Conscience For Me But Not For Thee: The Case for Pro-Life Docs and Pharmacists

In two recent threads over at Pharyngula, one about a poll and the other about some recent comments from HHS Secretary Mike Leavitt, I’ve gotten myself caught up in some pretty heated exchanges over the issue of pro-life doctors, and their impact on reproductive choice and access to health care.

This controversy has been building for some time, as legislatures and now licensing boards are increasingly confronting the question of whether, and to what degree, the consciences of anti-abortion doctors should be protected. More and more women are startled to find local doctors and pharmacists refusing what they had assumed were basic and perfectly legal prescriptions.

Now, as far as the original issues go, most of the things that anti-abortion docs, pharmacists, and their advocates are currently pushing for are indeed overboard. The idea that a doctor can refuse to refer a patient to another doctor, or refuse to even give them information, is unjustifiable. And if a CVS pharmacy wants to offer the pill to its customers, then it has all the cause in the world to only hire and retain staff that are willing to dispense it. It’s simply not unjust discrimination to fire someone if their conscience prevents them from doing what the employer needs done, and no reasonable (reasonable on the employer’s terms) accommodation can be found.

Unfortunately, many of my pro-choice compatriots have, I think the wrong idea themselves, asserting principles of their own that go far beyond the right of employers to set the conditions of employment. When it comes down to it, it seems that many people believe that doctors who refuse on ethical and/or religious grounds to prescribe birth control pills, pharmacists that refuse to fill such orders, or even, it seems ob/gyns that resist performing elective abortions should either ignore their consciences or essentially leave their chosen professions. But the justifications given for this harsh ultimatum are, I think fatally flawed.

Two principles in particular are, I think twisted or misapplied to this situation: the idea that pro-life doctors are forcing things on their patients, and the idea that pro-life doctors and pharmacists aren’t doing “their job.”

Doctors Have No Right To Force Their Choices on People

As general principle, this idea Is central to most cannons of medical ethics and medical license boards. And justly so. It’s based, first and foremost, on the idea that people of sound mind have an absolute right to accept or refuse medical care, and to pick the treatment plans they are comfortable with under the advice of the physician. It’s based on a laudable ethic of not forcing something on someone without their consent.

The problem is that this ethic seems to fall by the wayside whenever people start considering the views of people they don’t like. Or it gets implausibly twisted, so that the “forcees” are claiming to be the victims. It takes a true mangling of language to assert that someone not doing something for you constitutes forcing you to do anything. But that appears to be precisely what it going on here.

Consider the common assertion that doctors who refuse to prescribe birth control, especially when they practice in far-flung areas and stats that offer little choice in doctors to begin with, are “forcing” their own preachy choices on the patient. But are they?

When a family doctor sets up a shingle in a small town, people’s access to health care improves in real terms. But now suppose that the doctor refuses to prescribe birth control or perform elective abortions. Has the doctor actually “forced” anything on anyone? His or her values? His or her services?

In virtually all routine situations, no. The people in the town are certainly no worse off than they were before the doctor arrived. The doctor’s existence provides some benefits, but perhaps not all the benefits they’d want. Demand that the doctor violate his or her conscience or else find another profession, and you might well end up with no nearby doctor at all. The same goes for a hypothetical “pro-life” pharmacy.

Yes, people in that situation lack access to things they want and need, and are protected by law. But that’s the exact same situation they were in before the anti-abortion/anti-pill doctor set up shop.

So what’s the solution? Well, if we really care about access to birth control, if that’s really something we consider to be a moral value or even an assured, positive right, who has the responsibility to supply it? Does that responsibility fall almost entirely on the doctor who thinks it’s immoral, just because he happens to be the most local? Or does it fall on all the people who think it’s a basic right? If you answered the former, I have to admit that I’m simply flabbergasted.

The situation here is a little like the often confused outrage at “scalpers” who, during a disaster, offer things like water bottles for sale at ridiculously inflated prices. These people are routinely condemned as greedy, and they certainly are. But somehow it never occurs to all these outraged moralists that, if people in a disaster have some sort of positive right to receive water (free or cheaply), that this right cannot possibly be a burden and a responsibility that falls on some people more than others. At least the scalpers are offering water for sale at all. Rarely have any of the outraged people rushed over to offer even a drop of their own water, at any price. If the scalpers are as greedy as their inflated prices, then the moralists shaking their heads are themselves infinitely greedier.

Blaming the scalpers for a lack of available water, or blaming pro-life doctors for lack of available abortion services and birth control, is, in the end, nothing more than crude scapegoating. It takes the focus, rather conveniently I might add, off of the collective failure for which the moralists themselves are implicated.

And the further irony is that the moralists’ proposed solutions often wouldn’t really help anyone overall. Scalping only works when there is an extremely limited water supply: i.e. there’s too little water to go around in the first place. If scalpers simply gave away all their supplies for free, there would still be too little water: in fact, in the end, there would be exactly the same number of people with and without water. All that would be different is the method by which these people would be chosen (and the usual alternative, first come=first serve, is arguably no more “fair” than rationing the supply by price, which at least has some built in mechanism for assessing people’s relative need for the water).

Likewise, if anti-abortion/anti-pill physicians and pharmacies left the business, as their foes seem to suggest they should, there would still be the same shortage of medical care and lack of access to birth control that we started with.

From where I sit, that makes this issue look a heck of a lot more like an act of partisan revenge than a sound policy or pro-patient principle.

If They Don’t Want to Do What (I Say) the Job Entails, They Should Find Another Job!

This second principle, uttered as if it were an obvious truism, is in fact an utterly bizarre essentialism. Obviously, if we are talking about an employer defining what “the job entails” and finding someone wanting, there’s no problem. But this isn’t the sense in which some people mean “the job.” They mean it in a more cosmic sense: turning mere convention into Platonic form.

Who says that the role of being an ob/gyn, a family doc, or a pharmacist must involve prescribing or dispensing contraceptives? What defines that role such that it’s supposedly essential to this or that specialty? Is this some sort of immutable law of the universe? No. To the extent that they are set and regulated at all, the required roles of various professions (and the permitted variations) are set by committee or political process, not fate. And those debates have to deal with the very political and ethical questions we’re already considering.

Thus, asserting that elective birth control must be part of the role of certain doctors is little more than a begged question. If you regard a fetus or even a fertilized embryo to be a being with moral rights, then harming it without dire need would not legitimately be part of the role of any physician. Reject that idea, and it’s a legitimate part of reproductive health and choice. I certainly have my opinions, but I also have a respect for the importance of social pluralism. And we cannot simply presume anyone’s opinion from the get go when determining what medical ethics demand or deny.

A more reasonable question is: can anti-abortion doctors be reasonably accommodated into our medical system with their existence causing serious additional harm to anyone? I think the answer is yes.

My opponents disagree. They imagine Jehovah’s Witnesses as ER docs who then refuse to transfuse blood to car accident victims. But these examples are absurd. No one would hire such a doctor to such a position in the first place, and if one did, it’s unlikely it could be licensed to accept emergency patients (who are often in a very different situation than a person seeking a physician or going to a pharmacy). On the other hand, plenty of people in the United States not only would have no problem with seeing an anti-abortion ob/gyn, but would favor going to one. Is denying the possibility of this choice even in keeping with the respect for autonomy that underlies pro-choice politics in the first place? I think not.

The early pioneers of reproductive choice knew that making it a reality meant actually physically and financially getting doctors and products out to women everywhere. If choice is a positive right and not just a negative one (i.e. not merely something that the government cannot ban, but something that must actively be ensured, presumably by society itself) then it’s going to take a tall order of money, time, and resources to supply it. Butting heads with anti-abortion doctors and pharmacists, or demanding they conform or go out of business, isn’t even remotely the same thing.

46 Responses to Conscience For Me But Not For Thee: The Case for Pro-Life Docs and Pharmacists

  1. Blake says:

    I see where you’re coming from, and I believe yours is a fairly libertarian view. However, I’m not sure I followed your line of thought completely.

    In several sentences you used the term “proscribe” in reference to a health-care worker’s duties, as in “Who says that the role of being an ob/gyn, a family doc, or a pharmacist must involve proscribing or dispensing contraceptives?”

    Did you mean prescribe? They have very different meanings, and in the above example change the meaning of the entire sentence, and perhaps the meaning of your argument.

  2. Bad says:

    Yep. This is what happens when I dash off a post on a lunch break as opposed to spending time editing it. Oops. Went back and fixed some of that.

  3. Bexley says:

    I broadly agree with what you are saying here. However I’d suggest it isnt so simple (and I don’t necessarily have the answers).

    If you are an anti-abortion private practitioner in a town too small for more than 1 practitioner then arguably you have created a barrier to entry for any other doc who thinks about setting up in that town. Your mere existence there means it is much less likely that some other doctor (who may be pro-choice) will set up shop. Therefore it could be argued that you ARE indirectly forcing your morals on the patient.

  4. Bad says:

    I think I’m innocent of the charge of simplicity mostly because I don’t maintain that it is simple: markets, particularly health care markets, and hard, complex, and screwed up. But none of that, I think, changes the basic principle that if people are DUE certain things, then that means paying whatever price is necessary to obtain them. If that means subsidizing a pro-choice doc to operate in the area, so be it. Sometimes things are important… but they are also expensive. I don’t think it’s fair at all to say to someone “sorry, but you can’t work here because you don’t do what WE want you to do, but we don’t want to pay the money necessary to attract a competitor that does what you don’t.”

  5. bitchspot says:

    While in very general terms, I agree with what you’re trying to say, the case that sparked this discussion, the California reproduction case, doesn’t really match up. The doctors had no problem providing artificial insemination to anyone who came in the door, so long as they were heterosexual. It’s like saying “I’d be happy to be your doctor, so long as you’re not black”. We have anti-discrimination laws on the books for a reason, in California it is illegal to discriminate against someone on the basis of sexual orientation, period. It doesn’t matter if you’re the desk clerk at a hotel or a doctor, no one can discriminate on that basis.

    The case was decided properly, those doctors deserved what they got.

  6. Bad says:

    Well, the two Pharyngula posts in question weren’t really about that case. This is, I think a separate issue, because it’s not about patient population, it’s about procedures they think cause harm, period.

    But on the issue you mention, and I doubt this will win me many popularity contests, and as much as I’d like to have some way of getting back at discriminatory people and bigots, I don’t think anti-discrimination laws against private business-people are justified either. Yeah, it’s really scummy of someone to not want lesbians to have babies. Or to not let atheists buy your cars. But I don’t think that justifies using the law to force these people to comply with our values of tolerance, approval of homosexual life and reproduction, and so on. I’ve never bought the lame “well if they open their grounds to the public nonsense then they must…” arguments that people often bring up in these cases either.

    We allow people to be pricks in personal life without tossing them in jail. I don’t see what them selling things changes such that it’s suddenly legitimate to penalize them with government force for being pricks about who and what they’ll sell to whom.

  7. Glazius says:

    Bad, here are some pieces of extant legislation you may wish to read more about.

    The Church Amendment of 1976: recipients of public monies (ie Medicare/aid) cannot be forced to perform procedures that violate their consciences, or discipline an employee for citing reasons of conscience to fail to perform a procedure.

    The Coats Amendment of 1996: Specifically not offering training in abortion procedures is not grounds for losing certification.

    Hyde/Weldon Conscience Protection Amendment of 2004: Governments cannot mandate that any care provider or insurer pay for, perform, or refer for an abortion.

    I think Hyde/Weldon may even go a bit too far in the “no referrals” department. Church is a good law. Coats is alright but it couldn’t stand up to being generalized.

    Sticking a broad-based “no referrals, no information, because your conscience says so” exception into the law is going too far. And the reason is: medicine is at least theoretically evidence-based. At the same time your conscience tells you that doing something is wrong, you have to be willing to acknowledge the evidence out there that suggests it may be useful in accomplishing your patient’s goals.

    And the devil’s advocate in me wonders – has anybody ever cited the Church Amendment as a result of failing to provide medically assisted suicide?

  8. Leslie says:

    1. If a male patient in that same small town requests a vasectomy, it is within that doctor’s purview to refuse? Is it acceptable if he refuse to remove a man’s prostrate or perform any procedure which will render him sterile?

    2. If the conscientious objector is the only doctor on staff for the delivery of a woman’s sixth child and she requests a tubal ligation, is it acceptable for him to decline to perform the procedure, when doing so creates additional risk (not to mention financial burden) to her health?

    3. Ethically, can he refuse to treat a woman having an adverse reaction to birth control or man having some type of infection as a result of a vasectomy on moral grounds? Can he refuse to treat a woman hemorrhaging following an abortion?

    4. What if the doctor is working in an ER and the patient has a tubal pregnancy that treating almost always results in destroying the embryo? Does he have a moral obligation to save the woman’s life or can he exercise his conscience under those circumstances and let the woman die?

    5. Can that doctor refuse information to that same woman who appears in his office complaining of a pain in her side on the grounds that treating her tubal pregnancy is the same thing as an abortion?

    I am wondering where you draw the line.

    6. How would a pharmacist determine that birth control pills are being prescribed as a preventative method and not to regulate a woman’s cycle? If he can refuse to fill it on the grounds that it *could* be used to prevent pregnancy, therefore all birth control is bad, then he could refuse to fill a prescription for a large quantity of morphine for a hospice patient on the grounds it *could* be used for assisted suicide.

    If a doctor may follow his conscience regarding prescribing birth control or a pharmacist may decline to fill a birth control prescription on moral grounds, then I am to assume you believe that the doctor and pharmacist may follow their conscience on other matters as well?

    For instance, a doctor could have a conscience regarding offering information to drug addicts and alcoholics about liver transplants, or he could refuse to treat fat patients until they lost weight. A doctor could refuse to follow the contents of an advance directive or living will if his conscience supersedes the wishes of the patient.

    Would you support that as well?

  9. Bad says:

    I may have mentioned it previously, but I agree that refusing to refer a patient to another doctor does not hold up as refusing a particular service out of conscience.

  10. Bad says:

    Leslie: see most Catholic Hospitals, which do not perform procedures 1 and 2 already.

    And no, doctors cannot refuse to treat people who have emergent conditions, regardless of how those conditions came about. Doctors are required to treat murderers who have been shot by police. But not all doctors see patients of this sort in the first place: we’re talking about patients that come to see them for things like private practice, not cases where they have someone’s life on the line. Emergency rooms, and indeed inpatient matters at hospitals in general, are different in many ways than private practice and outpatient settings when it comes to these sorts of obligations, not least of which that these doctors have an employer and superiors. Of course, even in such cases, it’s not that uncommon for doctors to swap out with another doc if they feel they can’t do something, even for far more trivial reasons than conscience, as long as it won’t impact or degrade the standard of care.

    They cannot override the wishes of a patient: i.e. advance directives and living wills. But I think they most certainly should be able to refuse taking on fat patients, if that’s the sort of practice they want to run.

  11. Leslie says:

    Thank you for taking the time to clarify your position.

    Having lived in an isolated, rural community, I can tell you that the scenario you paint above is nonexistent. Hospitals are often a public/private cooperative, with tax dollars providing partial funding. Many times, the clinic is an extension of the hospital and after-hours, there is only one doctor on duty. The federal government offers huge incentives for physicians to work in rural areas.

    Most often, acute and emergency situations are found in the clinic examining room, not the ER. If the doctor on duty cannot treat it (or won’t), and there is no one else available who can, the patient is transported at enormous cost to facility in a larger metropolitan area.

    A helicopter transport in the community where I lived was in excess of $4,000.

    The crux of the issue is whether a doctor’s conscience overrides a patient’s need for services. Unfortunately, the idea that there are purely private practices is long gone, unless the facility refuses to accept insurance, medicare/medicaid, the doctor has a private malpractice insurance policy, he is not receiving any type of remuneration in the form of reduced school loans, etc.

    Or, are you suggesting we have one set of rules for doctors in big cities and another for rural health care practitioners?

    Again, in the ectopic pregnancy scenario, can the doctor refuse to give the patient medical advice on the grounds that treating the condition will result in the destruction of the embryo? This is, in fact, the same as an abortion, however, it is a medical necessity. Does the doctor have the right to refuse information to the patient or even treatment if the condition is not yet an emergency, and there is no other [not conscience stricken] physician to provide treatment?

    Surely you recognize that there could be a real problem in a small town if only one doctor was available for these types of treatments and a patient was forced to wait two or three weeks for an appointment (and yes, that does happen) or travel great distances to seek proper medical advice. And how would consumers know that the doctor was refusing vital medical information in the first place?

    Regarding your comment about refusing to treat fat people, I am assuming you would then agree that a physician may refuse to treat black people, Jews, women, the poor, foreigners, people with small dogs, ugly folks, elderly, etc.?

  12. bitchspot says:

    In the case of Catholic Hospitals, again, they aren’t performing the procedures in question on anyone so it’s difficult to see how they are discriminating against any part of the population. However, since Catholic hospitals often buy up struggling public hospitals and require them to follow Catholic rules, there may be some concern that certain procedures simply will not be available at all in some areas and that may be problematic.

    Just because individuals have a right to feel however they wish, doesn’t mean that they get to act on those beliefs in their professional lives. You can be racist as the day is long, but you cannot discriminate against blacks, period. You can be sexist until the cows come home, but you can’t deny services to women. That’s simply the way our society is set up. Freedom of belief does not translate into freedom of action.

  13. Terry says:

    Leslie> I don’t know of any religion that does not treat etopic pregnancies through abortion unless they are generally against medical intevention entirely.

    For the Catholic church in particular, etopic pregnancy falls under the the principle of “Double Effect”.

    From Wikipedia:

    The principle of double effect is frequently cited in cases of pregnancy and abortion. A doctor who believes abortion is always morally wrong may nevertheless remove the uterus or fallopian tubes of a pregnant woman, knowing the procedure will cause the death of the embryo or fetus, in cases in which the woman is certain to die without the procedure (examples cited include aggressive uterine cancer and ectopic pregnancy). In these cases, the intended effect is to save the woman’s life, not to terminate the pregnancy, and the effect of not performing the procedure would result in the greater evil of the death of both the mother and the unborn child.

    Bitchspot: The solution to Catholic hospitals buying up struggling public hospitals is to have secular institutions of charity that can fill the void instead. Usually if a hospital is successful it resists the diocese authorities and becomes an independant private institution with a saint’s name. It is the struggling hospitals which are not solvent where the church has the greatest influence.

    Simply put, the social safety net of even many developed and even far left nations rely on the charity of the congregations of the Catholic Church and other denominational institutions. The key advantage of organized religion is that they are organized. Until secular institutions of charity of sufficient size, organization, and volunteering zeal to the Church step up their game, the situation is likely to continue for the forseeable future.

    Also, I’d be worried about cutting rights to conscience-based objection if I were you. There is always the possibility of a military draft.

  14. Bad says:

    bitchspot: what you talk about with Catholic Hospitals buying up others is precisely what I mean, I think. There most definitely is a concern that certain procedures won’t be available. I think many of the people think the proper solution is to force the Catholic Hospitals to offer them. My solution is that we, especially we who care about the issue, put money into making sure those things are available, whether by government subsidy or, if need be, private subsidy. And this is based on my sense of what it means to have a positive right: i.e. that it is not anyone’s singular responsibility to supply it blame if they don’t. It’s a social, i.e. collective burden. It drives me nuts to have someone who has never themselves considered going to medical school to fill this right and need that they think is absolute, complain that others are not fulfilling it. Or complaining that doctors in rural areas don’t offer abortions, when they themselves have never even considered making anything approaching the same effort a doctor would have to make to move to such an area to provide them, or providing the subsidy that would make that possible.

    This isn’t a merely academic issue for me. My wife is a family practice doctor, and in fact one that wants to be able to provide the full slate of pre-term care, including abortion. Let’s say that we decide that providing pre-term services to one of the rural areas we’ve mentioned is something that’s on the table for her (and thus us). Moving out to such an area to fill that need is a huge cost for our family. It means moving away from family and friends and away from lots of things we enjoy. It might mean pretty much the end of most of my career ambitions. It could mean very different things for our level of income. And even right now it means fearing for our safety from all of the nutty pro-life types. All of these things are a big deal. There are a lot of costs and even dangers involved.

    But the point is: why do these costs seem to fall primarily on people like us, and not equally on all of the people running around claiming that full access to abortion services is an important right? I don’t think that the fact that my wife chose to be a doctor is a good excuse: not when it comes to issues of fundamental rights and who has the responsibility to provide them. Sure, she can provide abortions because she can train to do so. But other people are equally capable of providing abortions by giving equivalent amounts of money to groups like Planned Parenthood. So to me, the idea that somehow it’s specially the problem of doctors, not to mention pro-life doctors who don’t even agree that access to abortion is medically legitimate in the first place, seems both ridiculous and self-serving.

    As for the discrimination question, which I think we both agree is a separate issue, I think it all comes down to what you think about people’s rights of free association. I think they are basically very important and broad, and that they do not change just because money becomes involved. It doesn’t matter to me how “we do things” in our society. I agree that most people seem to think that professional discrimination should be illegal. I don’t. I think the justification for that sort of policy is unsound, and based on ideas of public entitlement to private resources that I simply cannot agree with.

    That’s not to say that I think discrimination is fine thing that we should tolerate as people in our society. But there are many ways to deal with it as a social issue, and I don’t think it obvious that using the government to enforce a value is always even the most effective way to disseminate that value. I’m not, as some people seem to think, an absolutist libertarian who is against government power and taxation. But I do think there are serious costs and missed opportunities when we decide to deal with something by simply making a law, as opposed to things like social action, engagement, boycott, and so on. We live in a society that has become increasingly complacent about the existence and maintenance of civil society and community outside of simply enforcing things via the government.

  15. Bad says:

    Leslie: yes, I recognize that there are huge costs when considering specialty medical care in rural communities. As with living in any place, there are upsides and downsides, costs and benefits, challenges and advantages.

    But that’s just it: there really ARE huge costs to it, and blaming anti-abortion doctors and institutions doesn’t make those costs go away, nor are they really the ones that created the situation in the first place.

    All it really means is that you are asking those doctors to shoulder ALL of those costs. That makes the costs less visible to you, and not show up as obviously on paper as single figure like 4000$. But they are no less real, and they have economic effects all the same (for instance: driving less people to become doctors or to practice in the area, thus making medical care even more expensive).

  16. Terry says:

    I’ve lived in a rural areas all my life. I lived in Saskatchewan until I finished university, and I live in the South Shore of Nova Scotia now.

    For medically unnecessary abortions, a 1-3 hour car ride or a 3-8 hour bus ride isn’t worth severely curtailing rights of conscience objection. I don’t anyone of any political stripe would advocate curtailing rights of conscience. Sure, the left dominates court decisions on the whole now, but you do not need to believe in left wing ideologies to be a good lawyer or to gain electoral/politcal appointment as a judge. What you do have to believe in however is precedent. So one should be wary of the precedents they establish lest it turns out to be a double-edged sword.

    As for access to healthcare in rural areas in general, what rural hospitals should focus on doing is keeping them alive until they can get to a better equipped and better staffed hospital in an urban centre. I would never have my wife’s etopic pregnancy operated on except by a very qualified surgeon, and those don’t exist in towns with less than 100,000 people, and the best ones will need larger urban centers than that.

    The 4,000 air ambulance trip is a pittance compared to trying to maintain a full medical facility capable of handling every medical emergency, much less elective procedures. You want the proper facilities, the proper diagnostic equipment, and the medical staff that has gained the experience to deal with this on a regular basis. If I got a heart attack on father’s farm in Saskatchewan, I’m not going to have to GP’s at the local hospital open me up. I have better odds attempting to keep me alive for a few hours and getting the bypass done in Saskatoon.

    Which brings me to my final point. Do you really want someone opening you up who doesn’t want to be there? Do you want people to hide what they actually believe and operate on you anyway? I sure as hell don’t.

  17. bitchspot says:

    I’m not going to suggest forcing private Catholic hospitals to offer services they are morally opposed to, but certainly I don’t think they should be allowed to remove services from other hospitals simply because they throw money at them. They did a show a couple of months back on the Minnesota Atheist’s Atheist Talk on Catholic hospitals buying up public hospitals and the dishonesty and lack of integrity they show when doing so, I’d have no problem stopping them from using tax-free money and religious donations to purchase what amounts to public resources. We wouldn’t let them buy public parks and re-open them as Catholic parks, would we? Why should we allow it with hospitals?

  18. Bad says:

    I think we would let them buy public parks and re-open them as Catholic parks: provided of course that the land simply went up for sale period and they were the ones that purchased it. Public resources can go private, at which point the same rules that govern public resources don’t really apply.

    I’m not sure what dishonesty and lack of integrity you’re referring to because I haven’t heard that story, but I certainly concede that, as in any endeavor, they could be pulling fast ones that we should object to.

    But Catholic Charities and so forth get the same sorts of tax breaks as all non-profits and hospitals, including those that support reproductive choice. I don’t think they can be specially held to account in that regard. They have a mission with which other people may or may not agree. So do lots and lots of non-profits.

  19. Leslie says:

    Back to the question at hand. . .

    A woman walks into her rural health care clinic, Friday afternoon before a long holiday weekend. All other physicians are gone. She has what appears to be an ectopic pregnancy. Doctor is opposed to treating it because it will result in an abortion and does not wish to provide her with information. The woman’s situation is not yet an emergency, but likely will be by Tuesday or Wednesday.

    The physician on staff cannot refer her to someone else because he’s the doc on call that entire weekend. (And yes, I’ve seen this scenario of one doc on call to serve a community of 10,000 people.)

    Can the doctor morally (and legally) withhold information from the woman?

  20. Bad says:

    Doctors cannot “not present her with information” as I’ve already said. Referring her to someone else either locally or somewhere else is their obligation as a licensed physician, and the recourse they have if they think some proceedure or decision is against their conscience.

  21. Glazius says:


    Per the Hyde/Weldon Conscience Protection Amendment of 2004, the doctor can legally withhold information from the woman.

    I think Hyde/Weldon goes too far, myself, but legality is the laws you have, not the laws you wish you had.

  22. Terry says:

    Leslie: I’m still waiting for an example of a religious group that both approves of medical intervention yet would not agree to do an etopic pregnancy abortion.

    Glazius: While it is true that the Hyde/Weldon Conscience Protection amendment allows for physicians to be discrimated on based on funding and allows them to not to be compelled to counsel a patient on how to have an abortion. I would however be extremely shocked if there was no legal recourse if he withholds information about her medical condition which leads to her death.

    I can think of several charges right off the top of my head, and the Hyde/Weldon Conscience Protection Amendment would be no defense whatsoever.

  23. Leslie says:

    Terry: So your point is that someone’s objection has be based on external religious influences and not their conscience? Some individuals do have an internal moral compass.

    Bad: The doctor can only refuse to treat the patient, not provide the patient with treatment options? You’ve also stated earlier that you believe a doctor can refuse to treat any patient for any reason, including racially based motives.

    Would you support a clinic or hospital requiring that doctors offer these choices as a condition of employment? Or that a clinic or hospital could refuse to hire a doctor based on his religious affiliation, say a Catholic physician in a public hospital?

  24. Bad says:

    Leslie: yes. But you seem to confuse, as so many do, several senses of the word “support.” I support the idea that we should be very very wart of using government force to coerce people into doing or not doing things or making arrangements with other people as they please, especially when those transactions are between them, and do not actually involve other people. But that’s a very far cry from saying that I “support” doctors that discriminate. I support the continued legal existence of the Westboro Baptist Church. But that doesn’t mean that I support or agree with them in any way.

  25. Leslie says:

    Yes, I understand that you are supporting the RIGHT to discriminate. I get it, I really do.

    I have no problem with private enterprise establishing whether or not they will do business with someone. My issue is when it comes to health care, you then begin to involve government funding. That then becomes a public enterprise.

    You have outright examples of government funding in the form of indigent health care, and more subtle forms in grants, liability insurance, tuition assistance, etc. If a clinic wants to establish itself WHOLLY and COMPLETELY free of public funding, staffed with doctors and nurses not receiving government aid, then they may decide who they will treat or not treat.

    However, if that organization or physician receives a dime of government money, then they are operating in a different sphere. It is the flip side of the current debate on stem cell research.

    It is no different than your City Hall refusing to give you a building permit because you are Jewish. However, I have no problem with Joe’s Hardware Store refusing to sell to Jews. I do have a problem with Joe’s Hardware Store if they are receiving local grants for a downtown beautification project.

    The government does not have the right to discriminate directly or through funding of those that discriminate.

    Catholic hospitals are not solely funded by the church. If physicians want to exercise their consciences, they need to find employment in the private sector — where it is truly “private” and not receiving public assistance.

    I do not support government funded discrimination.

  26. Terry says:

    Leslie: Oh sorry, I thought you were constructing a straw man of pro-life positions. I retain my suspicions when you singled out catholic church as being discrimanatory.

    I am a citizen in a democracy like yours, Canada, where Catholic hospitals also contribute to the public health care system. Like the United States, Catholic Hospitals follow a standard of ethics which preclude offering abortion services.

    Frankly I don’t like the fact that my tax dollars are being used to murder helpless human beings. Objections of conscience are what allow you and I to live to live in the same society. For the most part, if a person is not compelled towards a certain action, then he can live his life peacefully. If he is forced to participate in something that he cannot abide, you’ve just backed that person into a corner.

    The military draft is definately a better analogy than comparing it to Joe’s Hardware. The draft requires a certain service from its citizens, and people are given the right to object based on conscience. They are instead given other unpleasant tasks to do, because the realization is that they will be poor soldiers.

    Likewise, if you try to compel doctors or hospitals to perform procedures that they believe are evil and immoral, then you end up with a poor doctor. It is better to let them offer their services for other tasks that need doing, and have a good doctor.

    As for the bogeyman of Catholics buying up financially struggling hospitals, it isn’t like people who contribute to the collection plate and their time to Catholic charities are more numerous than their ideolgical opponents. We are simply more organized, and we give more charity than people who don’t commit to any institutions. Any institution you would prefer to the Catholic Church exists, but everyone is suffering from a lack of money and a lack of manpower.

    The solution to ensure that Catholics aren’t the sole provider of health care is to build institutions to compete, fund them well, and contribute time. People who don’t belong to an instution that encourages community involvement (such as a church) generally have a habit of not contributing much to charity because they go home and watch TV or surf the web. The problem is going to get worse as all the old secular community organizations wither and die along with our grandparents, and churches dwindle in membership.

  27. Leslie says:

    “People who don’t belong to an institution that encourages community involvement (such as a church) generally have a habit of not contributing much to charity because they go home and watch TV or surf the web.”

    An unbelievably offensive comment that people who do not officially affiliate with a church organization are lazy and selfish. . .

    . . . my how very Christian.

  28. Bad says:

    I 100% agree Leslie: the government absolutely cannot discriminate, nor can it support financially those institutions that do. I do think that generalized tax breaks that fall on, say, all non-profits, shouldn’t count as subsidy. And then there is the gray area given that many of non-profits do discriminate to some extent, and in ways that I think many of us find acceptable. Battered women’s shelters don’t, as a rule, allow men access to their services. Homeless meal kitchens probably will try not to give you free meals if you happen to have a home. And so on.

    The problem is a little different still with abortion though, because as far as pro-life people are concerned, abortion IS discrimination: discrimination against the rights of fetuses and embryos. And question is whether or not a given proceedure will or won’t be given to everyone. The reality is that whether the government will fund clinics and hospitals and medical schools that provide abortions is an inherently political and ethical question up for contention. We can’t avoid battling out on that question, nor accepting that when the decision is made to fund abortion clinics or not, what you’ll be left with are de facto winners and losers in a struggle of pure force, rather than any universally agreed on principle or coming to negotiated terms.

  29. Terry says:

    Leslie: Not lazy and selfish… just not in the habit.

    You can get similar results if you belong to any secular instution, program or charity that keeps you involved on a regular basis. But people have to belong to those institutions first before they can get in the habit of contributing.

    Aside from the charities of churches who are suffering from manpower shortages (since people don’t got to church anymore) pretty much everyone across the board is suffering from lower membership. Fraternal organizations, hospitals, soup kitchens, rest homes, group homes, education facilities, community recreation organizations… Heck, even organizations that promote abortion are having problems getting enough warm bodies to keep things moving.

    Simply put, there isn’t a wider community that exists anymore, because largely civic involvement and charity competes for both time and resources with entertainment. It is really why we have less time for things in this day and age. We have a lot of entertainment to whittle away the hours.

    Churches are one of the last bastions of group resources and community that exist, and they will be under increasing strain as their numbers begin to fall. I have to say though, no matter what charitable endeavor I am involved in, both inside and outside the church, I’m one of the very few who don’t have gray hairs on my head. If I look at the numbers the church body is going to shrink by half when the seniors die, and by 3/4 again when the baby boomers begin to drop off. That’s going to be a lot of money and a lot of manpower that is going to have to made up somehow.

  30. Leslie says:


    You said people who do not belong to an organization that encourages community involvement watch television or surf the web. Your argument seems to be that the ONLY way someone may be involved in their community is to belong to some organized group or church.

    Is that the case? I want to make sure I’m getting your point, because it is not clear.

  31. Leslie says:


    Okay, we’re agreed that public funding of facilities cannot restrict access to health care, including abortions. I agree that there are some areas that are currently “gray”, but I don’t necessarily agree that we should be using ANY public funds for charitable organizations. That, however, would be another discussion.

    Since abortion is legal in our country, then abortions will be performed (never mind that Nature aborts more pregnancies than any clinic). Embryos and fetuses are not people, they do not have “rights.”

    I think the solution is quite simple. Catholic hospitals should stop accepting public money if they want to offer services outside the scope of what is allowed by law. They should educate their own physicians, operated their own pharmacies and disclose this to the public.

    Physicians, and those who oppose abortion, should not perform abortions or have abortions, nor be educated in schools that train people who to perform an abortion, nor work in a hospital or clinic that receives any public funding, nor treat women of childbearing years without disclosing that the treatment they receive may not be full and complete. They should not work in a facility that uses RU-486 for rape victims, either as the period induced might be aborting a very early term (hours old) pregnancy.

    I think a statement of the doctor to each patient in writing should be made on what they will and will not treat, what they refuse to provide information on, if the doctors they refer to also refuses certain treatments — with the patient having the ability to refuse the doctor’s services without any obligation whatsoever.

    Let’s bring it out in the open. After all, patients have the right to know that the physician treating them has certain moral difficulties in their job and this should be disclosed to everyone entering the facility — whether they receive funding or not.

    But wait, if 43% of women getting an abortion identify as Protestant & 27% Catholic, then maybe they don’t want to really go to these doctors? It’s a good thing that physicians who perform abortions don’t discriminate against women who might later picket them, or they might not have any patients to treat at all.

    What it really comes down to is that anti-abortionists want to impose their beliefs on others. You can dance around it, but the fact is that no one is forcing Catholics to have an abortion. For those people who object that abortion is illegal, instead of using force, they should either change the laws, or move to a country that does not allow abortion — there are over 90 of them.

    What’s next? Moral objections over vasectomies and tubal ligations? Physicians refusing to give information about birth control to married women? Doctors refusing to advise patients that condoms reduce the spread of certain STD’s because it might also prevent a pregnancy?

  32. Terry says:

    Leslie: That is pretty much what I am saying, yes.

    I suppose you can find a person or two who of their own initiative will spend large amounts of time or money without having it as part of their social network, but they certainly aren’t any appreciable number. Most everyone dontates a bit of money, but it usually isn’t more than they can claim for income tax purposes, and it is a pittance compared to people who actively involved in volunteering for institutionalized charity.

    As for it being a shiny happy world if everyone just swallows your ideology the world would be a better place… I don’t think you’re really hearing what Bad and I are saying. If you want to force the issue, the following things will happen.

    1) You are talking about imposing your beliefs on others. To force a catholic institution or doctor to preform abortions is imposing your beliefs, because you are making your ideology the litmus test as to who can serve. Tehran does it, Communist countries did it, the U.S. Justice Department had a scandal recently because they did it. Surely you can imagine somebody like myself having that kind of power over you?

    2) You will lose the services of many people in society that can’t agree with your ideology. Simply put if the Catholic Church didn’t use government money, they would simply have fewer hospitals. No matter how many government bureacrats you pay, and no matter how many taxes you raise, you are still going to need the Church’s volunteers and endowments to provide the extra care that the system doesn’t have the resources for. So if you demand these standards, congratulations you’ve just screwed over far more people than you’ve helped.

  33. Leslie says:


    First, I did not say that a doctor or Catholic hospital should be forced to perform abortions. Do not put words in my mouth, it is dishonest.

    I said that if doctors have a crisis of conscience, they should not perform abortions, get abortions, or work in a public hospital or a setting accepting public funds where patients expect SECULAR TREATMENT. They should also disclose to their patients that they will not offer complete and religiously unbiased information to their patients.

    I do not think churches and other religious institutions should receive public funds to provide public services, unless such services are purely secular.

    Do you realize that Bill Gates and Warren Buffett are two of the largest donors in America — and both of them profess to not follow organized religion? You also have scores of people serving their community in the political arena and not as part of any formal group or organization. Your argument really doesn’t stand up to scrutiny.

    This is not “my ideology”, this is “our political doctrine”, something called separation of church and state. This is a fundamental doctrine of our nation which demands a secular government so that individuals may have greater religious freedoms. It allows people like YOU to practice your faith without interference by the government. It should also allow people who want to practice NO FAITH to live without interference by the government or other religiously motivated groups.

    Imagine for a moment that an Islamic group was vying with the Catholics for all those public funds for health care. If the Muslims win, the women cannot get abortions, nor can they be examined by a male doctor. You can forget OB/GYN services, breast cancer screening and so forth.

    Would you have a problem with that?

    I would.

    That is why I don’t support ANY religious organization operating public services with public funds. What you don’t seem to get is that it may not be the Catholics who win the next bid. It could be Jehovah Witnesses, Mormons, Hindus, etc. Are you prepared to have a Islamic fundamental group dictating your health care in small towns across America?

    Yes or no. My bet is you won’t bother to answer the question.

    If you do have a problem with the above Islamic scenario because of the lack of services in your community, understand that it is no different than women who DO want to have abortions available to them. You have no right to impose your religious beliefs on others, just as the Muslims have no right to impose their beliefs on you.

    That door swings both ways.

  34. Terry says:

    Okay, Warren Buffett and Bill Gates founded charitable institutions that you are claiming that are unnecessary, and largely work by giving grants to other charitable institutions, including religious ones. Aside from that, their foundations despite their billions, are a pittance compared to the sheer mass of resources that millions of volunteers in instutional charities (including religious ones) contribute to the health of overall society. There is no more black and white way that I can say that the social safety net cannot do without non-profits and churches. Non-profits and churches cannot do without people who are personally invested in those institutions.

    Secondly, what you are advocating is not seperation of Church and State. What you are advocating is official atheism. Seperation of church and state simply means that is no official state religion, and that the courts have no legislative, judicial or executive authority. Since the Catholic hospitals aren’t printing up US passports, I think seperation of Church and State is just fine.

    What seperation of church and state doesn’t mean is that I can’t follow my religious convictions in performing public office, or recieving goverment contracts, or recieving goverment funding. In fact, seperation of church and state is supposed to protect against that sort of thing. This is for your secularist benefit as well, because I can then screen you out based on your ideology and moral positions as well despite no proof of causing harm if I had sufficient power. You claim that my practices are based on religious thought and therefore cannot be considered for taxpayer funding, I can simply claim that your practices are based on atheism or strict secularism and I don’t want my tax dollars going to explicit endorsement of your “religion”.

    Finally, I’m not any more scared of Muslims than I am scared of people of your camp. Both have extremists that would shoot people like me if they feel it would create a better world. Heck, I’ve extremists in my camp who would shoot you. I will however, trust for moderates to prevail and allow people and institutions to have their conscience on not compell them to participate in actions which will be both counter-productive, cause deliberate exacerbation of tensions, and possibly be used as an excuse for a purge. I think accomidation as long as it doesn’t lead to direct harm should be the order of the day in a pluralistic society. Yes, it brings problems and people with other positions will angry up the blood, but it is better than the alternative.

    I think it is mandatory for a doctor to diagnose accurately and to tell the patient the range of treatments he is willing to offer. I also think people have a right to health care, and should be able to use any doctor they choose. Those are the two rules I would follow on this issue, though of course when it comes to human care and human suffering things will always get confused and multiple exceptions will have to made to do the moral thing. Moral dilemmas after all aren’t not choices between right and wrong.

    So I think I’ve answered all your questions, so since you are calling me out I’d like to a question of my own. There are some people who say that doctors should be forced to provide information about the embryology of the foetus and provide information on government support programs to aid single mothers and/or struggling families. If Catholic hospitals are supposed to provide information to have an abortion and Catholic hospitals should be forced to allow abortions under their care, surely this is a good analogy right?

    Be careful of the precedents you set. It is usually better to leave people alone.

  35. Bad says:

    Terry: not having a religion is not, itself, a religion. Not funding religion is simply not the same thing as funding having no religion.

    But I certainly agree with you that SoCaS does not mean leaving your beliefs at home when you venture out into the public square, nor does it mean that religious people cannot get government money to do things that society wants to subsidize.

    What it does mean that religion itself, separate from the business of giving charity, is not something that the state should explicitly fund. Funding charities run by religious people with religious motivations for performing charity is one thing. But funding groups to actually promote religion is what crosses the line. Most large religious charities have actually been handling that difference quite well for decades: they’ve simply keeping two separate books. And that’s how I think things should be, for the good of everyone on all sides of the issue. Catholic Charities is actually a great example of this. They have values, and they have a mission, and that mission is informed by religion. But they are an equal opportunity employer: they want people that can do the work of getting things done, and that’s that, regardless of what they believe.

  36. Leslie says:


    You seem to make these rather large jumps in your statements and attribute arguments to me that are completely false and I find this highly distasteful. If you cannot have intellectual honesty in your arguments, then it means you do not have confidence in your position.

    You claim that I am an atheist and that is the basis for my objections, and that I am advocating state sanctioned Atheism as an official religion. Exactly where did I say I was an atheist? You need to retract that statement based on your erroneous assumptions.

    You also failed to acknowledge that I never said that doctors should be forced to perform abortions. You need to retract that statement as well.

    And despite pointing that out to you, you then go on to make the statement that I supposedly believe that, “Catholic hospitals are supposed to provide information to have an abortion and Catholic hospitals should be forced to allow abortions under their care” when I have NEVER advocated that.

    In fact, I believe Catholic hospitals should be able to exist and function as they see fit, as well as Catholic doctors — AS LONG AS THEY ARE NOT RECEIVING GOVERNMENT FUNDING in any form or manner. Public hospitals, clinics and doctors receiving government funding should provide purely secular services.

    To continue to assert something I have not said after being corrected is bearing false witness.

    Lies are not going to get anyone to come over to your side of the issue.

  37. Leslie says:


    It appears the issue is whether government should be funding religious based charities.

    I believe they shouldn’t. I think that the scope of the federal government should be limited to providing a standing military, basic infrastructure, enacting laws, etc. This is exactly why we have this problem — public funding of private enterprise.

    Churches and other charities should be supported via donations. My tax dollars should not be used to support private organizations (regardless of whatever services they are providing), especially those who are not required to make full financial disclosures or pay taxes.

    If government was out of health care completely, then doctors WOULD be free to exercise their conscience. The problem comes in when you take money from all citizens in the form of taxes, and then give it to a select group to further that organization’s ideals.

  38. Bad says:

    The problem is that Catholic Hospitals ARE providing secular services: medical care. If they were getting government grants to pray over patients, that would be one thing. But they are getting government money to fund ERs. The fact that they don’t offer some elective services is not enough to take them out of the running for the things they do do.

  39. Leslie says:

    And what I am saying is that the government should not be providing health care.

  40. Terry says:

    Oh well, I can’t agree with no public health care. I’m as right wing as they come, but a public health care system is just good infrastructure. It reduces costs for business , allows for more early diagnosis of problems, reduces sick days taken, and ensures that the uninsured have access to care. Now I wouldn’t go as far as Canada does and not allow patients to pay out of their own pocket to get more care than the systems allows, but government sponsored health care is a good idea. Think of it as government infrastructure for the labour resource, like roads are infrastructure for transport.

    As for Bad’s point about atheism as a religious position, I’m afraid it isn’t quite so cut and dried as that. Yes, atheism is a lack of a religion rather than a religion (though atheism can be combined with religious beliefs). However, atheism still falls under the seperation of church and state. For example, a muslim theocracy might forbid the practice of other religions because of religious reasons. An atheist regime might forbid the practice of religions because they feel it is a poisonous delusion that is the opiate of the masses.

    The same principles of the seperation of church and state would apply to prevent the government that uses the U.S. constitution from implementing these policies and disenfranchising its pluralistic citizenry. So like it or not, atheism falls under the purview of seperation of church and state like religions, ideologies and certain points of worldview.

  41. Leslie says:

    Can you read, Terry? Seriously.

  42. Terry says:

    Ah, missed the “not”. I’ll admit to being a little sheepish. Though your casual contempt over an honest mistake makes me like you a little less.

    Anyway, the government still provides the health care, just certain facilities don’t do certain elective surgeries. People can still go to to other hospitals to engage in medically unecessary and immoral procedures.

  43. Leslie says:

    Medically unnecessary and arguably immoral. . . like cosmetic surgery and breast augmentation?

  44. Terry “People can still go to…other hospitals to engage in medically unecessary and immoral procedures.”
    Ah, so you’ve been to my hospital, then? We specialize in all the fruits of mad (medical) science. 10% off being transformed in to a radioactive super-soldier if you book before the end of the month! For a limited time, unjoined twins siamesed for free! Moo ha-ha!

  45. Leslie says:


    Well, it seems you’ve been caught with your pants down and are too “sheepish” to respond.

    You admit that you don’t read posts very carefully, and when called on it, you try to blame me for your failure. For the record, it wasn’t one missed point, it was several very lengthy posts you simply skimmed or ignored altogether. Carelessness is not “an honest mistake.”

    So I posted a one-liner to see if you would actually address one point, directed at you. You ignored it. Intentionally.

    And truly, I don’t care whether you like me or not. I do not judge my self-worth based on how I am viewed by others wholly unconnected to myself. I really don’t respect your opinion — not because it opposes mine, but because it is not well thought out or presented well.

    I appreciate BAD’s position, while not necessarily agreeing with it, because he has considered the ramifications of his position. You have not. My thoughts and opinions on this matter are likely to be changed by his arguments rather than your’s.

    Your position is like many rabid fundamentalists, devoid of reason, based mostly on religious zeal, lacking critical thinking skills and often hastily structured. You spend so much time screaming your position and then patting yourself on the back that you miss much of the opposition’s arguments. It is as if you believe that if you can successfully ignore an argument, then that is the same thing as being victorious in debate.

    I’m not even sure whether you are attempting to convince me or yourself of your position. You don’t seem very confident in your stance.

    So, are you here to feel victorious, to debate the subject, or change someone’s mind?

  46. What a excellent post! I did a of blogging for dummies over on one of the CPA Marketing forums and I believed it was too simple for them, but the quantity of emails I got asking questions just like what you addressed was unbelievable. As young people today we have grown up with computers, but it’s easy to forget that even people just a a couple of years older have not! Really good post! :)

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