National bioethicist: Texas needs better conscience protections for medical professionals

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A disturbing trend is occurring across the United States.  Medical professionals are increasingly facing the prospect of being compelled to perform procedures or facilitate medical decisions to which they conscientiously object.  The consciences of doctors, nurses, pharmacists, and other medical professionals are often not adequately protected under law.  Under the Obama administration, the U.S. Department of Health and Human Services (HHS) ignored complaints about conscience violations.  This prompted President Donald Trump to authorize the creation of the Conscience and Religious Freedom Division within the HHS Office of Civil Rights. This new division will enforce and expand protections through regulatory rules, which many have welcomed as a step in upholding the nobility of their medical professions.

However, according to Wesley J. Smith, a renowned bioethicist and writer at National Review, Texas is not immune to the ongoing danger of medical professionals being coerced into potentially violating their consciences.  Texas Right to Life recently hosted an event at the Texas Capitol for elected officials and Capitol staff, where Smith outlined the importance of conscience protections in the medical profession.  He has written extensively about this subject in numerous books and on his blog at National Review.    

At the event, Smith articulated that many medical professionals are threatened with a dilemma: conform or get out of the business.  “We are now in a situation,” Smith stated, “where there are attempts being made to force doctors to do the very things they swore never to do only sixty to seventy years ago.”  Pro-Life medical professionals are particularly under threat, with many anti-Life individuals advocating for acceptance to perform and refer for abortion as a requirement for health care workers.  Such rhetoric claims that doctors, nurses, pharmacists, and other professionals in medicine must decide whether to participate or facilitate in a procedure or action that runs contrary to their conscience or get out of medicine.  Smith spoke specifically about physicians in Australia who are forced to travel thousands of miles across the country to avoid being compelled into performing procedures to which they conscientiously object.  These medical professionals are facing “medical martyrdom”, a situation he described “where doctors are actually sacrificing and suffering harm in order to maintain integrity on these issues.”

Smith emphasized the fact that conscience protection for medical professionals is a non-partisan issue, behind which individuals from across the political spectrum can join for the promotion and protection of health care.  Along with this, Smith pointed out the danger looming over this issue.  If medical professionals are increasingly compelled to perform or facilitate elective procedures to which they conscientiously object, there may be a mass exodus of qualified health professionals from the medical field.

Smith made another critical point for public policy debates around medical conscientious objection; that law must differentiate between elective and non-elective procedures.  He distinguishes non-elective procedures, such as providing life-sustaining treatment, from other elective procedures like an abortion or sex reassignment surgery.  This is the difference between a procedure that is medically necessary and one that is freely being chosen by the patient and the lack of which causes no physical threat to their life or health.  Smith clarified that medical professionals should only be allowed to refuse elective procedures.

Smith underscored the fact that conscience protections are applicable to and necessary for the protection of all health care professionals, not just those who might have religious objections to a medical procedure. To actually enforce this protection, Smith asserted the necessity of having not only administrative enforcement, but also civil remedies.  Administrative remedies alone are insufficient because of the inherent political shifting that occurs in institutions and even in governing bodies like the Texas Medical Board.

On this last point, Smith used the example that left-leaning medical professionals may be conscientiously opposed to circumcision, which they may view as child abuse.  Should these professionals be required to participate in or facilitate a circumcision procedure?  Smith concluded that, just as a Pro-Life nurse should not be compelled to participate in an abortion, an anti-circumcision nurse should not be forced to violate his or her conscience.  “We need not coercion, we need comity,” Smith succinctly summarized.

As Smith rightly noted, forcing medical professionals to engage in procedures against their consciences may cause them to leave medicine altogether.  This would drastically weaken the medical profession, as otherwise bright, qualified, and pioneering individuals would look for employment elsewhere.  This is an issue that impacts everyone.  As Smith stated, “All of society is hurt by this. And by the way, why would they want to force and compel? Because when a doctor says ‘No, I can’t do this, this is wrong,’ it sends a very powerful message to society and to the patient that something isn’t right here.  That’s the real target of trying to squash medical conscience.”  Protecting conscientious objections of medical professionals is of utmost importance and is a fundamentally non-partisan issue. Ensuring these protections is the prudent and proactive step to take.

Throughout his talk, Wesley Smith encouraged the audience to prioritize strengthening Texas’ sub-par laws during the 86th Legislative Session.  This includes not only protecting medical professionals’ consciences, but also reforming the draconian and unconstitutional Texas Advance Directives Act (TADA) that jeopardizes the lives of patients in Texas hospitals, which Smith rightly likened to the recent UK cases of Alfie Evans and Charlie Gard.  Smith urged Texas legislators, their staff members, and Texas Right to Life to proactively address these issues in the Pro-Life movement before it is too late.  

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