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

Service, not Servitude

American College of Obstetricians and Gynecologists Demands Compulsory Referral for Abortion (30 August, 2005)

2nd Project Letter to the ACOG President

Re: Compulsory referral for abortion

10 November, 2005 

Michael T. Mennuti, MD, FACOQ, President
American College of Obstetricians and Gynecologists,
Department of Ob-Gyn,
University of Pennsylvania Medical Center,
3400 Spruce Street,
Pennsylvania, USA 19104-4283

Dear Dr. Mennuti:

Thank you for your letter of 18 October, 2005, responding to the Project’s interest in your letter to American senators, demanding that doctors who morally object to abortion should be required to refer patients to abortion providers. I am pleased to see that you evince profound respect for the convictions held by your members, and heartened by your assurance that members holding a diversity of views are welcome in the ACOG. This gives me some reason to hope that further representations from the Project will be graciously received.

You have made it clear that your demand for compulsory referral arises from a general policy developed by the Executive Board on access to services for women. However, you have not explained why access to such services can be ensured only or chiefly by the suppression of freedom of conscience through compulsory referral.

It is customary in other liberal democracies to maintain and accommodate such fundamental freedoms unless it can be demonstrated that accommodation is not reasonably possible. Moreover, the burden of proof in this regard lies on those who would suppress or abolish freedom, not those who exercise it. With respect, you have not discharged this burden. In the absence of significant evidence to the contrary, it is difficult to believe that a country as powerful and wealthy as the United States does not have the resources or imagination to ensure both access to abortion and accommodation of freedom of conscience.

I understand that well-respected individuals with a diversity of views about abortion assisted the ACOG Executive Board in the development of its policy.  Be that as it may, I respectfully suggest that a policy of compulsory referral could only be arrived at by excluding or discounting ethical viewpoints to the contrary. This is hardly a satisfactory method of achieving an ethical consensus. In short, you have not yet established the ethical basis for your claim that physicians must refer for morally controversial procedures.

Finally, I draw your attention to recent developments in Europe that bear directly on the issue of referral, and which, I believe, provide additional reasons for the ACOG to reconsider its position. The first is a joint statement issued in December, 2003 by two Belgian universities and the Flemish Association of General Practitioners that requires objecting physicians to refer patients to colleagues for euthanasia. The second is a finding by two committees of the British parliament that a mandatory requirement to refer patients for euthanasia is probably a violation of the European Convention on Human Rights. In consequence, the bill’s sponsor, Lord Joffe, has agreed to delete the provision.

The first of these developments underlines the relevance of precedent to the present discussion. If it is legally and ethically permissible to force an objecting physician to refer for abortion, there is no principled reason not to force him to refer for other morally controversial procedures, including euthanasia, assisted suicide, sex selective abortion, or infant male circumcision. Indeed, the arguments used to justify compulsory referral for euthanasia are much like the ones offered in an attempt to justify compulsory referral for abortion. I doubt that, in drafting a policy of compulsory referral for abortion, the ACOG actually meant to establish a precedent for compulsory referral for such things, yet that is its effect.

The finding by the British House of Lords’ Select Committee that compulsory referral probably violates European human rights law was based on a report to that effect from the parliamentary Joint Committee on Human Rights. Moreover, numerous written and oral statements taken in evidence by the Select Committee protested the draft bill’s compulsory referral provision, testifying, one might say, to widespread understanding and acceptance of the principle of vicarious moral responsibility.

For your further consideration I have enclosed the Project essay Referral: A False Compromise; the Belgian and English documents relevant to the preceding discussion are available on the Project website.

In conclusion, I request that the American College of Obstetricians and Gynecologists withdraw its demand that the U.S. Senate suppress freedom of conscience by legally compelling physicians to refer for abortion. Alternatively, if the issue has now become moot due to the current status of the bill, I request that the ACOG not renew its demand until it has formally revisited the issue of referral with the benefit of input from those who would be opposed to it.

I look forward to learning how the ACOG plans to proceed with respect to this issue from this point forward, and I welcome the opportunity for further discussion and reflection.


Sean Murphy,

Note:  The ACOG did not respond and ignored requests for the courtesy of a reply.