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. . .
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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. . . .
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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. . .
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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. . .
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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. . .
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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. . .
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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. . .
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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." . . .
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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. . .
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