Healthcare Right of Conscience - PowerPoint Presentation

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Healthcare Right of Conscience

David Stevens, MD, MA (Ethics)

CEO

Christian Medical & Dental Associations

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The freedom to practice healthcare in accordance with your deeply held religious, moral or ethical convictions.

Definition

:

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Don’t be

CONFUSED

Health Right of Conscience is not refusing to treat because you don’t like or approve of the patient, their beliefs, attitudes or behavior.

It is exercised when a healthcare professional is being asked or required to participate in or facilitate some way an action they believe violates their ethical, moral or religious beliefs.

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But I

DON’TAGREE!

Protection of someone’s right to object does not equate with support for that position.Indeed, we must pay special attention to protecting the rights of others when we do not support their position.*

*(Claims of conscience rights can be abused)

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This is Not a New

IssueIn Healthcare

Moral Debate 2500 Years Ago

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. But in purity and in holiness, I will guard the sanctity of life and my role as healer.

Hippocratic Oath, 429 BC

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Congress shall make no law respecting religion or prohibiting the free exercise thereof…

First Amendment

What Right?

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James Madison

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The rights of conscience we never submitted, we could not submit. We are answerable for them to our God.

I consider the government of the U.S. as interdicted by the Constitution from intermeddling with religious institutions, their doctrines, discipline, or exercises.

Thomas Jefferson

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Conscience is the most sacred of all property the exercise of that, being a natural and unalienable right.

The Religion of every man must be left to the conviction and conscience of every man; and it is the right of every man to exercise it as these may dictate.

JAMES MADISON

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Church Amendment

Public Health Services ActMedicare/Medicaid ACGME Law Weldon Amendment

Federal Law

Limited to federally funded programs. No enforcement provisions.

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State Laws on

ROC

45 States have some sort of ROC laws

State by State Laws -

http://

www.consciencelaws.org

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VA Laws on

ROC

Nothing in §§18.2-72, 18.2-73 or §18.2-74 shall require a hospital or other medical facility or physician to admit any patient under the provisions hereof for the purpose of performing an abortion. In addition, any person who shall state in writing an objection to any abortion or all abortions on personal, ethical, moral or religious grounds shall not be required to participate in procedures which will result in such abortion, and the refusal of such person, hospital or other medical facility to participate therein shall not form the basis of any claim for damages on account of such refusal or for any disciplinary or recriminatory action against such person, nor shall any such person be denied employment because of such objection or refusal. The written objection shall remain in effect until such person shall revoke it in writing or terminate his association with the facility with which it is filed.

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AMA reaffirms that neither physician, hospital, nor hospital personnel shall be required to perform any act

violative

of personally held moral principles. In these circumstances, good medical practice requires only that the physician or other professional withdraw from the case, so long as the withdrawal is consistent with good medical

practice.

Except in emergencies, physicians

shall

be free to choose whom to serve, with whom who to associate and the environment in which to provide medical care

.

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Everyone shall have the right to freedom of thought, conscience and religion. This right shall include freedom to have or to adopt a religion or belief of his choice, and freedom, either individually or in community with others and in public or private, to manifest his religion or belief in worship, observance, practice and teaching.

United Nations

INTERNATIONAL COVENANT

ON

CIVIL AND POLITICAL RIGHTS

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The physician should be free to make clinical and ethical judgments without inappropriate outside interference.

Everyone has the right to freedom of thought, conscience and religion; this right includes… freedom …to manifest his religion or belief in worship, teaching, practice and observance.

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Physicians who object to abortion for reasons of conscience are advised to inform their patients of their objections so that the patient can consult another physician. The CMA stresses that physicians who decline to participate in abortion should not be discriminated against, and emphasizes the need to respect the rights of conscientious objectors, especially those in training for obstetrics and gynecology, and anesthesia.

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Pharmacist

have a duty to act with conviction of

conscience.Code of Ethics, APhA.

the

right of pharmacists… to decline to participate in therapies they consider to be morally, religiously or ethically

troubling.

-

American

Society of

Health

-System Pharmacists

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With All These Protections

What is the Problem?

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RIGHT OF CONSCIENCE IS

UNDER ATTACK

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A threat to

reproductive rights

It’s the “Right of Refusal”

Health related decisions made between a provider and patient should be made on the personal welfare and healthcare needs of the patient - not the morals or belief of the caregivers.

While we firmly believe that all people have a right to their own opinions and moral beliefs,

it is unethical

for healthcare providers to stand in the way of a woman

’

s access to safe, legal and professional

healthcare.

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That is, a patient's very ability to choose these procedures or medications is dependent upon the existence of a doctor who is willing to facilitate whatever choice the patient makes. Consequently, a doctor's unwillingness to act in a particular way due to her conscience becomes a barrier to a patient's self-realization.

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Abortion Access ProjectACLU - Reproductive Freedom ProjectPCRC -Pro-Choice Resource CenterSpotlight CampaignMerger WatchMaryland NARAL Hospital Provider ProjectPlanned Parenthood

Efforts to Abolish Laws

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Attacks

on ROC

Alaska (1997) - Valley Hospital Assoc.

California (2003)

– Benitez

v. North Coast

Women's

Medical Care

Illinois (2005) – Gov. Rod Blagojevich

Washington (2007) - Pharmacy

Regs

.

Many

More

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ACOG Committee Opinion #

385

Patient autonomy final arbitrator for Rx

Right to Demand Rx = Right to Refuse Rx

ROC is just a personal opinion

Moral obligation to pt. over rides ROC

Inconvenience imposes

provider’s

beliefs on pts.

Patient

’

s concept of well-being trumps

Physicians must

refer for abortion

If

they can

’

t

timely refer, must provide

Those who refuse to provide abortions should only practice in areas where abortion services

exist.

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New policy issued in January 2008: certification contingent on compliance with ACOG ethical principles.

Under pressure reversed in 1/09.

American Board

Of

Obstetrics & Gynecology

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Can’t “

discriminate in the employment, promotion, termination, or the extension of staff or other privileges to any physician or other health care personnel because he performed, assisted in the performance, refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.”

HHS

Policy Protecting

R

ight

of

Conscience

Effective January

20,

2009

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B

y pro-abortions groups, some politicians and mediaFalse claims, e.g., women will not be allowed contraception Media blitzLegal action taken1/15/09 - PP, ACLU, 7 State Attorney Generals file suit in CT to overturn

Anaphylactic

Reaction

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Overturning HHS Regulations

February 2009

President Obama announces he will rescind the regulation

April 9, 2009 -30 Day Public -Comment Period ends300,000 commentsAll reference to regulations taken off HHS website. Gutted 2/11

The Washington Post reports that the Department of Health and Human Services gutted most of a federal regulation that in 2008 broadened existing conscience protection

rules.

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Church, Weldon and other laws only apply to annual HHS appropriations

Reform bill only protects physicians from insurance companies coercing them to do abortions

No protection for other professionals

No protection from other groups

No protection on other issues

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But Is This Really

E

ffecting

Healthcare Professionals?

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CMDA Faith

Focused HealthcareProfessionals Survey

40% report being pressured to compromise convictions>43% know someone else who was pressured>24% have lost position, promotion or compensation as a result>88% think the problem is getting worse

Survey of 2,400 Physicians, Nurses, Pharmacists, etc

.

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April 29, 2010

NEW YORK — Alliance Defense Fund attorneys filed a lawsuit Friday against Mt. Sinai Hospital in New York state court on behalf of a nurse forced to participate in a late-term abortion procedure under threat of disciplinary action, including possible termination and loss of her license.

Nov. 24, 2010NEW YORK - However, in today's ruling the court found that there is no right to private action or private remedy under the statue cited by DeCarlo in her suit - the so-called "Church Amendment.” Her suit was summarily dismissed.

Ms. Cenzon-Decarlo

NURSE ‘FORCED’ TO HELP ABORT –

NYPOST.com

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November 11, 2011

NEWARK, N.J. – “One, Fe Vinoya, a nurse for 21 years, said she and her fellow 15 plaintiffs “have dedicated our lives to helping patients. Our managers told us very clearly that all same-day surgery unit nurses must immediately begin training in and assisting abortion patients, including all aspects of those patients’ care during their visit,” she said. “They did this in spite of our repeated effort to tell them we had religious and moral objections. They said very clearly that if we did not assist we would face termination.”

Ms. Fe Vinoya

December 11, 2011ABC News – “Twelve nurses who sued one of the state’s largest hospitals after claiming they were forced to assist in abortions over their religious and moral objections reached a deal Thursday with their employer in federal court. Under the agreement, 12 nurses in the same-day surgery unit of the University of Medicine and Dentistry of New Jersey can remain in their current positions and not be compelled to assist in any part of an abortion procedure.”

12

Nurses Accuse

UMDNJ of

Forcing Them

to

Assist

in

Abortion Cases

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Unless Religious Employer:(a) Whose purpose is the inculcation of religious values;(b) That primarily employs persons who share the religious tenets of the employer;(c) That primarily serves persons who share the religious tenets of the employer; and(d) That is a nonprofit organization under section 6033(a)(2)(A)(i) or (iii) of the IRS Code

Secretary of HHSAuthority -> Preventative Care Coverage Must provide all FDA Approved Contraceptives

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88% Americans say it is important that they have a similar set of moral beliefs as their healthcare professional

87% oppose forcing professionals to violate their moral objections63% support conscience regulations54% less likely to vote for Congressman that oppose ROC

What Do American’s Think About This Issue

The Polling Company,

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On some positions cowardice asks the question, 'Is it safe?'

Expediency asks the question, 'Is it politic?'

Vanity asks the question, 'Is it popular?'

But conscience asks the question, 'Is it right?'

And there comes a time when one must take a position that is neither safe, nor politic, nor popular. But ... because it is

right.

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To Kill

A MockingbirdHarper Lee, 1960

The one thing that doesn't abide by majority rule is a person's conscience.

_______________

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If we don

’t protect personal integrity, we would go down a dangerous avenue. By taking a professional license you do not step out of your personal morality. You have taken on an additional responsibility, but that does not mean you have given up your integrity as a person.

Linda Rankin, Bioethicist, U of

TN

In Christian Science Monitor

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"Must the citizen ever for a moment, or in the least degree, resign his conscience to the legislator? Why has every man a conscience then? I think that we should be men first, and subjects afterward. The only obligation which I have a right to assume is to do at anytime what I think right."--Henry David Thoreau, Civil Disobedience (1849)

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Is our healthcare system in need of more conscience-driven doctors or more "ethically neutered" doctors?Do we want medical schools to systematically strip our future doctors from any and all religious and ethical convictions that have not been approved by the state?Your doctor's conscience may some day be the last line of protection between you and those who would profit from your early death.

Conscience & Healthcare

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Referral means:

I endorse the competency, judgment and ethics of the doctor to whom I’m referring.I enter into a professional relationship with that doctor. I will receive a report back from him.I believe they will “do no harm.”

Why

Don’t Some MD’s Refer?

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MORAL COMPLICITY

What is It?Culpable association with or participation in wrongful acts.Use of information, technology or materials obtained through immoral means. Using, rewarding, profiting, perpetuating, justifying or ignoring past or present evil.Enabling or facilitating future immoral acts. We must strive to never commit evil ourselves, nor should we participate in or encourage evil by others.

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Biblical Guidelines

We must avoid evil

(I Thessalonians 5:22)

We may never do evil that good may come.

(Romans 3: 8)

We must oppose evil.

(Romans 12: 9)

We should separate ourselves from evil.

(II Corinthians 6: 17)

We can

’

t totally separate ourselves from evil.

(I Cor. 5: 9&10)

We should overcome evil with good.

(Romans 12: 21)

We should seek wisdom.

(James 1: 2-5)

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Intent

- Our motives must be always to promote good, never evil.

Magnitude

- Some evil acts are so heinous that any association with them is unacceptable.

Timing

-Passage of time may diminish complicity with prior evil acts, though it does not diminish the evil nature of the original act.

Proximity

-A greater degree of association with an evil act increases culpability.

Knowledge

- Knowledge that an original act was evil and knowledge that a subsequent act is associated with that act are both required

for culpability.

Certitude

- A greater degree of certainty that the original action was evil increases complicity.

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Moral complicity

with evil does not exist when all the following conditions are satisfied:

our intent is for good;

the association with the past or present evil is sufficiently uncertain, or the act is sufficiently distanced from the original evil act; and

the action does not reward, perpetuate, justify, cooperate with, or ignore the original evil.

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What will convince them? This, and this only: cease to call slavery wrong and join them it right. And this must be cone thoroughly – done in acts as well as words. Silence will not be tolerated – we must place ourselves avowedly with them…. The whole atmosphere must be disinfected from all taint of opposition to slavery, before they will cease to believe that all their troubles proceeds from us.

Abraham Lincoln

Cooper Union address of 1860

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The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last.

Crispin

Sartwell

Los Angeles Times

9

/2/08

Self Described

“

Pro-Choice

Atheist”

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Represents 50 organizations

Education & Mobilization

Blogs, Twitter, FacebookPolls/Surveys95% of faith based healthcare professionals would quit medicine before violating their conscience

SPEAKING OUT –

Freedom2Care.org

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<freedom2care.org><cmda.org>Ethics Statements, PP’s, Standards for Life, “Just Add Water”, DVD’s<consciencelaws.org>“Protecting the Health Care Provider's Right of Conscience” Teresa Colette, JD <chbd.org>Issues of Conscience Laurel Hughes