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The Most Important Bioethical Issue You Face

by David Stevens, MD, MA (Ethics)
Today's Christian Doctor - Fall 2009

How would you concisely and competently communicate with a colleague, a friend, or your local newspaper about right of conscience (ROC)?

Since this is the most important bioethical issue you face – your very ability to practice medicine is at stake – it is something you need to learn to do.

Let me share an acronym that I teach members during media training to help them formulate messages concisely and effectively. It is a lot easier than learning the Kreb Cycle!

We call it putting together your DiMES.

  • “Di” What is the Dilemma? Why should somebody care about this issue?
  • “M” What is your main Message? What sub-points support it?
  • “E” What Examples – analogies, statistics, quotes, sound bites – validate your message?
  • “S” Solution – how can this dilemma be solved? What does the listener need to do?

Let’s put some flesh on these bones.

The dilemma is that doctors and other healthcare professionals are being pressured and discriminated against by employers and colleagues because of their deeply held religious or moral beliefs. Almost one in four (23 percent) faith-based professionals state they have been discriminated against by employers, educators, or others in the healthcare system. Nearly two out of five have been pressured to violate their beliefs by referring, writing a prescription, or doing a procedure.

Planned Parenthood, the ACLU, and other radical abortion organizations have well-funded projects to do away with what they call “The Right of Refusal.” A good number of their allies in the administration, Congress, and the courts are eager and willing to help them accomplish their goal to force faith-based and other professionals out of healthcare.

For example, a family practice doctor in San Antonio felt that she should NOT dispense contraceptives to unmarried women. She referred them to a colleague across the hall. Her employer learned of this, called her in, and forced her to resign within a week.

An anesthesiologist in NC was seeing pre-op patients on Saturday call coverage. A woman, who the OB/Gyn had listed as an elective D & C, said, “No, this is an elective abortion.” When the anesthesiologist contacted the scheduling physician, the doctor was irate that he wouldn’t handle the case. He contacted the medical director, administrators, and even board members, and the doctor got calls threatening that he would lose his hospital privileges if he didn’t provide the anesthesia. A hospital administrator, after hearing a talk on ROC by a CMDA staff member a few days later, stated, “I thought we had to pressure him to do this case. I didn’t know we were breaking the law.”

A medical school applicant in a NYC interview was asked only one question, “How would you advise a 16-year-old pregnant girl?” When he didn’t offer an abortion, the interview was quickly over and he wasn’t accepted. He was accepted to Harvard Medical School, instead.

After spelling out the dilemma, your key message could be, “Abolishing right of conscience is dangerous,” with the sub points that it is dangerous for our country, our healthcare system, and for every patient.

It is dangerous for our country because it does away with one of our most basic inalienable liberties, the “free exercise of religion,” that is guaranteed in the first amendment of the US Constitution. James Madison, its author, made this very clear in the original version of the amendment that was later made more concise. He wrote: “The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed.”

Do we want the government to ethically neuter doctors of all morality that is not approved by the state? What Hippocrates knew was that the moral integrity of the doctor is the patient’s best protection, and this is especially true in a healthcare system increasingly being driven by cost.

When the state demands that any citizen yield their conscience or moral beliefs, to that degree it becomes totalitarian and dangerous. The greatest atrocities in the last hundred years have taken place in regimes that have done just that, from Nazi Germany to Communist Russia.

You don’t have to agree with a person’s position on a moral issue to protect their right to exercise it. I might be willing to bear arms in the military, but I will defend the right of a Quaker to conscientiously object.

Abolishing right of conscience is dangerous for our healthcare system. Many of our most compassionate faith-based doctors, nurses, and pharmacists, who more often work in rural areas and with the poor, would be driven out of healthcare. Hospitals could close. One in six patients in the US get healthcare at a Catholic hospital. Look across the hospital listings in many communities and it is likely you will find Baptist, Methodist, Seventh Day Adventist, and other facilities started or run by religious groups. Many would shut their doors before violating their beliefs.

Doing away with right of conscience is dangerous because everyone will sooner or later be a patient. You don’t want to go to your doctor or hospital and find a sign hanging on the door, “Out of business! Wouldn’t do abortions or physician-assisted suicide.” In a recent survey of over 2,800 faith-based doctors, pharmacists, physician assistants, and nurses, 95 percent of them said they would quit medicine before violating their conscience. As we look at a healthcare system already facing personnel shortages in the face of an aging population, losing these professionals would be catastrophic resulting in healthcare rationing, suffering, and death.

So what is the solution? The majority of people (two to one) oppose rescinding healthcare right of conscience laws and regulations. The same percentage see it as an inalienable right. They oppose it to the point that 54 percent of Democrats, Republicans, and Independents say they will punish politicians that try to abolish this right. Nine to one, people want a healthcare professional who shares their moral beliefs.

Protecting right of conscience gives patients choice. We wouldn’t require Target to carry everything that Walmart carries, or vice versa. Patients who want an abortion will find plenty of doctors who are willing to provide this to them. There are no lines outside abortion clinics. Sterilizations and contraception also are readily available. Health and Human Services put $1.8 billion dollars into contraception services last year. We dare not take away one of our most precious liberties merely to avoid inconvenience to a patient.

Doctors should also not be required to refer patients for morally objectionable procedures. A medical referral is not like telling someone where to get a product a store may not carry. It means the referring doctor endorses the competency and ethics of the doctor they are referring to. It means they enter into a formal relationship with that doctor and expect a report about the diagnosis or treatment rendered. It means the referring doctor has facilitated an abortion, a suicide, or other intervention, and now is morally complicit in what occurred.

Each professional and every patent can protect this right by educating themselves with resources on (see sidebar, pg. 17), talking about the issue with their friends, writing or calling their Representatives, Senators, or the White House, or writing a letter to their local newspaper.

As Thomas Jefferson said, “The Religion of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate.”

Now that wasn’t too hard, was it? If we speak to patients, colleagues, friends, and elected officials we can protect what James Madison called, “The most sacred of all property.” If we don’t, we have shirked our duty to protect our liberty and this great democracy from those blinded by their ideology. They want to wipe away any criticism of their actions.

I’m going to stand up and be counted. Won’t you?


David Stevens, MD, MA (Ethics) is the CEO of CMDA. From 1981 to 1991, Dr. Stevens served as a missionary doctor in Kenya, helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in that country. As a leading spokesman for Christian doctors in America, Dr. Stevens has conducted hundreds of television, radio, and print media interviews. Dr. Stevens holds degrees from Asbury College and the University of Louisville School of Medicine. He is board certified in family practice. He earned a master’s degree in bioethics from Trinity International University in 2002.

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