09 April 2008

Check Your Conscience At The Exam Room Door.

Pro-Life Doctors: A New Oxymoron?

By Christopher Kaczor

From First Things - "On the Square" Tuesday, April 8, 2008, 5:43 AM

In November 2007, the Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion # 385 entitled, “The Limits of Conscientious Refusal in Reproductive Medicine.” The committee opinion sought to “maximize accommodation of an individual’s religious or moral beliefs while avoiding imposition of these beliefs on others or interfering with the safe, timely, and financially feasible access to reproductive health care that all women deserve.”

Unfortunately, the balance struck by the committee between the right of conscience of physicians and the reproductive health care of women so emphasizes patient autonomy that it turns physicians into medical automatons forced to act against their best ethical and medical judgment. As pointed out on March 14, 2008, by Health and Human Services secretary Mike Leavitt: “The ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification.” Put simply, committee Opinion 385 could be the end of the pro-life doctor.

According to the ethics report, physicians objecting to abortion or contraception must refer patients desiring such services to other providers (recommendation # 4); may not argue or advocate their views on these matters though they are required to provide prior notice to their patients of their moral commitments (recommendation #3); and, in emergency cases or in situations that might negatively affect patient physical or mental health, they must actually provide contraception and/or perform abortions (recommendation #5, emphasis added).

In order to justify these recommendations, the committee appeals to an idiosyncratic conception of ethics and conscience. The ACOG guidelines implicitly view ethics as a matter of private emotion and sentiment, rather than as common rationality and shared practical wisdom. Against Kant’s unconditional command, Newman’s magisterial dictate, and Butler’s famous dictum (”were its might equal to its right, it would rule the world”), the ACOG committee makes conscience a mere prima facie guide. “Although respect for conscience is a value, it is only a prima facie value, which means it can and should be overridden in the interest of other moral obligations that outweigh it in a given circumstance.”

This peculiar account of conscience stands in no small tension with the view expressed by Antigone in Sophocles’ tragedy, Socrates in the Crito, and Aquinas in the Summa Theologiae. Traditionally, conscience is the supreme proximate norm for human action precisely because it represents the agent’s best ethical judgment all things considered.

The ACOG’s own previous policy positions imply a very different understanding of the nature, scope, and claims of conscientious judgment, including the judgment that a proposed treatment is not in the best interest of the patient. In earlier statements, the ACOG defended the individual judgment of the physician in determining what is medically indicated as a buttress against laws criminalizing partial-birth abortion. If an individual doctor believes it is in the best interest of the patient’s health to perform a particular method of abortion, then this judgment must be defended. The ACOG Statement of Policy on Abortion (reaffirmed in 2004) affirmed that partial-birth abortion “may be the best or most appropriate procedure in a particular circumstance to save the life or preserve the health of the woman, and only the doctor in consultation with the patient, based on the woman’s particular circumstances, can make that decision. . . . The intervention of legislative bodies into medical decision making is inappropriate, ill advised, and dangerous.” Here the ACOG holds that the judgment of the physician is paramount in determining what is or is not medically indicated.

Some physicians, however, refuse to perform abortions and/or provide contraceptives precisely because in their view, having examined the empirical evidence, such as the recent Royal College of Psychiatrists statement on women’s mental health and abortion, these practices contradict the best interests of their patients. In such cases, the ACOG proposes to override their best medical judgment in favor of “standard care” as determined by the ACOG. It would seem that the conscientious judgment of the individual physician chosen by the patient is paramount only when this facilitates abortion.

Here's the whole thing.
 

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