Anti-Christ Legions of the Underworld

If you think that doctors should practice medicine according to their own consciences, you’re the Anti-Christ.

… ought to be the name of a Heavy Metal band.

But it’s actually how a spokesman for Colorado Right to Life described the ACLU, for its support of the right of a physician at a Catholic hospital to give medical advice dictated by medical research rather than by a bishop. Full quote: “It’s not surprising that the Anti-Christ Legions of the Underworld would use the police-state force of government to compel an institution to aid and abet the dismemberment of unborn children.” Note that the “police-state” tactic under discussion is defending a professional practicing his profession according to his own conscience against outside pressure.

Query to supporters of “conscience clauses” allowing individuals and institutions to opt out of providing medical services or products of which they conscientously disapprove: Do you believe that Dr. Demos is entitled to the conscientous practice of medicine? If not, what is the meaning of “conscience clause,” execept that everyone should have to conform his conscience to yours?

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

14 thoughts on “Anti-Christ Legions of the Underworld”

  1. I would say he is “entitled to the conscientious practice of medicine” at an institution where his conscience does not conflict with the institution’s aims. And I’d say that of a practitioner at a regular hospital who refused to perform some medical procedures on a religious basis, too.

    You really shouldn’t think you’re entitled to be employed some place, if your idea of what the job is differs from your employer’s.

    The real problem comes in when some third party imposes a conception of the job on both.

    1. This sounds to me like a complete repudiation of “conscience” clauses as currently written. The whole point of those laws has been that, say, pharmacists who refuse to dispense contraceptive over the counter or as prescribed, or doctors and nurse who refuse to participate in pregnancy terminations, cannot be disciplined by their employers. I’m glad to hear you stand with the sensible people at least a little.

      (As far as the hospital case goes, I think it’s unfortunate that the dispute is nominally located in the rights of the physician as was the case with Roe v. Wade and many subsequent cases. It makes much more sense for it to be about either unlicensed practising of medicine or behavior that makes a person or organization unfit to run a hospital. You can get booted out of the management of a casino or an airline or even a brokerage house for behavior that interferes with the rights of your customers to safe, proper treatment, but apparently not from the management of a hospital.)

    2. “I would say he is “entitled to the conscientious practice of medicine” at an institution where his conscience does not conflict with the institution’s aims.”

      The point is that the institution’s rule conflict with medical ethics, not just this doctor’s ethics.

      1. You do realize that, up until comparatively recently, abortion was considered to be just about the definative violation of medical ethics, right up there with assisting suicide, and had been for centuries? And it’s still, outside of situations of genuine medical necessity, seriously despised by most doctors. Polls have show that only a small fraction of OB/GYNs are willing to perform them.

        So, while medical ethics may have been nominally altered by political pressure, the docs don’t seem to be going along with it.

        My position is that, if you don’t want to do the job you were hired for, and instead demand to do some other job, you should go looking for somebody who’ll hire you to do what YOU want to do.

        An employer accomidating their employees’ religious preferences is really nice, but this is not the sort of thing employees should think they are entitled to demand, and keep their jobs.

        The government, of course, is in a different situation, as the 1st amendment applies to it.

        1. Dr. Demos doesn’t claim he was prevented from performing abortions. He claims he was prevented from discussing it with his patients. Giving patients incomplete or misleading information is, unequivocally, unethical—and that’s what the hospital was demanding that the doctor do.

        2. You do realize that, up until comparatively recently, abortion was considered to be just about the definative violation of medical ethics, right up there with assisting suicide, and had been for centuries?

          I’d like you to defend this assertion.

          1. I take it you’re unfamiliar with this thing called “the Hippocratic oath”?

            I take it that you are dodging the question, which is that you support your assertion that that is how the Hippocratic Oath was interpreted for centuries. Can you support that or not?

          2. We all may need a little help from Brett with respect to the Hippocratic Oath. The relevant passage reads, “ὁμοίως δὲ οὐδὲ γυναικὶ πεσσὸν φθόριον δώσω.” “In like manner, to no woman will I give an abortive pessary.” This forbids the administration of a specific method of abortion, namely a vaginal pessary, which carried a risk of ulceration. Other methods of abortion were well known to the ancients, mostly orally administered herbs such as ferula and pomegranate. It may be significant that a specific method of abortion falls within the wording of the oath. Later interpretations broadened the prohibition, so that in some English versions, “abortive pessary” is translated “abortive remedy.” It seems absurd to make your attitude towards the ethics of abortion depend on which English translation you consult.

            Two interpretations seem reasonable: the literal one is that Hippocrates was forbidding a particular method of abortion which carried a higher risk of complications than rival methods (advocates of safe abortion will favor this one); the looser one is that he was forbidding all methods of abortion. The second interpretation, on balance, seems to me to have a bit more support from the context of the entire oath, which is also against suicide. Both suicide and abortion were generally condoned by the ancients. Hippocrates held a minority opinion for his time. Brett’s interpretation of the oath actually does have support in tradition and history. Many ancient physicians rejected the school of Hippocrates because it went against prevailing norms.

            However, the original version of the oath has been abandoned by virtually every medical school in the US and the UK. Graduating medical students planning to go into surgery would have to swear not to use the knife for suffers of the stone (which often drove men to suicide), but to refer them to others trained in this art. The prohibition of teaching anyone outside the guild of physicians would seem to forbid a physician from teaching paramedics how to do their jobs, if strictly interpreted and enforced.

            Some applications of the oath would be interesting to see in modern practice. Hippocrates says that the first line treatment of any condition is dietetics, then pharmacology, and last of all, referral to a surgeon. If an emergency room physician is seeing a patient with a heart attack, should he/she begin immediate treatment with thrombolytics and other drugs, or should a nutritional approach be employed first?

            In other words, Brett, if you want to be a stickler on one point of the original Hippocratic Oath, why not on all of its provisions? What should be done with doctors who do not believe in Apollo?

            Or is this going to be another one of those selective applications of rigid principles?

          3. I guess I’m not so concerned with what Hippocrates meant by the oath he wrote and much more interested in how the oath was actually applied over the last century or so. Did physicians, particularly those in the U.S. actually use it to justify not discussing or practicing abortion at all?

    3. Brett, I’m sure you also agree with antitrust regulation of hospitals such that there is always a choice between institutions that practice based upon best evidence and those that restrict it, right?

    4. Medical and nursing professionals have a duty to the patient that, in cases where there is conflict, overrides their duty to serve the interest of their employers. Reasonable people can differ on what it means to have a duty to the patient, but this isn’t a case on the margins at all. It’s well established that patients should have (should be given) the information they need to make informed decisions about their own care. There is a long and atrocious history of what happens when that rule isn’t followed.

      1. This, too. When you get into the business of providing medical care you assume obligations that limit your ability to restrict what your employees can and can’t do.

    5. A couple of facts may help out here. It appears from the ACLU complaint that Dr. Demos was following a pregnant patient with Marfan Syndrome, which carries a high risk of aortic dissection if pregnancy occurs. He was measuring the diameter of the aortic root, practicing according to recommendations of ACC guidelines for adults with valvular heart disease, and planning to discuss abortion if the diameter was greater than 4 cm in diameter.

      The ACC guideline drew on published research which included Immer FF, Bansi AG, et al. Aortic Dissection in Pregnancy: Analysis of Risk Factors and Outcome (Ann Thorac Surg 2003;76:309 –14) . The money quote from the abstract is: “We found that aortic root enlargement (> 4cm) or an increase of aortic root size during pregnancy in patients with BAVD, and Marfan syndrome is associated with a considerable risk for the occurrence of Type A dissection. “

      Dr. Demos was adhering to standards of practice for his specialty. It is this with which Dr. Bellmore appears to have an issue. Perhaps he can contact the American College of Cardiology and set them straight.

      Perhaps he can also set them straight on other guidelines, such as those for the management of pulmonary hypertension with Eisenmenger physiology, for which the ACC also has published guidelines recommending abortion, preferably in the first trimester, in order to avoid the high maternal and fetal mortality associated with this condition.

      Who knew that the American College of Cardiology and the American Heart Association were the Antichrist Legions of the Underworld? Where would we be without the conservatives to reveal to us what has been concealed beneath a cloak of demonic deception?

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