ACOG conscience position outrages 'pro-life' MDs
Group urges weighing conscience, patient welfare
A paper reporting the American College of Obstetrics and Gynecologists (ACOG) association's position on how far doctors can go in conscientious refusal to perform abortions and prescribe emergency contraception is an attack on "pro-life" physicians, according to two medical associations.
ACOG released Limitations of Conscientious Refusal in Reproductive Medicine in November, a position paper that proposes a definition of conscience and describes how its member physicians should weigh their claims of conscience against provision of reproductive medicine. ACOG describes the paper as "a framework for defining the ethically appropriate limits of conscientious refusal in reproductive health contexts."
However, the American Association of ProLife Obstetricians and Gynecologists (AAPOG) and the Christian Medical Association (CMA), along with some 20 other health, religious, and conservative organizations, countered with objections that ACOG is attempting to "shut down" the convictions of doctors who are opposed to abortion and sterilization.
In a letter to ACOG, leaders of CMA, AAPOG, and other national organizations with pro-life positions, write that the ACOG position paper "suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith, and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion."1
CMA Director David Stevens, MD, says not only does ACOG's position threaten the certification of physicians who conscientiously object to providing certain types of reproductive care, it infringes on individual religious and speech liberties.
"ACOG is not only out of touch with conscience-driven physicians, but also with our long-standing American tradition to protect the rights of citizens to not participate in conscience-violating actions, especially when those actions would take a human life," Stevens says. "This statement goes a step beyond not representing our life-affirming values to actually advocating policies to prevent us from exercising those values."
ACOG: Conscience can't interfere with care
ACOG's position paper states that physicians' personal conscience "is not merely a source of potential conflict," but rather "has a critical and useful place in the practice of medicine." [2] Conscience can foster "thoughtful, effective, and humane care," the paper points out.
It's when the physician's conscience is in conflict with patient care that limits on conscientious refusal are needed, according to ACOG. "Even when appeals to conscience are genuine, when a provider's moral integrity is truly at stake, there are clearly limits to the degree to which appeals to conscience may justifiably guide decision making," the paper, drafted by the ACOG Committee on Ethics, states.
When crises of conscience arise, the association instructs physicians to consider four criteria:
- the degree the conscientious refusal creates an imposition on the patient;
- the effect the refusal can have on patient health;
- scientific integrity;
- potential for discrimination.
ACOG recommends physicians with strong moral objections to abortion, sterilization, emergency contraception, and other reproductive therapies:
- make patient well-being paramount;
- impart unbiased and accurate information for patients to use in making informed decisions;
- disclose, accurately and ahead of time, their personal moral commitments regarding the objectionable practice;
- refer patients to other providers when they are unable to provide "the standard reproductive services" requested by patients;
- in an emergency, provide medically indicated care regardless of personal moral objections;
- practice in proximity to physicians who do not share their moral objections, or otherwise insure a referral process that allows patients to receive the care they request.
Objecting physicians feel pressured
"ACOG's attitude seems to be, 'If you don't toe the ACOG line on abortion, the morning-after pill, and the application of reproductive technology,' then you shouldn't be practicing obstetrics — and if you do, we're going to do everything in our power to force you to accommodate our abortion agenda,'" Stevens insists.
In a prepared statement issued in response to the position paper, AAPOG called the recommendations "a raw power play to cripple, and ultimately eliminate from practice, those doctors who hold a conscience conviction on the sanctity of human life," and suggested that physicians who do not comply with the ACOG recommendations risk losing ACOG certification.
CMA Executive Vice President Gene Rudd, MD, an obstetrician and gynecologist, says the ACOG position led him to resign his ACOG membership of more than 25 years.
"My conscience can no longer support their lack of conscience," says Rudd.
References
- Letter to American College of Obstetrics and Gynecology, Dec. 7, 2007. Available on-line at www.cmda.org. Click on "Public Policy — Ethics and Position Statements;" then select "Conscience Rights." Under "Resources and Downloads," click "ACOG Response Letter."
- ACOG Committee Opinion, No. 385. The Limits of Conscientious Refusal in Reproductive Medicine. Obstet Gynecol2007;110:1203-1208.
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