ACOG may redo abortion conscience policy

Some anti-abortion doctors fear their board certification would be at risk if they refuse to refer patients to doctors willing to perform the procedure.

By — Posted April 14, 2008

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Under fire from anti-abortion physicians and Health and Human Services Secretary Michael Leavitt, the American College of Obstetricians and Gynecologists announced in March that it will re-examine a controversial November 2007 opinion outlining the limits of conscientious refusal.

The ACOG ethics committee opinion said physicians who have religious or moral objections to "standard practices," such as abortion, sterilization or the prescribing of contraceptives, are not ethically obligated to provide those services but do owe patients a timely referral to another doctor willing to deliver them.

For months, anti-abortion doctors have complained that the opinion disrespects doctors' rights to practice medicine in accord with their beliefs. But the controversy reached a crescendo when Leavitt released a letter to leaders of ACOG and the American Board of Obstetrics and Gynecology.

Leavitt expressed "strong concern" that the opinion might endanger conscience rights. A January ABOG bulletin indicates that a physician's board certification could be revoked for "violation of ABOG or ACOG rules and/or ethics principles." Leavitt worried that anti-abortion ob-gyns could be decertified for refusing to refer patients to other doctors willing to provide abortions. He said health care organizations that require ABOG certification could be in danger of violating the Weldon Amendment, a law barring recipients of federal funds from discriminating against doctors who refuse to perform or refer for abortions.

Leaders from the college and the board responded quickly, saying Leavitt's interpretation was off base.

In a letter to Leavitt, ABOG Executive Director Norman F. Gant, MD, said the organization has no policy on providing or referring for abortions. The issue is not a consideration in any of the board's certification requirements or exams, he added.

In a statement posted to the college's Web site, ACOG President Kenneth L. Noller, MD, said an ob-gyn's board certification is not determined or jeopardized by the doctor's adherence to the ethics committee opinion on conscientious refusal. But, Dr. Noller added, the college's executive committee "noted the uncertain and mixed interpretation" of the opinion and ordered the ethics committee to re-evaluate it as soon as possible.

An HHS spokesman said Leavitt is now "satisfied that the conscience rights of ob-gyn doctors will not be undermined by the board-certification process."

Doctors from both camps weigh in

Anti-abortion physicians, however, said reassurances from the current leadership are not enough.

"The policy as it's stated leaves significant potential for decertification and discrimination," said Joe DeCook, MD, vice president of the American Assn. of Pro-Life Obstetricians and Gynecologists, a special interest group within ACOG. "That may not be the intent, but the effect of the language is there, and we need some provision in the language that makes plain that this is not referable to our conscience convictions."

Gene Rudd, MD, vice president of the Christian Medical & Dental Assns., resigned from ACOG when he learned of the ethics opinion. While pleased that it will be re-examined, he said anything short of a retraction won't do. "There is no way they can satisfy many people, including myself, if they want to compromise conscience."

Physicians who support abortion rights blasted Leavitt's involvement in the matter and said ACOG should not change its original opinion.

Lee P. Shulman, MD, is an oral examiner for ABOG and immediate past chair of the Assn. of Reproductive Health Professionals' board of trustees. He said Leavitt's letter was "political mumbo jumbo" and that targeting ABOG was a "travesty" and "ridiculous."

The AMA policy on abortion states, "Neither physician, hospital, nor hospital personnel shall be required to perform any act violative of personally held moral principles." Also, an AMA ethical opinion states that a doctor may refuse to enter a physician-patient relationship when "a specific treatment sought by an individual is incompatible with the physician's personal, religious or moral beliefs."

But a 2007 Council on Ethical and Judicial Affairs report says "a conscientious objection should, under most circumstances, be accompanied by a referral to another physician or health care facility."

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External links

"The Limits of Conscientious Refusal in Reproductive Medicine," American College of Obstetricians and Gynecologists Committee on Ethics opinion, November 2007, in pdf (link)

"Physician Objection to Treatment and Individual Patient Discrimination," AMA Council on Ethical and Judicial Affairs, June 2007, in pdf (link)

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