by Jonathan Imbody

This excerpt is the first in a series of essays on conscience in healthcare, by Jonathan Imbody, Vice President for Government Relations of the Christian Medical Association and Director of Freedom2Care.

Weaponizing “the patient comes first” eliminates ethical protections and professional judgment
Affordable Care Act architect Dr. Ezekiel Emanuel and University of Pennsylvania professor Ronit Stahl advocate barring from medicine all physicians who would decline a patient’s demand for morally controversial services such as abortion.
In a New England Journal of Medicine opinion piece entitled “Physicians, Not Conscripts — Conscientious Objection in Health Care,” Emanuel and Stahl make an argument against conscience freedom in healthcare that they summarize as follows:
“The proliferation of conscientious objection legislation in health care violates the central tenet of professional role morality in the field of medicine: the patient comes first.”

“The patient comes first” sounds good in theory; who would argue that physicians should pursue as their primary goal the patient’s best interest? Physicians often make admirable personal sacrifices in order to advance health and healing for their patients, and many enter the medical profession motivated by compassion and a strong desire to help others.

So if “the patient comes first” is taken to mean that a physician should lay aside personal comfort, convenience and selfish ambition in order to focus on a patient’s wellbeing, the phrase will find little argument and much example in the medical community.

But if “the patient comes first” is taken to mean that a physician must lay aside ethical convictions and professional judgment in order to fulfill every patient’s preferences and demands, that interpretation will meet with great and justifiable resistance.

Ideologues can wrap a warped version of the noble notion around their political agenda, weaponizing “the patient comes first” to undercut professional judgment and the ethical standards that protect patients and the integrity of medicine. To assert that caring for patients requires doing whatever legal procedure and prescribing every prescription the patient demands is a flawed premise that leads to a flawed conclusion—that all conscientious objectors must be banned from medicine.

Corrupted into a power grab, a “patient comes first” rule turns medicine into a patient dictatorship with no checks and balances. Ezekiel and Stahl’s plan illustrates the danger, requiring the unilateral confiscation of conscience rights from all health professionals in order to ensure patients receive whatever controversial procedure or prescription they demand. Behind the rhetoric of Emanuel and Stahl appears to be an aggressive agenda aimed specifically at eliminating objections to abortion, by eliminating from medicine all professionals objecting to abortion.

What the authors actually require, but of course do not spell out, is that everyone must accept as dogma their view of what is a patient’s best interest. While claiming to advance the consensus of the medical community, they actually are asserting the controversial agenda of abortion rights activists.

In doing so, they contravene the objective standards that have guided medicine for millennia.

“First, do no harm” protects patients, physicians and medicine
Although the authors avoid it and abortion advocacy has suppressed its use in recent years, for millennia the well-balanced principles of the Hippocratic Oath have served as “the central tenet of professional role morality in the field of medicine.” The first principle of Hippocratic medicine, the professional ethic that formed the basis for the oath, is not simply “the patient comes first” but rather “do no harm.”

The Hippocratic oath does not pit patients against physicians but instead positions both as worthy of honor and protection, while spelling out objective standards to guide the practice of medicine. Hippocratic medicine recognizes both the vulnerability of the patient and the physician’s unique role as a professional entrusted with potentially lifesaving or lethal power.

The Hippocratic Oath, therefore, constrains the physician to abide by objective ethical principles, at the same time emphasizing that a physician’s ethics and professional judgment serve as the prime protectors of a patient’s best interests:

“I will use treatment to help the sick, according to my ability and judgment, but I will never use it to injure or wrong them.

“I will not help a patient commit suicide, even though asked to do so, nor will I suggest such a plan. Similarly, I will not perform abortions.

“But in purity and in holiness, I will guard the sanctity of life and my role as healer.” 1

The role of the physician, therefore, is to exercise ability and judgment to help the sick and to guard the sanctity of life, thus preserving medicine as a healing and not a killing profession.

1 A number of medical schools began opting out of administering the longstanding Hippocratic Oath when abortion and assisted suicide, both proscribed under the oath, gained acceptability among some in medicine. Such advocates typically emphasize patient autonomy in healthcare, as a way to circumvent obstacles presented by medical ethics that do not support these lethal practices.