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| If abortion activists can eliminate conscience protections, then health professionals can be forced to participate in abortion. |
Coercion appeals to some activists because coercion is much quicker than persuasion in affecting change. If abortion activists can eliminate conscience protections, then health professionals can be forced to participate in abortion or else sacrifice their careers.
American principles protect conscience even at a price
Affordable
Care Act architect Dr.
Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl lay the
foundation for getting rid of healthcare conscience protections, in a New England Journal of Medicine opinion
piece entitled, "Physicians, Not Conscripts — Conscientious Objection in
Health Care."[2]
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| According to Emanuel and Stahl, choice is a one-way street. Patients get to choose; doctors don’t. Photo by Letizia Bordoni on Unsplash |
Their
message is simple: Choice is a one-way street. Patients get to choose; doctors
don’t—at least not after they enter the medical profession.
Emanuel
and Stahl attempt to establish this radical principle by postulating a sharp
distinction between conscience accommodations for military draftees and conscience accommodations for physicians.
Emanuel
and Stahl write,
"Although
this [healthcare conscience protection] legislation ostensibly mimics that of
military conscientious objection, it diverges considerably. Viewing
conscientious objection in health care as analogous to conscientious objection
to war mistakes choice for conscription, misconstrues the role of personal
values in professional contexts, substitutes cost-free choices for penalized
decisions, and cedes professional ethics to political decisions."[3]
In the
United States, a pacifist opposed to the military draft can receive a
conscientious exemption from combat duty, even during a time of war when every
other able-bodied citizen his age is expected to fight to defend the national
interest. The cost to the country is high if counted in terms of fewer soldiers
available for active duty.
Yet the
authors would countenance no such rights, no such accommodation of cost, to a
pro-life physician who cannot on the basis of conscience end the life of a
developing baby in an elective abortion. While permitting the pacifist draftee
a conscientious objection to killing, the authors contend, Government must deny
the same objection by a health professional.
Why? According
to Emmanuel and Stahl, the reason is that physicians choose their professions, whereas draftees do not choose to join
the military.
Our Founders envisioned freedom of conscience for all
Lay aside
for the moment the huge problem that by such reasoning, every professional who
chooses a career involving service to the public—loses conscience freedom upon
entering that career. First consider that the false dichotomy between
conscience freedom for military draftees versus medical professionals ignores significant
commonality between the two.
Accommodating
the conscience objections of both the draftee and the medical professional is consistent
with the bedrock American tradition of not coercing its citizens to violate their
consciences.
Freedom of conscience and thought, and the freedom to act
consistently with our beliefs and ideals, provided the basis for the First
Freedom in the U.S. Constitution's Bill of Rights:
"Congress shall make no law respecting an establishment
of religion, or prohibiting the free exercise thereof; or abridging the freedom
of speech…."
The Declaration of Independence emphasized the God-given
freedom of independent thought:
"We hold these truths to be self-evident, that all men
are created equal, that they are endowed by their Creator with certain unalienable
Rights, that among these are Life, Liberty and the pursuit of Happiness."
The Declaration invoked the ultimate authority for
conscientious objection, by "appealing to the Supreme Judge of the world
for the rectitude of our intentions…."
When enshrining
this tradition in the Constitution and Bill of Rights and highlighting its
principles in the Declaration of Independence, the framers made no distinction
between non-professionals and professionals or between those who find
themselves thrust into an unwanted employment and those who choose their
employment.
Conscience
freedom is a foundational, inalienable right for all.
Who's "jamming their beliefs down our throats"?
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| Listening to opponents of conscience freedom, one gets the impression that somehow conscientious objectors are "jamming their beliefs down our throats," |
Listening
to opponents of conscience freedom, one gets the impression that somehow
conscientious objectors are "jamming their beliefs down our throats,"
as if a mere objection somehow coopts their freedom. One would think that
pro-life health professionals were trying to force abortion doctors out of
medicine, and not the other way around.
Disqualifying abortion doctors from practicing medicine
actually would have a solid basis in millennia of Hippocratic medical ethics. But
as we know, abortion activists turn medical ethics upside down. They would have
every physician forced submit to the 1984-style
Newspeak notion that killing an unborn child is a healthcare service.
Another commonality
neglected by Emmanuel and Stahl between conscientious objection by draftees and
conscientious objection by medical professionals is that accommodating an
objection does not require stopping the objectionable activity. Wars continue
and abortions continue despite conscientious objectors.
America
won World War II while exempting conscientious objectors from active combat
duty, in the process preserving the very freedoms that make conscientious
objection possible. Exempting conscientious objectors from abortion has not
shuttered the abortion industry (unfortunately), as evidenced by roughly a
million abortions performed in this country every year.
So one
must ask those lobbying so hard to strip conscience rights from health
professionals, what is the driving reason to end conscientious objection to
abortion? Are a million human lives ended each year through abortion not
enough?
Doctors choose a profession of healing—not killing
Even if
one were to accept the rationale for stripping conscience rights from
professionals simply because they choose their profession, the rationale does
not apply properly to physicians and abortion.
That's
because a physician chooses a profession of healing.
Healing is incompatible with killing.
It is only
the perverse corruption of the medical profession (and the corruption of
language) by a fringe minority that has categorized the killing of an unborn
baby as "healthcare."
How can a
healing professional be compelled to kill? Perhaps a professional soldier might
be expected to kill on command, but a physician dedicated to saving lives?
When a "Medical Moral Majority" rules absolutely
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| The authors would argue that the medical establishment —in their words, "collectively, the profession"--should dictate. Photo by Edwin Andrade on Unsplash |
A key
question for conscience opponents who assert that physician objectors are
outliers and have no place in medicine:
Who gets
to decide the boundaries for accommodating a physician's conscience?
The
authors would argue that the medical establishment—in their words, "collectively,
the profession"[4]--should
dictate the prescriptions, procedures and patient counseling approaches to
which physicians must submit.
Whereas a
democratic republic protects the rights of the minority, Emmanuel and Stahl
suggest a scheme in which the majority rules absolutely and the minority submit
or lose their careers. The patient demanded something that the "Medical Moral
Majority" favors, you refused to deliver, so you lose your job.
What about
when patients and doctors differ on a course of action, based on differing
moral persuasions? Some would insist that rather than attempting to navigate
the differences, physicians must simply function essentially as waiters, taking
and fulfilling the orders of patients. Just as retail sales persons sometimes
have been instructed to act as if "the customer is always right," now
health professionals also must act as if "the patient is always
right."
The
problem with conflating merchandising and medicine is that for health
professionals, human lives and not just product sales are at stake. Sometimes a
patient wants something that is actually harmful, not helpful. Sometimes a
physician has good reason for not providing certain services or prescriptions
on demand—even if those services and prescriptions are accepted by others in law
and in the medical community.
Nevertheless,
Emanuel and Stahl argue that health professionals may not exercise any ethical objection
that contradicts a patient's demands:
"Thus, a
health care professional cannot deny patients access to medications for mental
health conditions, sexual dysfunction, or contraception on the basis of their
conscience, since these drugs are professionally accepted as appropriate
medical interventions."[5]
The authors
insist that the medical community writ large can be trusted fully to determine
what is acceptable and appropriate:
"Thus,
collectively, the profession—not politicians, judges, or individual
practitioners—sets its contours."[6]
In other
words, they don't want pesky democratic institutions such as Congress, regulatory
bodies, the courts and the rule of law to interfere with their medical
oligarchy. As long as the patient's request aligns with a professional medical
organization's stance, Emanuel and Stahl would automatically compel the questioning
physician to choose between conscience or career.
They do
not countenance another far less draconian solution--namely, that the patient
could simply select another physician.
When a
doctor declines to fulfill a demand for an abortifacient prescription, for
example, why must the doctor sacrifice her entire career when the patient can
simply get the prescription elsewhere? Even if in some barely imaginable
situation in which the patient could not get the prescription filled anywhere
else in the country, would that consequence even remotely compare to
eliminating a physician from medicine?
What goes around comes around
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| Emanuel and Stahl's totalitarian approach subordinates a professional's conscience to the dictates of government and professional bodies. Photo by Nicholas Kwok on Unsplash |
Both
authors, Emmanuel and Stahl, teach at the University of Pennsylvania. It does
not seem to have occurred to them that their own arguments to deny freedom to
medical professionals could be turned against them in their own profession.
What if Emanuel
and Stahl's totalitarian approach, which subordinates a professional's conscience
to the dictates of government and professional bodies, were applied to
professors at the University of Pennsylvania? What would prevent the Middle
States Commission on Higher Education (remember the absolute power the authors assign
to "collectively, the profession") from dictating that Professors
Emanuel and Stahl must teach students ideas and principles that violate the professors'
deepest held beliefs?
How would
Dr. Emanuel, known as an architect of the Affordable Care Act, react if he were
compelled by the administration to highlight in his lectures how that law led
to the loss of patients' preferred physicians and a crisis in the cost of
health insurance?
Or closer
to the abortion and conscience debate, how would Dr. Stahl, who has written
that "women’s equal participation in economic life rests on control of
reproductive decision-making" react if the administration directed her to
lecture about the harms and injustice of abortion?[7]
After all,
they chose the profession, so now according to their own principles they must
submit their consciences to the dictates of "collectively, the profession."
If conscience protections are lost when professionals choose their professions,
then conscientiously objecting academics must face the same fate as objecting physicians.
If
"the patient comes first" negates physician conscience freedom, then
"the student comes first" negates academic freedom. If students assert
that grades and tests discriminate and create stigma, then of course only
bigoted professors would attempt to use those tools, and they should be
summarily dismissed. So decrees the culturally sensitive and politically correct
Academic Moral Majority--"collectively, the profession."[8]
Besides
undermining medical judgment and academic freedom, the Emanuel-Stahl
"choose, you lose" policy also would rob attorneys of their
professional conscience freedom to choose or decline clients and cases. This anti-conscience
coercion would hardly benefit accused criminals. What defendant wants an
attorney who's been forced to defend the accused against the attorney's will
and professional judgment?
"Injustice anywhere is a threat to justice everywhere"
 |
| As Dr. Martin Luther King, Jr. noted, "Injustice anywhere is a threat to justice everywhere." Photo by Zach Lucero on Unsplash |
As Dr.
Martin Luther King, Jr. noted, "Injustice anywhere
is a threat to justice everywhere."[9] Liberally
protecting conscience freedom and professional judgment protects us all.
By contrast,
Emanuel and Stahl urge a stingy accommodation of conscience, denying the
freedom to virtually all who choose a profession that serves the public.
Choose, you
lose.
Emanuel
and Stahl attempt to make their case for dismissing conscience freedom for
physicians by mischaracterizing healthcare conscience laws as "one-sided,
protecting only those who refuse to treat patients, not those whose conscience
compels them to provide medically accepted but politically contested
care."[10]
The
authors postulate that legal protections for conscientiously objecting health
professionals have merely attempted to "ostensibly mimic that of military
conscientious objection," as if such imitation were the only way to
justify the exercise of conscience in healthcare.
It does
not seem to occur to Emanuel and Stahl that First Amendment conscience freedom
might apply broadly to all Americans and across many applications, from "liberal"
anti-war or anti-death penalty causes to "conservative" anti-abortion
or anti-euthanasia causes. Their characterization of healthcare conscience laws
as "one-sided protecting only those who refuse" is patently false.
The Church
Amendment conscience law, which the authors selectively excerpt, unambiguously
spells out conscience protections both for those who perform and for those who decline
to perform abortions. The law bans discrimination on the basis that an
individual "performed or assisted in the performance of a lawful sterilization
procedure or abortion, [or] because he refused to perform or assist in the
performance of such a procedure or abortion…."[11]
Dissenters can save lives
Freedom of
thought, expression and action in our democratic republic hinges on tolerating
dissension from consensus. But the freedom to dissent is not merely a nice
philosophical concept; sometimes independent thinking literally saves lives.
 |
| Sometimes making a call that contradicts the prescribed norms of the professional establishment saves lives. Photo by Austin Neill on Unsplash |
A former
fighter pilot, Captain Chesley "Sully" Sullenberger, exercised his
professional judgment to contravene the control tower's plan to attempt to return
to the airport.
After
losing both engines in a bird strike, Sully notified La Guardia air traffic
control. Controller Patrick Harten gave the flight a heading to return to
LaGuardia, telling Sully that he could land to the southeast on Runway 13.
A published
analysis[12] of the crisis details
what happens next:
"The controller asks if Sullenberger wants to divert to
Teterboro in New Jersey, a few miles west of the Hudson.
“'Yes,'” says
Sullenberger.
"But in the time it takes the controller to contact
Teterboro and find an available runway for an emergency landing, Capt.
Sullenberger knows he can’t make it, and is already running out of sky and
turning left over the George Washington Bridge, losing height fast and heading
down for the Hudson.
“'Unable'” he tells the controller. “'We can’t do it.'”
"Then, in a few more beats of the heart, he says 'We’re
gonna be in the Hudson.'"
The article explains the significance of Captain Sully's blink-of-an-eye
judgment:
"What’s actually happened is that a man has supplanted
all the sophisticated technology that modern aviation can muster. He’s flying
by the seat of his pants. His reflexes and instincts have become an extension
of the crippled airplane."
Air
traffic control assumed the establishment approach: turn back and land at a
nearby airport. Sully, however, had quickly and instinctively realized--tapping
in a nanosecond the memory banks of years of experience and professional
judgment--that attempting the traditional plan would fatally fail.
Flight
simulations after the event reveal that if Sully had submitted to the establishment
approach rather than exercise his professional judgment, US Airways Flight 1549
would have crashed somewhere short of the LaGuardia Airport. The passengers and
anyone else in the plane's path on the ground when it crashed would have
perished.
Instead, Captain
Chesley Sullenberger diverged from the establishment, exercised his
professional judgment and heroically landed his imperiled plane—intact--in the Hudson
River.
All 155 passengers
safely evacuated the airliner, owing their lives to a professional who, drawing
upon convictions and observation born of years of experience, made a call that
contradicted the prescribed norms of the professional establishment.
Sometimes
the consensus is wrong and the "collective profession" can learn from
the individual objector.
[2] "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.
Stahl and
Emanuel, p. 1384.
[3] Stahl and Emanuel, p. 1384.
[4] Stahl and Emanuel, p. 1384.
[5] Stahl and Emanuel, p. 1383.
[6] Stahl and Emanuel,., p. 1384.
[8] Unfortunately, some universities appear closer than
ever to this approach, as documented at https://www.adflegal.org/issues/religious-freedom/university/university-stories,
accessed 9/26/17.
[9] Letter from Birmingham Jail, April 16, 1963.
[10] Stahl and Emanuel, p. 1381.
[11] 42 U.S.C. Section 300A-7(b)(1).
[12] " Hero Pilot to
Tower," The Daily Beast,
February 5, 2009, accessed online October 12, 2018 at https://www.thedailybeast.com/hero-pilot-to-tower.
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