Without a conscience, what is a doctor, nurse, or pharmacist except a technician willing to follow the whims of law?
(Again, this is not sound-bite material!) I received an e-mail from the American Defense Fund concerning the lawsuit against the State of Arizona by Planned Parenthood over a law to protect those of us in medicine who have consciences.
The ruling overturned a two year old injunction that prevented quite a few limitations placed on abortion in the State, including informed consent, parental consent, and the requirement that doctors, not nurses, perform abortions as well as the conscience issue.
Over the last decade, there have been several deliberate attacks against the right of medical professionals to obey our consciences and to refuse to provide services that we do not believe are “medical care.” I’ve tried to cover them at LifeEthics.org., even though I had a hard time keeping my promise to avoid politics and religion on that blog.
The articles at LifeEthics.org include this one from the American Journal of Bioethics, this one by a lawyer writing in the New England Journal of Medicine, and this one from this year about the Obama Administration’s refusal to protect the conscience.
Here’s the update, dated August 11, 2011:
A litigation update:
The Arizona Court of Appeals issued an opinion today on conscience rights.
In a case litigated partially by the State, partially by the Speaker of the Arizona House, and partially by ADF, BDF, and CAP on behalf of a variety of pro-life medical groups (Ave Maria Pharmacy, Christian Medical and Dental Associations, Christian Pharmacists Fellowship International, American Association of Pro-Life Obstetricians and Gynecologists, and Catholic Medical Association) . . . . . . the Court upheld Arizona’s state conscience protection statute Ariz. Rev. Stat. § 36-2154, against a challenge by Planned Parenthood of Arizona. The Court also upheld the right of the aforementioned pro-life groups to intervene in the case to defend the conscience law.
Here is the opinion,http://azcourts.gov/Portals/89/opinionfiles/CV/CV090748.pdf and below I provide some highlights.
The conscience statute protects hospitals, physicians, and staff from being involved in abortion, and all of the above plus pharmacists and pharmacy employees from being involved in any abortive or anti-implantive drug or device. The Court of Appeals’ decision reverses an injunction that Planned Parenthood had obtained below in the Arizona trial court, which had enjoined not only conscience protections but a bunch of pro-life provisions of Arizona law (including laws about parental involvement in abortion, prohibiting non-doctors from performing them, and other pro-life measures).
PP threw the kitchen sink of anti-conscience arguments against this conscience statute, and the Court specifically addresses PP’s arguments on pages 32-37, saying some very helpful things against some of the popular “access” arguments we all hear against conscience rights. (The Court does unfortunately characterize the conscience statute as “refusal provisions.”)
Among the arguments the court smacked down are the following:
- The Court rejected PP’s argument that conscience protections violate a woman’s right to access abortion. The Court gave several reasons. First, in a previous case the Court had upheld an Arizona law prohibiting abortions at state university hospitals, saying “Even as plaintiff does not have an absolute right to an abortion on demand, she also does not have the right to select any public facility she chooses for an abortion.” By extension, therefore, the Court held that since “Even a state actor can refuse to facilitate an abortion,” it is even more true that private actors can refuse.
- In addition, the Court declared that the conscience law protecting private individuals and institutions can’t possibly violate a woman’s constitutional rights because “any reproductive rights that might exist under [the Arizona Constitution] can only be asserted against governmental acts, not the decisions of private individuals. . . . Therefore a woman’s right to an abortion or to contraception does not compel a private person or entity to facilitate either.”
- The Court further noted: “In its arguments below, PPAZ also contended the statutes would ‘thwart women’s ability to chart their own medical course.’ As explained above, whatever right a woman may have to ‘chart her own medical course,’ it cannot compel a health-care provider to provide her chosen care.”
- The Court rejected PP’s argument that the conscience law “allows medical professionals to abandon their patients, even in an emergency.” The Court pointed out that because the Arizona Constitution protects common law medical malpractice actions from being abrogated by statute, the conscience statute therefore does prevent a woman from suing any physician for denying her the standard of care, whatever that might be. A woman’s ability to impose malpractice liability therefore defeats the argument that the conscience statute allows abandonment in an emergency.
- The Court rejected PP’s argument that the conscience statute “justif[es] practices inconsistent with the peace and safety of the state.”
- First, “no authority suggests that permitting individuals to choose whether to facilitate abortions places the peace and safety of the state at risk.”
- Second, the Arizona Constitution says that constitutional protections for conscience do not protect violations of peace and safety, but it does not prohibit the legislature from protecting conscience even more than the constitution happens to do.
- Third, the “peace and safety” limitation is merely a limit on how far judges are supposed to interpret the constitutional protections; it does not allow private citizens to sue to contend that too much conscience is being protected.
- Notably, the Court observed that the conscience statute may well protect employees of Planned Parenthood who object to involvement in abortion, but it went on to reject PP’s above arguments anyway.
Presumably PP will appeal this case to the Arizona Supreme Court, but the Court has discretionary review so it could simply deny the petition. In any event, the case will go back down to the trial court for final proceedings (to the same judge who issued the injunction), because this was just a “preliminary” decision.