Physician Conscience Blog II
I’m delighted to announce that with the help of Planned Parenthood, my blog -- for the first time -- received more visits than my teenage son’s MySpace page. Perhaps I’ll address the subject of physician conscience one more time.
Having served as Governor for 11 years and now in my fifth year as a member of the President’s Cabinet, the debate over abortion is not a new one to me. I was not surprised by the more than 850 comments. Consistent with the comment policy, we will post all but about 25 which violated our rules because they contained what the reviewers described to me as “profane language or personal attacks on your body parts, religion or family.” This is part of an ongoing debate in our country and there isn’t much new.
One thing I did find helpful was the clear explanation of the ideological basis of opposition to physician conscience. Mary Jane Gallagher, President of the National Family planning and Reproductive Health Association, was quoted in Congressional Quarterly’s HealthBeat saying,
“Family planning providers work to provide family planning services. So it’s really not acceptable to the people I represent that this administration is considering allowing doctors and nurses and pharmacists that have received their education to provide services to now be able to not provide those services if they don’t want to.”
“Who’s going to provide access to contraceptives services if the administration provides this large loophole to deny services?"
CQ reported Ms. Gallagher continued: “Providers are ‘given an oath—now they get to pick and choose what they want to do' if a regulation is issued, she said.”
So, according to Ms. Gallagher’s ideology, if a person goes to medical school they lose their right of conscience. Freedom of expression and action is surrendered with the issuance of a medical degree.
There is something I’d like to point out to Ms Gallagher and the people she represents. It is currently a violation of three separate federal laws to compel medical practitioners to perform a procedure that violates their conscience.
Obviously, some disagree with the federal law and would have it otherwise, so they have begun using the accreditation standards of physician professional organizations to define the exercise of conscience unprofessional and thereby make doctors choose between their capacity to practice in good standing and their right of conscience. In my view, that is simply unfair and a clear effort to subvert the law in favor of their ideology.
This is not a discussion about the rights of a woman to get an abortion. The courts have long ago identified that right and continue to define its limits. This regulation would not be aimed at changing or redefining any of that. This is about the right of a doctor to not participate if he or she chooses for reasons they consider a matter of conscience. Does the National Family Planning and Reproductive Health Association believe we can protect by Constitution, statute and practice rights of free speech, race, religion, and abortion—but not conscience?
Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?
I want to reiterate. If the Department of Health and Human Services issues a regulation on this matter, it will aim at one thing, protecting the right of conscience of those who practice medicine. From what I’ve read the last few days, there’s a serious need for it.
Posted on August 11, 2008 in Physician Conscience
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In the physician-patient relationship, trust is a key ingredient. The patient needs to be able to TRUST in the integrity and beneficence of his/her physician; otherwise, how can he be confident that his doctor will truly do his best and act upon his best wisdom and insight on behalf of the patient. In these days of managed care and frequent attempts to control costs by limiting access to care, a patient needs to know that the physician will not be influenced by the third party in recommending diagnostic or therapeutic actions.
Right of conscience laws to protect the physician (and other health care workers) are critically important to safeguard the trust between patient and doctor. Does a patient REALLY want a physician who will violate his integrity upon request from the patient? If I as a physician will do what I believe is wrong (medically or ethically) because the patient askes me to, how can my patient be sure that I will not do what I believe is wrong if the insurance company asks me to.
Patients and doctors do not always agree on what should be done; but the patient should always be able to trust that the physician is acting in accordance with his conscience. We must have safeguards so that physicians (and others) are not penalized for being persons of integrity.
Posted by: Priscilla Strom, M.D. | August 11, 2008 at 05:47 PMThank you, Sir.
Unfortunately, most doctors today did not take the oath that Ms. Gallagher refers to. However, if we had taken the traditional Hippocratic oath ("First do no harm, give no pessary for abortion, etc.")I'm not sure how it would help her cause. And I'm sure she would have us violate it.
Posted by: Beverly B. Nuckols, MD, MA (Bioethics) | August 11, 2008 at 05:53 PMBeverly Nuckols, MD, MA (Bioethics)
Family Medicine and Bioethics
New Braunfels, Texas
As a physician, I have been more than once approached by patients to refer for abortion. I don't believe in abortion. I will always make it clear to my patients that I will continue to treat them no matter what they choose, but that I don't agree with abortion. Some still choose to terminate their pregnancy; some choose to carry to term. As an adoptive parent, also, who was unable to conceive, it's very important to me that adoption remain a viable option. Why can I not talk to my patients about that? Why should I HAVE to refer someone for a procedure I feel is unethical? Legal or not? Just because I have been trained doesn't make it right. I also know how to end a life but does that mean I HAVE to refer someone for euthenasia? No, but that's only because it's not legal.
Posted by: Katherine Jones, MD | August 11, 2008 at 05:53 PMI am so happy that someone is finally taking a stand on this and helping us physicians be able to do what is right, not just what is legal. There are plenty of physicians in the USA who feel diffrently. Abortion is still legal. Don't make some of us do something against our morals.
Since you are such an old hand at the abortion wars, then surely you are well aware of the anti-choice tactic of defining abortion down -- the medically dubious assertion that pregnancy occurs before implantation. A great deal of the outrage over this proposed regulation centers on the potential of your department legitimizing this view under the guise of "protecting conscience," thus putting not only access to abortion, but access to necessary birth control, in jeopardy.
And nothing you have said so far contradicts that.
Specifically, I refer you and your readers to the portion of the HHS document -- available here: http://www.rhrealitycheck.org/emailphotos/pdf/HHS-45-CFR.pdf -- which reads: "A 2001 Zogby International 'American Values' poll revealed that 49% of Americans believe that human life begins at conception....the conscience of the individual or institution should be paramount in determining what constitutes abortion." It is commonly thought that some of the most common forms of birth control (like the Pill and IUDs) act after fertilization and before implantation. Setting aside the absurdity of using polling data to determine the definitions of medical terms, how can you possibly reconcile this with your claims that these new regulations are not intended to impact access to birth control?
So how about, Secretary Leavitt? Are you prepared to explain this, or issue an explicit, concrete denial that this new regulation will impact birth control? A lot of handwaving and misdirection about conscience and the Constitution is not a valid substitute for a substantive explanation.
Posted by: Dan Raybrig | August 11, 2008 at 05:56 PMTHANK YOU SECRETARY LEVITT for protecting the Moral Consciences of America's Doctors and Nurses - several of which have already stopped performing Abortions because of their agonizing consciences & their memories from those murderous operations. If America ever compels anyone to do what they feel is wrong - just because a powerful person makes a law that forces them - how then shall we draw the line between enforcing right & punishing wrong ? You can STAND TALL Sec. Levitt - because you have done what God says is right - and you have protected and honored LIFE above greed, profitability and convenience.
Posted by: John Ritsema | August 11, 2008 at 06:51 PMSecretary Leavitt,
Thank you for your efforts to support existing laws protecting the conscience rights of healthcare professionals. I recently graduated from medical school and will be an obstetrician/gynecologist--a profession strongly impacted by right of conscience laws.
As a pro-life physician, I am committed to protecting the lives of our most vulnearable patients--those who are not yet born. I, like many of my colleagues, believe that life begins at fertilization and I am grateful for the freedom to choose not to participate in procedures that violate my conscience such as abortion. On behalf of all physicians, I applaud your efforts.
This issue is of great importance to all physicians, whether pro choice or pro life. It is much larger than an "abortion issue." The laws that are set today will impact us as health care providers in future ethical decisions, such as physician assisted suicide. We all need to be able to practice in an environment that does not force us to practice medicine in ways that compromise our integrity, regardless of our individual convictions about abortion, euthanasia, etc.
Thank you for your courage and hard work. We need you.
Sincerely,
Posted by: Caroline Hedges, M.D., M.A. | August 11, 2008 at 06:55 PMCaroline Hedges, M.D., M.A.
I appreciate your strong defense of conscience rights. I believe this allows healthcare professionals a chance to actually live up to the part of the Hippocratic Oath about "Never do deliberate harm to anyone for anyone else's interest."
Posted by: Clark Hise | August 11, 2008 at 07:13 PMThank you so much, Secretary Leavitt, for taking a principled stand on physician conscience rights.
Posted by: Stephen Rotholz, MD | August 11, 2008 at 07:47 PMI think the VAST majority of pro-life OB-GYNs in the US have no problem whatsoever with providing contraceptive services and counseling. I have been in practice for 15 years and have written thousands of prescriptions for oral contraceptives. However, let's be blunt about who is truly being dishonest with the women of America.
The pro-abortion lobby tells you they are looking out for women and being honest with them. However, they routinely lie boldly to women seeking their services. They will tell a patient that their 10 week old baby (call it an embryo if you want to be technical, but it's a baby) is not really a baby yet but just a "smear of tissue" so they shouldn't feel badly about aborting it.
Check it our for yourself...nowhere do these salespeople of "choice" show their patients what a 10 week embryo REALLY looks like. They would see arms and legs and a face! They would see the baby move and realize it's not a "smear" but a tiny human.
Routinely, patients at their first obstetric visit in my office are shocked by how human these tiny babies look...because they've bought into the lies spead by the abortionists...
Please don't allow the pro-abortion lobby to destroy the joy of obstetric practice! I am one of only 4 OB/GYNs within a 150 mile radius of my little town in central Wyoming. I will not provide or refer for abortion ever. Laws that would seek to force me to do so are unethical and will destroy OB/GYN services all over rural America.
God Bless you and protect you in your efforts...surely you will face strong opposition...the just always do!
Thank you for speaking on true freedom of choice!
Why is it the "Pro-choice" (i.e. pro-death) crowd gets so touchy when another person is granted the freedom to exercize the freedom of their own conscience?
Posted by: James Witt | August 11, 2008 at 07:59 PMSince you are such an old hand at the abortion wars, then surely you are well aware of the anti-choice tactic of defining abortion down -- the medically dubious assertion that pregnancy occurs before implantation. A great deal of the outrage over this proposed regulation centers on the potential of your department legitimizing this view under the guise of "protecting conscience," thus putting not only access to abortion, but access to necessary birth control, in jeopardy.
And nothing you have said so far contradicts that.
Specifically, I refer you and your readers to the portion of the HHS document -- available here: http://www.rhrealitycheck.org/emailphotos/pdf/HHS-45-CFR.pdf -- which reads: "A 2001 Zogby International 'American Values' poll revealed that 49% of Americans believe that human life begins at conception....the conscience of the individual or institution should be paramount in determining what constitutes abortion." It is commonly thought that some of the most common forms of birth control (like the Pill and IUDs) act after fertilization and before implantation. Setting aside the absurdity of using polling data to determine the definitions of medical terms, how can you possibly reconcile this with your claims that these new regulations are not intended to impact access to birth control?
So how about, Secretary Leavitt? Are you prepared to explain this, or issue an explicit, concrete denial that this new regulation will impact birth control? A lot of handwaving and misdirection about conscience and the Constitution is not a valid substitute for a substantive explanation.
Posted by: Dan Raybrig | August 11, 2008 at 07:59 PMDear Sir,
Thank you for your strong defense for conscience rights! I appreciate you.
Posted by: Marcie K. Miller | August 11, 2008 at 08:02 PMSecretary Leavitt,
Posted by: Lawrence C. Cairns, MD | August 11, 2008 at 08:15 PMAs a practicing Obstetrician and Gynecologist for more than 30 years, I applaud your clarification of the issue of conscience. Now that it is clear that someone leaked an inaccurate rough draft, the concerns of most of the blog responders, already published, can be laid to rest. Those who pursue this as some sort of religious issue look pretty silly. Secretary Leavitt, you have hit the appropriate nail on the head. No one, regardless of training or professional sphere, should ever be forced, bullied, coerced or shamed into doing anything contrary to conscience. A clear conscience is a priceless possession – one that should not be trampled upon by the ideologies of others. Sadly for the lives of the aborted unborn, pregnant women will seek pregnancy terminations and will find practitioners who will end one life for the convenience of another. Lives of gravid women are rarely in mortal danger from their pregnancy – I can recall only one that came close in all my years of delivering babies, a condition that now can be treated successfully at no risk to the preborn baby. I have never felt that terminating a preborn infant’s life was necessary or in anyway beneficial to any mother to whom I rendered care. Legislating that any licensed medical professional must refer a gravid woman to a terminator, prescribe or provide abortifacient drugs, or move their practice close enough to an abortionist so as to not inconvenience a woman bent on ending the life of her own progeny, would be akin to legislating a call schedule for every practitioner to rotate through prison death chambers to administer intravenous lethal cocktails. A seared, calloused conscience can be transformed, reawakened and revitalized when a person takes accountability for his/her actions and, with help, turns the direction of their life around. However, a person forced, by whatever authority, to do what he/she knows is innately wrong, will face an uphill battle for healing of his/her violated conscience. The end result is three victims, not just two.
I greatly appreciate Secretary Leavitts stand on the conscience issue.We all should have the right to do or not do something that would go against our conscience.I am not a physician but i agree with the comment from Caroline Hedges,M.D.,M.A.,listed prior to mine.
Posted by: Patricia | August 11, 2008 at 08:25 PMIt is ironic to see the army of "choice" at war with the freedom of a health care professional to choose and adhere to an ethical stance. How many times have we heard that an abortion decision "should be between a woman and her doctor?" Apparently the consultation room is now a little more crowded, because the American College of Obstetrics and Gynecology wants to monitor that discussion.
Posted by: Mark Buchanan, MD | August 11, 2008 at 08:25 PMThe insistence that every physician must stand ready to refer a patient for abortion has little to do with the woman's access to abortion. Planned Parenthood has its shingle out in practically every county, and the Yellow Pages has a section where any woman can search for "Abortion Providers." A woman who really wants an abortion can find an abortion provider as quickly as a doctor can refer her.
Why then do ACOG and other abortion-rights advocates insist on forcing pro-life doctors into the process? Apparently, to forcibly silence all who disagree with them. This is an exercise of raw power by those who have been unable to persuade through reason. It is therefore appropriate that the civil authority, in this case the Secretary, step in to protect the rights of those whose consciences are being trampled.
I, too, want to thank you for your stand on protecting the rights of doctors and nurses. In the race to protect the rights of some, our laws don't always uphold the rights of everyone. Those who speak loudest prevail the most unfortunately.
Thank you
Posted by: Becky Bryan | August 11, 2008 at 08:28 PMThank you for considering regulations which would further protect medical practioners from being compelled to violate their consciences as they serve their patients. Such rules are essential to protect patients. As professionals, physicians are expected to not only be technically competent, but to practice with moral integrity. Patients should not be required to entrust themselves to the care of a physician who would disregard his or her conscience. All of us should have the opportunity to choose medical care that we can trust to respect our moral codes and convictions. This strengthens the doctor patient relationship which is so important for effective medical care.
Posted by: Karl Williams, MD | August 11, 2008 at 08:46 PMSecretary Leavitt,
I want to say thank you for taking a stand on this issue and bringing it to a place where people can post their thoughts.
I was born just prior to the Holocaust and remember the horror of what I saw when 6 Million Jews wer slaughtered by Hitler and the 3rd Rich.
Have you ever wondered why the word holocaust was chosen to describe this horrific act? If you look it up you will find that the word means a scrafice totaly consumed upon the altar.
There is a greater holocaust happening around the world and I have read where 6,000 babies are murdered every day. Where? In their mothers woumb. I have also read where it is estimated that 60 Million children have died since Roe vs Wade was ruled on by our Supreme Court.
I have often wondered if this holocaust is a sacrifice to the goddes or god of sex.
If this were happening to a animal, other than the humans (Yes I know that we are an animal) how many of the bleeding hearts would be up in arms to prevent it from happening.
I am not a medical professional, but I work daily to help people maintain a longer healthier life.
I believe that Drs. that hold life in their hand should strive to save and protect life instead of destroying lives.
Posted by: James Kinney | August 11, 2008 at 08:50 PMSecretary Leavitt,
A "zygote" as you may know contains 46 chromosomes. 23 chromosomes from the ovum and 23 from the sperm. Combined they form the beginning of life.
Thank you for supporting the protection of physicians' consciences.
Posted by: Romano Da Silva | August 11, 2008 at 09:22 PMRomano Da Silva
Thank you, Secretary Leavitt, for your position on supporting physician choice to follow their convictions and not be pressured by groups with a clear agenda. Thank you also for not falling into the erroneous belief that this issue is about a woman's right to choose. There are plenty of physicians that are willing to be involved in abortions, etc. so clearly the argument that this will block access is false.
As referenced above, it is clear that Ms. Gallagher is not familiar with the oath that we have taken as physicians that is, in fact, in line with physician choice than forced care.
Thank you again.
Posted by: Merlin Lowe, MD | August 11, 2008 at 09:31 PMPhysicians should be allowed (perhaps some would argue they should have the right) to practice medicine within the boundaries of their theological ideals. One should never be forced to perform an unconscionable procedure or practice that violates the foundation of what they believe. Such services can easily be obtained/provided by a different physician who does not object to said practice. The actions of of some professional medical societies appears to be a strategic move designed to coerce objecting physicians to "fall in line" or risk the consequences. And those consequences (being reprimanded or expelled from your specialty's national society) can have profound political, legal, social, and personal ramifications.
Posted by: | August 11, 2008 at 09:32 PMDear Secretary Leavitt,
Posted by: Stephen Adams, MD | August 11, 2008 at 09:33 PMThank you for your support of physician conscience rights. It seems that things are headed towards a new standard where there will be penalties for physicians who take their conscience seriously.
Stephen Adams, MD
Thank you so much, Mr. Secretary. Your forceful and entirely rational arguments for your conscience position are a breath of fresh air out of Washington.
My only objection would be your supporting by reference the notion that a "right" to abortion somehow exists, derived from our Constitution or any legitimate US legal source other than too many years of precedent related to what most legal scholars consider a terribly flawed decision (Roe v Wade 1973).
Posted by: Bob Reynolds | August 11, 2008 at 09:39 PMI have been practicing medicine for over 20 years. As part of our oath to practice medicine, we are to do no harm. If I violate my conscience at the request of my patient, colleague or organization, how can I keep my oath to do no harm. Surely the "harm" is not just physical. We have been trained to view the patient as a total person and that would include the physical, emotional, and spiritual aspects of him/her. If I felt that it would not be in my patient's best interest, then I should not be forced into complying. Specifically regarding abortion, we as physicians should not be forced to performing a procedure that violates our conscience. Thank you for letting our opinions be heard.
David McGehee MD
Posted by: David McGehee | August 11, 2008 at 09:41 PMThank you very much Secretary Leavitt for supporting the moral integrity of the physicians serving this country. I especially appreciate this as a young physician looking to start a practice sometime in the near future. A physician's moral integrity is important to both the patient and the physician and the value of human life. If that integrity is forced to be broken -the value of the patients care has greatly been devalued and compromised -no matter whose standards they are. Please continue to support the right for moral integrity and thus the value of the patient's care.
Posted by: Lydia Childress | August 11, 2008 at 09:44 PMI am a fourth year medical student. As I understand it, the current issue the Secretary is discussing is the idea that physicians should have the freedom to choose whether or not they will perform an abortion. This is an issue I have been following closely as it will greatly affect my decision to specialize in OB. I will not perform an abortion, and if I were required to do so, I would change my specialty. Even if that meant I had to return to residency. I know abortion hurts women and men because I have watched a college friend drop out of school and watched her boyfriend struggle to process the loss of his child and his relationship with his girlfriend because they chose abortion. I have taken two children into my home that were born to a struggling mother. They have a chance at life because she chose to give them that life. Abortion is not the answer and I fully believe that requiring physicians to perform them will decrease the number of practicing obstetricians. Ask any woman and she will very likely say that she would rather have an OB that will not perform abortions than no OB at all.
Thank you for your support of this issue Secretary.
Posted by: Bethany Shoemaker, MSIV | August 11, 2008 at 09:47 PMSecretary Leavitt,
It is beyond my comprehension that anyone would be offended by a health care professional who valued human life. But the tragedy is our culture has regressed to a form of barbarism unseen in centuries where progress in technology and science has poisoned our minds, hearts and souls where the intentional destruction of innocent and vulnerable human life has become more important than saving it.
Those of us living and working in a society where human life is expendable by government dictate but fail to stand up to protect and cherish life at any and all costs will live to regret it.
You are doing the right thing Secretary by allowing those of us in the health care profession live our moral and ethical consciences rather than forcing us to choose another profession.
Posted by: Elaine Biggerstaff, pro-life citizen | August 11, 2008 at 09:51 PMSecretary Leavitt:
I thank you for your position and the opportunity to comment on your views. While I have many concerns about President Bush's administration, and were he able to run for re-election, I would not vote for him, this is one issue I cannot agree more with.
As a medical student, I had the honor of being mentored by a rural family practice doctor who had to address this matter. He was comprehensive in his listing of options to his patient, and when he discussed the concept of termination was gentle and diligent, stating that his group did not terminate pregancies, but that the appropriate information was readily available in the community.
Later when selecting a residency, I was deeply torn between gynecology and radiation oncology. While I enjoyed very much the field, I did have the opportunity to observe a voluntary termination. These memories today are as vivid as the day I was in the clinic and I resolved that I could never facilitate in any way, passively or actively that procedure. The experience influenced me to discontinue OB training and enter radiation oncology. I have followed with concern and alarm ACOG's increasingly aggresive position and the report that came to your attention and this year quietly decided to allow my membership in ACOG to lapse, largely because of this report.
I think you are very correct in addressing this issue. Specialty societies hold incredible influence over the practice of the specialty and medicine in general. In the past, the specialty boards constrained themselves to questions of adequacy of knowledge and training. It is increasingly worrisome that the power and influence of these boards are now being used to attempt to shape both public policy and individual behavior. I think it is not only appropriate, but necessary to draw some limits.
Posted by: Walter Roberts, MD, MSc | August 11, 2008 at 09:54 PMSecretary Leavitt - You wonder why there has been such a reaction to the draft HHS purposal. If you ever had to carry a child to term or have an abortion or miscarriage, you may have more empathy. By redefining an abortifacient as an agent that prevents implantation, HHS will effectively rewrite the definition of pregnancy according to the medical community, including the FDA and ACOG (american college of obstetrics gynecology. But more importantly, millions of women engaging in routine methods of contraception (including BREASTFEEDING) would suddenly be considered to be possibly aborting the "unborn". You speak so strongly re: health professional rights - as a physician myself, I want to know about how this regulation will affect patient's rights. Until I see the final proposal, I remain wary and alarmed for all American women of reproductive age.
Posted by: Justine Wu, MD, MPH | August 11, 2008 at 09:54 PMJustine Wu, MD, MPH
Secretary Leavitt,
Posted by: Jacob W. Scheeres, MD FACS | August 11, 2008 at 09:59 PMThank you for defending the moral standards God has given us and our Constitution supports. Early in my career as a surgeon a determined mother brought her pregnant daughter to have an abortion. Counseling with the daughter and her fiance, both college students, allowed me to share with them the enormity of abortion. Thankfully, they chose to keep the pregnancy and both finished college as a family.
Thanks, Secretary Leavitt, for taking a stand for medical personnel -- and for all Americans who do not wish to act against their deeply-held personal beliefs.
God bless you!
Posted by: Dixie Bishop | August 11, 2008 at 09:59 PMSecretary Leavitt,
Posted by: Tracy Bradford | August 11, 2008 at 10:09 PMI am a pharmacist and appreciate what you are standing for in this fight. I have been faced with decisions in the past that have been tough, because I am torn between wanting to meet my patients needs and providing the pharmaceutical care that lets me sleep well at night. I applaud you and ask that you will continue your hard work.
Sincerely,
Tracy Bradford
Dear Dr. Leavitt
Posted by: Mark A. Walker, M. D. | August 11, 2008 at 10:14 PMThank you for all of your efforts to help protect healthcare workers as well as the American public from the potential for conscience discrimination. Unfortunately, ACOG and others are trying to persuade you and the HSS that these guidelines will only hurt the patient by restricting the pill and potentially abortion. You and many of us understand that it will just protect the physician and other healthcare workers from going against their moral beliefs. ACOG knows this as well, but they would like the public to think differently. Thank you for putting your reputation on the line for a morally true mission. May God continue to bless you.
I applaud your efforts to support physician freedom of conscience and the right to life of the unborn!
Thank you in behalf of my family (eight children, 28 grandchildren) and all American citizens who value the sanctity of life and religious freedom.
Posted by: Ann Olsen | August 11, 2008 at 10:17 PMIt is amazing to me that there is even a discussion as to whether an American Citizen has the right to exercise their own conscience. This goes for doctors and patients. I have the pleasure of serving citizens that have Substance Abuse Problems and Mental Illness. I have always been very careful to respectfully treat patients with these problems in such a way to clearly explain all the alternatives and options available to them to try and deal with their difficult diagnoses and problems. If they select a treatment that I provide, I willingly engage them in this process. If they choose to proceed with a treatment that I don't agree with, then I will assist them in finding a physician / provider that provides this alternative. Forcing me to provide a treatment that violates my right of conscience is definetly not what is best for the patient and requires me to give up an important Liberty. Liberty is defined on dictonary.com as "freedom from arbitrary or despotic government or control". I wish to retain my liberty and my patient's liberties in these matters. We must learn to honor and respect one another, even we have opposing points of view. Trying to force physicians to practice outside their conscience will result in a lot of early retirements, or is that a liberty that is also debatable?
Posted by: Anthony Burnett MD | August 11, 2008 at 10:22 PMDr. Priscilla Strom asked an important question:
Posted by: Jeannie Bath | August 11, 2008 at 10:23 PMIf she violates her conscience at the patient's request, how can she be trusted not to violate her conscience at an insurance company's request?
I don't know.
Secretary Levitt,
Thank you for inviting comments on this important topic.
I am a practicing physician who is morally opposed to abortion. I value the right to practice medicine in a way that allows me to both advocate for my patients and still hold onto that which makes me who I am - what I believe. I fear without these protections, there may be a day when physicians like myself cannot practice due to loss of licensure, or students with more conservative beliefs decide not to practice medicine.
Please continue to support our rights to conscience in medical practice.
Sincerely,
Matthew Bressie M.D.
Posted by: Matthew Bressie | August 11, 2008 at 10:40 PMThank you Secretary Leavitt for keeping the main thing, the main thing. That is the right of each of us to practice medicine free of prescriptions on what we MUST do for our patients. I, as a family physician, have cared for and continue to care for patient's whose action and behaviors, I do not approve of. I care for them and yet at the end of the day, we go our separate ways. I, however, have to live with myself and must reflect on my daily actions with my patients in light of my own beliefs, ethics and my desire for consistency. To be forced to do something that goes against those beliefs would eliminate one of the most important qualities my patient's want, the ability to trust me and for me to be consistent. Thank you for your proposal to maintain rules and regulations that will allow me to keep my integrity.
Posted by: Dale E. Michels, MD F-AAFP | August 11, 2008 at 10:41 PMThank you Sec. Leavitt, for your stand on protecting free moral conscience in the matter of allowing doctors and other medical practitioners to opt out of procedures which they believe are objectionable, specifically abortions on demand.
As a family therapist, I have seen first-hand the damage done to both individuals and families by hasty and desperate decisions to end "inconvenient/unplanned" pregnancies. I've also seen first-hand the joy and reward of choosing instead to give life the benefit of the doubt, and bring the baby to term, to either be raised by the bio family or by a loving adoptive family. Also, when given medical facts about prenatal development, and how the abortion procedure is done, most women I've dealt with, both personally and professionally, would choose life everytime for the baby.
For Katherine Jones: What you are saying sounds like fascism or, on the other end of the radical spectrum, Marxism, where people are not free to live as their consciences dictate, but instead are forced to do whatever the State requires. This is America, Dr. Jones, not Cuba or China.
Posted by: L Diane Black, MA, LMFTA | August 11, 2008 at 10:50 PMThank you Secretary Leavitt. As a recent medical school graduate I can attest to the fact that I entered this demanding profession with genuine altruism at heart. It is rather astonishing to me that there are organizations in this country that would force me, or my colleagues, to violate our consciences simply to promote their agendas. As you clearly stated, a Department of HHS regulation will not impact the legality of abortion but, rather, it will protect the integrity of those that wish to practice medicine guided by their own moral compass. I applaud your dedication to the health care providers of this great nation.
Posted by: Keith Proctor DO | August 11, 2008 at 10:55 PMThank you Secretary Leavitt, for standing up for the rights of health care providers not to have to go against their consciences. This right is equal in value to the rights listed in our Bill of Rights. John Adams said, "Our constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other." Our founding fathers knew that our rights come from God, not from man. When man decides our rights, man can take them away. Taking away people's right to choose to be moral will lead us away from what is left of our democratic republic.
Posted by: Ursula Berty | August 11, 2008 at 10:56 PMThank you for your good work. [edit]
Posted by: Ken LeRoy | August 11, 2008 at 11:02 PMIt is ironic that those who would argue most strongly for a woman's right to choose would deny the same right to Physician's and other healthcare providers. I practice in a small rural town in Minnesota. I have never in 25 years of practice referred a woman for an abortion. Patients who have come in requesting a referral have left understanding my position regarding the sanctity of life, and left with out being angry at me for following my conscience and not referring them to an abortion provider. The nearest provider of abortion services is 2-3 hours away, yet women intent on terminating their pregnancy find them without difficulty. In this information age a few clicks on the internet can provide information that was formerly available only to their family doctor.
Posted by: Steven Parnell MD | August 11, 2008 at 11:19 PMThank you Secretary Leavitt for your efforts to support existing laws protecting the conscience rights of healthcare professionals. As a physician, I realize we are here to preserve life, not destroy it.
It is funny how the very same people who fight to make saying the pledge during school voluntary are the same ones who fight to make the process of abortion involuntary.
We should remember that our rights of "life, liberty, and pursuit of happiness" are given to us by our Creator, or at least that is what is written in the Declaration of Independence. And although each person is entitled to his own opinion and way of life, please do not infringe upon the majority of us who wish to show some reverence to our Creator by opposing what is morally wrong.
Posted by: Thomas Bakondy | August 11, 2008 at 11:19 PMIt is very important that a physician or other health care provider not be compelled to violate his or her conscience in order to practice his/her profession. This includes both not being compelled to directly perform procedures that violate conscience, but also not being compelled to refer patients to other physicians/health care providers for the purpose of the patient obtaining what the first physician cannot in good conscience provide. Being forced to refer a patient for something that I believe to be unethical or harmful to my patient is the ethical equivalent to what in legal terms would be an accessory to the crime. I say ethical equivalent recognizing that we are discussing legal procedures.
Posted by: Patricia Lee June, M.D. | August 11, 2008 at 11:22 PMProtecting physicians' and other health care providers' consciences would not affect the legality of any procedure or medication that is now legal. Nor would it prevent any patient from seeking the procedure or medication from another physician or health care provider.
Medicine is both an art and a science. Since the time of Hippocrates, it has been recognized that physicians have an ethical obligation not to intentionally harm their patients, even if asked to do so by the patient. Eliminating physicians' conscience and judgment eliminates the art of medicine and makes us into mere automotons which is not in the best interest of our patients.
Patricia Lee June, M.D.
Thanks for your thoughtful comments and concerns about protecting our First Amendment rights. Patients understand that a physician will not violate his/her conscience but will provide information appropriate to the situation and encourage them to make the best decision with the information provided. They understand that they have the right to seek additional information and opinions from other physicians. I do not need to refer them or provide the service if it violates my conscience. Adequate resources are available for them to access the services they desire after they have considered the information they have received. There is no need to force me to violate my ethics and conscience.
Paul D. Wardlaw, M.D.
Posted by: Paul D. Wardlaw, M.D. | August 11, 2008 at 11:23 PMRegardless of whether or not a person takes one oath or another, governments should minimize and attempt to avoid forcing any person to act in a manner that is deemed immoral to that individual.
The morals of people may differ, thus totally avoiding such conflict may be impossible. But this clause allows people to act according to their moral beliefs. What if abortion and birth control weren't the major issues? What if a pharmacist was forced to fill a lethal prescription to an average person? I would hope they would have the chance to step in and object to dispensing it. To force a person to do so makes them party to what they perceive as homicide. But when the belief enters the realm of the womb and life at early stages, suddenly, there are people that insist that no one has the right to deny medical treatments.
Without such an exception present, I could never consider a career in the medical field. If I faced such a situation and someone objected to my refusal to treat them, I would be forced to abandon the career.
If patients seek certain medical procedures or medication and are refused, we live in a free-market society. They can go elsewhere. If they live far from anyone that provides what they want, they are free to move to an area that does provide what they want. If this seems to burden the poor, remember that the poor can actually be more mobile than the rich, as they can pack up and move often in minutes or hours rather than days or weeks. People will quickly realize whether their medical providers are willing to continue providing the products and services they have in the past. If they don't like things, they can look elsewhere.
Posted by: Jim Burke | August 11, 2008 at 11:37 PMSecretary Leavitt,
Posted by: Robert W. Bruechert DMD | August 11, 2008 at 11:38 PMThank you for your excellent comments. Your statement connecting freedom of speech, etc to conscience rights seems obvious, but is being so glibly denied by abortion rights supporters. I wonder if Dr Jones, in her comment above, has considered that a physicians right of conscience (personal integrity) could be more important than a persons ease of access to birth control (although i see the concerns about access as a red herring).
I urge you to continue your efforts to pass the regulations to enforce existing law.
Sincerely,
Robert W. Bruechert DMD
Secretary Leavitt,
Thank you for addressing this important issue, and thereby creating the opportunity to potentially defend and protect the conscience rights of physicians who are caught in the midst of a tumultuous societal issue.
I clearly remember that the first lesson taught on day one of medical school, and repeated throughout the four years was: "First, do no harm." As a physician who is "pro-life" from a medical, scientific, biological, social, and religious perspective-- elective abortion remains for me and apparently to many other medical practitioners as well, just that: doing harm by taking of innocent life.
Why should my arm be "twisted" to "indirectly" provide a "service" which I find abhorrent and indefensible?
The shear audacity of the notion that a medical practitioner will ultimately be indirectly "coerced" or directly "forced" by different private or public entities to practice in a manner which violates his/her conscience is particularly troubling, is un-American, violates existing laws, should not progress in any way, shape, or form-- and should unhesitatingly be stopped.
Posted by: Andrew Florea, M.D. | August 12, 2008 at 12:03 AMSecretary Leavitt,
Thank you for bringing up this very important topic. It is not only important for physicians and pharmacists to have their rights of conscience protected but support staff as well. As a physician assistant (PA) I am able to perform medical procedures, assist in surgery and prescribe medications under the authority of my supervising physician.
Not all PAs are as fortunate as I to have a supervising physician with similar morals and values. They may refuse to perform a service they disagree with, on moral grounds, and later be sanctioned or disciplined. Furthermore, to practice in a hospital setting we all are required to go through background checks and credentialing to receive "privileges" to perform our jobs within a hospital. Again, if we are required by the hospital to perform a procedure, assist in a surgery, or prescribe a medication that conflicts with what our conscience dictates, we have limited recourse (as we work as subordinates) and may end up losing our privileges or our jobs. These scenarios may be extrapolated to other staff members such as Nurse Practitioners, Registered Nurses, Surgical Assistants, Medical Assistants, etc.
As support staff we are less protected than physicians by state and federal laws. We, too, need to be protected with comprehensive "right of conscience" laws extending to all members of the healthcare team.
Thank you for your interest in this very timely subject.
David Brunk, MMS, PA-C
Posted by: David Brunk, MMS, PA-C | August 12, 2008 at 12:17 AMSecretary Leavitt,
Posted by: Timothy Donahue MD | August 12, 2008 at 12:24 AMThank you for trying to protect the right of conscience of physicians. I have been fortunate to have been able to op out of being involved in treatments that I feel are morally wrong. However, I can forsee the possibility that either a loss of job or decreased payments could occur if I do this in some other situation. The abortion lobby believes that their right to abortion is the same as the right to life as laid down in our founding documents. However, I believe there is no such right to a morally wrong procedure like this. As long as we are in a free country, I believe we should be able to work without violating these moral rights and not be coerced into doing things that violate our conscience. If that day comes in our country, then we will have passed into a new era much like the many repressive dictatorships we read about around the world. There are plenty of doctors available to carry out the desires of the abortion industry. Please don't make us servants to their bidding by abolishing the conscious rights of doctors.