Re: Wisconsin Assembly Bill 67

Testimony before Wisconsin Senate Committee
on Health, Children, Families, Aging and Long-Term Care
October 7, 2003

First: Conscience is in the tradition of American practice and jurisprudence.

Our first amendment prohibits congress from making a law that would deal with "an establishment of religion, or prohibiting the free exercise thereof." It would seem appropriate for rights of conscience to fall under that prohibition. More recently the precedent of conscience has been well established in U.S. case law. One frequently cited is Brophy v. New England Sinai Hospital (1986). There the court stated that physicians have the right to refuse to participate in actions that violate their ethical and moral standards.

Second: To require a physician to violate her conscience destroys the patient physician relationship

Medicine is a serving profession. When I am at the office I am there as a professional to serve my patient. I do not serve by simply doing the will of the patient. I serve as a professional. By that I mean that I profess to have a knowledge that I desire to use for the benefit of my patient. Further, I want to approach my patient concerned for her whole life situation. I want to understand the meaning of her disease in the context of her emotions, spiritual values and social relationships. Similarly I come not only with my knowledge but also with my whole self as a caring person. This must include my emotions and spiritual values. That relationship between patient and physician as two whole people is essential to the healing process.

A system that would require me to violate my conscience and give into the demands of a patient would destroy that relationship. Out of respect for my patient, I am reticent to push her to do anything in violation of her conscience. Where medically appropriate I offer, educate, argue, strongly encourage, but I will not force my opinion on her. If a patient did not show the same respect for me, but insist that I act in violation of my conscience, I would consider that a grave violation of the covenant of mutual respect that must exist between us. I have continued to care for wealthy patients who do not have enough respect for me to pay their bills, I have continued to care for others who have sued me, but if a patient showed so little respect that they would force me to violate my conscience; I would not be able continue their care.

I know I am not alone in this and suspect that if forced to violate conscience a number of exceptionally qualified individuals will leave or never enter the practice of medicine. I would humbly ask what kind of a physician would you like caring for you: one who is principled and sensitive to issues of conscience or one who is willing to do things which she feels are wrong?

Third: Right of Conscience is necessary to the practice of the type of medicine we want.

Medicine, with its current emphasis on evidence and outcome studies is based on the premise that research can demonstrate one best way to practice. This presupposes that there is objective truth. Medicine does not believe that any individual's approach is as good as another until studies have proved it. The nature of conscience is similarly based on the premise that there is right and wrong.

Many people deny that there is any objective truth. Truth for them is subjective and individual. Conscience is a subjective interpretation and is not related to any objective truth. Seeing no truth basis in their own consciences they do not allow for truth claims in the conscience of others. To force a practitioner to act against her conscience will dramatically alter the very nature of medicine.

Medicine is not to be arrogant over the truth as if we have all the answers. We are in a search for truth and only ask for the privilege of living in a way consistent with where we are in that search. That requires protection of conscience.

Fourth: To make a referral is just as much against conscience as to provide the service.

When I refer to someone I am commending the patient to the doctor for the service and the doctor to the patient. I cannot do that when it would be contrary to my conscience. What I can do is politely defer, allow another physician to assume the care, and make sure that I do my utmost to provide records to assure an orderly resumption of care.

Fifth: There is no reason why a patient's autonomy should take precedence over that of the provider.

Conflicts between the rights of individuals are intrinsic to free people. It is only in the context of a slave culture that the rights of one individual are allowed to trump the rights of another only on the basis of station in society. It is not appropriate for the rights of a patient to trump the rights of a physician simply because of their respective roles.

I would say in closing, that, as a geriatrician, I am sensitive to the issues of the dying. I place great importance on advance directives and sincerely seek to honor them. In 30 years of being a Doctor I have never had a conflict between advanced directives and my own conscience. It may some day come. If it did, I, and I believe all doctors that I would consider worth their salt, would seek to work things out in gracious and caring ways which would allow respect for both the patient and the physician.

Senators I know that you recognize the sobriety of this matter. This is about the very character of medicine as it has been traditionally practiced in this country and which many of us continue to cherish. I believe that the house bill is wise and will protect the quality of medicine we want to preserve.