UNDER ATTACK! Conscience Rights: Healthcare Providers’ Right to Refuse to Kill
By Ralph A. Capone, M.D. and Julie Grimstad
Conscientious objection, when exercised by healthcare practitioners, is a refusal to provide a legal “medical service” (such as abortion or assisted suicide) that conflicts with their deeply held religious or moral convictions.
Calls to Exclude Conscientious Objectors from Medical Practice
On February 6, 2015, the Supreme Court of Canada struck down the federal law prohibiting assisted suicide and euthanasia. Subsequently, Canadian lawmakers passed legislation to permit “medical assistance in dying,” the euphemism assisted suicide advocates employ to avoid the word “suicide.” The law went into effect in June 2016. Many healthcare practitioners, exercising their conscience rights, have refused to participate.
The Journal of Medical Ethics, April 27, 2016, published an essay entitled “Why medical professionals have no moral claim to conscientious objection accommodation in liberal democracies.” It was written by Udo Schuklenk and Ricardo Smalling, colleagues at Queens University in Ontario, Canada. Schuklenk is a professor of philosophy at Queens, but more importantly, he is co-editor of Bioethics, one of the world’s leading journals in the field. Schuklenk and Smalling contend that “conscientious objection has no place in the practice of medicine.” Their abstract states, “We discuss common counterarguments to this view and reject all of them.”[i] In other words, there isn’t a single reason they would accept for a healthcare provider to follow the dictates of their conscience in their practice of medicine.
This is genuine irony. It is almost impossible to believe that academia has become so blinded or hard-hearted that the authors’ contention is, in fact, accepted by the “illumined intelligentsia” and published in a once serious scholastic journal. A classically liberal democracy is one in which freedom is maximized for all. Nevertheless, Schuklenk and Smalling assert that such a liberal democracy tolerates no freedom for individuals who dare to dissent from the left’s progressive agenda, better known as the culture of death.
In June 2016, a group of influential bioethicists and philosophers met in Geneva, Switzerland, to participate in a workshop on conscientious objection in healthcare. At its conclusion, more than a dozen bioethicists signed a ten-point “Consensus Statement.” The “ethical guidelines” these bioethicists propose boil down to this: “Healthcare practitioners’ primary obligations are towards their patients, not towards their own personal conscience.” Further, they believe “a patient’s desire for a legal, professionally sanctioned medical service” should override a healthcare practitioner’s personal conscience. “When they have a conscientious objection,” these bioethicists declare, “they ought to refer their patients to another practitioner who is willing to perform the treatment. In emergency situations, when referral is not possible, or when it poses too great a burden on patients or on the healthcare system, health practitioners should perform the treatment themselves.” Even more troubling is their stance on training new practitioners: “Medical students should not be exempted from learning how to perform basic medical procedures they consider to be morally wrong.”[ii] [Stress added by authors.] “Basic medical procedures” include abortion by various methods, terminal sedation accompanied by patient starvation and dehydration, and, wherever legal, prescribing drugs for assisted suicide and lethal injections.
These and other “ethical guidelines” proposed by bioethicists in the last few years demonstrate the escalation of efforts to coerce healthcare professionals to accede to immoral societal and patient demands. Those individuals who unwaveringly resist coercion will be either marginalized or disqualified altogether from carrying out their professional duties within a moral framework that values human life.
Secular Bioethics and the Corruption of Medicine
Just a few decades ago (within our memory), every person who joined the medical profession understood that intentionally killing patients is wrong. Medical ethics was initially based on natural law. This was articulated by the ancient Greeks and codified by Hippocrates whose Oath prohibited the deliberate killing of patients because of the recognized inherent value of human life. Later, the work of the Church fathers (e.g., Augustine and Aquinas) Christianized this understanding of natural law. From their work several core principles were articulated, including human dignity–arising from man being made in God’s image (imago Dei)–and the resultant concept of the sanctity of life. Secular society, too, protected human life, especially in the legal and medical professions. Historically, society revered human life based on the general consensus that human life, itself, is special. As such, the common good is best served by establishing laws, principles, and practices that value and safeguard each and every human life.
Bioethics, which emerged in the 1960s, has become a secular field of study, untethered from the theological roots of medical ethics. Efforts by Christian bioethicists to accommodate humanistic ethics and to influence it have mostly failed. Most affected is the concept of the dignity of the human person based upon inherent qualities (endowments from God) that cannot be taken away by governments or other third parties. The right to life is one of these intrinsic and inalienable qualities at much risk today. Further, since the advance of secular bioethics over the past 50 plus years, and especially with the legalization of abortion in many countries, the once high ideals of an independent medical profession have been steadily corrupted. The secular culture has co-opted medical ethics to serve its own purposes, hostile to God’s authority and remarkably anti-Christian.
In fact, most bioethicists today embrace a secular, post-Christian, utilitarian (an unproductive person is a useless person) philosophy. Viewed through this “quality of life” lens, human lives burdened by advanced years, serious illness, or special needs are regarded as no longer worth protecting, nor worth the cost necessary to care for them. And lives judged “worthless” are disposable.
For example, in 1993, Dr. Ezekiel Emmanuel, the physician and ethicist who was to become the architect of the Affordable Care Act (a.k.a., Obamacare), wrote in the American Journal of Medicine: “…increasingly it will be our collective determination as to what lives are worth living that will decide how incompetent patients are treated. We need to begin to articulate and justify these collective determinations.”[iii]
When patients who have never expressed a wish to die are judged incompetent (that is, unable to make their own decisions), bioethicists, like Dr. Emmanuel, want to rely on “collective determinations” to decide their fate. On the other hand, for those supposedly competent individuals who ask for help to commit suicide or to be killed, such bioethicists promote a radical personal autonomy, not a group decision. The bottom line is, if you fall in line with what the culture promotes, you get to decide. If you are unable to speak for yourself or if you resist what the culture promotes, then a “collective determination” is called for. There is so much wrong with this notion that it is hard to believe it was ever advocated. Talk about fascism!
This illustrates the often denied “slippery slope” that accompanies the legalization of euthanasia. The freedom of individuals to choose death for themselves gradually becomes a duty to die where others decide, in the words of Dr. Emmanuel, “what lives are worth living.” Thus, the attack on physicians’ conscience rights can extend to an assault on patients’ conscience rights, as well as their right to life. This is just plain DANGEROUS for everyone.
Do we want a healthcare system in which the only doctors available are those willing and trained to kill us? And the only socially acceptable choice for physically or mentally incapacitated individuals is to unburden society by choosing their death?
Or, do we want a just healthcare system, one that protects patients, doctors, and other healthcare providers who value human life, and one that rejects expanding the scope of healthcare to include harming (i.e. killing) patients.
Combating Attacks on Conscience Rights
Dark days are imminent for Christian healthcare providers and others who stand firm in their belief that medical killing is immoral. These individuals risk legal, professional, and financial punishment. Nevertheless, there may be reasons for hope.
In Vermont, where assisted suicide was legalized (Act 39) in 2013, a federal court dismissed a lawsuit brought against officials at the Board of Medical Practice and the Office of Professional Regulation who interpreted Act 39 in a manner that infringes upon the conscience rights of healthcare workers. The Alliance Defending Freedom (ADF) is now exploring legal options for conscientious objectors.[iv]
Representing the Vermont Alliance for Ethical Healthcare and the Christian Medical and Dental Association, ADF Senior Counsel Steven H. Aden stated, “Vermont health care workers just want to act consistently with their reasonable and time-honored convictions without fear of government punishment.” LifeNews, April 5, 2017, reported, “As the brief in support of the requested motion for preliminary injunction in Vermont Alliance for Ethical Healthcare v. Hoser explains, ‘Vermont’s Act 39 makes the State the first and only one to mandate that all licensed healthcare professionals counsel terminal patients about the availability and procedures for physician-assisted suicide, and refer them to willing prescribers to dispense the death-dealing drug. Act 39 coerces professionals to counsel patients about the ‘benefits’ of assisted suicide–benefits that Plaintiffs’ members do not believe exist–and in addition stands in opposition to a federal law protecting healthcare professionals who cannot participate in assisted suicide for conscientious reasons.’”[v]
There is good news on another front. Last month (March 2017), Arizona’s legislators approved a bill (SB 1439) “intended to protect medical professionals and the facilities where they work from discrimination if they refuse to assist in end-of-life procedures” (such as removing a feeding tube in order to cause or hasten a patient’s death) and Governor Doug Ducey signed it. The bill was supported by the Legislature’s Republicans and, unfortunately, opposed by Democrats.[vi] Assisted suicide is not legal in Arizona, but, presumably, this bill would protect objecting healthcare practitioners in the unhappy event that it is ever legalized in the state.
Call to Action
Let’s speak out–loudly and clearly–in every state and every nation. Let’s tell our leaders to enact laws that protect the conscience rights of doctors and all healthcare professionals, and to put teeth in those laws so they will be enforced.
We must do this to renew and strengthen the integrity of the once-revered medical profession.
We must do this because, if we do not, doctors, nurses and other healthcare providers of good conscience will be prevented from practicing in the future, leaving only those willing to dispose of a life–your life or the life of a loved one.
As important as the preceding reasons are, it is even more imperative that we do this to proclaim the truth of the immeasurable worth and dignity of every human life, now, in our lifetime, and to safeguard the splendor of this truth for our children and for all generations to come.
Note: “The Health Care and Conscience Debate” by Luke W. Goodrich, is an excellent explanation of federal law/regulations regarding the conscience rights of healthcare providers.[vii]
About the authors: Ralph A. Capone, MD, FACP, is board-certified in Hospice and Palliative Medicine and Internal Medicine, and presently teaches Catholic Bioethics at St Vincent College and for the Diocese of Greensburg, Pennsylvania. Julie Grimstad lives in Bedford, Texas, is executive director of Life is Worth Living, Inc., coordinator of St. John’s Befrienders (outreach program to nursing home residents and homebound elderly), a speaker and writer on healthcare issues, and editor of the PHA Monthly. Julie has served as a volunteer patient advocate for 31 years.
[iii] American Journal of Medicine, January 1993, Vol. 94, p. 115