when read in conjunction with a new bulletin from the American Board of Obstetrics and Gynecology (ABOG), posed a significant threat to freedom of conscience for American physicians specializing in obstetrics and gynaecology. [See American College of Obstetricians and Gynecologists continues attacks on freedom of conscience].

The ACOG statement generated spirited comments and replies from objecting physicians and others concerned about the organization's attack on freedom of conscience in health care. Despite the criticism, the ACOG reaffirmed the statement in November, 2010, eliciting further critiques.

Readers may also be interested in a similar controversy that arose in Canada when a guest editorial by two law professors that appeared in the Canadian Medical Association Journal also claimed that objecting physicians are required to refer patients for abortion. The editorial was denounced by a number of Canadian physicians. [See Responses to "Abortion: Ensuring Access" ]

Reponses to ACOG Committee on Ethics Opinion No. 385

Christian Medical Association

. . .The way things are going, some would actually force out of the profession those physicians who have moral objections to procedures like abortion, and that loss of physicians, especially obstetricians and gynecologists who, as you know, are already leaving a practice because of malpractice insurance costs, would have a severe impact on the delivery of healthcare. . . continue reading

Christian Medical Association et al

. . . The ACOG statement suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion. . . . continue reading

Christian Medical & Dental Associations

. . . Healthcare professionals and patients must be made aware that such opinions, if accepted by the profession as a whole, will have a devastating effect on the practice of medicine. Mandating such an approach would have the effect of making healthcare professionals mere technicians, stripping from them the ability to apply moral reasoning to their practices. . . continue reading

American Association of Pro-Life Obstetricians and Gynecologists

. . .We find it unethical and unacceptable that a small committee of ACOG members would pretend to provide the moral compass for 49,000 other members on one of the most ethically controversial issues in our society and within our medical specialty-and that without ever consulting the full membership. . . continue reading

Catholic Medical Association (USA)

. . .the Opinion not only fails to provide helpful guidance, but is so flawed that it threatens the reputation of ACOG itself. The Catholic Medical Association urges ACOG to rescind this opinion immediately. . . The Opinion contains a seriously flawed and gratuitously condescending approach to conscience. . . continue reading

American Health and Human Services Secretary

. . . It appears that the interaction of the ABOG Bulletin with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification. . . continue reading

Christopher Kaczor

. . . the balance struck by the committee between the right of conscience of physicians and the reproductive health care of women so emphasizes patient autonomy that it turns physicians into medical automatons forced to act against their best ethical and medical judgment. . . continue reading

Paul Adams

. . . None of this has anything to do with imposing my views on the client, as anti-exemptionists and militant secularists often claim. . . . "Conscientious objection. . .implies the physician's right not to participate in what she thinks morally wrong, even if the patient demands it. It does not presume the right to impose her will or conception of the good on the patient."  . . . continue reading

Robert P. George

. . .The ACOG Committee report is an exercise in moral philosophy. It proposes a definition of conscience, something that cannot be supplied by science or medicine. It then proposes to instruct its readers on "…the limits of conscientious refusals describing how claims of conscience should be weighed in the context of other values critical to the ethical provision of health care." . . . continue reading
. . . Dr. Edmund Pellegrino asked me to offer a formal comment on Dr. Lyerly's presentation of her committee's report. I was happy for the opportunity to call her and her colleagues out on their attempt to use their special authority as physicians to force fellow physicians to practice medicine in accord with the their contestable - and contested ­ philosophical, ethical, and political judgments. And make no mistake about it: at every key point in the report, their judgments are contestable and contested. . . continue reading

E. Christian Brugger

. . .In this essay, I will elaborate the ACOG account, juxtapose it to what I call the "classical account" as defended in Western philosophy, and finally answer the question whether healthcare providers have a right to refuse to treat some patients. . . continue reading