Conscience Clause in the Practice of Medecine

Posted by on Apr 29, 2017 in Medical Discoveries and Medical Ethics, Science

Conscience Clause in the Practice of Medicine.                    Philip Ney MD, FRCP(C)

The American College of Obstetricians and Gynecologists (ACOG) have again ruled physicians must perform an abortion or refer to someone who will when asked by a women or else the physician will lose his certificate as a specialist.  The State of Victoria, Australia has legislated that all physicians in that state must do the same or lose their license to practice.  To some this may seem to be reinforcing one of the most noble traditions of the much honored practice of medicine i.e. you must never say no to a person who is seriously ill.

This tradition spurred a deep sense of duty which impelled the tired country doctor to hitch his going-lame horse to the buggy without much covering and face a blizzard to assist a women with a breach delivery many miles away. He had been summoned by a distraught husband in the middle of the night.  This is what kept us young residents working into the dawn; responding to crises of patients on wards for which we had responsibility. 

But there are 3 essential differences: a) women choosing to have an abortion are not patients because: pregnancy is not an illness, their choice is not an indication for treatment, their distress is not a disease.

b) The doctors who do abortions are not practicing good medicine.

c) The abortionist’s motives are essentially wrong.

The practice of good medicine entails performing only those procedures, which are:

i)                Indicated.  There must be something wrong; some recognized disease to warrant doing this treatment.

ii)              Beneficial. There must be scientifically established benefits in the long run of the patient’s life.

iii)            Free of harm.  There are very few procedures that don’t have some detriment. Most are temporary and borne well by patients who foresee the benefit.

iv)             The last resort.  Every form of less invasive, more reversible treatments must be seriously tried and have failed first.

v)               In good conscience.  The performing physician must first analyze data collected on his/her patients in follow-up at 1 mo, 6mo, 1yr and 5yrs to be convinced in his/her mind that the patients’ truly benefit from this procedure in his/her hands.

vi)             Recommendation given.  After a thorough examination the physician must make a clear recommendation for treatment to which the patient may or may not agree.  If he/she disagrees and will not accept any other form of good medicine their physician recommends, the patient has voluntarily withdrawn from the care of this physician.  Their implied or stated contractual relationship has ended.  The physician can no longer be held responsible for that person’s health except as a citizen.

vii)           Ethics.  It is unethical for physicians not to announce and display their ethics.  Since patients cannot assume their physician affirms the Hippocratic Oath, they need to know well in advance, what is their physician’s basic intent on major contentious issues.

viii)         Consent.  Having indicated the patient’s  willingness to receive treatment that was recommended, the physician makes doubly sure of their consent to treatment by very carefully outlining the recommended procedure, indicating the benefits, hazards and alternatives then providing plenty of time for the patient to ask questions.

ix)             Consideration.  Since these are matters of wellness and wholeness in the long term, the patient must be given the opportunity of days to make up their mind without interference.

x)               Second opinion. If the patient is ambivalent, the attending physician should be the first to suggest a second opinion and give a list of competent colleagues, especially those who have a valid different point of view.

 The current practice of abortion, meets none of these criteria.  It is bad medicine or more accurately is not medicine.  No physician can be forced to practice bad medicine.  Among their colleagues, in their associations, in court, good physicians need only say. “Nothing will make me practice bad medicine, so help me God.” Science will support them.

 Having collected data from an adequate sample of ex-abortionists, I can report from their responses on a confidential questionnaire, that their motives primarily are: money, power, notoriety, reenacting unresolved problems from their past.  They have given up their practice of abortion because: a) they have changed, usually a life changing spiritual experience, b) they can no longer deny the humanity of the preborn child, c) they know they are practicing bad medicine and could not defend themselves in court when a charge of malpractice is brought against them.

 As to choice. Of course patients have and should have a choice in accepting or refusing their physician’s recommendation.  But not in directing what their treatment should be. For example, consider mechanic Joe.

In removing a big tractor clutch Joe wrenches his left arm.  It hurts like heck but he doesn’t have time to have it seen by his physician because of a backlog of important customers.  He tries various pain killers and home remedy but the pain persists for days and nights.  So in the middle of a busy day, he shouts to his foreman.  “I’ve had enough of this, I’m going to get old doc to cut the bl…..y thing off.  It hurts like h… and just gets in the way”.

After a cursory examination, Doctor Smith says.  “Joe, I think you have a small fracture that can be fixed.” 

Joe. “Nah Doc. I’m fed up with this stupid arm. Just cut it off.”

Dr. Smith. “But Joe, I can fix it.”

Joe, “Look Doc. I don’t have time and besides it’s my body.  I know my rights.  If I choose, you must cut or refer to someone who will”

Dr. Smith apologetically, “Okay Joe, I can’t do this. It’s against my conscience but here is the address of someone who will do a clean job.”

The practice of abortion by choice is that ludicrous.

 As forced labor.  When the state or the medical association insist a physician must work in a certain way, on pain of losing their source of livelihood, it is tantamount to slavery.  I thought that was abolished.

 “God Almighty has set before me two great objects, the suppression of the slave trade and the reformation of manners.”  William Wilberforce.  His great, great, grandson, Rev. Gerard Wilberforce states, “Abortion is THE injustice issue of today”.