The Right Of The Right Of ConscienceConscience

The Right Of The Right Of ConscienceConscience

DefinitionDefinitionHealthcareHealthcare

Right of ConscienceRight of Conscience

DefinitionDefinitionHealthcareHealthcare

Right of ConscienceRight of Conscience

The freedom to practice The freedom to practice healthcare in accordance with healthcare in accordance with your deeply held religious, your deeply held religious, moral or ethical convictions.moral or ethical convictions.

Martin Luther KingMartin Luther KingMartin Luther KingMartin Luther King

On some positions cowardice asks the On some positions cowardice asks the question, 'Is it safe?' question, 'Is it safe?'

Expediency asks the question, 'Is it politic?' Expediency asks the question, 'Is it politic?' Vanity asks the question, 'Is it popular?' Vanity asks the question, 'Is it popular?' But conscience asks the question, 'Is it But conscience asks the question, 'Is it

right?' right?' And there comes a time when one must take And there comes a time when one must take

a position that is neither safe, nor politic, a position that is neither safe, nor politic, nor popular. But ... because it is right.nor popular. But ... because it is right.

Harper LeeHarper LeeTo Kill a MockingbirdTo Kill a Mockingbird, 1960, 1960

Harper LeeHarper LeeTo Kill a MockingbirdTo Kill a Mockingbird, 1960, 1960

The one thing that doesn't The one thing that doesn't abide by majority rule abide by majority rule is a person's is a person's conscience.conscience.

This is Not a New IssueThis is Not a New IssueThis is Not a New IssueThis is Not a New Issue

Moral Debate 2500 Years AgoMoral Debate 2500 Years Ago I will neither give a deadly drug to I will neither give a deadly drug to

anybody if asked for it, nor will I anybody if asked for it, nor will I make a suggestion to this effect. make a suggestion to this effect. Similarly I will not give to a woman Similarly I will not give to a woman an abortive remedy. But in purity an abortive remedy. But in purity and in holiness, I will guard the and in holiness, I will guard the sanctity of life and my role as sanctity of life and my role as healer.healer.

Hippocratic Oath, 429 Hippocratic Oath, 429 BCBC

What Right?What Right?What Right?What Right?

Congress shall make no law Congress shall make no law respecting religion or respecting religion or prohibiting the free exercise prohibiting the free exercise thereof.thereof.

Bill of Rights, First AmendmentBill of Rights, First Amendment

Writing the First AmendmentWriting the First Amendment James Madison, June 7, 1789James Madison, June 7, 1789 The Civil Rights of none shall be The Civil Rights of none shall be

abridged on account of religious belief or worship, nor shall any abridged on account of religious belief or worship, nor shall any national religion be established, national religion be established, nor shall the full and equal nor shall the full and equal rights of conscience be in any manner, nor on any pretext rights of conscience be in any manner, nor on any pretext infringedinfringed. No state shall violate the equal rights of conscience or . No state shall violate the equal rights of conscience or the freedom of the press, or the trial by jury in criminal cases.the freedom of the press, or the trial by jury in criminal cases.

House Select Committee, July-28House Select Committee, July-28 No religion shall be established No religion shall be established by law, by law, nor shall the equal rights of conscience be infringednor shall the equal rights of conscience be infringed..

House Version, Aug-20House Version, Aug-20 Congress shall make no law establishing Congress shall make no law establishing religion, or to prevent the free exercise thereof, religion, or to prevent the free exercise thereof, or to infringe the or to infringe the rights of conscience.rights of conscience.

Final Version Sept 24Final Version Sept 24 Congress shall make no law respecting an Congress shall make no law respecting an

establishment of religion, or prohibiting the free exercise thereofestablishment of religion, or prohibiting the free exercise thereof..

Founding FathersFounding Fathers

The rights of conscience we The rights of conscience we never submitted, we could not never submitted, we could not submit. We are answerable for submit. We are answerable for them to our God.them to our God.

I consider the government of I consider the government of the U.S. as interdicted by the the U.S. as interdicted by the Constitution from Constitution from intermeddling with religious intermeddling with religious institutions, their doctrines, institutions, their doctrines, discipline, or exercisesdiscipline, or exercises. . Thomas JeffersonThomas Jefferson

James MadisonJames Madison

Conscience is the most Conscience is the most sacred of all property.sacred of all property.

The Religion of every man The Religion of every man must be left to the must be left to the conviction and conscience conviction and conscience of every man; and it is the of every man; and it is the right of every man to right of every man to exercise it as these may exercise it as these may dictate. dictate.

AMA StatementAMA StatementAMA StatementAMA Statement

AMA reaffirms that neither physician, AMA reaffirms that neither physician, hospital, nor hospital personnel shall be hospital, nor hospital personnel shall be required to perform any act violative of required to perform any act violative of personally held moral principles. In these personally held moral principles. In these circumstances, good medical practice circumstances, good medical practice requires only that the physician or other requires only that the physician or other professional withdraw from the case, so professional withdraw from the case, so long as the withdrawal is consistent with long as the withdrawal is consistent with good medical practice.good medical practice.

Except in emergencies, physicians Except in emergencies, physicians shallshall be be free to choose whom to serve, with whom free to choose whom to serve, with whom to associate and the environment in which to associate and the environment in which to provide medical care.to provide medical care.

World World Medical AssociationMedical Association

World World Medical AssociationMedical Association

The physician should The physician should be free to make be free to make clinical and ethical clinical and ethical judgments without judgments without inappropriate outside inappropriate outside interference.interference.

Other Countries/CodesOther Countries/CodesOther Countries/CodesOther Countries/Codes European Convention on Human RightsEuropean Convention on Human Rights

Everyone has the right to freedom of thought, conscience Everyone has the right to freedom of thought, conscience and religion; this right includes… freedom …to manifest his and religion; this right includes… freedom …to manifest his religion or belief in worship, teaching, practice and religion or belief in worship, teaching, practice and observance.observance.

Canadian Medical AssociationCanadian Medical Association Physicians who object to abortion for reasons of conscience Physicians who object to abortion for reasons of conscience

are advised to inform their patients of their objections so are advised to inform their patients of their objections so that the patient can consult another physician. The CMA that the patient can consult another physician. The CMA stresses that physicians who decline to participate in stresses that physicians who decline to participate in abortion should not be discriminated against, and abortion should not be discriminated against, and emphasizes the need to respect the rights of conscientious emphasizes the need to respect the rights of conscientious objectors, especially those in training for obstetrics and objectors, especially those in training for obstetrics and gynecology, and anesthesia.gynecology, and anesthesia.

Another Perspective -Another Perspective - ““The Right of RefusalThe Right of Refusal””

Another Perspective -Another Perspective - ““The Right of RefusalThe Right of Refusal””

““A threat to reproductive rights.A threat to reproductive rights.”” ““Health related decisions made between a Health related decisions made between a

provider and patient should be made on the provider and patient should be made on the personal welfare and healthcare needs of the personal welfare and healthcare needs of the patient - not the morals or belief of the patient - not the morals or belief of the caregivers.caregivers.””

““While we firmly believe that all people have a While we firmly believe that all people have a right to their own opinions and moral beliefs, it right to their own opinions and moral beliefs, it is unethical for healthcare providers to stand in is unethical for healthcare providers to stand in the way of a womanthe way of a woman’’s access to safe, legal and s access to safe, legal and professional healthcare.professional healthcare.””

Refusal ClausesPlanned Parenthood Website

Battle FrontsBattle FrontsBattle FrontsBattle Fronts Plan B and PharmacistsPlan B and Pharmacists Insurance PlansInsurance Plans Abortion TrainingAbortion Training Standards of CareStandards of Care Direct Pressure on Direct Pressure on

ProfessionalsProfessionals Bypass or emasculate Bypass or emasculate

present laws.present laws.

State State Attacks on ROCAttacks on ROC

State State Attacks on ROCAttacks on ROC

Alaska (1997) - Valley Hospital Assoc.Alaska (1997) - Valley Hospital Assoc.

California (2003) - Benitez v. North Coast California (2003) - Benitez v. North Coast

Women's Medical CareWomen's Medical Care

Illinois (2005) – Gov. Rod BlagojevichIllinois (2005) – Gov. Rod Blagojevich

Washington (2007) - Pharmacy Regs.Washington (2007) - Pharmacy Regs.

Many More SinceMany More Since

Training IssuesTraining IssuesTraining IssuesTraining Issues Overt: Mandatory Abortion Training in Overt: Mandatory Abortion Training in

NYC NYC 2002: Mayor Bloomberg orders abortion 2002: Mayor Bloomberg orders abortion

training in All NYC medical schoolstraining in All NYC medical schools NY guidelines make it very difficult to NY guidelines make it very difficult to

conscientiously objectconscientiously object Covert: Pro-life students denied Covert: Pro-life students denied

admission admission ((Issues in Law and Medicine, Spring, 1996Issues in Law and Medicine, Spring, 1996))

ACOG Committee Opinion ACOG Committee Opinion # 385, 11/07# 385, 11/07

ACOG Committee Opinion ACOG Committee Opinion # 385, 11/07# 385, 11/07

Patient autonomy final arbitrator for RxPatient autonomy final arbitrator for Rx Right to Demand Rx = Right to Refuse RxRight to Demand Rx = Right to Refuse Rx ROC is just a personal opinionROC is just a personal opinion Moral obligation to patient over rides ROCMoral obligation to patient over rides ROC Inconvenience imposes providers beliefs on pts.Inconvenience imposes providers beliefs on pts. PatientPatient’’s concept of well-being trumpss concept of well-being trumps Must refer for abortionMust refer for abortion If canIf can’’t timely refer, must providet timely refer, must provide Those who refuse to provide abortions should only Those who refuse to provide abortions should only

practice in areas where abortion services can be practice in areas where abortion services can be provided. provided.

American Board of American Board of Obstetrics and GynecologyObstetrics and Gynecology

American Board of American Board of Obstetrics and GynecologyObstetrics and GynecologyNew policy issued in January 2008: New policy issued in January 2008: certification contingent on compliance certification contingent on compliance with ACOG ethical principles. 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 CMDA Faith-Based Professional SurveyProfessional SurveyCMDA Faith-Based CMDA Faith-Based Professional SurveyProfessional Survey

40% of member report being 40% of member report being pressured to compromise convictionspressured to compromise convictions

>43% know someone else who was >43% know someone else who was pressuredpressured

>24% have lost position, promotion >24% have lost position, promotion or compensation as a resultor compensation as a result

>88% think the problem is getting >88% think the problem is getting worseworse

CMDA Public PollCMDA Public PollCMDA Public PollCMDA Public Poll

September 2008 CMDA commissioned September 2008 CMDA commissioned the polling company TM, Inc.the polling company TM, Inc. to to conduct a nationwide telephone pollconduct a nationwide telephone poll +/- 3.1% at 95% confidence level+/- 3.1% at 95% confidence level 42% think law obligates doctors to 42% think law obligates doctors to

perform/refer for abortionperform/refer for abortion 38% no obligation38% no obligation 11% unsure11% unsure 5% depends5% depends

If we donIf we don’’t protect personal integrity, we t protect personal integrity, we would go down a dangerous avenue. By would go down a dangerous avenue. By taking a professional license you do not taking a professional license you do not step out of your personal morality. You step out of your personal morality. You have taken on an additional have taken on an additional responsibility, but that does not mean responsibility, but that does not mean you have given up your integrity as a you have given up your integrity as a person.person.

Linda Rankin, Bioethicist, U of TNChristian Science Monitor, 4/26/04

Conscience & HealthcareConscience & HealthcareConscience & HealthcareConscience & Healthcare

Is our healthcare system in need of more Is our healthcare system in need of more conscience-driven doctors or more conscience-driven doctors or more "ethically neutered" doctors?"ethically neutered" doctors?

Do we want medical schools to Do we want medical schools to systematically strip our future doctors from systematically strip our future doctors from any and all religious and ethical convictions any and all religious and ethical convictions that have not been approved by the state?that have not been approved by the state?

Your doctor's conscience may some day be Your doctor's conscience may some day be the last line of protection between you and the last line of protection between you and those who would profit from your early those who would profit from your early death.death.

Federal LawFederal LawFederal LawFederal Law Church AmendmentChurch Amendment Public Health Services ActPublic Health Services Act Medicare/Medicaid Medicare/Medicaid 42 U.S.C. §238n 42 U.S.C. §238n Weldon AmendmentWeldon Amendment

Limited to federally funded programs. Limited to federally funded programs.

No enforcement provisions.No enforcement provisions.

State LawsState LawsState LawsState Laws

45 states have some sort of ROC laws45 states have some sort of ROC laws ArizonaArizona

36-3205 . Health care providers; immunity from liability; conditions

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.

State by State Laws State by State Laws http://www.consciencelaws.orghttp://www.consciencelaws.org

More Current EventsMore Current EventsMore Current EventsMore Current Events January 20, 2009: HHS policy goes into

effect protecting right of conscience CanCan’’t t discriminate in the employment, promotion, discriminate in the employment, promotion,

termination, or the extension of staff or other termination, or the extension of staff or other privileges to any physician or other healthcare privileges to any physician or other healthcare personnel because he performed, assisted in the personnel because he performed, assisted in the performance, refused to perform, or refused to performance, refused to perform, or refused to assist in the performance of any lawful health assist in the performance of any lawful health service or research activity on the grounds that service or research activity on the grounds that his performance or assistance in performance of his performance or assistance in performance of such service or activity would be contrary to his such service or activity would be contrary to his religious beliefs or moral convictions, or because religious beliefs or moral convictions, or because of the religious beliefs or moral convictions of the religious beliefs or moral convictions concerning such activity themselves.concerning such activity themselves.

Anaphylactic reaction by pro-Anaphylactic reaction by pro-abortions groups and some mediaabortions groups and some media False claims, e.g., women will not be False claims, e.g., women will not be

allowed contraception allowed contraception Media blitzMedia blitz Legal action takenLegal action taken

1/15/09 - PP, ACLU, 7 State Attorneys 1/15/09 - PP, ACLU, 7 State Attorneys General file suit in CT to overturnGeneral file suit in CT to overturn

Overturning HHS Overturning HHS RegulationsRegulations

Overturning HHS Overturning HHS RegulationsRegulations

February 2009February 2009 President Obama announces he will President Obama announces he will

rescind the regulationrescind the regulation April 9, 2009 April 9, 2009

30 Day Public Comment Period ended30 Day Public Comment Period ended 300,000 comments300,000 comments All reference to regulations taken off All reference to regulations taken off

HHS website. HHS website. Gutted 12/10Gutted 12/10

Freedom2Care.orgFreedom2Care.orgFreedom2Care.orgFreedom2Care.org Represents 50 organizationsRepresents 50 organizations Education & MobilizationEducation & Mobilization Blogs, Twitter, FacebookBlogs, Twitter, Facebook Polls/SurveysPolls/Surveys

91% of faith-based physicians 91% of faith-based physicians agreed, “I would rather stop agreed, “I would rather stop practicing medicine altogether practicing medicine altogether than be forced to violate my than be forced to violate my conscience.”conscience.”

88% Americans say it is important 88% Americans say it is important that they have a similar set of moral that they have a similar set of moral beliefs as their healthcare beliefs as their healthcare professional.professional.

87% oppose forcing professionals to 87% oppose forcing professionals to violate their moral objections.violate their moral objections.

63% support conscience regulations63% support conscience regulations 54% less likely to vote for 54% less likely to vote for

Congressman that oppose ROC.Congressman that oppose ROC.

Healthcare ReformHealthcare ReformHealthcare ReformHealthcare Reform Church, Weldon and other laws Church, Weldon and other laws onlyonly

apply to annual HHS appropriationsapply to annual HHS appropriations Reform bill Reform bill onlyonly protects physicians protects physicians

from insurance companies coercing from insurance companies coercing them to do abortionsthem to do abortions No protection for other professionalsNo protection for other professionals No protection from referralNo protection from referral No protection on other issuesNo protection on other issues

Why I Don’t Refer?Why I Don’t Refer?Why I Don’t Refer?Why I Don’t Refer?

Referral means:Referral means: I endorse the competency, judgment I endorse the competency, judgment

and ethics of the doctor to whom Iand ethics of the doctor to whom I’’m m referring.referring.

I enter into a professional relationship I enter into a professional relationship with that doctor. with that doctor. I will receive a report back from him.I will receive a report back from him.

I believe they will I believe they will ““do no harm.do no harm.””

Moral ComplicityMoral ComplicityMoral ComplicityMoral Complicity CMDA believes moral complicity with CMDA believes moral complicity with

evil does not exist when all the following evil does not exist when all the following conditions are satisfied:conditions are satisfied: our intent is for good;our intent is for good; the association with the past or present evil is the association with the past or present evil is

sufficiently uncertain, or the act is sufficiently sufficiently uncertain, or the act is sufficiently distanced from the original evil act; anddistanced from the original evil act; and

the action does not reward, perpetuate, justify, the action does not reward, perpetuate, justify, cooperate with, or ignore the original evil.cooperate with, or ignore the original evil.

Conscience RightsConscience RightsConscience RightsConscience Rights

Protection of someoneProtection of someone’’s right to s right to object does not equate with support object does not equate with support for that position.for that position.

Indeed, we must pay special Indeed, we must pay special attention to protecting the rights of attention to protecting the rights of others when we do not support their others when we do not support their position.*position.*

*(Claims of conscience rights can be abused)*(Claims of conscience rights can be abused)

Insurance MandateInsurance Mandate

Sec. HHS Authority Institute of Medicine Must provide all FDA Approved Contraceptives

Unless Religious Employer: (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 ExemptionMinisterial Exemption

Lutheran Church v. Equal Employment Commission 4th Grade Teacher Replaced So Sued School Court considered her a minister

Commissioned by Church Had religious training She claimed a ministerial housing allowance Organized and led chapel at school and gave religious training

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.

What will convince them? This, and this only: What will convince them? This, and this only: cease to call slavery cease to call slavery ((abortionabortion)) wrong, and join wrong, and join them in calling it right. And this must be done them in calling it right. And this must be done thoroughly - done in acts as well as in words. thoroughly - done in acts as well as in words. Silence will not be tolerated - we must place Silence will not be tolerated - we must place ourselves avowedly with them…..The whole ourselves avowedly with them…..The whole atmosphere must be disinfected from all taint of atmosphere must be disinfected from all taint of opposition to slavery opposition to slavery (abortion),(abortion), before they will before they will cease to believe that all their troubles proceed cease to believe that all their troubles proceed from us."from us."

What will convince them? This, and this only: What will convince them? This, and this only: cease to call slavery cease to call slavery ((abortionabortion)) wrong, and join wrong, and join them in calling it right. And this must be done them in calling it right. And this must be done thoroughly - done in acts as well as in words. thoroughly - done in acts as well as in words. Silence will not be tolerated - we must place Silence will not be tolerated - we must place ourselves avowedly with them…..The whole ourselves avowedly with them…..The whole atmosphere must be disinfected from all taint of atmosphere must be disinfected from all taint of opposition to slavery opposition to slavery (abortion),(abortion), before they will before they will cease to believe that all their troubles proceed cease to believe that all their troubles proceed from us."from us."

Abraham LincolnAbraham Lincoln

Cooper Union address of 1860Cooper Union address of 1860

Why This Assault on Conscience?

The extent to which an institution seeks to The extent to which an institution seeks to expunge individual conscience and moral expunge individual conscience and moral autonomy is the extent to which it is autonomy is the extent to which it is totalitarian and dangerous. The idea that I totalitarian and dangerous. The idea that I resign my conscience to the institution or resign my conscience to the institution or to the state is perhaps the single most to the state is perhaps the single most pernicious notion in human history. It is at pernicious notion in human history. It is at the heart of the wars and genocides of this the heart of the wars and genocides of this century and the lastcentury and the last..

Crispin SartwellCrispin Sartwell

Los Angeles TimesLos Angeles Times

Self Described Self Described

““Pro-Choice AtheistPro-Choice Atheist””

ResourcesResources <freedom2care.org><freedom2care.org> <cmda.org><cmda.org>

Ethics Statements, PPEthics Statements, PP’’s, Standards for s, Standards for Life, Life, ““Just Add WaterJust Add Water”” DVD DVD’’ss

<consciencelaws.org><consciencelaws.org> <physiciansforlife.org><physiciansforlife.org> ““Protecting the Health Care Provider's Protecting the Health Care Provider's

Right of ConscienceRight of Conscience”” Teresa Teresa Colette, JD <chbd.org>Colette, JD <chbd.org>

BookBook - Issues of Conscience - Issues of Conscience Laurel Laurel

HughesHughes