This month the American College of Obstetrics and Gynecology (ACOG) reviewed and reaffirmed the 2007 Ethics Committee Number 385, entitled The Limits of Conscientious Refusal in Reproductive Medicine. This rule states, “physicians and other healthcare professionals have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive service that patients request.” Furthermore, “in an emergency in which referral is not possible or might negatively affect a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care regardless of the provider’s personal moral objections.” Additionally, the rule suggests that pro-life physicians should relocate in order to be closer to an abortionist to whom they might refer patients, and that the patients’ autonomy trumps the physician’s conscience.
You might ask yourself, what does this mean for healthcare providers? What kind of authority does the ACOG Ethics Committee have? To answer this question one must read these rules with the requirements for board certification found in the 2011 Bulletin for Basic Certification in Obstetrics and Gynecology from the American Board of Obstetrics and Gynecology (ABOG). Section III Part F of this Bulletin explains that an individual can have his or her board certification revoked if he or she acts in “violation of ABOG or ACOG rules and/or ethical principles.” The combination of ACOG Ethics Committee Number 385 and the ABOG 2011 Bulletin for Basic Certification makes for a toxic environment for healthcare providers.
The medical community was also faced with this combination of coercive ethics rules, coupled with draconian requirements for certification, in the Spring of 2008. Recognizing this threat to the ability for conscientious healthcare providers to practice medicine, the Bush administration first reprimanded the ABOG and ACOG. In his letter to Norman F. Gant, the Executive Director of ABOG, Michael Leavitt (the former Secretary of Health and Human Services) explained the coercive nature of the combination of these rules with the requirements for board certification, stating, “It appears that the interaction of the [ABOG Bulletin for 2008 Maintenance of Certification] with 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.” The Secretary also pointed out that there are federal laws that protect provider conscience and this policy is in violation of such laws.
When the reprimand from the Secretary of Health did not persuade ABOG and ACOG to change their policy, the Bush administration met this opposition with the Regulation Ensuring that the Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Practice in Violation of Federal Law in December 2008. The purpose of this regulation was to mandate that entities that received funds from HHS would certify that they will act in compliance with the established federal conscience protection laws—namely, Church, Coats, and Hyde-Weldon.
Healthcare providers no longer have the benefit of an administration that will advocate for their right to practice medicine morally in accordance with the dictates of their consciences. In fact, one of the first things that the Obama administration did was to propose the rescission of this provider conscience regulation in April 2009. This proposed rescission sheds light on the contrast between the administration’s attitudes toward conscience rights, and no doubt encouraged ACOG to defiantly proceed with the reaffirmation of the ethics code that is clearly in violation of federal law.
While there are federal laws on the books and 47 states do provide some degree of protection for healthcare rights of conscience, this continued hostility toward conscience rights from board certifying organizations and the Obama administration should be confronted with stronger conscience protection laws on both the state and federal level, starting with a permanent version of the Hyde/ Weldon Conscience Protection Amendment (a current appropriations rider that is subject to annual renewal). Americans United for Life encourages the new Congress to make this a priority.