CMDA's The Point

"Patient Autonomy" – The Trojan Horse Assault on Conscience Freedom in Healthcare

January 4, 2018
Trojan Horse

by Jonathan Imbody

This excerpt is the fourth in a series of essays on conscience in healthcare, by Jonathan Imbody, Vice President for Government Relations of the Christian Medical Association and Director of Freedom2Care. The essays respond to "Physicians, Not Conscripts — Conscientious Objection in Health Care," Ronit Y. Stahl, Ph.D. and Ezekiel J. Emanuel, MD, PhD, New England Journal of Medicine 376;14, April 6, 2017.

Just as the Declaration of Geneva’s original commitment in 1948 to honor pre-born life fell to new ideology, so did the original commitment to healthcare professionals' conscience freedom.

The relevant clause in the original Declaration of Geneva read simply,

"I will practice my profession with conscience and dignity.”i

The Declaration recognized that as a professional, a physician professes to ethical standards and then exercises professional judgment in the application of those standards. So the 1948 Declaration did not dictate what specific conscience convictions were allowed or disallowed. Prescribing specific clarifiers would have undermined the main point, which is that a healthcare professional exercises ethical judgment.

All that changed, however, within a few decades and with the insertion of a few seemingly innocuous phrases.

The U.S. Supreme Court's 1973 Roe v. Wade decision that legalized abortion on demand followed transformational cultural shifts that helped make abortion socially acceptable. Having won acceptance and legalization, many abortion advocates have shifted sights to the next goal: eradicating opposition and mandating submission.

Unsatisfied with the mere acceptance and legalization of their position, they now aim at forcing others to submit to and carry out their ideological agenda. A prime target for forcing abortion rights doctrine on everyone: conscientious objectors in the medical community.

In 2017, Declaration of Geneva revisionists followed this playbook by adding an innocuously phrased but politically charged limitation to freedom of conscience. The revision reads (changes in italics),

"I will practice my profession with conscience and dignity and in accordance with good medical practice."ii 

Everyone would have understood the original Declaration statement, "I will practice my profession with conscience and dignity," to presume good medical practice. No one would have countenanced a medical ethics oath that provided cover for bad medical practice. By keeping the statement simple without adding unneeded qualifiers, the original statement provided for maximal latitude for medical professionals to exercise conscience, practiced within the bounds of the high dignity of the profession and calling.

So in the seven decades after the original 1948 Declaration, did new evidence of medical abuses in the name of conscience require qualifying the original statement? Certainly if physicians exercising conscience judgment had been causing deaths and harm to patients, abortion advocates would have shouted it from the rooftops.
So why then, in the absence of such evidence, would Declaration of Geneva committee members go to all the trouble to add onto a complete and satisfactory statement?

When "good medical practice" actually means ideological conformity
The most obvious answer is that ideologues, most notably abortion activists, wanted to lay the groundwork for narrowly defining "good medical practice" to fit their own radical ideology. If one can assert the claim that abortion is an essential part of "good medical practice," then a physician can be denied any claim of conscience as grounds for declining to participate in abortion.

That is precisely the path Affordable Care Act architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl take in their New England Journal of Medicine opinion piece, "Physicians, Not Conscripts — Conscientious Objection in Health Care."

  • First, they contend that "although abortion is politically and culturally contested, it is not medically controversial." They cite American Medical Association documents to assert that abortion "is a standard obstetrical practice."
  • Therefore, they reason, objectors "cannot completely absent themselves from providing these services." The authors, at least for now, stop short of demanding that objecting physicians perform abortions but still would require all physicians to refer for abortions. Many pro-life physicians view referring for an abortion as an act of complicity in the morally impermissible act of abortion. So requiring a pro-life physician to refer for abortions is like requiring an abolitionist to refer slave buyers to slave traders.
  • Finally, to invalidate conscience claims, Emanuel and Stahl invoke patient autonomy, which they consider the trump card against conscience and the highest principle of "good medical practice:" "To invoke conscientious objection is to reject the fundamental obligation of health care — the primary duty to ensure patients’ continued well-being."
    Authors Emanuel and Stahl, like the Geneva Declaration revisionists, will hardly come right out and say, "Oh, and by the way, by 'good medical practice,' we mean participating in abortion." That tie-in task is left to others, and, unfortunately, too many in the medical community are eager to take on the role of conscience limiters.

Conscience limiters assert "patient's well-being" to leverage agenda
In fact, the American College of Obstetrics and Gynecology (ACOG), in 2007 actually published an ethics committee opinion declaration entitled, "The Limits of Conscientious Refusal in Reproductive Medicine." ACOG's document (which subsequently was tied to the career-determining ethics requirements of ABOG, the American Board of Obstetrics and Gynecology), asserted,

"When conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires either that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal."

Like Emanuel and Stahl, ACOG also cleverly conflated patient wellbeing with abortion in order to undermine physicians' conscience freedom:

"In the provision of reproductive services, the patient's well-being must be paramount. Any conscientious refusal that conflicts with a patient's well-being should be accommodated only if the primary duty to the patient can be fulfilled."

Therefore, ACOG concluded, even physicians conscientiously opposed to abortion are obligated to refer patients for abortions and, in some cases, even to perform abortions.

Somehow ACOG obstetricians, in all their deliberations over "a patient's well-being," never considered that the unborn baby is also a patient, a patient whose wellbeing ends abruptly in an abortion.

The ACOG strategy of undermining physicians' conscience freedoms by trumping those freedoms with "patient rights" is not an isolated opinion but a worldwide ideological assault. The framework for coercion and discrimination against pro-life physicians has been laid down in many arenas, using the clean-sounding language of patient autonomy, medical consensus/good medical practice, duty, human rights and civil liberties.

Activists focus first on acceptance, then legalization and finally coercion
Abortion activists are redeploying these positive concepts to build their case for coercing all healthcare professionals and institutions to participate in morally controversial practices.

  • The strategy begins with using cultural influencers to promote acceptance of a radical agenda.
  • The resulting shift in public acceptance helps activists leverage laws to permit the agenda.
  • The final stage is eradicating all opposition and mandating participation.

This same process—acceptance, legalization, coercion—has been followed by LGBT activists and will be followed by assisted suicide activists as well.

"Patient autonomy" is the cornerstone of the radical new ethic. Patient autonomy is the strategic nuclear weapon deployed to eradicate all competing notions of morality and all appeals to conscience.

This is why Declaration of Geneva revisionists insisted on literally "shifting all new and existing paragraphs focused on patients’ rights to the beginning of the document, followed by clauses relating to other professional obligations."

"Patient autonomy" is the handsome Trojan Horse that has infiltrated medicine and opened the door for the enemies of conscience to coerce, discriminate against and force pro-life professionals, clinics, care centers and institutions into submission.

i Declaration of Geneva, World Medical Association, adopted October 1949.
ii Declaration of Geneva, World Medical Association, October 2017.

Jonathan Imbody

About Jonathan Imbody

Jonathan serves as Director of Federal Government Relations with CMDA and directs the Christian Medical Association's Washington Office. As CMA's liaison with the federal government, he has participated in over 30 White House meetings and events and makes over 200 personal contacts with Congressional leaders and government officials each year. Jonathan testified on euthanasia and assisted suicide before a U.S. Senate committee. 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. World magazine featured his essay summarizing the major medical accomplishments and challenges of the past millennium. He has also written numerous magazine articles, marketing materials and educational curricula. 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. His on-site research on euthanasia in the Netherlands formed the basis for the No Mercy video and a presentation at an international conference in The Hague. 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.

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