Choice For Me, But Not For Thee

Health care provider conscience laws began to appear on the federal books shortly after the United States Supreme Court decided Roe v Wade in 1973.  These statutory provisions protect health care professionals from discrimination if they refuse to participate in abortion and sterilization services on the basis of religious or moral objections.

In 2008, the Bush administration issued a rule strengthening the requirements for compliance with the conscience protections set forth in the Public Health Service Act, the Church Amendments, and the Weldon Amendment.  Widely criticized as a nose-thumbing anti-abortion swan song for President Bush, the eleventh hour ruling was actually in the works for most of 2008.

Mike Leavitt, Secretary of Health and Human Services at the time, pushed for the regulation in response to a move by the American College of Obstetricians and Gynecologists (ACOG) and the American Board of Obstetrics and Gynecology (ABOG) to require pro-life physicians to provide abortion referrals as a condition of board certification.  Concerned that the ACOG and ABOG policies violated freedom of conscience and non-discrimination laws, HHS issued the final interpretive rule in December 2008.

The new administration moved swiftly to begin the rescission process when President Obama took office.  But, as Tabitha Hale points out, while the interpretation of conscience laws may change significantly under the Obama administration, it is highly unlikely that pro-life doctors will be forced to perform abortions any time soon.

And that just doesn’t sit well with Jacob Appel.  He’s a storytelling bioethicist with a fever, and the only cure is more abortionists.

You may remember Jacob Appel from his recent call for an abortion pride movement.  His latest lament is that the number of abortion providers has steadily decreased, and yet pro-life medical practitioners are still permitted to take up valuable slots in OB/GYN training programs.  He proposes that medical programs help abortion providers increase their ranks by using a pro-choice litmus test to screen OB/GYN residency applicants.

Using religious and moral objections to abortion to bar qualified doctors from receiving training in obstetrics and gynecology is a clear violation of conscience protection laws, but Appel has an answer for that.

In the case of abortion, the current shortage of providers justifies a limited waiver of conscience exemptions as applied to the training of new OBGYNs.  If we do not act, women may find themselves in a position similar to that of the criminal defendant who in theory has the legal right to counsel, but cannot find any lawyer willing to take her case.

Appel does not bother to address why a doctor who intends to specialize in geriatric gynecology, for example, would need to perform abortions.   He also neglects to consider that pro-life doctors are not the only ones who refuse to terminate pregnancies. Indeed, there are many pro-choice physicians who are just as unwilling to provide abortion services.

But the greatest flaw in Appel’s argument is his contention that he is a champion of patient choice and access.  Appel is only interested in ensuring choice and access for women seeking abortion doctors, not for women seeking doctors who respect their beliefs because they share them.

A woman should be able to choose a doctor whose moral compass points in the same direction as hers. Families should know that their doctor shares their values and will remain faithful to them, especially in a life or death situation.  Revoking conscience protections would revoke patient choice, a violation that would offend more pro-choice liberals if they were, at the very least, concerned with being consistent.

Most liberal feminists would balk at receiving gynecological care from a dedicated pro-lifer.  Shouldn’t pro-life women be able to choose a doctor who doesn’t engage in professional practices they find morally objectionable?

Appel’s essay is not a harmless, isolated intellectual exercise.  His views are shared by many of the liberal feminist chatterati, including some in the medical community.

Dr. Julie Cantor, for instance, feels conscientious objection in medicine has gone awry, and that we, as a society, are far too tolerant of individual conscience.  Like Appel, she believes that “physicians and other health care providers have an obligation to choose specialties that are not moral minefields for them. Qualms about abortion, sterilization, and birth control? Do not practice women’s health.”  She feigns passionate support for putting patients’ interests first, but not so shockingly, that support does not extend to choosing a doctor one doesn’t consider an agent of death.

A doctor’s conscientious refusal to perform an abortion does not strip a patient of her constitutionally protected right to seek an abortion, not even if she has to get an advance on her paycheck and shimmy across the frozen tundra on her pregnant belly to reach the closest abortion provider.  The government is not your mom, your BFF, and your knight in shining armor all rolled into one convenient, omnipresent package.

There is, without a doubt, a demand for abortion providers in America.  There is also a demand for doctors whose work is informed by a pro-life perspective on abortion, contraception, sterilization, and end-of-life decisions.  It is not the government’s role to decide that one of these categories of professionals should be phased out because it is less valuable than the other.

When did it become acceptable to ask the government to facilitate the subordination of a pro-life patient’s dignity to a pro-choice patient’s dignity?


2 Responses to “Choice For Me, But Not For Thee”

  1. Eclectic Radical on April 7th, 2009 7:51 am

    The majority of us concerned about provider conscience laws are concerned about women whose health care choices are limited by either their health care provider or their economic situation not being able to receive the assistance they are seeking. Most of us have no interest in forcing anyone unwilling to perform an abortion to do so, but we do have a desire to make sure women have access to whatever services they need… abortion or otherwise. The reason for much of the hue and cry over the Bush legislation was that, given the most favorably pro-life interpretation, it would allow a pro-life medical assistant to deny a woman seeking family planning services (abortion or otherwise) access to doctors and counselors who might themselves be pro-choice were said medical assistant to be working the front desk the day the woman in need showed up at the clinic.

    That said, I agree with you about any litmus test for doctors… pro-choice or pro-life. Someone’s moral, religious, or political views should not be held up to inquisition as part of the medical certification process. In my experience, most pro-life doctors would be willing (though certainly not eager) to perform an abortion in a situation where it was necessary to save the life of the mother and that is all that is necessary. A patient not in that kind of crisis will not be in a position where she cannot find a doctor willing to help.

    I believe the Bush regulation, as written, is bad because it allows far too many loopholes for misconduct by individuals not responsible for making health care decisions in other circumstances and because it would also, as written, protect medical professionals who refused to give a blood transfusion or perform surgery if this violated their religious beliefs, even if the patient died. The language is literally that loose, and that is not at all a good thing.

    My reservations about the specific regulations in question aside, the idea of forbidding pro-life doctors from choosing an OB-GYN specialty is repugnant. The solution is improving the family planning infrastructure, not attempting to create a thought police for doctors.

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