the right of conscience david stevens, m.d,m.a. (ethics) ceo christian medical association

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  • Slide 1
  • The Right Of Conscience David Stevens, M.D,M.A. (Ethics) CEO Christian Medical Association
  • Slide 2
  • Definition Healthcare Right of Conscience The freedom to practice healthcare in accordance with your deeply held religious, moral or ethical convictions.
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  • Martin Luther King "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."
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  • Harper Lee To Kill a Mockingbird, 1960 "The one thing that doesn't abide by majority rule is a person's conscience."
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  • The Issue Alaska (1997) - Valley Hospital Assoc. California (2003) - Benitez v. North Coast Women's Medical Care Illinois (2005) - Governor Rod Blagojevich Washington (2007) - Pharmacy Regs
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  • Overt: Mandatory Abortion Training in NYC 2002: Mayor Bloomberg orders abortion training in All NYC medical schools NY guidelines make it very difficult to conscientiously object Covert: Pro-life students denied admission (Duquesne Law Review)
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  • ACOG Committee Opinion # 385, 11/07 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 providers beliefs on pts. Patients concept of well-being trumps Must refer for abortion If cant timely refer, must provide Those who refuse to provide abortions should only practice in areas where abortion services can be provided.
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  • American Board of Obstetrics and Gynecology New policy issued in January 2008: certification contingent on compliance with ACOG ethical principles. Under pressure reversed in 1/09.
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  • Two Opinions the right to abortion, artificial means of contraception, assisted reproductive technology, physician-assisted suicide, or other legally permissible procedures or medications becomes meaningless without physicians who are willing to provide such services. The irony of trampling individual liberties and conscience rights while marching under the banner of "choice" will not be lost on the American public.
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  • This is Not a New Issue 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. Hippocratic Oath
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  • Another Perspective - The Right of Refusal A threat to reproductive rights 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. 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 womans access to safe, legal and professional healthcare. Refusal Clauses Planned Parenthood Website
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  • What Right? "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof" (Bill of Rights, First Amendment) What does Freedom of Religion mean if you cant follow your conscience?
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  • Writing the First Amendment James Madison, 1789-JUN-7 The Civil Rights of none shall be abridged on account of religious belief or worship, nor shall any national religion be established, nor shall the full and equal rights of conscience be in any manner, nor on any pretext infringed. No state shall violate the equal rights of conscience or the freedom of the press, or the trial by jury in criminal cases. House Select Committee, JUL-28 No religion shall be established by law, nor shall the equal rights of conscience be infringed, Livermore, AUG-15 Congress shall make no laws touching religion, or infringing the rights of conscience. House Version, AUG-20 Congress shall make no law establishing religion, or to prevent the free exercise thereof, or to infringe the rights of conscience. Conference Committee SEPT 24 Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof.
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  • Founding Fathers 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
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  • James Madison Conscience is the most sacred of all property. 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.
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  • If we don't protect personal integrity, we would go down a dangerous avenue. By taking a professional license, you do not in fact 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 Christian Science Monitor - 4/26/04
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  • 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.
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  • AMA Statement 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.
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  • World Medical Association The physician should be free to make clinical and ethical judgments without inappropriate outside interference.
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  • Other Countries/Codes European Convention on Human Rights 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. Canadian Medical Association Physicians who object to abortion for reasons of conscience are advised to inform their patients of their objections so that the patient can consult another physician. The CMA stresses that physicians who decline to participate in abortion should not be discriminated against, and emphasizes the need to respect the rights of conscientious objectors, especially those in training for obstetrics and gynecology, and anesthesia.
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  • Pharmacist Association Statements Pharmacist have a duty to act with conviction of conscience. Code of Ethics, APhAAPhA recognizes the individual pharmacists right to exercise conscientious refusal Pharmacist Conscience Clause, 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
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  • Federal Law Church Amendment Public Health Services Act Medicare/Medicaid 42 U.S.C. 238n Weldon Amendment Limited to federally funded programs.
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  • State Laws 45 states have some sort of conscience laws on abortion Illinois 45 ILCS 70/1- Healthcare right of Conscience Act It is the public policy of the State of Illinois to respect and protect the right of conscience of all persons. State by State Law
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  • Problem Continues CMDA Member Survey 40% of member report being pressured to compromised convictions >43% know someone else who was pressured >24% have lost position, promotion or compensation as a result >88% think it is getting worse
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  • CMDA Public Poll September 2008 CMDA commissioned the polling company TM, inc to conduct a nationwide telephone poll +/- 3.1% at 95% confidence level 42% think law obligates doctors to perform/refer abortion 38%, no obligation 11% unsure 5%, depends
  • Slide 26
  • Protecting a right does not mean endorsement of the position Protection of someones right to object does not mean be equated with support for their position Indeed, we must pay special attention to protecting the rights of others when we do not support the position.* *(Claims of conscience rights can be abused)
  • Slide 27
  • 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
  • Slide 28
  • Why Not Refer? Referral means: I endorse the competency, judgment and ethics of the doctor Im refer