Category: Commentary

Moral Safeguards for Patients, Too

Letter to the Editor
The Washington Post
4 September, 2008

Reproduced with permission

Jonathan Imbody*

The misunderstanding expressed in the Aug. 26 letter, “Health Care’s Conscientious Objectors,” illustrates the need for the conscience-protecting regulation recently proposed by the Department of Health and Human Services.

The regulation would implement 35 years of civil rights laws passed by Congress to protect health-care professionals from discrimination, coercion and job loss for adhering to life-affirming ethical standards. The regulation would simply disallow forcing professionals to perform elective abortions and other procedures that violate millennia of medical ethics codes.

Contrary to the letter’s assertion, health-care professionals would continue to care as always for wounded soldiers, AIDS patients, post-abortive teenagers, felons and drunk drivers. In fact, the regulations would protect patient access to the compassionate, conscientious health-care professionals who are among the most dedicated to caring for such individuals.

Abortion Article Was Incorrect

Letter to the Editor
The Daily News,
Harrisonburg, VA
2 September, 2008

Reproduced with permission

Jonathan Imbody*

Shirley Kirkwood’s recent Open Forum wrongly suggests that a regulation proposed by the U.S. Department of Health and Human Services is somehow aimed at blocking contraception use (“Abortion Is A Religious Right,” Aug. 21).

That’s nearly as implausible a stretch as the notion that ending human lives is a religious right. The agency this year alone will spend over $1.6 billion on “family planning” programs.

What has been long established is the right to follow one’s conscience according to the dictates of faith and ethics.

That’s what the regulation will protect, as health care professionals push back against a culture that devalues life and work to restore life-affirming values such as those expressed in the Hippocratic Oath, the Judeo-Christian Scriptures and standards applied to medical ethics.

Conscience and coercion

Letter to the Editor

Salt Lake City Tribune
2 September, 2008
Reproduced with permission

Jonathan Imbody*

The Tribune editorial “Going too far: Proposed rule affects contraceptive information” (Our View, Aug. 26) wrongly charges that a recently proposed federal regulation will somehow “force poor women to limit their health-care choices to just those that are morally acceptable to taxpayer-funded providers.”

The regulation implements 35 years of civil liberty laws protecting health care professionals from coercion, discrimination and job loss for following life-affirming standards of medical ethics, such as the Hippocratic oath. It does not outlaw or hinder any legal procedure or prescription, nor does it prevent a patient’s access to information about contraception or abortion, which is readily available.

An intolerant approach to individual conscience is fomenting a crisis of access in health care, particularly in obstetrics and gynecology, where doctors and medical students are leaving for fear of reprisals or coercion to do abortions.

These regulations will protect health care professionals who adhere to high ethical and moral standards – those most likely to provide compassionate care for under-served patients.

Planned Parenthood and “Anti-Choice” Rhetoric

Sean Murphy*

A response to Mario Toneguzzi, “Planned Parenthood Targets ‘Anti-choice’ Docs”, Calgary Herald (19 August, 2004)

Planned Parenthood and "Anti-Choice" Rhetoric

In 1999, citing allegations by un-named “individuals,” a Councillor of the Alberta College of Physicians and Surgeons claimed that some physicians who were not “supportive” of women seeking abortions were “rude and bullying to patients.”(1) Canadian Physicians for Life rebuked the Councillor for relying upon “polemical hearsay” and demanded that the College substantiate the allegation.(2) No evidence was forthcoming.

Three years later the Assistant Registrar of the College indicated that complaints about physician ‘moralizing’ were largely hearsay “from groups who provide birth control and family planning counselling to women” – not a bad definition of Planned Parenthood.(3)First-hand accounts from individual patients were a “distinct minority” of the total.(4)

Planned Parenthood Alberta is now recycling the accusation that physicians who object to abortion may “scare” patients with “misinformation” or “impose their moral beliefs.”(5) One of the problems with this kind of generalized smear is that it may be unfairly applied to conscientious objectors to abortion who follow the guidelines of the Canadian Medical Association (CMA) and the College of Physicians and Surgeons of Alberta (CPSA).

The CMA advises physicians to “inform a patient when their personal morality would influence the recommendation or practice of any medical procedure that the patient needs or wants,” and to advise patients of their objections to abortion so that they can consult another physician.(6) The CPSA does not require physicians to advise every pregnant woman that she can have an abortion or put her child up for adoption,(7) but does expect them to provide information to patients seeking abortion so that they can “make informed decisions on all available options for their pregnancies, including termination.”(8)

In following these guidelines an objecting physician must, at all times, be respectful of the patient’s dignity, and must not be threatening, overbearing or abuse his authority by preaching or moralizing in order to influence his patient’s decision. On the other hand, objecting physicians can hardly be expected to present morally controversial procedures as morally uncontroversial, or in such a way as to indicate that they approve of them or are indifferent to them (i.e., to adopt a ‘neutral’ position). Moreover, the information they reasonably believe necessary to permit the patient to make a truly “informed decision” may be more comprehensive or in other respects different from what Planned Parenthood is accustomed to provide its clients.

A third party who was not present during this kind of exchange, especially an interest group like Planned Parenthood, might well stigmatize the discussion as ‘moralizing’ and providing ‘misinformation’. Partisan polemics of this sort do not provide a basis for sound policy making.

Planned Parenthood Alberta suggests that patients who are unsure of their doctor’s position on abortion should contact the organization because it is compiling a list of what it calls “anti-choice doctors”. Asking the doctor directly seems a simpler and more reliable way for patients to resolve such doubts. If it is desirable to help patients find physicians who share their outlook on moral issues, it would be preferable for doctors to identify themselves, perhaps through the College of Physicians and Surgeons or professional associations.

In the meantime, if Planned Parenthood persists in its plan to identify “anti-choice doctors”, it should include in its list the names of physicians who believe that their colleagues should not be forced to provide or facilitate morally controversial procedures.

Notes

1. Kretzul E. Ethical Responsibilities in Dealing with Women Requesting Abortion Services. The Messenger. 1999 Sep; 73: 6.

2. Canadian Physicians for Life. News Release: Alberta College of Physicians and Surgeons challenged to think about conscience rights [Internet]. Powell River: Protection of Conscience Project; 1999 Oct 11.

3. Theman TW. Freedom of Conscience and the Needs of the Patient. Presentation to the Obstetrics and Gynecology Conference “New Developments-New Boundaries”; 2001 Nov 9-12; Banff, Alberta.

4. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Jan 2. 1 leaf. Located at: Protection of Conscience Project.

5. Be Aware of Anti-Choice Doctors and Radiologists [Internet]. Edmonton: Planned Parenthood Alberta; 2004 [cited 2004 Aug 28].

6. Canadian Medical Association. Induced Abortion [Internet]. CMAJ. 1988 Dec 15 [cited 2020 Sep 16]; 139:12 1176a–1176b. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1268491/pdf/cmaj00181-0059.pdf.

7. Theman, Trevor W. (Assistant Registrar, College of Physicians and Surgeons of Alberta). Letter to: Sean Murphy (Administrator, Protection of Conscience Project). 2002 Mar 27. 1 Leaf. Located at: Protection of Conscience Project.

8. College of Physicians and Surgeons of Alberta. Termination of Pregnancy. 2000 Jun.

Project Letter to the Western Standard

14 May, 2004

Sean Murphy, Administrator
Protection of Conscience Project

Should doctors be forced to abandon their faith?  by Terry O’Neill  draws attention to the problem of freedom of conscience in health care.

A bit of history is instructive. The first protection of conscience clause debated in the House of Commons was introduced by M.P. Robert McCleave as an amendment to the Omnibus Bill that legalized abortion in Canada in 1969. Mr. McCleave believed that abortion should be  legalized, but also believed that ‘freedom of choice’ should be extended to health care workers.

Compare Mr. McCleave’s notion of ‘choice’ with that espoused by Joyce  Arthur. Speaking for the “Pro-choice Action Network,” she refuses to  respect the choices of health care professionals who do not wish to participate morally controversial procedures. She seems to believe that freedom of conscience is a problem to be solved by abolishing it, at least  in the case of those who don’t agree with her. Arthur’s position is doubly ironic, since Henry Morgantaler justified his defiance of Canadian abortion law in a 1970 article titled, A Physician and His Moral Conscience.1

Referral is not a satisfactory solution for many physicians who have grave moral objections to a procedure. Objecting physicians hold  themselves morally culpable if they facilitate an abortion by referring a  patient for that purpose. Nor is this an unusual view. Consider the controversy in Canada over the deportation and torture of Maher Arar. This suggests that few believe that one can avoid moral responsibility for a wrongful act by arranging for it to be done by someone else.

Certainly, Joyce Arthur does not consider abortion to be a wrongful act. However, she has not explained why others should be forced to abide by her moral views.

Unfortunately, between the writer’s desk and publication, a couple of factual errors were introduced into the story.

In the first place, the Project followed the case from the outset, and the student was provided with the same kind of service extended to others in similar situations. His relationship with the Project has been cordial,  but it is incorrect to describe me as “a friend of the would-be doctor.” We have never met.

More important, the final paragraph attributes to me statements that I did not make. While I am, nonetheless, in agreement with a number of the points made, I did not suggest that a devout Muslim doctor might refuse to  treat women, nor make any statement to a similar effect.

It would be most unfortunate if this falsely attributed statement were  to contribute to the already adverse social pressures experienced by Muslims in North America. Muslim health care workers and students are welcome to contact the Protection of Conscience Project. One of the  Project advisors is Dr. Shahid Athar, a regent and former vice-president of the Islamic Medical Association of North America and the Chair of its       Medical Ethics Committee

Notes

1. The article appeared anonymously in The Humanist. Quoted in Pelrine, Eleanor wright, Morgantaler: The Doctor Who Couldn’t Turn Away. Canada: Gage Publishing, 1975, P. 79