Editor's Note: This is the ninth essay in a series on conscience in healthcare, by Freedom2Care Director Jonathan Imbody. For the other essays, click "ConscienceEssay" on Topics at left.
In their
view, conscience protections essentially function as an instrument of class
warfare, a bourgeois oppression of the proletariat. A tool by which wealthy,
selfish physicians dominate their poor, powerless patients.
 |
| Emanuel and Stahl decree that upon entering the profession, physicians sacrifice conscience and individual medical judgement. |
Emanuel and Stahl demand that physicians cast aside their self-centered concerns and bend to the will of the patient (especially when the patient demands a morally controversial procedure or prescription).
Since
conscience objections in healthcare most commonly arise over pro-life issues,
of course, the goal appears to be coercing into conformity all physicians who
resist the authors' ideological tilt.
Emanuel
and Stahl decree that upon entering the profession, physicians sacrifice
conscience and individual medical judgement and "become obligated to
provide, perform, and refer patients for interventions according to the standards of the profession (emphasis
added)."
Abortion advocates prefer coercion to conscience accommodation
But apparently
only those professional standards that comport with Emanuel and Stahl's
intolerance of conscience—like abortion edicts issued by professional Ob-Gyn organizations[iii], [iv]--will qualify. The authors insist
that "professional associations should resist sanctioning conscientious
objection as an acceptable practice."
They
condemn as "internally inconsistent," for example, the American
Medical Association's statements on conscience and duty to patients. The AMA
holds that “physicians’ ethical responsibility [is] to place patients’ welfare
above the physician’s own self-interest” and declines to compel physicians to
participate in procedures "'incompatible with the physician’s deeply held
personal, religious, or moral beliefs."
Yet the
AMA is simply advocating for selflessly caring for patients and also applying
ethical standards to patient care; the two are compatible. The authors
similarly condemn as "ambivalent" the American Pharmacists
Association and the American Nurses Association, for advocating for patients'
best interest alongside conscience freedoms for professionals.[v]
Conscience and faith can help advance patients' health
So focused
on compelling physicians to perform abortions on demand in cases of
controversy, it does not seem to occur to Emanuel and Stahl that a physician's personal,
religious, or moral stance actually could advance
a patient's best interest.
 |
| To disqualify faith-based health practices and convictions simply because they are faith-based is hardly an evidence-based approach to patient care. |
A growing
body of research
reinforces that assumption, quantifying many benefits that faith can have on a
person's health. To disqualify faith-based health practices and convictions
simply because they are faith-based is hardly an evidence-based approach to
patient care.
No evidence
suggests, for example, that the medical community needs to challenge orthodox
Jewish patients to start eating bacon or faithful Catholics to engage in
premarital sex or evangelical Christians to stop praying for healing, simply
because such behaviors are based on faith and conscience. On the contrary, the
evidence suggests that finding a physician who practices medicine in concert
with faith principles could actually help
patients, and especially those who are engaged in practices harmful to their
health.
Sometimes we need our doctors to challenge us
Ah, but challenging
a patient's harmful health behavior might involve a physician saying something
the patient does not want to hear. That sounds "judgmental" and "authoritarian."
It might make the patient feel "unsafe" or "unaccepted."
The truth
is that sometimes we need our physicians, who often are among the few people with
whom we can share personal information under the protection of privacy, to
inform and even challenge our health
choices. The physician who truly merits our trust is not the one who does
whatever we ask regardless of outcome or ethics but the courageous one who puts
evidence, ethics and truth above cowardly accommodation for the sake of
cultural acceptability.
Physicians
who study both the design and Designer of our bodies may well be able, given
the freedom to do so, to offer counsel that benefits
patients regarding health practices consistent with religious belief. They also
might be able to draw on those religious beliefs to counsel patients away from
health harms.
But not if
they have to check their religion at the door.
[i] "Physicians, Not Conscripts — Conscientious
Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel,
M.D., Ph.D., New England Journal of
Medicine 376;14, April 6, 2017.
[ii]Stahl and Emanuel, p. 1380.
[iii] "The Limits of Conscientious Refusal in
Reproductive Medicine, "ACOG Committee
Opinion Number 385, Nov. 2017, stated, "Physicians and other health care
providers have the duty to refer patients in a timely manner to other providers
if they do not feel that they can in conscience provide the standard
reproductive services that patients request. … Providers with moral or
religious objections should either practice in proximity to individuals who do
not share their views or ensure that referral processes are in place."
[iv] The American Board of
Obstetrics and Gynecology (ABOG) in 2007 published written guidance (Bulletin for 2007 Maintenance of Certification)
that linked its physician certification procedures with the ethics positions of
the American College of Obstetricians and Gynecologists (ACOG). The bulletin on
page 26 outlined penalties if "the physician shall have violated any of 'The
Ethical Considerations in the Practice of Obstetrics and Gynecology' currently
published by The American College of Obstetricians and Gynecologists and
adhered to by the Board." Those ACOG positions include a controversial
official position issued in November (ACOG Committee
Opinion Number 385) that called upon conscience-objecting obstetricians
to refer patients for abortions—an act which many such physicians consider
unethical.
[v] Stahl and Emanuel, p. 1382.
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