Friday, March 21, 2008

HHS Secretary challenges ACOG conscience guidelines

In November 2007, the American College of Obstetrics and Gynecology (ACOG) Committee on Ethics issued new ethics guidelines on "the limits of conscientious refusal in reproductive medicine." The guidelines state that conscientious refusals -- that is, a provider's denying a patient requested services (such as contraceptives or abortion) because of a personal moral objection -- "should be accommodated only if the primary duty to the patient can be fulfilled." In ACOG's view, refusals that impose the provider's religious or moral beliefs on the patient, negatively affect the patient's health, reinforce negative social or racial stereotypes, or are based on scientifically invalid information "should be limited." Patients are to be provided with advance notice of the provider's views, so as not to be caught unawares in a crisis; and if the provider decides to refuse to provide requested services, he or she is obligated to provide a timely referral to another provider. Finally, providers in areas without such referral availability should either provide the services requested (against their own commitments) or find another place to work.

This week, in a letter to Norman Gant, Executive Director of the American Board of Obstetrics and Gynecology, HHS Secretary Mike Leavitt suggested that the guidelines and any punitive actions ABOG might take are discriminatory and may conflict with existing Federal law. You can also hear the story on NPR's Morning Edition.

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bob koepp said...

If the ethical issues of conscientious objections are to be seriously addressed, it is necessary to at least get the general parameters in clear focus. First, a conscientious refusal to provide a requested service needs to be clearly distinguished from "imposing the provider's religious or moral beliefs on the patient." This reflects a basic distinction in both ethics and law. Second, while it is entirely appropriate to insist that the "primary duty to the patient" must be fulfilled, such insistence is empty until we have a clear statement of what that primary duty is. Perhaps someone can construct a persuasive argument to the effect that this primary duty includes the provision of services that are not medically indicated, and that don't treat any recognized medical pathology -- but if so, I haven't yet seen such an argument.

Sue Trinidad said...

Yes--I was surprised (when I actually read the guidelines) by (1) how vague they are and (2) the "kitchen-sink" nature of the list of inappropriate/discouraged activities. After all, who would argue *against* the claim that physicians (or anybody else, really) shouldn't impose their moral or religious views on their patients/clients?

That said, it does seem that conscience laws are a hot topic at the moment (in addition to this story, various rules concerning pharmacists' objections to emergency contraception have been in the news in the past week or so) perhaps we can hope that greater clarity is forthcoming? Hope springs eternal!