American College of Obstetricians and Gynecologists Demands Compulsory Referral
Letter to American Senators from the President of the ACOG, 30 August, 2005
A letter from the President of the ACOG to US Senators included a number of statements concerning matters unrelated to freedom of conscience, but included a request that lawmakers force conscientious objectors to abortion to facilitate the procedure by referral. Rather than edit the letter or reproduce the single section of interest, which might invite questions about editorial accuracy and context, the entire letter has been reproduced below and the relevant section highlighted.
The Project wrote to the President of the ACOG on this issue, eliciting a reply dated 18 October, 2005. The reply failed to account for the ethical position taken by the ACOG. A second letter sent by the Project was ignored, despite repeated requests for the courtesy of a reply, the last in March, 2006.
In November, 2008 the ACOG again attempted to impose its ethical views, this time through an opinion from its ethics committee [See ACOG continues attacks on freedom of conscience (2008)].
Office of the President
Michael T. Mennuti, MD, FACOQ
Department of Ob-Gyn
University of Pennsylvania Medical Center
3400 Spruce Street
Phi1adelphia, PA 19104-4283
August 30, 2005
Dear Senator:
On behalf of the American College of Obstetricians and Gynecologists (ACOG), representing 49,000 physicians and partners in women’s health, I urge you to adopt several provisions that would improve the health of women and families across the nation, as you consider the FY06 Labor Health and Human Services, and Education Appropriations bill.
We believe that women should be able to plan their pregnancies, appropriately spacing births according to theft family goals. Currently one half of all pregnancies, approximately 3 million, are unintended, with 1.3 million ending in abortion. Unintended pregnancies can also pose unnecessary health risks to women's access to family planning, funding women’s health research and outreach, and providing medically accurate, comprehensive sexuality education could help reduce these alarming rates and improve the quality of women’s health care.
Continue Support for the National Fetal Infant Mortality Review
The House bill contains report language, which would ensure funding for the National Fetal Infant Mortality Review. ACOG has had a cooperative partnership with the Health Resources and Services Administration (HRSA) since 1990 to manage this program, resulting in improved communication between local health systems that work to decease the infant mortality rate.Fund the Provider’s Partnerships ProgramThe House bill also encourages the HRSA to continue funding the longstanding Provider’s Partnership program. Program finding of $500,000 would allow these partnerships to coordinate care between local health providers and public agencies to address important issues in women’s health such as postpartum depression or smoking cessation during pregnancy.
Increase Funding of Comprehensive Sexuality Education
The Senate bill would increase abstinence only. ACOG believes in comprehensive sexuality education that includes education on abstinence and contraceptives, and requests no further increase in abstinence only education funds.
Review and Update the 4parents.gov Website with Medically Accurate
Information
The Senate bill includes language that would require the
Department of Health and Human Services to review the 4parents.gov website. In
April, ACOG called on the Department to change medically inaccurate information
on the site regarding STDs, contraception and pregnancy.Require Doctors with Moral Objections to Refer for Abortions
The Senate bill would also alter the current Abortion Non-Discrimination Act language so that it would only apply to the counseling and provision of abortion services, and not referrals. Doctors who morally object to abortion should be required to refer patients to other physicians who will provide the appropriate care.Fund Detection and Treatment Programs for Perinatal Depression
Lastly, the Senate bill contains language that would increase support for mental health needs, especially perinatal depression (occurring during pregnancy or postpartum). ACOG strongly supports more research funding and funding of programs to improve detection and treatment of a condition that affects as many as 1 in 10 pregnant women in the US.We hope that you will keep these important provisions in the final appropriations bill Should you have any questions, please contact Krysta Jones, ACOG Government Relations staff at 202-314-2322.
Sincerely,
Michael T. Mennuti, MD, FACOG
President
Protection of
Conscience
Project
www.consciencelaws.org
19 September, 2005
Office of the President
Michael T. Mennuti, MD, FACOQ
Department of Ob-Gyn
University of Pennsylvania Medical Center
3400 Spruce Street
Philadelphia,
Pennsylvania, USA 19104-4283
Dear Dr. Mennuti:
I am writing in response to your letter to
American senators dated 30 August, 2005, in which you stated that
doctors who morally object to abortion should be required to refer
patients to other physicians who will provide the procedure. I note that
you did not offer the senators any reasons to support this dogmatic
assertion.
The Protection of Conscience Project does not take a position with
respect to the morality of abortion or other controversial procedures,
so the objective moral or ethical status of abortion or referral for
abortion is not here in issue. Instead, I would like to have the benefit
of your justification for the demand that physicians who profoundly
disagree with your moral assessment of referral for abortion should,
nonetheless, be compelled by law to accept and live by your moral
convictions rather than their own.
I look forward to hearing from you in the hope that some dialogue on
this issue would be mutually beneficial.
Sincerely,
(Sean Murphy),
Administrator
Michael T. Mennuti, MD, FACOQ
Department of Ob-Gyn
University of Pennsylvania Medical Center
3400 Spruce Street
Phi1adelphia, PA 19104-4283
18 October, 2005
Mr. Sean Murphy
Protection of Conscience Project
7120 Tofino Street, Powell River
British Columbia, Canada V8A 1G3
Dear Mr. Murphy:
Thank you for contacting me with your concerns about ACOG's position regarding
the Labor Health and Human
Services and Education Appropriations Bill. I am sorry that our position on this
bill has caused you concern, and I want
to assure you that comments from our ACOG members are important to us, are
always taken seriously, and help
inform our decisions.
ACOG, and I personally, recognize that support for or opposition to abortion is
a matter of profound moral
conviction, and ACOG respects the need and responsibility of its members to
determine their individual
positions on this issue based on their personal values and beliefs. We also want
to assure that members with a
diversity of views on this issue have a place in our organization.
ACOG's policy on abortion was developed in 1993 in a special session of our
Executive Board, which included
thoughtful and well-respected individuals on all sides of this difficult issue,
and reaffirmed in July 2004. Through this
policy, ACOG supports access to all needed health care for all women, without
regard to financial status, and opposes
unnecessary regulations that limit or delay access to care.
As you know, the bill in question specifically involves care paid for by federal
Title X funds, and would limit access to
care for primarily low income women. While ACOG would oppose any attempt to
require physicians who have
religious or moral objections to perform abortions, the issue of limiting access
by not referring, particularly based on
source of payment, is contrary to our position on any aspect of women's health
care.
While this explanation may not resolve the long-standing debate among our
members regarding abortion, I want to
provide you with the basis for our position on this bill, and most importantly,
to assure you that we take your concerns
seriously.
Sincerely,
Protection of
Conscience
Project
www.consciencelaws.org
10 November, 2005
Michael T. Mennuti, MD, FACOQ, President
American College of Obstetricians and Gynecologists,
Department of Ob-Gyn,
University of Pennsylvania Medical Center,
3400 Spruce Street,
Philadelphia,
Pennsylvania, USA 19104-4283
Dear Dr. Mennuti:
Thank you for your letter of 18 October, 2005,
responding to the Project’s interest in your letter to American
senators, demanding that doctors who morally object to abortion should
be required to refer patients to abortion providers. I am pleased to see
that you evince profound respect for the convictions held by your
members, and heartened by your assurance that members holding a
diversity of views are welcome in the ACOG. This gives me some reason to
hope that further representations from the Project will be graciously
received.
You have made it clear that your demand for compulsory referral arises
from a general policy developed by the Executive Board on access to
services for women. However, you have not explained why access to such
services can be ensured only or chiefly by the suppression of freedom of
conscience through compulsory referral.
It is customary in other liberal democracies to maintain and accommodate
such fundamental freedoms unless it can be demonstrated that
accommodation is not reasonably possible. Moreover, the burden of proof
in this regard lies on those who would suppress or abolish freedom, not
those who exercise it. With respect, you have not discharged this
burden. In the absence of significant evidence to the contrary, it is
difficult to believe that a country as powerful and wealthy as the
United States does not have the resources or imagination to ensure both
access to abortion and accommodation of freedom of conscience.
I understand that well-respected individuals with a diversity of views
about abortion assisted the ACOG Executive Board in the development of
its policy. Be that as it may, I respectfully suggest that
a policy of compulsory referral could only be arrived at by excluding or
discounting ethical viewpoints to the contrary. This is hardly a
satisfactory method of achieving an ethical consensus. In short, you
have not yet established the ethical basis for your claim that
physicians must refer for morally controversial procedures.
Finally, I draw your attention to recent developments in Europe that
bear directly on the issue of referral, and which, I believe, provide
additional reasons for the ACOG to reconsider its position. The first is
a
joint statement issued in December, 2003 by two Belgian universities
and the Flemish Association of General Practitioners that requires
objecting physicians to refer patients to colleagues for euthanasia. The
second is a finding by two committees of the British parliament that a
mandatory requirement to refer patients for euthanasia is probably a
violation of the European Convention on Human Rights. In consequence,
the bill’s sponsor, Lord Joffe, has agreed to delete the provision.
The first of these developments underlines the relevance of precedent to
the present discussion. If it is legally and ethically permissible to
force an objecting physician to refer for abortion, there is no
principled reason not to force him to refer for other morally
controversial procedures, including euthanasia, assisted suicide, sex
selective abortion, or infant male circumcision. Indeed, the arguments
used to justify compulsory referral for euthanasia are much like the
ones offered in an attempt to justify compulsory referral for abortion.
I doubt that, in drafting a policy of compulsory referral for abortion,
the ACOG actually meant to establish a precedent for compulsory referral
for such things, yet that is its effect.
The
finding by the British House of Lords’ Select Committee that
compulsory referral probably violates European human rights law was
based on a
report to that effect from the parliamentary Joint Committee on
Human Rights. Moreover, numerous written and oral statements taken in
evidence by the Select Committee protested the draft bill’s compulsory
referral provision, testifying, one might say, to widespread
understanding and acceptance of the principle of vicarious moral
responsibility.
For your further consideration I have enclosed the Project essay
Referral: A False Compromise; the Belgian and English documents relevant
to the preceding discussion are available on the Project website (http://www.consciencelaws.org/Examining-Conscience-Background/Euthanasia/BackEuthanasia08.html).
In conclusion, I request that the American College of Obstetricians and
Gynecologists withdraw its demand that the U.S. Senate suppress freedom
of conscience by legally compelling physicians to refer for abortion.
Alternatively, if the issue has now become moot due to the current
status of the bill, I request that the ACOG not renew its demand until
it has formally revisited the issue of referral with the benefit of
input from those who would be opposed to it.
I look forward to learning how the ACOG plans to proceed with respect to
this issue from this point forward, and I welcome the opportunity for
further discussion and reflection.
Sincerely,
Sean Murphy,
Administrator