August 21, 2008 01:55 PM
Dr. Bill Toffler, a physician and professor at Oregon Health and Science University, says it’s “a sad reality” that the government must protect conscience of health providers.
Dr. Toffler, a member of Holy Rosary Parish in Portland, blames pro-abortion groups, saying their zeal for abortion rights leads them to trample other rights.
“The average secular person will acknowledge the right of conscience,” Dr. Toffler says. “Who wouldn’t want a doctor practicing conscientiously, following his or her ethical compass?”
As the Bush Administration aims to beef-up enforcement so that conscience rights of health providers are not violated, Oregon Catholics are debating the issue, which is not simple.
Regulations soon to be published by the Department of Health and Human Services will clarify and enforce a handful of federal laws outlawing discrimination based on moral and religious convictions of health care personnel in programs receiving federal funds.
Abortion rights organizations and some members of Congress have attacked the regulations, saying they could limit access to abortion and birth control.
So far, few are seeking to force health providers to actually carry out procedures they find morally objectionable. The main part of the debate is whether doctors, nurses and pharmacists should be required to refer such patients to willing providers.
Several developments prompted the Department of Health and Human Services to act.
Earlier this year, the American College of Obstetricians and Gynecologists issued an ethics report that called on doctors who oppose abortion to refer patients to amenable physicians or risk losing board certification.
In March, Health and Human Services Secretary Mike Leavitt wrote to the medical organization’s leaders warning them that they were in danger of violating federal law.
“I am concerned that the actions . . . could result in the denial or revocation of board certification of a physician who — but for his or her refusal, for example, to refer a patient for an abortion — would be certified,” Leavitt wrote.
In the past four years, Catholic Charities in New York and California have been forced by their state supreme courts to offer employees health coverage for contraceptives or eliminate prescription drug benefits altogether. Either move violates Catholic principles.
In 2004, New Mexico officials refused to approve a community-owned hospital lease because it was against the new health system’s policy to perform elective abortions.
The governors of Illinois and Washington have begun requiring pharmacists to fill prescriptions for the controversial “morning-after” pill, which in some cases causes abortions. California and New Jersey have similar laws.
Oregon has made no such move yet, but here and elsewhere, the notion of referral is being contested.
Dr. Toffler travels through time to argue that it is wrong to require a doctor, for example, to refer a patient to someone who will perform an abortion. Imagine a blacksmith in 1857 who has come to see the evil of slavery, he says. A slave owner comes to him with a slave recently caught after an escape. The owner asks the blacksmith to repair the damaged shackles.
“The only answer he could give in good conscience is, ‘I can’t help you with that,’” Dr. Toffler says. “When the owner asks if he’ll refer him to another blacksmith, and he refuses, the owner may throw a fit. But most people recognize that if the blacksmith referred, he would be cooperating with the evil of slavery.”
Dr. Toffler has a standing disagreement with his employer. OHSU requires doctors to refer out for procedures they will not do themselves. In a densely-populated area like Portland, Dr. Toffler counters, it is not an undue burden on patients to refuse referral.
Gary Balo, a member of All Saints Parish and longtime owner of Paulsen’s Pharmacy in Portland’s Hollywood District, emerged in the 1990s as the voice of pharmacists who oppose Oregon’s assisted suicide law.
But Balo believes it is his duty to refer patients if he cannot offer the prescription they want, be it an assisted suicide dose or drugs that might cause an abortion.
“You don’t want to cut somebody off,” says Balo. “You need to allow them a choice to make a decision. If the patient is making that decision, I am not making that decision for the patient.”
By referring, Balo says health providers maintain their own integrity without abandoning the patient and upsetting the medical enterprise altogether.
Dr. Michael Grady, who treats underinsured patients at a Silverton clinic, has over the years seen several women opt for adoption over abortion when he informed them of the option. If the women endure in their desire for abortion, which he refuses to perform, he refers them to a safe place.
Dr. Grady, a member of St. Paul Parish in Silverton, says that if he were simply to announce that he would not refer, he would miss out on a chance to educate and minister.
For the most part, he believes fears of doctors’ consciences being violated are overblown.
Father John Tuohey, ethicist for Providence Health and Services in Portland, says that while Catholicism clearly considers abortion evil and supports conscience, it also views healthcare as part of the common good. That means there must be some predictability in the system.
It would not do, he says by way of example, for a physician who considers depression a lack of faith to withhold anti-depressents and refuse referral.
“You can’t leave patients on their own to find medical care,” Father Tuohey says. “We need to find a way to respect the healthcare provider’s conscience without abandoning the patient. It can’t be onerous; patient care is what it’s about.” The best solution, Father Tuohey says, is upfront communication. Doctors should make it clear what they will not do. That way, patients will not be surprised. For example, Providence makes it plain that it takes no part in abortion and assisted suicide.
John Brehany, a healthcare ethicist and executive director of the Catholic Medical Association, predicts that government-run and sponsored medicine of the future may require more providers to perform or refer out for morally objectionable procedures.
Cardinal Justin Rigali, chairman of the United States Conference of Catholic Bishops’ Committee on Pro-Life Activities, wrote to all members of Congress in July defending the Bush administration efforts to reaffirm and implement laws on conscience protection.
Cardinal Rigali said this “should be a matter of agreement among members who call themselves ‘pro-life’ and ‘pro-choice’: the freedom of health care providers to serve the public without violating their most deeply held moral and religious convictions on the sanctity of human life.”
The cardinal went on to say that patients with pro-life convictions, including women who require a physician’s care for themselves and their unborn children during pregnancy, deserve access to health care professionals who do not have contempt for their religious and moral convictions or for the lives of their children.
“This issue,” Cardinal Rigali said, “provides self-described ‘pro-choice’ advocates with an opportunity to demonstrate their true convictions….. [I]s the ‘pro-choice’ label a misleading mask for an agenda of actively promoting and even imposing morally controversial procedures on those who conscientiously hold different views?”
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