CMDA's The Point

Edict Aimed at Pro-Life OB/Gyns Shows what “Choose, You Lose” Looks Like in Practice

February 7, 2019
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by Jonathan Imbody

In a New England Journal of Medicine opinion piece entitled, “Physicians, Not Conscripts — Conscientious Objection in Health Care,” Obamacare architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl advocate ridding healthcare of conscience protections.

Eliminating conscience protections effectively would rid healthcare of doctors, nurses and other health professionals who rely upon those protections. Polling indicates that ethically driven physicians will leave medicine altogether, avoid the OB/Gyn specialty or restrict their practices rather than compromise their consciences. The results of nationwide polling by The Polling Company, Inc., for Freedom2Care in 2009:

  • Over nine of 10 (91 percent) faith-based physicians agreed, “I would rather stop practicing medicine altogether than be forced to violate my conscience.”
  • “When asked how rescission of the [Bush-era] conscience rule would affect them personally, fully 82 percent said it was either ‘very’ or ‘somewhat’ likely that they personally would limit the scope of their practice of medicine. This was true of 81 percent of medical professionals who practice mainly in rural areas and 86 percent who work full-time in serving poor and medically-underserved populations.”
  • 33 percent of faith-based physicians surveyed “considered not pursuing a career in a particular medical specialty because of attitudes prevalent in that specialty that is not considered tolerant of your moral, ethical or religious beliefs.” Of those 33 percent, 81 percent identified OB/Gyn as the intolerant specialty.

Given these risks, on what grounds do Emanuel and Stahl justify removing conscience rights from physicians?

First, Emanuel and Stahl allege a fundamental difference between the assertion of conscience freedom for military conscripts versus for physicians. They highlight the obvious difference that military conscripts have no choice over becoming soldiers, whereas physicians choose their profession. They do not, however, highlight the obvious shared conscientious objection to killing—by pacifists who will not kill by participating in war and by pro-life physicians who will not kill by participating in abortion.

According to Emanuel and Stahl, the right to follow one’s conscience—the principle that compelled our forebears to seek America and which the founders emblazoned in the First Amendment to the U.S. Constitution—apparently ends upon entering medical school. When you choose a career to serve the public, you sacrifice your rights.

“Choose, you lose.”

Second, Emanuel and Stahl assert that patient autonomy means patients may not be denied any legal medical procedure or prescription. Thus the doctor, stripped not only of conscience freedom but also of professional judgment, either complies with patient demands or gets booted out of medicine. A self-ruling medical body—in the words of Emanuel and Stahl, “collectively, the profession—not politicians, judges, or individual practitioners”—determines who gets booted out.

The Hippocratic Oath is replaced by a new, vacuous mantra: “Whatever the patient wants, the patient gets.” No more conscientious objection, no more professional judgment, no more objective ethical standard.

The majority rules and the minority leaves.

Since the purging of objectors is a mark of totalitarianism and not democracy, one might hope that such a radical, intolerant view would be dismissed out of hand in the United States. Unfortunately, Emanuel and Stahl are not alone in urging a purge of conscientious objectors from healthcare. An alarming number of academics, abortion advocates and others are echoing the “choose you lose” view.

Even major medical bodies have attempted to actually implement the draconian policy.

ACOG mocks and marginalizes abortion objectors

In 2007, the aggressively pro-abortion American College of Obstetricians and Gynecologists (ACOG) strikingly illustrated what “choose you lose” looks like in practice.

ACOG issued an official ethics opinion that broadcast its goal in the title: “The Limits of Conscientious Refusal in Reproductive Medicine.” The ACOG establishment sought to forcefully limit and corral conscience, concluding that all OB/Gyns must perform or refer patients for abortions.

First, the ACOG elite mocked conscientious conviction as amounting to little more than feelings and conscience claims as motivated by shallow preferences and cowardly self-interest.

“An appeal to conscience would express a sentiment such as “If I were to do `x,’ I could not live with myself/I would hate myself/l wouldn’t be able to sleep at night.'”

“Claims of conscience are not always genuine. Providers who decide not to perform abortions primarily because they find the procedure unpleasant or because they fear criticism from those in society who advocate against it do not have a legitimate claim of conscience.

“Positions that are merely self-protective do not constitute the basis for a genuine claim of conscience.”

Then, ACOG moved to publicly marginalize pro-life physicians, asserting that they must be publicly labeled, Scarlet Letter-style, as objectors:

“Where conscience implores physicians to deviate from standard practices, including abortion, sterilization, and provision of contraceptives, they must provide potential patients with accurate and prior notice of their personal and moral commitments.”

ACOG also issued a gag order to bar pro-life OB/Gyns from discussing with patients the reasons for life-affirming views.

“In the process of providing prior notice, physicians should not use their professional authority to argue or advocate these positions.”

Asserting abortion to be “standard practice” as if it were beyond challenge, ACOG insisted that even pro-life OB/Gyns who refuse on moral grounds to participate in abortions still must send their patients to abortionists to do the deed.

“Physicians and other health 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 services that their patients request.”

In case it wasn’t clear how just how far ACOG was prepared to go in forcing pro-life physicians into submission, the radical abortion advocacy group also actually asserted where pro-life physicians must live in order to practice medicine:

“Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide. Rights to withdraw from caring for an individual should not be a pretext for interfering with patients’ rights to health care services.”

After the abortion mandate, the objector labeling, the gag order and the forced relocation, the only thing missing from the ACOG edict was requiring pro-life physicians to wear on their lab coats a yellow star.

OB/Gyn accrediting board ties a noose for the necks of conscientious objectors

OB/Gyn physicians depend upon the American Board of Obstetrics and Gynecology (ABOG) for accreditation, which in practice helps determine an OB/Gyn physician’s ability to practice medicine. In 2007, the same year ACOG issued its missive limiting conscience rights, ABOG made clear that physicians would lose their ABOG privileges upon “violation of ABOG or ACOG rules and/or ethics principles….”

Enforcing that declaration would have tied a noose around the necks of all pro-life OB/Gyn physicians who declined to perform or refer for abortions, which violated the ACOG conscience-limiting ethics declaration.

Thankfully the Bush administration, led by Secretary of Health and Human Services (HHS) Mike Leavitt and Assistant Secretary for Health Dr. Joxel Garcia, challenged the ACOG and ABOG scheme. The Christian Medical Association and others supported and assisted in this effort. HHS issued a new regulation to publicize and enforce longstanding federal conscience laws that preclude abortion coercion.

Otherwise, the “choose you lose” scheme would have advanced inexorably toward abortion advocates’ covert goal: a medical profession cleansed of pro-life obstetricians.

That dream of pro-abortion homogeneity in medicine has already advanced in countries that have stripped health professionals of conscience freedom and compelled them to comply with pro-abortion ideology. Authors Emanuel and Stahl celebrate such tyranny:

“Indeed, Sweden, Finland, and Iceland do not allow public health care professionals to deny ‘a legal medical service for reasons of [conscientious objection] when the service is part of their professional duties.'”

Doctors’ judgment can protect patients from harm.

Compelling physicians to accommodate whatever a patient demands not only eradicates conscience freedom; it also eviscerates professional judgment.

For millennia, when a physician’s judgment has diverged from a patient’s preference, the physician has not been censured for trampling patient autonomy but instead affirmed as a professional who can offer helpful counsel based on years of research and experience.

Sometimes patients have bad ideas. In some cases, those bad ideas can cause the patient grave harm and even death. Professional medical judgment can protect patients from those consequences.

One might argue philosophically, of course, that absolute truth does not exist, that autonomy is the only rule and that judging anyone else’s views or actions is unacceptably intolerant.

Actually, biology and reality are not tolerant. Gravity brings things down, regardless of what we hypothesize. Bodily testing an alternative theory is not recommended.

Patients acting on ideas misaligned with biology and reality can lead to their harm, misery and death. Just ask any emergency physician or medical examiner.

A patient who persists in a demand that runs counter to the physician’s professional judgement and counsel has two reasonably simple options: Get a second opinion or change doctors.

But the “choose you lose” scheme dismisses these reasonable alternatives and instead forces the physician to either cave to the patient’s demands or leave the profession.

A medical “Star Chamber” threatens the careers of pro-life health professionals.

Abortion rights activists and abortion clinics would delight in the prospect of no more Capitol Hill hearings featuring pro-life OB/Gyns highlighting the harms of abortion. Planned Parenthood—a billion-dollar business that rakes in over half a billion dollars in government funds while performing nearly a third of a million abortions a year—would delight in eliminating life-affirming clinics from government grants competition.

Abortion activists know that in the absence of compelling reason or evidence or rightness of cause, the only way to secure ideological victory and financial profit is to eliminate their opponents by decree. That is why Emanuel and Stahl insist that “collectively, the profession—not politicians, judges, or individual practitioners” will determine who may practice medicine, what procedures they must do and what prescriptions they must fill.

The idea of an unaccountable ruling elite parallels the infamous “Star Chamber” established in England in the late 15th century. Although promoted as a vehicle to advance justice, the secretive extra-judicial chamber instead oppressed whole classes of people through its arbitrary rulings and unilateral abuses of power.

As Lord Acton famously observed, “Power corrupts, and absolute power corrupts absolutely.”

If pro-life and faith-based health professionals do not stand up and speak out to protect their rights and their patients’ access to principled healthcare, they may soon find themselves ejected from the profession by a self-proclaimed medical Star Chamber.

“The only thing necessary for the triumph of evil is for good men to do nothing.”


About Jonathan Imbody

Jonathan previously served as CMDA's Federal Policy Analyst and as CMDA's liaison with the federal government in Washington, D.C. A veteran writer of more than 30 years, Jonathan authored Faith Steps, which encourages and equips Christians to engage in public policy issues. He has published more than 100 commentaries in The Washington Post, USA Today, New York Times, Los Angeles Times, San Francisco Chronicle, Chicago Sun-Times and many other national publications. Jonathan's writing focuses on public policy issues including freedom of faith, conscience and speech; human trafficking; abortion; assisted suicide; stem cell research; the role of faith in health; international health; healthcare policy; sexual risk avoidance and HIV/AIDS. Jonathan received his bachelor's degree in journalism and speech communications from the Pennsylvania State University, a master's degree from Penn State in counseling and education and a certificate in biblical and theological studies from the Alliance Theological Seminary in New York. Jonathan's wife Amy is an author and leads the Redemptive Education movement. They have four children and four grandchildren.


  1. Avatar Rick Vaughan on March 3, 2019 at 8:02 pm

    Right on………….

  2. Avatar robert stockburger on March 5, 2019 at 3:01 pm

    I refused to do abortions in the Army at Tripler AMC in 1978. I was subjected to warnings, threats, harassment, by Staff and fellow residents (one of whom was officer in CMDS-Gene R___). I never did them, period. Lots of anger from peers. Robert Stockburger, DO FACOG

    • Avatar P. J. Elkins on December 13, 2020 at 5:07 pm

      Great!!!. I am a missionary in Latvia and I have a pregnancy center and just purchased an ultrasound machine to show
      mommies their babies and teach against abortion. I have been doing this for about 20 years, but now I am starting a new
      program. I am praying for God most earnestly to lead me. I know He has a plan but it is impossible for me to fight the enemy.
      P. J.

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