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.

Conservative vs. Progressive (no adjectives)

Once again, we're reminded about the great gulf between perception and reality (just look at the repetition of the names of authors whose ethics comments are published in the "mainstream" science and bioethics journals and explore the political and religious viewpoints of those authors and editors), between the idea that all humans are people possessing rights endowed by "their Creator," and the difference between exercising those rights and the restrictions and privileges afforded by government. And we see another example of projection, re-definition to attack pro-life conservatives.

(Go ahead and read the Declaration of Independence (Here's another text version). I believe it's a good primer for understanding conservativism.)

The latest American Journal of Bioethics includes a silly little target article, "Biotechnology and the New Right: Neoconservatism's Red Menace," (the abstract is free, the rest is behind a pay-wall. Let me know if you want to read it) by Jonathan Moreno, Ph.D. and Sam Berger. Both "progressives" are mouth pieces a Senior Fellow and a (former?) Research Assistant at the Progressive Bioethics Initiative. The PBI is an off-shoot of the "Center for American Progress," a far-left think-tank started by John Podesta.

Moreno and Berger look at the fathers of some men that opponents have named "neocons," and build upon the argument that

"Although the neoconservative movement has come to dominate American conservatism, this movement has its origins in the old Marxist Left. . . . By not acknowledging and embracing their intellectual roots, neoconservatives are left with a deeply ambivalent and often confused view of biotechnology and the society that gives rise to it."

The "Open Peer Commentary" pieces are written by volunteers who review and argue the target article. Remember the Womens Bioethics Project and their "God's Bioethics" expose'? (Read more about that here and here.) The Commentary "Responding to Neocon Critiques of Biotechnology: A Progressive Agenda" (sorry, another pay-to-read) by Kathryn M. Hinsch, and Robin N. Fiore, Ph.D., of the Women's Bioethics Project should offend conservatives of all ages and progressives as well.

In order to overcome what they see as impediments to their goal of ". . . attempting to construct a coherent consensus “progressive view” that could be acceptable to the wide range of extant progressive views (plural)," (sic) they suggest that Progressives work on the following problems:

1) Widespread scientific illiteracy permits the substitution of rhetoric about vague but disquieting threats to human nature, engenders distrust of the scientific enterprise and its products, and sanctions relativism with respect to non-scientific and pseudoscientific explanations and justifications for empirical claims. For example, neocons have successfully exploited the public’s lack of understanding with respect to the differences between therapeutic and reproductive cloning in order to pursue a ban on all forms of embryo research.

2) Social arrangements structured by historical gender, race and class inequities continue to appropriate women’s sexuality, their reproductive capacities, and their labor. Progressives as well as conservatives often neglect analyses of (current and potential) distributions of power and privilege. For example, neither conservatives nor progressives address caregiving in ways that acknowledge the increasing dependence on uncompensated care
by women in families and the impact of caregiving burdens on women’s own well-being. The President’s Council on Bioethics issued a lengthy report that finally concludes with a recommendation (sigh) that yet another commission be appointed to study this issue (President’s Council on Bioethics 2005).

3) Progressives are identified as being more concerned with social justice and conservatives as more concerned with human dignity — 45 million uninsured Americans rebut both propositions. On questions of access, disparities in healthcare and medical entrepreneurship,
progressives have failed to distinguish themselves. Conservatives offer a dystopian vision of a future gerontocracy and blame ill health on the personal irresponsibility of the medically least well off. Mainstream bioethicists have offered arguments from“justice” about individuals’ duty to refuse expensive medical interventions
after a “fair” share of normal life expectancy, but have been unable or unwilling to specify a “fair” profit margin for entrepreneurial healthcare systems and insurers.

4) Moreno and Berger (2007) suggest that the neocon attempts to ban whole sectors of biotechnological research and commercialization — particularly those that implicate reproduction — stem from neocon’s understanding of “people” (scare quotes added for emphasis) as too weak, imperfect, and immoral to make certain weighty decisions. This view of moral agency has, of course, been routinely applied to women and other infantilized social actors, particularly with respect to individual decisions regarding sexuality and reproduction. In Gonzalez v. Carhart, the Supreme Court of the United States justified upholding the ban on late-term abortion in part by invoking gender stereotypes and claiming that women needed to be protected from poor decision-making. As Justice Ginsberg pointed out in her dissenting opinion, this decision could have been accomplished by strengthening informed consent rather than depriving women of the right to autonomous choice. Conservatives are now attempting to limit forms of medical progress that have implications for the moral agency of previously privileged social actors. For example, Francis Fukuyama and Leon Kass, both members of the President’s Council on Bioethics, support legislation that would criminalize the prescription or utilization of treatments developed (anywhere in the world) from cloning technology.
A progressive alternative to technology embargoes and diminished moral scope might focus on developing programs to enhance technological information literacy, critical thinking and decision-making skills and supports, as well as broadening opportunities for community participation. Such efforts may nourish solidarity and ground more substantive forms of autonomy.
5) The patenting of drugs, devices and other medical technologies both stimulates innovation and deprives the medically indigent, creating special interest wealth at the expense of life and health. In contrast, Benjamin Franklin refused a patent on his design for an improved wood stove, preferring that all people benefit from it.
Ultimately, progressives must engage the difficult problem of ensuring that the benefits of the new biology and medical advances are distributed as broadly as fairly as possible.

Both the Progressives and the Women would do well to consider what it means to believe that the right to "life, liberty and pursuit of happiness" are endowed on all humans, rather than legislated and regulated. So many of the misconceptions outlined above are answered anew by this simple philosophy. No matter who your father was.

Note: Post was edited 11/2/07, because of an error in Ms. Hinsch's name.

Enough: ultrasounds, abortion, women and blood

While calling us "anti-choice," some "pro-choice" men and women are beginning to look at the true nature of what is being chosen. They're noticing that we who oppose abortion are more likely to accept the woman with an unwanted pregnancy and championing the laws that make adoption and parenting a true choice. They're noticing that we have valid reasons, too.

The Family Research Council blog has a beautiful post quoting the words of one of the many "pro-choice" women that are being convicted about the humanity of the unborn child.

In the May, 2007 Atlantic, Caitlin Flanagan recounts a heart wrenching review of two books, The Choices We Made, and The Girls Who Went Away, of abortion, maternity homes and the girls and women who are and have been impacted by it.

Along the way, she tells us,

But my sympathy for the beliefs of people who oppose abortion is enormous, and it grows almost by the day. An ultrasound image taken surprisingly early in pregnancy can stop me in my tracks. In it is much more than I want to know about the tiny creature whose destruction we have legalized: a beating heart, a human face, functioning kidneys, two waving hands that seem not too far away from being able to grasp and shake a rattle. One of the newest types of prenatal imaging, the three-dimensional sonogram—which is so fully realized that happily pregnant women spend a hundred dollars to have their babies’ first “photograph” taken—is frankly terrifying when examined in the context of the abortion debate. The demands pro-life advocates make of pregnant women are modest: All they want is a little bit of time. All they are asking, in a societal climate in which out-of-wedlock pregnancy is without stigma, is that pregnant women give the tiny bodies growing inside of them a few months, until the little creatures are large enough to be on their way, to loving homes.

These sonogram images lay claim to the most powerful emotion I have ever known: maternal instinct. Mothers are charged with protecting the vulnerable and the weak among us, and most of all, taking care of babies—the tiniest and neediest—first. My very nature as a woman, then, pulls me in two directions.

Abortion hurts us all. As Ms. Flanagan says, abortion has left a trail of blood. It doesn't matter whether the abortion is legal or illegal, the blood flows from the cuts made by the culture that makes so many women throughout history and all around the world believe that they have no choice other than to choose this child or their lives, this child or their future, or (Lord help us) this child or his father.

It's past time to look at abortion and say, "Enough."

Money for Babies?

There is a gut reaction, what Dr. Leon Kass has called a "yuck" factor, to the idea that a mother would trade her child for money, however the idea is framed.

ABC news picked up another news item, this time from my hometown. Our local Chamber of Commerce owns the copyright to the title of "Texan of the Year" and makes the award at our "Legislative Conference" every spring. The event is pretty big as far as State politics go, so there are usually quite a few of our Legislators present. I do my best not to miss it, but had to work yesterday, so I missed seeing our Governor, Rick Perry honored.

I also missed my chance to hear Senator Dan Patrick make the case for his proposal to pay women $500 if they will choose to carry their babies to term and put them up for adoption rather than have an abortion.

I'm all for supporting women who have chosen life for their child, and for individual support of local charities and outreach, as well as public policy that blatantly and unequivocally favors life over abortion. However, something doesn't feel right about this cash money for babies deal.

At the very least, the proposal appears to favor adoption over keeping your own child to raise, at least as much as it favors adoption over abortion - possibly more.

I find it difficult to believe that a woman or girl will continue a pregnancy for the promise of $500 in 8 months or so, after the birth and after signing the rights of the child away. However, I can see desperate or depressed women and girls who have just given birth deciding that they can't handle motherhood and considering the right-now $500. I'm also afraid that predators will find ways to take advantage of these mommas and the would-be adoptive parents.

My feminist side - my matriarchal/sisterhood side - is stirred to thoughts of "Just like a man!" (The Libertarian/Republican side is certain that the money could be spent more wisely.)

Frankly, I'm a little insulted by the implication that $500 will override the heartache, confusion and crisis that brings a woman or girl to the point of believing she has to make a choice between her child and her life, her future, her education or (all too often) the support of the man who got her pregnant or the family who should protect her most of all. These problems are not that cheap, and the currency is not money.

First, if you're going to spend the money (sorry, Republican/Libertarian), spend it to give girls more options before they put themselves at risk of an unwanted pregnancy. Education is directly associated with delayed childbirth. Unfortunately, delayed childbirth is also related to increased infertility.

All too often, the only resources on college campuses for pregnant women are abortion-referral services. (See Feminists for Life) How would it be if we enabled and supported mothers and mothers-to-be in school, work, and the home? We could provide campus housing for married students and families, more daycare and family-centered health care and social services in the universities and colleges, where we are already investing our State tax funds.

Or, as a last resort, you could add that $500 per pregnancy to the Medicaid and TANF funds.

Added: My husband (who donates at least that much each month to life-causes, even if you just count the time I could be working instead of going to Austin and blogging) just commented: It's strange that he'd talk about how priceless human life is, and then proceed to offer $500."

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.

Feminists For Life History

I wrote about Serrin Foster's article on National Review Online, yesterday. Be sure and click through to the actual op-ed and to the Feminists for Life website. (Especially the "Covetable Stuff"!)

The actual founders of F4L were two women, Catherine Callaghan, Ph.D. and Pat Goltz. Like many of us in the '70's and '80's, these women recognized the conflict between abortion and feminism. Both were once members of the National Organization of Women. Ms. Goltz was expelled from her local chapter, and both eventually resigned from the national organization.

Feminists for Life reminds us how common it is to assume that we know all about other people and other groups. It seems that we quickly stereotype and assume division, rather than look for common ground.

I love common ground! My goal has been to offer that ground and possibly to offer my translation and peacemaking skills in order to demonstrate the logic of the prolife arguments to the domestic and sexual violence communities, non-Christians and even atheists, pro-life churches and other prolife groups who assume they have nothing in common. Unfortunately, far too many prolife organizations require members to agree to a Christian creed.

For more surprises and information on opposing abortion in the public square, take a look at Libertarians for Life and Democrats for Life. And then, check out the Atheists and Agnostics Prolife Leaque (you've got to see their url).


(For those Christians who are offended, I offer the book of Romans - I try to live so that others can see some of the insight in Romans 1 through my example. A little bit of truth can serve as a catalyst for more truth.)

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.