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The Right Of Conscience
Definition Healthcare Right of Conscience The freedom to practice healthcare in accordance with your deeply held religious, moral or ethical convictions.
Martin Luther King On some positions cowardice asks the question, 'Is it safe? ' Expediency asks the question, 'Is it politic? ' Vanity asks the question, 'Is it popular? ' But conscience asks the question, 'Is it right? ' And there comes a time when one must take a position that is neither safe, nor politic, nor popular. But. . . because it is right.
Harper Lee To Kill a Mockingbird, 1960 The one thing that doesn't abide by majority rule is a person's conscience.
This is Not a New Issue w Moral Debate 2500 Years Ago w I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. But in purity and in holiness, I will guard the sanctity of life and my role as healer. Hippocratic Oath, 429 BC
What Right? w Congress shall make no law respecting religion or prohibiting the free exercise thereof. Bill of Rights, First Amendment
Writing the First Amendment w James Madison, June 7, 1789 The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed. No state shall violate the equal rights of conscience or the freedom of the press, or the trial by jury in criminal cases. w House Select Committee, July-28 No religion shall be established by law, nor shall the equal rights of conscience be infringed. w House Version, Aug-20 Congress shall make no law establishing religion, or to prevent the free exercise thereof, or to infringe the rights of conscience. w Final Version Sept 24 Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.
Founding Fathers w The rights of conscience we never submitted, we could not submit. We are answerable for them to our God. w I consider the government of the U. S. as interdicted by the Constitution from intermeddling with religious institutions, their doctrines, discipline, or exercises. Thomas Jefferson
James Madison w Conscience is the most sacred of all property. w The Religion of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate.
AMA Statement w AMA reaffirms that neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical practice. w Except in emergencies, physicians shall be free to choose whom to serve, with whom to associate and the environment in which to provide medical care.
World Medical Association The physician should be free to make clinical and ethical judgments without inappropriate outside interference.
Other Countries/Codes w European Convention on Human Rights w Everyone has the right to freedom of thought, conscience and religion; this right includes… freedom …to manifest his religion or belief in worship, teaching, practice and observance. w Canadian Medical Association w Physicians who object to abortion for reasons of conscience are advised to inform their patients of their objections so that the patient can consult another physician. The CMA stresses that physicians who decline to participate in abortion should not be discriminated against, and emphasizes the need to respect the rights of conscientious objectors, especially those in training for obstetrics and gynecology, and anesthesia.
Another Perspective “The Right of Refusal” w “A threat to reproductive rights. ” w “Health related decisions made between a provider and patient should be made on the personal welfare and healthcare needs of the patient - not the morals or belief of the caregivers. ” w “While we firmly believe that all people have a right to their own opinions and moral beliefs, it is unethical for healthcare providers to stand in the way of a woman’s access to safe, legal and professional healthcare. ” Refusal Clauses Planned Parenthood Website
Battle Fronts w Plan B and Pharmacists w Insurance Plans w Abortion Training w Standards of Care w Direct Pressure on Professionals w Bypass or emasculate present laws.
State Attacks on ROC w Alaska (1997) - Valley Hospital Assoc. w California (2003) - Benitez v. North Coast Women's Medical Care w Illinois (2005) – Gov. Rod Blagojevich w Washington (2007) - Pharmacy Regs. w Many More Since
Training Issues w Overt: Mandatory Abortion Training in NYC w 2002: Mayor Bloomberg orders abortion training in All NYC medical schools w NY guidelines make it very difficult to conscientiously object w Covert: Pro-life students denied admission (Issues in Law and Medicine, Spring, 1996)
ACOG Committee Opinion # 385, 11/07 w w w w w Patient autonomy final arbitrator for Rx Right to Demand Rx = Right to Refuse Rx ROC is just a personal opinion Moral obligation to patient over rides ROC Inconvenience imposes providers beliefs on pts. Patient’s concept of well-being trumps Must refer for abortion If can’t timely refer, must provide Those who refuse to provide abortions should only practice in areas where abortion services can be provided.
American Board of Obstetrics and Gynecology New policy issued in January 2008: certification contingent on compliance with ACOG ethical principles. The combination of ACOG Ethics Committee Number 385 and the ABOG 2011 Bulletin for Basic Certification makes for a toxic environment for healthcare providers.
CMDA Faith-Based Professional Survey w 40% of member report being pressured to compromise convictions w >43% know someone else who was pressured w >24% have lost position, promotion or compensation as a result w >88% think the problem is getting worse
CMDA Public Poll September 2008 CMDA commissioned the polling company TM, Inc. to conduct a nationwide telephone poll w +/- 3. 1% at 95% confidence level w 42% think law obligates doctors to perform/refer for abortion w 38% no obligation w 11% unsure w 5% depends
w If we don’t protect personal integrity, we would go down a dangerous avenue. By taking a professional license you do not step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person. Linda Rankin, Bioethicist, U of TN Christian Science Monitor, 4/26/04
Conscience & Healthcare w Is our healthcare system in need of more conscience-driven doctors or more "ethically neutered" doctors? w Do we want medical schools to systematically strip our future doctors from any and all religious and ethical convictions that have not been approved by the state? w Your doctor's conscience may some day be the last line of protection between you and those who would profit from your early death.
Federal Law w Church Amendment w Public Health Services Act w Medicare/Medicaid w 42 U. S. C. § 238 n w Weldon Amendment Limited to federally funded programs. No enforcement provisions.
State Laws w 45 states have some sort of ROC laws w Arizona w 36 -3205. Health care providers; immunity from liability; conditions w A health care provider is not subject to criminal or civil liability or professional discipline for any of the following: 1. Failing to comply with a decision or a direction that violates the provider's conscience if the provider promptly makes known the provider's unwillingness and promptly transfers the responsibility for the patient's care to another provider who is willing to act in accordance with the agent's direction. w State by State Laws w http: //www. consciencelaws. org
More Current Events w January 20, 2009: HHS policy goes into effect protecting right of conscience w Can’t discriminate in the employment, promotion, termination, or the extension of staff or other privileges to any physician or other healthcare personnel because he performed, assisted in the performance, refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.
w Anaphylactic reaction by proabortions groups and some media w False claims, e. g. , women will not be allowed contraception w Media blitz w Legal action taken w 1/15/09 - PP, ACLU, 7 State Attorneys General file suit in CT to overturn
Overturning HHS Regulations w February 2009 w President Obama announces he will rescind the regulation w April 9, 2009 w 30 Day Public Comment Period ended w 300, 000 comments w All reference to regulations taken off HHS website. w Gutted 12/10
Freedom 2 Care. org w Represents 50 organizations w Education & Mobilization w Blogs, Twitter, Facebook w Polls/Surveys w 91% of faith-based physicians agreed, “I would rather stop practicing medicine altogether than be forced to violate my conscience. ”
w 88% Americans say it is important that they have a similar set of moral beliefs as their healthcare professional. w 87% oppose forcing professionals to violate their moral objections. w 63% support conscience regulations w 54% less likely to vote for Congressman that oppose ROC.
Healthcare Reform w Church, Weldon and other laws only apply to annual HHS appropriations w Reform bill only protects physicians from insurance companies coercing them to do abortions w No protection for other professionals w No protection from referral w No protection on other issues
Why I Don’t Refer? w Referral means: w I endorse the competency, judgment and ethics of the doctor to whom I’m referring. w I enter into a professional relationship with that doctor. w I will receive a report back from him. w I believe they will “do no harm. ”
Moral Complicity w CMDA believes moral complicity with evil does not exist when all the following conditions are satisfied: w our intent is for good; w the association with the past or present evil is sufficiently uncertain, or the act is sufficiently distanced from the original evil act; and w the action does not reward, perpetuate, justify, cooperate with, or ignore the original evil.
Conscience Rights w Protection of someone’s right to object does not equate with support for that position. w Indeed, we must pay special attention to protecting the rights of others when we do not support their position. * *(Claims of conscience rights can be abused)
Insurance Mandate w Sec. HHS Authority w Institute of Medicine w Must provide all FDA Approved Contraceptives w Unless Religious Employer: w (a) Whose purpose is the inculcation of religious values; (b) That primarily employs persons who share the religious tenets of the employer; (c) That primarily serves persons who share the religious tenets of the employer; and (d) That is a nonprofit organization under section 6033(a)(2)(A)(i) or (iii) of the IRS Code
Ministerial Exemption w Lutheran Church v. Equal Employment Commission w 4 th Grade Teacher Replaced So Sued School w Court considered her a minister w w Commissioned by Church Had religious training She claimed a ministerial housing allowance Organized and led chapel at school and gave religious training w Court Said, Requiring a church to accept or retain an unwanted minister, or punishing a church for failing to do so, intrudes upon more than a mere employment decision. Such action interferes with the internal governance of the church, depriving the church of control over the selection of those who will personify its beliefs.
Why This Assault on Conscience? What will convince them? This, and this only: cease to call slavery (abortion) wrong, and join them in calling it right. And this must be done thoroughly - done in acts as well as in words. Silence will not be tolerated - we must place ourselves avowedly with them…. . The whole atmosphere must be disinfected from all taint of opposition to slavery (abortion), before they will cease to believe that all their troubles proceed from us. " Abraham Lincoln Cooper Union address of 1860
The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last. Crispin Sartwell Los Angeles Times Self Described “Pro-Choice Atheist”