Mirror of Justice

A blog dedicated to the development of Catholic legal theory.
Affiliated with the Program on Church, State & Society at Notre Dame Law School.

Saturday, June 29, 2013

Conscience and Its Enemies

The Protection of Conscience Foundation has posted a substantial chunk of the title chapter of my new book, Conscience and Its Enemies, here:  http://www.consciencelaws.org/ethics/ethics079-010.aspx.  The chapter zeroes in on a report issued by the Ethics Committee of the American College of Obstetrics and Gynecology entitled "The Limits of Conscientious Refusal in Reproductive Medicine."

Conscience and Its Enemies (the book) is available here:  http://www.barnesandnoble.com/s?store=allproducts&keyword=Conscience+and+its+enemies

Some excerpts from the PCF excerpt:

I found the ACOG Ethics Committee 's opinion shocking and,  indeed, frightening. One problem was its lack of regard - bordering on contempt , really - for the sincere claims of conscience of Catholic, Evangelical Protestant , Orthodox Jewish , and other pro-life physicians and health-care workers. But beyond that, it treated feticide - the deliberate destruction of a child in the womb - as if it were a matter of health care, rather than what it typically is: namely, a decision based on nonmedical considerations (such as whether a woman or her husband or boyfriend happens to want a child). On the understanding of medicine implicit in the report, the ends of medicine are fundamentally not about the preservation and restoration of health considered as an objective reality and human good but rath er concern satisfying the personal preferences or lifestyle desires of people who come to physicians requesting surgeries or other services, irrespective of whether these services are in any meaningful sense medically indicated. . . .

The report goes on to "outline options for public policy" and propose "recommendations that maximize accommodation of the individual's religious and moral beliefs while avoiding imposition of these beliefs on others or interfering with the safe, timely, and financially feasible access to reproductive health care that all women deserve." Yet again notice that every concept in play here - the putative balancing, the judgment as to what constitutes an "imposition" of personal beliefs on others, the view of what constitutes health care or reproductive health care, the judgment about what is deserved - is philosophical, not scientific or, strictly speaking, medical.

To the extent that they are "medical" judgments even loosely speaking, they reflect a concept of medicine informed, structured, and shaped by philosophical and ethical judgments - bad ones, by the way, such as the implicit judgment that pregnancy, when unwanted, is in effect a disease.

Those responsible for the report purport to be speaking as physicians and medical professionals. The report's supposed authority derives from their standing and expertise as physicians and medical professionals, yet at every point that matters, the judgments offered reflect their philosophical, ethical, and political judgments, not any expertise they have by virtue of their training and experience in science and medicine. . . .

The report, in other words, in its driving assumptions, reasoning, and conclusions, is not morally neutral. It represents a partisan position among the possible positions debated by people of goodwill in the medical profession and in society generally. For me, the partisanship of the report is its most striking feature. It represents a sheer power play on behalf of pro-abortion individuals who happen to have acquired power in their professional association. This is not about medicine. It is about ideology. It is about politics and political power.

If the committee's advice were followed, this medical field would be cleansed of pro-life physicians whose convictions required them to refrain from performing or referring for abortions. Faithful Catholics, Evangelicals and other Protestants, and many observant Jews and Muslims would be excluded from or forced out of obstetrics and gynecology. The entire field would be composed of people who agreed with, or at a minimum went along with, the moral and political convictions of the report's authors.

So, in truth, who in this debate is guilty of intolerance? Who is trampling on freedom? Who is imposing values on others? These questions, too, answer themselves.

It won't do to say that what the committee seeks to impose on dissenters is not a morality but merely good medical practice, for it is not science or medicine that is shaping the report's understanding of what counts as good medical practice. It is, rather, a moral opinion doing the shaping. The opinion that abortion is good medicine is a philosophical, ethical, and political opinion; it is a judgment brought to medicine, not a judgment derived from it. It reflects a view that abortion is morally legitimate and no violation of the rights of the child who is killed. It also reflects the view that medicine is rightly concerned with facilitating people's lifestyle choices even when they are neither sick nor in danger of being injured, and even when the "medical" procedure involves the taking of innocent human life. . . . 

The report's constant use of the language of"health" and "reproductive health" in describing or referring to the key issues giving rise to conflicts of conscience is at best question begging. No, that's too kind. The report's use of this language amounts to a form of rhetorical manipulation. The question at issue in abortion is not "reproductive health" or health of any kind, precisely because direct abortions are not procedures designed to make sick people healthy or to protect them against disease or injury. Pregnancy is not a disease. The goal of direct abortions is to cause the death of a child because a woman believes that her life will be better without the child's existing than it would be with the child's existing. In itself, a direct (or elective) abortion - deliberately bringing about the death of a child in utero - does nothing to advance maternal health (though sometimes the death of the child is an unavoidable side effect of a procedure, such as the removal of a cancerous womb, that is designed to combat a grave threat to the mother's health). That's why it is wrong to depict elective abortion as health care.


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