The Division Of Conscience And Religious Freedom Vs. Basic Workplace Ethics [UPDATED]

In May, the Trump administration issued a new rule  that gives health care workers the power to refuse to provide services their religion disapproves of, such as abortion, sterilization or assisted suicide. A religious conviction isn’t even essential to trigger the rule; a matter of conscience is enough. The measure essentially revived a Bush rule that the Obama administration reversed.

It’s a bad rule, and an unethical rule, as Ethics Alarms has held before. If you can’t perform all the duties of a job, then don’t take the job. If an employee can get his or her employer to agree that he or she is exempt from certain duties, that’s freedom of contract. Fine.  The Trump rule, however, like the Bush rule before it, breaches a basic principle of the workplace, and common sense as well. It also leads inevitably to messes like this one:

The federal government has accused  the University of Vermont Medical Center in Burlington, Vermont of violating  federal law by forcing a nurse to participate in an abortion despite her objections. The hospital denies it.

The nurse, who is Catholic, filed a complaint with the Office for Civil Rights. It  alleges, that she was misled by supervisors to believe she was assisting in a procedure scheduled after a miscarriage. “After [she] confirmed that she was, in fact, being assigned to an abortion, [her employer] refused her request that other equally qualified and available personnel take her place,” the complaint reads. She then participated in the procedure and “has been haunted by nightmares ever since.”

Now the Office for Civil Rights at the Department of Health and Human Services has filed a notice of violation against the hospital, the  first since the Division of Conscience and Religious Freedom was added to HHS in  2018.

“This should never happen in America,” OCR head Roger Severino told reporters. “There is room for disagreement on these issues without having to coerce people to choose between a career dedicated to supporting life versus instances and situations where they were being forced to take life.”

Utter baloney.

Everyone has to choose between careers that require them to do things they would rather not but that have other attractions, and careers that are more comfortable but less rewarding, financially or otherwise. A lawyer seeking  employment at a big law firm can announce at her interview that she won’t represent international corporations, defendants in environmental cases and accused white collar criminals as a matter of conscience, and good luck with that. If she doesn’t reeval her intentions, takes the job and then demands a pass in cases that wound her sensibilities, she should be sacked, and will be.

There’s no difference here, except that the Trump administration has created this rule as one more hurdle to the right to an abortion. It’s a neon-bright Kantian violation: if every health worker opted out of abortions, then abortions would be impossible. That systemic ethical breach obviously doesn’t trouble those who oppose the right to the procedure.

The notice of violation gives the medical center 30 days to agree to work with the agency “to change its policies so it no longer requires health care personnel to participate in abortion against their religious or moral objections, and to take immediate steps to remedy the effect of its past discriminatory conduct.” If not, its federal funding is at risk. The hospital is taking the position that the allegation isn’t supported by the facts. I’d rather see it challenge the rule outright.

The hospital maintains that it hews to a policy that no health care worker will be forced to participate in a procedure that’s against his or her beliefs except in cases of life or death. “I don’t know of any cases where we’ve compelled someone to do something against their will,” the hospital’s administrator claims.  If true, it should. “Do your job” is always a legitimate demand from any employer, or ought to be. Conscience rules confuse this basic principle of the workplace. As long as there is a sufficient supply of potential health care workers who will do all of their job duties, no hospital should have to hire one that won’t.

UPDATE: Commenter “Here’s Johnny” points to Federal Health Care Conscience Protection Statutes: 42 U.S.C. § 300a-7, the handiwork of Republican Senator Frank Church in the Seventies. “No individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded in whole or in part under a program administered by the Secretary of Health and Human Services if his performance or assistance in the performance of such part of such program or activity would be contrary to his religious beliefs or moral convictions.
Office of Civil Rights, U.S. Department of Health & Human Services.”  The law does not, however, require a health service program to hire a worker who cannot or perform all of their duties.


Facts: NPR 1 ;NPR2

60 thoughts on “The Division Of Conscience And Religious Freedom Vs. Basic Workplace Ethics [UPDATED]

  1. In Australia, the new Religious Freedom Act explicitly gives the right to any medical service provider to refuse any and all treatment to anyone whatsoever if they claim that it is against their religion, and businesses may not refuse to employ anyone who does this, nor criticise them if they do.

    Atheists of course may not take advantage of this.

    This stuff is malignant and highly contagious. It’s why I comment on it at its source, and from where the campaign money funding the Religious Right lobby groups worldwide emanates from.

    Then there’s this

    Mississippi law gives special protection to certain Religious beliefs about gay marriage, so the claimants here say it would be giving unconstitutional preference to some Religious beliefs if their Christian beliefs were not protected in the same way. I think they have a point.

    • This stuff is malignant and highly contagious. It’s why I comment on it at its source, and from where the campaign money funding the Religious Right lobby groups worldwide emanates from.

      I do not think that you are seeing the larger context, and I have the same feeling about Jack. If you focus on what you consider to be “malignant and highly contagious” you will likely produce a short-list of the essential values that had formed the value-structure of Occidental culture. Now, in the mass-effort to overturn that value-structure — a massive transvaluation of values — you see the core of those transcendent values as malignant and highly contagious. That is likely how you would describe the ‘religious right’-leaning groups in general.

      I suggest that *you* are an emissary (if you will kindly allow this rhetorical usage) of a Hyper-Liberal cultural metaphysics. You have to expose and defeat anything that could act as a brake on the extreme forward-movement of metaphysical progressivism.

      In fact it is possible to make a counter-proposition to your assertion about what is malignant and contagious by turning the lens of examination around. I would turn it into a question though, a question to be asked: What is malignant and what is contagious as we consider the influences that undermine moral structure and ethical commitment?

      What I notice in what you assert is that you really do see yourself as holding to the higher values. You see yourself as the metaphysical norm. And it is your system of view which is coercive in a high degree — because it is more often than not based on shaming and emotion-based *argument* — and easily communicable in situations of active social hysteria.

      It is not at all hard to make rational counter-propositions to the core of the pseudo-philosophical ideas — very badly and partially thought-out — that one always discovers in those of Hyper-Liberal and Ultra-Progressive bent. See here for what I consider to be a rational counter-proposition to article you cite. You cite such an article because, in your distorted view, a stance against racial mixing is really and truly incomprehensible to you. All you need to do is to cite where an ignorant Christian holds such a view to make your point about malignancy and contagion.

    • Zoe
      You wrote, “Atheists of course may not take advantage of this.”
      While true, with all due respect, atheists have been in the vanguard of the movement to eliminate all public displays of belief. Beginning with Madeleine Murray O’Hare atheists argue that they have a right to be free FROM religion which is a distortion of the establishment clause of the first amendment which states we all have the right free to exercise of religious beliefs . How is a law that forces people to abandon their religious beliefs any different than a school that blasts the Christian Lord’s prayer over the PA system, or any religious practice at a public event. That too is something that no other group can take advantage of.

      I fully support your rights to do as you choose but bear in mind that for you to be able to do as you choose requires someone else to forfeit the right to do as they choose if they feel they are being compelled to violate his or her belief to accommodate your choices. Assuming you are an atheist, you can not have any religious objections to a particular medical procedure. I assume if such procedures were banned by law on religious grounds you would feel that your 1st amendment rights were being trampled by the imposition of religion upon you. You would be correct. Now, if you are Catholic and you are forced to participate in a procedure that violates your beliefs you would feel the same way and you would still be correct.

      What I do not comprehend is why it is necessary, in today’s environment, that people feel the need to litigate every legitimate disagreement in belief. Move on. Find a vendor that bears you no ill will and would be happy to serve you. I would, and so would many others without such deep seated convictions. Sure, there are going to be some that use the law to game the system for their own benefit just as there are those that game the welfare, disability, and immigration systems. What is your actual goal? Is it to participate fully in our society or to change society to reflect your ideals and beliefs? And what of the ideals and beliefs of others that want laws to protect those ideals and beliefs? Are they subservient to yours?

      What advocacy groups should consider in their strategic plans is that attempts to get their ideas into the mainstream by forcing sub-sets to adopt or be economically destroyed is that ultimately the others in the mainstream will see the changes as threats to supplant their ways of life with another and pass laws to protect those ways of life. That is exactly why the conscience bills exist.

      Kantian ethics has been referenced in this post and for the most part I agree with that. However, I often see this as a specious argument because not everyone will opt out of serving others because we all have differing beliefs and relative importance we place upon those beliefs. If everyone had the same mindset to withdraw services, logically the issue would be moot because no one would force the issue. If they did not have the same mindset it would be those differences that creates an opportunity for others to fill the void. Especially in our society, the opportunity to make a buck will offset any ethical values one might hold.

      • I assume if such procedures were banned by law on religious grounds you would feel that your 1st amendment rights were being trampled by the imposition of religion upon you. You would be correct. Now, if you are Catholic and you are forced to participate in a procedure that violates your beliefs you would feel the same way and you would still be correct.

        What I do not comprehend is why it is necessary, in today’s environment, that people feel the need to litigate every legitimate disagreement in belief. Move on.

        This is a question and it is also sort of a ‘plea’: Why in such difficult times, with so many people seeming to be pushed to their wit ends, with their sense of values and their value-limits being pushed against constantly to the point they feel walls closing in against them, why do you (a general you-plural) insist on pushing farther and farther unrelentingly?

        It seems to me that this is a plea voiced by many who define themselves as Conservative. When I say Conservative I do not mean necessarily activist Republican-NeoCon — those who are carrying out the Republican push backs and turning-backs against Obama’s policies (whether they are good or bad I will not say), but average socially-conservative citizens.

        They have made so many sacrifices; they have ‘bent over backwards’ on many issues; and yet the Progs and the Hypes (Progressives and Hyper-Liberals) just want more. They will not stop. They will even begin to inform you, in resolute moralizing tones, that the dogs that you own must be seen by you not as your possession if it concerns their reproduction! (Literally, there is an opinion-piece in the Times on this topic). There literally seems to be no stopping point for progressive ambitions!

        But I guess this is something that we will just have to accept. That things seem to be on a course that tends to evermore opening into social conflict.

        In this circumstance, the only thing that I can conceive of doing is to tighten up the arguments that can be used against these various ‘agenda’. Along the lines of course of what you have nicely done here I should say.

    • While I am not familiar with the Australian statute you described, American law certainly protects atheists as well as religionists. A doctor or nurse could easily argue that their moral convictions dictate that they not participate in some procedures, regardless of any religious motives involved. I could easily picture someone feeling that participation in a procedure would violate their moral code for dozens of different reasons, such as cosmetic surgery performed on minors, clitorectomies (in places where that is legal), or other controversial or high-risk procedures.

  2. How does this square with people needing reasonable accomodations due to a diagnosed disability?

    Does the rule you suggest mean as long as there are plenty of abled people that can perform all activities equally well then employers should only hire the mentally and physically abled.

    If the argument is that the disabled cannot change their condition but those with convictions are not physically bound to them then using using threats of termination or not being hired at all because you will not participate in 1% of all duties assigned is a form of coercion.

    I tend to agree with the post but I often see conflicts of well meaning laws that result in forcing one group to lose rights to others whose desires are more favorable politically.

    We have discussed indoctrination by our schools at length here but to state that employees must sacrifice beliefs or choose another line of work is a form of economic coercion no different than requiring a,student to parrot the professors beliefs or face consequences.

    Just some thoughts.

    I would have made an attempt to accomodate the objections of the nurse.

    • It’s not up to them to accommodate her. It’s up to her to do her job. In the disability realm, the idea is to hire those with disabilities who can do all of the duties of a job with reasonable assistance. Nobody has to hire a firefighter in a wheelchair, or a blind pilot.

      • You see accomodations as a physical assistive device. I do not.

        I will ask this question. If you had a valued employee whose child or spouse was diagnosed with a severe medical condition that required your employee to sometimes be late and unable to complete some tasks because that employee had to care for that relative do you have an obligation to accomodate that employee? NO. Should you? That depends on what you value and what options are available to you.

        Some physical limitations can be fully overcome others cannot. In some cases accomodation can mean the ability to leave a workstation to lie down if an anxiety attack is suspected. Lactating mothers can go to special rooms to pump milk during work hours.

        We make accomodations for all sorts of things. Further, there is a dispute as to the facts of this case.

        Would your opinion change if this nurse was chosen because of her known opposition to such procedures to force her to tow the line? If she was the only qualified nurse on duty to assist in the procedure I can see your point.

        The question is why was she misled?

        If she was not misled and is using this as a political stunt to push an anti- abortion agenda then fire her for insubordination.

        Using the Kantian ethics logic you used if every employer never gave an inch to any employee ever, the system will collapse under the weight of duality of interests.

  3. The ironically named Church Amendments have been around for a long time, and the language seems quite clear. If you take the taxpayer’s money, you can’t discriminate in employment, promotion, or termination, against a medical professional who claims performing or assisting in sterilization or abortion procedures would be “contrary to his religious beliefs or moral convictions”.
    The current administration, and the previous two, each issued rules on how to apply the law, but the law itself has not been changed.
    Anyone seeking employment in a hospital that offers sterilization or abortion should know about the conscience exemption, and the employer should likewise be knowledgeable.
    Thus, someone claiming a conscience exemption is not refusing to do a part of her job; her job description was already limited by the law to shield her from those procedures. (Both parties should be clear from the moment of hiring that a conscience exemption would apply, but the law doesn’t seem to require that.)
    The law itself may be unethical, but it still is the law. Making rules which, in effect, change the law, making it more or less restrictive, is definitely unethical.
    The facts in this case are in dispute, but they are critical as to whether the hospital or the nurse acted unethically. But, claiming a conscience exemption in accordance with the law is not and cannot be considered unethical.

    • You still don’t have to hire such a person, and shouldn’t. That’s not religious discrimination; it’s a reasonable requirement: to get the job, you have to be able to do the job, all of it. And it’s unethical to seek or accept a job when you know you can’t or won’t do all of it. “But, claiming a conscience exemption in accordance with the law is not and cannot be considered unethical” is wrong, the classic confusion of law with ethics. The fact that the law allows such conduct doesn’t make it ethical.

      • Taking the subject to the nextmost turtle on the infinite liberal stack of unprincipled exceptions, can the law’s permission of abortion as a legitimate medical practice be a case of legal-but-unethical? Considering this likelihood, the existence in law of conscience-based exceptions would constitute an inconsistency in the underlying just-so moral reasoning but as a means of mitigation of past errors. The necessity of such exceptions is a testament to a preceding error by swingin’ 60s activist judges, and the banalization of that necessity by comparing it to mere preferences or now-taboo pseudo-moral reservations is an exercise in question-begging. This is like quibbling that a mobster has no right to argue in court that his conscience was violated when the don ordered him to assassinate a rival. The laws stand in judgment of themselves. The world has gone mad, and we’ve accepted it, quibbling over technicalities as we tumble violently over each other in the vortex.

        • Taking the subject to the nextmost turtle on the infinite liberal stack of unprincipled exceptions, can the law’s permission of abortion as a legitimate medical practice be a case of legal-but-unethical?

          That’s exactly what it is. Just like slavery.

          • The irony in the argument is that if one believes that an act is unethical yet legal, the ethical person must absorb 100 % of the economic burden to act ethically when it is argued that an employee must perform all legal acts – even if unethical – irrespective of their ethical concerns or go elsewhere to engage in their professional craft of choice.

            • It’s a weird situation…. In almost any other situation, if someone is given the opportunity to do something legal, but unethical, and they chose to do it, any defense of that action would be seen as a rationalization.

              1A. Ethics Surrender, or “We can’t stop it.”
              4. Marion Barry’s Misdirection, or “If it isn’t illegal, it’s ethical.“
              5. The Compliance Dodge.
              15. The Futility Illusion or “If I don’t do it, somebody else will.”
              21A. The Criminal’s Redemption, or “It’s just a small part of what I am!”
              23. The Dealer’s Excuse. or “I’m just giving the people what they want!”
              25. The Coercion Myth: “I have no choice!”
              25A. Frederick’s Compulsion or “It’s My Duty!”
              39. The Pioneer’s Lament, or “Why should I be the first?”
              50. “Convenient Futility,” or “It wouldn’t have mattered if I had done the right thing.”
              51. The Apathy Defense, or “Nobody Cares.”
              54. Tessio’s Excuse, or “It’s just business”
              67. The Herd’s Excuse, or “We’re all in this together!”

              I depends on how exactly they try to justify their behavior, but some lend themselves to the situation better than others, and it wouldn’t be too hard to add more to the list if you were a little imaginative. I highlighted the more obvious, but what I think matters more are numbers 15 and 39.

              15 attempts to excuse your unethical behavior because if you didn’t do something unethical, someone else would. 39 is related, but kind of the reverse, it assumes that no one wants to do the unethical thing, and if everyone acted ethically, the thing wouldn’t happen, but because you’ve been tapped to do the thing, you resent falling on your sword first.

              Paging Emmanuel Kant!

              What happens if all the people who are religiously opposed to abortion are allowed to opt out of performing those procedures?

              What happens is all the people who are religiously opposed to abortion choose to do the ethical thing and quit?

              Give them the damned accommodation.

      • With regard to hiring, the law forbids discrimination based on the conscience exceptions, so an employer subject to the law would have to tread very carefully and refuse to give any reason at all for not hiring.
        With regard to seeking employment, you and I see the nurse’s job description differently. Assuming she did not hide her conscience objections, then she was applying for a job that did not include assisting in abortion or sterilization procedures. If she kept those objections hidden, then she would have been a dishonest employee and obliged to resign when given those duties. The OCR report says she made her objections known a number of times. Don’t know if she did at the time of hiring, but she certainly should have.
        For its part, UVMMC says, “We do not discriminate against any employees for exercising their rights to opt out of procedures to which they object.” That’s a tacit admission that the job description varies based on the conscience objections.
        There are some jobs where they can throw anything legal at you and you are obliged to comply. Most of the jobs descriptions affecting me in the military included the phrase “other duties as assigned.” I don’t think that’s the case for the nurse here.

  4. The hospital is taking the position that the allegation isn’t supported by the facts. I’d rather see it challenge the rule outright.

    The rule in question is similar to the below.

    A federal jury in Peoria, Ill., has awarded $240,000 to two Somalian-American Muslims who were fired from their jobs as truck drivers at Star Transport, an over-the-road trucking company, when they refused to transport alcohol because it violated their religious beliefs, according to the U.S. Equal Employment Opportunity Commission (EEOC), which brought the case. The trial started on Oct. 19, and the jury returned its verdict the next day after 45 minutes of deliberation.

    • Moslems are afforded rights which we are not. This is the way of modern “”civilization.””

      But beyond the boilerplate, transporting alcohol? This reeks of concern trolling over-litigiousness – another right Moslems are granted.

      • That’s because there are favored groups and non-favored groups. Remember: government over business, the individual over government, at least when that individual isn’t a white male, the group over the individual, female over male, colored over white, non-Christian over Christian, the environment over everything, and anything else over the police or the military. Oh, and the gays and Muslims? Give them whatever they want!

        • Where they left goes afoul of logic and decency is when it’s Muslim vs. gays. The West is terrible, there are people won’t bake cakes for gay weddings. But beheading gays in Muslim majority countries? Where is the problem?

  5. Alternatively, abortion is a practice which is inherently and ostensibly repugnant in every respect. It’s propped up by a web of legal fictions, anti-philosophical meaningless rhetoric, and droning, one-dimensional, and constant propaganda. Everyone, especially its supporters, is aware of these things. Indeed, the purpose of legalizing such a monstrosity has not been to care for women, as the empty slogans go, but to poison the minds and souls of the otherwise innocent and degrade society. Even the circumstances of the current case bear this out, wherein a dissenter was sought to perform the diabolical blood sacrifice (bake the cake, photograph the mock-wedding, &c.). Thus, to treat this open, deliberate affront on the faith and morals of decent people as a fair-minded operation of business-as-usual while speaking of those who’d prefer to play no part in monstrous human butchery as though they’ve rejected the right to pursue an otherwise noble profession (which they have previously already chosen and trained for) is precisely to characterize these things as opposite to their respective realities.

    Error has no rights. There is neither a right to be wrong nor to compel others to cooperate with wrongness. If the laws declare otherwise, then to Hell with the whole medical enterprise or with the laws. I won’t endure sanctuary states and stand idly while those of sane conscience are forced out of medical care (an end-state for civilization, to be sure – on par with their enforced exile from academia).

    • I am so glad you made the statement/comment above. I was struggling with how to put my thoughts on the matter into words, and you did an amazing job. Thanks for bottom lining this whole sorted matter and saving me a whole lot of time and effort. I like your style.

      • Thank you! I sometimes fear that my moral approach is off-topic – at least with respect to the general style of our glorious host and the other commenters. These cases in which the perpetration of evil isn’t only legal but legally mandatory (barring the exemption) have a way of throwing me into an inarticulate rage which I then somehow have to articulate (this forum not being amenable to my style of frustrated, jerking interpretive dance).

        There can’t be a solution to the problem of inconsistent laws until the problem of inconsistent underlying moral philosophies is addressed. Kant can’t cut it anymore. He’s a relic of a bygone era when there were still enough underlying, unspoken Christian moral axioms for civilization to skate by. Too many generations have passed not speaking them that there’s no floor under any of our laws anymore. We can’t even agree what they’re supposed to do.

  6. The way I see it, freedom of conscience is a freedom either we have or we don’t. Like freedom of speech, though, it shouldn’t be one you shed at the office door, unless you are in a military or paramilitary organization, where no one gets to have an opinion on anything unless he is paid to give one.

    What would you say if a hospital allowed Jewish and SDA nurses to refuse to come in on Saturday, while everyone else had to work the shifts they were given? What would you say if Muslim cab drivers could refuse to transport anyone with a dog or anyone carrying alcohol, or Muslim cashiers could refuse to ring up pork products? What about if a train engineer opposed to a war refused to move a train carrying supplies for the war? I guarantee you that in any of those cases the media, and, until recently, the administration, would have sided with the people asking for the accommodation. I see no reason why Catholics who want no part of abortion or contraception shouldn’t also be allowed to opt out.

    This nation kind of painted itself into a corner on the question of conscience with the Seeger and Clay cases, which allowed individuals to opt out of what would otherwise be required governmental service in wartime due to differing beliefs. Seeger (not Pete) just had a general opposition to war, while Clay (later Muhammad Ali) believed he could not fight a war not in the service of Islam. In the past we found ways around that, like SDA pacifist Desmond Doss serving as an unarmed medic or members of the so-called historic peace churches becoming firefighters or smoke jumpers during WW2 to free up others to join the military. Once we started setting a precedent that individual beliefs outweighed most other factors, we left ourselves open for this kind of situation.

    Of course it’s a Kantian problem. Things wouldn’t get done if everyone refused to do them. That said, how many times have you heard the left say that police should refuse to enforce an unjust law, or that everyone should cross a line so the line will have to be removed? Let’s also not forget the oft-quoted paraphrase of one of Carl Sandburg’s poems, “Suppose they gave a war and no one came?” To the left it’s a GREAT thing if everyone refuses to do something, if it’s something the left thinks is wrong. But a Catholic nurse refuse to assist in an abortion or an evangelical judge refuse to perform a gay marriage? Nope.

  7. I find your parallel examples lacking Jack. Abortion is about killing a human being. Having a hand in death is parallel to few other things. Perhaps I’ll make another that I think is closer:

    We have a hard time finding executioners. It’s a function that the state does. Argue it is part of being state employment. How about we ask any random employee in the medical field to administer the death cocktail (every state has many such employees universities, state hospitals, etc.). If they refuse, fire them. No concious objection allowed, do it or be fired.

    Is that ok? It’s part of something the state does and is legal and many consider necessary.

    • The position of the medical profession is that it is NOT killing a human being. If it were, then abortions would violate the Hippocratic Oath. If you do not accept the underlying principles of a profession, then it is unethical to enter that profession.

          • Who institutes the position of the medical profession.? How do they sanction doctors that violate their positions?

            I thought the State licensed and sanctioned MD’s for violating professional standards. Can the State compel an MD to perform an abortion?

          • Naturally, without quibbling the notions of “alive” and “human” too much. Alternatively, they could accept the definitions of those terms both inside and outside the subject and merely choose to regard the consequent violation of the oath as not a violation of the oath. Or perhaps we could suppose that the states ‘in violation of the Hippocratic Oath’ and ‘not’ are equal – incapable of being differentiated.

            We’ve set enough precedent that anything can be considered anything else or not and at the same time.

          • Jack are there any rules or laws prohibiting the sale or handling of the dead tissue of the aborted fetus?

            If the aborted fetus is required to be treated with the same reverence as that of a deceased human then the abortion must be considered the ending of a human life.

            Otherwise, the tissue is mere property that can be bought, sold and traded as a commercial enterprise with no more regulatory control than that of the USDA.

          • Why? What if they just lied? Almost all biologists and physicians believe that life begins at conception. The recent survey of biologists because ~70% approve of abortion and ~90% believe that life begins at conception and that fetuses are humans. The fiction that fetuses aren’t human is just there so that abortion can remain legal.



            All of this reminds me of the joke about the special FBI task force. They only selected a very few to train for this. They would be pushing the bounds of legality to fight terrorism wherever they found it. They needed complete loyalty to the cause and couldn’t allow any questioning of orders. The day for the final loyalty test came. The brought the first candidate in. They told him “Here is a loaded gun. Your wife is in the next room. Kill her to prove your loyalty.” He went into the room, his wife started to cry, he started to cry, he couldn’t do it. “You fail”. They told him. They brought in the second candidate, same thing. This continued until the last candidate. He took the gun, went into the room, and the program heads heard ‘BLAM! BLAM! BLAM!. Then, sounds of a scuffle ensued. He emerged from the room and said “Good job jerks! Someone put blanks in the gun and I had to beat her to death!”.

            If you have a program with borderline ethics and no one is allowed to object, don’t be surprised if the only people in it have borderline ethics. Is this the path we really want to take with medicine? Look at Europe where you can guilt the elderly into letting you kill them.

        • The record for abortions on a single unconsenting mother is 114.

          The mother was still in the womb, and had multiple foetus in foetu.

          Despite this heroic attempt at salvage of the pregnancy, the grandmother miscarried.

          It’s complicated, OK?

          Removal of a dead and rotting foetus from the womb is also classed as an abortion.

              • Erm… you said the attempt to remove the incredibly abnormal situation of fetuses in a fetus was in an attempt to save the life of the most likely to survive fetus right?

                I mean, the pro-life side has answered this question a thousand times. When ALL lives will die given a natural (but unlikely situation), some lives might be defensibly sacrificed.

                This isn’t a gotcha.

                (Also, it’s a bit silly for you to have called the fetus a “mother”. It makes it really hard to take you seriously.)

          • No, removal of a dead fetus is a D&C. It is the same procedure. The difference is the difference between a vivisection and an autopsy.

      • “The position of the medical profession is that it is NOT killing a human being.”

        The “medical profession” is a large and non-homogeneous group and within that group there are the same range of positions regarding abortion as in the general population. The American Medical Association strongly backs abortion rights but the AMA does not speak for all physicians on abortion or other issues. I suspect there are very few controversial issues on which the position of the “legal profession” is unanimous.

        “If it were, then abortions would violate the Hippocratic Oath.”

        It surprises many laymen to learn that only about half of all physicians take the HIppocratic Oath. It might further surprise them to learn that of those physicians who do take the oath, not all of them take the same oath with only a small percentage of medical schools using the original oath. In the oath that the majority of physicians take, the sentence “Similarly I will not give to a woman a pessary to cause abortion” is omitted. The oath contains some good precepts such as do no harm, keep patient confidences, and abstain from all intentional wrongdoing, but it was written over two thousand years ago and contains guidance that is not pertinent today. Finally, the oath does not have the force of law and violating it carries no penalty unless the provision violated, for example maintaining confidentiality, is a matter of statute.

        “If you do not accept the underlying principles of a profession, then it is unethical to enter that profession.”

        Providing abortions or holding a position that abortion is not killing a human being, is not an underlying principle of the medical profession. To me underling principles of a profession include things such as obeying the code of ethics, maintaining proficiency in the profession, and always acting in the best interest of the client. Abortion is only one of the myriad tasks that fall to the medical profession. Only a minority in the profession are qualified to perform abortions. I agree that it is unethical for a provider to go into any specialty unless that provider is willing when required to perform all the services that are typically provided by that specialty. For those entering obstetrics and gynecology, those services would have to include abortion as long it is legal.

        I wrote this prior to seeing Michael’s post below. My answer to that question is “no” as I discuss above. By my observation, the majority of medical professionals hold that belief, but I assure you there are a large number of medical professionals, some I know personally, who hold a very strong belief that abortion IS killing a human being.

        • That doesn’t surprise me. I am also aware that the Hippocratic Oath is only incorporated into most medical ethics codes, or approximated. In this it is analogous to the duty to zealously represent one’s client in law, a principle of the profession that is absent from most state rules but still acknowledged by the legal community as a core ethical principle.

          What you are saying is that medical professionals prefer not to deal actively with the obvious ethics conflict that abortion entails.

          • I think medical professionals are trying to deal actively with the ethical conflicts particularly looking at the conflicts regarding abortion. The general position of all the major medical groups I am aware of such as the AMA is that abortion is a part of women’s health care and there should not be barriers to providing services that the law allows. The group with the biggest stake in the issue is the American College of Obstetricians and Gynecologists. ACOG put out a position paper in 2007 “The Limits of Conscientious Refusal in Reproductive Medicine.”

            In discussion of the limits of conscientious refusal they state, “Even when appeals to conscience are genuine, when a provider’s moral integrity is truly at stake, there are clearly limits to the degree to which appeals to conscience may justifiably guide decision making. Although respect for conscience is a value, it is only a prima facie value, which means it can and should be overridden in the interest of other moral obligations that outweigh it in a given circumstance. Professional ethics requires that health be delivered in a way that is respectful of patient autonomy, timely and effective, evidence based, and nondiscriminatory. By virtue of entering the profession of medicine, physicians accept a set of moral values—and duties—that are central to medical practice (15). Thus, with professional privileges come professional responsibilities to patients, which must precede a provider’s personal interests (16). 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. The section beginning “By virtue of entering the profession” seems to reflect the same ethical analysis you made.

            Another group of providers, The Christian Medical & Dental Associations took exception to that saying, “ACOG’s position “minimizes the whole concept of the right of conscience and elevates the patient’s autonomy as the trump card. If the patient wants it, the doctor has the obligation to provide it.” They go on to say that for a physician who sees abortion “as taking the life of a human being” even making a referral makes them complicit.

            As you can see, the arguments among members of the medical profession are as heated and uncompromising as arguments among the general population. I have very little direct involvement in this issue in my practice, but as a medical professional my position is essentially the same as that put forth by ACOG. My perception is that the major professional medical organizations also take this position.

            In reply to Chris above, there is no central authority that speaks for “the medical profession.” Each of the professional medical associations has a code of ethics for their members. These for the most part are not legally enforceable and following them is more a matter of “professionalism.” Breaking them, such as breaking the Goldwater Rule, might get one a poor reputation and possibly even evicted from the association, but is not likely to result in legal trouble.

            The state legislators, usually with the advice of one or more medical associations, makes the laws that a medical professional must follow if licensed in that state. Violation of those laws will bring sanction by the medical board that could be as severe as loss of license either temporally or permanently. Depending on the law violated, there may also be criminal prosecution or civil malpractice actions. Of course there are also federal laws, primarily those that deal with controlled substances.

            I don’t know whether the state could compel a doctor to perform an abortion but doubt it. In general, doctors are free to accept or refuse any patient but having accepted a patient cannot stop seeing them without following certain procedures. I guess if a doctor signed a contract with a medical facility saying they would provide abortions and then refused that would be a matter for contract law. The only real circumstance I can think of where a doctor might face legal sanctions would be if a provider qualified to do abortions refused to provide an abortion when a pregnant woman’s life was in immediate danger and an abortion was necessary to save it and no other qualified provider was available. I think in that circumstance even a provider with conscientious objections to elective abortion would act to save the mother.

            • Drm Billingsley,

              I appreciate you addressing my question however personal experience suggests that doctors and their practices can and will refuse to treat a patient who they find unwilling to sheepishly accept poor impersonal service.

              I am one who was summarily dropped from the Meritus Family Practice which is part of Meritus Hospital for communicating in writing that I was dissatisfied with the quality of care I felt I was receiving. Two weeks after I sent the letter I received a letter by certified mail that I the practice members decided that I was to be dropped due to “the breakdown in communication between the patient and doctor.”
              This action violated Meritus’ written code of patient rights such that I was promised I could file a complaint without fear of retribution. I addressed my concerns in writing directly to the doctor and not to the practice. I was never offered a different doctor in the practice.

              To add insult to injury, the practice sent me a bill for a missed appointment 18 months earlier that prompted my finally complaining when I walked out after 90 minutes waiting in the exam room. I moved on after being dropped but when I got a bill I wrote the president of Meritus Hospital and he agreed that the practice was supposed to follow the enumerated patient rights and responsibilities and he said he would address the issues I presented – I sent him copies of my original letter to the doctor and the dismissal letter I received. Several months ago I found out that president did not last long at the hospital.

              That was two years ago and perhaps I will find a new physician. My experience has soured me on the GP concept given that so far none are willing to give me the time of day. I wonder why.

              • Chris, sorry to hear about your experience. I am aware of doctors who terminate patients for what I think are inappropriate reasons. I don’t know about the state where you live, but in Florida a doctor can terminate their relationship with a patient for any reason but cannot abandon the patient. They are required to give written notice and to provide care for 30 days including giving appropriate prescriptions. It is recommended that they assist the patient in finding a new provider, but that is not a legal requirement. I wish you luck in finding a new GP. I recommend getting lists of providers through your state medical society and to particularly look for providers who are relatively new in practice; in my experience they often take a more collaborative approach, rather than a strictly “doctor knows best” approach, to patient care.

      • That’s a pretty sweeping statement for one of the largest industries in the world. There most certainly is a sizeable portion of the doctors, nurses, administrators and others who will ardently disagree with you. They view abortion as a flagrant violation of the hippocratic oath because it is killing a human.

        I don’t think it has been pointed out yet in the comments, but there is actually a way out for those that object to abortion and want to work in the medical industry: Catholic hospitals. They do not do contraceptives nor abortion there. Any employee can go to work for a Catholic hospital and be certain that they will never be asked to participate in an abortion.

        • It should be sweeping. The medical profession has had no trouble making executions nearly impossible by refusing to administer the various killing chemicals, and I have not seen or heard much controversy about THAT. If substantial numbers of the medical profession and the AMA declared abortion “harm” and acted accordingly, it would be a significant development.

  8. Overall, I think you have a valid point. I saw a case a few years ago about some teachers being let go for a Christian school for not being Christian because part of their job was to share and encourage faith. In that way, I agree. If the woman was hired to do things like abortions, she should have not taken the job.

    However, this is where you lose me. If there are accommodations in the contract/policy, I don’t know how you can claim “do your job” when she is doing the job. If it was in her contract, they should still be obligated to accommodate her, if it is in the policy, once policy changed, she should either do it, quit, or be fired (this is what should have happened to Kim Davis).

    • I don’t know of any hospital that hires medical personnel specifically to do abortions. Every floor usually is geared to a type of service offered and nurses do not often rotate between floors. Surgical nurses also do not rotate routinely because specialty fosters efficiency and efficacy.

      This whole issue could be avoided by moving Catholic nurses to geriatrics or pediatrics. Even if assigned to ICU she would not have been in position to be in conflict with her beliefs as the procedure in question are not done in the ward. The nurse should seek a transfer to a ward where the liklihood of having to participate in an abortion is nil. That would be a reasonable accomidation because nurses have no specialties other than the experiences they gain from the floor they are routinely assigned.

      • Thank you, Chris, for pointing this out. My daughter is a nurse and although not a Catholic she is vehemently opposed to abortions not performed out of medical necessity. She has chosen to work in areas of nursing where she will not have to participate in performing abortions.
        Also, the idea of making accommodations due to religious beliefs is nothing new. Way back in 1975 I was hospitalized for a work injury and had an RN whose religion prohibited drawing blood or giving a transfusion. Other nursing personnel performed those duties and she performed other tasks in exchange. I can’t remember what religion she practiced but she was otherwise a very skilled and able nurse. She seemed respected and liked by all the other staff.
        Also, I personally count more than a dozen doctors and a number of PAs, NPs, nurses and medical technologists -all Christians- within my circle of friends and they all oppose abortion except for medical necessity. All practice (or are retired from practice) in aspects of medicine/health care that do not include performing abortions. So, I disagree with he conclusion that the “medical profession” supports abortion on demand. The “health care industry,” however, is a different story. The health care industry would support just about anything that would make a dollar, including gross mutilations that occasionally pop up on social media. Many doctors, I fear, have totally sold out to the health care industry.

  9. Jack, tangentially related:

    I read the prior post relating to the ethics of requiring pharmacists to fill legal prescriptions for contraceptives because they chose that profession.
    I agreed then and still do.

    Here is my question, how do we sue firms that fill orders of pharmacies for opiods so they may fill legal prescriptions from doctors.

    Given that doctors are far more capable of understanding the pharmacology of such drugs than any long legged high heeled pharma rep, why do the doctors get to claim ignorance?

    All the marketing materials I am familiar with rely on statements of fact by the engineers and designers of products.

    If management willfully failed to disclose evidentary data to the FDA I can see the argument that they misled doctors with their sales literature. If doctors use sales literature as a substitute for obtaining a real clinical understanding of treatment options, that is pure negligence.

  10. This goes back to the fundamental principle that no job is guaranteed. Many people run afoul of ethical conflicts between their beliefs and their jobs. If I could not ethically do my work, I would find something I could do ethically. Either that, or I would compromise my ethics. It’s pretty much one or the other if the workplace is unwilling to accommodate my objections.

    Life is full of conflicts between ethics and performance of duties or necessary tasks. How we handle those is a big part of what defines us.

    • Glenn
      I would agree wholeheartedly with your comment if the nurse was hired specifically to work in the area of Ob-Gyn or Med-Surg at the hospital. There are however so many other tasks that nurses perform that would not force the employee to have to forfeit the time,costs and energy training to serve in the capacity of a registered nurse simply because that person finds a procedure antithetical to belief. Arguing that these consciencious objectors could find work in Catholic or religious based hospitals to avoid the conflict would be equivalent to all other forms of separate but equal doctrine.

      • I

        There are however so many other tasks that nurses perform that would not force the employee to have to forfeit the time,costs and energy training to serve in the capacity of a registered nurse simply because that person finds a procedure antithetical to belief.

        Yeah, Chris, I agree, but I think both employer and employee have to agree that a) the employee is willing and able to do the “other work” and b) that the employer in question has a spot to move them to without displacing an equally qualified person.

        And of course, there is no reason why a nurse, unless she is an Ob-Gyn specialist, should not be able to find another job given the high demands of the profession.

        Arguing that these consciencious objectors could find work in Catholic or religious based hospitals to avoid the conflict would be equivalent to all other forms of separate but equal doctrine.

        I’m not sure I’m arguing that, exactly. Unless the objector’s belief extend outward beyond the department to the entire hospital, there’s no reason why he/she couldn’t simply change specialties or otherwise avoid the ethical conflict of having to perform abortion-related services that conflict with her beliefs at secular hospitals.

        And as you know, “separate but equal” was a government segregation policy. Objectors to abortion who find insurmountable ethical conflicts are selecting themselves for segregation, rather than the government doing so. So by my lights, the two are not similar.

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