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.

Wesley Smith on Toronto Conference on End of Life

Wesley's report is at his blog, Secondhand Smoke.

The medical interventional suicide or "Physician Assisted Suicide" (PAS) offers a false sense of control to people who are actually the healthiest of the patients who know that they are nearing the end of life.

It's false because before legal medical regulations can be used to "help" terminal patients to control the "time and manner of their death," the laws are actually being sold to voters who aren't sick, who are encouraged to think "there but for the grace of God, go I." Instead of giving dignity to patients in pain, talking about the indignity of having others care for our bodies and the horrors of uncontrollable pain increases the revulsion toward physical weakness and dependency.

Mr. Smith says that in Toronto ( as at the Houston Holocaust Museum last month), he focused the bulk of his talk on "Futile Care Theory."

Calling all cases of withdrawal of care "Futile Care Theory" and eugenics is also false. It denies any acknowledgment that doctors act on their conscience. By denying that doctors and medical ethics committees -a group of peers and lay people, clergy, and ethicists - can be acting in good conscience, even when it goes against the wishes of surrogates and families condemns us all. If we can't trust these people, how can we trust a judge or a jury to act in good conscience?

I hope everyone reads what Wesley says about another speaker, Ms. Frazee:

She told the audience that there are two general veins of opposition to assisted suicide; political and spiritual, with people in each camp disagreeing with each other on other issues. She suggested that the best way to work together would be to develop a philosophical approach that would include all and permit people to also pursue other agendas when not working against assisted suicide.

Too often, the only common ground is the hatred of the control that doctors seem to have. Suicide proponents and "futile care" activists declare doctors the bad guys who diagnose and couldn't cure, who bring the bad news of unavoidable death and who won't "do everything."

As I reported after Wesley spoke at the Houston Holocaust Museum, the risk is to squeeze doctors between two extremes.

I suggest that the doctrine of double effect can help us make the distinction. Doctors may not act with the intended result of death, but we know that some of our actions may cause death, unintentionally. In all cases, the intention and the act must be ethical, but sometimes - as when we poison the body with chemotherapy or radiation to fight cancers - only medical knowledge and experience can inform our conscience.

Laws and the legal process are a poor substitute for medical ethics and will result in the death of those same ethics.

The logical result is an end to all laws protecting the conscience of doctors, pharmacists, and nurses, in favor of laws leading to court and cookbook algorithms. The practice of medicine won't be a profession - much less a calling - with peer review, judgment and conscientious men and women. It will be a job done by people capable of following orders, even when it goes against their best medical and moral judgment.

Who will you trust? Lawyers and judges like Blackmun and Greer? Juries who live in a society that forces medical professionals to act in a way they believe is wrong? Legislatures and referendums that give us Oregon's assisted suicide? Or doctors and pharmacists who are prescribing and dispensing the potassium, heart stimulants or blood pressure control in the IV, adjusting the ventilator, dialysis machine and the dosage of pain meds under the watchful eye of nurses and the rest of their community?

Some Bloggers shouldn't reproduce

They shouldn't reproduce their thoughts in writing, that is.

Take a look at the comments on "Laws, conscience, medicine and bloggers," for a perfect example of "they just don't get it."

Freedom of conscience is part of the Washington State law. The Governor threatened to replace the members of the State Pharmacy Board if they voted against an invalid law. The pharmacists do not have to dispense over the counter medications.

All sorts of red herrings have been raised to defend the law, including accusations that someone might refuse to prescribe medicines for HIV patients and insulin for diabetics.

This is also a good example of my editorial style. You would be shocked by some of the answers I've typed and erased.

Watson un - reasonable

Dr. James Watson, the man who is credited with discovering the structure of DNA, along with Francis Crick and Rosalin Franklin, has lost his laboratory and much of his status as a respected science icon after allegedly making racist remarks.

From the Times Online (London, UK):

In his interview Watson had said that he was “gloomy about the prospects for Africa” because “all our social policies are based on the fact that their intelligence is the same as ours — whereas all the testing says not really”.

He also said he opposed discrimination and that he hoped all races could be equal, but added: “People who have to deal with black employees find this not true.”

Last month, Dr. Watson spoke at the opening to the "Medical Ethics and the Holocaust: How Healing Becomes Killing: Eugenics, Euthanasia and Extermination" series of lectures co-sponsored by the University of Houston and the Houston Holocaust Museum. (Earlier posts on the series here

At that event, Dr. Watson was one of three Nobel laureates (along with Eric Kandel, MD and Feric Murad, MD, PhD) who spoke on the history and - at least in my opinion - of eugenics, including the sad history of eugenics studies in the early part of the 20th century at Cold Spring Harbor Laboratory.

Dr. Watson opened by telling us that he does not believe that the traits and abilities of people are completely genetic. He believes that his values for life were taught to him by his parents, who taught him to make his decisions based on reason, with "nothing from revelation. They also taught him the value of honesty, kindness, and involvement.

The doctor appeared to fall asleep a couple of times during the Houston presentation. He went out of his way to note that he came before us with "No religious feeling whatsoever." (I believe that he had an assumption that the people in the audience were interested in religion.) He also said that if you are better than than others, you'd better be perceived as helping others, and implied that the Jews killed by the Nazi's in Germany were marked and hated because they were more intelligent and successful than other Germans.

We learned that he had declined information about his genome that would tell us whether or not he carried the genes for a familial type of dementia. He stated that he believed that the study of the genome would improve psychiatry, which he said is still at the level that it was in Nazi Germany.

One of the most truthful statements he made is that "Since I won the Nobel Peace Prize I am heard."

Jesus, embryos, research, and IVF protesters

Newsday printed an op ed by Michael D. Kerlin, "Where faith and stem cells meet: Jesus might have us use embryos - otherwise destined to be discarded - to aid the sick and dying." (That's pretty much it, except to testify to his Christianity, his alma mater, and to lay the fate of all sick and dying at the feet of President George Bush.)

As I commented at the site, Jesus taught that "self" belongs in front of "sacrifice."

The other posters and Mr. Kerlin do not seem aware of the facts about the numbers of embryos that would actually be available for research.

And a couple of the posters are horrified that I set the responsibility for ensuring the safety of the embryonic humans on the parents and the labs who created humans in harm's way. They ask whether I would forbid in vitro fertilization (IVF) and tell men and women who are unable to have children by natural intercourse, "tough luck." One poster doubts my sincerity, since there are so few picketers and protesters outside of IVF facilities. He questions whether the protests are only hypocritical abuse and harassment of poor single women, rather than rich couples seeking IVF.

There was a RAND study on the numbers of embryos available for research (Hoffman DI, Zellman GL, Fair CC, Mayer JF, Zeitz, JG, Gibbons WE, and Turner TG. May 2003. "Cryopreserved Embryos in the United States and Their Availability for Research." Fertility and Sterility 79 (5): 1063–1069.)and Art Caplan published one a few years ago, and he was surprised at how few parents would even consider research and how reluctant they and the clinics were to simply destroy the "excess" embryos. In addition, for those currently frozen, it's unlikely that the proper informed consent.

Yes, there are few protesters at IVF clinics, because most people have empathy for the parents who want children so much that they would go through all that IVF requires. Also, most people simply aren't aware of how many embryos are discarded.

However two wrongs don't make a right. Again, "self" should always precede "sacrifice."

It was our empathy that created the current situation, where the brothers and sisters of those babies who are now in the arms of the parents who wanted them so much died during the IVF process and more are frozen and at risk. We must steel ourselves to resist the temptation to help "the sick and dying," everyone from celebrities to tiny children who beg us and our legislators to sacrifice human embryos for their sake.

Who is to decide that some humans may be destroyed and dissected for research or so many spare parts for the benefit of someone else?

Because we know that embryonic stem cell research leads to a slippery slope. We know because some men and women have already fallen down that slope.


I'm sure that most of us have read about the women paid to become pregnant and have abortions for research and profit in the Ukraine and about all the full term healthy babies who mysteriously die in some of that country's hospitals. At one of these hospitals, graves of infants who had had brains and other organs have been found.(More here and here. Warning - graphic descriptions)

Debate On Ethics

After several days of discussion about a baby that Texas lawyer Jerri Ward asked Wesley Smith to blog about on Secondhand Smoke, I have been asked "How can you be a doctor and not know this about what passes for ethics nowadays?"

Because I have a different understanding "about what passes for ethics nowadays."

I do not agree that euthanasia is practiced in Texas medicine or that utilitarian arguments prevail in medical ethics, especially in Texas. I am a pro-life family doctor who has been studying and practicing medicine, and now, bioethics in Texas. My activism and biggest motivator has been focused on the manipulation and dehumanizing of humans at the beginning of life, because of the advocacy for abortion and destructive embryonic research. I am repeatedly reassured that our Texas physicians do not support euthanasia at the end of life by what I know of them and by what I witness at our medical association meetings and at the meetings where we have been debating the amendment of the Texas Advance Directive Act.

I know what is said in the literature, in the media, in the blogs, and what is said between doctors. I've experienced being the patient, the daughter, wife and mother of a patient, and the doctor in some tough ethical situations.

The elite "ethicists" across the world voice and publish all sorts of utilitarian ideas, including the feminist bioethicists at the American Society of Bioethics and Humanities who discounted conscience as a legitimate guide for physician's actions. I oppose this sort of "ethics" every chance I get.

However, the doctors in Texas do not advocate or encourage such drivel. The very rare doc who is unwise enough to voice the opinion that some lives are not worth living is immediately countered and out-numbered and out-reasoned by his or her professional and compassionate colleagues.

In contrast to my own experiences and education, in the one-sided reports on the blogs and in the media, I hear a story that never quite fits what I know about medical facts, much less about the way I see practical clinical ethics being practiced and taught in Texas. Unlike the other posters at Secondhand Smoke, it is not at all "obvious" to me what happened in this case.

Concerning the bit we know about the case in question, it's not at all "obvious" to me that any pediatrician would have argued to an ethics committee that there are not enough resources to go around or that a child would be better off dead than to have a safe tracheostomy and feeding tube placement in order to continue the current level of technology and in anticipation of transfer to the proper step down care.

On the other hand, if, as I suspected, there had been concerns about imminent death or about a crisis due to the mitochondrial defect flaring after stress of surgery, then it would have been appropriate to object to treatment that could hasten death while causing pain and (surgically) separating the child from her/his mother.

I spent several hours over the last two days watching and listening to the hearings last August 9 on the TADA. I couldn't attend them because my mother was in the hospital - she died August 14. I was reassured by the testimony of the doctors and hospital representatives.

As I said, part of what the lawyer who reported this case experiences is most likely ("obviously") the result of her previously publicized comments in the media that doctors and hospitals kill patients and bury their mistakes.

Language change alert ("Embryonic" at 8 weeks)

We were due, I guess. We went through the redefinition of pregnancy (implanted in a uterus"), embryo (after 14 days or implanted in a uterus), cloning (therapeutic cloning, then somatic cell nuclear transplantation, nuclear transplantation, patient specific stem cells, production of "early stem cells, etc.)

And now, we're supposed to move the line of "embryonic" to eight weeks of gestation.

And we should just forget all the past promises about "14 days," implantation, along with our objections to killing the youngest of our children.

Some of us have warned that embryonic stem cell research, with it's high risk of teratomas - tumors that (to paraphrase a popular slogan) "contain all the cell lines in the body," would lead to further maturation of human embryos into the fetal stage of development. Since the goal is usable tissues and stem cells, it made sense to us that researchers will eventually get around to demanding for funding to grow the embryos in human or surrogate wombs in order to "save lives," and further their grant requests.

There have been previous examples (I'm on my way to a meeting, so the references will have to wait 'till tonight) in production of "embryonic" nerve tissues being used to treat a few children with neurological metabolic diseases. In fact, the "embryonic" tissues used to harvest these cells must come from children who are aborted at 7 to 9 weeks, technically fetuses, not embryos.

Further evidence of the possible direction of stem cell research - if we allow it - comes to us this week, from the online journal, PLOS-Medicine.

Here's the press release that showed up in my Google alerts file, from Eureka News Alerts, "Human stem cell transplants mature into neurons and make contacts in rat spinal cord.":

Human stem cell transplants mature into neurons and make contacts in rat spinal cord

Human nerve stem cells transplanted into rats' damaged spinal cords have survived, grown and in some cases connected with the rats' own spinal cord cells in a Johns Hopkins laboratory, overturning the long-held notion that spinal cords won't allow nerve repair.

A report on the experiments will be published online this week at PLoS Medicine and "establishes a new doctrine for regenerative neuroscience," says Vassilis Koliatsos, M.D., associate professor of neuropathology at Johns Hopkins. "The spinal cord, a part of the nervous system that is thought of as incapable of repairing itself, can support the development of transplanted cells," he added.

"We don't yet know whether the connections we've seen can transmit nerve signals to the degree that a rat could be made to walk again," says Koliatsos, "We're still in the proof of concept stage, but we're making progress and we're encouraged."

In their experiments, the scientists gave anesthetized rats a range of spinal cord injuries to lesion or kill motor neurons or performed sham surgeries. They varied experimental conditions to see if the presence or absence of spinal cord lesions had an effect on the survival and maturation of human stem cell grafts. Two weeks after lesion or sham surgery, they injected human neural stem cells into the left side of each rat's spinal cord.

After six months, the team found more than three times the number of human cells than they injected in the damaged cords, meaning the transplanted cells not only survived but divided at least twice to form more cells. Moreover, says Koliatsos, the cells not only grew in the area around the original injection, but also migrated over a much larger spinal cord territory.

Three months after injection, the researchers found evidence that some of the transplanted cells developed into support cells rather than nerve cells, while the majority became mature nerve cells. High-powered microscopic examination showed that these nerve cells appear to have made contacts with the rat's own spinal cord cells.

###

The research was funded by the National Institute of Neurological Disorders and Stroke, the Muscular Dystrophy Association and the Robert Packard Center for ALS Research at Johns Hopkins.

Authors on the paper are Jun Yan, Leyan Xu, Annie M. Welsh, Glen Hatfield and Koliatsos, all of Hopkins, and Thomas Hazel and Karl Johe of Neuralstem of Rockville, Md.

On the Web:

http://neuroscience.jhu.edu/VassilisKoliatsos.php
http://www.plosmedicine.org
http://pathology2.jhu.edu/disease/home_files/page0003.htm

There is nothing alarming - and quite a bit that's encouraging - in that press release. However, reading the actual published articles leads to the discovery that the stem cells in question come from human fetuses. I'm afraid that I don't know of any way to harvest neural stem cells from human fetuses without harming those unborn children.
Here's the first article, "Extensive Neuronal Differentiation of Human Neural Stem Cell Grafts in Adult Rat Spinal Cord."

And the second, which explains where we are going:"Making Human Neurons from Stem Cells after Spinal Cord Injury"

Spinal cord cells were obtained from cervical and upper thoracic spinal cord of an eight-week-old human embryo and expanded in monolayer culture in defined medium with the mitogen FGF2 (a member of the fibroblast growth factor family).

(Emphasis mine)

In the future, perhaps fetal neural stem cells can be developed from cells harvested from placentas collected after the birth of children or as a by-product of amniotic fluid tests done for medical indications and then used as we use other cellular and tissue transplants of adult stem cells and specialized tissues.

Perhaps Dr. Atala and his research group could follow this line.

However, I expect to see a call for more money for fetal stem cell research and for a demand for an expansion of the time that human "extracorporeal" embryos can be maintained.

And won't it be interesting to see how these nascent human beings are grown to eight weeks or so?

Publish (destroy embryos) or perish

Professor James L. Sherley is losing weight on his hunger strike, but Fox News and Reuters are the only mainstream media outlets to take notice. It seems that racial discrimination, storming the Administration building of a university and even extreme measures of weight loss are not newsworthy if you're critical of embryonic stem cell research and cloning.

It doesn't matter that Dr. Sherley reported a break-through on the secret to inducing adult stem cells to divide and how and why these cells can form cancers (here and here). It is of no consequence whatever that he won an award from the NIH, and millions of dollars in research money to go with it. Unfortunately, he also criticized embryonic destruction and cloning in public, with letters to the editors in Science, Nature, and The Boston Globe.


Dr. Sherley has shown rare conscience and integrity by confronting and exposing the bias and prejudice within academia encountered by those who believe that human beings should not be killed in experiments, and most certainly should not be created for the purpose of killing.

He has been a vocal critic - albeit one who is rarely quoted in the media - of embryonic stem cell research, creating embryos for the purpose of killing for research, and of cloning in order to obtain embryos for research and killing in research.

He is using the tools - the legitimate, legal and ethical tools using current law and endangering no one other than himself - that have been provided by the law, the media and his own intellectual and moral adversaries. But, don't expect to see his story in the National news.

In the United States, the law protects those discriminated against because of their race and Dr. Sherley has charged that he is a victim of racial discrimination at the Massachusetts Institute of Technology. According to this article (from a conservative news service begun by Brent Bozell - one of the very few reporting at all on the story) points out that Dr. Sherley is "he first and only black faculty member of MIT's Division of Biological Engineering, and he was awarded a $2.5 million research grant last year from the National Institutes of Health." Colleagues support the conflict of interest demonstrated by the choice of the lead tenure reviewer - who is married to someone who was a prior critic of Dr. Sherley:
From the Boston Globe,

Some MIT professors are circulating a letter that asks for further investigation into the process that denied Sherley tenure. The letter states that a head of Sherley's department is married to a senior faculty member whose relationship with Sherley has been "openly contentious." That division head should have recused himself from deciding Sherley's case, rather than soliciting an internal letter from his wife to include in Sherley's tenure file, the letter said.

"We checked to see whether that influenced the decision, and we are confident that it did not," Clay said.

Of 740 tenured faculty members at MIT, 27 are African-American or Hispanic. Three minority faculty members have earned tenure since Sherley was denied, according to the school.

The mainstream media have not given Dr. Sherley the same publicity that they would if he would just advocate for the killing of a few embryos. Even his hunger strike is not very successful at gaining national attention.

Could it be that no one at UPI, any of the big 3 television networks, Time, Newsweek, or CNN cares about racial discrimination at MIT? There's nothing from any of these as of this morning - not one little note - according to my Google News search at about 7:30 AM CST.


Or could it be that no one cares about the discrimination against a man who has had a letter published in Nature criticizing embryonic stem cell research?

Majority of Doctors Oppose Abortion

In that NEJM article that I blogged on earlier, there are numbers about the "Intrinsic religiosity" of physicians, based on the answers of the 1000 or so docs who answered the questionaire.

The authors seem to have no feeling for the history of bioethics as an outcome of the Holocaust or Tuskegee. Instead, the fuss and bother is over docs refusing to follow through on legal killing. (Okay, I will admit that the authors might be trying to avoid in their analysis what they seem to see as a problem: "for the doctor to describe that objection to the patient." Heaven forbid -oops- that anyone name "wrong," wrong!)

27% of responders measured moderate and 36% were high on the "Intrinsic Religiosity" scale:

"We also assessed physicians' intrinsic religiosity and religious affiliations. Intrinsic religiosity — the extent to which a person embraces his or her religion as the "master motive" that guides and gives meaning to his or her life (12) — was measured on the basis of agreement or disagreement with two statements: "I try hard to carry my religious beliefs over into all my other dealings in life" and "My whole approach to life is based on my religion." Both statements are derived from Hoge's Intrinsic Religious Motivation Scale13 and have been validated extensively in previous research.(13,14,15) Intrinsic religiosity was categorized as being low if physicians disagreed with both statements, moderate if they agreed with one but not the other, and high if they agreed with both."

10% of the docs said they had no religious affiliation, while 18% identified as Protestant, 22% as Catholic, 16% as Jewish, and 14% as "other." The surveyors defined other as "a category that included Buddhist, Hindu, Mormon, Muslim, Eastern Orthodox, and other."

52% of the docs object to abortion for failed contraception, by the way and 46% object to providing contraception to children 14 - 16 years old when their parents object.

Oddly, the authors cite a lack of consensus about these matters of conscience, and don't seem to question the moral rightness of any of the practices, only to the fact that a some few docs might actually follow through on their beliefs.

And watch out, docs! The authors suggest a need to actually observe your reaction when patients ask for abortions.

Bad, Bad Doctors (Religious, with Consciences)

The NEJM has a free on line article evaluating the results of a survey of doctors, "Religion, Conscience and Controversial Clinical Practices," which is a perfect example that far too much of the effort of "medical ethics" or "bioethics," goes into deciding who can be killed.

"In recent years, several states have passed laws that shield physicians and other health care providers from adverse consequences for refusing to participate in medical services that would violate their consciences. For example, the Illinois Health Care Right of Conscience Act protects a health care provider from all liability or discrimination that might result as a consequence of "his or her refusal to perform, assist, counsel, suggest, recommend, refer or participate in any way in any particular form of health care service which is contrary to the conscience of such physician or health care personnel." In the wake of recent controversies over emergency contraception, editorials in leading clinical journals have criticized these "conscience clauses" and challenged the idea that physicians may deny legally and medically permitted medical interventions, particularly if their objections are personal and religious. Charo, for example, suggests that the conflict about conscience clauses "represents the latest struggle with regard to religion in America," and she criticizes those medical professionals who would claim "an unfettered right to personal autonomy while holding monopolistic control over a public good." Savulescu takes a stronger stance, arguing that "a doctor's conscience has little place in the delivery of modern medical care" and that "if people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors.""

"If physicians' ideas translate into their practices, then 14% of patients — more than 40 million Americans — may be cared for by physicians who do not believe they are obligated to disclose information about medically available treatments they consider objectionable. In addition, 29% of patients — or nearly 100 million Americans — may be cared for by physicians who do not believe they have an obligation to refer the patient to another provider for such treatments. The proportion of physicians who object to certain treatments is substantial. For example, 52% of the physicians in this study reported objections to abortion for failed contraception, and 42% reported objections to contraception for adolescents without parental consent."

Not surprisingly, these "controversial" "legal" practices are abortion "for failed contraception," giving "birth control to teenagers between the age of 14 and 16 if their parents do not approve," and "sedation to unconsciousness in dying patients." For some reason, the authors do not give results or even discuss the other "Controversial Issues in Medicine": Physician assisted suicide, withdrawal of artificial life support or abortion for congenital anomalies.



First, "elective" abortion is neither mandatory nor beneficial.

Second, I guess that the first discussion must be whether or not "legal" implies that a practice is necessarily "beneficial," moral, or required.

Third, the legality of providing contraceptives to minors under the age of consent, against their parents' wishes, is questionable, except in Federally funded clinics, where it is mandated under Title X funding for Family Planning clinics.

Fourth, it is illegal in most states to participate in "Physician Assisted Suicide."

And fifth, the "monopolistic control" is distraction. Are all professionals who are licensed by the government required to do whatever is demanded of them by whomever can use their services? Let's see: architects, engineers, all those media types?

If so, I'd like to ask Alta Charo - who, after all is a licensed lawyer, working for a State University that receives Federal funds - to give me some good, solid quotes that do not advocate the taking of human life or the defamation of those of us who act on our convictions.





Take a look at the survey and the article. Take the survey.

Do you agree with the "bioethicists" quoted in the introduction?

Feminists For Life op-ed on National Review Online

Serrin Foster, whose latest essay is published on National Review Online, is one couragious woman. She is the President of Feminists for Life, which some people are absolutely convinced is an oxymoron.

No, it's not. At the least, half of all the human beings that are killed by abortion are female. In some of the world, many, many more of the abortions are for "sex selection" - meaning they're culling the culturally less desirable girls.

And then there are the women who, like me are convinced that women should not be pushed to "choose" as the mother of "Sophies' Choice" did: between their children (the child you're carrying now and the children of the future) or between their children and their lives, their education or their jobs. Or between being fully women (who do get pregnant and bear children, by nature) or more like the men.

Between someone else's definition of success and failure.

Ms. Foster writes about the pressures placed on college girls to abort - the only "choice" offered on too many campuses seems to be what kind of abortion to have.

(Edited above - to correct some spelling - including Ms. Foster's name and her title. See the February 2 post for more on Feminists for Life.)

Take a look at the next post on Feminists for Life History.

Universal screening of pregnancies - guidelines

In medicine, a guideline published by a specialty association is more than a "suggestion." If a doctor varies from that guideline, he or she is presumed guilty of varying from the standard of care. And had better find a defense lawyer, because there's a good chance she'll be sued for malpractice or, in the case of the new American College of Obstetricians and Gynecologists (ACOG) guidelines, for "wrongful life."

The consequences of routine general screening of women for Down's syndrome will mean that more women will be faced with more false positives. More doctors will be placed in the position of having to inform a woman of her "choice" to abort her baby. Many will stop doing OB. The cost of medical care and obstetric care in particular will go up in the US.

And an entire group of children will disappear.

What will be the target of the next "screening" guidelines? The "gay" gene? Asberger's?> Cystic Fibrosis?
How about Sickle Cell disease, or just the trait?

How about the many genetic abnormalities that show up, but which are not yet associated with any specific disease?

And where will all of the genetic counselors come from? And who will pay for their services?

What else are we wiping out that we don't know about, by removing these children from the gene pool?


For more on the subject, read Patricia A Bauer's editorial in the New York Times, and Nigel Cameron's comments. Or read Dr. Shari DeSilva's note from last year and my comments on this blog.

Babies on "spec"

Jennalee Ryan, in San Antonio, Texas, is offering pre-frozen embryos to momas and daddies who like the selection in the Abraham Center for Life catalog.

In the terms used for new homes, she's not building custom babies or even semi-custom babies, she's offering "spec" babies. If the babies were dresses, these might be called "designer babies," but we're getting close to "off the rack," as noted by Washington Post reporter, Rob Stein, at the link above. If we were at a restaurant, we'd be restricted to the menu, with no a la carte or "on the side" requests! The "product" is sitting there in the freezer, not being made to order.

BTW, Mr. Stein quotes an ethicist from the University of Texas at Austin,

"I know some people say: 'This is shocking. Embryos made to order,' " said John Robertson of the University of Texas at Austin, who advises fertility specialists on ethical issues. "But if you step back a little bit, you realize that people are already choosing sperm and egg donors in separate transactions. Combining them doesn't pose any new major ethical problems."

Mr. Robertson makes sense, and he is technically correct. There is no difference between selecting a sperm donor or oocyte donor for artificial insemination or in vitro fertilization, as has been done for years. Except in this case, we are actually creating embryonic humans in a high risk environment, since the "good" ones are sold and/or frozen, the "failed" ones are discarded.

It should be noted, however, that Lawyer Robertson is the current chair of the Ethics Committee of the American Society of Reproductive Medicine, and hhas argued in favor of sex selection by abortion. (report available here and the transcript is here.)

ASBH day 2: Human rights and Public Health Ethics

Ever been the only conservative in the room? I can go one better: a woman from Rhode Island responded to my confession that I'm a conservative by saying that we should talk, since she'd never had a conversation with a conservative before and she wanted to understand how we think.

BTW, before I go on, I need help: I was told by one of the speakers that some proponents of human dignity defend the "dignity" of "stem cells" in the same way that they defend the dignity of "the impaired." Supposedly, in the discussion about the ethics of research on human tissue banking, some focus on the dignity of the tissue as separate from the infringement on the dignity of the original donor of the tissue. She could not give me a reference, but seems a bright young woman, so I wonder if anyone can explain where this idea could come from.


I guess I ought to explain how the conference is set up. Most of the day, there are 1 to 1 1/2 hour sessions with 5 or 6 different groups, consisting of 2 or 3 (up to 5) panelists who present a paper (or summarize a paper, if time seems short) on a given theme. The presentations are followed by a question and answer period. There's never enough time for the Q and A, so I end up asking my questions after the conference.

Today, I attended sessions on "Bioethics and Public Health Ethics" and "Human Rights and Human Dignity: Curb your enthusiasm." Each of the sessions touched on the basic idea of human rights. And each seemed to get the most bang out of political points: the Bush administration is abusive and against the bioethics Powers That Be.

In the first, we were asked to consider the proposition that Public Health Ethics should be more concerned with the good of the community, rather than attentive to individual rights. After all, public health and most health care systems are public, community enterprises, and an activity of the State that relies on pooled resources and interdependence.

However, aren't Law and the Court system activities of the State, based on pooled resources and interdependence? And aren't these systems still governed by the fact that the rights of the individual are primary?

We also heard how inept the Bush administration was proved to be in the Katrina/Rita hurricane "debacle," although the panelist later stated that the basic problem was the failure to repair the levies and protect the people in the way of the flood. Somehow, the panelists believe that all political failures in public health policy began in 2001. There was no mention about the debacle that came from the redefinition of oral sex as not being "sex," for instance.

The second session was based on the deconstruction of a single term, "human dignity," and a rather confused discussion about human rights. In both cases, the presenters seem to believe that the Bush administration is responsible for attempting to foist an idea of the inalienable rights of human individuals.

Like Caulfield and Brown in this article, the presenters object to protection of human embryos and the children of the future as bearers of human dignity because the concept is not held by all and will not stand in a pluralistic society.

An interesting twist was the first presenter's statement that the proponents of human dignity include "stem cells." (see above)

Beliefs about which members of the human species are bearers of rights are not consistent throughout the world. Islamic nations do not hold that women bear full human rights: women are not protected from killing, enslavement, and are not allowed freedom of movement or ownership of property.

However, regardless of a lack of consensus, or more particularly in the case of disagreement, hasn't history shown that it is it better to support the wider classification of human rights in the case of all races, both sexes, all religious and political backgrounds?

The fact that some of the "dignitarians" and human rightists have expressed concern about the humanity of our descendents who are no longer members of our species was mentioned. I believe that this concern will complicate our efforts to protect the (negative) right to life. Believers hold that humans are created in the image of God base our argument for human dignity on our duty to Him for giving us life. If we are created, it's obvious that we and our children are not here because of our plan and efforts, but because of His. Those of us who are concerned about whether or not our children who are not of the human species are 'human" would do well to spend some time contemplating whether or not it is possible to divide the image of God.

Edited for typos at 11:30 PM CDT