American College of Obstetricians and Gynecologists continues attacks on freedom of conscience

The Limits of Conscientious Refusal in Reproductive Medicine

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

In October, 2005, a letter from the President of the ACOG to US Senators included a request that lawmakers force conscientious objectors to abortion to facilitate the procedure by referral. The Project wrote to the President of the ACOG on this issue, eliciting a response that failed to establish an "ethical basis for [a]claim that physicians must refer for morally controversial procedures." A second letter sent by the Project was ignored, despite repeated requests for the courtesy of a reply.

Perhaps recognizing that the 2005 letter 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, particularly when read in conjunction with a new bulletin from the American Board of Obstetrics and Gynecology (ABOG), poses a significant threat to freedom of conscience for American physicians specializing in obstetrics and gynaecology. The threat comes from two directions.

In the first place, the ACOG opinion can be used to allege a 'standard of care' in disciplinary or legal proceedings against objecting physicians, or by employers or supervisors bent on suppressing the exercise of freedom of conscience by subordinates. Perhaps assisted by additional opinions from "expert witnesses" who support the ACOG position, disciplinary tribunals and judges may cite the opinion as evidence that refusal to refer for abortion or contraception fails to meet the standards set by the profession.

Second, the ABOG, is one of 24 boards that comprise the American Board of Medical Specialties, one of the professional groups in the United States responsible for certifying the competence of physicians and specialists. The ABOG's Bulletin for 2008 Maintenance of Certification, Voluntary Recertification Certificate Renewal includes a warning that certification can be revoked "for cause," including "violation of ABOG or ACOG rules and/or ethics principles." Since this statement is broad enough to include ACOG Opinion 385, it appears that it would provide grounds to revoke the certificates of obstetricians and gynaecologists who refuse to refer for abortion and/or contraception. This would likely jeopardize the livelihoods of objectors, since, according to one professional familiar with the American system, hospitals frequently rely on certification by such boards as a measure of the competence of physicians applying for admitting privileges.

Writing in February, 2008, Dr. David Stevens, CEO of Christian Medical and Dental Associations, warned that "ACOG's new ethics statement clearly targets pro-life physicians, requiring us to either perform or refer for abortions." He continued:

ACOG's perception of and disdain for conscience rights is appalling. Those familiar with ACOG are not surprised at its strident abortion advocacy, though this new step seems bold even for ACOG. What makes this especially dangerous for pro-life physicians is that for the first time, ABOG apparently has colluded with ACOG by linking ABOG certification to compliance with ACOG ethical guidelines. This is a direct threat to pro-life physicians' conscience rights and livelihoods, and we must make our voices heard to stop it. (CMDA News and Views 26 February, 2008)

The ACOG statement has generated spirited comments and replies from objecting physicians and others concerned about the organization's attack on freedom of conscience in health care. A number of the responses to the statement of the ACOG Committee on Ethics are being posted on the Project site.

Readers may also be interested in a similar controversy that arose in Canada. A guest editorial by two law professors in the Canadian Medical Association Journal claimed that objecting physicians are required to refer patients for abortion. The editorial was denounced by a number of Canadian physicians.