Secularists are not content to demand that they live their lives free of traditional morality, but insist that their own vision of a re-engineered humanity be imposed on society at large, and in particular, on religious medical professionals who disagree with them. This was the topic of a second lecture on “Conscience and Coercion,” by Dr. Christopher Hook of the Center for Bioethics and Human Dignity and Associate Professor of Medicine at the Mayo Clinic at the annual L’Abri Conference in Rochester, Minnesota on February 13 and 14.
Dr. Hook first discussed the American founders’ support of liberty of conscience, particularly Thomas Jefferson’s statement that “no provision in our constitution ought to be dearer to man than that which protects the rights of conscience against the enterprise of civil authority.” He went on to quote William Perkins, one of the early thinkers attempting to develop a “theology of conscience.” He stated that “conscience is of a divine nature … it is a thing placed of God in the middle between Him and man, as an arbiter to give sentence and to pronounce sentence either with man or against man unto God.” Perkins declared that God gave liberty of conscience with respect to His own ceremonial law of the Old Testament, and therefore will not have the individual conscience bound by “the laws of sinful men.” Freedom of conscience was thus integral in the founding of American civilization and government. Hook noted that in the first draft of the Bill of Rights, James Madison included the provision that “the civil rights of none shall be abridged on account of religious beliefs or worship, nor shall any national religion be established, nor shall the full or equal rights of conscience be in any manner, or on any pretext infringed.” Hook said that “there are many days when I wish that language was still present in the First Amendment.”
The controversy over liberty of conscience, and particularly as it pertains to the field of medical care, is exacerbated by the fact that contemporary theorists understand there to be two kinds of rights, “negative rights,” and “positive rights.” The former, which is ordinarily what is meant in the classical liberal tradition, is freedom from coercion, the right to be left alone. The latter, which now is in conflict with liberty of conscience, is the right to be assisted, which results in a duty to assist. It may be observed that negative rights are most properly rights, since they are freedom from government regulation, whereas positive rights are an imposition of government regulation. Hook observed that through “muddled language and … social pressure to create health care rights as a positive right” it is now increasingly held that “people have a right to demand interventions, even when the provider believes that these are inappropriate medically or immoral ethically.” Hook said that “this does violence to concept of right when it comes to medicine.”
Court decisions of the past tended to support liberty of conscience. In Girouard vs. the United States (1946), it was found that naturalization could not be denied an immigrant who refused to bear arms in the military. This was because no religious test can be used to determine eligibility for Congress, and therefore it was held that such a religious consideration could not determine eligibility for citizenship. Hook observed that when health care workers are penalized for following their consciences with such penalties as firing, denial of training, or exclusion from health care systems, the claimed justification of harm to the public is far less than the harm caused by not defending the nation. Indeed, it might be added that it is the program to re-engineer humanity which is truly harmful, and medical conscientious objectors are preventing harm, but even if one concedes that real harm is caused by conscientious objection, that caused by refusal to bear arms is far greater, “not even close, in terms of the social contract,” according to Hook. In Palko vs. Connecticut (1937), the Supreme Court found that “freedom of thought is the matrix, the indispensable condition of nearly every other form of freedom.” In Brophy vs. New England Sinai Hospital (1986), the Supreme Judicial Court of Massachusetts said “there is nothing in the law which would compel medical professionals to take active measures which are contrary to their view of their ethical duty toward their patients.” These court cases show that “health care rights are really negative rights, it’s a right to be left alone.” This is also the justification in Roe vs. Wade, which said patients should not be forbidden from obtaining abortions. But the court did not announce a “positive right” to demand an abortion. There is “a permission for abortion, but not a positive right to claim.” The Church Amendments of 1973 prohibit discrimination in institutions receiving federal funding on the basis of conscientious objection to abortions.
Nevertheless, conscience protections have in recent years “been under massive assault.” Bills before the 110th Congress identified contraception as a fundamental right, with conscientious objection prohibited. This legislation also claimed that professional judgments are separable from moral judgments. But these, Hook said, are necessarily intertwined. The American College of Obstetrics and Gynecology (ACOG) Opinion no. 385 entitled “The Limits of Conscientious Refusal in Reproductive Medicine,” asserts that “patient autonomy is the final arbiter for treatment.” Hook said that this is “a radical shift in our understanding of rights.” The document claimed that “moral obligation is to the patient, which overrides a right of conscience.” It also declares that “inconvenience is equivalent to that which imposes provider beliefs on patients.” It declares that doctors must refer for abortions regardless of moral conviction, or provide them if they cannot be referred, and that conscientious objectors should only practice where abortion is readily available. Dr. Hook observed that the statement has many severe problems. “Physician beneficence,” not “patient autonomy,” has for centuries been understood to be “the final arbiter of treatment decisions.” He also observed that if the issue were concerning any other area of medicine than sexuality or reproduction, it would be understood as ridiculous to allow patients to prescribe their own treatment, whether or not the doctor considers it medically indicated. Indeed, under such a rule as patient autonomy, the function of the doctor is unclear, since patients are determining treatment.
Personnel in training have, in line with this viewpoint, been denied training based on conscientious objection, with one student even told that she “would be a bad doctor because of my Christianity, and that I was biased.” Another student was told that she would have to perform abortion procedures to remain in training. Another resident was fired for discussing complications associated with abortion.
In Illinois, a strong law protecting the health care right of conscience did not prevent pharmacists from being required to provide abortifacients. There, the governor, Roy Blagojevich, specifically indicated that the rule he issued was intended to require religious pharmacists to violate their consciences. Ultimately, the court finally deciding the case determined that the pharmacy, not the pharmacist, had the duty to fill the prescription.
In response to the ACOG position and the general threat to provider conscience, the Bush Administration in its closing days issued a regulation protecting provider conscience, using laws which protect medical conscience. It prohibited discrimination against conscientious objectors. The Obama Administration not only immediately rescinded the regulation, but required federal and private funds to pay for abortion through the Affordable Care Act (Obamacare), thus making the American people at large pay for abortion.
More ominous than even the denial of liberty of conscience at secular institutions is the effort of the American Civil Liberties Union (ACLU) to require religious institutions to adhere to secular, not religious, standards in the provision of medical care. The ACLU specifically states that “when religiously affiliated organizations move into secular pursuits, such as providing medical care or social services to the public or running a business, they should no longer be insulated from secular laws. In the public world, they should play by public rules.” Hook noted that “ACLU Director Ira Glasser has also stated that their ultimate goal is to eliminate conscientious objection policies and laws throughout the country.” Planned Parenthood has similarly stated that conscientious objectors should be required to provide abortions. It should be noted that the obvious problem with this is that a religious institution exists primarily as an exercise of religious duty, and only secondarily a medical, educational, or social service. There is no good reason to think that the “free exercise of religion” refers only to the performance of religious ceremonies in house of worship, but reasonably includes social service as a religious duty. More particularly, there is no greater harm than taking an action one believes is wrong, however offended anyone else is.
Dr. Hook noted that the direction of thought in the academy and professional associations is that the denial of liberty of conscience should be a condition of serving the public. It has been noted that this bears a striking similarity to the defense offered by war criminals at Nuremberg (i.e., they were just following orders). Conscientious objection is seen as “a threat to cultural hegemony” of the secularists, and will not be tolerated. Dr. Hook quoted Abraham Lincoln’s observation that “what would truly satisfy the pro-slavery faction? What will convince them? This, and only this, cease to call slavery wrong, and join them in calling it right, and this must be done thoroughly, done in acts as well as in words, silence will not be tolerated, we must place ourselves avowedly with them, the whole atmosphere must be disinfected from all taint of opposition to slavery, before they will cease to believe that all their troubles proceed from us.” Dr. Hook claimed that abortion advocates are really taking the same position, and he concluded, “you will be made to care.”
Dr. Hook then mentioned the situation in Canada, where the Canadian Supreme Court just “eliminated any prohibitions against assisted suicide and euthanasia, while the Royal Society of Canada has recommended that objecting physicians be forced to refer.” He noted that, internationally, the Center for Reproductive Rights sent a letter to the U.N. Council on Human Rights accusing the Vatican of torture because of its opposition to abortion. The Center has asked the U.N. to declare the Vatican “international torturers and criminals against human dignity.” It essentially said that moral condemnation of abortion, and the mental anguish thus inflicted, is a form of torture. Despite the intense controversy about conscience with respect to medical treatment in the areas of sexuality and reproduction, Dr. Hook noted that 99.9% of what physicians do has nothing to do with birth control, “but that is the issue” on which they may be “eternally judged incompetent to practice medicine.”
He then asked how we define conscience, conceding that it may be “highly subjective.” Also, those with no specific religious affiliation may have difficultly explaining why they find a conscience conviction binding. Conscience claims may also be insincere, and terrorists may claim conscience conviction for their terrorism. Conscience has been defined as “an inner sense or what is right or wrong in one’s conduct or motives impelling one toward right action.” Hook conceded that this seems “nonrational.” Another definition is “the complex of ethical and moral principles that controls or inhibits the actions or thoughts of an individual.” Another is a feeling of guilt at an action considered wrong. A spiritual definition is “the internal accountability to God, from God’s natural law.” “Coupled with conscience is the concept of complicity,” Hook said, “which could be understood as collective wrongdoing.” It raises the issue of “degrees of separation.” If the distance of separation is far enough, one is not reasonably involved.
Dr. Hook said that Mayo Clinic took over a decade to develop a conscience policy. Mayo considered whether conscience was a luxury, an institutional good, or a net liability. Does conscience conflict with diversity? Mayo concluded that health care professionals “should be individuals of high moral virtue, to be conscientious, and thus to have well developed consciences.” The ultimate doctrine adopted by the Clinic had “strong virtue oriented language.” Mayo claimed that its employees “do have the right to not perform activities that violate their conscience.” The only exception to this was a situation in which emergency, life-saving care was involved. The Clinic also endeavored to say that the claim of conscience involves adverse judgments against acts, not persons.
In response to a question regarding the claim of the ACLU that all organizations serving the public must play by public rules, Dr. Hook said that the progressive mindset sees the state as the “ultimate value.” This, he said, is contrary to the view of the American founders, which was that the state should protect “private and personal interests.” As we move toward a “state-centric, totalitarian” future, “there is no such thing as private, anymore.” This, Dr. Hook said, is not where we should be going, because in this view “the individual has no value, other than their service to the collective.” Because of the extent to which the American body politic and influential professional groups have come to accept this statist viewpoint, civil disobedience may be necessary, as well as to “take what possibilities we still have as an electorate” to elect government officials who will favor the rights of conscience.
In response to another question, Dr. Hook said that it is becoming increasingly difficult for a private institution to function without taking government monies. In so far as it is possible to avoid government money, this is a good thing, yet it is, he said, quite difficult to avoid doing this.
In answer to another question, as to why, in view of the alternative therapies available, such as Chinese medicine, or chiropractic, it is not possible to have specifically Christian health care, provided according to Christian principles, Dr. Hook said that he has concluded that alternative therapies are acceptable to the secularists precisely because they are non-Christian. Asked as to whether specific disfavoring of Christianity would hold up in court, he responded “unfortunately, it has.” While enemies of conscience try to avoid being this explicit, they route arguments against Christian conscience back to a claim of the “public good.” What secularists would consider wrong with an explicitly Christian health care, he said, is that it has built into it a “no,” a moral condemnation of what the secular bioethicists and transhumanists are trying to advance.
Christian individuals and institutions need to remind themselves that their absolute duty is to God, and they may not disobey Him, regardless of the consequences. This is the uniform doctrine of the Bible, and understood by all Christian tradition. There is no point in making a conscience claim unless one is willing to take the penalty of disobeying the law of the state because of this absolute requirement. As Dr. Hook observed, we may be at a time when civil disobedience is the only route available for committed Christians. For a Christian institution, that may mean the end of its existence, as it indeed has for Catholic adoption agencies. For an individual, the consequence may be firing or loss of professional opportunity. Yet liberty of conscience has historic support in the West, supported explicitly by the American founders, and a large part of the public still agrees with the Christian (and common sense) understanding that it is wrong to require people to violate their consciences. And if a substantial loss of social service results from the secularist offensive against liberty of conscience (along with a very active and articulate apologetic in favor of conscience), the tide may turn over time. But whatever the future holds, Christians must above all remember that our overriding duty is to God, to Whom we will give account, and Who is our hope.
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