More “Access” Means Less Care

A thought experiment: Imagine you are an operating room nurse. You have built an excellent career and are skilled in a variety of challenging procedures. You work in an outpatient clinic with a cooperative, effective team.

But your clinic is part-owned by a major university, whose medical elites seek to prop up the marginalized state abortion industry.

So they decide to start offering late-term abortions, but not in their own backyard. Without consulting your 100 co-workers, most of whom later object, university officials declare that your workplace is now a late-term abortion clinic. You may even have to assist.

Think this scenario is farfetched? Think again. Earlier this year in Madison, Wisconsin, the University of Wisconsin Hospitals and Clinics (UWHC) announced it will begin performing 20-to-22-week elective abortions at a rate of about 120 a year. But not in its own buildings. Instead, the UW and its co owner, Meriter Hospital, are forcing a clinic they own, the Madison Surgery Center (MSC), to perform them. And there may be nothing MSC’s employees can do to stop it.

Abortion is always at the forefront of public discourse. But recently it has taken center stage as never before, in part because of unprecedented attacks on the conscience rights of health care providers who wish not to participate in life-destroying procedures. The Wisconsin controversy exemplifies an emerging trend as abortion advocates push to make abortion occur within mainstream and respected institutions.

A MATTER OF INDUSTRY SURVIVAL

The shrinking number of doctors willing to perform or train for abortions has made bringing the procedure into the mainstream a matter of industry survival. And it has therefore made conscience protection an intolerable obstacle to the so-called “right to access” abortion. But since proponents of “choice” would deny doctors the choice not to assist abortion, and deny pro-life patients the right to “access” prolife doctors, the result may be decreased medical access for millions of Americans.

When the UW announced that its tranquil Madison Surgery Center would become a late-term abortion clinic, pro-life and pro-choice employees alike were aghast. MSC anesthesiologist Nancy Fredericks testified against the decision at a February UWHC board meeting, saying that a “large majority” of the employees object to their own involvement. But by then the plan’s approval was a foregone conclusion.

Pro-life employees called the Alliance Defense Fund, which began insisting that state and federal laws protecting employee conscience rights be honored. ADF attorneys obtained UWHC emails that revealed not only long-held secret plans to force the center to perform abortions, but also evidence that a similar strategy is being implemented in hospitals throughout the country.

The plan’s impetus was the semi-retirement of a local late-term abortionist. Medical elites saw it as both a crisis and an opportunity to train medical students in-house on late-term abortions and to make abortion a more familiar, mainstream procedure in the medical community. Planned Parenthood of Wisconsin’s lead abortionist emailed the UW’s abortion advocates and stated their shared ideological goal: “to safeguard hospital-based abortion practices.”

But the stigma of abortion reared its head. Caryn Dutton, a UW faculty member and Madison Planned Parenthood abortionist, wrote in an email to her UW and Planned Parenthood coconspirators: “the vast majority of ob/ gyns in town are supportive, but other specialties and departments are terrified of having abortion happening ‘in their space.’”

This sentiment is universal. The prolife group Life Dynamics, Inc. (LDI) published a book called Access, which is a compilation of hundreds of quotes by abortion industry officials underscoring how, because of abortion’s stigma, “the medical establishment has yet to welcome abortion providers.”

Madison abortion advocates enlisted the help of David Grimes, a longtime abortionist in medical academia. Grimes leads the charge to, as he says, “put abortion back in the mainstream of medicine.”

Grimes encouraged performing second trimester abortions at MSC. The only obstacle was the conscience rights of MSC’s staff members. Once some employees heard about the plan, one of Dutton’s colleagues fretted that “there may be no staff on site willing to help.”

In an interview, LDI President Mark Crutcher explained why abortion promoters must oppose conscience rights to survive. “The abortion industry admits that its biggest failure has been the inability to bring abortion into mainstream medical practice,” he said. “Now because that won’t happen voluntarily, they have to look to coercive measures to do it.”

The US Catholic bishops similarly contend that the new attacks on conscience have been prompted by the “desperate desire by abortion proponents and others to legitimize procedures that carry a stigma in the medical profession and society at large…. If abortion had to be provided in all hospitals, this would lend the impression that it is basic health care.”

According to the Guttmacher Institute, a research organization affiliated with Planned Parenthood, the number of hospitals offering abortions dropped from 1,654 in 1977 to 603 in 2000. This coincided with a roughly 50 percent drop in the number of surgical abortionists. As Susan Hill, president of the National Women’s Health Foundation, told the Washington Post in September, “Our doctors are graying and are not being replaced…. The situation is grave.”

Conscience protections were once a bipartisan assumption based on America’s founding values. US Supreme Court Justice Harry Blackmun, author of the Roe v. Wade and Doe v. Bolton abortion decisions, approved conscience protections and even emphasized the abortion “right” as one belonging to the physician’s judgment as well as the woman’s.

Promptly after Roe, the United States Congress and most states overwhelmingly passed conscience protections. The federal government eventually added laws that protect hospitals, medical schools, individuals and states from conscience-violating mandates. But the deepening abortionist shortage and consequent need to bring abortion into the mainstream has put the industry’s survival on a collision course with conscience rights.

THE ABORTION ACCESS PROJECT

International groups like the Center for Reproductive Rights and Amnesty International have identified conscience protection as the primary obstacle to their goal of expanding legal and accessible abortion.

The United Nations Committee for the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) has scolded Croatia, Italy, Poland, Portugal, and Slovakia for not forcing pro-life doctors to assist abortions. President Obama favors subjecting US law to the CEDAW committee.

Planned Parenthood lawyer Dr. Julie Cantor, writing in April in the New England Journal of Medicine, puts the case bluntly: “Qualms about abortion, sterilization, and birth control? Do not practice women’s health.”

Abortion advocates frame the debate as an issue of patient autonomy and an absolute right to “access.” In an interview, Dr. Gene Rudd, Senior Vice President of the Christian Medical Association, explained that in the 1960s the medical field expanded its approach to patient information and decision making. But that movement was hijacked by abortion advocates. “Autonomy,” he said, “has been supported in medicine by those who also share the view that reproductive freedoms must be protected through autonomy.”

A patient’s right to be the ultimate decision-maker was transformed into a right to force doctors to do whatever a patient requests. “Access” became a concept not of opportunity but of compulsion.

Abortion proponents have put those ideas into practice. When Caryn Dutton needed help integrating late-term abortion into the UW, the Associated Press reports, she used materials from “an abortion rights center at the University of California-San Francisco.” That center is the Bixby Center for Global Reproductive Health, whose mission is “to help ob/gyn residency programs establish or expand hospital-based abortion services.” Bixby has established 51 such programs in the US as of July 2009.

In 1992, the National Abortion Federation crystallized its “Abortion Access Project,” aimed in part at “expanding both the number of providers being trained to provide abortions and the number of hospitals offering abortion services.” New York abortion advocates founded “Merger Watch” in 1996 to force Catholic hospitals to participate in abortions when they merge with private hospitals. They have helped more than 50 such campaigns nationwide.

In July 2009, a New York nurse represented by the Alliance Defense Fund sued her hospital for flouting federal conscience law by forcing her to assist with a 22-week abortion. Catherina Cenzon-DeCarlo was threatened by Mount Sinai Hospital with loss of her job and nursing license if she did not assist in violation of her Catholic beliefs.

Mount Sinai receives over $200 million in federal health funds every year, subjecting it to federal law that prohibits compelled assistance in abortion. In September, the hospital sought to dismiss DeCarlo’s lawsuit, contending that she cannot protect her conscience rights in court.

DeCarlo’s experience may soon become much more common. As Sean Higgins described in CWR’s June issue, the push for abortion expansion has led to unprecedented policy attacks. In November 2007, the American College of Obstetricians and Gynecologists and the American Board of Obstetrics and Gynecology threatened to prohibit board certification for ob/gyns unless they perform or refer for abortions.

Donna Harrison, MD, president of the American Association of Pro-Life Obstetricians and Gynecologists, explained in an interview that “if board certification is tied to a performance of or referral for abortions, those physicians who refuse will lose board certification. In order to practice in hospitals you have to have board certification.”

The ACOG/ABOG policy raised the alarm of Michael Levitt, then-secretary of the Department of Health and Human Services. In 2008 he oversaw the regulation that President Bush issued to make fund-recipients promise to follow applicable conscience laws.

Mere weeks after the Bush regulation went into effect, President Obama filed a regulation to rescind the rule. Obama and other abortion advocates insist that they support “sensible” conscience protections. But in practice this means that conscience clauses are swallowed by large loopholes.

The abortion movement’s concept of patient autonomy is ironic on many levels. Self-declared proponents of “choice” want to deny pro-life personnel their choice of a medical career and their decision not to assist with abortions. And patients would have a right to choose only what abortion advocates are selling—contraception, abortion, and assisted suicide. Women could not choose a prolife doctor for procreative care, because there wouldn’t be any such doctors—all ob/gyns would be required to perform and refer for abortions.

CONSCIENCE AS ONE -WAY STREET

If patient autonomy really includes the right to fulfillment of patient desires, then the medical industry must train pro-life ob/gyns, pay for Catholicfriendly fertility care, and ensure antieuthanasia elder care. But the abortion movement’s view of conscience is a one-way street.

The implications of increased attacks on conscience rights are particularly severe for Catholics. An absolute right to abortion access could destroy the growing national movement of Catholic birth and fertility clinics and Natural Family Planning-only medical professionals, who could not function if abortion or contraception assistance is mandated by licensing or universallyregulated health care.

“Access” absolutism also infects endof- life issues. The euthanasia movement, led by Compassion & Choices (C&C, formerly known as the Hemlock Society), uses the patient autonomy concept to clamor for assisted suicide.

The Montana Supreme Court heard arguments in September on a case in which the trial judge, prompted by C&C, mandated a “right” to assisted suicide with no conscience protections. In April C&C claimed that the unwillingness of Montana doctors to kill their clients frustrates the “right” to assisted suicide. Tellingly, C&C organized more than 5,000 comments against President Bush’s conscience regulations.

Catholic medical institutions increasingly are having to choose between civil disobedience and capitulation. After Washington state legalized assisted suicide in November 2008, the Catholic hospital network Providence Health and Services declared that it would not participate.

Washington’s law contains some conscience protections, but the protections exclude the dispensation of lethal drugs by pharmacies. Under pressure from Planned Parenthood for access to emergency contraception (EC), Washington in 2007 required all pharmacies to dispense any “lawfully prescribed drugs.” The federal appeals court preliminarily upheld that requirement this July. Therefore, according to anti-euthanasia experts Rita Marker and Wesley Smith, pharmacies must dispense lethal doses and complete suicide paperwork regardless of their religious objections.

Meanwhile, Connecticut now mandates that all hospital emergency rooms dispense EC to sexual assault victims. Connecticut’s Catholic bishops initially objected because EC might act as an abortifacient. But once the law was enacted the dioceses and hospitals changed their position, agreeing to dispense EC even when tests on the woman would show that the drug could not possibly achieve its main function of preventing ovulation.

The ultimate irony of absolutist “access,” the USCCB notes, is that “weakening conscience protection will reduce women’s access to all health care, by driving conscientious physicians and nurses out of medicine…. Many underserved areas, from rural counties to inner cities, are served only by religiously- affiliated health care providers.”

In a poll of pro-life doctors by a public opinion firm called The Polling Company, Inc./WomanTrend, 95 percent of respondents said they would retire or change fields rather than comply with compelled participation in anti-life practices. The Christian Medical Association has organized the Freedom2- Care coalition to call attention to the fact that violating conscience harms health care access.

Soon after the University of Wisconsin’s abortion plan was publicized in January, United States Congressmen F. James Sensenbrenner, Jr. and Paul Ryan sent a letter to UW President Donna Katen-Bahensky. They wanted assurance that she would fully inform employees of their conscience rights and would honor those rights.

Katen-Bahensky assured the congressmen that “participation…will be strictly voluntary.” But in May, the UW Medical Foundation wrote a memo to all MSC employees declaring that they would be expected to assist in “emergencies resulting from” lateterm abortions.

The Alliance Defense Fund pointed out that the UW was assuming illegal discretion to decide when violating conscience is “necessary.” As of this writing, the UW has given employees no detailed information about their conscience rights. And the abortions UW officials hoped would begin in January have yet to commence.

The dilemma for UW abortion advocates is the same dilemma faced by the national abortion industry: bring abortion into the mainstream and violate conscience rights, or go out of business. If abortion advocates get to decide who wins the clash between abortion and conscience, the outcome will be certain.