Conscience and the Practice of Medicine
Regarding Abortion

Philip G. Ney MD FRCP(C)

© Sept. 30, 2008 

  Although there is a hotly contended debate regarding the role of conscience in the decision making of physicians, particularly regarding abortion, I do not feel advocating the use of conscience, as a guide is the way to approach the problem.  After many centuries of struggling we now have a science that can be generally relied upon to demonstrate what is true.  This is wonderful for Christians who believe that there is one truth and only one source of truth.  For them, there must be close accord between scientific and theological truth.  In my experience in over half a century of examining this problem I have found spiritual and physical truths agree.   Whereas conscience can vary between individuals even of the same faith, science can be relatively objective and uniform.  It is now a very important time to apply what we know about the rules of scientific methodology and understanding to address this thorny issue of abortion. 

Abortion is considered by almost everyone to be a medical procedure.  It is done by medical staff, in medical facilities, and paid for by medical funds.  Even though it is not now well regulated by medical tenants and regulations, there is still an understanding that abortion must be done to benefit the health and welfare of each individual on whom it is performed.  Given that it is a medical procedure, the following principles and conditions must all apply.  Sadly very few of these tenants are ever used.  Consequently the practice of abortion has become an aberration in medicine.  It is time that we apply good science to bring the practice of abortion back into the folds of medicine and apply all the regulations that medicine must use.  If we don’t do this then abortion will be a technique performed by technicians for reasons that have nothing to do with science.

 Terrible as abortions by technicians would be, it would be better than the present situation.  Abortion has destroyed much of the nobility and honor that was once integral to all modern medicine.  We have returned to the ways of Nazi regulated medicine when it was unimportant to determine if there was any benefit to the patient as long as it was legal.  Medicine in Germany and satalitte countries was practiced without science and without conscience to destroy and dehumanize it’s own citizens.  In the same way medicine in most western countries of today neglects the rigors of science in order to carry out what is socially and legally approved.  So now, popular social and cultural mores regulate medicine, instead of a noble profession providing an example of how citizens should treat each other.

 

The following criteria must apply in every instance of medical investigation and treatment.  You might say that plastic surgery is an exception.  However if you examine that practice you will understand that no surgeon would perform an operation, regardless of whether the patient wants it or not, if he knew it was harmful.  One simple reason is that he knows he is much more likely to be successfully sued if when he did any harm  this patient, he/she took him/her to court.   

While reading through these criteria, have in mind both abortion and appendectomy and consider how they are applied.  You will see there is a wide discrepancy.   

1)      Necessity.  The procedure (appendectomy or abortion) must be necessary.  It must be indicated for the group of patients who have a certain condition.  It must also be necessary for the individual who is part of that group with that condition.  Necessary implies that without the intervention of that procedure the patient’s health would worsen and they could die.  Pregnancy is not a disease.  There are very few, if any, surgical or medical conditions that can be properly treated only if the patient’s preborn child is terminated.  Psychiatric illness is a contraindication to abortion.  There is universal agreement amoung clinicians and researchers that all psychiatric illnesses worsen following and abortion. Yet whenever an reason  must be given before an abortion is legally approved in some countries, the physician must frequently cites some psychiatric illnesses.  Such is the depth to which medicine has sunk.

2)       Benefit.  The individual patient must clearly benefit from the procedure.  Benefit means that their health in the short and long term will be improved. Benefit should be demonstrated in groups of people and in individuals.  Obviously one cannot randomly assign the treatment abortion to matched pairs. However  longitudinal studies or retrospective ones like ours, which included all the women of a representative sample for all their pregnancies can and must be done.  Since everyone is an individual, abortion must be demonstrated to be beneficial using the patient as their own control in the same woman after child birth and after an abortion.

The benefit must be mutual, particularly with respect to abortion.  All those associated with the pregnant woman, including her baby, husband and children, must benefit or else triage must apply.  Remember that it is impossible to benefit at the expense of one’s neighbour no matter how small or how limited is their “quality of life”. Therefore if the benefit isn’t mutual it isn’t beneficial.  Although there have been a few feeble attempts, there is no evidence to show abortion benefits anyone.     

3)      Proof.  It must be demonstrated, beyond reasonable doubt, that the individual patient needs this procedure and will benefit from it.  Although proof can never be conclusive, the benefit must outweigh any harmful effects. It must be substantial and reasonable.  The oness of proof lies with those who perform or support or fund any procedure to demonstrate it’s necessity and benefit.  It is not up to pro-lifer’s to demonstrate that abortion is harmful, although this is useful.  It lies heavily on abortion providers and promoters and those who are “pro abortion” to demonstrate that abortion is necessary and beneficial.  This has been one of the most basic tenants throughout  the history of modern medicine.  Pro abortion, pro choice supporters have never assumed this responsibility.  No abortionist has published a scientific article with data from a follow up study of his/her patients.  They have not and fell they need not only because abortion and abortionists have been so well supported by the government, courts, and media.

4)      Harm.  Although there are few if any medical procedures that are without some harmful side effects, it must be demonstrated that the harm is relatively less than the benefit.  It must also be shown that the harm does not occur sometime in the future.  Most studies regarding abortion have attempted to show there was no harm but the data was distorted, there was insufficient follow-up and then only for short periods of time and with less than a representative sample.  Even so, the recent APA summation of some studies carefully picked to favor a pro-abortion position has shown there are people who are seriously depressed and anxious following an elective abortion.  

In medicine, an agent is considered to be therapeutic if the person who most needs it most, benefits most.  With respect to abortion it has been demonstrated repeatedly that the worse the psychiatric condition prior to abortion the worse the outcome.  That forces one to consider the dictum “if it doesn’t benefit the patient it is not an agent of medicine”. 

There is increasingly strong evidence that abortion is harmful. Certainly there is much more evidence that it is harmful than that it is beneficial. Any civilized country cannot through court decisions or legislation provide any component of its society the unfettered right to harm people. This is why abortion is so incongruous. Doctors have been given the right to harm and be paid for their harming by public funds. No such thing has ever occurred in a civilization before.  

5)      Alternatives.  Especially with invasive techniques (abortion) and especially with
those techniques the effects of which are irreversible (killing a child), it is vitally important that alternatives that are less invasive and less irreversible first be offered and tried.  There is conclusive evidence that the longer the pregnancy lasts, the more  parents become attached to the preborn child and the more welcome he/she becomes.  Obviously the best alternative to abortion is waiting.  Primum non nocere certainly applies with pregnancies. However it is also necessary to work toward supporting the parents and helping them work through the difficult dilemmas regarding pregnancy.  There are approximately 53 harsh conflicts they must resolve.  By my calculations this takes at least six months. This is why it is very unlikely that any person gives a freely chosen informed consent.

       6)  Recommendation.  Having examined the patient and considered all the options that are available, the physician must make a clear recommendation to each patient. That recommendation must be predicated on his clinical findings, experience with the procedure and knowledge of the scientific literature.  The recommendation must clear and stated unequivocally. The patient then has a choice to accept or not accept that recommendation or elect further investigation and second opinion or request more time to consider his/her choice.   That is the limit and the responsibility of the patient’s choice. No patient can make a demand upon the physician to perform any procedure.  Most importantly, no patient can make a demand upon the physician to harm them. The physician’s rights to select his/her patients and to deny treatment must always be protected. His determination not to provide the treatment must be based upon science. Only if science is ambiguous can he refer to and rely upon his informed conscience.  To be coerced with threats they will lose their license, to do or refer to someone who will do an abortion , is clearly servitude.  It must be remembered that by referring a patient for any procedure has the legal implication that the referring physician approves of that procedure.  

If Joe McDowell from the backwoods comes to the doctor saying, “My arm hurts so much, I think you should cut it off. I’ve tried everything but there is no way to stop the pain.” After examination, the physician determines he has a fracture and offers to put his arm in a cast. If the patient said, “No, doctor, I’ve decided this arm is useless, please cut it off.” It would be ludicrous if the doctor  responded with, “Of course Joe, it’s your choice and it’s your body.  I will cut off your arm right away.”  With respect to the tenets of medicine that is how stupid it is to perform an abortion according to the patient’s choice.  

       7)  Consent.  The patient is consenting to a recommended procedure.  Thus the recommendation must be clearly stated.  The patient must be given plenty of time to ask questions, and even more time to carefully consider whether they will or will not accept that recommendation. With respect to abortion, that consent could only be valid if the patient had a clear impression of the child whose life is at stake,  both psychologically and physically as described by science and as seen on an ultrasound.

Since the consent is not only a consent to the procedure but a consent to the physician doing that procedure, the patient must know who the physician is and what is his/her basic ethic. Over time physicians subliminally inculcate their own values to the patient who is in a dependent situation. For both these reasons, it is vitally important that a physician declare his ethic, either by writing them out and pinning them to the wall of his waiting room, or handing them to the patients before any procedure is done.  

       8)  Triage.  From the earliest of modern medical history, physicians have been guided by the principle of triage. This insists that the physician most quickly and adequately attend to the patient who is most likely to benefit from treatment.  This applies whenver there is a limited number of medical personnel or resources. Since there is no evidence that in 99% of the time, there is an indication for an abortion, this means that other surgical procedures such as patients desperately needing heart surgery or cancer treatment, that abortion would be relegated far down the list.  This also means that regardless of size, intelligence or power the person, born or preborn who will benefit most from limited resources or skills, must be treated first.  This is usually the baby.  In practice this means we must develop techniques of transferring a preborn baby from a hostile or welcoming womb in a extremely ill woman, to a healthy and  welcoming one.    

       9) Payment.  The amount of payment of any medical procedure should depend upon the benefit to the patient, the skill of the physician that is required and the hazard in performing that procedure. If this were the case, it would mean that no physician should be paid for an abortion, because there is no evidence of benefit.  Patients should be able to pay directly, for that accords them dignity and a modicum of control. 

        10) Conviction.  The aborting physician must be convinced in his or her own mind that what he is about to do is truly beneficial to the patient. This inner conviction stems mostly from a followup of his or her previous patients in which this procedure has been performed. Otherwise he is doing something that creates an inner dishonesty from not knowing whether the patients he is treating are getting well or not. When he/she does not follow-up their patients, by far the most usual practice) it is a clear indication they suspect the outcomes are not good but don’t want to know.  

     11) Conscience. When all of the above fail, good physicians can rely upon their conscience to guide them. This is some inner sense that tells them whether what they are about to do is healing or harmful.  There is nothing between.  No physician can say with conviction that they don’t know, or that it’s somewhere between good and evil. It either helps or damages a patient. They must know this and be convinced in their own heart. When their conscience is not formed by science and by God, then they should not rely upon that conscience.  Then the old rule, if it was you or someone you loved, what would you choose, can apply.  

    12)  Funding. The government or private insurance can and should fund any procedure that fulfils all the above criteria. Otherwise no taxpayer and medical plan participant should be forced to make payment for something that is obviously of no benefit, but in fact harmful.  

To help remember the 12 items of medical tenet, this mnemonic may help:

No

Body

Puffs

Hard

After

Running

Cross 

Terrain

Piled 

Cum (with)

Concrete

Foundations      Or NBPHARCTPCCF.

If these tenets all applied to abortion, then with no difficulty individual doctors could say, “Of course I will do an abortion when and if these criteria are fulfilled.” Individual medical school applicants could say without hesitation, “When and if it is shown this would apply to any patient I would be glad to do this.” Any politician could without difficulty say to his electorate, “Of course I support abortion, when and if all of these apply. My concern is for the welfare and health of women.  I am not going to let people take advantage of them.” In doing this, it is possible to take the argument to the pro-abortionists and insist that they show beyond doubt that all of these apply. In the colloquial parlance, “Show me I am from Missouri .”  

B.  The Conscience Argument is a Dead End  

After decades of struggling to understand nature, science has now fairly reliable guidelines.  The truths of nature of every kind are being quickly discovered. Sadly many Christians have been suspicious of science. This was with good reason when alchemy and magic reigned.  But there is no reason to be dragging their feet now. They should be in the forefront of all science, knowing there is nothing that they can discover that will detract from their faith in God. In fact, with amazing discoveries of astro and particle physics, it is now easier to be a theist than it is to be an atheist.  

No one can assume that a physician’s conscience is Christian, or if Christian, that it is informed. There are many strange religions with people feeling strongly about certain aspects of the practice of medicine, such as not giving blood transfusions, female circumcision, and sometimes strong feelings against psychotherapy. If the rule regarding conscience is to apply universally, then anybody with honest religious prohibitions can object to doing on you a procedure, which may at some time be quite necessary. Without using science, there is no standard and one cannot have a certain expectation regarding the practice of medicine, such as now applies almost around the world.  

C. Students  

Christian students have had difficulty getting into medicine partly because when they are asked, if they would  perform an abortion. My advice which has been successful with medical students, is to say without hesitation, “When and if abortion on any individual can be shown to be necessary, beneficial, etc. of course,  I would do one”. He/she can safely assume that would almost never happen.  

D.  Court Actions.   In court it will do the abortion damaged plainfiff no good at all when you as the expert witness on her behalf state, “I wouldn’t do an abortion, your Honour, because it’s against my conscience.” The judge wants to hear your evidence that it is harmful and that there is no benefit. On this basis many abortionists have been successfully sued. There is nothing physicians hate more that being arraigned in court. It can successfully shut down the abortion industry.  

E.  Colleagues   Using science as the criteria to determine whether or not to do an abortion, colleagues who sit on the fence can be persuaded that it is not in the patient’s best interest from the data that you can show.  In this way you may be able to salvage many burned and burdened physicians from the torment of the twisted conscience.  

F. Conscience Protection.   Conscience clauses can easily be changed. They have in a number of situations including the pharmacists of one of the American states. The pharmacists were given a clause not to prescribe contraceptives if it was against their conscience or religion  but that provision was changed in short order.  

G.  The Bitter Debate   It is not likely that the above will succeed primarily because the abortionists will fight it tooth and nail. They know all too well they haven’t got a stone to stand on in a scientific sense. They know that they must keep it in the political arena. They will object to scientific criteria being applied and they will, if necessary, shoot the messenger who carries that message. I know from experience.