Thursday, May 28, 2009

Abortion and Conscience

Here's the assignment I developed for today's section of Harvard Medical School's required first year course on "Medical Ethics and Professionalism":
Drawing on the articles by May and Aulisio ["Personal Morality and Professional Obligations] and Curlin ["Religion, Conscience, and Controversial Clinical Practices"], discuss how you would respond to a respected colleague who is strongly against abortion and feels he cannot in good conscience refer a patient to a potential abortion provider and should discuss his moral perspective with his patients.
All 13 students (and I) believed that abortion should be legal, available and safe. My aim for the class was not to have yet another repetitive discussion of abortion ethics, but to engage with the question of whether and how our divided society can reduce the level of rancorous conflict and collaborate despite deep moral differences.

We conducted a segment of the class as a dialogue/role play. One student and I took the role of the anti-abortion physician envisioned in the assignment. The rest of the group was assigned the role of chief of the practice. Here's a summary of the dialogue, written as if it occurred between two people:
Chief: I've been told that you are refusing to refer patients for potential abortion services and are telling them about your personal moral outlook. Is that true?

Physician: It is. I know that abortion is legal and that a majority of the population believes it should be. But it seems so clear to me that abortion is killing a baby-in-the-making that there's no way of not seeing it as a profound wrong. I can't possibly support that - even by referring a patient to someone else.

Chief: Medical ethics is built around patient autonomy - that people have a right to make their own medical choices among legal alternatives. People can refuse life-saving treatment, and two states allow physician assisted suicide!

Physician: I know what the law says. In the country I came from female circumcision was legal and widely practiced, but I refused to do it or refer for it because I saw it as a deep moral wrong. The fact that the law allows abortion or female circumcision doesn't make these practices right or morally acceptable.

Chief: If you can't bring yourself to provide information patients are entitled to maybe you should have gone into a different profession!

Physician: I love medicine, and the feedback we get shows that my patients feel respected and well treated by me. Abortion is the one area where there's a problem for me in the practice.

Chief: It would be better to steer patients who want to consider abortion away from you in the first place.

Physician: That's a good idea.

Chief: Another thing. When you talk with patients about your views, we don't want you using terms like "evil" or "murder." You're entitled to your own views. But people who I regard as just as morally serious as you - including myself - disagree. You can say what you want in a political discussion, but not when you're a doctor dealing with patients.

Physician: I can live with that...
My aim in the class was to challenge us to respect a colleague we deeply disagreed with and not to demonize him because John Salvi and James Kopp felt called upon to murder abortion providers.

As I wrote in a post a few weeks ago, I think the best we can hope for is a gradual reduction of the virulence of the pro and anti abortion debate. (I don't like to use "pro life" and "pro choice" - all decent human beings value both life and choice!) President Obama has made a promising start with the working group he convened and his speech at Notre Dame (see here). And versions of the class experience my students and I had today - if repeated in a few million settings - may make a difference as well.

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