30 March, 2011
Reproduced with permission
William Saunders and Anna Franzonello
An issue of paramount importance for medical professionals is the protection of their right to conscience—their freedom to refuse or decline to do practices they oppose on religious or moral grounds. A February decision by the Obama administration, however, sweeps aside conscience protections instituted under President Bush.
The decision is not unexpected—the Obama administration initiated the process to rescind the Bush regulations on March 10, 2009. Unfortunately, it comes at a time when pressure to violate one’s conscience or leave the medical profession is not theoretical but very real.
Obama Rejects ‘Conscientious Refusal’
One such recent threat comes from the American College of Obstetrics and Gynecology (ACOG), which reviewed and reaffirmed its 2007 Ethics Committee Number 385, titled “The Limits of Conscientious Refusal in Reproductive Medicine” in November 2010.
Rule number 385 categorizes a conscience objection as a “refusal,” describing elective abortion and other controversial reproductive medical procedures and services as “standard.” The opinion states, “In some circumstances, respect for conscience must be weighed against respect for particular social values.”
On balance, according to ACOG’s rule, abortion is a social value that outweighs any conscientious objection. It requires prolife physicians to refer individual for abortions and even suggests they relocate their practices to better refer patients to nearby abortionists.
Could Strip Certification
The effect of the ACOG committee opinion is that otherwise qualified health care providers specializing in obstetrics and gynecology may lose their board certification solely because of their prolife values. According to the 2011 Bulletin for Basic Certification in Obstetrics and Gynecology from the American Board of Obstetrics and Gynecology (ABOG), an individual can have his or her board certification revoked if he or she acts in “violation of ABOG or ACOG rules and/or ethical principles.”
Without Board certification, a doctor is subject to discrimination by other entities. State and local governments, hospitals, or other institutions that require Board certification may take action against the physician. Thus, refusing to conform to the ACOG recommendations on abortion could result in the loss of a health care provider’s livelihood.
In finding that abortion is a circumstance where conscientious objection “can and should be overridden in the interest of other moral obligations that outweigh it,” ACOG’s subjection of conscience to patient autonomy leaves patients paying the ultimate price. Access to essential reproductive health care will be limited as prolife doctors are forced out of the field.
ACOG Threat Prompted Rule
When ACOG first issued its threat, then-Secretary of Health and Human Services (HHS), Michael Leavitt issued a letter to Norman F. Gant, executive director of ABOG, stating such discrimination would seem to violate federal laws protecting the right of conscientious objection to abortion.
ABOG and ACOG refused to change their policy, and the Bush administration enacted the “Regulation Ensuring that the Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Practice in Violation of Federal Law” in December 2008. The regulation required certification from entities receiving federal funds from HHS that they will comply with the established federal conscience protection laws.
A recent case demonstrated the importance of the Bush rule. A nurse at Mt. Sinai hospital in New York, Cathy DeCarlo, was forced to participate in an abortion despite her conscientious objection. A federal court dismissed her claim, saying she cannot bring suit by herself. HHS then ruled the court can pursue the case because of the Bush regulations.
Now that President Obama has revoked the rule, conscience rights will likely have little protection against threats from ACOG and ABOG. It is unlikely Congress (particularly the Senate) has the votes to convert the revoked guidelines into a binding statute. For this reason, Americans United for Life has drafted a model bill to protect conscience at the state level, blocking discriminatory practices such as “refusal of board certification.”
Health care professionals face serious ethical issues on a daily basis. The Obama administration’s rejection of conscience protection ought to concern both health care providers and patients.