Healthcare Right of Conscience

1. Healthcare Right of Conscience David Stevens, MD, MA (Ethics) CEO Christian Medical & Dental Associations

2. Definition: The freedom to practice healthcare in accordance with your deeply held religious, moral or ethical convictions.

3. Don’t be CONFUSED • Health Right of Conscience is not refusing to treat because you don’t like or approve of the patient, their beliefs, attitudes or behavior. • It is exercised when a healthcare professional is being asked or required to participate in or facilitate some way an action they believe violates their ethical, moral or religious beliefs.

4. Protection of someone’s right to object does not equate with support for that position. • Indeed, we must pay special attention to protecting the rights of others when we do not support their position.* But I DON’T AGREE! • *(Claims of conscience rights can be abused)

5. This is Not a New Issue In Healthcare Moral Debate 2500 Years Ago • I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. But in purity and in holiness, I will guard the sanctity of life and my role as healer. Hippocratic Oath, 429 BC

6. What Right? Congress shall make no law respecting religion or prohibiting the free exercise thereof… First Amendment

7. James Madison

8. The rights of conscience we never submitted, we could not submit. We are answerable for them to our God. I consider the government of the U.S. as interdicted by the Constitution from intermeddling with religious institutions, their doctrines, discipline, or exercises. Thomas Jefferson

9. Conscience is the most sacred of all property the exercise of that, being a natural and unalienable right. JAMES MADISON The Religion of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate.

10. Federal Law • Church Amendment • Public Health Services Act • Medicare/Medicaid • ACGME Law • Weldon Amendment Limited to federally funded programs. No enforcement provisions.

11. State Laws on ROC • 45 States have some sort of ROC laws • State by State Laws - http://www.consciencelaws.org

12. AMA reaffirms that neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical practice. • Except in emergencies, physicians shall be free to choose whom to serve, with whom who to associate and the environment in which to provide medical care.

13. Everyone shall have the right to freedom of thought, conscience and religion. This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching. United Nations INTERNATIONAL COVENANT ONCIVIL AND POLITICAL RIGHTS

14. The physician should be free to make clinical and ethical judgments without inappropriate outside interference. • Everyone has the right to freedom of thought, conscience and religion; this right includes… freedom …to manifest his religion or belief in worship, teaching, practice and observance.

15. Pharmacist have a duty to act with conviction of conscience. • Code of Ethics, APhA. the right of pharmacists… to decline to participate in therapies they consider to be morally, religiously or ethically troubling. - American Society of Health-System Pharmacists

16. With All These Protections What is the Problem?

17. RIGHT OF CONSCIENCE IS UNDER ATTACK

18. A threat to reproductive rights It’s the “Right of Refusal” While we firmly believe that all people have a right to their own opinions and moral beliefs, it is unethical for healthcare providers to stand in the way of a woman’s access to safe, legal and professional healthcare. Health related decisions made between a provider and patient should be made on the personal welfare and healthcare needs of the patient - not the morals or belief of the caregivers.

19. That is, a patient's very ability to choose these procedures or medications is dependent upon the existence of a doctor who is willing to facilitate whatever choice the patient makes. Consequently, a doctor's unwillingness to act in a particular way due to her conscience becomes a barrier to a patient's self-realization.

20. Efforts to Abolish Laws • Abortion Access Project • ACLU - Reproductive Freedom Project • PCRC -Pro-Choice Resource Center • Spotlight Campaign • Merger Watch • Maryland NARAL Hospital Provider Project • Planned Parenthood

21. Attacks on ROC • Alaska (1997) - Valley Hospital Assoc. • California (2003) – Benitez v. North Coast Women's Medical Care • Illinois (2005) – Gov. Rod Blagojevich • Washington (2007) - Pharmacy Regs. • Many More

22. ACOG Committee Opinion # 385 • Patient autonomy final arbitrator for Rx • Right to Demand Rx = Right to Refuse Rx • ROC is just a personal opinion • Moral obligation to pt. over rides ROC • Inconvenience imposes provider’s beliefs on pts. • Patient’s concept of well-being trumps • Physicians must refer for abortion • If they can’t timely refer, must provide • Those who refuse to provide abortions should only practice in areas where abortion services exist.

23. American Board Of Obstetrics & Gynecology • New policy issued in January 2008: certification contingent on compliance with ACOG ethical principles. • Under pressure reversed in 1/09.

24. HHS Policy Protecting Right of Conscience Effective January 20, 2009 Can’t “discriminate in the employment, promotion, termination, or the extension of staff or other privileges to any physician or other health care personnel because he performed, assisted in the performance, refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.”

25. Anaphylactic Reaction • By pro-abortions groups, some politicians and media • False claims, • e.g., women will not be allowed contraception • Media blitz • Legal action taken • 1/15/09 - PP, ACLU, 7 State Attorney Generals file suit in CT to overturn

26. Overturning HHS Regulations • February 2009 • President Obama announces he will rescind the regulation • April 9, 2009 • -30 Day Public -Comment Period ends • 300,000 comments • All reference to regulations taken off HHS website. • Gutted 2/11 The Washington Post reports that the Department of Health and Human Services gutted most of a federal regulation that in 2008 broadened existing conscience protection rules.

27. Church, Weldon and other laws only apply to annual HHS appropriations • Reform bill only protects physicians from insurance companies coercing them to do abortions • No protection for other professionals • No protection from other groups • No protection on other issues

28. But Is This Really Effecting Healthcare Professionals?

29. CMDA Faith Focused Healthcare Professionals Survey • 40% report being pressured to compromise convictions • >43% know someone else who was pressured • >24% have lost position, promotion or compensation as a result • >88% think the problem is getting worse Survey of 2,400 Physicians, Nurses, Pharmacists, etc.

30. NURSE ‘FORCED’ TO HELP ABORT – NYPOST.com April 29, 2010 NEW YORK — Alliance Defense Fund attorneys filed a lawsuit Friday against Mt. Sinai Hospital in New York state court on behalf of a nurse forced to participate in a late-term abortion procedure under threat of disciplinary action, including possible termination and loss of her license. Nov. 24, 2010 NEW YORK - However, in today's ruling the court found that there is no right to private action or private remedy under the statue cited by DeCarlo in her suit - the so-called "Church Amendment.” Her suit was summarily dismissed. Ms. Cenzon-Decarlo

31. 12 Nurses Accuse UMDNJ of Forcing Them to Assist in Abortion Cases November 11, 2011 NEWARK, N.J. – “One, Fe Vinoya, a nurse for 21 years, said she and her fellow 15 plaintiffs “have dedicated our lives to helping patients. Our managers told us very clearly that all same-day surgery unit nurses must immediately begin training in and assisting abortion patients, including all aspects of those patients’ care during their visit,” she said. “They did this in spite of our repeated effort to tell them we had religious and moral objections. They said very clearly that if we did not assist we would face termination.” December 11, 2011 ABC News – “Twelve nurses who sued one of the state’s largest hospitals after claiming they were forced to assist in abortions over their religious and moral objections reached a deal Thursday with their employer in federal court. Under the agreement, 12 nurses in the same-day surgery unit of the University of Medicine and Dentistry of New Jersey can remain in their current positions and not be compelled to assist in any part of an abortion procedure.” Ms. Fe Vinoya

33. Secretary of HHS • Authority -> Preventative Care Coverage • Must provide all FDA Approved Contraceptives • Unless Religious Employer: • (a) Whose purpose is the inculcation of religious values;(b) That primarily employs persons who share the religious tenets of the employer;(c) That primarily serves persons who share the religious tenets of the employer; and(d) That is a nonprofit organization under section 6033(a)(2)(A)(i) or (iii) of the IRS Code

34. What Do American’s Think About This Issue • 88% Americans say it is important that they have a similar set of moral beliefs as their healthcare professional • 87% oppose forcing professionals to violate their moral objections • 63% support conscience regulations • 54% less likely to vote for Congressman that oppose ROC The Polling Company,

35. On some positions cowardice asks the question, 'Is it safe?' Expediency asks the question, 'Is it politic?' Vanity asks the question, 'Is it popular?' But conscience asks the question, 'Is it right?' And there comes a time when one must take a position that is neither safe, nor politic, nor popular. But ... because it is right.

36. To Kill A Mockingbird Harper Lee, 1960 _______________ The one thing that doesn't abide by majority rule is a person's conscience.

37. If we don’t protect personal integrity, we would go down a dangerous avenue. By taking a professional license you do not step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person. Linda Rankin, Bioethicist, U of TN In Christian Science Monitor

38. "Must the citizen ever for a moment, or in the least degree, resign his conscience to the legislator? Why has every man a conscience then? I think that we should be men first, and subjects afterward. The only obligation which I have a right to assume is to do at anytime what I think right." • --Henry David Thoreau, Civil Disobedience (1849)

39. Conscience & Healthcare • Is our healthcare system in need of more conscience-driven doctors or more "ethically neutered" doctors? • Do we want medical schools to systematically strip our future doctors from any and all religious and ethical convictions that have not been approved by the state? • Your doctor's conscience may some day be the last line of protection between you and those who would profit from your early death.

40. Why Don’t Some MD’s Refer? • Referral means: • I endorse the competency, judgment and ethics of the doctor to whom I’m referring. • I enter into a professional relationship with that doctor. • I will receive a report back from him. • I believe they will “do no harm.”

41. Moral complicity with evil does not exist when all the following conditions are satisfied: • our intent is for good; • the association with the past or present evil is sufficiently uncertain, or the act is sufficiently distanced from the original evil act; and • the action does not reward, perpetuate, justify, cooperate with, or ignore the original evil.

42. What will convince them? This, and this only: cease to call slavery wrong and join them it right. And this must be cone thoroughly – done in acts as well as words. Silence will not be tolerated – we must place ourselves avowedly with them…. The whole atmosphere must be disinfected from all taint of opposition to slavery, before they will cease to believe that all their troubles proceeds from us. Abraham Lincoln Cooper Union address of 1860

43. The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last. Crispin Sartwell Los Angeles Times 9/2/08 Self Described “Pro-Choice Atheist”

44. SPEAKING OUT – Freedom2Care.org • Represents 50 organizations • Education & Mobilization • Blogs, Twitter, Facebook • Polls/Surveys • 95% of faith based healthcare professionals would quit medicine before violating their conscience

45. <freedom2care.org> • <cmda.org> • Ethics Statements, PP’s, Standards for Life, “Just Add Water”,DVD’s • <consciencelaws.org> • “Protecting the Health Care Provider's Right of Conscience”Teresa Colette, JD <chbd.org> • Issues of Conscience Laurel Hughes