The Medical Right Wants to Deny You Health Care

This article was originally published on the website of the Religious Coalition for Reproductive Choice. You can read more about the right-wing assault on medicine here.

The Christian Medical and Dental Associations (CMDA) is pressing a major campaign to demand that physicians be permitted to refuse medical care to patients. The organization has made this campaign a centerpiece of its activities.

In the past three months, the organization has launched a fundraising drive on the rights of Christian doctors to refuse to provide services, a special edition newsletter, a website collection of resources and documents, a survey of members, a letter-writing campaign , and requests for prayers.

Dr. David L. Stevens, the organization's CEO, said on April 17, 2008, that CMDA is making physician refusals a top priority, based on its Biblical beliefs. The issue, said Stevens, is "a battle to determine the very future of Christians in healthcare."

CMDA is a behemoth among the medical groups aligned with the Religious Right, which the Religious Coalition for Reproductive Choice (RCRC) terms the "Medical Right." With an annual budget in excess of $11 million, CMDA operates an extensive complex in Bristol, Tennessee, and maintains an office in the Washington D.C. area. The organization claims to have 15,000 members, although not all are doctors. Its mission is to equip physicians to glorify God, influence patients towards "a right relationship with Jesus Christ," and advance "Biblical principles" in healthcare.

The organization has been particularly incensed by a November 2007 report from the Ethics Committee of the American College of Obstetricians and Gynecologists (ACOG). The ACOG report acknowledges that some doctors may ethically decline to provide abortions based on their beliefs or conscience but states that doctors are responsible for referring their patients to a provider who will perform the services.

CMDA opposes abortion and insists that referring patients for abortions is no different from performing them. "Though our members would comply with a request for transfer of a patient's medical record to another licensed medical practitioner, to refer a patient for an abortion involves moral complicity in the death of a human being," Stevens wrote in a letter to ACOG on April 9.

The April 17 CMDA "News & Views" newsletter notes that ACOG may "redo" the ethics opinion. But Gene Rudd, senior vice president of CMDA, said that the only acceptable ACOG response is a complete retraction.

"There is no way they can satisfy many people, including myself, if they want to compromise conscience," Rudd said.

In a press release, Rudd said he resigned from ACOG after the ethics opinion was released.

Using catastrophic language and heightened demands, Stevens sent a fundraising letter to CMDA members, declaring: "A dangerous new attack has been launched on our right to practice medicine according to conscience." He said: struggle for our 'right of conscience' is raging all around us -- and if we lose it, we may be denied admittance to training schools or even forced out of practice!" (as printed) Later, he adds, "Hyperbole? I wish it were."

CMDA said it intends to litigate, even to the Supreme Court, and to be "the ones framing the issues rather than those who seek to silence us."

Stevens also claims that Christians in general are at risk: "Christian doctors are the first line of defense in this battle. If we are ultimately stripped of a protection … then this right will soon be under attack in other professions, in our schools, and even in your church and mine!" So dire is the situation, he said, that "fundamental rights such as our freedom of speech will also fall like dominoes."

Jonathan Imbody, CMDA vice president for government relations, raised an implicit comparison between ACOG and Nazism in the April 7, 2008, CMDA newsletter. He quoted Pastor Martin Niemoller about the perils of not responding quickly to Nazi perils.

Imbody writes: "The worldview underlying the … words of ACOG is radical autonomy - a worldview that trumps the Scriptures, the Hippocratic Oath and any other objective standard conflicting with self-rule." Imbody insists: "Apart from a change of worldview -- a departure from radical autonomy and a return to objective ethical standards - ACOG can be expected to continue to elevate abortion autonomy over all rights."

The CMDA resource center includes a March 14, 2008, letter from 16 members of the U.S. House of Representatives, including five who signed as medical doctors and Rep. Christopher Smith (R-NJ), the head of the pro-life caucus in the House. In it, the representatives object to the ACOG ethics opinion, which, they say, could result in decertification of pro-life physicians. "(P)ro-life women would lose the right to choose OB-GYNs who share their moral convictions," they assert.

In February, CMDA sent a survey to its physician members, asking whether they had "been pressured to compromise your Biblical or ethical convictions" or been denied an opportunity because of a "right of conscience stand." CMDA says that it intends to use the stories to publicize the cause of doctors who face difficulties because of their religious convictions.

This intensified lobbying and public relations campaign is in addition to involvement in litigation. CMDA filed papers to intervene in litigation on the Weldon Amendment, which permits the federal government to withhold funds from entities that do not permit physicians to refuse to perform or refer for abortions (see below).

In 2007, CMDA also filed two briefs in pending cases that have issues of medical refusals on reproductive healthcare. One supports the refusal of two California doctors to perform artificial insemination on a lesbian patient; the other is on behalf of pharmacists in Illinois who oppose a rule requiring them to fill all legal prescriptions, including for emergency contraception.

Decision in Weldon Amendment Lawsuit
Does Not Require Religious or Moral Basis for Refusals

A little-noticed ruling from a federal district court in San Francisco could have a critical effect on the operation of state refusal clauses. In the ruling on March 18, 2008, the court turned down a challenge to a national medical refusal provision known as the Weldon Amendment and left the clause standing unimpeded. The decision by Bush appointee Judge Jeffrey S. White of the northern district of California ended litigation brought by former California Attorney General Bill Lockyer in 2005.

The Weldon Amendment states that the U.S. government may withhold federal funds from any federal, state or local entity that does not permit medical institutions or doctors to refuse to provide abortions or refer for them. After Congress failed to pass a separate bill with the same language, Rep. Dave Weldon (R-FL), aided by the Bush Administration, slipped the proviso into a 3,500-page omnibus spending bill for the year 2005. It has been continued every year since.

California argued that the Weldon Amendment conflicted with state law requiring medical providers to deliver all services, including abortion, in the event of an emergency. Officials said the Weldon Amendment could cost California $37 billion if the state were to enforce its own law and lose federal funds as a result. The state also argued that the clause created an undue obstacle to women's exercise of their constitutional rights to legal abortion services.

Three years after the lawsuit was filed, Judge White dispensed with the state's claim on a summary judgment motion, saying that no one had been harmed in California because of the Weldon Amendment, nor had the state lost any money. As a result, the judge said, the matter was premature for a decision by the courts and lacked "ripeness."

The result is to leave the Weldon Amendment in full force. The language of the Weldon Amendment states that it is "discrimination" to take action against medical personnel or institutions that refuse to provide abortion care or referrals, or that refuse to pay or cover them, for example, in insurance programs.

Unlike another federal provision, the Church Amendment, which allows doctors to refuse to provide abortion because of religious or moral beliefs, no religious or moral basis is required for refusals to be considered discrimination under the Weldon Amendment. To many observers, the language was seen as radical expansion of refusal clauses.

Previously, a federal court in the District of Columbia dismissed an action brought by the National Family Planning and Reproductive Health Association, saying that it lacked standing to bring a claim. That decision was upheld by an appellate court in 2006.

Although the California judge's decision is on strictly procedural grounds, Medical Right organizations have been celebrating the ruling. Several Medical Right groups had become formal intervenors in the matter, permitting them to participate on an equal footing with the state and federal government. The intervenors included the Christian Medical Association, the American Association of Pro-Life Obstetricians and Gynecologists and the Alliance of Catholic Health Care.

On a more serious level, HHS Secretary Michael Leavitt referenced the Weldon Amendment when he wrote to the American College of Obstetricians and Gynecologists (ACOG), objecting to an ethical opinion that said doctors who decline to provide abortions should refer the patients. Organizations representing anti-abortion doctors objected vehemently to the statement that doctors who would not perform abortions should refer patients to doctors who would do so. Leavitt said that any disciplinary action against doctors who refuse to refer patients could result in a loss of federal funding.

Leavitt wrote: "As you know, Congress has protected the rights of physicians and other health care professionals by (two laws and) … annually renewing an appropriations rider that protect(s) the rights, including conscience rights, of health care professionals in programs or facilities conducted or supported by federal funds."

States that have more restrictive medical-refusal laws than the Weldon Amendment can expect ongoing pressure to buckle to federal government demands and refuse to enforce their own state laws, or face a loss of federal funding.

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