New Bioedge edition available

The weekly newsletter, Bioedge, from the land down under is one of the better bioethics/biotechnology on-line newsletters.

Readers who consider the pro-life movement mainly as a US political matter, may be surprised by the existence of Bioedge, since it is pro-life. The publishers' aim is to:

* to promote evidence-based ethics in medicine
* to promote compassion in medical care
* to highlight the fact that medical excellence is not possible without ethical principles
* to provide high-quality up-to-date information and commentary on bioethics
* to facilitate the participation of health professionals in policy debates on bioethics

This week's headlines include

"Stem cell scientists seek to shed snake oil image"

"California euthanasia lobby scores victory"

"Nature attacks ‘human dignity’"

"Surprise on operating table"

"US Catholic bishops reject embryonic stem cell research"

Election year pro-abortion push

If you don't want your child to suffer, you don't choose Partial Birth Abortion (Intact Dilation and Extraction or "D&X") and you certainly shouldn't complain about State laws concerning prevention of fetal pain during the abortion.

msnbc.com and Self Magazine have teamed up to discuss "When there is no good choice."

In the story, we read about abortions - one at 22 weeks and and one at 30 weeks pregnancy, after two mothers learn that their babies have severe birth defects. While the story spends a lot of space trying to explain that the mothers are having the abortions because they don't want their babies to suffer, the story condemns laws requiring anesthesia, informing the mothers that their children may feel pain during the procedure, or mandating lethal injections to kill the child before dismembering him or her. Of course, we are told how wrong it is to call "D&X" "partial birth abortion," or to ban the procedure itself.

This is a story about the politics of an election year, written to tug on our heart strings rather than inform.

Obviously, I am pro-life, and so, I must be one of those the article calls "anti-abortion." The story claims that I "demonize" the mothers who have abortions at 28 weeks, and mentions that because of George Bush, the Republicans, and "red staters," these women have troubles and the doctors claim that they worry about being charged with breaking the law. However, each woman does abort her child.

The author doesn't seem to notice the irony that she is practicing demonization, herself.

The good news is that the article reports on perinatal hospice, now available across the country:

Today some 60 U.S. hospitals, hospices and crisis pregnancy clinics offer perinatal hospice services; in Minnesota, women seeking to abort fetuses with fatal anomalies are required by law to be informed about hospice as an alternative. “Women appreciate the grieving process and being able to spend time with their babies,” says Dr. Calhoun, vice chair of obstetrics and gynecology at West Virginia University School of Medicine in Charleston. “Perinatal hospice gives women an alternative that is a better choice than abortion.”

Gynecology and Obstetrics Policy makers respond to doctors on conscience

It appears that the American College of Obstetricians and Gynecologists and ABOG (the American Board of Obstetricians and Gynecologistsmay be about to abort their efforts to change laws concerning conscientious refusal in Washington. It remains to be seen whether they will deliver on their promise to support -- without limits - the Conscientious Refusal to perform or refer for certain procedures. (I'm sorry, I can't resist obvious puns, even on such a serious subject.)

LifeEthics has been covering the controversy over the American College of Obstetrics and Gynecology's "Opinion #385, Limits of Conscientious Refusal in Reproductive Medicine," which states that,

Providers with moral or religious objection should either practice in proximity to individuals who do not share their view or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient's physical or mental health, providers have an obligation to provide medically indicated and requested care."

First, "medically indicated" should be up to the physician and not dependent on autonomy - the patient's wants and wishes. Remember that Joseph Kennedy, the father of John and Robert, had his daughter lobotomized because she was too wild. At that time, according to Joe, the lobotomy was medically indicated.)

Obviously, this is not a moral obligation - but one that can be enforced by the use of the words "standard practice" and "standard reproductive services." In other words, abort, refer, or face lawsuits and risk your board certification. And the definition of "emergency" varies.

We also reported that the Secretary of Health, Michael O. Leavitt, had written to the Presidents of the American College of Obstetrics and Gynecology, the professional organization that supposedly sets the standard for these professionals, and the American Board of Obstetrics and Gynecology which certifies and tests OB/Gyns Presidents of ACOG and ABOG. He informed them that they were in danger of risking their own funding for training programs and status by any attempt to override the protections for Conscience in Federal funding regulations.


Even NPR noticed and covered the controversy.

The leaders at the Christian Medical and Dental Association have let CMDA members know that the President of ACOG, Kenneth L. Noller, MD, responded to the Fellows (certified OB/Gyns) last week and Norman F. Gant, MD, the President of ABOG, responded to Secretary Leavitt by letter on March 19, 2008.

Dr. Gant doesn't have a clue what the Secretary is talking about:

I am responding to your letter addressed to me asking about the American Board of Obstetrics and Gynecology’s stand with respect or to a physician’s choice to violate their conscience by referring patients for abortions or taking other objectionable action, or risk losing their board certification.” I can only say that I do not know where you came up with any suggestion, much less documentation, that the American Board of Obstetrics and Gynecology has ever asked anyone to violate their own ethical or moral standards.

And Dr. Noller reassures the Fellows that in this case, an Opinion is just an Opinion (and we're supposed to forget the attempts to change the laws):

We want to be clear the Opinion does not compel any Fellow to perform any procedure he or she finds to be in conflict with his or her conscience and affirms the importance of conscience n shaping ethical professional conduct. For example, while this is not a document focused on abortion, ACOG recognizes that support of or opposition to abortion is a matter of profound moral conviction and ACOG respects the need and responsibility of its members to determine their individual position on this issue based on their personal values and beliefs. We want to assure members with a diversity of views on this issue that they have a place in our organization.
Ethics Committee Opinions provide guidance regarding ethical issues. This Committee Opinion is not part of the “Code of Professional Ethics of the American College of Obstetricians and Gynecologists.” This Committee Opinion was not intended to be used as a rule of ethical conduct which could be used to affect an individuals initial or continuing Fellowship in ACOG. Similarly, it is not cited in the American Board of Obstetrics and Gynecology’s “Bulletin for 2008,” and “Bulletin for 2008 Maintanence of Certification” and an obstetrician-gynecologist’s board certification is not determined or jeopardized by his or her adherence to this Opinion.
Conscience has an important role in the ethical practice of medicine. While this Opinion attempted to provide guidance for balancing the critical role of conscience with a woman’s right to access reproductive medicine, the Executive Committee has noted the uncertain and mixed interpretation of this Opinion. Thus, the Executive Committee has instructed the Committee on Ethics to hold a special meeting as soon as possible to reevaluate ACOG Committee Opinion #385.

Designated Donations (Saving black girls from punishment)

There's no way to avoid the politics if I'm going to comment on these two stories.

First, here's a link to the audio recordings of Planned Parenthood employees, agree will be earmarked to decrease the number of "African Americans" or a "black baby." The employees include the Vice President of Development of the New Mexico PP, Sue Riggs, agreeing to accept money that the caller has specifically said should go to the abortion of an African American. Another call includes the statement that the man does not want his children to face a lot of competition in college due to affirmative action.

These calls should be enough to make any thinking person condemn at least the lack of sensitivity and training at the offices of Planned Parenthood. Unless you realize that they probably think they're rescuing a black woman or girl from the punishment of having a black baby -- as stated so clearly by Barack Obama last Sunday, March 30, while campaigning in Philadelphia:

"I've got two daughters -- 9 years old and 6 years old," Obama said. "I am going to teach them first of all about values and morals. But if they make a mistake, I don't want them punished with a baby. ... So it doesn't make sense to not give them information."

The mindset that calls pregnancy a "punishment" is one that we who value human life often encounter. In a classic case of projection - seeing your own opinion, wants, flaws or tendencies in the other person - the abortion advocate will claim that we see sex as bad, and that women and girls should be punished.

No, we see women and girls as us. We see their babies as the children of the future - as our fellow human beings and citizens. The information that we give our children is that there are consequences to our actions. Each of us has a responsibility to work toward good consequences by choosing our actions. Taking responsibility, expressing compassion and empathy, and even parenthood are not "punishment."

In fact, you could call the opportunity and ability to do so a "blessing."

Edited 4/2/08 at 10:00 PM for typos.

Secretary of Health Supports Conscience

Secretary of Health Michael O. Leavitt has stepped up to protect the right of conscience and conscientious refusal, specifically in the right not to be forced to commit or be complicit in abortion and other forms of killing. The Secretary has sent a letter to the President of the American College of Obstetrics and Gynecology warning about a possible conflict with Federal anti-discrimination rulings secondary to ACOG's Ethics Statement #385. (that's a pdf)

See the LifeEthics post explaining the origin of the conflict, here.

The American Association of Pro-Life Obstetrics and Gynecology, alerted us to the Press Release sent out by the HHS, most likely due to the fact that the ACOG Ethics Committee is meeting Monday and Tuesday, March 17 and 18.

Here's the news item:

FOR IMMEDIATE RELEASE Contact: HHS Press Office
Friday, March 14, 2008 (202) 690-6343

HHS SECRETARY CALLS ON CERTIFICATION GROUP TO PROTECT CONSCIENCE RIGHTS

Unless changes are made, physicians could be forced to refer patients for abortions even if it violates their conscience

Health and Human Services Secretary Mike Leavitt today expressed disappointment in a new policy put forth by the American College of Obstetricians and Gynecologists (ACOG).He also called on the American Board of Obstetrics and Gynecology (ABOG) to reject this policy and protect the conscience rights of physicians.

In a letter sent to ABOG Executive Director Dr. Norman Grant today asking for clarification, Secretary Leavitt notes, "It appears that the interaction of the [ABOG Bulletin for 2008 Maintenance of Certification] with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification."

In particular, the Secretary expressed concern that enforcement of this ACOG policy by certain federally-funded entities would violate federal laws against discrimination.

Secretary Leavitt continues, "As you know, Congress has protected the rights of physicians and other health care professionals by passing two non-discrimination laws and annually renewing an appropriations rider that protect the rights, including conscience rights, of health care professionals in programs or facilities conducted or supported by federal funds."

The full text of Secretary Leavitt's letter appears below:

Norman F. Gant, M.D.,
Executive Director
The American Board of Obstetrics and Gynecology
2915 Vine Street
Dallas, TX 75204

Dear Dr. Gant:

I am writing to express my strong concern over recent actions that undermine the conscience and other individual rights of health care providers. Specifically, I bring to your attention the potential interaction of the American Board of Obstetrics and Gynecology's (ABOG) Bulletin for 2008 Maintenance of Certification (Bulletin with a recent report (Opinion Number 385) issued by the American College of Obstetricians and Gynecologists (ACOG) Ethics Committee on November 7, 2007 entitled "The Limits of Conscience Refusal in Reproductive Medicine".

The ACOG Ethics Committee report recommends that in the context of providing abortions, "Physicians and other health care professionals have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive service that patients request." It appears that the interaction of the ABOG Bulletin with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification.

As you know, Congress has protected the rights of physicians and other health care professionals by passing two non-discrimination laws and annually renewing an appropriations rider that protect the rights, including conscience rights, of health care professionals in programs or facilities conducted or supported by federal funds. (See 42 U.S.C. § 238n, 42 U.S.C. § 300a-7, and the Consolidated Appropriations Act, 2008, Pub. L. No. 110-161, 121 Stat. 1844, § 508). Additionally, threats to withhold or revoke board certification can cause serious economic harm to good practitioners.

I am concerned that the actions taken by ACOG and ABOG could result in the denial or revocation of Board certification of a physician who -- but for his or her refusal, for example, to refer a patient for an abortion -- would be certified. These actions, in turn, could result in certain HHS-funded State and local governments, institutions, or other entities that require Board certification taking action against the physician based just on the Board's denial or revocation of certification. In particular, I am concerned that such actions by these entities would violate federal laws against discrimination.

In the hope that compliance of entities with the obligations that accompany certain federal funds will not be jeopardized, it would be helpful if you could clarify that ABOG will not rely on the ACOG Ethics Committee Report, "The Limits of Conscience Refusal in Reproductive Medicine" when making determinations of whether to grant or revoke board certifications.

Thank you very much for your assistance in this matter.

Sincerely,

Michael O. Leavitt
cc:
Kenneth Noller, M.D.

The American College of Obstetricians and Gynecologists

Women do not want pro-abortion President

The New York Times has weighed in on the secret to Hillary Clinton's win in New Hampshire: women voters.

I am convinced that Senator Clinton’s campaign is very aware of the importance of the women's vote. (I believe that the "crying" incident of January 6th was aimed at reminding women that Hillary is a woman, and that this is their chance to have a woman President. But that's just my opinion.)

Pro-life voters who do not want a pro-abortion President must begin to emphasize and educate one another about the voting record of the candidates. Our belief that every human life has value (not the personalities of the candidates, inevitabilities, and religious identification) is something that we have in common with members of both the major parties.

There is no question that Hillary and Obama fought the Partial Birth Abortion ban (Hillary as First Lady and then as NY Senator and Obama while still in the Illinois legislature). Polls like this one (comments here and the poll in .pdf, here) from the Susan B. Anthony List, from last August, show that even among women who want to vote for a woman to get a woman President, a large number will not vote for the advocates of Partial Birth Abortion. These are the voters we need to alert/inform.

The reality is that politics will play a part in our goal of protecting human rights in medicine and science policy in the US. The next President will, like this one, be in a position to name several Supreme Court Justices.

Abortion, miscarriage, and risk to later babies

I'm afraid that the report I blogged about a couple of days ago is being misinterpreted by at least one Pro-life source.

The numbers are impressive enough from a public health and pro-life view point, without ignoring the fact that the original data is 40 to 50 years old (without the advantage of our current Neonatal Intensive Care Units and the wonderful advances in our medical abilities) and that there's no way to know whether the mothers in the study had a miscarriage or an intentional, induced abortion. The authors do report on more recent, reliable data showing an increase after abortion, compared to miscarriage, not the 300% to 900% increase seen in the earlier (and less relevant to today's medical realities) report.

As I said before, we can't really control the numbers of miscarriages, but we can control and decrease elective abortion. That would decrease the numbers of premature births and low birth weight babies who are at such risk for early death and chronic problems like cerebral palsy and lung disease.

Abortion and risk to the health of later babies

New analysis of old data published in the January 2008 issue of the Journal of Epidemiological Community Health (free abstract) has confirmed the association between induced abortions and later premature birth and low birth weight babies. Babies born prematurely and/or weighing less that normal are much more likely to die in the first month or have severe health problems like lung disease or brain damage.

However, the focus of the original research is based on self-reported information from over 45,500 moms who gave birth from 1959 to 1966 and the records don't tell us whether the mothers had spontaneous abortions (miscarriages) and induced intentional abortions. The authors do find that increased numbers of miscarriages or abortions increase the risk of low birth weight at full term and of premature birth:

Compared with women with no history of abortion, women who had one, two and three or more previous abortions were 2.8 (95% CI 2.48 to 3.07), 4.6 (95% CI 3.94 to 5.46) and 9.5 (95% CI 7.72 to 11.67)times more likely to have LBW, respectively. The risk for PB was also 1.7 (95% CI 1.52 to 1.83), 2.0 (95% CI 1.73 to 2.37) and 3.0 (95% CI 2.47 to 3.70) times higher for women with a history of one, two and three or more
previous abortions, respectively.

The new information from the JECH is nearly 50 years old and can't distinguish between miscarriages and induced abortions, so it doesn't really tell us much about the risk from today's elective abortions or give proof that induced abortion is risker than miscarriage. I'm afraid that that is the emphasis of media reports like those in Time and Medical News Today. (Although they don't note the surprising result that the study found no association between smoking and premature birth, although there was a significant association between smoking and low birth weight.)

However, the authors review results from other studies which do make distinctions between the mothers who had previous induced abortions and those who had miscarriages. Those studies do show an association between induced intentional abortions and low birth weight, term low birth weight, and premature birth. Instead of the 300 to 900% risk over full term live birth, most found at least a small 1.1 to 1.4 (10% to 40%) increased risk after one intentional induced abortion and up to 3 times the risk after 2. While there is also a risk after miscarriage, miscarriage can't be helped. The variables which can be changed - not those that can't be - are matters for public health policy.

And fewer of our children will have to die for it.

Doctors, Abortion and Conscience

The debate on medical ethics has definitely moved from "Our Bodies, Our Choice," to "My Choice, You Don’t Have a Choice." Autonomy, the "I want" ethics, trumps the right to life, the right to liberty and the physician's duty to do no harm. Where once laws were written to punish doctors who harmed patients, doctors are now threatened with lawsuits and the loss of our licenses for refusing medications or procedures demanded by patients and their surrogates.

The American College of Obstetricians and Gynecologists ethics statement, "The Limits of Conscientious Refusal in Reproductive Medicine" is a case in point. Abortion is so important to the ACOG Ethics Committee that they deny the right not to be killed and threaten the right not to be enslaved by calling abortion the “standard reproductive care that patients request” and demands that doctors who “deviate from standard practices” (object to abortion) “practice in proximity to individuals who do not share their views or ensure that referral processes are in place” (with a willing abortionist). The President of ACOG then wrote letters asking Congress for laws to force these limits on our consciences: doctors who object to abortion should either change their practice so that they don't take care of women and girls or move close to a willing abortionist.

The Christian Medical Association and 28 other pro-life, pro-family organizations have written a letter criticizing ACOG’s Statement as “a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.”

GrannyGrump posted several reasons conscientious doctors should consider elective intentional abortion bad for the mother. I agree with her that abortion is wrong because it is bad for women. I also believe that she begins from the same viewpoint that I do: Even if abortion weren't bad for women, it would still be wrong.

Elective intentional abortion is immoral because it takes the life of a human being. If the mother's life is in danger, she has the right to self preservation and it is moral to help her save her life. Even then, the child's life should also be protected if at all possible. The intent can never be to produce a dead child.

State officials have mandated that all medical students learn to perform abortions in New York and that all pharmacies stock and dispense contraceptives in Illinois and Washington. ER doctors are forced to dispense Emergency Contraception in Connecticut, California, Massachusetts, New Jersey, New Mexico, New York, Ohio and Washington. How long before autonomy supersedes the physician's right to conscience at the end of life since the American Medical Association has condoned the use of Oregon's "Physician Assisted Suicide" law (now renamed and redefined as "Aid in Dying")?

Laws against the conscience are a poor substitute for medical ethics and will result in the death of those same ethics. The end result of limiting the physician’s conscience is cook book health care written in court rooms by lawyers and judges. The practice of medicine will no longer be a profession, much less a calling, practiced by men and women of conscience. It will become a job done by people capable of following orders, doing what they believe is wrong.

Text of Letter from CMA to ACOG on Conscience

(The press release is here and the LifeEthics coverage is here.)

December 7, 2007
American College of Obstetricians and Gynecology
Douglas W. Laube, MD, President
PO Box 96920
Washington, D.C. 20090-6920

Dear Dr. Laube:
The undersigned individuals and organizations urge the repudiation and withdrawal of the recently published position statement of The Committee on Ethics of the American College of Obstetricians and Gynecologists (ACOG), "The Limits of Conscientious Refusal in Reproductive Medicine."
The ACOG statement suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion.
The paper indicates that ACOG views the exercise of conscience and faith not so much as a cornerstone right in a democracy or as a historic hallmark of medicine, but rather as an inconvenient obstacle to abortion access.
A few excerpts from ACOG's paper illustrate these concerns:

1. "An appeal to conscience would express a sentiment such as 'If I were to do 'x,' I could not live with myself / I would hate myself, I wouldn't be able to sleep at night."

By caricaturing conscience as a pitifully self-centered, subjective feeling, ACOG denigrates the objective sources of conviction. Physicians of faith base decisions of conscience not on personal whims and feelings but
on the objective teachings of Scripture--the same Scriptures that have provided the foundation for the laws of much of civilization. A physician's conscience may also be informed by time-honored ethical standards such as the Hippocratic Oath, which for centuries provided a foundation for medical ethics until abortion advocacy censored its teachings.

2. Physicians may not exercise their right of conscience if that might "constitute an imposition of religious or moral beliefs on patients."

This harshly skewed view of the exercise of conscience would have the practical effect of reducing physicians to pawns of patients, since in ACOG's view, conscientiously declining a prescription or procedure is tantamount to "imposing religious or moral beliefs on patients."

3. "Physicians…have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive service that patients request."

This assertion contradicts a basic corollary of conscience. The same life-honoring, objective principles—"Thou shalt not kill," and "first, do no harm"--that persuade many conscientious physicians not to perform abortions also persuade them not to recommend someone else to do the deed.

4. "All healthcare providers must provide accurate and unbiased information so that patients can make informed decisions."

Normally no one would question this principle, but in this case, context is everything. Since ACOG has gone to court to fight laws requiring abortion doctors to offer informed consent information to patients on the risks and alternatives to abortion(1), clearly ACOG intends to selectively apply this requirement only to pro-life physicians to force them to offer abortion as an option.

5. "Providers with moral or religious objections should … practice in proximity to individuals who do not share their views…"

It is incredible that ACOG would actually require a pro-life physician to relocate his or her practice to be close to an abortion facility. Besides the fact that this drastic requirement is selectively invoked only against pro-life doctors, it would also have the negative practical impact of removing desperately needed doctors from underserved areas.
ACOG's misguided and uninformed public statement on conscience limits is bound to have the effect, whether unintended or actually intended, of discouraging persons of faith from practicing or choosing obstetrics and gynecology as a profession. At a time when many communities are already suffering the loss of obstetricians and gynecologists forced out of their practices for economic reasons, it seems especially unwise to send such a message of ideological intolerance and religious discrimination.
ACOG's aggressive political advocacy for abortion has significantly impaired its ability to speak for all physicians and to judge matters of medical ethics without bias. We urge ACOG to reconsider and withdraw this statement as a step toward remedying that lamentable loss of respectability and credibility.
Sincerely,

David Stevens, MD
Chief Executive Officer
Christian Medical Association

1 American College of Obstetricians v. Thornburgh, 737 F.2d 283, 297-98 (3d Cir.1984).

Please see the CMDA website for the other signers.

CMDA to ACOG: Stop Attack on Conscience

The Christian Medical and Dental Association has released a statement condemning the American College of Obstetrics and Gynecologists for ACOG's position statement (earlier coverage, here and here) that would require all doctors who object to abortion to either change their practice or make sure that they work next to a willing abortionist:

Physicians call on The American College of Obstetricians and Gynecologists to stop attacking conscience rights

December 11, 2007--The nation's largest faith-based association of physicians, the 15,000-member Christian Medical Association (www.cmda.org), today joined other leading national organizations in challenging The American College of Obstetricians and Gynecologists (ACOG) to stop its attack on the conscience rights of pro-life physicians.

A letter, drafted by CMA and signed by other national organizations, blasted ACOG's Committee on Ethics position statement, "The Limits of Conscientious Refusal in Reproductive Medicine." CMA's letter noted that the statement "suggests a profound misunderstanding of the nature and exercise of conscience, an underlying bias against persons of faith and an apparent attempt to disenfranchise physicians who oppose ACOG's political activism on abortion."

CMA CEO David Stevens, MD said, "ACOG is not only out of touch with conscience-driven physicians, but also with our long-standing American tradition to protect the rights of citizens to not participate in conscience-violating actions—especially when those actions would take a human life. That American tradition rests on constitutional principles of religious freedom and speech."

ACOG's position paper targets pro-life physicians, insisting that abortion-objecting physicians refer patients to get abortions and declaring that physicians who will not participate in conscience-violating procedures and prescriptions must actually move close to doctors who will.

Dr. Stevens added, "Many physicians had been realizing that because of their aggressive abortion lobbying, ACOG officials do not represent the values of most physicians and mainstream medicine. This statement goes a step beyond not representing our life-affirming values to actually advocating policies to prevent us from exercising those values. ACOG's attitude seems to be, 'If you don't toe the ACOG line on abortion, the 'morning-after pill,' and the application of reproductive technology, then you shouldn't be practicing obstetrics--and if you do, we're going to do everything in our power to force you to accommodate our abortion agenda."

CMA Executive Vice President Gene Rudd, MD, an obstetrician and gynecologist, noted, "I have withdrawn my ACOG membership of over 25 years. My conscience can no longer support their lack of conscience. ACOG's strategy seeks to marginalize dissenting opinions. I as an obstetrician have a moral obligation not only to act in my patient's best interest, but also in the best interest of the developing baby, and of society as a whole."

Colorado's Human Life Amendment

Although Time Magazine, the Denver Post and the blogs insist on calling it the "fertilized egg rights" law, Colorado's State Supreme Court has approved the wording for a proposed "Human Life Amendment." The proponents of the amendment need 76,000 signatures in order to get the initiative on the November, 2008 ballot.

The Chicago Tribune reporter at least understands that after fertilization we are talking about an "embryo." The Trib even found three ethicists who agree that the human embryo is alive. Which puts them in opposition Justice Blackburn’s opinion ( which medical school did he go to, anyway?) in Roe v. Wade that no one knows when life begins.

Unfortunately all three of those ethicists are much more worried about the definition and description of the qualities and abilities of those living humans they deem worthy of “personhood” than whether or not it is acceptable to discriminate between which humans are persons or not. Their main objection seems to be that protection of the inalienable right not to be killed, enslaved or treated as research material “would cause a lot of problems." (I'll bet that they disagree with the Dred Scot opinion, though. Overturning that one sure caused a lot of problems.)

U.S. law, based as it is on “unalienable rights” mentioned in the Declaration of Independence, should absolutely prevent courts, laws and ethicists from infringement of the right not to be killed or enslaved. Ethicists – of all people – shouldn’t need a lawyer to understand that the full exercise of unalienable rights affects infants, children, the mentally disabled and the mentally ill. Parents have special duties to their children and children can't claim the same expression of liberty (drinking, driving, entering into contracts) that their parents do. There are legal precedents for dealing with the “problems” posed by the varying abilities of the mentally ill and disabled as well as for minors – including very young infants who can legally be restrained against their will (in a crib, playpen or car seat).

The “ethicists” in the Tribune article, as well as readers' comments in both papers and in blogs all over the internet, bring out every pro-abortion objection except the coat hanger. They warn us that fertile women will be “monitored,” that women who miscarry or who drink a glass of wine will be prosecuted. They insist that if State law recognizes the human being as a person from fertilization, we’ll have to decide whether to try to save every child at miscarriage and ectopic pregnancy or fail to enforce the law. Elective intentional abortions and manipulation that is intended to end the organization of an embryo - are acts which may be prohibited under law and the State Medical regulations. Spontaneous abortions (miscarriages), and stillbirths, like so many natural deaths, are impossible to prevent and cannot be prohibited.

Since US Supreme Court rulings (Roe v. Wade and Casey, among others) all base the “right” to an abortion on the autonomy of the mother and while affirming the right of the State to protect the child in certain cases, the “extracorporeal” embryo should be protected, somehow, even in current law.

It might be worth noting that the law requires determination of the cause of death of everyone who dies, and that Texas requires a special review of children under 6 and those of any age who die within 24 hours of admission to the hospital. Texas also names a “person” as living human individual from fertilization to natural death through our Penal Code. The 2003 Prenatal Protection Act allows criminal charges when a third party causes the death of an unborn child while exempting the actions of the mother or deaths due to legal medical procedures with the consent of the mother.

In fact, 3 men have been convicted of capital murder under our 2003 Prenatal Protection Act. The convicted men were abusive, the father, and intended to kill the child(ren). One killed twins at 5 months gestation but not the mother, the other two each killed mother and child. One man received the death penalty for killing a teenaged girl he'd gotten pregnant. There are charges pending in at least one more case, a drive-by shooting that caused the death of a pregnant woman.

Last month, the Texas Court of Criminal Appeals ruled in favor of the conviction of a man who killed one of two women he was sleeping with after the first told him she was pregnant. He told his second girlfriend that he would take care of the pregnancy of the first, and shot the first woman 3 times with a shotgun, once in the face.

As for "monitoring the actions of women:" a couple of county District Attorneys in Texas have tried to turn the law into an excuse to lock up mothers for endangering their unborn children. The outcome was similar to the cases in South Carolina a few years ago, when women were arrested after being tested as part of their pregnancy screening, required by that State’s Medicaid regulations. One lawyer made a speech to a group of lawyers that the Act could be coordinated with our State's Consent Laws to charge doctors with capital crimes. Texas State Attorney General has given an official statement on the intent of the Legislature that exempts mothers and doctors.

The handling of an ectopic pregnancy is well established under the doctrine of self-defense. With our current medical technology, the child cannot be saved and he or she is a direct danger to his mother’s life.

While we can’t verify the soul, we can verify which embryos are organisms: techs do it all the time in labs. The embryo, unlike the sperm, egg, and transplanted organs, is an organized organism. It's easy to tell within a day whether the oocyte is fertilized and which are not. It's also easy to tell the difference between embryonic stem cells and an embryo.

"embryo uber alles"

Ellen Goodman reminds us that it ain't over yet. As she said in her November 20, 2007 op-ed piece (Free registration at the Boston Globe may be necessary),

Democrats, on the other hand, may breathe a sigh of regret. The stem-cell controversy gave pro-choicers an iconic image of their enemy: someone who put the embryo uber alles. It gave progressives a poster girl in Nancy Reagan - and a poster boy in Michael J. Fox. Stem cells were to the left what partial-birth abortion was to the right, a way to frame a touchy issue and look like the reasonable center.

The next time someone has any questions about the source (or existence) of the divisive politics and agendas in the life issues, just point them to Ms. Goodman's observation.

But first, arm them with the explanation that there's no such thing as a "fertilized egg" (there's either an egg or an embryo) and note that the funding for embryonic stem cell research never existed before the President Bush's policy was set and was never maxed out on the Federal level.

Governments threaten physicians for anti-abortion policy

In our Nation, with our First Amendment, why doesn't someone threaten all the bodies placing restrictions on conscience clauses and against religious-based practices?

In Portugal, the Health Minister has been threatening to take the Portugal Medical Association to Court for its policy that states that doctors should respect human life from fertilization to natural death.

More here, here, and here.

Then, there's the woman doc in England, who is being threatened with charges of "unprofessional conduct" and being removed from the National Health Services, for telling women to "think twice" before they have an abortion.

The American College of Obstetricians has a new statement on ethics, #385, entitled, "The Limits on Conscientious Refusal in Reproductive Medicine."

Worse, according to the American Association of Pro-Life Obstetricians and Gynecologists, ACOG ACOG sent a letter to Senators in Washington:

"Dr. Michael Mennuti, writing as the President of the American College of Obstetrics and Gynecology (ACOG), has requested the United States Congress to “require doctors with moral objections to refer for abortions.” Urging the Senators to alter the current Abortion Non-Discrimination Act, Mennuti states, “Doctors who morally object to abortion should be required to refer patients to other physicians [for an abortion].”"

Any ethics statement by ACOG carries the weight of "standard of care," and places all doctors, nurses and other medical professionals at risk of legal penalties if we do not follow the guidelines.

Even though I haven't delivered a baby in 10 years, I may still be the primary care doc for a woman who sees an obstetrician for her pregnancy and I still care for a women in the first 20 weeks of pregnancy, as far as diagnosing the pregnancy and caring for threatened miscarriage and tubal pregnancies. I am careful to meet the guidelines of ACOG, because I know that I could be sued - and it would be a slam dunk for the patient if I am ever accused of varying from them.

ACOG now says that I shouldn't care at all for women who might be or are pregnant unless I am willing to make arrangements for an abortion if the woman wants one. That organization also says that hospitals shouldn't offer emergency care for rape victims or maternity care if the organization has objections to elective abortion or sterilization.

The ACOG statement essentially mandates that all of us must offer abortion and/or referral for abortion - and that if we don't offer abortion ourselves, we probably should either practice "in close proximity" to some one who does and/or that we shouldn't practice in areas that don't have easy access to an abortion!

Family Practitioners and other pediatricians are more likely to be religious and those who practice in Rural areas are more likely to be from a rural area. If ACOG's policy is followed, there would be an acute shortage of primary care doctors for women of childbearing age.

The Position Statement mixes "emergency" and "reproductive" care, and severely goof in calling the conscience an inner voice that tells us that we couldn't live with ourselves if did so and so. As Dr. Robert Orr (a Family Physician and ethicist) says in his rebuttal written for the Christian Medical and Dental Association, the conscience is much more - the conscience cannot be separated from the world view of the person and people of faith often consider the knowledge of right and wrong and the conscience that leads us to follow it to be part of what we call the "Image of God."

Non-believers can be "pro-life" and they also have consciences which they should not be forced to violate.

Again, a person who will go against her or his conscience is a person who will do what he knows is wrong

I still think it would be simpler for all the proponents of abortion to pay to move the abortionists around than for them to try to force docs to act against our conscience.

Court upholds Texas Prenatal Protection Act

In 2003, the Texas Legislature passed a Prenatal Protection Act, which named the unborn children of Texas individuals from fertilization to natural death. Texas law also calls the "individual" a "person." With the world the way it is after Roe versus Wade, and because most of us have compassion for a woman who believes she doesn't have a real choice, we had to make exceptions for the decisions of the mother, including abortion and - even when the child is not in her womb - for those she empowers, such as doctors and techs at in vitro fertilization clinics.

However, the law in Texas protects a woman and her child against some one else taking the life of her child against her wishes. We will also punish the murderer when we can't protect them.

Today, the Sixth Texas Court of Appeals upheld the conviction of a man for killing his pregnant girlfriend under our Prenatal Protection Act.

The man was dating two women when one became pregnant. He told the other woman that he would "take care of it," and then shot the mother of his child 3 times with a shotgun, once in the face.The jury determined that he knew the woman was pregnant and that he intended to kill them both. He was convicted of capital murder and sentenced to life imprisonment.

The Court decision plainly states:
"By expressly defining capital murder such that one of the victims may be any unborn child from fertilization throughout all stages of gestation, the statute leaves no ambiguity as to what conduct is proscribed. In particular, the plain language of the statute prohibits the intentional or knowing killing of any unborn human, regardless of age. No ordinary person reading the statute would have any doubt as to whether it encompasses victims at all stages of gestation."

We know that violence often begins when a woman is pregnant and that 25% to 30% of deaths during pregnancy are due to homicide, usually at the hands of the father of the child.

I hope that this Court opinion and the original law will save lives. I wish for a day when no one is in danger of being intentionally killed by someone else, much less a loved one. And I hope that the publicity about this law will cause everyone - the person about to get behind the wheel after drinking as well as the abusive husband or boyfriend, to consider the risk of harming a mother too dangerous to even think about.

I believe we are much more likely to overturn Roe now than we have been at any time since 1973, while still ending up with restrictions in at least as many States as we had then. And I believe that the reason why this is so is because more than half of our citizens are unhappy with elective intentional abortion on demand as it is practiced in too many States today.

I also believe that a pro-life Congress could restrict the Courts from interfering with the States' legislative actions on abortion tomorrow, on the grounds that it's obvious that the unborn are persons.

For one thing, we have 4-D ultrasounds now and babies born as young as 20 weeks go home healthy.
In addition, many minds were changed - are still being changed - by the debate over partial birth abortion.


However, the reality is that there is zero chance of getting a Human Life Amendment through the Senate, much less getting 2/3 of the States to ratify it if the States themselves are not already doing it. (Please read up on how the 13th and 14th were ratified: the Legislators from the Southern States were not allowed to participate.)

Far too many men and women think of abortion as insurance against their bad decisions, rather than one more (awful) bad decision.

There are still too many people who think rape and incest are appropriate reasons in themselves for an abortion. They haven't heard how many women decide to carry their children to term after rape or considered the very real humanity of the unborn child, who shouldn't be punished for his father's crime.

But we do have a chance at returning the choice to the States where the majority would restrict abortion except to save the life of the mother. And each person that we teach to think of the unborn child as a person, the closer we get to ending elective intentional abortion.

Human dignity: What it is

Whether it's a genetic result of evolution or the way we are designed by a Creator, even very young children seem to have a sense that it's important to understand that there are consequences to infringing rights of other people before they can express "That's not fair!."

My attempt a couple of days ago to discuss the foundations of conservative philosophy and human dignity is not nearly so elegant as this one from Professor Francis Beckwith, associate professor of philosophy and church-state studies at Baylor University:

It is the view that human beings have intrinsic dignity by nature that is not a consequence of their size, level of development, environment or dependency.

and

"We don’t become less intrinsically valuable because others think it is in their interest to destroy us.

The Professor's letter addressed the controversy over abortion in Waco, Texas the home of Baylor. It might also give the editors of the American Journal of Bioethics a better understanding the base of the conservative philosophy and human dignity.

Admittedly, the result can be risky for people, individually and in groups. This is where government comes in and why it's vital to educate the public about the nature of rights as endowed to each human individual from the beginning of life until death. The danger comes from other people who discriminate between which human individuals fit into artificial categories smaller than the species category. The re-defining and discrimination - and the distraction by adding adjectives and qualifiers - is the beginning of the infringement of rights, whether the categories are according to physical or political power, race, status, location, development or function.

Thanks, to Jivin' Jehosaphat for the link to the Beckwith editorial in the Waco Tribune-Herald.

AMA editorial on Partial Birth Abortion Ban

I would like to respond to the Commentary by Lawrence O. Gostin, JD, “Abortion Politics: Clinical Freedom, Trust in the Judiciary, and the Autonomy of Women.” in the Journal of the American Medical Association, October 3, 2007.(behind a pay wall)

Declaring that the Supreme Court's consideration of the “respect for the dignity of human life” in their ruling on the Partial Birth Abortion Ban Act (Gonzales vs. Carhart, 2007) is “Congress’ overtly political discourse,” he neatly sums up his position in this sentence from his last paragraph:

“Morality alone is an insufficient justification for the government to intrude on the private lives of women and the clinical freedom of physicians.”

On the contrary: morality, especially the laws concerning the killing of one human being by another is the basis for all law:

“What makes killing morally wrong, then, when it is wrong, is that a human life, the one killed, is treated as a life that has little or no worth rather than as a life of incalculable worth and as one having a right to be treated accordingly. If laws were permitted to embody the idea that in some circumstances life loses its worth, or that some people lack sufficient worth to have their lives protected, individuals would no longer enjoy equal protection of the law so far as their lives are concerned. Furthermore, some principled basis for protecting human life other than its sanctity would have to be provided to justify what would constitute violations of the unquestioned worth of every individual human life.” Arthur J. Dyck When Killing is Wrong (Cleveland, Ohio: Pilgrim Press, 2001), p. 77. Emphasis mine)

However, the Court did not review the "right to abortion" in Gonzales vs. Carhart. It only ruled on the Constitutionality of the regulation of medical practice in one narrow procedure, which Gostin admits "does not save a single fetus because physicians could instead use a standard D&E method."

Gostin objects to the Supreme Court of the United States over-ruling lower Federal courts and to State governments who dare to regulate medical practice as though he Founding Fathers wrote the Constitution so that only the Federal Judiciary decides the really, really important issues and the representatives of the People are only allowed to decide the inconsequential. He forgets or ignores that Blackburn’s 1973 Court intervened between State legislators and their rightful power to regulate the practice of medicine in Roe vs. Wade, and invented State’s rights that gradually phase in based on trimesters.

Moreover, he seems unaware of the precedent set and precedents reviewed in Washington vs Glucksberg (1997), or Vacco vs. Quill, (1997) when that Court ruled in favor of laws from Washington and New York that served to criminalize “physician assisted suicide.”

Concerning the 1993 Planned Parenthood vs. Casey ruling to which Mr. Gostin frequently refers,

"At the heart of liberty is the right to define one's own concept of existence, of meaning, of the universe, and of the mystery of human life. Beliefs about these matters could not define the attributes of personhood were they formed under compulsion of the State." (Casey, 505 U. S., at 851.)

the Court has stated,

“[A]lthough Casey recognized that many of the rights and liberties protected by the Due Process Clause sound in personal autonomy, 505 U. S., at 852, it does not follow that any and all important, intimate, and personal decisions are so protected” (Washington vs. Glucksberg, 1997)

I suggest that it’s important to share at least some perceptions about reality within the Universe. Otherwise we would not be able to discern the difference between sanity and insanity, much less between ethical and unethical medical practice.

Abortion restrictions can be healthy

The last couple of weeks I've been getting ready for the American Academy of Family Physicians' Annual Scientific Assembly and the hearing of several controversial resolutions at our Academy's Congress of Delegates, held last week in Chicago, Illinois.

One of the resolutions called for the protection of "physician-patient confidentiality" by restricting the information that insurance companies could send to the homes of minor children. It seems that some doctors object to parents being involved in their children's health care, if it means that the parents will find out about "reproductive health services." In other words, parents should pay for, but not know that they are paying for, their child's birth control, treatment for STD's and, I suppose, abortion.

Another resolution called for "the repeal of the Hyde amendment," the rider that Congress has passed each year since 1976 to restrict federal funds from being used to pay for abortions except in cases of rape, incest and life of the mother. In other words, a few family docs are convinced that taxpayers should pay for elective abortions - those that are actually birth control.

Fortunately neither of these resolutions was passed and neither will become part of the position statements of the AAFP. However, during the testimony in front of the Reference Committees, there we heard the usual red herring arguments of increased teen Sexually Transmitted Diseases and the threat of increased illegal abortions.

Several of us were able to stand to tell the truth about abortion and abortion restrictions, as well as parental involvement laws and their effects on the abortion rates and health of minors.

Last month, LifeEthics posted a brief review of an article in the Journal of Law, Economics, and Organization Advance Access published online by Jonathan Klick and Thomas Stratmann on September 4, 2007 entitled, "Abortion Access and Risky Sex Among Teens: Parental Involvement Laws and Sexually Transmitted Diseases."

The statistics show that state parental notification laws result in lower STD rates for teens in those states. The article also reviews some of what we know about laws that restrict abortion and their effects on health, pregnancy rates and abortion rates.

However, it is possible that passage of parental involvement laws will affect the incentives teenagers face, inducing them to engage in less risky sex which would decrease the demand for abortion without increasing the incidence of teen motherhood. That is, if teens implicitly view abortion as a form of birth control, increasing the psychic costs of obtaining an abortion through parental involvement laws may induce teens to substitute toward other forms of birth control such as condoms, birth control pills, or abstaining from sex altogether. For this substitution effect to occur, however, teens must be forward looking in their decision-making process regarding their sexual activities, and parental involvement must represent a nontrivial increase in the total cost faced by a teen when obtaining an abortion.
We examine the effect of parental involvement laws on the decision to engage in risky sex using Centers for Disease Control (CDC) data on the incidence of gonorrhea among teenage girls. Using gonorrhea rates among adult women to control for contemporaneous variation in unobservable characteristics of the state population, we find that parental involvement laws reduce teen gonorrhea rates by 20% for Hispanics and 12% for white teens. The effects are smaller and not statistically significant for young black women.
The results are robust to a wide range of empirical specifications. These results suggest that parental involvement laws reduce risky sexual behavior among teens as predicted by a model in which teens consider costs and benefits when deciding to engage in sexual activities.

When abortion was legal in a few states, those states had higher STD rates than the national average. When Roe v Wade made abortion legal in all states, the STD rates went up all over, to match those found earlier in the states with legal abortion on demand:

Klick and Stratmann (2003) attempt to avoid the data problem illegal abortions represent in examining pregnancy rates by focusing on the incidence of sexually transmitted diseases (STDs) as a proxy for the incidence of risky sex (Klick 2004). That is, since more sex in the aggregate and the substitution toward sex without a condom will both lead to an increase in STDs, increasing abortion access will lead to an increase in STD incidence if individuals are forward looking in their decision to engage in risky sex. Klick and Stratmann (2003)examine the ‘‘double experiment’’ provided by US abortion policy to examine this link. They find that when Alaska, California, Hawaii, New York, and Washington legalized abortion on demand in the period 1969–1970, the gonorrhea and syphilis rates in those states rose significantlycompared to the rest of the country. When the Supreme Court legalized abortion on demand nationwide in 1973, the STD gap between the early legalizers and other states disappeared.

We also know that parental notification laws decrease not only abortion rates for minors, but pregnancy rates as well.

Interestingly, in a more recent article examining the experience of Texas whose parental notification law went into effect in 2000, Joyce et al.(2006) find a significant effect on the abortion rates of those women covered by the law relative to 18-year-old women.

There's also evidence that restricting funding for legal abortion does not increase illegal abortions. When the Hyde Amendment was first passed in 1976 to forbid federal funding of abortion, abortion rates went down but there were no increased rates of illegal abortion. The results of State restrictions on abortion funding were reviewed in the CDC's Mortality and Morbidity Weekly in June, 1980 (no link available):

The present study in Texas found more than one-third of the legal abortions expected among Medicaid-eligible women were not obtained in the postfunding restriction period. The data cited from the present study are consistent with those from a previous investigation in Texas, which found approximately 40% of the expected number of subsidized abortions were not being obtained in the interval after the funding restriction . .. In Texas, pregnant, low-income women who do not have federal or state funds for abortions do not appear to be resorting to illegal abortions to terminate unwanted pregnancies . . . These findings are consistent with those from a national monitoring system, which also could not document that the restriction of public funds for abortion caused
a large percentage of Medicaid-eligible women to choose elf-induced or non-physician-induced abortions.

It's important for each of us to become aware and involved in the making of public policy as much as we are able. We can save the lives of our children of tomorrow and improve the health of our children, today.

Democrats for Life (yes, they exist - barely)

Joe Carter at the blog, Evangelical Outpost, reviews a new book (Democrats for Life: Pro-Life Politics and the Silenced Majority by Kristen Day)about the Democrats for Life, which covers how the Democrats became the Party of the Abortion Rights Movement.

The true difference between Republicans and Democrats is best demonstrated by taking a look at the Democrats for Life of America website. Take a look at the "90/10" initiative (pdf brochure, here) which focuses on government spending plans to decrease abortion and the Position Statements, which emphasize the "secular" nature of the US government, as well as feminism and humanism.

Catholic Bishops to Allow Plan B in Emergencies

Can anyone be forced to act against his conscience? Do religious convictions have any weight in the law? How far can the courts go to make a person do an act that he believes is unethical or immoral?

I hope these questions are not ignored due to the sensationalism that surrounds emergency contraception.

The Catholic Bishops of Connecticut have decided to allow the doctors in Emergency Rooms at the Catholic hospitals in their State to prescribe Plan B for rape victims. (More here.) The courts had ruled that the hospitals would be required to follow state law mandating that all emergency rooms prescribe the pills, even those belonging to religious organizations which object to contraception and abortion.

The law requiring all hospitals to prescribe Plan B to rape victims, which passed in June and takes effect Monday, does not allow for an ovulation test. Instead, it requires a pregnancy test.

Barry Feldman, a spokesman for the Connecticut Catholic Conference, said that since the bill passed, the bishops have questioned the feasibility of the original policy because of "further revelation by them about the state of existing science and the lack of definitive teaching by the church and the fact that there are many who are affiliated with the church that believe the ovulation test isn't necessary."

Feldman said the bishops' decision to allow Plan B to be used for all rape victims in the hospitals does not mean that the bishops' personal beliefs have changed. Also, they still believe the law is seriously flawed and should be changed to allow an ovulation test.

In June, Bridgeport Bishop William E. Lori said the new law violated religious liberties and suggested that politicians might force Catholic hospitals to perform abortions or euthanasia.

Sen. Jonathan Harris, D-West Hartford, who worked to negotiate a compromise bill with the church, said lawmakers have no interest in taking such steps.

"Our efforts had only one goal, to protect the victims of rape," he said. "There was no other agenda. It was started to just do that."

Rape crisis counselors in Connecticut said there have been unclear and inconsistent policies for supplying Plan B to victims who seek treatment in emergency rooms across the state, including some in nonreligious hospitals.

According to Connecticut Sexual Assault Crisis Services Inc., 40 percent of rape victims were not offered or did not receive the full dose of emergency contraception at the hospitals where they were treated during the first half of 2006.

Plan B, a package of pills containing levonorgestril, a progesterone, is also called "the morning after pill."

My review, "Plan B, How It Works and Doesn't Work," with links to reliable information and research papers, is here.

It appears that the bishops aren't just caving in to legal pressure, but were convinced that the pill works, when it works, by delaying ovulation or keeping the sperm from getting to the oocyte. There is quite a bit of evidence that this is true and none (from some pretty good studies in animals and ovulating women) that the Plan B formulation prevents implantation or causes an implanted embryo to be aborted.

The biggest problem now is that the courts in Connecticut dared to over-rule a religious principle and conscience issue in the first place. At what point can the state f