Skip to comments.The Celestial Fire of Conscience — Refusing to Deliver Medical Care
Posted on 06/16/2005 9:01:37 AM PDT by hocndoc
The Celestial Fire of Conscience Refusing to Deliver Medical Care R. Alta Charo, J.D.
Apparently heeding George Washington's call to "labor to keep alive in your breast that little spark of celestial fire called conscience," physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
Largely as artifacts of the abortion wars, at least 45 states have "conscience clauses" on their books laws that balance a physician's conscientious objection to performing an abortion with the profession's obligation to afford all patients nondiscriminatory access to services. In most cases, the provision of a referral satisfies one's professional obligations. But in recent years, with the abortion debate increasingly at the center of wider discussions about euthanasia, assisted suicide, reproductive technology, and embryonic stem-cell research, nurses and pharmacists have begun demanding not only the same right of refusal, but also because even a referral, in their view, makes one complicit in the objectionable act a much broader freedom to avoid facilitating a patient's choices.
(cont'd) At the heart of this growing trend are several intersecting forces. One is the emerging norm of patient autonomy, which has contributed to the erosion of the professional stature of medicine. Insofar as they are reduced to mere purveyors of medical technology, doctors no longer have extraordinary privileges, and so their notions of extraordinary duty house calls, midnight duties, and charity care deteriorate as well. In addition, an emphasis on mutual responsibilities has been gradually supplanted by an emphasis on individual rights. With autonomy and rights as the preeminent social values comes a devaluing of relationships and a diminution of the difference between our personal lives and our professional duties.
Finally, there is the awesome scale and scope of the abortion wars. In the absence of legislative options for outright prohibition, abortion opponents search for proxy wars, using debates on research involving human embryos, the donation of organs from anencephalic neonates, and the right of persons in a persistent vegetative state to die as opportunities to rehearse arguments on the value of biologic but nonsentient human existence. Conscience clauses represent but another battle in these so-called culture wars.
Most profoundly, however, the surge in legislative activity surrounding conscience clauses represents the latest struggle with regard to religion in America. Should the public square be a place for the unfettered expression of religious beliefs, even when such expression creates an oppressive atmosphere for minority groups? Or should it be a place for religious expression only if and when that does not in any way impinge on minority beliefs and practices? This debate has been played out with respect to blue laws, school prayer, Christmas crèche scenes, and workplace dress codes.
Until recently, it was accepted that the public square in this country would be dominated by Christianity. This long-standing religious presence has made atheists, agnostics, and members of minority religions view themselves as oppressed, but recent efforts to purge the public square of religion have left conservative Christians also feeling subjugated and suppressed. In this culture war, both sides claim the mantle of victimhood which is why health care professionals can claim the right of conscience as necessary to the nondiscriminatory practice of their religion, even as frustrated patients view conscience clauses as legalizing discrimination against them when they practice their own religion.
For health care professionals, the question becomes: What does it mean to be a professional in the United States? Does professionalism include the rather old-fashioned notion of putting others before oneself? Should professionals avoid exploiting their positions to pursue an agenda separate from that of their profession? And perhaps most crucial, to what extent do professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all professional services?
(cont'd) Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth. But the assumption that one's own conscience is the conscience of the world is fraught with dangers. As C.S. Lewis wrote, "Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience."
Professor Charo teaches law and bioethics at the University of Wisconsin Law and Medical Schools, Madison.
An interview with Professor Charo can be heard at www.nejm.org.
The complete article is available for free on line at http://content.nejm.org/cgi/content/full/352/24/2471
There is also an audio of an interview with Charo at
There is no disclosure that Professor Charo is an outspoken and well-traveled advocate for abortion, cloning, and embryonic stem cell experiments. She was on a panel covering the legal issues of cloning and embryonic stem cell research this past weekend in Houston. http://www.freerepublic.com/focus/f-news/1420130/posts http://www.genpol.org/
She was also quoted in a recent MSNBC/Newsweek article, "Ethics, Eggs and Embryos," concerning the donation of oocytes for cloning for embryonic stem cells. http://www.msnbc.msn.com/id/8185339/site/newsweek/
This editorial is an excellent example of her work: she immediately jumps to the conclusion that religion and right wing politics are at the base of conscience laws and assumes that her views are the only correct views, with basis in fact and law rather than personally held beliefs (i.e., religion by another name):
""" Finally, there is the awesome scale and scope of the abortion wars. In the absence of legislative options for outright prohibition, abortion opponents search for proxy wars, using debates on research involving human embryos, the donation of organs from anencephalic neonates, and the right of persons in a persistent vegetative state to die as opportunities to rehearse arguments on the value of biologic but nonsentient human existence."""
I agree with R. Alta Charo's opinion, as implied by her objection to conscience clauses within State and Federal laws, that mere legality does not make any act "right." However, I disagree with her conclusion that these laws are politically motivated, limited to those who belong to the specific religions she names, or that the refusal of medical professionals to participate in killing members of our species is a recent innovation.
The most ancient (pagan, Greek) recorded code of medical ethics called upon medical professionals to "First, do no harm" and prohibited the deliberate ending of human life. This code has been reaffirmed in the Nuremberg Code, the Declaration of Helsinki, and the United Nations' International Declaration of Human Rights. History has repeatedly shown us the result of discrimination, whether legal or not, between members of our species when following this code.
Professor Charo appeals to morality - the discernment between right and wrong acts - whether explicitly or not. Upon what does she base her morals which cause her to travel about the country advocating for cloning and other means of obtaining embryonic stem cells? And why is she not a "moral busybod(y)" in her desire for consequences for those who violate her idea of professionalism?
Gentlemen, please ping your lists.
Doctors: please consider writing the editors of the NEJM at email@example.com about this latest misuse of their editorial discretion.
What does it say about a persons character when they find an act of conscience an evil bad thing when it is used to save a life or refuse to take part in a prceedure which is at odds with ones personal,religious beliefs.<p. Do we hold a gun to a Doctors head and make him/her perform an abortion.
here's those links, again:
The "Perspective" piece, with free access to full text:
The free audio interview on NEJM:
Last week's FR thread on an embryonic stem cell advocacy summit, which hosted not only Charo, but Dr Hwang (Doctor of Veterinary Medicine), who has done the famous experiments in cloning humans:
The sponsoring organization for the Summit:
Newsweek article on donation of human eggs (oocytes) for use in cloning to produce embryonic stem cells, in which Charo states that she is willing to donate her oocytes to the cause (well, why doesn't she?):
Doctors under HilleryCare will have to become what the Firemen were in Fahrenheit 451.
I can save everyone the trouble of reading this. His position is that refusing to kill your patient is tyranny. Refusing to perform an abortion is "legalized discrimination". Obeying your conscience is "exploiting your position".
Moreover, should all doctors provide Botox treatments, and should every pharmacist fill every prescription for addictive, controlled substances? (Pharmacists routinely confiscate suspected forged 'scripts for these drugs, contact the doctor about them, and even call the doctor(s) to let them know when someone is filling multiple scripts from various doctors.)
Do we want doctors, nurses, and pharmacists who regularly practice the suppression of their consciences?
mark for later read.
Ms. Charo forgets that rights belong to individuals, and that societies and governments are only as powerful as they are by the collective use of those individual rights.
She also conveniently forgets that abortionists and sellers of "emergency contraception" do not want legal or malpractice consequences of their acts, either.
I wonder what her opinion is of psychiatrists who choose to refrain from treating homosexuals seeking to change to heterosexuality?
We can guess that she is in favor of this sort of discrimination.
Who can be surprised - after all, she's willing to kill people to get what she wants.
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Though I'm sure almost every doctor, nurse and pharmacist using the conscience clause believes it's better for their patient to avoid being a victim of abortion, this section shows why They Just Don't Get It. The medical professionals making these choices are doing so because they believe they would be party to murder, and if they thought it would benefite their patients, they would make the same choice.
This is just an extention of the HMO mndset. The Docs have allowed themselves to become straightjacketed by outsiders. I know, my Doc has to get approval for ANY little thing he does for me. We may be vey close to the bottom of this slippery slop.
The author states,
"And perhaps most crucial, to what extent do professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all professional services? "
Section 1. Neither slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction.
Amendment XIII pretty well sums it up on this question of whether a "professional" has the right to withhold "services" for whatever reason.
Are they demanding to keep their principles and their job too?
If an employer requires something of you that you find is against your principles, you have the right to leave that employment. To stay would be unprincipled. Perhaps one could start a company of their own where one is not required to sacrifice their principles in the performance of their job. That would be the principled thing to do. The American thing in fact.
Thank you. Great info.
The question is who do licensed professionals work for?
Many health professionals are self-employed.
Even those who are employed by corporations are *professionals* and citizens. We have a duty to do the right thing. It is not a defense to say "I was just following orders." Remember not only the Nuremberg trials, but the way we look at those doctors who performed lobotomies on women such as the Kennedy daughter and the doctors who were complicit with managed care's refusal of hospitalizations, surgeries and tests.
I hear ya doc. Couldn't agree more.
I started performing contract computer consulting so that I could dictate the ethics of the business in which I was involved. Starved for the first couple of years. Then started making good money, did my best work, never lost a minutes sleep over it.
IBM then offered me more than twice as much money, to do the same work for them. WHOA! Opportunities to more than double your pay don't come along every day, even in the tech biz. So I joined IBM.
What I discovered though, was that you had to adopt their ethics. My ethics were, provide the best solution you can, and get as much as you can for it. IBM's ethics were, get as much money as you can, as fast as you can, and do only that which is required to get it.
After 6 months with IBM, I left. They forced on me a decision; between the Christian morals and ethics that become more important to me every day, and the additional $85,000 I was making with IBM. No contest.
So I'm back to making a lot less money, doing the best work I can, and honoring my Christian vows. Couldn't be happier with my choice
I believe that is the way principles are suppose to work.
At least the left is honest enough to let us know their real intentions.
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physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
This raises the question of what medical care may be refused under the cover of concience. Abortion seems the main one discussed; perhaps birth control pills; maybe blood transfusions. Could a doctor refuse to prescribe a particular drug because she considers the drug company to be sleazy? How about denying care to illegal aliens, smokers, drunks, drug addicts, soccer fans? (That's a bit different, one isn't denying care under because the care is problematical but because the patient is.)
Actually, I do know a Pulmonologist who will not care for people who continue to smoke.
However, matters of conscience are not that complicated: the first priority is to do no harm, while the second is to do good. *Elective* abortion is not done to save life, while abortion to save the life of the mother (rare as they are) and blood transfusions are.
Even in the case of ectopic or tubal pregnancies - when treatment is an emergency and not elective - the doctrine of double effect has long led physicians to remove the entire fallopian tube. The child dies as a result of this action, but his death is not intended. Newer techniques intended to preserve the mother's fertility (opening the tube and removing only the child or administering drugs to kill the child in place) turn out to be more dangerous for the mother and more likely to result in later, repeat tubal pregnancies or infertility.
And, of course, Charo begs the question as to whether or not "emergency contraception" is "emergency," "contraception," or, whether in fact, it causes an abortion.
I believe that when you compel healthcare providers, especially physicians who took some version of the Hippocratic Oath, from which the clause, "First, do no harm", has been distilled from the Latin, "Primum non nocere", to act against their conscience is the essence of tyranny.
Compelling actions by healthcare providers which is against their conscience is different from discriminating which patient is worthy of treatment.
I remember reading a story in the British Medical Journal about a smoker who needed coronary artery bypass surgery whose surgery was delayed because the patient still smoked. After the patient managed to quit, the patient died shortly before the scheduled surgery.
Personally, I believe in free will, and that we are all sinners.
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It would have been great if Nazi Germany had doctors with consciences.
"Personally, I believe in free will, and that we are all sinners."
And so does Alta Charo, or she wouldn't constantly be trying to change things. She just doesn't recognize her own bias - or the natural source.