Re: Wisconsin Assembly Bill 67
Testimony before Wisconsin Senate Committee
on Health, Children, Families, Aging and Long-Term Care
October 7, 2003
Where medically appropriate
I offer, educate, argue, strongly encourage, but I
will not force my opinion on her. If a patient did
not show the same respect for me, but insist that I
act in violation of my conscience, I would consider
that a grave violation of the covenant of mutual
respect that must exist between us.
I believe the following five points effectively
argue for this excellent law that protects the right
First: Conscience is in the tradition of American
practice and jurisprudence.
Our first amendment prohibits congress from
making a law that would deal with "an establishment
of religion, or prohibiting the free exercise
thereof." It would seem appropriate for rights of
conscience to fall under that prohibition. More
recently the precedent of conscience has been well
established in U.S. case law. One frequently cited
is Brophy v. New England Sinai Hospital
(1986). There the court stated that physicians have
the right to refuse to participate in actions that
violate their ethical and moral standards.
Second: To require a physician to violate her
conscience destroys the patient physician
Medicine is a serving profession. When I am at
the office I am there as a professional to serve my
patient. I do not serve by simply doing the will of
the patient. I serve as a professional. By that I
mean that I profess to have a knowledge that I
desire to use for the benefit of my patient.
Further, I want to approach my patient concerned for
her whole life situation. I want to understand the
meaning of her disease in the context of her
emotions, spiritual values and social relationships.
Similarly I come not only with my knowledge but also
with my whole self as a caring person. This must
include my emotions and spiritual values. That
relationship between patient and physician as two
whole people is essential to the healing process.
A system that would require me to violate my
conscience and give into the demands of a patient
would destroy that relationship. Out of respect for
my patient, I am reticent to push her to do anything
in violation of her conscience. Where medically
appropriate I offer, educate, argue, strongly
encourage, but I will not force my opinion on her.
If a patient did not show the same respect for me,
but insist that I act in violation of my conscience,
I would consider that a grave violation of the
covenant of mutual respect that must exist between
us. I have continued to care for wealthy patients
who do not have enough respect for me to pay their
bills, I have continued to care for others who have
sued me, but if a patient showed so little respect
that they would force me to violate my conscience; I
would not be able continue their care.
I know I am not alone in this and suspect that if
forced to violate conscience a number of
exceptionally qualified individuals will leave or
never enter the practice of medicine. I would humbly
ask what kind of a physician would you like caring
for you: one who is principled and sensitive to
issues of conscience or one who is willing to do
things which she feels are wrong?
Third: Right of Conscience is necessary to the
practice of the type of medicine we want.
Medicine, with its current emphasis on evidence
and outcome studies is based on the premise that
research can demonstrate one best way to practice.
This presupposes that there is objective truth.
Medicine does not believe that any individual's
approach is as good as another until studies have
proved it. The nature of conscience is similarly
based on the premise that there is right and wrong.
Many people deny that there is any objective
truth. Truth for them is subjective and individual.
Conscience is a subjective interpretation and is not
related to any objective truth. Seeing no truth
basis in their own consciences they do not allow for
truth claims in the conscience of others. To force a
practitioner to act against her conscience will
dramatically alter the very nature of medicine.
Medicine is not to be arrogant over the truth as
if we have all the answers. We are in a search for
truth and only ask for the privilege of living in a
way consistent with where we are in that search.
That requires protection of conscience.
Fourth: To make a referral is just as much
against conscience as to provide the service.
When I refer to someone I am commending the
patient to the doctor for the service and the doctor
to the patient. I cannot do that when it would be
contrary to my conscience. What I can do is politely
defer, allow another physician to assume the care,
and make sure that I do my utmost to provide records
to assure an orderly resumption of care.
Fifth: There is no reason why a patient's
autonomy should take precedence over that of the
Conflicts between the rights of individuals are
intrinsic to free people. It is only in the context
of a slave culture that the rights of one individual
are allowed to trump the rights of another only on
the basis of station in society. It is not
appropriate for the rights of a patient to trump the
rights of a physician simply because of their
I would say in closing, that, as a geriatrician,
I am sensitive to the issues of the dying. I place
great importance on advance directives and sincerely
seek to honor them. In 30 years of being a Doctor I
have never had a conflict between advanced
directives and my own conscience. It may some day
come. If it did, I, and I believe all doctors that I
would consider worth their salt, would seek to work
things out in gracious and caring ways which would
allow respect for both the patient and the
Senators I know that you recognize the sobriety
of this matter. This is about the very character of
medicine as it has been traditionally practiced in
this country and which many of us continue to
cherish. I believe that the house bill is wise and
will protect the quality of medicine we want to