The Right Of
Conscience
David Stevens, M.D,M.A. (Ethics)
CEO
Christian Medical Association
Definition
Healthcare
Right of Conscience
The freedom to practice healthcare
in accordance with your deeply
held religious, moral or ethical
convictions.
Martin Luther King
"On some positions cowardice asks the question,
'Is it safe?'
Expediency asks the question, 'Is it politic?'
Vanity asks the question, 'Is it popular?'
But conscience asks the question, 'Is it right?'
And there comes a time when one must take a
position that is neither safe, nor politic, nor
popular. But ... because it is right."
Harper Lee
To Kill a Mockingbird, 1960
"The one thing that
doesn't abide by
majority rule is a
person's conscience."
The Issue
 Alaska (1997) - Valley Hospital Assoc.
 California (2003) - Benitez v. North
Coast Women's Medical Care
 Illinois (2005) - Governor Rod
Blagojevich
 Washington (2007) - Pharmacy Regs
 Overt: Mandatory Abortion Training in
NYC
 2002: Mayor Bloomberg orders
abortion training in All NYC
medical schools
 NY guidelines make it very difficult
to conscientiously object
 Covert: Pro-life students denied
admission (Duquesne Law Review)
ACOG Committee Opinion
# 385, 11/07
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Patient autonomy final arbitrator for Rx
Right to Demand Rx = Right to Refuse Rx
ROC is just a personal opinion
Moral obligation to pt. over rides ROC
Inconvenience imposes providers beliefs
on pts.
Patient’s concept of well-being trumps
Must refer for abortion
If can’t timely refer, must provide
Those who refuse to provide abortions
should only practice in areas where
abortion services can be provided.
American Board of
Obstetrics and Gynecology
New policy issued in
January 2008: certification
contingent on compliance
with ACOG ethical
principles. Under pressure
reversed in 1/09.
Two Opinions
 “the right to abortion, artificial means of
contraception, assisted reproductive technology,
physician-assisted suicide, or other legally
permissible procedures or medications becomes
meaningless without physicians who are willing to
provide such services.”
 “The irony of trampling individual liberties and
conscience rights while marching under the
banner of "choice" will not be lost on the American
public.”
This is Not a New Issue
 Moral Debate 2500 Years Ago
I will neither give a deadly drug
to anybody if asked for it, nor will
I make a suggestion to this
effect. Similarly I will not give to
a woman an abortive remedy.
Hippocratic Oath
Another Perspective “The Right of Refusal”
 “A threat to reproductive rights”
 “Health related decisions made between a
provider and patient should be made on the
personal welfare and healthcare needs of the
patient - not the morals or belief of the
caregivers.”
 “While we firmly believe that all people have a
right to their own opinions and moral beliefs, it
is unethical for healthcare providers to stand in
the way of a woman’s access to safe, legal
and professional healthcare.”
Refusal Clauses
Planned Parenthood Website
What Right?
"Congress shall make no law
respecting an establishment
of religion, or prohibiting the
free exercise thereof…"
(Bill of Rights, First Amendment)
What does Freedom of Religion mean if you can’t follow your conscience?
Writing the First Amendment
 James Madison, 1789-JUN-7 The Civil Rights of none shall be abridged
on account of religious belief or worship, nor shall any national religion
be established, nor shall the full and equal rights of conscience be
in any manner, nor on any pretext infringed. No state shall violate
the equal rights of conscience or the freedom of the press, or the trial by
jury in criminal cases.
 House Select Committee, JUL-28 No religion shall be established by
law, nor shall the equal rights of conscience be infringed,
 Livermore, AUG-15 Congress shall make no laws touching religion, or
infringing the rights of conscience.
 House Version, AUG-20 Congress shall make no law establishing
religion, or to prevent the free exercise thereof, or to infringe the
rights of conscience.
 Conference Committee SEPT 24 Congress shall make no law
respecting an establishment of religion, or prohibiting the free exercise
thereof.
Founding Fathers
 The rights of conscience we never
submitted, we could not submit. We are
answerable for them to our God.
 I consider the government of the U.S. as
interdicted by the Constitution from
intermeddling with religious institutions,
their doctrines, discipline, or exercises.
Thomas Jefferson
James Madison
 Conscience is the most sacred of all
property.
 The Religion of every man must be left to
the conviction and conscience of every
man; and it is the right of every man to
exercise it as these may dictate.
If we don't protect personal integrity, we
would go down a dangerous avenue.
By taking a professional license, you
do not in fact step out of your personal
morality. You have taken on an
additional responsibility, but that does
not mean you have given up your
integrity as a person.
Linda Rankin, Bioethicist, U.of TN
Christian Science Monitor - 4/26/04
Conscience & Healthcare
 Is our healthcare system in need of
more conscience-driven doctors or more
"ethically neutered" doctors?
 Do we want medical schools to
systematically strip our future doctors
from any and all religious and ethical
convictions that have not been approved
by the state?
 Your doctor's conscience may some day
be the last line of protection between
you and those who would profit from
your early death.
AMA Statement
 AMA reaffirms that neither physician, hospital, nor
hospital personnel shall be required to perform any
act violative of personally held moral principles. In
these circumstances, good medical practice
requires only that the physician or other
professional withdraw from the case, so long as
the withdrawal is consistent with good medical
practice.
 Except in emergencies, physicians shall be free to
choose whom to serve, with whom who to
associate and the environment in which to provide
medical care.
World
Medical Association
The physician should be
free to make clinical and
ethical judgments
without inappropriate
outside interference.
Other Countries/Codes
 European Convention on Human Rights
 Everyone has the right to freedom of thought,
conscience and religion; this right includes… freedom
…to manifest his religion or belief in worship, teaching,
practice and observance.
 Canadian Medical Association
 Physicians who object to abortion for reasons of
conscience are advised to inform their patients of their
objections so that the patient can consult another
physician. The CMA stresses that physicians who
decline to participate in abortion should not be
discriminated against, and emphasizes the need to
respect the rights of conscientious objectors,
especially those in training for obstetrics and
gynecology, and anesthesia.
Pharmacist
Association Statements
 “Pharmacist have a duty to act with
conviction of conscience.”
Code of Ethics, APhA“APhA
 recognizes the individual pharmacist’s right to
exercise conscientious refusal”
Pharmacist Conscience Clause, APhA
 “the right of pharmacists… to decline to
participate in therapies they consider to be
morally, religiously or ethically troubling.
American Society of Health-System
Pharmacists
Federal Law
 Church Amendment
 Public Health Services Act
 Medicare/Medicaid
 42 U.S.C. §238n
 Weldon Amendment
Limited to federally funded programs.
State Laws
 45 states have some sort of conscience
laws on abortion
 Illinois 45 ILCS 70/1- “Healthcare right
of Conscience Act”
 “It is the public policy of the State of
Illinois to respect and protect the right of
conscience of all persons.”
 State by State Law
 http://www.consciencelaws.org
Problem Continues
CMDA Member Survey
 40% of member report being
pressured to compromised
convictions
 >43% know someone else who was
pressured
 >24% have lost position, promotion
or compensation as a result
 >88% think it is getting worse
CMDA Public Poll
September 2008 CMDA commissioned
the polling company TM, inc to
conduct a nationwide telephone poll
 +/- 3.1% at 95% confidence level
 42% think law obligates doctors to
perform/refer abortion
 38%, no obligation
 11% unsure
 5%, depends
Protecting a right
does not mean endorsement
of the position
 Protection of someone’s right to
object does not mean be equated
with support for their position
 Indeed, we must pay special
attention to protecting the rights of
others when we do not support the
position.*
*(Claims of conscience rights can be abused)
Efforts to Abolish Laws
 Abortion Access Project
 ACLU - Reproductive Freedom Project
 PCRC -Pro-Choice Resource Center
 Spotlight Campaign
 Merger Watch
 Maryland NARAL Hospital Provider
Project
 Planned Parenthood
Why Not Refer?
 Referral means:
 I endorse the competency, judgment
and ethics of the doctor I’m referring
too.
 I enter into a professional relationship
with them.
 I will receive a report back from him.
 I believe they will “do no harm.”
Current Events
 January 20: HHS policy goes into effect
protecting right of conscience
 Discriminate in the employment, promotion,
termination, or the extension of staff or other
privileges to any physician or other health care
personnel because he performed, assisted in the
performance, refused to perform, or refused to
assist in the performance of any lawful health
service or research activity on the grounds that
his performance or assistance in performance of
such service or activity would be contrary to his
religious beliefs or moral convictions, or because
of the religious beliefs or moral convictions
concerning such activity themselves.
Overturning HHS
Regulations
 Anaphylactic reaction by proabortions groups and some media
 False claims, e.g., women will not be
allowed contraception
 Media blitz
 Legal action taken
 1/15/09 - PP, ACLU, 7 State Attorney
Generals filed suit in CT to overturn
Overturning HHS
Regulations
 February 2009
 Obama announces will rescind
regulation
 30 Day Public Comment Period
ends April 9th.
 Comments reviewed and Rules
Eliminated
What would truly satisfy the
pro-slavery (abortion)
faction
"[W]hat will convince them? This, and
this only: cease to call slavery(abortion)
wrong, and join them in calling it right.
And this must be done thoroughly - done
in acts as well as in words. Silence will
not be tolerated - we must place
ourselves avowedly with them…..The
whole atmosphere must be disinfected
from all taint of opposition to slavery
(abortion), before they will cease to
believe that all their troubles proceed
from us."
Abraham Lincoln
Cooper Union address of 1860
The extent to which an institution
seeks to expunge individual
conscience and moral autonomy is the
extent to which it is totalitarian and
dangerous. The idea that I resign my
conscience to the institution or to the
state is perhaps the single most
pernicious notion in human history. It
is at the heart of the wars and
genocides of this century and the last.
Crispin Sartwell
Los Angeles Times
Self Described “Pro-Choice Atheist”
The “Right” of
Convenience
versus
Right of Conscience
Martin Niemoller
(1892 - 1984)
"First they came for the Jews. I was
silent. I was not a Jew. Then they
came for the Communists. I was
silent. I was not a Communist. Then
they came for the trade unionists. I
was silent. I was not a trade unionist.
Then they came for me. There was
no one left to speak for me."