Essay 15: Medicine needs challengers

History shows that the medical community too often tragically
has failed to police itself, leading to the loss of lives and to grave,
 irreversible injustices. Courageous conscientious objectors
can help challenge a failed system and end the injustice.

As noted in previous essays, a New England Journal of Medicine opinion piece entitled, "Physicians, Not Conscripts — Conscientious Objection in Health Care,"[1] by Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl, advocates for limiting the exercise of conscience objections. The rare ethical issues for which they would countenance conscience freedom are only those issues for which the "healthcare community" has not yet developed a consensus:

"There is, however, a specific role for conscientious objection. It provides limited recourse in professionally contested interventions — that is, interventions about which the health care community is debating whether participation is appropriate or not. For example, physician-assisted suicide is currently legal in five states, and whether physicians should participate in it is at the center of a robust ethical debate among health care professionals. (Conversely, although abortion is politically and culturally contested, it is not medically controversial…)."[2]

If a Supreme Court decision were to unilaterally make assisted suicide on demand legal nationwide, as it did in 1973 with abortion on demand, presumably Emanuel and Stahl's grudging conscience allowances regarding assisted suicide would evaporate.

Even closer to their point, if the American Medical Association (AMA) supported abortion on demand, or human cloning[3] or life-destroying embryo research,[4] objections become moot and all dissenters must submit to this "health care community consensus." In fact, the AMA does support each of those controversial practices, and many health professionals consider the practices ethically repugnant.[5]

Eighth-grade ethics: "Popularity makes right."

Emanuel and Stahl offer an ethic fit for the eighth grade. Just as young teens who don't follow the popular elite face bullying and social conformity demands in the eighth grade, so too healthcare professionals with less popular views must submit to the medical elite or face ostracization and censure.

The majority rules and the minority lose. Wear the same clothes and listen to the same music like everyone else or eat lunch alone. Support abortion, human cloning and lethal embryo research or lose your healthcare career.

What happens when the consensus is dead wrong?

In a 1927 U.S. Supreme Court decision upholding eugenics legislation, Justice Oliver Wendell Holmes, Jr. cited the need to "call upon those who already sap the strength of the state" to sacrifice their progeny, since they are "manifestly unfit from continuing their kind." Justice Holmes succinctly summarized the rationale for medical assaults on non-consenting adults, quipping, "Three generations of imbeciles are enough."[6]

President Teddy Roosevelt expressed a widespread view when he asserted, "I wish very much that the wrong people could be prevented entirely from breeding."[7]

The plan for physicians to cleanse the population of undesirables followed the consensus of the political, academic and cultural elites, including some in the medical community.

Enjoying legal and political sanction and participation by the medical profession, eugenics at the time could have been considered a guiding norm—the kind of norm that under the Emanuel-Stahl plan would have to be followed regardless of conscience objections. Non-eugenicists, physicians who conscientiously object to sterilizations, need not apply for medical positions.

"Choose, you lose." You chose the medical profession; now you must follow the dictates of the medical profession's elites.

The United States Holocaust Museum[8] notes that in early twentieth-century Germany, it was not Hitler and the Nazi party but rather the medical community that first provided the philosophical foundation and legitimization for ridding society of unwanted human beings. Apparently bereft of any moral authority higher than utilitarian pragmatism and nationalism, the German healthcare community elite had come to deem as standard medical practice the euthanasia of "useless eaters":

"Eugenics advocates in Germany included physicians, public health officials, and academics in the biomedical fields, on the political left and right. Serving on government committees and conducting research on heredity, experts warned that if the nation did not produce more fit children, it was headed for extinction. A growing faction, linking eugenics to race, championed the long-headed, fair 'Nordics' as 'eugenically advantageous' and discussed 'race mixing' as a source of biological degeneration. Eugenic ideas were absorbed into the ideology and platform of the nascent Nazi Party during the 1920s."[9]

The American eugenics movement outlasted the Nazi program, for seven decades carrying out approximately 60,000 sterilizations in 32 states, including 20,000 in California alone.[10] Adolph Hitler actually had highlighted the American program as a competitive example, urging his countrymen to surpass it.

Emanuel and Stahl's autocratic proposal--to ban conscience objections when the medical community has established a consensus--would have eliminated from the medical profession any German physician who conscientiously objected to systematic euthanasia and ethnic cleansing. Under Emanuel's and Stahl's "popularity makes right" ethic, German physicians in the 1930s who dated object to racism and medicalized murder would be ejected from the profession. Only those who embrace the state's doctrine of Aryan supremacy and the medical community's embrace of euthanasia may practice medicine.

Hitler's SS would not need to round up conscientious objector physicians; the medical community would do the job.

Likewise, Emanuel and Stahl's anti-conscience proposal would have eliminated any objectors to America's eugenics policies. The policy pronounces that health professionals gave up their conscience freedom upon choosing the medical profession. In doing so, they become bound to submit to the elite-driven consensus of the health profession. So objectors must submit to elites in the medical community intent on ridding the nation of "imbeciles" through eugenic forced sterilizations.

Tyrants can wear military uniforms or lab coats.

Whether through military force or professional edicts, the ultimate goal of tyrants political and professional is to secure and enforce their own power and purpose and to eliminate all opposition. The intolerant, authoritarian policies advocated by conscience freedom opponents such as Emmanuel and Stahl do precisely that.

The take-no-prisoners, conscience-intolerant approach they espouse establishes an unyielding, supreme authority that quashes dissent. A medical elite dictates that every health professional must perform any procedure and write any prescription that patients demand and the elite has determined is acceptable.

If the patient wants it, you give it, you do it. No exceptions.

That's ideological tyranny, dressed up as patient autonomy. And it's not coincidental that those who suffer and lose their careers under such tyranny are pro-life health professionals.

"Even if you like your doctor, you cannot keep your doctor."

Authors Emanuel and Stahl leave no doubt about what they consider non-negotiable dogma, going so far as to assert that abortion "is not medically controversial." That view, of course, is disputed by the thousands of pro-life and faith-based physicians who say they actually will leave the medical profession before compromising their conscience on ethical issues such as abortion.[11]

What happens to conscientious health professionals when medical associations or the government follow Emanuel and Stahl's line of thinking and exclude such professionals from the practice of medicine?

For the authors, the consequences are stark:

"Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession."

Leave the profession.

What happens, then, to patients who depended on those doctors? Emanuel and Stahl claim to be protecting patient choice by eliminating conscience laws from medicine.

Those patients lose access to the health professionals they had chosen.

Absent conscience protections in healthcare, patients lose access to the thousands of faith-based professionals, hospitals and clinics who currently minister to the poor, the marginalized and the uninsured. Pro-life women lose access to and the ability to choose pro-life obstetricians. The one-in-six patients currently served by Catholic health institutions[12] suddenly must look elsewhere. The already severe shortage of primary care physicians suddenly erupts into an unsolvable crisis, erasing healthcare access for millions of Americans.

"Even if you like your doctor, you cannot keep your doctor."

Eliminating conscience freedom hardly protects patients.

How does disallowing conscientious objection on issues of abortion, transgender surgeries or embryo research protect patients?

·       Half the patients who enter abortion facilities do not leave alive. Unborn babies are certainly not protected by eliminating conscience objections.

·       Research shows that most children and teens conflicted with transgender issues—it's called dysphoria for a reason--eventually change their minds as adults. [13] Yet a 2016 rule by the U.S. Department of Health and Human Services disallowed conscientious objections to transgender demands. Children and teen patients who will later regret a transgender change that a doctor could have counseled them about are not protected by disallowing conscience and professional judgment.

·       Far from helping patients, embryo-destroying stem cell research has only diverted millions of research dollars away from proven-effective non-embryonic stem cell research—research that has already provided cures and therapies for patients with over 80 diseases. Patients awaiting non-embryonic stem cell therapies are not protected by disallowing conscience objections.

Protecting patients and protecting conscience freedoms go hand in hand.

Whistleblowers can turn the tide of an unethical consensus

No one needs conscience protections for views that accord with the establishment or popular opinion. We only need conscience protections when our views diverge from the dictates of the ruling elite or the pressures of the dominant culture.

Why is it worth allowing dissent? One practical consideration: Whistleblowers can save lives.

During the infamous "Tuskegee Study of Untreated Syphilis in the Negro Male," the United States Public Health Service in a secret experiment purposely withheld effective syphilis treatments of penicillin from poor African American sharecroppers. The U.S. government's health officials launched the unconscionable experiment in 1932. It took four decades until a courageous whistleblower, 28-year-old U.S. Public Health Service employee Peter Buxtun, exercised conscientious objection and exposed the horror of the experiment.

Buxtun knew all too well what happens when government and institutional medical elites dictate health policy. His family had escaped the Nazis in Czechoslovakia in 1939. Buxtun's conscientious objection helped expose the Tuskegee experiment and its cost in human lives, eventually leading to the program's shutdown in 1972.[14]

Conscientious physicians remain patients’ last line of defense

I highlighted the value of conscientious objectors in medicine, in a commentary published in USA Today entitled, "Personal conscience strengthens law:"

Citing revelations of substandard outpatient conditions at the Walter Reed Army Medical Center, a USA TODAY editorial promotes legal protections for whistle-blowers. But legal protections alone are insufficient to motivate an individual to buck an establishment that has gone AWOL ethically.

Whistle-blowing requires resolute character and a conscientious commitment to bedrock ethical standards.

The absence of such individual character and universal standards breeds ethical malpractice, such as the infamous Tuskegee experiment, which deliberately denied penicillin treatment for African-American syphilis patients.

Such lessons from history apparently have not given pause to the Obama administration, which proposes removing a conscience protection regulation that implements the right of health care professionals to follow life-affirming, patient-protecting standards such as the Hippocratic oath.

Based on three civil rights laws passed over the past 35 years with bipartisan support, the provider conscience regulation implemented by the U.S. Department of Health and Human Services simply ensures that participating in abortion and other controversial procedures remains a choice and not a mandate for health care professionals.

According to two recent national surveys, Americans support the conscience protection regulation by a 2-1 margin, and 92% of faith-based physicians surveyed warn that they will leave medicine before bowing to pressure to violate ethical standards and convictions. The administration can avert a crisis of health care access for poor patients and those in medically underserved areas by simply keeping regulatory and legal protections for health care professionals who remain anchored to ethical standards.

When the political or medical establishment loses its moorings, conscientious physicians remain patients’ last line of defense. [15]

History shows that the medical community too often tragically has failed to police itself, leading to the loss of lives and to grave, irreversible injustices. In such cases, it has taken courageous conscientious objectors to challenge the system and end the injustice. The historical evidence shows that conscientious objection provides a vital and sometimes lifesaving check on institutional power.

Absolute power corrupts, and when tyrants silence conscientious objectors, absolute power corrupts absolutely.

2.       American conscience law and principles defy the anti-conscience movement in healthcare

Health professionals today who hold to historically noncontroversial moral and ethical standards--such as not killing born or unborn patients—face increasing pressures to compromise those moral and ethical standards. The coercive pressures come from ideologues and activists within and outside medicine, from demanding patients and from the government.

In times like this, it's important for health professionals to know your defensive weapons so you can use them when (not if) attacked.

Religious freedom laws provide defensive protections

In 1993, President Bill Clinton signed into law a bipartisan, powerful and increasingly needful federal law, the Religious Freedom Restoration Act (RFRA).[16] (Sadly, some of RFRA's cosponsors likely would overturn the measure today given the chance, because it impedes coerced acceptance of their current intolerant agenda on abortion and sexual ideology.)

The RFRA law establishes several principles focused on protecting our First Amendment right of free exercise of religion and restraining the government:

"… from substantially burdening a person's exercise of religion … except that the government may burden a person's exercise of religion only if it demonstrates that application of the burden to the person: (1) furthers a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest."

So three principles prevail regarding governmental conflicts with your conscience:

1.      The government may not substantially burden your religious exercise—i.e., through fines, job loss, forced participation in activities you find morally abhorrent, etc.

2.      The government had better have a darned good reason—a compelling interest, such as saving lives—for messing with your religious exercise freedom. Historically, not even the country's security interests during war have been used as a compelling interest to force conscientious objectors from participating in combat.

3.      Assuming satisfaction of the first two requirements above, the government must figure out how to accomplish its compelling interest by using the least restrictive means to accomplish the goal.

So under RFRA, the federal government cannot threaten the ministry of Catholic nuns with the substantial burden of draconian fines simply because the nuns decline to participate in the contraceptives mandate promulgated under the Affordable Care Act (Obamacare).[17] The government attempted quite stretch to claim a compelling interest for a nationwide contraceptives coverage mandate when contraceptives long had been ubiquitous and easily obtained apart from any government mandate. And considering that the United States distributes for free more contraceptives overseas than any other country, doing the same in the U.S. would be a far less restrictive means than forcing conscientious objecting citizens to help pay for and participate in contraceptives against their will.

Similarly, thanks to a preliminary injunction in a federal court case brought by the Christian Medical Association and others, the federal government may not force physicians to participate in transgender operations and prescriptions against their medical or moral judgment.[18]

In neither case could the government demonstrate that it had fulfilled the constitutional obligation to protect conscience apart from a compelling interest, by using only the least restrictive means and without substantially burdening freedom of religious exercise.

How religious freedom law speaks to patient-physician conflicts

The least restrictive means principle outlined in RFRA—figuring out a way to do controversial things without putting conscientious objectors through the wringer--aptly applies to the infrequent cases when physicians and patients cannot agree on a course of action.

For example, a patient may insist on an abortion, which represents a clear moral and ethical violation for a physician who adheres to biblical and Hippocratic standards. Or a patient may want a prescription for contraceptives, which depending on religious convictions and the contraceptive's mode of action, may raise religious and ethical concerns for the physician.

In such cases, accommodating a physician's conscience entails comparatively minor inconvenience for the patient. The patient typically can easily find another doctor, often even within the same practice or institution.

But refusing to accommodate conscience in such situations is a totally different story altogether for the physician.

Refusing to accommodate conscience for a health professional with strong convictions means literally forcing a choice between conscience and career.[19] Because when regulation of the practice of medicine--as enforced through law, accreditation, licensure, privileges or contract--hinges on participating in morally controversial practices, health professionals of conscience will no longer be able to practice medicine. This is certainly true of faith-based health professionals, who do not, and cannot, separate the faith principles that motivate them to serve others from the faith principles that uphold the sanctity of human life.

Forcing a physician to choose between conscience and career in order to meet a patient's controversial demand exacts an incalculable price not only on the physician, but also on all of the patients who stand to lose their physician as a result.

It's hard to imagine any objective observer, absent a blinding ideological compulsion, determining that ending a physician's medical career is preferable to having a patient simply choose another doctor.

Unfortunately, these days it seems that objective observers are fewer and fewer and blind ideologues are more and more aggressive.

Five First Amendment freedoms bar government coercion

At an even higher level than federal religious freedom law, the First Amendment to the U.S. Constitution guarantees five vital freedoms that enable American citizens to believe as we choose and to live our lives in accordance with our deepest held convictions:

"Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the government for a redress of grievances."

Not coincidentally, the First Amendment deliberately places as first the freedom to exercise our religious convictions without governmental coercion. The government can neither impose a state religion nor make laws preventing our free exercise of religious conviction.

The other four freedoms—freedom of speech, press, assembly and petition—all follow from the freedom to believe and act upon one's beliefs. They all ensure freedom from government coercion and interference.

The framers of these Constitutional rights, who included physicians, attorneys and other professionals who risked their lives in revolt against governmental oppression, would have deemed absurd and antithetical any notion of excluding professionals from those freedoms and subjecting them to government coercion.

Conscience laws took aim at restoring freedoms threatened by abortion on demand

Yet the exclusion of professionals from conscience protection is precisely what some activists today are asserting. In a New England Journal of Medicine opinion piece entitled, "Physicians, Not Conscripts — Conscientious Objection in Health Care,"[20] Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl make a flimsy case against conscience rights in healthcare.

Because Emanuel and Stahl want all health professionals to conform to a particular ideology, they want to remove professional protections for all who differ with that ideology. To buttress this drive for ideological purity, they attempt to separate conscience freedom for health professionals from conscience freedom for other citizens. They specifically allege a contrast between conscience rights for conscripted soldiers and conscience rights for voluntary medical professionals.

They suggest, for example, that when Congress passed conscience laws for health professionals in the early 1970's, the action did not follow from constitutional concerns but merely from an emotional overreaction to war. The authors would have us believe that in the heat of the moment, Congress mindlessly melded two supposedly unrelated issues—conscientious objection to war and conscientious objection to medical moral controversies.

Emanuel and Stahl point to protests against the Vietnam war and military draft as a prime impetus for some of the first statutory conscience protections in healthcare, such as the 1973 Church Amendment to the Public Health Service Act. They note that Democrat Senator Frank Church, author of that 1973 conscience protection law, opposed the Vietnam War, and they attempt to make anti-war concern and not abortion coercion concern the motivation behind conscience law:

"Legislative protection for conscientious objection in health care emerged at the height of conscientious objection to military service. Supporters of conscientious objection in health care explicitly referenced 'the right of conscience which is protected in our draft laws' to justify and legitimate it. Yet conscientious objection in health care diverges substantially from conscientious objection to war."[21]

Actually, Senator Church included as motivation for his conscience legislation the infamous 1973 Supreme Court abortion decision in Roe v. Wade. That case overturned state prohibitions on abortion and erected abortion on demand as a federal fiat.

As documented in the Federal Register, Senator Church cited not only Roe v. Wade but also an instance where a Federal court had ordered a Catholic hospital to perform sterilizations:

"I see no reason why the amendment ought not also to cover doctors and nurses who have strong moral convictions against these particular operations."[22]

So clearly, preventing coerced participation in abortion—and not simply reinforcing conscientious objection to combat as Emanuel and Stahl would have us believe—sent bipartisan conscience protection legislation for health professionals sailing through Congress.

Conscience freedom provides a restraint on government power

Although the Hippocratic oath has stood for millennia as a bulwark of patient protection, Emanuel and Stahl insist that doctors now must disregard such objective ethical standards in order to "protect" and accommodate patients. Specifically in their view, doctors must accommodate patients by participating in morally controversial procedures such as abortion, even though the Hippocratic oath proscribes abortion. As Emanuel and Stahl are well aware, legal protections for individual conscience and institutional ethics stand as a significant obstacle to abortion as well as to government healthcare edicts.

Emanuel and Stahl's elevation of the dictates of the state over the rights of the individual contradicts the constitutional principles of a country founded for and upon conscience freedom. It does comport, however, with the expansive government approach of the Affordable Care Act (Obamacare) that Emanuel helped design as President Obama's special adviser on health care.[23]

Corralling government coercion maximizes individual freedom

In advancing their own ideology, activists like Emanuel and Stahl grievously neglect a fundamental principle of our constitutional democracy, which always advances and protects freedom to the greatest extent possible. As reflected in the First Amendment, the freedom to believe and act according to one's conscience ranks highest among individual freedoms.

As Thomas Jefferson explained, conscience is a higher standard that does not, cannot submit to the dictates of government or professional organizations:

"But our rulers can have authority over such natural rights only as we have submitted to them. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God. The legitimate powers of government extend to such acts only as are injurious to others."[24]

For this reason, whenever a conflict arises involving an assertion of conscience freedom, Congress and the courts have made clear that the government may only restrict freedom for a compelling interest, without substantially burdening conscientiously concerned individuals and by using the least restrictive means possible.

This same sensible approach can help resolve conflicts in healthcare, when patients and physicians disagree on controversial procedures and prescriptions. Applying the principles of compelling interest, least restrictive means and avoiding substantial burdens can help ensure that political activism and ideology do not drain medicine of some of its most principled and dedicated professionals, in the process depriving some of the most needy patients of their competent and compassionate care.

Conscience-driven health professionals and students, take note: Do not expect this battle to resolve itself. Protecting your conscience and career requires your standing up and speaking out, even at professional and personal risk.

Prepare to winsomely and courageously battle for your beliefs in conversations with colleagues, professors, lawmakers, neighbors and patients. Equip yourself now by learning about conscience law at https://www.freedom2care.org/laws-regs-cases and by using the resources at www.Freedom2Care.org/resources.

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[1] "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.

[2] Stahl and Emanuel, p. 1383.

[3] AMA Code of Medical Ethics Opinion 7.3.8: "Regardless whether they are obtained from embryos donated by individuals or couples undergoing in vitro fertilization, or from cloned embryos created by somatic cell nuclear transfer (SCNT), use of embryonic stem cells currently requires the destruction of the human embryo from which the stem cells derive. … Embryonic stem cell research does not violate the ethical standards of the profession. Every physician remains free to decide whether to participate in stem cell research or to use its products." https://www.ama-assn.org/delivering-care/ethics/research-stem-cells, accessed March 1, 2019.

[4] Code of Medical Ethics Opinion 7.3.8" "Physicians who conduct research using embryonic stem cells should be able to justify greater risks for subjects, and the greater respect due embryos than stem cells from other sources, based on expectations that the research offers substantial promise of contributing significantly to scientific or therapeutic knowledge." https://www.ama-assn.org/delivering-care/ethics/research-stem-cells, accessed March 1, 2019.

[5] The AMA Code of Medical Ethics Opinion 4.2.7: "The Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law." https://www.ama-assn.org/delivering-care/ethics/abortion, accessed March 1, 2019.

[6] Buck v. Bell, a 1927 Supreme court case upholding a Virginia law that authorized the state to surgically sterilize certain “mental defectives” without their consent.

[7] "When America believed in eugenics," New Statesman, Dec. 10, 2010. https://www.newstatesman.com/society/2010/12/disabled-america-immigration accessed 9/27/17.

[8] Visit https://www.ushmm.org/information/exhibitions/online-exhibitions/special-focus/nazi-persecution-of-the-disabled. Accessed March 1, 2019.

[9] "Science as Salvation: Weimar Eugenics, 1919–1933," U.S. Holocaust Museum website, https://www.ushmm.org/exhibition/deadly-medicine/narrative/index.php?content=science accessed March 1, 2019.

[10] "Unwanted Sterilization and Eugenics Programs in the United States," PBS Independent Lens, Jan. 26, 2016, accessed online at http://www.pbs.org/independentlens/blog/unwanted-sterilization-and-eugenics-programs-in-the-united-states/ 9/27/17.

[11] Over nine of ten (91%) of faith-based physicians in a national survey agreed, "I would rather stop practicing medicine altogether than be forced to violate my conscience." http://www.freedom2care.org/learn/page/polls-april-2009, accessed 9/19/17.

[12] Catholic Health Association, https://www.chausa.org/about/about/facts-statistics accessed 9/19/17.

[13] Research shows that there are significant risks with gender transition procedures in childhood. Along with physical impacts like heart conditions, increased cancer risk, and loss of bone density, the peer-reviewed longitudinal studies of children with gender dysphoria (that HHS accepted as valid) found that fewer than 1-in-4 children referred for gender dysphoria continued to experience that condition into adulthood.

[14] For more about Peter Buxtun and the Tuskegee study, see "Tuskegee Experiment: The Infamous Syphilis Study," at the History channel's website, https://www.history.com/news/the-infamous-40-year-tuskegee-study. Accessed March 1, 2019.

[15] Jonathan Imbody, "Personal conscience strengthens law." Published in USA Today, May 8, 2009.

[16] For RFRA bill text, cosponsors and more, see https://www.congress.gov/bill/103rd-congress/house-bill/1308/text.

[17] For more on this case, Little Sisters of the Poor v. Azar, see https://www.becketlaw.org/case/littlesisters.

[18] A federal district court in 2016 issued a federal preliminary injunction issued in the transgender mandate case, currently titled Franciscan Alliance v. Azar. The Becket law firm represented the Christian Medical Association, Franciscan Alliance and several states in the lawsuit. For more, see https://www.becketlaw.org/case/franciscanalliance.

[19] A survey conducted for the Christian Medical Association's Freedom2Care by The Polling Company, Inc. revealed that 92 percent of faith-based physicians said they would be forced to leave medicine if coerced into violating the faith tenets and medical ethics principles that guide their practice of medicine. See www.freedom2care.org/polling.

[20] "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.

[21] Stahl and Emanuel, p. 1380.

[22] 119 Congr. Rec. S5717–18 (Mar. 27, 1973), quoted in Federal Register / Vol. 82, No. 197 / Friday, October 13, 2017 / Rules and Regulations, p., 47845.

[23] "Bioethicist Becomes a Lightning Rod for Criticism," New York Times, Aug. 24, 2009, http://www.nytimes.com/2009/08/25/health/policy/25zeke.html accessed 9/19/17.

[24] Thomas Jefferson, Notes on the State of Virginia, Query 17, 157—61, 1784.