For years the Christian Medical and Dental Association (CMDA) has been advocating in Washington, DC for the conscience rights of its members and all healthcare professionals, encouraging legal protections and education and reform in the medical profession. The issue took center stage recently when the New York Times published an article based on a leaked copy of draft regulations by the U.S. Department of Health and Human Services (HHS) on conscience rights in healthcare.
The revelation of draft regulations to protect conscience rights set off an avalanche of protests from abortion advocates, many of whom have asserted that healthcare professional literally should choose another career if unwilling to participate in abortions. Opponents of the regulations wrongly asserted that HHS was trying to stop abortions and limit contraceptive use—very difficult charges to make stick, since the regulations would not outlaw a single abortion and since HHS this year will fund over $1.6 billion in “family planning” services.
CMDA responded to the New York Times article and alerted its members to communicate with HHS and their congressional leaders, and to write letters to the editor, to explain the need for conscience protections in healthcare. Members responded with insightful communications and personal stories such as those excerpted below:
Steven Hammer, MD: “In my 23 years as a practicing family practice doctor, I have seen rising pressure on physicians to violate their consciences. Everyone wants a physician who has moral integrity, yet special interest groups are increasingly compelling physicians to prescribe and do things that many of them find unconscionable.”
Douglas Lindberg, MD: “The moral fabric upon which I base my practice and which is contained in the Hippocratic Oath provides a framework for me as I seek to provide appropriate and responsible care. For this reason, I have been quite alarmed at the growing pressure that physicians are facing to provide services which they find morally reprehensible. I myself have experienced pressure to do so. I fear that our society stands on the brink of forcing physicians to choose between abandoning their convictions or exiting the profession.”
Keith J. Peevy, JD, MD: “I am writing to ask your support of HHS regulations that protect the individual medical practitioner’s right to practice in a manner consistent with their conscience, rather than being coerced to practice according to guidelines that violate their faith. Recent proposals and guidelines by professional organizations fall outside of medical guidelines and have entered into attempts to legislate thought, and in so doing have violated the individuals right to practice in accordance with their conscience and have violated the patient’s right to seek care givers of like mind. Please support legislation/regulations which uphold traditional safeguards against these pernicious trends.”
Donald F. Thompson, MD, MPH: “As a physician with over a quarter century of service in the U.S. military, I take my vows very seriously. Twenty-two years ago, I took the Hippocratic Oath when I graduated from medical school, but regrettably was required by military regulations to violate it within my first few years of practice by participating in referring women for abortions. I appreciate your commitment to upholding the existing anti-discrimination laws of our nation that protect our individual and institutional freedoms, particularly our First Amendment rights.”
Read more communications to policy leaders by CMA members.
HHS Secretary Mike Leavitt responded by posting two blogs on the draft regulations to protect conscience rights in healthcare. In one of his blogs, Secretary Leavitt wrote, “The Bush Administration has consistently supported the unborn. However, the issue I asked to be addressed in this regulation is not abortion or contraceptives, but the legal right medical practitioners have to practice according to their conscience and patients should be able to choose a doctor who has beliefs like his or hers.”
As that blog drew a volley of heated responses from abortion advocates, CMDA alerted its members to the opportunity to post comments on the blog and provide evidence supporting the regulations. Within minutes of sending that mass email alert, comments from CMA members began to appear on the blog. Here’s a sampling:
Sandy Christiansen, MD: “As an obstetrician/gynecologist who has chosen not to perform elective terminations of pregnancy, I can testify to the pressures that physicians, particularly physicians-in-training, face when attempting to practice medicine according to their own conscience. As an intern, I was the only one among my group who declined to perform elective abortions, and it was understood that it was because of my Christian beliefs. As a direct ‘consequence ‘of this choice, I was not permitted to participate in training opportunities that my fellow interns were given. I questioned my chief resident as to why I wasn’t being given these opportunities and was told that the others had ‘worked hard doing the abortions and had earned this privilege’ whereas I had refused to do this work and hence did not get the ‘perk’.”
William Bolthouse, MD: “To deny physicians the ‘right of conscience’ means that we as doctors will necessarily have to act outside the bounds of our personal integrity and conform to someone else’s standard of what it means to provide the best care for the patient. It seems to be unthinkable that anyone would want to put their own doctor in that kind of position… unless, of course, they had an agenda other than allowing their physician to practice to the best of his medical abilities and moral conscience.”
Beverly B. Nuckols, MD, MA (Bioethics): “As a Family Physician, I thank you for protecting the right of conscience of all medical professionals. Each of us must be allowed the freedom to refuse to act against our conscience or we will no longer have a profession, only educated technicians willing to carry out the demands of others.”
Read more CMDA member comments on the HHS blog
In a follow-up blog entry, Secretary Leavitt quoted Mary Jane Gallagher, President of the National Family planning and Reproductive Health Association, who said that ” it’s really not acceptable to the people I represent that this administration is considering allowing doctors and nurses and pharmacists that have received their education to provide services to now be able to not provide those services if they don’t want to.”
Sec. Leavitt noted that “according to Ms. Gallagher’s ideology, if a person goes to medical school they lose their right of conscience. Freedom of expression and action is surrendered with the issuance of a medical degree. There is something I’d like to point out to Ms. Gallagher and the people she represents. It is currently a violation of three separate federal laws to compel medical practitioners to perform a procedure that violates their conscience.
“Obviously, some disagree with the federal law and would have it otherwise, so they have begun using the accreditation standards of physician professional organizations to define the exercise of conscience unprofessional and thereby make doctors choose between their capacity to practice in good standing and their right of conscience. In my view, that is simply unfair and a clear effort to subvert the law in favor of their ideology.
“If the Department of Health and Human Services issues a regulation on this matter, it will aim at one thing, protecting the right of conscience of those who practice medicine. From what I’ve read the last few days, there’s a serious need for it.”
Many CMDA members have also provided their personal stories for use in educating policy makers and the public on the need for conscience rights in healthcare. A few of these stories are excerpted below:
Rebecca Lavy, MD: “I was employed in a teaching position at the University of Texas Southwestern in Dallas, TX from 1999 – 2001. While I was there, the faculty was required to take in house night call. This included performing the sexual assault examinations – all of which for Dallas County were referred to our ER. It was not uncommon to be called to perform 2-3 of them in a night. One of the things the department said was required was that we prescribe for these women the post-coital use of oral contraceptives (Erroneously, in my opinion, called the ‘post-coital contraceptive’) I refused to prescribe it and was told, ‘This may be an employment issue.’ The obvious, not-so-subtle implication was that I would be fired if I refused. We went round and round. Since I didn’t agree with simply calling someone else in (one of the residents) to prescribe the medication (if prescribing them is ethically wrong, asking someone else to do it for me is equally wrong).
J. Wesley Earley: “I am a third-year medical student. In my second semester, we take a Medical Ethics course. On numerous occasions, I was repudiated by the professor for my unwillingness to profess as acceptable her position that all physicians MUST refer a patient wishing an abortion to an abortion provider (since I obviously was unwilling to perform one myself). The professor’s point was that the woman desiring the abortion was my patient and I was ethically bound to refer her in order to meet my ethical obligation of ‘non-abandonment’ once I had accepted her as a patient. My response to her was that I was ethically and morally beholden to defend the life of the unborn child, and that my vow of placing my patient’s well-being before all else took precedent in preserving the child’s life over terminating the pregnancy for the woman’s convenience.”
Jeffrey A. Keenan, MD: “Earlier in my career, I was basically brought up on ethics violation charges because I refused to work with patients who would destroy embryos. Even though there were other MD’s in the community and even in our department who did destroy embryos, I was forced to basically be confronted with these charges in public and endure the ‘hearing’. I won out in the end of course, but it was still very disturbing.”
Trevor K. Kitchens: “I am a first year medical student in the beginning stages of deciding which specialty I would like to pursue. I am currently very interested in OB/GYN, but I am afraid of the relationship between this field and abortion. By the way, I am 100% against abortion, and there is no way I would perform one. Moreover, there is no way I would tell a patient that abortion is an option under any circumstance, because I do not believe it is an option. My concern is that I will start a residence and would subsequently be required at some point to give a patient the option of abortion, which I would refuse. My fear is that taking this stand would cost me my residence position.
“Now, if that is what it comes down to, I will be glad to take the stand for Jesus Christ and give up my position. However, I would really like to be able to avoid this situation and complete my residence so that I could go on and serve the Lord in that field. So I guess my question is, Can an institution take action against a resident for taking this type of a stand against abortion? And are there any institutions in particular that would be understanding of my beliefs and not ask me to compromise them?”
Read more CMDA member stories on conscience
A message from CMDA Chief Executive Officer, David Stevens, MD
I could not have been more proud of CMDA members than I was as I read all of your responses on this issue. With wisdom, grace and eloquence, many of you took time to make your concerns known.
Numbers count in Washington, and to issue regulations it is always vital to show there is a problem that needs to be rectified. Over the weekend, before our alert to members, the overwhelming number of comments on the blog site were opposing the right of conscience or distorted the intent of the HHS Secretary. After my e-mail alert went out, scores of members responded. The blog comment totals went from 250 to over 800 in one day!
Keep at it and don’t stop now. If you have already shared your concern, you can go back and blog again to respond to a point made by a blogger on the other side. Tell your like-minded colleagues, staff and friends to register their support for regulations as well.
This is a pivotal moment where we can change the tide that has been flowing against the freedom to practice ethical medicine. We can send a clear message to those who would put your and my conscience into shackles — a message that their campaign of intolerance has backfired! As the wise old adage goes, it is not wise to awaken sleeping giants.