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