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Code Red For Christian Doctors

Wesley J. Smith, a Christian and one of the most acute observers of bioethics and life issues, issues a strong warning: “Pro-Lifers, Get Out Of Medicine”. [1] Excerpts:

Doctors in the United States cannot be forced to perform abortions or assist suicides. But that may soon change. Bioethicists and other medical elites have launched a frontal assault against doctors seeking to practice their professions under the values established by the Hippocratic Oath. The campaign’s goal? To force doctors, nurses, pharmacists, and others in the health field who hold pro-life or orthodox religious views to choose between their careers and their convictions.

Ethics opinions, legislation, and court filings seeking to deny “medical conscience” have proliferated as journals, legislative bodies, and the courts have taken up the cause. In the last year, these efforts have moved from the relative hinterlands of professional discussions into the center of establishment medical discourse. Most recently, preeminent bioethicist Ezekiel Emanuel—one of Obamacare’s principal architects—coauthored with Ronit Y. Stahl an attack on medical conscience in the New England Journal of Medicine, perhaps the world’s most prestigious medical journal. When advocacy of this kind is published by the NEJM, it is time to sound the air raid sirens.

The authors take an absolutist position, claiming that personal morality has no place in medical practice. Under the pretext of “patients’ rights” and a supposed obligation of doctors to adhere to the medical moral consensus—a tyranny of the majority, if you will—Emanuel and Stahl would prohibit doctors from conscientiously objecting to performing requested procedures on moral grounds.

More:

Emanuel and Stahl would drive noncooperating doctors out of medicine (my emphasis):

Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession.Shattering medical conscience rights would also dissuade those who hold officially unwanted values—orthodox Catholics and other Christians, Jews, Muslims, and pro-lifers—from entering medical school in the first place. There is a method to this madness: The goal is to cleanse healthcare of all those who would dare to practice medicine in accord with sanctity-of-life moral viewpoints.

Read the whole thing.  [1]

I write about this in The Benedict Option. [2] Excerpt:

Public school teachers, college professors, doctors, and lawyers will all face tremendous pressure to capitulate to this ideology as a condition of employment. So will psychologists, social workers, and all in the helping professions; and of course, florists, photographers, backers, and all businesses that are subject to public accommodation laws.

Christian students and their parents must take this into careful consideration when deciding on a field of study in college and professional school. A nationally prominent physician who is also a devout Christian tells me he discourages his children from following in his footsteps. Doctors now and in the near future will be dealing with issues related to sex, sexuality, and gender identity but also to abortion and euthanasia. “Patient autonomy” and nondiscrimination are the principles that trump all conscience considerations, and physicians are expected to fall in line.

“If they make compliance a matter of licensure, there will be nowhere to hide,” said this physician. “And then what do you do if you’re three hundred thousand dollars in debt from medical school, and have a family with three kids and a sick parent? Tough call, because there aren’t too many parishes or church communities who would jump in and help.”

I did not identify my source, at his request, but trust me, he is a physician at the top of his field. As Smith writes in that First Things piece, this is not an abstract threat. Canada is already farther along the road to this dystopian future.

What do you physicians, nurses, and others in the medical field think?

67 Comments (Open | Close)

67 Comments To "Code Red For Christian Doctors"

#1 Comment By Siarlys Jenkins On May 17, 2017 @ 3:25 pm

If I had to pick a fictional fantasy dystopia that *could* be our future, I’d go with “The Hunger Games”, not “The Handmaid’s tale”.

I’ll second that.

I am aware of an actual case headed to litigation in which a medical professional is facing an anti-discrimination lawsuit for declining to be part of someone’s gender transition.

I’m enough of a fool to rush in where our gracious host fears to tread. I’m sure he has good reasons, but I can’t resist:

If the case is decided on “you refuse to treat a patient who is ‘trans-gender’,” then the doctor may well lose. If the doctor is able to reframe the question, and testify that he has no confidence in the treatment desired, believes the diagnosis to be experimental in the extreme, cannot in good conscience as a doctor recommend doing it, and therefore does not believe he would be competent to oversee it either, then he may well win.

It can be an uphill battle to make the difference clear, but there is a very real difference.

#2 Comment By The other Eric On May 17, 2017 @ 3:55 pm

Section 4. Whenever the Vice President and a majority of either the principal officers of the executive departments or of such other body as Congress may by law provide, transmit to the President pro tempore of the Senate and the Speaker of the House of Representatives their written declaration that the President is unable to discharge the powers and duties of his office, the Vice President shall immediately assume the powers and duties of the office as Acting President.

If the vice president and the leader of the senate says he goes, he goes. Imagine what this could do to our democracy. And fitness for office is a political decision, not a medical or psychiatric one.

#3 Comment By EngineerScotty On May 17, 2017 @ 4:29 pm

Let’s transport La Lubu back in a time machine. In my state, there was little debate as recently as the 1970s about the morality of forced sterilization for people of both sexes deemed promiscuous or unintelligent. Even if a physician had a moral objection, should she have been forced to refer her 17 year old patient with a baby to a physician to do a sterilization at the mother’s request? Or: Lobotomies were at one time done. Any doctor who had a moral objection to performing or referring for one- should have just done it? There are many historical instances of practices having wide medical acceptance which in retrospect are clearly immoral. Doctors should be allowed the freedom not to participate in elective, nonemergent procedures.

Mary,

Forced sterilizations or lobotomies are hardly elective procedures. Nobody is suggesting that patients be required to take birth control or have abortions (the latter often happens in China if a woman gets pregnant with more kids than allowed, BTW), and that doctors may not object to this.

Every thing we are discussing is voluntary from the point of view of the patient, and in some cases medically necessary.

There needs to be a distinction between “I don’t want to participate in X” and “I want to seek to prevent patients from doing X”. Often times when the former is claimed, the latter is meant–in some of the Obamacare/contraceptive cases, it is rather obvious that the employer doesn’t simply want to be out of the “loop” of their employees receiving birth control; they want to make it as hard as possible for their employees to do so. There are probably some (secular) employers out there who, if they could, would fire employees for doing so, even if entirely on their own dime.

Avoiding sin, and punishing sinners, are two different things.

#4 Comment By EngineerScotty On May 17, 2017 @ 4:36 pm

I’m a family doctor who doesn’t prescribe contraception on moral grounds, and my front desk staff is instructed to tell this to every new female patient between the ages of 15 and 45. I am unaware of any physician with similar principles who doesn’t try to tell patients in advance the same thing. Occasionally, someone who wants birth control will slip through, in which case I offer to return their copay. Usually in this situation, the person will shrug her shoulders and ask for an evaluation for a different complaint while she is there. I mention that there are many other physicians who would be happy to prescribe contraception for her- but don’t do a formal referral, since in this case one isn’t needed. My experience is that the vast majority have no problem with my explanation that I don’t prescribe birth control for personal reasons. Interestingly, on the handful of occasions where someone has decided to pitch a fit, it has always been a woman raised Catholic who has either abandoned her faith, or specifically, the teaching on contraception. Nobody else has a problem. This includes observant Christians who have no objection to birth control but respect someone taking a stand on moral grounds.

And I have no objection to this policy. You are up-front about the limits to your practice, you attempt to mitigate damages in case a mistake occurs, and (I assume) this is all non-emergency medicine, so patients who do want birth control have ample opportunity to obtain it elsewhere.

(Though I might ask–do you prescribe birth-control medicine for reasons other than prevention of pregnancy? If not, do you refer these patients to other providers, or is there a clinically-effective therapy you provide instead?)

#5 Comment By Mary Russell On May 17, 2017 @ 6:50 pm

EngineerScotty,
You make a good point about elective vs no elective procedures. However, (and here I wish the NEJM article weren’t behind a paywall), I took the authors to mean that a physician is required to perform (or refer for) any procedure approved by medical consensus. No. She does not. And patient’s request to have a procedure done has never meant a physician is required to perform it- even when it agrees with medical consensus. If someone decides they don’t want their perfectly normal right leg, a general surgeon is not required to amputate. And even if an obstetric patient at 34 weeks without any medical complications decides that she wants to be induced and delivered, knowing and consenting to all of the complications that might occur- her obstetrician is not required to do it, or refer to someone who does.

“In some of the Obamacare cases, it is clear the employer doesn’t just want to be out of the loop…”

Examples?

“Do you prescribe birth control for reasons other than pregnancy.”

Very rarely. In most cases, there’s an evidence based (and widely used) alternative for whatever the problem is.

#6 Comment By Mary Russell On May 17, 2017 @ 7:10 pm

In medicine, consent for a minor to have a medication or procedure is given by the guardian(s). I was just now reading about the history of lobotomy- in many cases, parents gave consent for their minor children to have this procedure, and in other cases the patients themselves were able to understand and approve having it done. It was widely approved in the U.S. So- physicians who refused to perform it or refer to a surgeon who would do it are guilty of- what, exactly?

Another, more contemporary example: although I don’t personally have a problem with infant male circumcision, there are more than a few physicians who would ordinarily be responsible for performing it (pediatricians, family docs) who do. It is widely accepted in the U.S., with the AAP coming out a few years ago in favor of its availability and medical benefits. Yet I have no problem with those physicians who don’t want to perform or refer for it- not performing or referring for it.

#7 Comment By Clyde Schechter On May 17, 2017 @ 8:17 pm

Well, I certainly hope Smith is wrong in his prognostication.

When I was in medical school, abortion had only recently been legalized. I objected to abortion (for moral, not religious reasons; I’m a life-long atheist) and requested to be excused from participating in any. I was prepared to drop out of medical school rather than kill a fetus. Fortunately, I was allowed to do other things that I did not find objectionable during that week. (My personal view on abortion has shifted over time, and I now believe that it should not be illegal, although I would still personally refuse to perform or assist in one.)

There are many medical treatments over the horizon that raise serious moral questions and that people with moral objections should be able to refuse to perform or assist in. “Assisted suicide” is one. Germ-cell genome modification is another. Perhaps human cloning. These are difficult questions that reasonable people can disagree about. It will be a sad day if people are prohibited from following their consciences in these serious matters.

Even in times of war, our country has allowed conscientious objectors to be exempted from killing and provide alternate forms of service. How could we justify not similarly exempting medical conscientious objectors, when there is no compelling national interest even at stake?

I think it is important that opposition to this new tendency, if it really is a tendency, not be too deeply rooted in religion. Strong moral secular arguments can be raised in favor of allowing health care providers to follow their consciences, and these arguments will carry greater weight with those who ultimately will influence the outcome. It would be good, though, if both secular and religious conscientious objectors can work side-by-side to oppose incursions on conscience.

I feel fortunate that having retired from clinical practice several years ago, I will not have to face these dilemmas myself.

#8 Comment By La Lubu On May 17, 2017 @ 8:41 pm

EngineerScotty beat me to it: consent matters. In fact, I find the examples given more in line with what I’d like to prevent: procedures and practices unilaterally imposed by physicians onto non-consenting patients.

Mary, I wish your policy was common practice—tell people over the phone when making an appointment what services won’t be available so patients don’t have to lose a day’s pay with an appointment that won’t meet their needs. (do you also post this on your website?) None of the physicians in my city have that information posted on their website. It’s bizarre. There’s also a certain disconnect between the ratio of physicians in my area that are opposed to birth control and won’t prescribe it, and the number of women who regard birth control as just as important and sensible as vaccinations. The community norm is very pro-birth control, the provider norm…increasingly less so.

Also: your cutoff is age 45? Oh please, tell me that was a typo and you meant “55”. There’s plenty of us 45 and over who haven’t entered menopause yet, and are more motivated than ever to avoid pregnancy! (been there, done that. Glad I did, but am too old for a repeat performance.)

#9 Comment By Siarlys Jenkins On May 18, 2017 @ 9:10 am

Anything that Engineer Scotty and Mary Russell can come to consensus on is fine with me. But we might have to lock them in a room and tell them nobody comes out until they have arrived at a mutually acceptable consensus. I think they are close enough they could do the job.

#10 Comment By Mary Russell On May 18, 2017 @ 9:17 am

“Also: your cutoff is age 45? Oh please, tell me that was a typo and you meant “55”. There’s plenty of us 45 and over who haven’t entered menopause yet, and are more motivated than ever to avoid pregnancy! (been there, done that. Glad I did, but am too old for a repeat performance.)”

No, 45. There are not “plenty” of women over age 45 who want reversible contraception. Most women that age are done with childbearing and have opted for sterilization years ago. There are also a lot of mainstream gynecologists who are not comfortable with prescribing estrogen containing reversible methods due to the amplificatiin of risks associated with age.

There are more examples of consenting patients asking for widely used treatments approved by medical consensus being denied b providers. Another recent example that comes to mind is pain treatment. About 15 years ago pain became “the 5th vital sign”, and providers were told that refusing to control pain with any approved means, including opioids, was unethical. What followed was huge profits by pharmaceutical companies and the mess we are currently in. Yet I am aware of physicians who refused to get on the bandwagon out of a moral sense that people should not be able to get narcotics just like that. These physicians were told they were too conservative, not compassionate, not up to date, and unresponsive to patients needs. Yet by being stingy, they probably saved lives.

This is the kind of physician who would be punished by the regime suggested by these ethicists.

#11 Comment By Siarlys Jenkins On May 18, 2017 @ 12:51 pm

The attempts to tweak standards for opiates is an example of how factions and pressure groups and ideologies does not produce an optimum result. The truth is, some people are in pain so severe that they really need opiates. Also, a lot of people who are in pain might be suffering, but really would be much worse off, long term, if they were prescribed opiates. So swinging the pendulum between idiotic slogans like “The Fifth Vital Sign” and absolute prohibitions like “don’t give anyone opiates, they’re all addicts on the make” are not helpful. Without knowing her or her practice well, I have a sense that Mary Russell could recognize when opiates really are in order, and follow up closely on how long and at what dose.

But yes, physicians do need some leeway to make their best medical judgment. And patients do have the option to go elsewhere. The result will not be perfect… but neither is an absolutist demand for perfect conformity… which also isn’t perfect.

#12 Comment By JonF On May 18, 2017 @ 2:02 pm

Re: Another recent example that comes to mind is pain treatment. About 15 years ago pain became “the 5th vital sign”, and providers were told that refusing to control pain with any approved means, including opioids, was unethical.

Well, pain should not be ignored: it does damage one’s quality of life, and it may be a canary in the coal mine that something is wrong that is not obvious in tests. However there needs to be a middle ground. Opioid drugs have a place, but it should be a much more limited one than it has been. IMO, except in cases of severe injury (when the patient will probably be confined to a medical facility) and in cases of terminal illness, no more than ten opioid pills should ever be prescribed at a time– the habit of handing out thirty or sixty pills at a time is not a good idea (again, with the aforementioned exceptions). There are other analgesics which can be used ( e.g., Ibuprofen) albeit they may have issues too.

#13 Comment By La Lubu On May 18, 2017 @ 5:38 pm

No, 45. There are not “plenty” of women over age 45 who want reversible contraception. Most women that age are done with childbearing and have opted for sterilization years ago. There are also a lot of mainstream gynecologists who are not comfortable with prescribing estrogen containing reversible methods due to the amplificatiin of risks associated with age.

There are enough of us. Sterilization for women isn’t as common in my area because of how insurance works—if your HMO or PPO provider is the Catholic hospital, you’re out of luck (unless you have that kind of money in your back pocket, which most people don’t). Most of the time when this happens, it’s done in conjunction with childbirth, when you have a certain amount of recovery time by default. If your job is at all physical—and for most working class women it is—there is a reluctance to go in for additional surgery even if the money was there (which it isn’t), because that can affect employment.

Which is why vasectomy is the frequent go to solution! But if a woman becomes single in her forties, that is no longer a solution. Then, the Pill may still be in play, or there’s always the diaphragm or IUD (I pick diaphragm, because my insurance plan only pays for the Pill, and then only for non-birth control reasons….but most physicians won’t hesitate to find a way to prescribe it anyway if the patient is seeking birth control).

There really, truly are single, sexually active “older” women who don’t want to leave pregnancy up to chance. BC is a better solution than abortion.

#14 Comment By will On May 18, 2017 @ 6:06 pm

I have been a physician for 35 years. It is clear that a physician’s religion and ethics will be less endangered under republican governance than progressive rule. This includes Trump.
In this very issue of TAC is an article “Trump Reverses Obama on Religious Colleges”.
Why then does Mr Dreher seem hell bent on adding to the anti Trump hysteria and the impeachment drumbeat mania? I don’t keep score but it seems Dreher has written almost nothing positive or neutral about the president.

#15 Comment By Mary Russell On May 18, 2017 @ 6:48 pm

“There are enough of us.”

Not in my area. In the course of my 17 years practicing medicine I can count on my fingers the number of women over 45 who were on OCPs. IUDs are more common. Diaphragms are really rare, at least in my area. And because we were talking about why I don’t mention my principles to women over the age of 45, it’s worth mentioning that many, perhaps most, family doctors, don’t place IUDs or fit diaphragms. Because my practice is not unique in that regard, there’s no need for my front desk to mention this fact to > 45 year old women scheduling appointments.

#16 Comment By Mary Russell On May 18, 2017 @ 9:23 pm

“If your job is at all physical—and for most working class women it is—there is a reluctance to go in for additional surgery”

I have to disagree with La Lubu here. The recovery time for tubal ligation is 2 days. My practice is mostly what I would call working class- high school educated men and women who are working on their feet, often lifting and carrying. People can and do go in for elective surgery, and they can and do take a few days off for it.

Oh, and Siarlys: thanks for your contributions to this thread. Of course, you and JonF are correct to modify my point about opioid prescribing, in a way that doesn’t undermine my point. The days of prescribing #120 Percocet 10s per month (for example) for non cancer pain are over for responsible physicians. The providers who always refused to practice medicine in this way (and there weren’t many in family medicine) were the unusual exception.

#17 Comment By Siarlys Jenkins On May 19, 2017 @ 12:27 am

Why then does Mr Dreher seem hell bent on adding to the anti Trump hysteria and the impeachment drumbeat mania?

Because the man is so utterly capricious and corrupt that he shouldn’t have his finger on the nuclear codes? Because his tenure will put a real strain on constitutional republican government? Because these things are simply more important than any given issue or pet project?