This past week I attended the meeting of the Council on Health Care Ethics for our state medical society. In the packet of information for the meeting was a resolution on “right of conscience” along with 2 “supporting” documents, one by Julian Savulescu and the other by Alta Charo, both addressing the issue of abortion and both filled with “entitlement” rhetoric (the article by Salvulescu even stated that those who are unwilling to provide services to which people were “entitled” should not be physicians, as if abortion is the vital core of healthcare). Based on the “supporting” documents, the tenor of the meeting seemed less than balanced.
To my great surprise, the author of the resolution was a first-year medical student. The resolution had been brought to the state convention, where it encountered considerable opposition and was sent to our committee for further discussion (presumably out of deference to her status as a young student). The resolution in its current state was greatly truncated, seeking merely to preserve “collegiality” among physicians through support of the right of conscience of all physicians by the state medical society.
When the resolution was read by the author to our committee, there was silence in the room. To break the uncomfortable tension I applauded the resolution and spoke of the importance in a pluralistic society of protecting the right of conscience of all practitioners, noting that much of our disagreement centers on differing definitions of conscience (self-chosen values vs. moral obligation to a Higher authority). Taking advantage of the opportunity, I then addressed the fallacies of the “supporting” articles by Savulescu and Charo, pointing out that both ignored (or implicitly denied) a crucial fact: that abortion is a negative right which entails no corresponding obligation–a fact ignored by most supporters of abortion “rights.”
There. It was out in the open: that “a” word. I watched with curious amusement as the other members danced around that word for the remainder of the brief discussion. Brief? Yes, brief, because one member quickly responded by slinging out the term “moral fascists.” Moral fascists? Really? (I seem to say that a great deal lately.) Really? The comment was profoundly ironic: those trying to establish protection from the moral encroachments of others are labeled “moral fascists”; and secularists who label religious sensibilities “irrational”–who claim no higher power than reason–are unable to mount a rational argument in defense of their position.
The discussion detoured briefly before dead-ending in the issue of “referral for abortion” which has curiously become the central contention in the debate–another curiosity. For 25 years I have practiced obstetrics and gynecology–now just gynecology–in rural communities with no abortion services, located in both eastern and mid-western states. In those 25 years I have never had a patient come to me 1) seeking an abortion, 2) asking where to go to obtain an abortion, or 3) requesting a referral for abortion. Two patients (two!) have made appointments with me to discuss their decision and/or to receive assurance that they could return to me for care after the procedure. In both cases those women already had appointments scheduled for the procedure. Patients “know” where to go, whether through family or friends or general “street knowledge”–not to mention that it is first listing in the yellow pages after “abortion alternative.” Nor are referrals required by the provider or insurer. In cases involving congenital fetal anomalies or life-threatening maternal health conditions, the patient is sent to a tertiary center for evaluation, counselling, and treatment–not specifically for abortion. Quite frankly, the issue seems like a red herring…
Right of conscience extends far beyond the issue of abortion into many other aspects of care, a horizon that will no doubt expand even farther in the coming years as our technological innovations continue to outstrip our moral sensibilities, yet the same principles apply. A decade ago, Nigel Cameron suggested that given our ideological disparities, medicine might best be served by the establishment of two separate factions of healthcare providers: Hippocratic and non-Hippocratic. Perhaps it is an idea whose time has come. Just as all businesses have “mission statements” today (another irony–or oxymoron…), hospitals, clinics, and individual providers could have their mission or value statements posted on-line or at the facilities, allowing individuals to choose primary providers and facilities whose values were most consistent with their own. It would also fulfill the idea of informed consent, enabling individuals to make informed choices about the providers of their care. It is an option that would eliminate “moral fascism” and promote freedom in a pluralistic society–the essence of “liberty and justice for all” in healthcare.