Doctors in the United States cannot be forced to perform abortions or assist suicides. But that may soon change. Bioethicists and other medical elites have launched a frontal assault against doctors seeking to practice their professions under the values established by the Hippocratic Oath. The campaign’s goal? To force doctors, nurses, pharmacists, and others in the health field who hold pro-life or orthodox religious views to choose between their careers and their convictions.
Ethics opinions, legislation, and court filings seeking to deny “medical conscience” have proliferated as journals, legislative bodies, and the courts have taken up the cause. In the last year, these efforts have moved from the relative hinterlands of professional discussions into the center of establishment medical discourse. Most recently, preeminent bioethicist Ezekiel Emanuel—one of Obamacare’s principal architects—coauthored with Ronit Y. Stahl an attack on medical conscience in the New England Journal of Medicine, perhaps the world’s most prestigious medical journal. When advocacy of this kind is published by the NEJM, it is time to sound the air raid sirens.
The authors take an absolutist position, claiming that personal morality has no place in medical practice. Under the pretext of “patients’ rights” and a supposed obligation of doctors to adhere to the medical moral consensus—a tyranny of the majority, if you will—Emanuel and Stahl would prohibit doctors from conscientiously objecting to performing requested procedures on moral grounds. From “Physicians, Not Conscripts—Conscientious Objection in Health Care” (my emphasis):
Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions.
This includes human life–taking actions such as abortion:
[A]bortion is politically and culturally contested, it is not medically controversial. It is a standard obstetrical practice. Health care professionals who conscientiously object to professionally contested interventions may avoid participating in them directly. … Conscientious objection still requires conveying accurate information and providing timely referrals to ensure patients receive care.
This would mean that a Catholic doctor who opposes contraception would have to prescribe it or find a doctor willing to fill out the prescription—even if she informs her patients before being retained that she practices medicine in accord with her church’s moral teachings. It would also require a pro-life OB/GYN who refuses to terminate a pregnancy to find an abortionist, thus becoming complicit in the act. The authors would still allow doctors to decline to assist suicides—for now—but only because that practice is not yet accepted generally within the medical community. If euthanasia ever does becomes generally accepted—as it is now in the Netherlands, Belgium, and Canada—under the Emanuel/Stahl rule, dissenting physicians would be required to participate in homicide.
Emanuel and Stahl would drive noncooperating doctors out of medicine (my emphasis):
Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.
Shattering medical conscience rights would also dissuade those who hold officially unwanted values—orthodox Catholics and other Christians, Jews, Muslims, and pro-lifers—from entering medical school in the first place. There is a method to this madness: The goal is to cleanse healthcare of all those who would dare to practice medicine in accord with sanctity-of-life moral viewpoints.
The attacks on conscience have already moved beyond mere intellectual advocacy. The government of Ontario, Canada is on the verge of requiring doctors either to euthanize or to refer all legally qualified patients. In Victoria, Australia, all physicians must either perform an abortion when asked or find an abortionist for the patient. One doctor has been disciplined under the law for refusing to refer for a sex-selective abortion. In Washington, a small pharmacy chain owned by a Christian family failed in its attempt to be excused from a regulation requiring all legal prescriptions to be dispensed, with a specific provision precluding conscience exemptions. The chain now faces a requirement to fill prescriptions for the morning-after pill, against the owners’ religious beliefs. In Vermont, a regulation obligates all doctors to discuss assisted suicide with their terminally ill patients as an end-of-life option, even if they are morally opposed. Litigation to stay this forced speech has, so far, been unavailing.
The ACLU recently commenced a campaign of litigation against Catholic hospitals that adhere to the Church’s moral teaching. For example, it sued a Catholic hospital that refused to sterilize a woman in conjunction with her caesarian section. That lawsuit failed. Undaunted, the supposed guardians of civil liberties—except the free exercise of religion, it seems—recently brought a case against a Catholic hospital for refusing to permit doctors to perform an elective hysterectomy as part of a sex-reassignment surgery.
There is a reason that moral diversity is under attack in health care. When doctors refuse to abort a fetus, participate in assisted suicide, excise healthy organs, or otherwise follow their consciences about morally contentious matters, they send a powerful message: Just because a medical act is legal doesn’t make it right. Such a clarion witness is intolerable to those who want to weaponize medicine to impose secular individualistic and utilitarian values on all of society.
Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism. He is also a consultant to the Patients Rights Council.