Whose Choice?
Protecting Healthcare Providers' Conscience Rights

Deborah Sturm
Copyright 2009 Catholics United for the Faith
Reproduced with Permission
Catholics United for the Faith

"Slowly but surely, more and more pro-life doctors, nurses and other healthcare professionals are getting the message that they and their views are unwelcome in today's health care system." -Nancy Valko, R.N.1

"The conflict between social pressure and the demands of conscience can lead to the dilemma either of abandoning the medical profession or of compromising one's convictions. . . . There is a middle path . . . It is the path of conscientious objection, which ought to be respected by all, especially legislators." -Pope John Paul II, Address to the International Congress of Catholic Obstetricians and Gynecologists, June 18, 2001

A nurse is threatened with firing because she refuses to follow a doctor's verbal order to increase a morphine drip on a patient "until he stops breathing."2 Five pharmacists in the state of Illinois lose their jobs because they refuse to abide by an executive order from the governor forcing all pharmacists in the state to dispense the morning after pill.3 Another nurse, accused of "religious bias," is harassed by a unit manager because she refuses to encourage women to have abortions.4

Situations like these are increasing in incidence across the United States. In previous decades, the front line of the war against the culture of death was primarily fought through prayers and protests in front of abortion facilities. In recent years, the battle has extended to healthcare settings, moving pro-life healthcare professionals - nurses, doctors, pharmacists, etc. - from a "demilitarized zone" to the front line.

However, pro-life healthcare professionals are now facing the possibility of being removed from the front line of the battle against the culture of death and, in a sense, being made "prisoners of war."

In April 2007, Senators Barack Obama and Hillary Clinton, along with other pro-abortion legislators, re-introduced what is called the Freedom of Choice Act (FOCA). Denise Burke, legal counsel for Americans United for Life, describes FOCA as "a radical attempt to enshrine abortion-on-demand into American law."5 The National Right to Life Committee describes FOCA as an attempt to "invalidate all limits on abortion."6 Barack Obama has pledged his support for FOCA and promised Planned Parenthood that if he was elected president, he would sign FOCA into law if the legislation reached his desk.7

How Radical is the "Freedom of Choice Act?"

Denise Burke writes about FOCA:

FOCA creates a new and dangerously radical "right." It establishes the right to abortion as a "fundamental right," elevating it to the same status as the right to vote and the right to free speech (which, unlike the abortion license, are specifically mentioned in the U.S. Constitution). Critically, in Roe v. Wade, the Supreme Court did not define abortion as a "fundamental right." And with the exception of one justice's attempt in 1983 to distort the Court's abortion jurisprudence by framing the abortion license as a "fundamental right," the Court has not subsequently defined abortion as a "fundamental right."8

If abortion is established as a "right" on par with the freedom of speech and freedom of religion, no American citizen will be able to object to any woman's plan to have an abortion. FOCA puts the "right" to abortion on a collision course with the First Amendment rights of freedom of religion and freedom of speech. As Burke states, FOCA is "a radical attempt to prematurely end debate about abortion."9 Thus, not only can we expect abortions to increase in this country - despite the fact that abortion proponents often call abortion a "tragedy" and something they would like to see decreased in incidence - but no healthcare provider will be able to conscientiously object to a woman's request to have an abortion. Healthcare providers, then, will be forced to go against their religious and ethical beliefs, or they will have to leave their professions.

Burke highlights the practical implications of the enactment of FOCA, and the list is quite extensive. (See her article online at http://www.aul.org/FOCA). To name a few, FOCA will nullify the legal protections that have been afforded to Catholic hospitals, force all medical students to train to perform abortions, overturn parental notification and informed consent laws, and force American taxpayers to fund abortion, which many find morally objectionable.

No doubt, FOCA could also force the closure of pregnancy help centers, which typically counsel women on abortion options. It is certainly conceivable that abortion proponents will level accusations against pro-life counselors, purporting that women will be "coerced" into choosing life and be denied their "fundamental right" to have an abortion.

Attacks on the Rights of Conscience Have Become Commonplace

After the 1973 Roe v. Wade decision, healthcare professionals could "opt out" of involvement with abortion, as conscience clause protections sprang up across the country to protect them from employment discrimination. Yet despite these protective laws, healthcare professionals have been regularly harassed across the country, as they have been viewed as standing in the way of women's "reproductive rights."

Many lawsuits have been filed at various levels in the United States court system, and many pro-life battles have been won. One key battle was won recently in the state of Illinois.

In 2005, Governor Rod Blagojevich, by "executive fiat," issued an "emergency executive rule" mandating that all community pharmacists in the state procure and dispense all forms of contraception, including those known to be abortifacients.10 Blagojevich's rule was in direct violation of an existing law, the Illinois Healthcare Right of Conscience Act, a law designed "to afford broad protection for healthcare workers in all healthcare settings."11 At least five pharmacists lost their jobs in Illinois for violating the governor's order. Knowing that other healthcare providers will be the next targets of discrimination, several pro-life organizations, including the National Association of Pro-Life Nurses and the Catholic Medical Association, have filed an amicus ("friend of the court") brief in this case.

The Illinois Supreme Court recently ruled that the pharmacists who filed suit deserve their day in court. The Court noted that Blagojevich and his subordinates "have publicly stated that they will vigorously prosecute pharmacists with religious objections to drive them out of the profession and that a pharmacy must fill Plan B prescriptions without making moral judgments if it wants to stay in business."12

Many abortion supporters overtly show their hostility to pro-life healthcare providers. Mainstream medical journals are rife with articles and editorials that show hostility to healthcare providers who refuse to participate in abortion and other morally objectionable procedures. For example, a recent New England Journal of Medicine editorial, co-authored by Alta Charo, J.D. (a bioethicist who has served on the board of Planned Parenthood), asserts that a healthcare provider's failure to cooperate with certain "reproductive rights" amounts to "patient abandonment."13 According to John Brehany, executive director of the Catholic Medical Association, Charo is quite influential in the field of healthcare bioethics and has a long history of attempting to pave a way to criminalize conscientious objection.14 She has even insinuated that those who object to abortion should be put behind bars.15

Pro-Abortion Providers Are in a Parallel Universe to Pro-Life Providers

Before proceeding on this issue, let's be clear about the difference between how a pro-abortion and a pro-life healthcare provider view abortion. Bruce Maskarinec, D.O, president of the Pittsburgh guild of the Catholic Medical Association, writes:

Part of our defense regarding the accusation of abandonment must be the articulation for all to understand that physicians [and other healthcare workers] do not have contracts with patients to provide them with medical care. Instead, physicians take an Oath (a contract with God, not the patient or healthcare insurance company) to which they are dutifully bound (to God) to make professional judgments in the best interest of the patient.16

The classical Hippocratic Oath says, "I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman an abortive remedy."17 However, the classical version of the oath has been deconstructed, as the aforementioned clauses are often omitted. Additionally, many physicians entering the healthcare field do not profess a belief in God. As Brian W. Donnelly, M.D., secretary/treasurer of the Pittsburgh guild of the Catholic Medical Association, points out, "The current approach says that we are health care providers and will provide whatever the consumer/client wishes." The modern-day approach also fails to view the pre-born child as a person with rights, as well as possessing inherent dignity and worth.18

Recent Attempts to Protect Pro-Life Healthcare Providers

The Bush administration, no doubt aware of the threat of FOCA-and sensitive to the plight of pro-life healthcare providers-worked with Michael Leavitt, secretary of the Department of Health and Human Services, to propose federal regulations in an attempt to ensure the rights of conscientious objection to abortion and other morally objectionable practices, such as euthanasia and physician-assisted suicide. The proposals have been applauded by many pro-life organizations, such as the National Association of Pro-Life Nurses (http://www.nursesforlife.org). President Bush was urged by religious leaders such as Bill Donahue of the Catholic League to proceed with the enactment of the proposals.19 The United States Conference of Catholic Bishops discussed FOCA at their fall meeting in Baltomore last November, asserting they would close Catholic hospitals before being forced to perform abortions.

The Department of Health and Human Services under the Bush administration, on December 18, 2008, finally issued a regulation that "considerably strengthens the rights of health care workers to practice according to their conscience; it affects those who work in federally funded health care institutions."20 Donahue applauded the decision and urged the incoming Obama administration to "resist the appeal of pro-abortion extremists to overturn this regulation."21

How Should Catholics Respond?

Catholics must stay tuned in to what's going on in Congress. They must write letters and make phone calls to their senators and representatives voicing their opposition to FOCA. Individuals with Internet access should also participate in online campaigns circulated on the Internet and sign petitions against FOCA (for example, http://www.FightFoca.com).

Dr. John Brehany said that Catholic healthcare providers must return to the roots of the Catholic Church. They must engage the culture, understand why the Church teaches what she does, and be able to articulate it to others. Dr. Brehany also said pro-life healthcare providers must create and renew organizations, emphasizing the importance of peer support. "We must preach to the choir," he said, "because if we stop preaching, the choir ceases to exist."22

Catholics in general-and pro-life healthcare providers in particular - must be willing to grow in virtue by inconveniencing themselves, something anathema to the "culture of death." For example, when we are faced with pain and suffering - whether it is due to illness or persecution - this pain must be united to the sufferings of Christ. As Raymond Arroyo writes in his book on Mother Angelica, "Every pain we endure with love, every cross borne with resignation, benefits every man, woman, and child in the Mystical Body of Christ."23 When we bear suffering with love, we are humbled and realize that we can do nothing without Christ. And when we realize we aren't in control and get out of God's way, so much more can be accomplished.

Pro-life nurses should be willing to accept caring for patients who other nurses don't want to care for. In this way, the nurse becomes "Christ incarnate" and the best witness to the Christian faith.

When I lived in the Cleveland, Ohio, area, I couldn't help but notice that the pro-lifers showed up outside of the local abortion facilities under the most adverse circumstances. They prayed in whipping rain, subzero wind-chill temperatures, and blustery lake-effect snow. The abortion supporters, on the other hand, showed up primarily in the comfortable warm weather of spring and summer. Only this level of commitment - one that goes beyond doing what is convenient - will ever effectively challenge and eventually defeat the culture of death.


1 Nancy Valko, "Are Pro-life Healthcare Providers Becoming an Endangered Species?" in Voices Online Edition: Medicine and Morality, vol. 18, no. 2, http://www.wf-f.org/03-2-Healthcare.html. [Back]

2 Ibid. [Back]

3 American Center for Law and Justice, "A Matter of Conscience," Jay Sekulow's Trial Notebook, November 11, 2006, http://www.aclj.org/TrialNotebook/Read.aspx?id=407. [Back]

4 Deborah Tuttle, "Perils of a Pro-life Nurse," Journal of Christian Nursing, vol. 19 no. 1, pp. 33-34. [Back]

5 Denise M. Burke, "The Freedom of Choice Act: A Radical Attempt to Prematurely End Debate Over Abortion," Americans United for Life, http://www.aul.org/foca. [Back]

6 "The Freedom for Partial-Birth Abortionists Act' Pro-Abortion Lawmakers Propose FOCA' to Invalidate All Limits on Abortion," National Right to Life News, vol. 34, no. 5, pp.1, available from http://www.nrlc.org. [Back]

7 Ray Kerrison, "Obama's Holy Hell: War Brews Over Abortion Bill," New York Post, December 8, 2008, available from http://www.nypost.com/seven/12082008/postopinion/opedcolumnists /obamas_holy_hell_143201.htm?page=0. [Back]

8 Burke. "The Freedom of Choice Act." [Back]

9 Ibid. [Back]

10 Elizabeth Rose, "Tip of the Spear: Defending Pharmacists' Right of Conscience," Americans United for Life, Available from http://www.aul.org/Tip_of_the_Spear. [Back]

11 Ibid. [Back]

12 American Center for Law and Justice, "ACLJ Pleased with Illinois Supreme Court's Decision Involving Pro-Life Pharmacists," December 18, 2008, available from http://www.aclj.org/TrialNotebook/Read.aspx?id=703. [Back]

13 Allan Rosenfield, Alta Charo, and Wendy Chavkin, "Moving Forward on Reproductive Health," The New England Journal of Medicine, vol. 359:1869-1871, no. 18, available from http://content.nejm.org/cgi/content/full/359/18/1869. [Back]

14 John Brehany, "Conscience, Healthcare, and Evangelization," a talk given at Franciscan University of Steubenville, April 23, 2008. [Back]

15 Ibid. [Back]

16 Email interview with Bruce Maskarinec, D.O. [Back]

17 Available from http://www.pbs.org/wgbh/nova/doctors/oath_classical.html. See also Ami Naramor's article, "Supporting Doctors with Ethical Objections," available from http://www.beliefnet.com/News/Science-Religion/2004/06/ Supporting-Doctors-With-Ethical-Objections.aspx. [Back]

18 Email interview with Brian Donnelly, M.D. [Back]

19 Catholic League, "Religious Rights for Health Providers: Bush Needs to Act Now," November 19, 2008, available from http://www.catholicleague.org/release.php?id=1518. [Back]

20 Catholic League, "Rights of Healthcare Workers Get a Boost," December 18, 2008, available from http://www.catholicleague.org/release.php?id=1533. [Back]

21 Ibid. [Back]

22 Brehany, "Conscience, Healthcare and Evangelization." [Back]

23 Raymond Arroyo, ed., Mother Angelica's Little Book of Life's Lessons and Everyday Spirituality (New York, NY: Doubleday, 2007), p. 119. [Back]

Deborah Sturm is a registered nurse and a graduate of Franciscan University of Steubenville. She currently serves as the secretary of the National Association of Pro-Life Nurses. She and her husband, Michael, are members of St. Peter's Catholic Church in Steubenville, Ohio.