Should doctors be forced to kill?
Fifty years ago, doctors would have been excoriated professionally for assisting a patient’s suicide or performing a non-therapeutic abortion. After all, the Hippocratic Oath proscribed both practices, while the laws of most states made them felonies.
My, how times have changed. Today, abortion is a national constitutional right, and two states have passed laws legalizing doctor-prescribed death. Meanwhile, destroying human embryos may become the basis for cellular medical treatments and people diagnosed with a persistent vegetative state could, one day, be killed for their organs — a proposal often made to alleviate the organ shortage in some of the world’s most notable bioethics and medical journals.
With life-taking procedures threatening to become as much a part of medicine as life-saving techniques, a cogent question arises: What about the rights of doctors, nurses and other medical professionals who believe in traditional Hippocratic ethics? Increasingly those who do are castigated as interfering with “patient rights.” Indeed, medical professionals may one day be forced to choose between their careers and their morals.
Actually, that day has already arrived in some parts of the world. For example, the state of Victoria, Australia, requires all doctors to either perform abortions or be complicit in the pregnancy termination by forcing morally objecting doctors to refer their abortion-seeking patients to doctors they know will do the deed. That requirement has already impacted the lives of some pro-life physicians. When I toured Australia speaking against legalizing euthanasia in July 2010, I met several who moved away from their homes in Victoria solely to avoid being forced to choose between their morality and their professions.
Victoria’s formula may soon be copied in other countries. Euthanasia is legal in the Netherlands, for example, but doctors are not yet required by law to kill. But that protection is eroding. Recently, the Dutch Medical Association (KNMG) released an ethics directive about euthanasia that, like Victoria’s abortion law, requires objecting doctors to refer legally qualified euthanasia-requesting patients to doctors willing to administer the lethal jab. This is the same KNMG, by the way, that pointedly also allows doctors to provide how-to-commit-suicide information to suicidal patients not qualified for legal euthanasia.
Surely, such coercion would never happen in the USA. Alas, the anti-conscience tide is already flowing. A few years ago, Washington State promulgated a regulation requiring pharmacies to dispense all legal prescriptions. The Catholic owners of a small pharmaceutical chain sued, claiming that the rule forced them to provide the morning after pill in contravention of their religious beliefs. The Ninth Circuit Court of Appeals was entirely unsympathetic, ruling in Stormans v. Selecky that the law was generally applicable, and hence, the owners’ freedom of religion had not been violated.
That decision is relevant to whether medical professionals can be forced to participate in the taking of human life. Here’s how: Washington legalized physician-assisted suicide in 2008. Thus, under the terms of the Stormans case, all pharmacies would be required to knowingly dispense death-causing drugs for use in legal assisted suicide. (Washington regulators are rewriting the regulation, which is, for now, suspended. But the appellate court’s reasoning remains the law throughout the Ninth Circuit.)
The increasing hostility to medical conscience rights was demonstrated vividly by the furor unleashed after the Bush administration promulgated a rule explicitly protecting health care workers from workplace discrimination if they refuse to participate in a medical procedure that violates their conscience. Several medical associations objected. So did some medical journals. For example, an editorial in the April 9, 2009 New England Journal of Medicine urged revoking the Bush rule, stating, “health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.”
Unsurprisingly, the mainstream media jumped with both feet into the anti-conscience bandwagon. The New York Times called the protections “an awful regulation,” while The St. Louis Post Dispatch went so far as to state, “Doctors, nurses, pharmacists choose professions that put patients’ rights first. If they foresee that priority becoming problematic for them, they should choose another profession.”
In other words, the Dispatch editorialists believe that health care professionals should be forced to choose between killing in abortion, assisted suicide or other potentially lethal procedures, and their careers.
In the face of such implacable opposition, the Bush protections didn’t last long. One of the new Obama administration first official acts began the process of revoking the Bush rule, which fell last February — although some aspects of federal law still protect against forced participation in abortion.
It is becoming increasingly clear that medical professionals who wish to continue in the Hippocratic tradition will face increasing pressure to yield their consciences to the desires of patients and the reigning moral cultural paradigm. The question thus becomes what to do about it.
Ironically, some in Europe have already begun the task of protecting medical professionals who don’t want to kill. The Council of Europe recently passed “The Right to Conscientious Objection in Lawful Medical Care,” which states in part:
No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason.
This is the exactly right approach. We live in an increasingly morally polyglot society about matters of life, death and the overarching purposes of medicine. Death-causing procedures — or treatments derived from the destruction of human life — may well become more widely and legally available in the coming years. But just because something is legal, that doesn’t mean it is right. The time has come for Congress and state legislatures to follow the lead of the Council of Europe and pass strong laws protecting medical conscience. Doctors, nurses, pharmacists and other medical professionals should not be forced to comport their professional conduct with the lowest common ethical denominator.
Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism, a consultant to the Patient’s Rights Council, and a special consultant to the Center for Bioethics and Culture.