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Protection of Conscience Project

Service, not Servitude
Legal Commentary

Re: Wisconsin Assembly Bill 67

Testimony before Wisconsin Senate Committee
on Health, Children, Families, Aging and Long-Term Care
October 7, 2003

Cynthia Jones-Nosacek, M.D.
St. Mary's Medical Clinic, Milwaukee, Wisconsin

Finally, the protection provided in this bill for the refusal to refer. This is not abandonment. We will continue to treat the patient. However, we refuse to treat in a manner that we think is immoral. Remember that what has been legal is not always moral. If a physician in the Tuskegee Syphilis study had refused to let his patients be placed into that study, should he have been forced to do so?

My name is Cynthia Jones-Nosacek, MD. I am a board certified family physician with St. Mary's Medical Clinic in Milwaukee, WI. As a family physician, I cover all aspects of patient care from delivering babies to caring for patients in nursing homes. I am here to testify in favor of AB 67, the conscience clause bill.

If you read and listen to the responses against this legislation, you can't help but be shocked. The idea that basic health care would be denied Wisconsin residents sounds too horrible to be true. Pregnant women denied treatment for their diabetes and high blood pressure, patients dying in agony, even men being denied their medicine for genital herpes, what's next? The only thing that hasn't been said against this legislation is that it will destroy life on earth as we know it. Though perhaps being called part of the "Islamic Jihad of Wisconsin" is close.

So before I came here to testify, I did what any good voter should do and looked up the proposed legislation. And this is what it states: this bill protects the rights of conscience for health care providers, including pharmacists, who refuse on religious or moral grounds to do

1. "a sterilization procedure"

2. "an abortion" (defined as the "use of an instrument, medicine, drug or device with intent to terminate the pregnancy of a woman known to be pregnant or for whom there is reason to believe that she may be pregnant and with the intent other than to increase the probability of live birth, to preserve the life or health of the infant after live birth or to remove a dead fetus.")

3. "an experiment or medical procedure that destroys an in vitro human embryo or uses (its) cells or tissues…"

4. "an experiment or medical procedure on an in vitro human embryo that is not related to (its) beneficial treatment…"

5. "an experiment or medical procedure on a developing (unborn) child… in any stage of development that is not related to (its) beneficial treatment…"

6. "a procedure, including a transplant procedure, that uses fetal tissue or organs other than fetal tissue or organs from a stillbirth, spontaneous abortion, or miscarriage"

7. "the withholding or withdrawal of nutrition or hydration, if the withholding or withdrawal of nutrition or hydration would result in the patient's death…rather than from the underlying terminal illness or injury…"

8. "an act that intentionally causes or assists in causing the death of an individual, such as by assisted suicide, euthanasia, or mercy killing"

And after reading the above, I agree with my first impulse. What is being said is too horrible for the simple reason is that it is not true.

I am still unclear how this legislation would prevent a man from getting his medicine for genital herpes since he is not pregnant, can never get pregnant, does not involve the withholding of nutrition or hydration, or result in his death. But perhaps he misread the bill.

Women will not be denied prenatal care. In Planned Parenthood's sworn testimony before the state legislature, they insisted that this bill would include insulin for diabetic women. Others contend that women who had high blood pressure during pregnancy would not be treated. However, since both conditions must be treated to preserve and protect the health and life of both mother and child, these claims are easily refuted. It is true that some blood pressure medications are contraindicated in pregnancy, but there are many others that can be used instead. In fact, I am presently doing this for a patient of mine who wants to get pregnant. Unfortunately, I am racing against the clock of keeping her pressure under control before this happens, since her pro-choice physician simply removed her IUD and gave her no other contraception before sending her to me.

Other conditions that occur during pregnancy, such as a tubal pregnancy, will continue to be treated as before by pro-life physicians. In a tubal pregnancy, not only does implantation occur outside the uterus, ending it is not considered by pro-life physicians to be an abortion since the intent is to remove the diseased tube, not kill the embryo. I know this to be the case since this is what has been done to my patients when I have referred them to obstetricians who are passionately pro-life.

But these are simple cases. Let me give you more difficult ones and tell you why treatment will continue.

Take for example, epilepsy in pregnancy. The medicines used cause birth defects, and there are no good alternatives. Yet, we would not tell our pregnant patients to stop them because again, the life of both mother and child would be placed in jeopardy.

Here's a harder one. Say the woman has breast cancer. She could quite easily survive without treatment until the baby is born. But by then, it may be too late to save her life. She would be treated, even if that treatment places the fetus' life at risk. In fact, treatments are now available during this time only because pro-life women were not willing to abort their babies so that they would be treated. Even hysterectomy for cancer during pregnancy before viability of the fetus can be done for the same reason. The reason is that, in neither of these examples, does this constitute an abortion since the intent is to treat the disease, not kill the child.

For us, it is not an "and/or" situation. It is not the mother OR the child. It is the mother AND the child.

And how can I sit here and state this with such conviction? Because, in all the years since the legislation passed protecting physicians from being forced to perform abortions, I have not seen this happen. In all of these examples, patients have received care from their pro-life physician.

When it comes to denying "palliative treatment" to the dying, I am puzzled by the idea that refusing to deny food and water to a patient, unless medically contraindicated (which is covered in the statute), is denying treatment. Is refusing to deny treatment denying treatment? And while it is true that euthanasia is presently illegal, every year, bills have been introduced in the legislature to legalize this. Including this provision is just being proactive as is the protection against other treatments that involve the destruction of life such as the transplantation of cloned or fetal stem cells.

Patients and their families do have the right to vote with their feet if we disagree on treatment. I have had patients obtain abortions after I have counseled against it. Many continue to see me even after they have had the procedure.

Finally, the protection provided in this bill for the refusal to refer. This is not abandonment. We will continue to treat the patient. However, we refuse to treat in a manner that we think is immoral. Remember that what has been legal is not always moral. If a physician in the Tuskegee Syphilis study had refused to let his patients be placed into that study, should he have been forced to do so?

I have never heard before this that I must agree to do whatever the patient requests or refer to a physician who will. If that were true, if I saw a patient with a viral infection who continued to demand an antibiotic, I would have to find a physician who does.

In civil law, as I have been taught, if I refer to a surgeon I know to be incompetent and who botches the surgery, I will be sued along with the other doctor. Legally, I am just as responsible. If I knowingly refer a patient to Jack Kevorkian, I will be an accomplice to euthanasia which we all agree is illegal and I will face prison time. And I suppose that would also be true if a pharmacist did the same thing.

Recently in the news, there was an uproar about the US sending suspected terrorists to countries whose ideas of civil rights are not as delicate as ours. Even if we do not torture these prisoners ourselves, morally we are still responsible since we sent them to these countries knowing that to be a possibility. So it is with the referral of a patient for an abortion or euthanasia or any other treatment that involves the destruction of life such as embryonic stem cell transplantation. If we refer to another to end a life, we are no different than the person who says, "I don't do murder for hire. But here's the phone number of Vinny the Snake. He'll do it for you."

I also find it interesting, as a member of the Wisconsin Medical Society, that this organization who spent so much effort so that we physicians would not be "forced" to refer to chiropractors under managed care, sees nothing wrong in forcing us to be responsible for the destruction of a human life.

As pro-life physicians, we will continue to provide a high level of care to our patients without the taking of human life. We will not abandon our vulnerable patients. For human life is of inestimable value from the moment of fertilization to natural death and demands that we be there to support it, not take it.

Ultimately, it comes down to how those in the medical profession are allowed to provide care. Are we to be someone who just follows orders based solely on what is legal? Or may I be allowed to treat everyone who comes into my office as a person with basic dignity and value. That is the choice before us.


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