"Irish Need Not Apply" read many storefront signs in the United States during the 19th century. Today, almost everyone disapproves of racial, ethnic, or religious discrimination. Yet important segments of our society support a different sort of discrimination which prevents conscientious objectors to abortion, including Catholics, from participating on an equal footing in the field of medicine.
New health care reforms may mean the legal imprimatur of views such as those expressed by the American College of Obstetricians and Gynecologists (ACOG) published in November of 2007. The ACOG wrote Committee Opinion number 385 entitled, "The Limits of Conscientious Refusal in Reproductive Medicine." This report attempted to "maximize accommodation of an individual's religious or moral beliefs while avoiding imposition of these beliefs on others or interfering with the safe, timely, and financially feasible access to reproductive health care that all women deserve."
"Reproductive health care" is a euphemism since the restoration or protection of reproductive capacity, restoring or protecting fertility, is almost never what is meant by the term. As used today, "reproductive health care" actually means inducing sterility or miscarriage both of which are indicative of a lack of health. It should also be kept in mind that these services are entirely elective. There is no need - in terms of health and restoration of the human body's proper functioning - for such services.
Unfortunately, the balance struck between respecting personal conscience and facilitating "reproductive autonomy" (i.e. abortion and contraception) forces some physicians to act against their best ethical and medical judgments.
For example, the report recommends that pro-life physicians must refer patients wanting "standard care" (abortion and contraception) to other service providers. The committee proposes a duty to cooperate in the wrongdoing of others, even when such services are judged by a physician not to be in the best medical interests of a patient. By contrast, in defending partial birth abortion, the ACOG champions the judgment of the individual doctor about what is best for a particular patient.
Some philosophers argue that such guidelines are needed lest physicians and health care providers impose their views on others. On this view, to conscientiously object and refuse to provide abortion or contraception is to force women to accept pro-life views and prevent them from exercising their legal freedoms.
This argument fails. I have a legal right to write whatever I like, but The New York Times has no obligation to publish it. I have a legal right to travel to Washington, D.C., but this does not mean someone has an obligation buy me a plane ticket. Women have a legal right to use contraception or get an abortion, but it does not follow from this that health care workers have an obligation to facilitate these choices.
Pro-life physicians cannot and do not impose their views on others as is evident from the fact that abortions are among the most common surgeries in the United States and contraception is even more widely used. The real question is whether advocates of "choice" will impose their views on others and attempt to force them to act against their conscientious beliefs.
The report also recommends that conscientiously objecting physicians provide prior notice to their patients that they do not provide abortion or contraception, but at the same time these doctors may not "argue or advocate" their views.
Opinion 385 of the ACOG puts pro-life physicians in the precarious bind of being forced to reveal what they believe, but forbidden to relate why they believe. It is also unclear why a doctor's First Amendment's protection of free speech does not include speech criticizing abortion. In other contexts, the ACOG opposes "gag rules" that restrict communication between physician and patient.
The committee recommends that pro-life doctors "practice in proximity to individuals who do not share their views." The report mentions no concern about patients in rural communities currently served by a pro-life physician whose wellbeing would be jeopardized by the loss of a local doctor.
The report even recommends that objecting physicians themselves perform abortions if not doing so would be detrimental to the physical or mental health of the person seeking abortion. Since "mental health" is customarily used in these discussions to cover virtually any circumstance, the report essentially vacates any conscience protection.
As the former Secretary of the Department of Health and Human Services Mike Leavitt points out: "The ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification." Unless conscience protections are written into law, the ACOG ethics report could be the end of the pro-life doctor.
This development would be disastrous for the medical profession and for the country in a number of ways. It would drive out many people of faith out of the practice of medicine entirely. Since Latinos and African-Americans are disproportionately religious, a prohibition on pro-life physicians would disproportionately affect minorities. It would also undermine Catholic health care which provides more than 10% of health care national wide. With fewer providers, the cost of health care would increase still higher.