Editor's note: Robert P. George is a member of the Deseret News Editorial Advisory Board. He is McCormick Professor of Jurisprudence and director of the James Madison Program at Princeton University. Recent litigation has reignited debate about health care practitioners' rights of conscience. An earlier version of this piece appeared in The Public Discourse, an online publication of the Witherspoon Institute.
In a report on the role of conscience in medicine, the American College of Obstetricians and Gynecologists (ACOG) discussed whether or not physicians should be allowed to follow their consciences in refusing to perform morally contested procedures like abortion. Perhaps most controversially, the report suggested that in some cases physicians should be compelled to perform abortions. Why is this problematic?
The ACOG Committee report is an exercise in moral philosophy. It proposes a definition of conscience, something that cannot be supplied by science or medicine. It then proposes to instruct its readers on "…the limits of conscientious refusals describing how claims of conscience should be weighed in the context of other values critical to the ethical provision of health care."
Knowledge of these limits and values, as well as knowledge of what should count as the ethical provision of health care, are not and cannot possibly be the product of scientific inquiry or medicine. The recommendation offered by those responsible for the ACOG Committee report represents a philosophical and ethical opinion — their philosophical and ethical opinion.
The report goes on to "outline options for public policy" and propose "recommendations that maximize accommodation of the individual's religious and moral beliefs while avoiding imposition of these beliefs on others or interfering with the safe, timely, and financially feasible access to reproductive health care that all women deserve."
Yet again, notice that every concept in the committee's report — the putative balancing, the judgment as to what constitutes an imposition of personal beliefs on others, the view of what constitutes health care or reproductive health care, the judgment about what is deserved — is philosophical, not scientific or, strictly speaking, medical. To the extent that they are "medical" judgments even loosely speaking, they reflect a concept of medicine informed, structured and shaped by ethical judgments.
Those responsible for the report purport to be speaking as physicians and medical professionals. The special authority the report is supposed to derive from their standing and expertise as physicians and medical professionals, yet at every point that matters, the judgments offered reflect their philosophical, ethical and political judgments, not scientific or medical expertise.
These judgments are contestable and contested. They are contested by the very people on whose consciences they seek to impose — the people whom they would, if their report were adopted and made binding, force into line with their philosophical and ethical judgments or drive out of medical practice. And they are contested, of course, by many others. And in each of these contests a resolution one way or the other cannot be determined by scientific methods. The debate is philosophical, ethical or political.
Lay aside for the moment the question of whose philosophical judgments are right. My point so far is only that the report is laced with philosophical assumptions, reasoning and conclusions that do not proceed from a basis of moral neutrality. It represents a strikingly partisan position.
Its greatest irony is the report's concern for physicians' allegedly imposing their beliefs on patients by, for example, declining to perform or refer for abortions — or at least declining to perform abortions or provide other services in emergency situations and certainly to refer for these procedures.