The Hippocratic Oath, Persona Non Grata

Writing in the latest  First Things  magazine (” Abortion After Obama “), Joseph Bottum worries that federal law may soon require medical schools to provide mandatory abortion training and all hospitals to cooperate with pregnancy terminations. This isn’t alarmism. Australia’s new abortion law, for example, requires that physicians either perform abortions when requested, or if opposed, still find a doctor on behalf of the patient who will likely agree to terminate the pregnancy. A proposal that didn’t pass in California would have similarly permitted terminally ill patients to demand palliative sedation accompanied by dehydration via the removal of food and fluids. Doctors who objected would have been required to find a colleague willing to go along. 
 
One purpose of these and other such proposals is to make all medical professionals potentially complicit in a bioethical culture of death. One answer to this threat is the so-called conscience clause that would permit healthcare professionals to refuse participation in such practices. Accordingly, the Bush administration has just promulgated rules prohibiting job discrimination against medical workers who refuse to perform abortions or engage in other medical acts based on moral or religious beliefs.
 
The bellows of protest have already begun, leading to the conclusion that people of a certain moral bent are to be driven completely out of health care. Indeed, in responding to the Bush Proposals, the St. Louis  Post Dispatch  recently editorialize d:

Michael O. Leavitt, the Bush administration secretary for Health and Human Services, lauded the rule last week. “Doctors and other healthcare professionals shouldn’t be forced to choose between good professional standing and violating their conscience,” he said.

No such conflict should exist. Doctors, nurses, and pharmacists choose professions that put patients’ rights first. If they foresee that priority becoming problematic for them, they should choose another profession.

 
How ironic that physicians and others who simply wish to adhere to the precepts of the Hippocratic Oath are declared  persona non grata  in medicine.
 
Be that as it may, those who believe in protecting medical conscience rights need to begin preparing the intellectual ground to protect dissenting professionals’ careers without also opening the door to conscience being used as a club to deny wanted life-sustaining treatments such as feeding tubes by physicians who consider it wrong to maintain patients with a “low quality of life”—a proposal already gaining stream in bioethics known as “medical futility.”
 
To keep from so throwing out the baby with the bathwater, I suggest that we consider at least two crucial distinctions in determining what would be a protected refusal to provide a requested medical intervention; first,  between elective and non-elective procedures , and second between  treatments and patients . Thus, doctors should be permitted to refuse elective procedures—that is, interventions not immediately necessary to save the patient’s life or prevent serious physical harm—if their conscience so dictates, whether it be rhinoplasty, abortion, or assisted suicide. To prevent care refusals from being a mere cover for discriminatory attitudes,  the requested procedure  should generally be what violates the conscience,  not bias against the patient . In this way, for example, an oncologist should not be able to refuse to treat a lung-cancer patient because the patient smoked or was a member of a racial minority.
 
No doubt there will be nuances within nuances here, so there will be much to consider. But with the rights of conscience likely to be an explosive bioethical controversy in the coming decade, the time to begin planning for the struggle is now.