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News Commentary 2005

Rights of Conscience - Exactly Whose Conscience Wins?

Christian Medical and Dental Associations (USA)
Reproduced with permission

Bradley G. Beck, MD, MS

If you were to listen to the liberal establishment, you would think there was a terrible abuse of human rights happening here in the US.

In fact, in April of last year, Illinois Governor Rod Blagojevich implemented an emergency rule. For what dire emergency you might ask? He ordered all Illinois pharmacies that carry contraception to have all pharmacists provide it to all patients presenting prescriptions, including the emergency contraction (the so-called "morning after" pill). Many pharmacists refused to fill these prescriptions because they believe that many oral contraceptives (in particular the "morning after" pill) are an abortifacient, and instead of preventing conception, these hormonal treatments can actually cause an early abortion after a woman is pregnant.

"Planned Parenthood is proud to stand along side the Governor…and thank him for his leadership in Illinois and in the United States to safeguard reproductive rights and to protect women's health," said Karen Pearl, national president of Planned Parenthood.

There are many recognized rights of conscience within the realms of the medical field. For example, the right of a patient to decide what treatment is ethical and appropriate for themselves has long been recognized. And there has been a general understanding that a healthcare facility such as a hospital may determine what procedures and polices which will be implemented and encouraged, such as the case of Catholic hospitals refusing to do abortions. Also, there has been a general consensus recognizing the right of physicians to limit the treatments and procedures they provide by their training or their moral conscience. Until recently, all healthcare professionals have had the right to refuse to participate in situations or procedures that they believe to be morally wrong or harmful to the patient or others.

But no longer. Our friendly ACLU, the defender of "civil liberties," and Planned Parenthood will stomp on your rights if they think you happen to deny someone else of what they perceive is their rights.

The ACLU apparently considers contraception a "human right." They declare on their web site, "If you are denied EC (emergency contraception), know that legal action is possible. EC is a legal form of contraception and you have every right to obtain it."

Teresa Stanton Collett, JD, a professor of law at University of St. Thomas School of Law in Minneapolis writes, "When understood in this manner, the question becomes that of whose freedom should trump the other. Should the doctor remain free to act in accordance with her conscience, or should the patient be free to obtain a legally permissible service from each and every doctor? Either way, someone's liberty will be restricted."

Collette goes on to say, "If the law compels physicians to provide treatments in conflict with their conscience, the freedom of a physician to practice medicine in accordance with his conscience is diminished."

In spite of this, there was a concerted effort a few years to ago to make abortion training mandatory within all physician obstetrical-gynecological training programs. The reason? The number of physicians willing to do abortions has been dropping dramatically over the past 10 years. This was a thinly veiled attempt to prop up the number of Planned Parenthood clinics who do abortions with a fresh crop of newly abortion-trained physicians. Who cared what the doctors in training really thought or felt about the procedure? So, let's make it mandatory.

Then the mayor of New York City got in on the action a few years ago. In 2002, Mayor Michael Bloomberg made abortion training mandatory in all NYC OB-GYN medical training programs. There was a conscience clause written into the program, so that those who opposed it could opt out, but the assumption made by the program was that all residents would train unless the residents actively chose to opt out of the training.6

If there is a common theme running through these situations, it is the insistence by some politicians in particular that health care providers simply comply with patient demands, regardless of any conflicting demands or issues of the health care providers' consciences.

Why isn't the ACLU fighting for the rights of the healthcare professional? Here the ACLU is showing its true colors. They believe the right of woman to access "reproductive health care" trumps all other rights, obviously including the rights of the conscience of the healthcare provider, and the right to life for the unborn child.

The movement is snowballing. In November 2005, Walgreens placed four Illinois pharmacists on unpaid leave after they refused to fill prescriptions for all contraceptives. This was because Walgreens believed the pharmacists were violating Governor Rod Blagojevich's emergency ruling that pharmacist had to prescribe EC if asked to do so. The American Center for Law and Justice filed a suit against the chain on behalf of the pharmacists in January.

Illinois state lawmakers responded to Governor Blagojevich in January with three proposed bills that would allow pharmacists to refuse to fill EC prescriptions that violate their personal or religious beliefs. "We're not saying take it off the market," said Rep. Ron Stephens, R-Greenville, a pharmacist himself. "We're just saying for those pharmacists who have a religious problem with it, don't make us fill it."

What was Governor Blagojevich's reply to this challenge? "Now, I understand that several bills have been introduced that would overturn my executive order to protect women's reproductive freedoms," Blagojevich said in his State of the State address. "So let me make something else very clear -- if any of those bills reach my desk, they are dead on arrival." Blagojevich again conveniently ignores the freedoms for the pharmacists in his state.

Even more recently in Massachusetts the state Board of Pharmacy jumped into action, ordering Wal-Mart to stock the morning after pill. Wal-Mart had previously refused to stock this medication nationally since 1999 as a company policy.

One of the successful plaintiffs in the Massachusetts suit, Dr. Rebekah Gee, summed up her case by asserting, "My patients should not have to shop around." As Jonathan Imbody of the Christian Medical Association writes, "Abortion advocates have found yet another new right in the Constitution--the right not to have to shop around."

There has been another switch in tactics that the "women's rights" advocates are now using. There is also a concerted push for over the counter (OTC) status for EC. It is an additional end-around to the tactic of forcing pharmacists or doctors to prescribe the medication, or to make it available. Although "Plan B" (the most popular form of EC) is a larger dose of a progesterone-like hormone (levonorgestrel) that is in all other prescribing circumstances considered a prescription medication. It seems to be of no concern to them that OTC hormonal medications are potentially dangerous, have otherwise only been prescribed by licensed physicians, and have not been used or even studied extensively for minors.

Can you see how the ACLU has a very selective filter regarding rights? Obviously this is done at the expense of the rights of the poor physician or pharmacist or physician who believes they are ending a human life.

The real question is just whose human rights are being stomped on here?

Rights of Conscience

Christian Medical and Dental Associations (USA)
Church Report, September 2005
Reproduced with permission

Dave Stevens, MD

Have you noticed the progression of demands from groups that society accept morally objectionable practices? Whether it is abortion on demand or the church allowing homosexual marriage, first there is a demand for tolerance. Once a practice is tolerated, the next demand is for acceptance without reservation. Those that fail to do this are criticized and considered bigoted. That quickly progresses to a demand for endorsement. The bad practice is not just tolerated or neutrally accepted, but now each individual must see it as a good.

The last step is to demand that there is active participation in the practice once seen as objectionable. Varied tactics are used to accomplish this goal. In the workplace, everyone is expected to display a ribbon or other symbol to show their support for gay pride day, for example. Coercion in Christian circles is less subtle. In Canada, a Christian radio station can lose its license if it broadcasts a scripture verse criticizing homosexuality.

The abortion battle is well into this fourth stage, as advocates demand that pharmacists dispense abortifacient morning after pills over their conscientious objection. And they are making progress. Governor Rod Blagojevich of Illinois recently issued an executive order requiring pharmacists to dispense all "legally prescribed medicines." The governor of Wisconsin vetoed a bill that would have protected pharmacists. In New York City, obstetrical residents are required to learn abortions. In Alaska, Catholic hospitals are required by law to dispense birth control methods that they oppose.

As I recently prepared for a CNN debate on this issue, I was reminded that our country was founded by conscientious objectors who built right of conscience protection into the first amendment of the Bill of Rights. It states, "Congress shall make no law respecting the establishment of religion, or prohibiting the free exercise thereof…" One of the foundations for the establishment of the United States was the freedom of each citizen to live according to their moral and religious precepts. Our founding fathers further explained their desire on this issue. John Madison stated, "Conscience is the most sacred of all property." Thomas Jefferson added, when speaking on the rights of government, "The rights of conscience we never submitted, we could not submit. We are answerable for them to our God."

If we don't protect the right of conscience of those in medicine, we head down a dangerous path. Do we want our schools to strip our future healthcare professionals of all ethical convictions that have not been approved by government? You do not give up your personal morality when you earn a professional license.

Ironically, boldly written on the morning after pill package is the statement, "Not an Abortifacient", though an American College of Obstetricians and Gynecologists (ACOG) article revealed that 38 percent of the time these pills caused death by preventing the implantation of the developing embryonic human being. A little verbal gerrymandering by ACOG solved that problem. They issued an edict that pregnancy didn't start until the embryo implanted. If you are not pregnant, you cannot abort, can you? They simply ignored the principle of informed consent, which states that every woman needs to know all the consequences of taking a medication.

Pro-life pharmacists are seen as an embarrassment to the cover-up when they don't want to dispense the morning after pill for the same reason they won't drive drunk--they are unwilling to risk killing another human being.
In all the debate, everyone has failed to notice that there is not one documented case of a woman not getting her morning after pills. The woman simply got it from another pharmacist. Ominously, this battle is between a woman's trivial right of convenience and the fundamental right of conscience.

Why should you be concerned? Coercing individuals to ignore their conscience ultimately will impact you and me. First it is the pharmacist, then it's the doctors and nurses. Then it will be pastors and churches, but the issue might not be birth control. Instead, it will be your hiring policies. The Christian Medical Association is already under attack on medical and dental school campuses, where pro-choice students and faculty are demanding that our student chapter leadership be open to all interested, whether they are Christians or not. Student chapters are being banned from campuses because they are "discriminatory", since they won't allow practicing homosexuals into leadership positions.

I'm reminded of the Martin Niemoller quote, about opposing the Nazis: "First they came for the Jews. I was silent. I was not a Jew. Then they came for the Communists. I was silent. I was not a Communist. Then they came for the trade unionists. I was silent. I was not a trade unionist. Then they came for me. There was no one left to speak for me."

Now is the time to speak up.

Rights of Conscience

Christian Medical and Dental Associations (USA)
MD News, July/August, 2005

Reproduced with permission

Dave Stevens, MD, MA (Ethics)

Some pharmacists in Illinois may soon have to decide between their job and their conscience. Recently, Governor Rod Blagojevich issued an executive order requiring pharmacists to dispense all legally written prescriptions, including those for the morning-after pill. Some pro-life pharmacists had referred those prescriptions to another pharmacist or pharmacy after an American College of Obstetrics & Gynecology journal article revealed that 38% of the time the pills acted by preventing implantation of the developing embryo. They don't want to dispense the morning-after pill for the same reason they won't drive drunk. They don't want to take the risk of killing another human being.

The right of conscience issue is not limited to pharmacists. Medical and physician assistant students are taught in some schools that they must refer patients who want an abortion to other doctors. Some have declined to participate in executions by lethal injection or refused to prescribe a lethal dose of barbiturates to a patient requesting assisted suicide. Faith-based hospitals in Alaska have been told they must do abortions or they will lose state funds.

Do healthcare providers have a right to follow their conscience? The First Amendment of the Bill of Rights directly addresses this issue when it says, "Congress shall make no law respecting the establishment of religion, or prohibiting the free exercise thereof…" One of the foundations for the establishment of the United States was the freedom to live according to each individual's moral and religious precepts. Our founding fathers further explained their desire on this issue. John Madison stated, "Conscience is the most sacred of all property." Thomas Jefferson added when speaking on the rights of government: "The rights of conscience we never submitted, we could not submit. We are answerable for them to our God."

If we don't protect the right of conscience of those in medicine, we head down a dangerous path. Do we want professional schools to strip our future doctors of all ethical convictions that have not even been approved by government? You do not give up your personal morality when you earn a professional license and denying the constitutional freedom of health professionals ultimately threatens the constitutional rights of everyone.

In response to this issue, Congress passed the Weldon Amendment last year guaranteeing right of conscience protection--but only to physicians. Pro-abortion groups are now challenging that law in court. It is ironic that some are willing to trample on the individual liberties of others while marching under the banner of choice.

Doctors must be in the forefront of defending the right of conscience of all healthcare professionals. If we are silent now, there will soon be no one left to stand with us when our right is threatened.

Letter to the Editor, The Globe and Mail
7 May, 2005

Reproduced with permission

RE: Heather Mallick's article in the Globe and Mail April 30th issue "Why do we have to see a pharmacist the morning after". As a pharmacist who refuses to dispence so-called emergency contraception, I ask myself this: Why should I be forced to give a woman an overdose of birthcontrol pills, when all my studies in pharmacology, physiology, and anatomy show that this could be harmful not only to herself, but also to a newly conceived embryo should fertilization take place? Ms Mallick's depiction of what she calls an ethical pharmacist refusing to provide a woman with a treatment for yeast infection is utterly ridiculous! Is she insinuating that a pharmacist cannot tell the difference between a parasite and a newly conceived human being?

While Ms Mallick's worldview may be one that includes abortion (be it surgical or chemical) on demand, there are those of us who affirm that human life in all its stages is sacred. In a democratic society where freedom of conscience and religion is upheld as a fundamental human right, I fail to understand why all citizens should abide by Ms Mallik's worldview. Frankly, I think she will find plenty of pharmacists who will agree with her views and provide her with the services she seeks. However, she must acknowledge that her view is not the only valid one, and that pharmacists like myself have a right to think differently and to practice according to our deeply held moral and ethical beliefs.

Cristina Alarcon, pharmacist
Vancouver, B.C.

Protect pro-life druggists

USA Today, 4 April, 2005

Reproduced with permission
Steven Aden
Counsel to the Health Care Right of Conscience Project
Center for Law & Religious Freedom.

Public policy debates ignited by special interest groups often lend more heat than light to issues. So it is with "Pharmacists vs. the Pill," a battle started by abortion-rights advocates.

The truth is pro-life pharmacists always have had the right to conscientiously object to providing drug therapies that violate their religious or ethical consciences. Like doctors and nurses, pharmacists are highly trained health care workers who serve the public under a canon of medical ethics.

The American Pharmacists Association "recognizes the individual pharmacist's right to exercise conscientious refusal and supports the establishment of systems to ensure patient's access to legally prescribed therapy without compromising" that right. The profession believes, and properly so, that the right of conscience and the right of patient access stand on equal footing. A pharmacist is not required to compromise his or her conscience to ensure that a patient obtains her medication when there are other options.

When there are pharmacies in almost every supermarket and big box retailer, a woman who encounters an objecting pharmacist usually needs only to go across the street to find one willing to serve her. Those who believe that a woman's right to access birth control pills whenever and wherever she wishes should trump a pharmacist's ethical standards are really arguing for a rule of convenience.

This is not a battle of two conflicting "rights" at all, but an attempt to strip health care professionals of a right as old as the Hippocratic Oath - to exercise professional judgment to decide how to heal without doing harm.

State laws are needed to protect pro-life pharmacists from politically motivated state regulators. Although 47 states have legislated some form of "conscience protection" for health care workers, only a few states make it expressly available to pharmacists. Already, pharmacists have been driven out of practice in states hostile to their conscience.

Forcing pharmacists to function like supermarket cashiers will not guarantee women easy access to the pill. It will result only in fewer pharmacists for everyone, as bright and talented young people decide against entering a profession that treats them like automated medicine dispensers.

Letter to the Editor,Canadian Pharmaceutical Journal
December 2004/January 2005, Vol. 137, No. 10

Reproduced with permission

In your editorial [...] you write that tolerance is a bedrock value of our democracy and that it goes both ways; yet in the next paragraph you contradict yourself by stating that the onus is on the health professional to respect the religious beliefs of the patient, and not the other way around. I believe that tolerance either goes both ways, or else it is not true tolerance. Your editorial in fact shows great intolerance towards those of your colleagues who wish to practice according to the traditional Hippocratic tradition of "you shall do no harm." This tradition is not based on religious fundamentalism, but on a great respect for the dignity of each person, including the unborn. Your criticism of a Jehovah's Witness who would withhold blood from your ailing child is unsubstantiated, as such a paramedic, if he were upright, would simply step aside and allow someone else to take over and do what he himself could not.

Similarly, pharmacists who object to the provision of morning-after pills are not denying access, as the patient is free to go to the pharmacy of her choice. Such pharmacists are also not disrespecting the religious beliefs of their patients. As far as I know, there is no religion that requires a woman to take MAP after sex. As for the example of your husband encountering a preaching health professional in the ER, this is also not realistic. He has greater chances of encountering such a person on the street corner. A better example would be that of your elderly mother encountering a physician in the ER who objects to a policy that would call for euthanizing the helpless, or a pharmacist refusing to participate in China's forced sterilization program.

Finally, in view of today's recent findings on the dangers of synthetic hormones, there are plenty of women around who believe that taking hormonal contraception is not in their best interests. Why not allow such women the option of shopping at the Calgary pharmacist's shop, while those who embrace contraception can all come running to yours?

Pharmacists are people too. They have varying opinions on moral, ethical, and health issues. The fact that they do not all practice alike should not be such a cause for concern. All lawyers do not practice alike either.

Cristina Alarcon, BSc(Pharm)
Vancouver, BC

Letter to the Editor,Canadian Pharmaceutical Journal
December 2004/January 2005, Vol. 137, No. 10

Reproduced with permission

The editorial written in October's issue was an excellent demonstration of the discriminatory harassment to which conscientious objectors are subjected. It is clear that Ms. Thompson and people like her feel their morality is superior and are prepared to impose it on anyone disagreeing with them. She reduces the debate to pro-life agendas, religious rights, and tolerance, disregarding the health and informed consent of women and children in the process. This is the only recourse such people have when their ideology is threatened, as it was in my radio interview.

The basis for my refusal to participate or refer is rooted in scientific fact, not in the "norms" that people like Ms. Thompson subjectively develop. My reasons are also essentially humanistic, shared by many number of individuals regardless of their religious convictions. I refuse to participate with products that interfere with the ability of a human embryo to implant itself in the endometrium. Contra-implantation mechanisms are described as abortifacients by Canadian embryologists Moore and Persaud. It is no secret that birth control pills and "morning after pills" have this capability, as documented in drug monographs, and medical textbooks. Furthermore, the international scientific community (embryologists, geneticists, biologists, etc.), rejects the propaganda of gynecologists and pharmacists, that conception and pregnancy begins at implantation. However, science is often blindsided when pro-abortion advocates mislead the media and the public into thinking they are strictly ovulation inhibitors.

Regarding morally controversial products and services, the interests of the health care worker and the patient are different. The patient may believe that she is being deprived of something to which she has a right, but in no sense is she made to do something she believes is wrong. If my colleagues want to participate in these situations, I won't stand in their way - they too are entitled to make a choice. Patients are also free to choose another pharmacist or pharmacy. As for those in rural areas, Iam unaware of a situation where there is only a single health care provider available. Surely, a small degree of inconvenience or thinking proactively is worth preserving freedom for all Canadian citizens.

My faith has never been discussed with a patient at the pharmacy counter. Ms. Thompson's accusation that objectors try to scare patients with misinformation or impose their morality is nothing more than a recycled urban legend. In fact, when the Alberta College of Physicians and Surgeons were asked to substantiate this claim, they admitted in 2002 that it was polemical hearsay from groups who provide birth control and family counseling to women.

Contrary to Ms. Thompson's article, pharmacist regulators already have decided that rights of the patient do not supercede those of the pharmacist. The Alberta College of Pharmacists is fully aware that I do not participate or refer for morally controversial products. Manitoba has developed a conscience clause whereby a pharmacist may refuse to participate or refer. It is much easier to steamroller freedom of conscience, as she has demonstrated so well, rather than develop policies that protect everyone. All we need is the political will.

As birth control products constitute only a small fraction of products available, my conscientious objections were considered reasonable according to Alberta Human Rights Law. Freedom does not mean license, which is why human rights laws do not protect those who wish to harm others. Can Ms. Thompson name a Jehovah's Witness who is employed as a paramedic, where providing blood products is a majority of the job description?

Sadly, to people like Ms. Thompson, the "bedrock value" of religious tolerance goes "both ways" only if one agrees with her ideology. Freedom of conscience and religion is for everyone, even those with "fringe concerns." Should such pharmacists be treated as second class citizens because they choose to protect the lives of all their patients?

Where is the author's proof that the patient's rights come first? Her claim is not grounded in law or ethics, as any constitutional lawyer will tell you. Dr. John R. Williams, former Director of Ethics for the Canadian Medical Association in 2000, stated that the CMA's policy of mandatory referral for abortion was dropped because there was no ethical consensus to support it. The claim, that the fiduciary duties of physicians require them to subordinate their conscientious convictions to those of their patients, rests upon a more recent Supreme Court of Canada ruling that fiduciary relationships and obligations are "shaped by the demands of the situation"; they are not governed by a "fixed set of rules and principles."

I demand that Ms. Thompson show me how her morality is superior before she forces me to live by it or leave my profession. Name the pharmacists who have tried to impose their morality on patients. If she can't, she must retract her accusations and apologize.

People know they can trust me to protect them in a life or death scenario. It is my dignity as a human being, not a dehumanized pharmaceutical robot, that rejects the social and verbal engineering presented in this so-called professional and scientific forum.

Maria Bizecki, BSP
Calgary, Alberta

People without Conscience

Reproduced with permission

Richard M. Doerflinger
Deputy Director, Pro-Life Activities
U.S. Conference of Catholic Bishops Secretariat

One apparent result of the November elections is that, even before the end of Congress's 2004 session, long-awaited federal protection for pro-life health professionals was enacted into law. The Hyde-Weldon Conscience Protection Amendment was approved as part of Congress's final omnibus funding bill. It forbids federal agencies, and state and local governments receiving federal funds, to discriminate against health care providers who choose not to participate in abortions.

You might think its approval would be a "no-brainer." After all, there are two sides in the abortion debate. One side opposes abortion. The other side wants to let everyone have a "free choice" on abortion. So this passed without a dissenting vote, right?

Well, no. The movement that once boasted of being "pro-choice" has acquired a new watch word, "access." It demands that government has an affirmative obligation to promote and provide abortion - and to enlist the aid of even conscientiously opposed health professionals in fulfilling that mandate. This coercive campaign has actually scored victories with the help of government officials and courts in some states, which is why the corrective offered by the Hyde-Weldon amendment is needed. The abortion lobby's allies in Congress opposed the amendment bitterly, and say they will try to rescind it when Congress reconvenes in 2005.

That is not soon enough for the pro-abortion group with the euphemistic name "National Family Planning and Reproductive Health Association (NFPRHA)." On Dec. 13, days after President Bush signed the law, NFPRHA filed suit in federal court to have it declared unconstitutional.

In case the prospect of the "pro-choice" movement declaring free choice unconstitutional is not bizarre enough, I invite readers to wade through the twisted logic of NFPRHA's complaint.

A central charge is that the amendment "impedes the rights of Title X clinics and their physicians to provide referral services." This is, of course, the exact opposite of the truth. The amendment forbids the government to punish these clinics and physicians for making their own judgment on whether to provide such referrals.

But wait, there's more: "Physicians who intend that a patient receive a referral for an abortion as part of the patient's health care will have their First Amendment rights to speech impaired by an individual who refuses to provide such a referral." The complaint explains that physicians sometimes provide these referrals by telling a nurse or other employee to do them.

Set aside, for a moment, the obvious fact that a physician is not a government, and so his actions toward his employees (no matter how insensitive) are not covered by a law forbidding discrimination on the part of federally funded government bodies. Also set aside the inherent elitism of what is assumed here about a nurse's status vis-a-vis a doctor. Ask yourself: How could my freedom of speech demand forcing someone else to violate his or her own freedom of speech and freedom of conscience?

The only possible answer is: Because only people who agree with me have rights worth protecting.

If you thought the abortion lobby shows disrespect only for the unborn, watch this lawsuit and learn an important lesson.