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February 5, 2008

In this age of radical patient autonomy and patient rights, the rights of doctors, nurses, and other health care professionals can sometimes be shortchanged. This may happen when individual choice trumps the right of a health care worker to refuse to perform a morally-controversial procedure.

The latest assault on conscience comes from the Ethics Committee of the American College of Obstetricians and Gynecologists. The committee has issued an opinion, summarized in an article entitled, “The Limits of Conscientious Refusal in Reproductive Medicine.” It reads, in part:

Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.

Notice the implications of this statement (source):
1) The millennia-old Hippocratic tradition of medicine is “first of all, do no harm.” Pro-life physicians feel that participation in abortion violates this tradition.
2) At the very least, the right to refuse to go against one’s conscience has been protected in ethics and by law.
3) The ACOG ethics statement insists that physicians must refer requests for abortion to other practitioners, even though such referral makes them complicit with the abortion act.
4) This even goes so far as to dictate where a physician may practice.
5) Finally, the statement insists that physicians must perform the procedure if no one else is available, if refusing might have a negative impact on physical or mental health (note the wording: we’re not necessarily talking about an immediate threat to the life of the mother here).

Furthermore, there is a move to link adherence to this ethics statment to board certification for OB-GYN doctors. Physicians who refuse to provide or refer for abortion may lose their right to practice medicine.

The ACOG ethics statement has not yet become policy, and has generated widespread disagreement and controversy, especially in view of the fact that it conflicts with laws in 46 out of 50 states.

Stay tuned.

(Conscience laws by state)

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