Politics & Policy

The Corner

Ezekiel Emanuel Attacks Medical Conscience

One of Obamacare’s major architects, Ezekiel J. Emanuel, has just co-authored (with bioethicist Ronit Y. Stahl) a major attack on medical conscience in the New England Journal of Medicine. His position is that physicians must abandon their own moral sensibilities once they don the doctor’s coat.

Interestingly, Emanuel has also supported healthcare rationing, meaning that he believes in certain circumstances that patients should be denied efficacious care, in his case, based on invidious judgments by the medical authorities of the patient’s “quality of life.”

This is in keeping with the authoritarian heart of Obamacare and Emanuel’s general thinking–which parallels the trend among the medical intelligentsia to impose a unified morality on all doctors via standards of care guidelines.

That is certainly where Emanuel goes in his current article. First he and Stahl (correctly) write that doctors should not be able to refuse treatment based on prejudice against the patient, say, racism or anti-gay animus.

They then describe doctors not wanting to perform services for an obese person due to “sloth,” which they would provide for a patient of normal weight based ona “lifestyle choice’ criteria. But that is essentially the same thing as refusing treatment based on race or sex.

But that kind of discrimination among patients isn’t what the (growing) medical conscience controversy is all about. Rather, it deals with particular treatments, services, or interventions to which doctors object to providing for any and all patients.

In other words, it isn’t the patient that is objectionable, but the procedure.

Emanuel and Stahl would treat these objections in the same way they would prejudice based on persons. From, “Physicians, Not Conscripts – Conscientious Objection in Health Care:”

Objection to providing patients interventions that are at the core of medical practice – interventions that the profession deems to be effective, ethical, and standard treatments – is unjustifiable (AMA Code of Medical Ethics [Opinion 11.2.2]10).28″31

Making the patient paramount means offering and providing accepted medical interventions in accordance with patients’ reasoned decisions. Thus, a health care professional cannot deny patients access to medications for mental health conditions, sexual dysfunction, or contraception on the basis of their conscience, since these drugs are professionally accepted as appropriate medical interventions. 

This would mean that a Catholic doctor who opposes contraception would have to prescribe it–even if she informed her patients before being retained that she practiced medicine in accord with her church’s moral teachings, and would not prescribe birth control.

It would also require a pro-life ob/gyn to participate or be complicit in a non-therapeutic abortion, meaning one not required to protect the mother’s life or health–merely because it is accepted generally within the profession:

…abortion is politically and culturally contested, it is not medically controversial. It is a standard obstetrical practice. Health care professionals who conscientiously object to professionally contested interventions may avoid participating in them directly… Conscientious objection still requires conveying accurate information and providing timely referrals to ensure patients receive care.

The authors would permit conscience to apply in assisted suicide–but only because it is not yet accepted generally within the medical community. If it were, one must assume doctors would be required to participate in causing death, either by doing the deed or referring to a colleague known to be willing to dispense death.

The authors would drive dissenting doctors out of medicine, or into narrow areas of practice in which they would not face moral dilemmas (my emphasis):

Health care professionals who are unwilling to accept these limits have two choices: select an area of medicine, such as radiology, that will not put them in situations that conflict with their personal morality or, if there is no such area, leave the profession. 

The point would also be to dissuade people with unwanted values–e.g., pro-lifers and some orthodox religious believers–from entering the medical professions at all.

Advocates like Emanuel and Stahl would eviscerate medical conscience and impose upon all doctors a tyranny of the majority, whereby any and all interventions generally accepted by the medical community–meaning people like him with the power to decide–must be provided, regardless of a doctor’s moral or religious objections. 

As I have written elsewhere, this kind of thinking effectively reduces doctors from learned professionals into so many technocratically-skilled order takers. When that process forces doctors to kill–as in abortion and euthanasia–the license to practice medicine requires acquiescing to tyranny.


Wesley J. Smith — Wesley J. Smith is a senior fellow at the Discovery Institute’s Center on Human Exceptionalism.

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