Essay 14: Edict aimed at pro-life Ob-Gyn's shows what "Choose, you lose" looks like in practice

The Ob-Gyn specialty in particular stands to lose
many physicians by undermining conscience
protections for pro-life doctors.

In a New England Journal of Medicine opinion piece entitled, "Physicians, Not Conscripts — Conscientious Objection in Health Care," Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl advocate ridding healthcare of conscience protections. [1]

Eliminating conscience protections effectively would rid healthcare of doctors, nurses and other health professionals who rely upon those protections. Polling indicates that ethically driven physicians will leave medicine altogether, avoid the Ob-Gyn specialty or restrict their practices rather than compromise their consciences.[2] The results of nationwide polling by The Polling Company, Inc., for Freedom2Care in 2009:

·       Over nine of ten (91%) faith-based physicians agreed, "I would rather stop practicing medicine altogether than be forced to violate my conscience."

·       "When asked how rescission of the [Bush-era] conscience rule would affect them personally, fully 82% said it was either 'very' or 'somewhat' likely that they personally would limit the scope of their practice of medicine. This was true of 81% of medical professionals who practice mainly in rural areas and 86% who work full-time in serving poor and medically-underserved populations."

·       33% of faith-based physicians surveyed "Considered not pursuing a career in a particular medical specialty because of attitudes prevalent in that specialty that is not considered tolerant of your moral, ethical or religious beliefs." Of those 33%, 81% identified Ob-Gyn as the intolerant specialty.

Given these risks, on what grounds do Emanuel and Stahl justify removing conscience rights from physicians?

U.S. Dept. of HHS: No, Hawaii, you can't make pro-life pregnancy centers refer for abortions

Thankfully, the U.S. Dept. of Health and Human Services is enforcing federal conscience laws. The press release below details one example of how the agency, unlike in previous administrations, is holding states accountable for illegal discrimination.

FOR IMMEDIATE RELEASE
March 22, 2019

Contact: HHS Press Office202-690-6343media@hhs.gov

OCR Issues Notice of Resolution to the State of Hawaii After Hawaii Takes Action in Safeguarding Conscience Protections for Pregnancy Care Centers

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) announced today that it issued a Notice of Resolution to the State of Hawaii after Hawaii took corrective action in response to OCR’s investigation of complaints of discrimination by the state against non-profit pregnancy resource centers.

Complainants, Aloha Pregnancy Care and Counseling Center, Inc. and Calvary Chapel Pearl Harbor, filed a complaint with OCR alleging that Hawaii engaged in impermissible discrimination under one or more of federal conscience laws when Hawaii enacted the notice requirements of Act 200, a 2017 law which required them to disseminate a government-scripted notice that promotes abortion – a service for which they do not offer, counsel, recommend, or refer. The Complainants are pro-life and dedicated specifically to providing women options other than abortion.

OCR’s new Conscience and Religious Freedom Division initiated an investigation into the allegations under OCR’s authority to enforce the Weldon and Coats-Snowe Amendments. As a result of OCR’s investigation, on March 15, 2019, Hawaii’s Attorney General issued a memorandum to the Department of the Attorney General for the State of Hawaii, which is charged with enforcing Act 200, stating that it will not enforce Act 200’s notice provisions against any limited service pregnancy center.

The Hawaii Attorney General also committed to notify Hawaii’s legislature of its decision not to enforce Act 200’s notice provisions against any limited service pregnancy center.

Hawaii’s actions follow the Supreme Court’s ruling in National Institute of Family & Life Advocates v. Becerra, 138 S. Ct. 2361 (2018) (NIFLA), which held that a California law similar to Hawaii’s Act 200 likely violated pregnancy resource centers’ Free Speech rights.  The action also follows stipulated permanent injunctions, entered by the U.S. District Court for the District of Hawaii against Act 200 in separate litigation in September 2018, against Hawaii enforcing the Act against the plaintiffs in the lawsuits.  Hawaii’s action in response to OCR’s investigation commits the state to respect the rights of every pro-life pregnancy resource center in the state, not just the particular parties covered by the injunctions. As a result, OCR now considers the complaints before it as satisfactorily resolved, and will be closing the matter.

Roger Severino, director of OCR stated, “Although Hawaii should never have burdened the rights of nonprofits seeking to provide pregnant women life-affirming options, we commend Hawaii for committing to not enforcing Act 200’s notice provisions against anyone, in response to our investigation.” Severino continued, “OCR takes allegations of conscience violations seriously.  We encourage other states to take a hard look at their own laws and make sure that they do not violate federal conscience and religious freedom statutes in health and human services.”

View OCR’s Notice of Resolution to Hawaii - PDF.*

Christian Medical Association Asks Supreme Court to Review and Uphold Indiana's Ultrasound Requirement for Abortion

Washington, DC—March 6, 2019--The Christian Medical Association (CMA, www.cmda.org), the nation's largest faith-based medical association, today joined a brief urging the U.S. Supreme Court to review a decision by the U.S. Court of Appeals for the Seventh Circuit. The brief defends Indiana's statutory requirement that women receive the benefit of ultrasound information when considering an abortion procedure.

• CMA CEO Dr. David Stevens said, "As our brief explains, offering ultrasound imaging provides an opportunity for truthful and essential medical information about a woman’s pregnancy. We, physicians, hold a responsibility to provide our patients with information relevant to the procedures they are considering, and abortion requires the woman's informed consent. What better way to be informed about the biological reality of her unborn child than to see an actual image of that child?"
• CMA Executive Vice President Dr. Mike Chupp added, "Offering ultrasound provides a pregnant woman the opportunity to have vital information that is relevant and necessary to her decision on whether or not to undergo an abortion procedure. Providing the opportunity for this information is required for her informed consent."
• CMA Vice President for Government Relations Jonathan Imbody said, "The grand jury report [p. 12] in the Kermit Gosnell born-alive infant murder case in Pennsylvania shows what happens when politics leave abortion clinics virtually unregulated by states. Polling shows that Americans on both sides of the life issue want and expect abortion clinics to be regulated. With the requirement for offering ultrasound information, Indiana is following its responsibility to apply reasonable medical standards for abortion, just like the state does for any other medical procedure."

Americans United for Life (AUL) filed today's Petition for Writ of Certiorari amici curiae brief with the Court in the case of Kristina Box, Commissioner, Indiana Dept. of Health, et. al. v. Planned Parenthood of Indiana and Kentucky, Inc., et. al, on behalf of the Christian Medical Association and other medical and pregnancy care organizations. AUL's Steven H. Aden (202) 741-4917, Steven.Aden@aul.org served as attorney of record.

Christian Medical Association lauds new Title X family planning rule

Washington, DC - February 22, 2019: The 19,000-member Christian Medical Association (CMA, www.cmda.org) in a statement today enthusiastically welcomed a final new rule that will govern tax funds awarded for family planning purposes under the Title X program administered by the U.S. Department of Health and Human Services.

The following statement may be attributed to VP for Govt. Relations Jonathan Imbody (JI@Freedom2Care.org), who also serves as Director of Freedom2Care (www.Freedom2care.org) and its over 30,000 constituents.

"Practically speaking, the new rule now opens the door to many more health organizations, which should translate into more and better options for patient care. Many life-affirming, full-service health organizations nationwide had been shut out of the program by the previous administration's abortion-related requirements.

"Our polling, cited in the final rule document, showed that 91 percent of faith-based health professionals will leave medicine rather than bow to pressure to compromise their life-affirming convictions.

"As the new rule document notes while citing this polling (p. 268), 'With the final rule’s added emphasis on protecting rights of conscience, more individuals may enter the Title X family planning program, helping to meet that unmet need for care.'

"The program remains open to any organization willing to respect the statutory separation of abortion from Title X family planning funds and operations. The only organizations shut out of the Title X family planning program will be those who insist on mingling abortion with Title X funds and programs. So Title X will no longer serve as an exclusive  funding pipeline for the abortion industry while shutting out pro-life health programs.

"This new rule finally brings the Title X family planning program in line with federal Title X law that forbids funds for abortion as a family planning method—a principle that reflects the values of the American people."

Medical organizations urge support of Born Alive Abortion Survivors Protection Act

The following letter by life-affirming medical organizations is being sent today to U.S. senators:

February 19, 2019

Joint Medical Statement on S. 311

Born Alive Abortion Survivors Protection Act

SUPPORT

Presented to the 116^th Congress U.S. Senate

Dear Senator,

As medical professional organizations and individuals representing over 30,000 physicians who practice according to the Hippocratic Oath, we write in support of S. 311, the Born Alive Abortion Survivors Protection Act.

Medical facts are important. 

Fact 1. It is an undisputed scientific fact that a distinct, living human being exists in the womb of a pregnant mother.

From the moment of fertilization, a human being meets all of the scientific criteria for a living organism^[1] and is completely distinct from her/his mother, not a part of her/his mother’s body.  This is scientific fact.  It is therefore scientifically correct for S. 311 to identify the living survivors of abortions as human persons and afford those human beings the full protection of the law in the same way that infants of similar gestational ages are currently protected.

Fact 2. Abortion is NOT healthcare, much less an essential part of women’s health care and abortions in the third trimester are NOT done to save a woman’s life^[2]. 

The fact that over 85% of ob-gyns in a representative national survey do not perform abortions on their patients^[3] is glaring evidence that abortion is NOT an essential part of women’s healthcare.  The vast majority of abortions are done by abortion providers who do not provide any other kind of medical care for the woman. Abortion treats no disease. Pregnancy is not a disease, and deliberately killing the unborn child by abortion is NOT healthcare. 

It is clear from testimony by abortion practitioners during the Partial Birth Abortion Ban hearings^[4] that, unlike a delivery which separates the mother and her fetus for the purpose of life, an abortion separates the mother and the fetus with the purpose of guaranteeing that the baby is born dead.  That’s why a fetus who survives an abortion is called a “failed abortion”.  The separation did not fail to occur.  What “failed” to occur in a “failed abortion” is the guarantee of a dead baby.

There are rare circumstances in which a mother’s life is in jeopardy due to either pre-existing conditions or pregnancy complications.  It is extremely rare for this to occur prior to the point of viability (currently 22 weeks after last menstrual period, 20 weeks after fertilization). After 20 weeks fertilization age, it is NEVER necessary to intentionally kill the fetal human being in order to save a woman’s life.^[5]  In cases where the mother’s life actually is in danger in the latter half of pregnancy, there is not time for an abortion, because an abortion typically is a two to three-day process.  Instead, immediate delivery is needed in these situations, and can be done in a medically appropriate way (labor induction or C-section) by the woman’s own physician. We can, and do, save the life of the mother through delivery of an intact infant in a hospital where both the mother and her newborn can receive the care that they need.  There is no medical reason to intentionally kill that fetal human being through an inhumane abortion procedure, e.g. dismembering a living human being capable of feeling pain^{[6] [7] [8]}(Also see Appendix A), or saline induction which burns off the skin (See Appendix B), or feticide with subsequent induction.

Obstetricians who abide by the Hippocratic oath strive, to the best of our ability, to save both lives when at all possible. There are two patients under our care.  We never intentionally target the unborn child during the separation procedure in order to guarantee that the baby is born dead.

Fact 3. No matter the circumstances of their birth, infants who are born alive must be given appropriate medical care.

Any infant who is born alive, at any stage of development, is a person entitled to the protections of the law and appropriate care as a new patient. There is no scientific or legal reason to distinguish between human beings born after an attempted abortion and human beings born after attempted live birth. A distressed newborn should get immediate emergency care and a professional evaluation to determine appropriate steps to promote his/her health and well-being. Obviously, a distressed newly born baby presents for emergency medical care at the moment of her or his birth, regardless of whether that birth results from an abortion attempt or attempted live delivery.  EMTALA mandates hospitals to examine and treat any person who presents for emergency medical care. 

These same principles apply in cases in which the human being in utero has a disability or has been given a life-limiting diagnosis, such as anencephaly.  Human beings who are disabled at birth deserve the same respect and dignity afforded to able-bodied children at similar gestational ages. The terms “incompatible with life” or “fatal fetal malformations” are not medical terms. For many children with medical conditions previously labelled as such, survival for years has been accomplished^[9], and is very possible when supportive care is provided.

Additionally, as health care professionals, we are notoriously poor predictors of whether infants will live or die when supportive medical care is offered^[10]. If a fetus has a potentially life-limiting diagnosis which is expected to result in death shortly after birth, families should be presented with the potential benefits of medical care and, accepting that such care might only prolong an inevitable death, be offered perinatal hospice. ^{[11] [12]}

Perinatal hospice respects the human dignity of the newborn and allows the family to hold and care for their child after birth, celebrating the precious time they have together as well as allowing them to grieve the brevity of this same gift. Perinatal hospice provides optimal care for the mother, honors the life of her child and allows the family the opportunity to acknowledge, love, and mourn its newest member. Literature comparing outcomes of delivery and perinatal hospice care with abortion in cases of anencephaly reveals significantly better mental health outcomes for mothers who do not abort. ^{[13] [14] [15]} Perinatal hospice is compassionate and comprehensive health care for women whose fetuses have life-limiting diagnoses.

S.311 provides a scientifically sound, medically accurate, and respectful approach to ensure that the innocent human being who survives an attempted abortion will be treated with the same human dignity and respect that similarly aged human beings receive in the course of good neonatal medical care.  S. 311 ensures that human beings with disabilities are not targeted for intentional killing at the moment of birth.

For all of these above reasons, we, the undersigned medical organizations and individuals, strongly urge you to pass S. 311.  Thank you for your consideration of these views.

Respectfully submitted,

Donna J. Harrison M.D.  Executive Director
American Association of Pro-Life Obstetricians and Gynecologists^[16]

Michelle Cretella M.D. Executive Director

American College of Pediatricians^[17]

John Schirger, M.D. President,

Catholic Medical Association^[18]

Dr. Carolyn Laabs, PhD, FNP-BC, RN

Chair, Ethics and Spirituality Committee 

National Association of Catholic Nurses, USA[19]

David Stevens, CEO

Christian Medical Association^[20]

Jane Orient, Executive Director

Association of American Physicians and Surgeons^[21]

Janice L. Benton, Executive Director
National Catholic Partnership on Disability[22]

Robin Pierucci, MD, MA

Neonatologist

Catholic Medical Association

Martin J McCaffrey, MD, CAPT USN (Ret)

Professor of Pediatrics

Division of Neonatal-Perinatal Medicine

Department of Pediatrics

UNC School of Medicine

Chaple Hill, North Carolina

---

^[1] Condic M. When Does Human Life Begin? The Scientific Evidence and Terminology Revisited. University of St. Thomas Journal of Law and Public Policy 8(1) Fall 2013 Article 4. Available at embryodefense.org/MaureenCondicSET.pdf (accessed 2019 02 18)

^[2] Greene-Foster D and Kimpart K. Who Seeks Abortions at or After 20 weeks? Perspectives on Sexual and Reproductive Health 2013 45(4):210-218 doi:10.1363/4521013.

^[3] Stulberg D, Dude A, Dahlquist B, Curlin F.  Abortion Provision Among Practicing Obstetrician-Gynecologists  Obstet Gynecol. 2011 September ; 118(3): 609–614. doi:10.1097/AOG.0b013e31822ad973.

^[4] Gonzales v Carhart USSC. Available at supremecourt.gov/opinions/06pdf/05-380.pdf (accessed 2019 02 18)

See page 9: “Yet one doctor would not allow delivery of a live fetus younger than 24 weeks because “the objective of [his] procedure is to perform an abortion,” not a birth. App. in No. 05–1382, at 408–409. The doctor thus answered in the affirmative when asked whether he would “hold the fetus’ head on the internal side of the [cervix] in order to collapse the skull” and kill the fetus before it is born. Id., at 409; see also Carhart, supra, at 862, 878. Another doctor testified he crushes a fetus’ skull not only to reduce its size but also to ensure the fetus is dead before it is removed.”

See also page 11:  “(b) As used in this section— “(1) the term ‘partial-birth abortion’ means an abortion in which the person performing the abortion— “(A) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and “(B) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus;…” [emphasis added]

^[5] Dublin Declaration on Maternal Health. Available at dublindeclaration.com (accessed 2019 02 13).

Excerpt: “As experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman. We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatment results in the loss of life of her unborn child. We confirm that the prohibition of abortion does not affect, in any way, the availability of optimal care to pregnant women.”

^[6] Testimony of Dr. Maureen Condic, District of Columbia H R.179J, 2013 05 23. Available at: govinfo.gov/content/pkg/CHRG-113hhrg81175/pdf/CHRG-113hhrg81175.pdf, pp 36-46

^[7] American Association of Pro-Life Obstetricians and Gynecologists Practice Bulletin 2: Fetal Pain. Available at  aaplog.org/wp-content/uploads/2019/02/PB-2-Fetal-Pain.pdf (accessed 2019 02 18).

^[8] American Association of Pro-Life Obstetricians and Gynecologists Fetal Pain Fact Sheet. Available at aaplog.org/wp-content/uploads/2019/02/2019-02-13-AAPLOG-fact-sheet-fetal-pain.pdf (accessed 2019 02 18).

^[9] Wilkinson DJ, Thiele P, Watkins A, De Crespigny L. Fatally flawed? A review and ethical analysis of lethal congenital malformations. BJOG. 2012 Oct;119(11):1302-8. doi: 10.1111/j.1471-0528.2012.03450.x.

^[10] Meadow W et al. Just, in time: ethical implications of serial predictions of death and morbidity for ventilated premature infants. Pediatrics. 2008 Apr;121(4):732-40. doi: 10.1542/peds.2006-2797.

^[11] Perinatal Hospice and Palliative Care. Available at perinatalhospice.org (accessed 02 18 2019).

^[12] American Association of Pro-Life Obstetricians and Gynecologists Practice Bulletin 1: Perinatal Hospice. Available at aaplog.org/wp-content/uploads/2019/02/PB-1-Perinatal-Hospice.pdf (accessed 2019 02 18).

^[13] Cope H, Garrett ME, Gregory S, Ashley-Koch A. Pregnancy continuation and organizational religious activity following prenatal diagnosis of a lethal fetal defect are associated with improved psychological outcome. Prenat Diagn. 2015 Aug;35(8):761-768. doi: 10.1002/pd.4603.

^[14] Calhoun BC, Reitman JS, Hoeldtke NJ. Perinatal Hospice: A Response to Partial Birth Abortion for Infants with Congenital Defects. Issues in Law and Medicine 1997; 13(2):125-143.

^[15] Calhoun BC, Hoeldtke NJ, Hinson RM, Judge KM. Perinatal Hospice: Should all centers have this service? Neonatal Network 1997;16(6):101-102.

^[16] The American Association of Pro-Life Obstetricians and Gynecologists is a 4,600 member organization consisting of OB/GYNs and other physicians and medical professionals who work in the field of reproductive health, and who practice according to the Hippocratic Oath. The mission of AAPLOG is to provide an evidence-based defense of both our pregnant patient and her unborn child.

^[17] The American College of Pediatricians is a Hippocratic medical organization dedicated to using the best available science to promote the optimal health of all children from their conception until natural death.

^[18] The Catholic Medical Association is a national, physician-led community of over 2,300 healthcare professionals consisting of 109 local guilds. CMA mission is to inform, organize, and inspire its members, in steadfast fidelity to the teachings of the Catholic Church, to uphold the principles of the Catholic faith in the science and practice of medicine.

[19] National Association of Catholic Nurses, USA gives nurses of different backgrounds, but with the same Roman Catholic values, the opportunity to promote moral principles within the Catholic context in nursing and stimulate desire for professional development.  This approach to Roman Catholic doctrine focuses on:  educational programs, spiritual nourishment, patient advocacy, and integration of faith and health.

^[20] The Christian Medical and Dental Associations is a 19,000+ member organization in the United States, consisting of healthcare professionals from multiple disciplines including medicine, dentistry, physician assistants, nurse practitioners, physiotherapists, optometrists, pharmacists, and many others. The mission of CMDA is to motivate, educate, and equip Christian healthcare professionals to glorify God by serving with professional excellence as witnesses of Christ love and compassion to all peoples and by advancing biblical principles of healthcare within the church and to our culture.

^[21] AAPS was founded in 1943 to preserve and promote the practice of private medicine. It upholds the sanctity of the patient-physician relationship and the ethical principles in the Oath of Hippocrates.

[22] Rooted in Gospel values that affirm the dignity of every person, the National Catholic Partnership on Disability (NCPD), founded in 1982, works collaboratively to ensure meaningful participation of people with disabilities in all aspects of the life of the Church and society.