conscience
Many people know that the great Sandy Koufax chose not to pitch in the first game of the 1965 World Series because the game fell on Yom Kippur. No big deal: he just went on to win the second, fifth, and seventh games of the Series for the Dodgers. The same problem had faced the great Tigers first baseman Hank Greenberg decades earlier, and would face a later Dodger, Shawn Green, just a few years ago.
But, in the spirit of Chaim Potok, let’s imagine a great baseball player — an outfielder, say — who would not play on the Sabbath. A pretty tough situation for his team, especially if (as might actually happen) they’re in a pennant race late in the season and find themselves faced with a Friday night game and a Saturday afternoon doubleheader.
Koufax and Greenberg and Green were each faced with an unusual situation, the kind of thing that might happen only a handful of times, if at all, in a long career. So not too many people were likely to be upset at their staying out of a game. But in the case of the imaginary star outfielder, some people will surely think that the strictness of his conscience, coupled with the regularity of the Sabbath, create an environment in which he should probably consider another line of work.
Stanley Fish asks, “Isn’t it a matter of conscience (in [Thomas] Hobbes’s sense) to abide by the rules that define the profession you’ve signed up for?” The answer, historically, seems to be “It depends.” If you generally abide by those rules, but there are rare circumstances in which you dissent, you can be cut some slack; but if your conscience regularly puts you at odds with your profession, that profession may be justified in ushering you out the door.
So it’s a sliding scale, and there’s no iron-clad law that will determine how much dissent is too much. What about the pro-life “health care professionals . . . who refuse involvement with abortion and contraception issues”? The Obama administration apparently thinks they’re like my imgainary Sabbatarian outfielder; I think they’re much more like Sandy Koufax, which is why I agree with Francis Cardinal George.
Our (Episcopal) campus ministry at the Medical University of South Carolina sponsored a lecture by philosopher Christopher Tollefsen this past Monday on exactly this topic. The lecture he delivered was a version of this paper , and we expect to have the video up soon.
— Patrick S. Allen+ · Apr 22, 04:43 PM · #
So you believe a person has the right to obstruct someone’s access to necessary health care based on their own personal biases?
I find it amusing and hypocritical that these pharmacists never seem to have problems dispensing, say, Viagra.
— Travis Mason-Bushman · Apr 22, 05:02 PM · #
[Citation needed]
Really? Every single woman I know who uses birth control has to purchase it at a pharmacy with a perscription from their doctor, even though the worst side-effect of an overdose of BC is apparently not getting pregnant. A hypothetical conscientious objector therefore probably has a hundred crisises of conscience every week as single women come in to fill their birth control.
The Sabbath is only once a week, and you thought that was probably too often to let someone be a baseball player. Surely one hundred such conflicts every week of employment is enough that we should dissuade those so conflicted from being pharmacists? Enough, surely, that we should not be required to admit them into the government-granted pharmacists’ monopoly?
I’m not saying that every single person who comes into a pharamcist’s business is entitled to whatever they ask. But we, the people, grant pharmacists an exclusive monopoly on the dispensation of drugs like birth control with the expectation that we’ll be repaid by the social utility of having pharmacies. If someone’s religion, or their idiosyncratic interpretation of it, seems to prevent them from meeting that public obligation I don’t have a problem with showing them the door. Doing them a favor, anyway, if they find these conundrums so intractable. (That’s assuming that it really is an intractable religious dilemma and not simply an excuse to enjoy a little religious-based slut-shaming. I’m trying to grant my opponents a little good faith, these days.)
— Chet · Apr 22, 05:34 PM · #
//So you believe a person has the right to obstruct someone’s access to necessary health care based on their own personal biases?//
They’re not obstructing. They’re refusing to participate. So you would support forcing doctors to perform acts that they consider to be murder? If the purpose of abortion being legal is that a woman should have control over her body, what about a doctor’s right to have control over his or her body by not performing a surgery that they consider to be deeply immoral?
If a doctor or pharmacist believes that abortion is murder, it is unconscionable to ask the government to force them to do it or lose the ability to do everything else.
There may be limitations as to what sort of discretion that we give doctors and pharmacists in that regard (reasonable accommodations are one thing, but iron-clad job protection is more problematic), but surely there are limitations to what we will force them to do because it’s legal and a patient wants it.
//I find it amusing and hypocritical that these pharmacists never seem to have problems dispensing, say, Viagra.//
There’s no contradiction here. Viagra may be used for reasons considered immoral by some pharmacists, but almost any pharmacist or doctor knows or circumstances where they would consider use moral. There is no inherent immorality. If a doctor or pharmacist believes that the prevention or termination of pregnancy is immoral, then passing out drugs or pills that always result (when used as directed) in the prevention or termination of pregnancy is always immoral.
If Viagra killed sperm in the process of doing its things, the comparison would be more apt. And the drug a whole lot more popular!
— Trumwill · Apr 22, 05:37 PM · #
Alan:
I’m pretty sympathetic to your analogy, but I’m not sure it works. Here’s why:
If Sandy Koufax is unwilling to work on Yom Kippur, somebody else will pitch the game. Now, maybe (probably) that person won’t pitch as well, but he’ll pitch well enough: he’ll play the game, even if he won’t win it. And Koufax would have no reason not to make sure somebody pitches the game.
By contrast, a doctor who believes abortion is murder would likely have a real problem referring a patient to another physician who would perform the procedure.
My understanding is that pre-Bush-era rules provided the Koufax level of protection – that is to say, they protected doctors and nurses who refused to perform abortions or directly assist in performing abortions from losing their jobs or otherwise being punished for their conscience. The new rules were designed to be broader in scope and allow personnel to refuse to participate in any fashion – including, for example, refusing to refer to other physicians who would perform the procedure, or even refusing to provide information to patients about abortion providers.
Now, I understand full well why a doctor who believed abortion was profoundly immoral would not be comfortable referring a patient to an abortionist. But that’s where the Koufax analogy breaks down, it seems to me.
— Noah Millman · Apr 22, 07:02 PM · #
Obama & Co. would disqualify those who took the Hippocratic oath from practicing?
I would have been extremely unhappy and uncomfortable at being forced to accept prenatal care from an ob-gyn who was killing babies between our appointments. I could not have trusted that person to take necessary steps to ensure our baby’s health before and after birth. Are we going to be driven into back allies and neighboring states to get prenatal care for children with disabilities from pro-life doctors?
The Cardinal is right. Second grade summer Bible school: “We ought to obey God rather than men.” Acts 5:29.
That freedom has been basic to the USA’s identity as a country, in the past. If we lose that, part of our essential core will have been discarded.
My father was a conscientious objector during the Korean War, when it meant refusing to take human life. He was put on a career path into health care because of it—not in spite of it.
— Julana · Apr 22, 07:08 PM · #
There’s another, more important way the analogy breaks down, however – or, actually, cuts the other way. Objections to abortion are not like objections to working on Yom Kippur, because there is no way to build a moral case against working on Yom Kippur. One declines to work on Yom Kippur in obedience to a specific command from God (or attachment to a tradition that posits such a command), but one would not expect one’s reasons for declining to work to be comprehensible to someone who did not experience that sense of command (or who lacked an attachment to that tradition).
By contrast, the profound moral objections to abortion take a form that is fully comprehensible to anyone, whatever their religious tradition. Those reasons can be disputed, and rejected, but they are reasons – they can be reasoned with.
I don’t know whether Jehovah’s Witnesses may perform blood transfusions, given that they are not supposed to receive them, but let’s say there’s a physician who is a Witness who will not perform transfusions for religious reasons. Depending on his or her specialty, that might or might not be reason enough for him to pick another profession (psychiatrist: no problem; cardiac surgeon: well . . .). But there would be no reason to contemplate broad protections for the physician protecting him or her from being punished for that “recusal” because no one would interpret that act of conscience as an objection to anyone else’s involvement in the act of performing blood transfusions.
Not so with abortion. Precisely because of profound moral contention over abortion, there is both reason to seek such broad protections and reason to object to such broad protections. Those who object in a fundamental way to the morality of abortion should not be satisfied by being allowed to recuse themselves – they should seek to keep their hands as clean as possible by avoiding any involvement in the activity. And those who see abortion as morally unproblematic, and the right to reproductive freedom as morally essential, will rightly want to restrict the zone of protection to the minimal scope of refusing to actually perform the procedure.
By extending a broader zone of protection, society is endorsing the notion that abortion is something about which there are profound moral disagreements, which it is attempting to accommodate as best it can. By narrowing the zone of protection, society is endorsing the notion that objections to abortion amount to religious dissents from normal social behavior comparable to, say, refusing to play baseball on Yom Kippur.
— Noah Millman · Apr 22, 07:23 PM · #
Noah, your first objection assumes that the pro-life doctor is the only means by which a patient might be referred to an abortion provider, but that’s obviously not true. There are many ways to find abortion providers.
Your second objection seems to be built on the claim that a given religious observance — or the observance of Yom Kippur, anyway — is “not comprehensible” to people from other religious traditions or none. But this too seems obviously wrong. I think I can comprehend many religious practices that I don’t follow. So I’m lost at the outset of that argument.
— Alan Jacobs · Apr 22, 07:33 PM · #
I have a lot of thoughts on this, but they’re all mashed up and I haven’t figured out how to get them out in a way that isn’t overly provocative.
Meanwhile, I’m at home with our children while my wife is at the trade show where a year ago we met retailers from Utah and Nevada who decide they could not carry our films for fear of prosecution. I ask, with an equal measure of sarcasm and sincerity, if I recast what I do as a religious observance, can I count on your full support when/if we take on the powers that be and assert our right to participate in the marketplace of ideas?
— Tony Comstock · Apr 22, 07:53 PM · #
Julana – can you explain who was forcing you to accept pre-natal care from that person? Nothing in the rules Obama re-established will make you do that, and nothing in Bush’s rules would have made you do that, either. In fact nothing under any proposed or actual universal health care plan would have made you do that. Even under full-on universal cradle-to-grave socialis-o-care, you can get another doctor if you have objections to the one you have.
— Chet · Apr 22, 07:58 PM · #
Fish isn’t arguing that objectors on occasion want to opt out of playing ball, he’s arguing that objectors want to redefine the rules and duties of the game during play.
For Fish, a doctor who objects to performing abortions would be be like an outfielder who will catch a fly ball, but will not stop a long line drive in his direction.
This holds only if abortion is successfully defined as a standard medical procedure of no moral consequence.
This is a sign of how abortion can further corrupt the medical profession. “What is not forbidden is mandatory.”
— Kevin J Jones · Apr 22, 08:03 PM · #
Okay, I’ll see if I can get this one out without setting the thread on fire.
In days not so long ago, it was not uncommon for doctors to kill babies that were born with deformities that were fatal. This was an open secret in the medical profession and of course along with the babies that were obviously going to live short agonizing lives, there were also babies that were born with conditions that less severe. Doctors used their best medical judgement to decide which babies should be euthanized, which should be allowed to die natural deaths, and which should they should attempt to save. I have met doctors who practiced during this era. I have even met a few who admitted to having killed newborn babies. I have no doubt they were good men acting in accordance with their conscience. I know one of them was devoutly religious.
For now I don’t have anything to add to that, except that on a previous thread here at TAS a commenter said something about how, when discussing these sorts of things, we always imagine we’re the ones that are gong to be in the drivers seat.
— Tony Comstock · Apr 22, 08:20 PM · #
“I have no doubt they were good men acting in accordance with their conscience.”
No doubt? Why did they merit that kind of certainty?
— Kevin J Jones · Apr 22, 10:15 PM · #
I’m afraid the action you describe automatically disqualifies those doctors from being “good men”.
And it also bears mentioning that the ancients who burned their infants to Moloch were most certainly devoutly religious.
— Ethan C. · Apr 22, 11:32 PM · #
This last Summer I met a doctor at the beach. While our daughters played, we struck up a conversation. I asked him about his work, and he told he worked in critical care, which means he mostly works with patients who are dying.
He went on to tell me that when he first started practicing he was somewhat idealistic, so he would, in accordance with his medical judgement and conscience, withhold mentioning treatment options which in his best opinion offered a vanishingly small chance of either prolonging patients lives or improving what time they had left.
But over time he became cynical and realized there was no reason for him to take the personal and professional risk of not making his patients aware of every option, no matter how expensive and improbable it was that the treatment would be of any benefit at all.
I didn’t get to know him well enough to form a judgement as to whether or not he was a good man. Nothing he said to me made me think that he was a bad man, or a bad doctor.
— Tony Comstock · Apr 22, 11:57 PM · #
Additionally – should we really be encouraging doctors to be making medical decisions from a basis of anything besides what’s in the patient’s best medical interest? I don’t want to go to a doctor and wonder if their advice is their best medical opinion, or simply the opinion least objectionable to a set of unannounced religious strictures.
— Chet · Apr 23, 02:05 AM · #
Are there really doctors out there being forced to perform abortions? I have a hard time imagining how this might come up.
— cw · Apr 23, 02:25 AM · #
Alan,
So I’m a hundred percent sympathetic to doctors or pharmacists who refuse to participate in or make referrals for abortions (/“terminations of pregnancies”), but it’s a long way from that sympathy to the belief that there should be laws protecting them from being fired. I suppose your hypothetical outfielder might be under contract, but it seems to me that his unwillingness to play on the Sabbath would certainly be a legitimate consideration for teams who might think about signing him. Similar considerations are relevant to the real-life cases at issue here, and it seems a mistake to insist that freedom of conscience must mean freedom from consequences.
Firing someone for refusing to perform or refer to an abortion is unjust, but then again so is performing or referring to an abortion in the first place – so it’s a screwed up business from the beginning. But if the business in question is allowed under the law, making it illegal to fire an employee who refuses to go in for it strikes me as an excessive response to the (further) potential injustice at stake.
— John Schwenkler · Apr 23, 03:53 AM · #
I think Rob Vischer (who blogs over at Mirror of Justice) has written a couple of interesting things about protecting conscience along with protecting institutions’ autonomy.
It seems to me, though, that John is understating the problem here a bit, at least so far as contraceptives and pharmacists are concerned since it is the law in Illinois at least (is it not?) that pharmacists must be willing to dispense medicines even against their conscience or risk losing their license. So it’s not just Walgreen’s but the state that’s effectively doing the firing. And the effort to trim these conscience provisions (or gut them entirely – or however one might describe them) seems to me part of a larger effort to make abortion in particular more widely available, to include requiring hospitals receiving public monies (all of them, that is) to perform abortions.
— Bryan · Apr 23, 04:13 AM · #
If what Bryan suggests is right, then yes, I was understating the problem. I’d have trouble believing, though, that the law wouldn’t leave firing up to the discretion of the employer … then again, there are lots of true things that I have trouble believing.
— John Schwenkler · Apr 23, 04:18 AM · #
//Are there really doctors out there being forced to perform abortions? I have a hard time imagining how this might come up.//
Not at present, but it’s a concern. New York City has made it mandatory for OB docs to receive abortion training. Yeah, there is an exception if you have a moral objection. Complaints about how people not willing to perform facets of the job should choose another line of work makes me concerned that the restriction could be lifted. Hopefully program’s like NYC’s will provide enough doctors with enough training that they won’t need any more help, but it’s one of those things that is going to vary from place to place (how many NYC-trained docs are going to relocate to North Dakota?).
The more immediate concern, though, is if the federal government mandates availability at hospitals receiving any federal funding. That could easily make it so that if you want to work at (or have privileges in) a hospital that accepts federal funding, you have to be willing to do it. A lot of OB hospitals would close down before performing abortions, so they might be taken over by the government… and impose that requirement.
Schwenkler states (and I agree in a vacuum) that hospitals should have the right to fire doctors that won’t do what the hospital needs them to do. The federal government of course has the right to attach strings to its money. So one government coerces hospitals coerce its employees. No one is technically being <i>forced</i> to do anything. Unless, of course, you are trained in rural medicine and plan to work in your specialty.
I think that Obama is too smart (and too cautious) to let any of this happen, but a lot of what he has said on the subject makes me concerned. The availability of abortion is apparently very important to him.
(Disclaimer: My wife is a rural physician with extensive OB training and an ethical opposition to abortion [though she doesn’t believe that there should be a law against early-term]. The chances of the above happening are not great, but the fact that it’s possible horrifies us.)
— Trumwill · Apr 23, 04:34 AM · #
One more story, then I’m to bed.
9/11 sort of threw my wife and I for a loop — emotionally, professionally, financially. By the end of 2004 we reached the point where we said to each other, if we don’t try to have another child now, it will be too late. We resolved to give ourselves some unspecified time to conceive and then we would begin looking into adopting a child. (You might remember this was right after the Indian Ocean Tsunamis. I don’t know if it’s correct, but the figure that stuck in my head was 250,000 orphans.)
As it happened, my wife was pregnant only a couple of months later, but by this time her age put her pregnancy in a higher risk category for birth defects. At a certain point she came home from the OBGYN with a bunch of pamphlets explaining what tests could be done, what the risks were of various test, what could and could not be known from these tests about fetal health, and what could and could not be done for a fetus or newborn that had the various birth defects that might be discoverer in these tests.
I suppose at one end of the spectrum lies the possibility of testing, discovering the child has some sort of abnormality, and deciding to abort; and at the other end one could decide to do no tests and simply deal with what ever fate had in store for us.
What we ended up deciding was that we would do whatever the recommended tests were, and if the results of these test suggested that further testing was warranted we would do those test as well. We also decided that unless the tests reveled that the child had a deformity so sever that it could not live outside the womb, my wife would carry the pregnancy to term and we would raise the child as best we could. I remember saying something along the lines of “We’ve had an awful lot of good luck in our lives. If that’s what’s in store for us, I am ready to accept that an try to make the best of it.”
Jump forward several months. All tests indicate that our baby is fine. Our first child has her heart set on a sister, so we’ve decided to determine the sex of the baby so that if it’s a boy, we can start getting her excited about the idea of having a baby brother.
At about 2AM we leave our house and begin the 40 minute drive to the hospital. Along the way it become apparent that this baby is going to come much more quickly than the first and I begin running red lights. When we get to the hospital I walk my wife into to ER. She’s taken away in a wheelchair and I go and park the car.
10 minutes later I am in the delivery room with her and two minutes later our second baby is born. She is grey-blue and as limp as a rag doll. I think she might be dead. The doctor and nurses are moving around very purposefully and I don’t know if my wife has seen her limp, grey child, so small, flopped lifelessly over the palm of the doctor’s hand as he carries her to the table where they begin to work on her.
If my wife’s seen what’s happening, I want to reassure her; if she hasn’t, I don’t want to alert her to the problem until I have a better idea what’s going on. Maybe it’s nothing, or maybe it’s the worst possible thing. I remember thinking, “We’ll get through this. It will be hard, but we’ll get through this.”
As it turns out, what had happened was quite routine. Babies need all that squeezing they get on the way out to get them ready for the world, and when they’re born too fast, they are often “stunned”; grey and lifeless looking, just like our daughter was. They ventilated her, and rubbed her and roughed her up a bit and she came to life and let out a howl and pretty much hasn’t stopped since.
There’s no real point to this story vis a vis this thread, except that it’s on my mind. My sister had something much worse happen around pregnancy, and birth defects and abortion. But that’s a story for another day. Right now it’s time for bed.
— Tony Comstock · Apr 23, 04:34 AM · #
So yeah, again, the things that Trumwill describes are obviously a big deal. I suppose I don’t think that the government’s right to attach strings to its money means it has the right to require the provision of abortions; to the contrary, I think that any such strings should require not performing abortions, and indeed that abortions shouldn’t allowed to be performed at all. But short of that, I think the most just situation is for the government to stay out of the business altogether and let hospitals, pharmacies, etc. set their own policies on hiring and firing – and performing or not performing abortions, etc. – as they see fit. If Obama’s going to aim for another extreme, that’s bad news.
— John Schwenkler · Apr 23, 05:19 AM · #
Tony, I remember being similarly terrified when our son was born. I don’t think I had ever realized what babies go through just to get here. Your other comments, I think, are on health/ethics issues that are similar to the ones I raised, but sufficiently different that they would need to be considered separately.
And John, I don’t know whether you think you’re disagreeing with me, but FWIW, I don’t think you are. My point was that the baseball team could legitimately decide that the Sabbatarian outfielder is more trouble than he’s worth — he misses too much work — but that if the Dodgers had cut Koufax for not pitching on Yom Kippur they would surely not be making room for a legitimate exercise of conscience. (They would also be morons, but thats not relevant to this post.) And my larger point is that the Obama administration seems to be intent on erasing that useful distinction: they’re moving towards a world in which every exercise of conscience places you in the camp of the Sabbatarian outfielder.
— Alan Jacobs · Apr 23, 11:58 AM · #
I hadn’t intended to raise heathcare issues, so much as to ponder the meaning of “an act of conscience”, which I understood this post to be about, with baseball and abortion as useful points of reference. If you don’t want to talk about what should or should not be done with infants that are born mortally wounded, we can always talk about my films. I’d add winkie, but somehow that feels like it would be in poor taste.
— Tony Comstock · Apr 23, 12:27 PM · #
So it’s all of a piece, then? Any viewpoint that says abortions should be avaliable is inherently invalid, and must not be considered or allowed for under any means?
At least the pro-choice side is willing to compromise – we’re not trying to force anyone to have an abortion they don’t want. It’s amazing that we can’t seem to get the same courtesy from people like you. There really is no law you wouldn’t support if it made abortions harder to get, right?
— Chet · Apr 23, 04:38 PM · #
Alan, critical point – did Sandy Koufax need a new law to keep his job as a pitcher?
All Obama has done is get rid of a law that was unnecessary to protect the Koufaxes and granted unreasonable protections to the hyper-Sabbatarians. “Seems intent on erasing the distinction”? That would seem to describe the people that brought the law forward in the first place; i.e. the Bush Administration.
— Chet · Apr 23, 04:41 PM · #
Chet: Did you read a single thing I said? I was arguing that people SHOULDN’T be protected from being fired if they refuse to do things that are legal according to the law.
It’s amazing I can’t seem to get the courtesy of an honest reading from people like you. There really is no level of misrepresentation you wouldn’t go in for if it enabled you to impugn the opposing side, right?
— John Schwenkler · Apr 23, 05:20 PM · #
Alan, it’s hard to engage your argument because your categories are so broad. Health care professionals? Are you saying dermatologists can opt out of doing abortions? Or that OB/GYN can opt out of having any training related to abortion? Lumping abortion and contraceptives together? As Chet points out, most pharmacists probably fill several contraceptive prescriptions every day.
— Michael Straight · Apr 23, 06:42 PM · #
Theyre not my categories, Michael: see the quotation marks? All I wanted to do in this post was to suggest that we can’t just say “conscience trumps all” or “conscience is irrelevant” — we need (we have historically used) what I call a sliding scale. If you want more fine-grained analysis of individual cases, I don’t think a blog post is the place to look. Not my blog posts, anyway!
— Alan Jacobs · Apr 23, 11:33 PM · #
Fellas,
Don’t let the passions aroused by abortion cause you to breech the standards of etiquette here at TAS. They are more valuable than any point you might make. I’m actually serious here. The etiquette and the generosity and good will behind it is one of the main reasons I spend (waste?) so much time here. And it is pretty unique, in my experience.
— cw · Apr 24, 12:08 AM · #
I know that sounded like I wear puffy-front dockers (though of course, I don’t), but I stand by the sentiment.
— cw · Apr 24, 12:15 AM · #
Wow—boil and bubble.
For Chet—no one was forcing me to accept pre-natal care from such a doctor. I’m looking at the future, given the direction things seem to be going, responding to the video link as much as the post.
— Julana · Apr 24, 03:06 PM · #
Could you be more specific? What specific legislation is on the table to force you to receive medical care from pro-abortion practitioners? What mainstream organization has suggested such legislation?
— Chet · Apr 24, 05:27 PM · #
Hi Chet,
There is no specific legislation on the table and no such suggestion from a mainstream organization, as far as I know.
Hope you’re having a good weekend.
— Julana · Apr 26, 10:10 PM · #