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News Commentary 2008

A matter of conscience

Washington Times
17 December,2008
Reproduced with permission

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association
Ashburn, Va.

Americans blanch at abortion coercion in China, where population control agents force mothers to end the lives of their unborn babies who exceed the mandated limit of one child per couple. Yet few Americans realize that abortion-related mandates are also threatening to U.S. health care professionals who follow medical standards such as the Hippocratic Oath.

Conscientious physicians and other health care professionals are being pressured, under threat of job loss, to violate medical ethics standards by performing abortions and referring patients to abortion clinics to do the deed.

Abortion advocates have been lobbying vociferously to cast abortion as standard medical care and to mandate abortion participation by all health care professionals. Only a tiny fraction of U.S. physicians otherwise are willing to violate the Hippocratic Oath, which has guided medicine for well over two millennia, by participating in abortions.

The abortion mandate strategy may be ill-conceived, but unfortunately it is not ill-fated.

Abortion, which neither heals nor comforts, does not qualify as standard medical care under historical medical standards; it has only recently and politically infiltrated health care. Since American health care professionals have long enjoyed a measure of autonomy in making professional decisions, mandating participation in a procedure prohibited by long-standing medical ethics standards seems likewise implausible.

But abortion ideology and zeal have a way of trumping all notions of ethics and professionalism.

Aggressive abortion mandate advocates dominate the American College of Obstetricians and Gynecologists (ACOG), a highly politicized medical specialty group with vast influence over the profession of obstetrics and gynecology. Last November, ACOG issued an official ethics statement tellingly entitled, "The Limits of Conscientious Refusal in Reproductive Medicine." The ACOG statement ignores the role of objective standards in conscientious objections to abortion. ACOG instead denigrates conscience as a mere subjective "sentiment." In reality, however, health care professionals who object to abortion do so not because of subjective feelings but because killing the unborn contravenes Hippocratic, biblical and other life-affirming objective ethical standards.

By contrast, abortion ideology rests on the subjective, unanchored notion of "privacy" and "patient autonomy." By ripping conscience from its foundation of objective standards and demoting it to the level of subjective feelings, ACOG paints abortion objections as a clash between a physician's feelings and a patient's autonomy. With autonomy elevated as the ethical trump card, physicians and all ethical standards must bow in submission.

Having demoted conscience to the subjective realm and elevated patient autonomy to a position of unchallengeable supremacy, ACOG opposes faith-based ethical standards as "an imposition of religious or moral beliefs on patients."ACOG even incredibly contends that pro-life obstetricians should not only be required to perform or refer for abortions; they should also relocate their practices close to abortionists to make such referrals more convenient.

Given the official link between ACOG ethics positions and physician board certification, obstetricians who refuse to follow ACOG's abortion mandate now presumably stand to lose their hospital privileges and their livelihood. Medical ethics thus would be turned upside down, as life-honoring physicians lose the ability to practice medicine simply for following the Hippocratic Oath.

Meanwhile, the abortion mandate movement will soon tap potentially irrepressible numbers in Congress and powerful advocates in the White House and the administration.

President-elect Barack Obama, Sen. Hillary Clinton and other abortion advocates have strenuously opposed a modest U.S. Department of Health and Human Services (HHS) regulation that would ensure freedom of conscience in health care. The regulation would finally implement over 35 years of federal civil rights law aimed at protecting health care professionals from abortion-related coercion.

The HHS regulation, expected to be finalized before Dec. 20, could be overturned by a pro-abortion Congress and president, either through new legislation or a new regulation.

Mandating abortion participation in health care is rife with irony. Most Americans easily recognize the hypocrisy of forcing "pro-choice" ideology on all health care professionals. The injustice of ending the lives of innocent unborn children has only persisted in this country, where most citizens oppose abortion on demand, under the smokescreen of choice.

By driving out pro-life obstetricians and gynecologists who refuse to participate in abortions, abortion mandates would ironically decrease women's access to some of the most conscientious and compassionate physicians in America, many of whom volunteer free medical services to poor women. Abortion mandates threaten to shut down thousands of life-affirming, faith-based hospitals and clinics that provide care in some of the nation's most underserved communities.

Maybe that's what it will take for Americans to penetrate the fog of abortion propaganda and recognize that breaching the foundational right to life imperils all other rights.

Don't doctors deserve a choice on abortion?

Baltimore Sun
13 November, 2008
Reproduced with permission

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association
Ashburn, Va.

The acerbic editorial "Bush rules" (Nov. 11) ironically accuses the Bush administration of attacking "personal rights" and then lambastes the U.S. Department of Health and Human Services for proposing a regulation to protect the civil rights of health care professionals.

The Baltimore Sun protests "extending the right to refuse to participate in an abortion to include an array of health care workers." Which medical professionals does the paper deem unworthy of civil rights so that they should be forced to violate their conscience and the Hippocratic Oath?

Thankfully, shortly after the Supreme Court in Roe v. Wade wrested decision-making control from the states and the people, a prescient Congress began passing laws to prevent coercion and discrimination against health care professionals on both sides of the abortion debate. Yet three major civil rights laws have never been implemented. Meanwhile, "pro choice" advocates, provoked by the fact that the vast majority of physicians refuse to perform abortions, have resorted to seeking to require participation in abortion.

A recent official statement of the American College of Obstetricians and Gynecologists not only requires that physicians perform or refer for abortions but also demands that pro-life physicians relocate in order to refer patients to nearby abortion clinics. Our members report losing jobs and promotions over their commitment to life-affirming standards. The proposed HHS regulation is urgently needed to protect compassionate and conscientious physicians who are simply extending the life-affirming ethic and patient protections of the Hippocratic Oath.

New-look Inquisitions want to call doctors in for a little chat

1 October, 2008
Reproduced with permission

Leah Sing

This summer, Canada's well-known doctor shortage almost got worse. A portion of doctors in Canada's largest province started scouting for jobs elsewhere, expecting that Ontario would soon require them to violate their conscience. The College of Physicians and Surgeons of Ontario, the licensing body for Ontario doctors, had drafted a policy that required doctors to refer for procedures with which they disagreed on moral or religious grounds.

The public reaction was loud and furious. Religious groups and opinion writers were quick to point out the authoritarian nature of such a policy. But the decisive blow came from within the profession itself: the Ontario Medical Association, the professional organization of Ontario's doctors, released a scathing condemnation of the policy and openly urged the College to abandon it. The OMA said: "We believe that it should never be professional misconduct for an Ontarian physician to act in accordance with his or her religious or moral beliefs."

In the end, the College gave in and enacted a vague and watered-down version of the original draft. The storm passed over. But in the ensuing calm, Ontario doctors still have grave reason for concern. The public debate revealed that the College of Physicians had produced the policy in response to suggestions by the Ontario Human Rights Commission. This notorious organ had indeed provided the College with two detailed submissions which asked the College to adopt the OHRC's troubled understanding of doctors' rights and duties.

The OHRC clearly expects doctors to inform patients about all legal treatments, and to refer for these treatments regardless of their moral or religious objections. In their view, a doctor's "denial of services or refusal to provide a woman with information relating to contraception or abortion… would be discriminatory". In fact, the OHRC has entirely reconstructed the doctor's role. It says: "It is the Commission's position that doctors, as providers of services that are not religious in nature, must essentially 'check their personal views at the door' in providing medical care." So much for conscientious objection.

Any citizen can bring a human rights complaint against any doctor in Ontario, at public expense - and the doctor, who must pay out of pocket for his own defense, can brace for judgment by the OHRC's new standard. Ontario doctors are not out of the woods. And the fire is spreading. The doctors' college of Manitoba has indicated plans to model its own policy after the Ontario College's first draft, and the doctors' college of Alberta is circulating a new draft policy that may indicate a duty to refer.

Things aren't heating up only in Canada. In the United States, a fierce debate is being waged about proposed federal regulations that would protect doctors who work in federally funded medical facilities from being forced to violate their conscience. The "Provider Conscience Regulation" issued by the US Department of Health and Human Services is intended to protect doctors who object to abortion or sterilization - some also believe the language could extend to contraception.

Many see this bill as a needed response to the tightening anti-conscience stands of prominent medical organizations like the American College of Obstetricians and Gynecologists. It is also a response to the emergency contraceptive laws that have been passed in 16 states, which require hospitals to provide sexual assault victims with information about emergency contraception and in some cases, to dispense it on demand. In the words of HHS Secretary Mike Leavitt, "Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience."

The government of the state of Victoria in Australia may not agree. There, the lower house of parliament has just passed a bill that would require doctors to refer for abortion regardless of their religious or moral objections. If the bill gets through the upper house later this month, Victorian doctors could be stripped of their freedom of conscience by Christmas. Catholic hospitals are considering shutting down their maternity and emergency departments rather than comply with this law.

Like in Canada, the Australian medical profession is split on this issue. The Royal Australian and New Zealand College of Obstetricians and Gynecologists supports the bill, but the Australian Medical Association has taken a stand against it. In a letter to Victoria's premier the AMA Victoria president said: "Respect for a conscientious objection is a fundamental principle in our democratic country, and doctors expect that their rights in this regard will be respected, as for any other citizen."

What are the intellectual roots of this assault on the conscience rights of physicians? Until only a few years ago, the popular opinion of conscience seemed to be favourable. Many proudly appealed to their conscience in using the Pill to prevent overpopulation or to avoid the Vietnam War; while theologians cited their conscience as they developed dissenting teachings. But these days, when conscience comes up in the media, the debate is mostly about whether its exercise should be suppressed. Why has the conscience become unpopular?

One reason may be that objective truth and morality are weakening their foothold on our society. In a world where conscience is believed to reflect only a subjective personal ethics, where an individual's right and wrong is considered to have no truth value beyond the individual's own mind, it makes supreme sense to suppress the capricious exercise of arbitrary personal values. Anything else would sink such a radically autonomous world into chaotic anarchy. Social order, in this kind of world, can only be achieved by the uniform enforcement of legally recognized rights.

In the medical field specifically, conscience may also have become more inconvenient because over the past few decades, courts and governments have legalized procedures that many doctors believe to be deeply unethical. The result: an exponential escalation of conflict between the law and doctors' consciences, and so between patients and doctors. If the only doctor in a small town refuses to prescribe emergency contraception, a woman may well lose her window of opportunity to use it. The law says this contraception is her legal and human right - while from the doctor's perspective, to prescribe or refer would be to participate in the killing of an innocent human being. This is a zero-sum game: there is no good compromise. Someone's got to lose - today, it is the doctor (and the embryo).

Finally, doctors may be facing more pressure to comply because their role in society has quietly but dramatically shifted. With the advent of the Pill, abortion and reproductive technologies, doctors have come to play a crucial role in helping millions of people plan and direct their reproductive lives. This is not the traditional role of doctors, who have always been concerned with sickness and disease. The state has now made them the exclusive providers of elective services that are based not on medical need but on personal preferences.

These reproductive services are self-prescribed, meaning that it is the patient who decides whether they are "needed". The doctor's expected role is that of a mere technician who administers these services on demand. Since doctors are the only people with a license to provide these services, legal scholars like R. Alta Charo now argue that the medical profession is "a kind of public utility obligated to provide service to all who seek it". This is not the kind of medicine that many doctors signed up for when they entered medical school.

The irony is that doctors are being subjected to a viewpoint Inquisition by the very society that constantly pays homage to tolerance. That comes as no surprise to many who have already experienced the intolerance of some parts of our society for truly divergent views, especially those that challenge today's reproductive freedoms. There is still some lip service to the importance of conscience - but in the end it is bulldozed as a necessary sacrifice for the new social agenda.

So much is obvious even from many of the various opinions expressed last week before the President's College on Bioethics in Washington. This eminent body is now considering the conscience issue, and has just published a number of fascinating presentations on its website. Last week, Dr Ann Lyerly, Chair of the Ethics Committee of the American College of Obstetrics and Gynecology, began her presentation by acknowledging that many people believe in the critical value of a doctor's conscience, "independent judgment" and "moral integrity" for good medicine, and in the importance of conscience for "democracy, bioethics, humanity".

But then she went on to address what to her are clearly more important concerns. The first was the health and welfare of the patient. Non-controversial? She described how women's welfare was reduced when they were denied sterilization during a C-section, or denied emergency contraception after rape. Lyerly's second concern was "fairness", which to her meant not placing a "disproportionate burden on disenfranchised women". Her example: lesbians should not be refused artificial insemination. Lyerly's final concern was "respect for autonomy", which she defines as respecting the "bodily dominion" of women by not refusing them certain treatments such as abortion. In her opinion, the freedom of conscience of doctors needs to be "balanced" (read: limited) by these considerations.

The desire to limit doctors' conscience rights in order to ensure easy access to reproductive services for patients appears to be gaining traction. Even if their conscience rights do not end up limited by law, a number of physicians' professional and regulatory bodies are being attracted to such policies. Might things get worse before they get better?

One thing is clear: doctors are not the only ones who will have to fight for their conscience rights. We've already seen some of the same arguments made about pharmacists, with regard to their right to refuse dispensing the morning-after pill. In Canada, the Ontario Human Rights Commission has also stated that marriage commissioners must "check their personal views at the door" - they are expected to perform gay marriages regardless of personal views about homosexuality. In fact, the Commission seems to believe that all providers of "secular services" have this duty to leave their morality at the doorstep of their workplace.

Secular services… like say, medicine, education, law, and most other areas of ordinary work. If medicine falls, these might just be the next dominoes.

Lea Singh graduated from Harvard Law School in 2003. She works for a nonprofit organization in Ottawa, Canada.
Proposed rule would protect doctors from discrimination

The Hill
24 September, 2008
Reproduced with permission

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association
Ashburn, Va.

The uproar over a modest proposal by the Department of Health and Human Services (HHS) reveals a widening culture chasm in healthcare, created by disparate views of medical ethics and civil rights.

When HHS recently proposed a regulation to finally implement 35 years of civil liberty laws protecting conscience rights in health care, opponents railed against an alleged conspiracy to "deny women access to contraception."

That's quite an implausible protest against an agency that this year will spend over $1.6 billion on "family planning" programs.

The real reason for the abortion lobby's protest stems from years of frustration in attempts to persuade physicians to violate their commitment to heal and to the Hippocratic Oath's prohibition on abortion and the mandate to "do no harm." The last remaining strategy to achieve their goal of involving more physicians is to literally force them to perform or refer patients for abortions, through state laws and medical organization policies forbidding the exercise of conscientious objection.

The only thing standing in the way of that coercive agenda is implementation of federal civil rights law.

Ironically, coercive laws and policies, though instigated in the name of insuring access to women's healthcare, in fact threaten to significantly decrease access - by eliminating physicians who hold to life-affirming standards of medical ethics.

Discrimination and coercion appear to be infiltrating many sectors of medicine. Over 40 percent of our members report having experienced pressure to compromise their commitment to medical ethics standards. Medical school applicants with life-affirming values report discrimination in entrance interviews. Residents report being denied clinical learning opportunities because they refused to perform abortions. Physicians report the loss of jobs and academic promotions based on their life-affirming stances.

The public likewise remains ignorant of existing federal civil rights protections. A scientific national survey by The Polling Company Inc. revealed that 42 percent of American adults incorrectly believe that federal law obliges a physician to either perform or refer for abortions.

The HHS regulation is urgently needed to remedy discrimination and coercion in healthcare before patients lose access to some of our bestand most compassionate medical professionals.

By implementing existing conscience-protecting laws and by initiating education, the regulation can take a vital step toward restoring a culture in medicine that honors professional standards and respects civil rights.

Letter to the Editor, Vancouver Sun
18 September, 2008

Your editorial ("Doctors have a duty of care notwithstanding their religious beliefs," Vancouver Sun, 17 September, 2008) refers to a doctor's "duty of care," but that is not what is at issue in Ontario. The draft Ontario College of Physicians policy is not about patients "receiving adequate treatment." It is about "accessing services," as one might access automotive repair: not about a duty of care, but a purported duty to do whatever a patient requires. The document addresses neither the health of the patient nor the nature of the service demanded.

Contrary to the Sun editorial, Dr. Zuliani did not say that physicians would not be required to refer; he said that they would not be required to perform procedures that they believe to be wrong. The demand that a physician assist patients to do something he believes to be wrong is no less ethically troubling than referral, since both raise the problem of complicity in wrongdoing. This is what concerns physicians who refuse to do what they believe to be wrong, not the personal characteristics, status or inclinations of a patient.

Sean Murphy, Administrator
Protection of Conscience Project

Check your Ethics

Ottawa Citizen
17 September, 2008
Reproduced with permission

Lea Singh

While the College of Physicians and Surgeons of Ontario (CPSO) has been in the spotlight for its proposal to restrict doctors' freedom of conscience, the source of the CPSO's attacks on doctors has been revealed to be the Ontario Human Rights Commission. And this bodes badly not just for Ontario doctors, but for the future freedoms of all working Ontarians.

The commission appears convinced of the need to remove ethical discretion from Ontario doctors and to turn them into technicians who will blindly provide any services that are legal, regardless of their personal values. Not only that: its submissions to CPSO hint that it expects this kind of conduct from "all Ontarians."

The commission says doctors must "'check their personal views at the door' when providing their services." What does this mean? One example: "A physician's denial of services or refusal to provide a woman with information relating to contraception or abortion, for example, would be discriminatory."

Another result: the doctor has the duty to refer, even for abortion. The commission insists that where a family doctor is able to refer a patient for the requested procedure, even if not himself competent to provide the procedure, the doctor must accept the patient and make the referral.

At this point, all doctors should be asking whether they still have any meaningful freedom of conscience in Ontario. Regardless of what happens with the much-attacked CPSO policy, the opinions expressed by the commission will stand. The commission has slammed its royal flush on the table. Any doctor who finds himself before the new Human Rights Tribunal now has fair warning, that these are the rules by which he will be judged.

And here's the crux: doctors are only among the first in the firing line, but the commission has it in for all of us. It says: "all Ontarians must make distinctions between their personal beliefs and opinions, religious or otherwise, and their obligation to act in a non-discriminatory manner."

What this means is that the Ontario Human Rights Commission expects everyone, other than "religious officials" such as clergy, to put their ethics aside in their daily workplace. They explain: "While the expression of their religious beliefs is essential for religious officials in the performance of their duties, secular service providers cannot claim that the performance of their job functions is an expression of their deeply held religious beliefs."

Of course, almost everything can be viewed as a "secular service," meaning that it is done by lay people and not officially connected to a church. Medicine, law, education, you name it -- it all falls under this term.

As does the Ontario public service. This is why the commission wrote a letter to the attorney general in 2004, recommending that marriage commissioners must be forced to perform same-sex marriages, and again noting that they must "check their personal views at the door."

In their submission to the CPSO, the commission further illustrates what it means by checking one's personal views at the door. They give the example of Hall v. Powers, the recent case where "a Catholic school board was required to allow a male student to attend the prom with his boyfriend." The commission applauds this result "because, although the board was entitled to hold beliefs against homosexuality, it was not permitted to act on these beliefs in a discriminatory manner."

There is a clear conflict here, and it threatens to explode not long from now. The commission's views could not be more opposed to the teachings of many religions about integrating one's faith into one's daily working life. To be one person in public, and another in private, would mean a fundamental betrayal of these faiths.

Those who follow such religions can expect rough weather ahead. The new prime directive in Ontario is that you'd better not let your ethics get in the way of your work.

Lea Singh graduated from Harvard Law School in 2003, and works for a nonprofit organization in Ottawa.

Shoving abortion down doctors' throats

National Post
17 September, 2008
Reproduced with permission

Barbara Kay

Time was, even as abortion became widely available, one's beliefs around the morality of the practice were one's own business.

Today, unconditional support for unfettered access to abortion seems to be the litmus test of an individual's or an institution's moral standing within the community.

Resistance can result in a form of politically correct "shunning" reminiscent of totalitarian regimes. We saw it last week in Bloc Quebecois leader Gilles Duceppe's reflexive call for the civic ex-communication of a Conservative party candidate on the basis of her affiliation with a pro-life prelature of the Catholic Church.

But the push for moral clarity around publicly funded abortion stubbornly persists: a Dr. Seuss-like cat in our cultural house that keeps coming back.

This time, it padded back in with Republican vice-presidential candidate Sarah Palin's serene acceptance of her Down syndrome fifth child, Trig, as a "gift."

The image of a politically ascendant woman drawing strength from two allegedly incompatible female traits -- soaring personal ambition and reproductive selflessness -- challenges the self-righteous certainties of politically correct ideologues, fuming at the marketing implications of Ms. Palin's story.

This was evident last week in a declaration from the notionally disinterested Society of Obstetricians and Gynecologists of Canada. Their executive vice-president, Dr. Andre Lalonde, worried aloud, with thinly veiled contempt for Ms. Palin, that "[Her decision to carry Trig to term] will have an implication for abortion issues in Canada."

His subsequent disclaimer that, "We offer the woman the choice … We're coming down to a moral decision and we all know moral decisions are personal decisions," rings hollow.

For if Dr. Lalonde himself really believes "moral decisions are personal decisions," Ms. Palin would not have been held up for public chastisement.

More consequential hypocrisy was evident in a draft document by the College of Physicians and Surgeons Ontario (CPSO) on physicians' conscientious objection to performing, or even referring for, abortions. The document's thrust -- to be voted on this week--is to threaten conscientious objectors with aggressive Human Rights Commission retaliation for failure to co-operate with abortion provision.

This is unconscionable, and the Ontario Medical Association, on behalf of its 25,000 members, quite rightly insists the initiative runs counter to the Charter's protection of freedom of religion.

The CPSO document is riddled with logical inconsistencies, as is usually the case with foregone conclusions arrived at through ideology rather than reason. To wit:

-We have no abortion law; yet, as liberals often boast, virtually no doctor in Ontario will abort a fetus after 22 weeks' gestation. Why, then, should doctors who are rendered squeamish by late pregnancy be spared a moral ordeal, but not those tortured by extinguishing life from conception forward?

-The CPSO says refusing abortion violates a patient's right to "treatment." Pregnancy is not a medical illness; it is a natural condition. Doctors in other disciplines routinely refuse to give treatment or write prescriptions they judge unnecessary for healthy patients, or to refer them to other doctors who might. Why the double standard for abortion?

-The CPSO states doctors must set aside personal beliefs to ensure patients get the "medical services they require." Medically speaking, most pregnant women do not "require" abortion. They want an abortion. The word "require" is an ideological construct, not a physiological observation.

The greatest irony is the CPSO statement that, "physicians [must] provide information to patients about all facets of their health care." If that were truly the case, abortion providers would inform their "clients" (what most are in fact) that abortion is linked to elevated risks of pre-term delivery -- and multiple abortions to Cerebral Palsy -- in future pregnancies, not to mention an elevated risk for future mental dysfunction, including suicide.

But they don't. Again, their ideological commitment to abortion's political symbolism outweighs their professional ethical obligation to ensure "informed consent."

In the end, the almost cultish aura that has been whipped up around the sanctity of abortion by politicians and medical bodies comes down to the morally irrelevant cause of satisfying consumer demand for a service of convenience. Hardly worth the sacrifice of individual freedom of conscience, the litmus test of a true democracy.

Hear that scratching at the door? It's that cat coming back.

Rules let care workers practice medical ethics

Letter to the Editor,
Detroit News,

16 September, 2008
Reproduced with permission

Laura Berman's Aug. 26 column, "Keep the choice in hands of patients," mischaracterizes a conscience-protecting regulation recently proposed by the U.S. Department of Health and Human Services as somehow pitting "health care workers with strong religious and moral beliefs against women needing care."

The regulation would finally implement 35 years of civil rights laws passed by Congress to prevent discrimination and coercion against health care professionals who adhere to life-affirming standards of medical ethics such as the Hippocratic Oath. Such standards not only
affirm the inherent value of the unborn and the elderly; they also aim to protect patients from sexual abuse, financial exploitation and violation of privacy in healthcare.

Two of five of our members report being pressured to violate standards of medical ethics. Residents report being denied clinical privileges for refusing to perform abortions. Medical students report switching out of obstetrics and gynecology for fear of reprisals and
coercion to do abortions. The pro-abortion American College of Obstetricians and Gynecologists
recently issued a position statement that all obstetricians are obliged to participate in abortion. Conscientiously objecting physicians face an implicit threat of loss of licensure.

The real threat to choice comes from perpetuating these violations of healthcare professionals' civil rights, which ultimately results in patients losing access to their most compassionate and conscientious physicians.

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association -- Washington Office

Re: Sept. 8 editorial "Leavitt should drop proposed health care rule."

Letter to the Editor
Austin American Statesman
15 September, 2008
Reproduced with permission

The editorial characterizes as "a back-door way to limit access to contraceptives" a regulation recently proposed by the U.S. Department of Health and Human Services to protect conscience rights in health care.

The regulation in no way prohibits access to either contraception or abortion. The regulation merely implements 35 years of civil rights laws to protect health care professionals from discrimination merely for adhering to life-affirming medical ethics such as the Hippocratic

More than 40 percent of our members - physicians and medical students - report that they have experienced pressure to violate standards of medical ethics. Medical students report eschewing careers in obstetrics and gynecology for fear of coercion to do abortions.

This regulation is urgently needed to prevent forcing these principled professionals out of their careers through discrimination and coercion, which results in less access to health care for women.

Jonathan Imbody
Vice president for Government Relations
Christian Medical Association

Moral Safeguards for Patients, Too

Letter to the Editor
The Washington Post

4 September, 2008
Reproduced with permission

The misunderstanding expressed in the Aug. 26 letter, "Health Care's Conscientious Objectors," illustrates the need for the conscience-protecting regulation recently proposed by the Department of Health and Human Services.

The regulation would implement 35 years of civil rights laws passed by Congress to protect health-care professionals from discrimination, coercion and job loss for adhering to life-affirming ethical standards. The regulation would simply disallow forcing professionals to perform elective abortions and other procedures that violate millennia of medical ethics codes.

Contrary to the letter's assertion, health-care professionals would continue to care as always for wounded soldiers, AIDS patients, post-abortive teenagers, felons and drunk drivers. In fact, the regulations would protect patient access to the compassionate, conscientious health-care professionals who are among the most dedicated to caring for such individuals.

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association

Conscience and coercion

Letter to the Editor
Salt Lake City Tribune

2 September, 2008
Reproduced with permission

The Tribune editorial "Going too far: Proposed rule affects contraceptive information" (Our View, Aug. 26) wrongly charges that a recently proposed federal regulation will somehow "force poor women to limit their health-care choices to just those that are morally acceptable to taxpayer-funded providers."

The regulation implements 35 years of civil liberty laws protecting health care professionals from coercion, discrimination and job loss for following life-affirming standards of medical ethics, such as the Hippocratic oath. It does not outlaw or hinder any legal procedure or
prescription, nor does it prevent a patient's access to information about contraception or abortion, which is readily available.

An intolerant approach to individual conscience is fomenting a crisis of access in health care, particularly in obstetrics and gynecology, where doctors and medical students are leaving for fear of reprisals or coercion to do abortions.

These regulations will protect health care professionals who adhere to high ethical and moral standards - those most likely to provide compassionate care for under-served patients.

Jonathan Imbody
Vice president for government relations
Christian Medical Association
Ashburn, Va.

Abortion Article Was Incorrect

Letter to the Editor
The Daily News, Harrisonburg, VA,

2 September, 2008
Reproduced with permission

Shirley Kirkwood's recent Open Forum wrongly suggests that a regulation proposed by the U.S. Department of Health and Human Services is somehow aimed at blocking contraception use ("Abortion Is A Religious Right," Aug. 21).

That's nearly as implausible a stretch as the notion that ending human lives is a religious right. The agency this year alone will spend over $1.6 billion on "family planning" programs.

What has been long established is the right to follow one's conscience according to the dictates of faith and ethics.

That's what the regulation will protect, as health care professionals push back against a culture that devalues life and work to restore life-affirming values such as those expressed in the Hippocratic Oath, the Judeo-Christian Scriptures and standards applied to medical ethics.

Jonathan Imbody
Vice President for Government Relations,
Christian Medical Association

A Handmaid's Tale
Will Ontario doctors be forced to ignore personal beliefs just to please a pompous human rights commission?

National Post
2 September, 2008
Reproduced with permission

Lorne Gunter

The sheer arrogance of human rights commissions will be their downfall: their conviction that they have a superior understanding of rights compared to anyone else and that once they have pronounced how rights shall be interpreted, the rest of us should fall in lockstep with smiles on our faces and cheery tunes on our tongues, content that our intellectual betters have shown us the error of our ways and revealed the path to true enlightenment.

Consider the Ontario Human Rights Commission's submission to the College of Physicians and Surgeons of Ontario (CPSO) on doctors' ability to practise medicine according to their consciences. It drips and oozes with the kind of sanctimonious condescension to differing views that has become a hallmark of such commissions.

The OHRC's conclusion, though couched as mere friendly advice, states barefaced that "doctors, as providers of services that are not religious in nature, must essentially 'check their personal views at the door' in providing medical care."

The gall of such a statement is stunning. Abortion? Contraception? Fertility counselling for same-sex couples? How are those not services that are "religious in nature"? Every one of the world's major religions has had views on these actions for hundreds of years.

They could only be considered non-religious in nature if you were a detached, disconnected, pompous human rights twit who was convinced you had the power to provide written-in-stone, immutable definitions that were binding on all concerned.

The Roman Catholic church, for instance has been opposed to contraception for centuries. Is the OHRC now saying it has the power to declare definitively that view null and void?

It would be impossible for a doctor to be a devout Catholic and perform abortions. So the OHRC is saying only some people can be doctors in Ontario -- i. e., those with no religious convictions in conflict with the province's human rights code. No orthodox Jews nor Evangelical Christians nor pious Muslims need apply. That sounds like the true discrimination to me.

The OHRC's response to such a charge would be that religious people are free to believe what they wish in private, but they have no right to act on those beliefs in public if the beliefs conflict with the current fashion in human rights thinking. Indeed, in their submission to CPSO on doctors' conscience, the commission states flatly "a physician's refusal to provide a service or accept a patient on the basis of a prohibited ground, such as sex or sexual orientation, is prima facie discrimination, even if the refusal is based on the physician's moral or religious belief."

The commission truly believes that "the freedom to hold beliefs is broader than the freedom to act on them," especially when religious beliefs come in conflict with causes for which the commission sees itself as chief cheerleader, such as gay rights and reproductive choice. On today's trendy ladder of rights, freedom of religion is on the bottom rung. It is the first to get stepped on by ambitious rights climbers.

The commission's submission is full of talk about the need to accommodate -- everyone should try to accommodate everyone else's beliefs. But the commission doesn't believe its own bumph. Over and over again it states (rather than merely advising) that the obligation to accommodate falls only on religious-minded doctors in this case. The commission has never sought to balance the beliefs of the faithful with the demands of advocates for causes it itself champions.

Nearly a decade ago, the OHRC showed its true colours in the Scott Brockie case. Mr. Brockie was a Christian and a printer. A gay rights organization sought to prove a point by seeking out Mr. Brockie and demanding he print their stationery. Even though there were many printers closer to the gay organization's offices --and therefore both their printing needs and Mr. Brockie's beliefs could have been easily accommodated if the group had obtained printing services conveniently elsewhere --the OHRC said religious rights could be exercised only in the private sphere. When they entered the public realm, they were secondary to gay rights.

It will be the same for Ontario doctors if their own college decides to become a handmaid to the pompous, dictatorial operatives at the OHRC. Doctors with strong moral or religious views on abortion and same-sex reproduction will be sought out by gay and feminist activists and, under the truncheon of the OHRC, forced to perform procedures they find morally repugnant, because the goal of human rights adjudicators and their ideological compatriots in the rights industry is not freedom for all but conformity by everyone to the prevailing rights thinking.

It is not enough that Ontario doctors who wish to may perform morally and religiously charged procedures without fear of prosecution. Today, all doctors must be forced to check their personal convictions at the door in the name of rights for the chosen few.

Some people must be made subservient to the biased views of the state's rights police so that those people favoured by the police may do as they wish always and anywhere.

Such is the sad state of human rights thinking and freedom of thought in Canada in the 21st century.

Doctors must always have right to follow conscience

Calgary Herald
22 August, 2008
Reproduced with permission

Susan Martinuk

Some 2,500 years ago, doctors were both healers and killers. Abortion and euthanasia were commonplace, and the type of medical service rendered depended on who was paying the bill or how the 'payee' asked the 'doctor' to take care of the patient. That ended in 400 BC, when a Greek physician named Hippocrates decided that patients deserved better and wrote an oath to affirm the sanctity of life and the doctor's duty to protect it.

Doctors who took the Hippocratic oath could then offer patients an element of trust and care that was previously non-existent and, for obvious reasons, Hippocratic physicians became the physicians of choice.

Well-known anthropologist Margaret Mead commented on this marked shift in the physician's role by saying, "For the first time in our tradition there was a complete separation between killing and curing. Throughout the primitive world, the doctor and sorcerer tended to be the same person. He with the power to kill had power to cure . . . (but now) One profession . . . (would) be dedicated completely to life under all circumstances . . .

"This is a priceless possession which we cannot afford to tarnish, but society is always attempting to make the physician into a killer -- to kill the defective child at birth, to leave the sleeping pills beside the bed of the cancer patient . . . it is the duty of society to protect the physician from such requests."

This oath became an important symbol of a doctor's integrity and commitment to protect life at all stages. But as with most traditions, it has increasingly fallen out of favour with medical schools. So, too, society seems to have come full circle in terms of its expectations of physicians -- the sanctity of life is no longer as important as our own convenience and demands.

The proof of this is in a draft proposal put forth by the College of Physicians and Surgeons of Ontario that will severely compromise the ethical integrity of physicians by limiting their ability to practice according to their own freedom of conscience and moral/religious beliefs. It would force physicians to set aside their moral consciences to fulfil all demands by all patients -- including providing or assisting patients in obtaining morally controversial services such as abortion, birth control and reproductive technologies for same-sex couples.

If physicians ignore the guidelines, they would be considered to have contravened the human rights code and their licences could be suspended; not because of incompetence or inappropriate activities -- but because of their religious beliefs.

Such tolerance is coming to Ontario physicians, courtesy of their government and its plan to expand the scope of the Ontario Human Rights Commission and increase the number of cases it hears from 150 to 3,000 per year. Sadly, this has motivated the commission to insert its misguided, Orwellian human rights policies into the realm of the physician-patient relationship.

Of course, a 2,000 per cent increase in cases doesn't equal a 2,000 per cent increase in human rights. Rights remain a very circular concept in that there are only so many to go around. Giving more rights to one group inevitably means taking rights from another. That means the commission will be taking away a whole bunch of rights from unsuspecting Ontarians. In this case, it's the physicians who lose.

All of this is disturbing on many levels. The college knew this would be controversial. A 2006 guest editorial in the Canadian Medical Association Journal that called for all physicians to be forced to make referrals for abortion generated such a firestorm that the CMA's director of ethics had to publish a statement saying CMA policy would not require this, since it would violate the conscientious or religious beliefs of many physicians.

Yet, in an indication of how much tolerance and freedom this new era of rights will bring, the college developed this proposal behind closed doors. There were no press releases and, despite placing an Aug. 15 deadline on consultations with physicians, no attempt was made to inform physician groups that will be most affected by/and want to comment on the policy. Since this proposal only came to light on Aug. 14, the college has now graciously responded to outraged demands by extending the consultation deadline to Sept. 12.

Section 2 of the Charter of Rights and Freedoms guarantees freedom of conscience to all Canadians. Yet, for some reason, the college (that should be defending the rights of its members) is eager to prematurely cede these rights at the mere suggestion of a human rights complaint. This willingness to give up suggests that college leaders may be moonlighting as motivational speakers for the Toronto Maple Leafs.

The fact is that every physician operates on some sort of moral framework, whether it be religious or secular or adamantly anti-religious. Just as one physician might encourage a patient to consider other options than abortion, another physician may withhold such information and suggest abortion is the only option. If we discriminate against one doctor's framework for practising medicine, we will inevitably discriminate against others. No doctor will be safe to practise or offer any human interpretation of, or context to, the medical facts.

We have an obligation to not let that happen.

© The Calgary Herald 2008
Dignity is key, says pro-life doctor

National Post
22 August, 2008
Reproduced with permission

Re: Violating doctors rights? Letter to the editor, August 18

Unfortunately, letter-writer Greg Hart continues to fail to see my point. This is about religious beliefs against science. It is about conscience and the right of physicians not to engage in harmful practices. In terms of science, abortion kills one unique human individual, hurts a significant number of women and dehumanizes the collaborators, including the abortionists. For an alternative, rational voice to the common-held myth that abortion is safe please watch the Women's Health after Abortion video from the de Veber Institute.

Without trivializing this debate in the context of abortion and euthanasia, let's say somebody with a healthy appendix wants to have it removed and demands a referral and I refuse it; am I being intolerant or moralizing? Doctors get requests they cannot fulfill all the time, especially if they go against their best medical judgment and conscience. A society that becomes intolerant of the freedom to act according to one's conscience is on its way to becoming a tyranny.

Dr. Rene Leiva, Ottawa.

Forcing our doctors' hands

National Post
18 August, 2008
Reproduced with permission

Lorne Gunter

One of the best-known aid organizations in the world is Medecins Sans Frontieres -- Doctors Without Borders. It may soon be joined by a similar group operating within Canada's largest province -- Medecins Sans Conscience -- Doctors Without Consciences.

If the College of Physicians and Surgeons of Ontario (CPSO) gets its way, Ontario's doctors will soon be stripped of their right to follow their moral convictions or religious beliefs when treating patients. In other words, doctors will risk losing their licenses if they run afoul of Ontario's human rights police.

If, out of moral conviction, they refuse to perform abortions, refer patients for abortions or prescribe morning-after and birth control pills, or if they refuse to help same-sex couples conceive children, their own governing body will take away their right to practice medicine.
Should euthanasia become legal at some point, physicians would be expected to help patients die, too, even if doing so violated their every moral fibre. I may not agree with social conservatives that assisted suicide or abortion should be illegal, yet I am repulsed by the idea of coercing doctors into participating in procedures that contravene their morality. It is nothing short of politically correct extortion to threaten doctors with their livelihood if they don't buckle under and practice medicine the way Ontario's human rights junta thinks it should be practiced.

The key passage in the CPSO's seven-page proposal states that a "physician's responsibility is to place the needs of the patient first, [so] there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical services they require."

But a lot of the services the CPSO proposes forcing physicians to perform are hardly "necessary."

A particular woman may want an abortion for any number of reasons, but unless her own life is in danger from her pregnancy, it cannot truly be said that an abortion is necessary. Similarly with the desire of same-sex couples to have children; it may be a strong desire, but it is hardly a necessity.

So long as there are no prohibitions against doctors performing these services, the rights of women and gays and lesbians are not violated. They may get what they want without trampling on the rights of conscientious-objector doctors.

There may be some inconvenience involved. Patients seeking abortions or same-sex conception may have to travel to another Ontario town or city to fulfill their rights, but inconvenience is not the same as discrimination.

Freedom often isn't easy. Yet we have developed a very juvenile notion that unless our freedoms come with no obligations or consequences, we aren't really free, which is nonsense.

What the CPSO is proposing, in effect, is to set itself up as an enforcer for the new Human Rights Tribunal of Ontario (HRTO) by incorporating the Tribunal's concept of rights into the physicians' code of professional conduct. This would enable the college to discipline a doctor for political rather than medical conduct. Any Ontario doctor refusing to abide by the twisted definition of rights contained in the province's human rights code -- in which some groups are more equal than others -- could be deemed a bad doctor and decertified.

This is yet another example of the tyranny of human rights commissions over our daily lives. Should these new rules be adopted next month, an Ontario doctor could be barred from practicing medicine not because he or she is unethical or incompetent, but merely because he or she fails to share the same political view of rights and morality as the HRTO (and the brass of the CPSO).

If this were really about maximizing human rights, the college would be proposing to protect from professional discipline any doctor assisting in abortions, same-sex conception or other morally charged procedures. Instead, by insisting that all doctors must participate in such procedures, regardless of their personal beliefs, the college is taking sides. Like human rights tribunals and commissions, it is placing the rights of women and gays ahead of those of doctors and people of faith, whether they are Jews, Muslims, Christians or others.

The college is not seeking justice, it is demanding conformity. It is not striving for "choice" for patients and doctors, it is attempting to force acceptance of one political and moral view on everyone.

If there is anything unethical in the debate over physicians' consciences, the one-philosophy-trumps-all attitude of the CPSO is it.

Letter to the Editor, National Post
16 August, 2008 (Not published)

Reproduced with permission

Many thanks to the Post and journalist Charles Lewis for drawing our attention to the proposed changes in the ethics policy of the College of Physicians and Surgeons of Ontario (Plan puts medicine before religion, August 16). I am a physician in Quebec, so one might think this policy does not affect me, but the trend it represents threatens us all.

The CPSO guidelines state the following: ". as a physician's responsibility is to place the needs of the patient first, there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require."

The crux of this question is clearly what we mean by a medical treatment someone "requires", and who decides that the person "requires" it. The doctor? The patient? The College of Physicians and Surgeons of Ontario?

Every conscientious physician has spent many, many hours of valuable time explaining to patients why the do not "require" what they think they do, whether it be antibiotics for colds, potentially harmful tests that are unnecessary but that the patient insists on because of anxiety about some symptom, or drugs advertised on the Internet that are inappropriate for the patient's needs.

Some of these issues are purely medical in nature; some involve a mix of medicine and ethics. We could go on to consider whether a woman "requires" an abortion because the child she is carrying is expected to have some congenital anomaly. Or whether another woman "requires" the morning-after pill because she has been imprudent in her love life (this being, of course, a social and behavioural issue, not a medical one at all). Or, if the law changes, whether a chronically depressed and suicidal patient "requires" medication to kill him or herself.

Physicians who object to these requests are not imposing their religion or morals on others. They are simply trying to care for their patients to the best of their ability.

Integrity has always been an essential aspect of the professionalism expected of doctors. To act with integrity is to follow one's conscience
at all times and in all circumstances. This virtue is strengthened every time a person is true to his or her conscience, and weakened every time he or she violates it. If professional bodies start demanding that physicians violate their conscience in some situations, how can they expect them to follow them in others? Such as respecting patient confidentiality, not taking advantage of vulnerable patients, and telling the truth.

Many people in our society no longer believe that anything is absolutely right or wrong. Morality is considered an individual decision, and this is why personal moral codes can conflict. To force physicians to bend to the desires of those they serve will only increase conflict and discourage those whose moral integrity is important to them from entering or continuing in medicine.

Catherine Ferrier MD
Montreal QC

cc. Dr. Preston Zuliani, College of Physicians and Surgeons of Ontario

Letter to the Editor, Seattle Post Intelligencer

16 July, 2008

Reproduced with permission

Asserting that his op-ed column will "bring down the wrath of those who see themselves as ordained guardians of our morals," Dan Thomasson proceeds to angrily moralize about pharmacists who withdraw from a prescription request in rare cases when they deem the prescription harmful to patients or deadly to developing babies ("Birth-control denial the height of arrogance," Op-Ed Tuesday). He lays down an authoritarian edict that even in such cases of professional judgment, the concerned pharmacist must blindly "follow the doctor's orders" or "find another profession."

Railing against "extraneous considerations such as religious convictions or mere assertions that it violates their own personal codes," Thomasson imagines that resistance to dispensing abortifacient drugs constitutes a conspiracy--"a sad trend to establish a strict religious-based social order, even in the health fields."

OK, we get it. Religion is evil and people of faith are Napoleonic conspirators who must be banned from health care and the public square. I defend Thomasson's right to voice such extreme views, given First Amendment freedoms protecting both the freedom to express one's beliefs and to practice one's faith. But if we actually enforce such militant intolerance and contempt for the beliefs of others, we will all eventually lose those freedoms.

Jonathan Imbody
Vice President for Government Relations
Christian Medical Association -- Washington Office
Protecting the Consciences of OB/GYN's

National Catholic Bioethics Center
24 June, 2008
Reproduced with permission

A recent issue of the Journal of Clinical Ethics published a series of articles addressing the question, to what extent should the consciences of obstetrician-gynecologists (ob/gyns) be protected? The importance of the question lay in the fact that ob/gyns may receive requests to perform controversial sexual or reproductive procedures. Such sexual/reproductive practices as prescribing contraceptives, undergoing in vitro fertilization, and abortion may be requested by the patient. Since all of these procedures are unfortunately legally protected, the physician who has an objection against any of them risks violating the legal "rights" of the patient. That is, there is an apparent tension between the patient's legal right to have access to the above procedures, and the conscientious physician's moral integrity in refusing to do them. Similarly, the moral integrity of pharmacists has been attacked by the recent position taken by the American Medical Association's Board of Trustees. The AMA position "supports legislation that would require individual pharmacists and pharmacy chains to fill legally valid prescriptions or to provide immediate referral to an appropriate alternative dispensing pharmacy without interference" (see Proceedings, June 17, 2008).

Edmund Pellegrino contributes a commentary in this series of articles, and I agree in toto with his position. But the other articles take a different stancp is issue. The<< basic argument seems to be the following: begin by countenancing the apparent tension mentioned above; stipulate that (1) the physician's professional role is to perform clinical duties consistent with his or her fiduciary duties to the patient, and (2) this professional role ought to be impervious to the moral commitments of the physician. Therefore, the physician ought to comply with the requests of the patient, or at the very least transfer the patient to someone who will. Of course, (2) is patently false. But in its defense proponents make a subtle though quite devastating move. One way to argue for (2) is to equate personal moral commitment with one's religious beliefs. That is to say, to the extent that one's moral commitments are "rooted" in one's religious convictions, they are religious claims, not moral ones. And if they are religious claims, then they ought not to infect the physician-patient relationship. Otherwise the physician is guilty of "paternalism" or of "shoving religious views down the patient's throat."

Another way to argue for (2) is to say that the physician's specifically clinical judgment ought not to be informed by his or her personal moral commitments. A clinical judgment is one that is tethered to reliable clinical evidence of expected benefit vis-a-vis the available alternatives. And, what counts as a benefit is determined by the patient, not the physician. So, if the physician were to refuse to perform an IVF procedure, the physician is defining what the benefits are, not the patient. The patient sees the benefit of "having children." The physician sees having children as a benefit, but for IVF, this is by means of destroying other children and violating the nature of the conjugal relation. In the end, the values of the patient matter, not the physician's.

Though I think this pattern and the various justifications for each step are open to an extended analytical critique, I have space only to make some broad comments in criticism of them. Notice the strategy behind the pattern. It is either to reduce the physician's professional role to making expert statistical judgments, or it is to reduce the physician's moral commitments to religious ones - and then excluding religious beliefs from infecting the physician-patient interaction. In either case, an important bifurcation takes place between medical judgments and ethical ones. In fact, it is common to see in the literature on this issue (i.e., the issue of conscience) a distinction drawn between medical concerns and moral ones, between clinical judgments and ethical judgments. But such a bifurcation is a grossly inapt description of the physician's task. The task of healing the person is an inherently moral task. A physician friend of mine, after I told him I was doing research on a bioethical issue, said it best: "I did bioethics all day too."