Laws defend the rights of pro-life medical professionals to refuse to perform certain procedures with which they morally disagree. But proponents of conscience rights are oddly unwilling to extend similar conscience rights to pro-choice medical professionals who believe that it's morally correct to give women autonomy over their bodies. Why is it that, legally, only anti-choice professionals are believed to have a conscience? Can't pro-choice people make moral decisions?
Recently, states like Virginia and Alabama have backed away from laws that would have required doctors to perform medically unnecessary and unsettlingly rapey transvaginal ultrasounds on many women seeking abortions. Texas, meanwhile, has just enacted one of the most extreme abortion laws in the country. According to pro-choice doctors, not only is this a violation of women's right to care, it's a violation of pro-choice medical professionals' right to provide care to patients in accordance with their own industry-established and personal ethical standards.
I spoke with Dr. Curtis Boyd, a Texas abortion doctor, about how the law is unfairly forces doctors to act as instruments of the state's anti-choice agenda. Boyd says that he and others like him find the law's requirements insulting to both women and doctors who work for reproductive choice. One provision of the new law requires doctors to give a woman seeking an abortion a list of crisis pregnancy centers 24 hours before terminating a pregnancy. These "alternative" pregnancy centers are not medically licensed, often run by churches and anti-choice groups, and work primarily to convince women to carry their pregnancy to term, regardless of her circumstances. Some women seeking abortions have reported to Boyd's staff that crisis pregnancy center employees told them they'd go to hell unless they continued their pregnancies. Texas' new abortion law also requires specific health professionals to perform specific, medically unnecessary tasks before a doctor is legally allowed to perform an abortion. The doctor, for example, must read aloud to the woman a detailed description of the abortion procedure, and describe, "in layman's terms," what is pictured on a sonogram. Boyd scoffs, "We're supposed to treat women as though they don't know that a pregnancy leads to a baby. They know what pregnancy is! That's why they're here to have an abortion. They don't want to have a baby! Women are not stupid."
All of this happens in conjunction with a strict 24-hour waiting period that requires any women living less than 100 miles from an abortion facility to make two trips in order to terminate her pregnancy. But the 100 mile rule is misleading. Boyd says that the rule requires a woman to wait 24 hours between sonogram and abortion if she lives less than 100 miles from a facility that provides any abortion services, and not necessarily the services she needs. Thus, if a woman needing a second trimester procedure resides more than 100 miles from one of the four cities in Texas that contain clinics that perform second trimester procedures but less than 100 miles from a first trimester facility, she's likely going to have to take two long trips.
Understandably, the new Texas law upsets pro-choice doctors like Boyd, who believes the 24 hour requirement in addition to the rule that dictates the same doctor provide both the sonogram and the surgical procedure puts undue burden on women seeking abortions and forces him to act in ways contrary to what he feels are best for the patient. Some states even require doctors to provide false information to their patients in literature that warns patients that abortions are very risky procedures — but neglects to mention that abortion after the first 8 weeks of pregnancy is about 10 times safer than childbirth (before 8 weeks, it's 100 times safer). There's no legal protection in place for pro-choice doctors morally uncomfortable with presenting medically misleading literature as fact.
Doctors and other medical professionals have faced even more heart-wrenching violations of their conscience at Catholic hospitals, in some cases putting women's health at risk in the name of adhering to doctrine. Federal law protects these facilities' rights to refuse to provide abortion services, but they don't protect doctors' rights to act in ways that they feel are best for their patients. The right of the institution trumps the right of the medical professional.
According to a paper by Lori Freedman published in the American Journal for Public Health, health care facilities run by The Catholic Church usually have strict guidelines that dictate that abortion can't occur under any circumstances, or can only occur to save the life of the mother. Some facilities dictate that evacuating the fetus can only occur once fetal heartbeat has ceased or the patient can be transported elsewhere, which can lead to tragedy and force doctors to act in ways they deem immoral. Freedman writes,
Dr P, from a midwestern, mid-sized city, said that at her Catholic-owned hospital, approval for termination of pregnancy was rare if a fetal heartbeat was present (even in ‘‘people who are bleeding, they're all the way dilated, and they're only17 weeks'') unless ‘‘it looks like she's going to die if we don't do it.''
In another case, Dr H, from the same Catholic-owned hospital in the Midwest, sent her patient by ambulance 90 miles to the nearest institution where the patient could have an abortion because the ethics committee refused to approve her case.
Another doctor described a horrifying scenario where she was forced to watch a woman bleed to death after her request to intervene in the pregnancy was declined on the grounds that fetal heartbeat was still present.
If a hospital forcing doctors to do nothing in a life-and-death situation is not a violation of conscience, the very words "violation" and "conscience" are meaningless.
But new laws leave pro-choice doctors little room for consciences of their own in treating patients in a regulatory and institutional environment that's operating with an increasingly anti-choice agenda. If Dr. Boyd or one of his colleagues disregarded Texas' state-imposed standards, for example, there is no warning issued by the state; he risks losing his medical license, being charged with a crime, or having his facility's surgery license revoked. In short, taking a stand by claiming pro-abortion rights morality could jeopardize access to abortion services for thousands of women.
Doctors in circumstances like the ones detailed in Freedman's paper aren't in much better shape. If pro-choice doctors have a problem with their religious hospital's policies butting against their personal morality, they can quit or risk violating policy and being fired. The reverse, however, isn't true. A pharmacy can't fire a pharmacist who refuses to fill Emergency Contraception prescriptions on religious grounds. And just months ago, nurses in a New Jersey hospital were granted the right to refuse to provide pre- or post-surgical care for women who were receiving abortions. Laura MacCleery, Director of Government Relations at the Center for Reproductive Rights, pointed out to me that this — women's reproductive health — is the only type of medical care wherein the government has granted legal protection to medical professionals and institutions who refuse to perform services that are in the best interest of the patient.