Discrimination against health care workers who refuse to participate in abortions is, unfortunately, a common occurrence, especially in public/university hospitals, where more liberal medical school faculty hold power. Medical students, residents (doctors in training), attending physicians, nurses, scrub techs and others have, and do, face regular opposition for acting upon their consciences. Sometimes this can take the form of subtle ridicule; other times it has led to pro-life workers being passed over for promotions, terminated, and even “black-listed” for future employment.
Certainly, facing discrimination is something Christians are taught to expect, and to react to with humility, grace and love. At the same time, being a voice for those who are vulnerable to mistreatment (e.g. medical students, nurses and others who would be most at risk from the ire of an angry pro-choice attending physician) is something Christians are called to do.
Moreover, encouraging a just culture, where people are free to follow their consciences, can have a protective effect for many people, including the people served by the health care workers whose consciences are protected. After finding systematic discrimination in medical school admissions against candidates who answered interview questions in a pro-life manner, the authors of the Report of the Task Force on Issues of Conscience challenge us to consider: “One final word − Enron. When you think of what medicine will be when we teach people to disregard their consciences, remember Enron.”[1]
As every bit as important as high ethical standards are in business, having physicians and nurses care for us who are ethical and who follow their consciences is a key to receiving good health care. If the people who care for us are simply reduced to “providers” who are paid for a “service,” it means we, as people, are little more than a means to an end (a paycheck). Therefore, if health care workers are told to “turn off” their consciences at work, health care could degenerate into a situation where as long as the provider of the service is paid, they’ll care little for what happens to the patient.
Realizing this, many have worked diligently to put protections in place for those working in health care. Since Roe v.
- Church Amendment (1973): mandated that federal, state or local entities receiving federal funds (e.g. Medicare & Medicaid) not discriminate against health care professionals or institutions that refuse to perform or participate in any lawful health service – including abortion or sterilization – if the refusal is based on moral objections. This legislation was passed just weeks after the U.S. Supreme Court decision Roe v. Wade legalized abortion.
- Public Health Service Act (1996): Extended federal protection to individual and institutional health care entities – including medical training programs – that refuse to perform, refer for or train in abortion-related services based upon conscientious objections.
- Weldon (or “Weldon-Hyde”) Amendment (2004): Extended conscience protections to individual and institutional health care entities – including hospitals and health plans – to be allowed to refuse to provide, pay for or refer for abortion-related services.[2],[3] (Not to be confused with the 1976 “Hyde Amendment,” which prohibits the federal funding of the abortions themselves.)
While these laws are helpful, religious-based discrimination is, if anything, on the rise. In many ways, this is a reflection of the overall trend in our culture in which, per the Employment Equal Opportunity Commission (EEOC), work-related religious discrimination has increased in the past ten years [4].
President Obama has stated he wants to overturn the interpretation of these statutes, as made by former secretary of Health and Human Services Mike Leavitt.[5] Mr. Leavitt created specific guidelines for employers to follow the above conscience statutes. The president has opened his proposal to remove these guidelines to a 30 day “comment” period.
While pro-choice activists claim Leavitt’s guidelines created new laws, what he did, in fact, was reference the prior statutes, and clarify how employers should follow them. After first proposing the formalization guidelines, secretary Leavitt received a firestorm of backlash from abortion proponents during the 30 day comment period he proposed[6]. The key theme in many of these protests seemed to focus on fears that if physicians (and other workers) were not compelled to do abortions, even against their wills, abortions will no longer be available (or as available as some would wish).
There are two shortcomings in this objection. First, the fact is that a few abortionists can easily do abortions on a great number of women (abortions take minimal physician time). Thus even if the vast majority of physicians chose to not perform abortions, women will still be able to readily access them.
Second, the voiced fear that abortions would become increasingly difficult to obtain if physicians are not compelled to participate against their consciences begs the question: if many (most?) physicians find it unconscionable to perform an abortion, what does that tell one about the morality of abortion? The implication is that many physicians, who do understand fetal development and just what happens during an abortion, in fact do find abortion at least morally troubling, if not outright immoral. Therefore, abortion proponents see the need to steer more physicians (especially young physicians and students studying to be physicians) toward performing abortions, and those who do not to be at least open to the procedure. Otherwise, they fear, abortion might cease to be performed in this country. Conversely, if physicians and nurses can be compelled to “quiet” their consciences in the name of “patient autonomy,” physicians and nurses can be coerced to be at least half-hearted participants in a woman obtaining an abortion.
Abortion is not a new practice. Contrary to those who try to frame it as a contemporary, enlightened “option,” its practice is as old as recorded history. The Oath of Hippocrates has long been seen as the standard of ethical medicine in western culture. While many will quibble over the semantics of various translations, the oath (in its original version) clearly prohibits a physician from performing an abortion (e.g. “I will not give a woman a pessary to cause an abortion” in one translation; others translate this as “abortive remedy”).[7] ,[8] However, a “modern version” of the oath, a dramatic rewrite done by Dr.
Thus, it becomes clear that while “pro-choice” activists rally around the concept of “choice,” they do not see individuals being able to act upon their conscience (if it means an impediment to abortions) as a legitimate “choice.” Their idea of whom should have choices of how to act, and what those choices should be, are clearly limited.
President Obama’s proposal, in fact, appears to be part of an ongoing effort by pro-choice zealots to remove the ability for health care workers to conscientiously opt out of abortions. The conscience statutes are often mentioned by pro-choice advocates as some of their chief “targets” for repeal. In the past, one way these protections have been targeted to be overturned was the introduction of the “Freedom Of Choice Act” (FOCA) in 2007—which then Senator Obama co-sponsored. So overtly (using lawsuits and legislation like FOCA and the president’s proposal) as well as covertly (by way of means such as “earmark” legislation, lawsuits and the ethical drift of universities) they would like to see pro-life doctors and nurses at least silenced, if not entirely removed from their professions.
The concern however is not just that limiting health care licensure to the pro-choice or indifferent would lead to more abortions, but that the process itself would lead to removing many people of conscience from health care. For if acting upon one’s conscience is no longer seen as a valid professional act, truly we could end up with a health care system that makes the greed and treachery of Enron seem small in comparison.
While often wary to come forward, many health care professionals have experienced being “passed over,” “blacklisted,” or otherwise discriminated against for acting upon their pro-life convictions at work. Doctors seem to be particularly vulnerable during their training years, even with the above protections in place (most training programs receive federal funding).[10] This is because as students, and then residents, their performance is evaluated by their superiors; these evaluations are entirely subjective, and often have a great bearing on what opportunities a physician has both during and after he/she finishes training (or even if he/she will be allowed to finish training!). Near my home, for example, Dr. Patrick Marmion experienced professional ostracism for refusing to supervise elective abortions during his final year of residency in Cincinnati,[11] having to move out of state and spend extra years training to be able to become a board-certified OB-GYN. Other health care workers, such as nurses and surgical technicians, spend their entire careers under the supervision of physicians, and therefore are also vulnerable to pro-choice physicians who would discriminate against them on account of their beliefs.
The Weldon Amendment and other federal protections are regularly being challenged by pro-choice activists in court. One such lawsuit resulted in a California Supreme Court case in March, 2008.[12],[13] The suit was an attempt by the California Attorney General to overturn Weldon so California could enforce a state law allowing the state to fine, revoke the licenses of, and even incarcerate physicians who refused to participate in abortions[14],[15] – even if the woman was able to find another physician to perform the abortion. While the court upheld Weldon, it doesn’t necessarily guarantee the same result in future cases, especially if legislation resembling FOCA were to overturn Weldon.
Pro-choice activists clearly would like the various conscience statutes overturned, and the president’s proposal seems to be their first salvo. Whether via a court decision, a “frontal assault” like FOCA, or more covert legislation that overturns conscience-protecting statutes, the stridently pro-choice seem to be bent on making sure no one who disagrees with their point of view takes care of patients. So while the president’s proposal clearly presents a stark danger, it is not the only danger.
More information, and the ability to respond to the present’s proposal, can be found at: http://freedom2care.org.
[1] Report of the Task Force on Issues of Conscience, May 2005, http://www.cathmed.org/publications/Conscience.pdf
[2] American Medical News,
[3] http://www.nrlc.org/Federal/ANDA/hydeweldonwebnrlnews.html
[4] http://www.cmda.org/AM/Template.cfm?Section=Right_of_Conscience&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=16749
[5] http://www.cnn.com/2009/POLITICS/02/27/conscience.rollback/
[6] http://archive.hhs.gov/secretarysblog/my_weblog/2008/08/physician-con-2.html
[7] English translation of Oath of Hippocrates by
[8] http://www.hsl.virginia.edu/historical/artifacts/antiqua/hippocrates.cfm
[9] http://www.pbs.org/wgbh/nova/doctors/oath_modern.html
[10] See, for example: http://www.cmda.org/AM/Template.cfm?Section=Right_of_Conscience&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=16722
[11] healthybeginnings.tripod.com/hbhistory.doc
[12] http://www.clsnet.org/clrfPages/pr_HealthCare.php
[13] http://www.cmda.org/AM/Template.cfm?Section=Right_of_Conscience&CONTENTID=13822&TEMPLATE=/CM/ContentDisplay.cfm
[14] http://www.alliancedefensefund.org/news/story.aspx?cid=3976
[15] http://www.alliancedefensefund.org/news/story.aspx?cid=3626
