Protection of Conscience Project
Protection of Conscience Project
Service, not Servitude

Service, not Servitude

Silencing the Conscience of Medical Professionals

Responding to: Charo RA. The Celestial Fire of Conscience - Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005
Reproduced with permission

John Mallon *

What are the limits of conscience? Can there be any limits on conscience? Professor R. Alta Charo, who teaches law and bioethics at the University of Wisconsin Law and Medical Schools in Madison, thinks there should be, and that the law should require health care professionals to violate their consciences in certain cases, and has written an article to that effect in the June 16 New England Journal of Medicine, one of the most prestigious peer-reviewed medical journals in the world, which as such, ought to be scientific and objective.

Yet Professor Charo's article, though cleverly written, is blatant Culture of Death propaganda, complete with dubious and flatly ideological presuppositions masquerading as presumed facts and conventional medical ethics.

She writes:

Largely as artifacts of the abortion wars, at least 45 states have 'conscience clauses' on their books - laws that balance a physician's conscientious objection to performing an abortion with the profession's obligation to afford all patients nondiscriminatory access to services. In most cases, the provision of a referral satisfies one's professional obligations. But in recent years, with the abortion debate increasingly at the center of wider discussions about euthanasia, assisted suicide, reproductive technology, and embryonic stem-cell research, nurses and pharmacists have begun demanding not only the same right of refusal, but also - because even a referral, in their view, makes one complicit in the objectionable act - a much broader freedom to avoid facilitating a patient's choices.

She objects to the idea that making a referral makes one complicit in an immoral act. (Not surprisingly she uses the term "objectionable" instead of immoral.) Charo apparently believes that if a physician has a moral objection to performing an abortion the needs of the physician's conscience are met in merely refusing to perform it himself or herself, but then they should be required by law to make a referral to a physician who will perform the abortion.

Evidently this professor of ethics has no idea what conscience means.

In other words, imagine that, in the not-to-distant future, it were legal for a physician to shoot a patient dead if the patient so requested. Charo believes a scrupulous physician may say to a patient, "No, I don't do that." but then would be required to say, "But, here, go to my colleague across the street, she will gladly shoot you to end your misery."

Far fetched? Not really. There are physicians who see no moral difference between shooting a patient on request and performing an abortion. In the consciences of these professionals both are murder. (Except in the case of the abortion the one being killed has no say in the matter.)

She complains:

This expanded notion of complicity comports well with other public policy precedents, such as bans on federal funding for embryo research or abortion services, in which taxpayers claim a right to avoid supporting objectionable practices. In the debate on conscience clauses, some professionals are now arguing that the right to practice their religion requires that they not be made complicit in any practice to which they object on religious grounds.

Even more remarkably, she suggests that those claiming conscience as grounds to refuse to participate in immoral medical procedures do so without honor if they are unwilling to pay a price for doing so:

Although it may be that, as Mahatma Gandhi said, "in matters of conscience, the law of majority has no place," acts of conscience are usually accompanied by a willingness to pay some price. Martin Luther King, Jr., argued, "An individual who breaks a law that conscience tells him is unjust, and who willingly accepts the penalty of imprisonment in order to arouse the conscience of the community over its injustice, is in reality expressing the highest respect for law."

Who says these professionals are not paying a price for their convictions?

She claims:

"What differentiates the latest round of battles about conscience clauses from those fought by Gandhi and King is the claim of entitlement to what newspaper columnist Ellen Goodman has called "conscience without consequence'."

What is truly breathtaking here is that she is willing to use the very words of Gandhi and King (and elsewhere, C.S. Lewis) to argue against precisely what they were fighting for: a just society in which one does not have to suffer punishment for following one's conscience. In fact, would not a society where one must suffer for following one's conscience be the very definition of an unjust society? Yet Charo would have it so for these healthcare professionals.

The spoken word is often more unguarded than the written word, and Charo makes an extremely telling remark as to her "ethical" orientation in an audio interview accompanying the online article .

She makes the statement, "What is happening it that [health care professionals] are saying, 'my role as an individual, as a Catholic, or a Methodist, or a Lutheran is more fundamental than my role as a physician, or a pharmacist, or an ambulance driver.'"

Yes, Professor, that is exactly what they are saying, because what makes them a good Catholic, Methodist or Lutheran is precisely what makes them good, ethical and trustworthy physicians, pharmacists or ambulance drivers: their conscience. The problem is you think that's a bad thing.

She continues: "And that's what's changed. That question of which is the most important hat you're wearing at the moment when you are dealing with the patient."

No, Professor, only since the legal fiction of Roe vs. Wade has this changed. Otherwise ethical behavior has been this way for 4,000 years: That there should be no conflict between what one most fundamentally is, as determined by one's conscience, and what one does in one's profession or any other aspect of life.

I want to continue where I left off my last article for, commenting on an article in the New England Journal of Medicine by University of Wisconsin Law Professor R. Alta Charo and her objections to conscience clauses protecting medical professionals from being forced to cooperate in immoral "medical" procedures. To recap, Charo thinks medical professionals may be permitted to opt out of immoral procedures but in so doing must be required by law to refer the patient to someone who will perform or prescribe the objectionable "medical services."

As mentioned in my previous article, Charo's article is so fraught with propaganda that it really requires some exposure to the light of further analysis. It is most disturbing that a publication with the stature of NEJM would publish such a piece of blatant ideological bias.

To jump right in, Charo says,

. . . of course, the professionals involved seek to protect only themselves from the consequences of their actions - not their patients. In Wisconsin, a pharmacist refused to fill an emergency-contraception prescription for a rape victim; as a result, she became pregnant and subsequently had to seek an abortion. . . . Under Wisconsin's proposed law, such behavior by a pharmacist would be entirely legal and acceptable. And this trend is not limited to pharmacists and physicians; in Illinois, an emergency medical technician refused to take a woman to an abortion clinic, claiming that her own Christian beliefs prevented her from transporting the patient for an elective abortion.

Charo makes several assertions in this jam-packed paragraph. Let's take them one at a time. First, she makes the rather bold judgment on the motives of health professionals as selfish, seeking their own good but not that of the patient. In this she violates the rules of civil discourse which discourage imputing motives to your opponents. Charo is not a mind reader.

Second, physicians in our society are highly honored professionals, rigorously trained, usually taking up their profession for noble and altruistic reasons and they are licensed by the state for their highly specialized and urgently needed skills. We expect medical professionals to be people of conscience and good judgment - even wisdom - who make very difficult decisions not only for the good of their patients but for the common good of society.

The procedures and actions Charo seeks to portray as normative medical care are in fact highly controverted. Many health care providers believe them not only to be harmful to their patients in particular, but society in general. Charo wants us to believe that contraception, "emergency contraception," abortion, and other ethically dubious items on the bio-ethical frontier are unqualified goods for society or at least "necessary" in a less than perfect world. She would have us believe that professionals who recuse themselves from these activities do so to support an agenda, rather than a genuine concern for their patients and the common good.

By her tone, attitude and presuppositions she is treating her own agenda of "value free" health care as a fait accompli and those professionals about whom she complains as laggards holding up progress with ethical concerns all "progressive people" have long dismissed.

Further, she falls back on the emotional appeal of "hard cases" referring to a woman refused "emergency contraception" who "had to seek an abortion." Last we heard, for Charo's ideological comrades, abortion was a "choice." Has something changed? Not to minimize the tragedy and trauma of rape, it still does not automatically medically indicate an abortion. In fact, abortion is virtually never indicated for strict medical reasons. Second, the dangers of "emergency contraception" are serious and well documented.

Then Charo poses the loaded question:

Should the public square be a place for the unfettered expression of religious beliefs, even when such expression creates an oppressive atmosphere for minority groups? Or should it be a place for religious expression only if and when that does not in any way impinge on minority beliefs and practices?

No Christian I know wants to see genuine minority groups oppressed, but there is a difference between ethnic, religious minorities and ideological "minorities." Charo seeks to conflate the two. Most adherents to the world's major religions subscribe to a moral code which is essentially the same in those religions, and they generally agree on traditional sexual and medical ethics.

Sexual ideologues, on the other hand - feminists and liberals of various stripes - have been hiding behind the skirts of minorities, the young, and the poor like snipers claiming that anyone who shoots back is taking aim at minorities. Like much of their rhetoric, this is nonsense, and shows the weakness - the emptiness - of their logic.

If they really cared so much for minorities, the young, and the poor they would stop patronizing them and killing their unborn and shoving contraceptives down their throats under the pretense that they "need" them for their own good. They would stop using them, attempting to borrow the "credibility of victimhood" for their anti-life agenda.

Charo needs to restudy the meaning and role of conscience, and remember that, like charity, it begins at home. Perhaps she should expend more concern for those being killed by questionable medical procedures like abortion than those being "offended" by the ethical decisions of conscientious professionals.