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What would referring for abortions mean?

I've discussed here the very real possibility that laws will be passed at various jurisdictional levels--one is under consideration in California right now--that would require doctors at least to refer for abortions. If the doctor won't perform an abortion, he has to provide the woman with "access" to abortion by helping her find an abortionist. A law like this is already in place Down Under, in Victoria, Australia.

I have predicted that, faced with such laws, some doctors and/or hospitals will capitulate insofar as they will do the referrals while refusing to (in the case of hospitals) allow abortions on-site or (in the case of doctors) perform abortions themselves.

My guess is that this will be rationalized on the grounds that the referral is purely pro forma, that the woman could have found an abortionist for herself anyway, and that therefore one is not making it materially easier for her to get an abortion by providing her with phone numbers and a referral. And by cooperating with the law, doctors who do not themselves provide abortions, who are personally pro-life, and hospitals that provide important services to the public, can remain open and continue to help people and provide a good influence. So, I conjecture, the reasoning will go.

Why is this reasoning misguided?

In passing, I note that there is already a program for poor people in Boston that bears a family resemblance to these other efforts to involve everyone in abortion. And the requirements of that program stipulate that the Catholic services provider must, if necessary, provide transportation for an abortion-seeking woman. While I won't say for sure that providing transportation will be required by the laws I envisage (the Boston situation is a set of requirements for the Catholic organization to receive a special contract), neither would I put it beyond the realm of possibility. And I hope we can all agree that providing a woman with transportation to an abortion is providing material assistance to her in getting the abortion.

But set aside the transportation question. What about referrals? Here I'm going to draw on my own experience as a patient in the American medical system. What does it mean when a generalist refers you to a specialist, for example? In my experience, one of the things it means is that the office staff at the GP's office offers to call up for you and make an appointment. Sometimes they even make an appointment without your having asked them to, and often you have to change the appointment, because (obviously) the office staff doesn't know what your calendar looks like. Another thing it usually means is a letter. The referring doctor writes a letter telling the specialist about the situation and saying that he recommends that the patient see the other doctor. In all cases, it involves the referring doctor's staff doing some amount of research for you and giving you the information you need to make an appointment, without your having to guess whether the other doctor offers the service in question, will be willing to see you, and so forth. It amounts, too, to a recommendation. Different GP offices have different specialists to which they refer you, and as a patient you take it that the referral means that the specialist has in some sense been "checked out," that he isn't a hack, that he does a good job, and so forth.

It should be absolutely obvious that any of these aspects of referrals, applied to abortion, amount to the normalization of abortion within the medical system. If the pro-life doctor's office staff call up for the patient and make a first appointment with the abortionist, this undeniably communicates that going to an abortionist is just another type of medical appointment, that it is a normal thing, that there is no taboo or problem about it. The pro-life doctor's refusal to perform abortions himself thus is demoted in significance from an actual protest against the abortion regime, a refusal to participate in it, to a mere difference of emphasis in practice, akin to a difference in specialization: "The doctors in our practice don't happen to do that procedure, but we'll refer you to Dr. Jones, who does."

Implicitly, too, Dr. Jones the abortionist now becomes a medical colleague. He just happens to perform a procedure that the patient ostensibly "needs," that the referring doctor doesn't happen to do, but that the pro-life doctor's office is going to guide the patient to obtain. The referral to him implies that he isn't a back-alley butcher, that he can be trusted, and that there is something ordinary and legitimate about what he does.

In short, a referral for an abortion from an erstwhile uncooperative pro-life doctor helps to make abortion socially routine and brings it into the warp and woof of medical practice.

And that's the point. Protestations to the contrary notwithstanding, the pro-aborts are lying if they imply that women are incapable of using the Yellow Pages and finding an abortionist for themselves and that therefore referrals are somehow necessary to "access." This claim is as phony as a three-dollar bill. What the pro-aborts don't like is the silent disapproval conveyed by a woman's meeting a stonewall when she asks her first GP or ob-gyn for an abortion. The message conveyed by, "We don't perform or refer for abortions," full-stop, is that just maybe abortion isn't a medical procedure on a par with having your tonsils out, that it is somehow segregated in the medical world, and that one's own doctor feels distaste about having anything to do with it and refuses to get involved with it in any way. We can't have that. No moral judgements should be conveyed to a woman, however implicitly, against her having an abortion. (This does not apply the other way, of course. The abortionist's staff are free to exercise all sorts of persuasion to get the woman to have an abortion.) So the pro-life witness, even the silent witness, of a doctor's office that refuses to have anything to do with abortion must be broken down. The entire point of the referral requirement is thus a social-approval and rhetorical point, and by cooperating with it, a doctor is cooperating directly with the pro-aborts' social agenda.

It is therefore immoral for a doctor to refer for an abortion.

Comments (26)

Dr. David Stevens of the Christian Medical Association made a similar point at a press conference a few weeks ago in favor of the Bush conscience regulations: referral is a technical medical term that is almost like endorsement, and is much more involved than throwing a yellow pages at the patient.

Matt, do you have a link to those remarks by Dr. Stevens? I'd be very interested to see them.

What is not often known is that one of Roe v. Wade's plantiffs was a physician. Why is this important?

The Court in Roe concedes that if the fetus a person, then it has 14th amendment rights. But the Court also claims that reasonable people, including physicians, disagree about when life begins and that the Court will not make a judgment on this matter. Thus, when the state requires a physician to act as if the fetus is not a person--such as forcing the physician to violate his own conscience--the state, ironically, violates Roe v. Wade!

I'm thinking about working on an article taking this angle. It seems to be almost never explored in the conscience-clause literature. What I am suggesting is that Roe v. Wade may itself include a conscience-clause whenever the state is providing direct or indirect aid to clinics and/or hospitals that provide abortions. That is, an independent conscience-clause, as a restraint on state-action, may not be necessary. It's already there!

.... the woman could have found an abortionist for herself anyway, .....

Then why the need for referral? (The only thing I can think of is for insurance purposes, where some plans require a referral from your primary care doc, assuming the plan covers it. But that can be taken care of by simply prohibiting the requirement for referral in that situation - not that I endorse any of that at all, but just thinking out loud what counter objections might come up).

I add that the law requires not merely material assistance, but *proximate* material assistance. I foresee bioethicists at unprincipled Catholic hospitals saying material cooperation is morally permissible, eliding the grave moral distinction between remote and proximate cooperation.

OK, the Freedom2Care website has all the records of the press conference.

I don't see that particular statement, because he said it in response to a question posed by a reporter after his prepared remarks. It may be on a video clip.

BUT Dr. Stevens says the same thing in a powerpoint presentation located on the same website:
(Powerpoint) http://www.freedom2care.org/docLib/20090325_RightofConscienceStevens.ppt

He says:

Referral means:
--I endorse the competency, judgment and ethics of the doctor I’m referring to.
--I enter into a professional relationship with them.
--I will receive a report back from him.
--I believe they will “do no harm.”

[tried to answer but I think I had too many links, I cut out a few and am trying again]

OK, the Freedom2Care website has all the records of the press conference.

I don't see that particular statement, because he said it in response to a question posed by a reporter after his prepared remarks. It may be on a video clip.

BUT Dr. Stevens says the same thing in a powerpoint presentation located on the same website:

He says:

Referral means:
--I endorse the competency, judgment and ethics of the doctor I’m referring to.
--I enter into a professional relationship with them.
--I will receive a report back from him.
--I believe they will “do no harm.”

Prof. Beckwith--and as you know, Doe v. Bolton confidently relied on the conscience protection in the Georgia statute. The Court didn't mandate conscience protection, but to the extent it relied on it you could say that conscience protection is part of the Roe right.

This is another example of the curious way in which the "right" to abortion operates in the mindset of many in a way that few other rights do. If someone shows up at a newspaper, and claims a right to have an article published, the newspaper is usually free to tell such a person to go pound sand, despite the fact that publishing the person's article would forward their right to free speech.

There is some curious principle at work here, something related I think to what Haldane called "hedonistic consequentialism" in First Things. Based on that thought, I think there will be more to this law even than hinted above. What will be the capstone is what might be called the "no alternative provider" problem. It has come up again and again in debates I have had with various supporters of these laws. The law must take into account the problem of lack of medical facilities. If the only hospital in town is a Catholic one (as in many towns where I live in the Midwest), the law will stipulate that the Catholic hospital must perform the abortion.

Then why the need for referral?

C Matt, the phrases that the pro-aborts will use to answer that question are "provide information" and "access." They will say that, since abortion is a legal "treatment option" (pregnancy being treated as a disease, here), doctors should be obligated at least to "provide information." This is a euphemism for referral to another doctor. The claim is that women who don't receive such "information" are being somehow blocked from getting their "right" to an abortion, because they are being kept ignorant somehow, in the dark. What this is all code for is that the woman's homework is not being done for her by the doctor to find an abortionist for her whom she feels she can trust and also that she might feel a stigma about getting an abortion _because_ the original physician didn't provide "information" (aka a referral).

Moreover, the "access" term gets to what Jonathan is talking about. It infuriates pro-aborts that there are parts of the country where it is hard to find an abortionist. They are determined to do something about that. One approach is being tried in New York City right now, and that is requiring all doctors in med school either to get abortion training or to try to opt out using a "conscience clause." The conscience clause is there, I gather, but the idea is that they will feel like it's a black mark against them if they avail themselves of it. If more doctors can be pressured into going through training in abortions, their inhibitions will be broken down and maybe more of them will actually become abortionists later.

It's very obvious that forcing Catholic hospitals to allow abortions on-site is the next move in the game, because of the very "access" issue.

In fact, in the case of providing a prescription for suicide drugs, it looks like we may move even faster than with abortion. In the case of abortion, requiring referrals will probably be an intermediate step. But in Washington State there are already both clear implications in newspaper articles and in one case a direct call for the legislature to require doctors to write prescriptions for suicide drugs. Evidently in this area a "no-provider" problem is arising _immediately_, because there is a greater stigma about that in the medical profession (as of yet) than about abortion. So the pro-death folks are having to move faster there and show their hand sooner. Referral by itself isn't going to overcome what they view as the problem of people who can't commit suicide fast enough.

I don't see the problem here about a referral for an abortion. Not for the Catholic Church!

The Catholic Church already issues referrals for divorces in order to have its own investigations regarding validity.

Such referrals are real DEATH SENTENCES to valid marriages, particularly after they go through the mostly rubber stamped process in the tribunals. They certainly are DEATH SENTENCES when a marriage (GASP) in not PROVEN null.

The Catholic Church then does all it can do to encourage adultery, hidden by a "brother and sister" relationship so that the "lover's can receive the Body and Blood of Christ, as they persecute the abandoned spouse and wait for their actions to bear the "final fruit" with that abandoned spouse's DEATH, in order for the lustily, panting at the Catholic Church door, priest, to marry the two, validly and sacramentally, before the old boy's(or girl's) body is cold.

So much for abortion referrals. The Catholic Church already does them so it should just shut its two-faced mouth!

Of course abortion is not murder-by-divorce. The Church opposes the former!

Karl, I am not Catholic. I am a Protestant Christian conservative, and I am arguing about what is right and wrong. You may be correct that the Church should not, by its own lights, encourage people to obtain civil divorces. However, that is beyond the scope of this thread. And if the Church is doing something wrong there, it certainly doesn't follow that it's okay for Catholic hospitals to do something else wrong in another area. Let's stick to the topic.

Lydia - I'll be interested to see if any of my erstwhile libertarian friends deign to notice these appalling attacks on liberty of conscience.

"The Catholic Church then does all it can do to encourage adultery, hidden by a "brother and sister" relationship..."

Start with Jack Chick or the latest from the sedavacantist desert and add some Jerry Springer inflection points and presto - you've got a very coherent, insightful appraisal. Or, good reason to make sure the med-cart doesn't miss any stops.

As for the claim that Sean O'Malley has caved, I called Caritas and they denied a deal was struck. Has it been confirmed that the Boston Archdiocese has thrown in with Moloch's car service?

Ralph de la Torre, MD, President/CEO
Caritas Christi Health Care
77 Warren Street
Boston, MA 02135

I can't find confirmation.

Try not to give Karl too hard of a time. He's been through some pretty awful crap.

I didn't know that before responding, so I apologize, but if he suffered at the hands of a churchman, hope he knows; he's not alone and great graces are attached to the suffering.

Kevin, I know that Caritas was originally seeking the contract and everything I've heard so far (even in the article you linked) indicates that the paperwork is grinding forward for them to have the contract. I'm not sure what O'Malley's "cautionary statement" means, exactly, in literal, legal terms. Does Caritas have the contract, or doesn't it? If it does, then it's obligated to provide the car service and phone numbers.

Does Caritas have the contract, or doesn't it?

Indeed, Lydia and I hope to get a straight answer tomorrow. Tonight, I'm going to hear Cardinal Chaput speak, and we need not worry about his resolve during the coming confrontation.

Steve, you know what I always say: Real libertarians are rarer than hen's teeth these days. Most of them are pseudo-libertarians to whom "libertarianism" means being _very_ upset if a city commission manages to use zoning to block the opening of a nude dancing joint but not at all upset if a state "human rights board" fines someone for refusing to photograph a lesbian commitment ceremony.

Real libertarians are rarer than hen's teeth these days. Most of them are pseudo-libertarians...

Hear, hear. Look no further than that staunch bulwark of liberty, and of civil liberties, the ACLU. Will someone please explain to me why only actions that tear down Christian morals are an expression of liberty? When is the last time the ACLU defended a person's civil rights to do something moral?

I don't know a lot about Karl's situation, Frank, but I think we shd. heed what Zippy says about not being too hard on him. And you know what a tyrant I am about threadjacking, so I won't let it happen to this thread, no fear.

Part of the problem as I have understood it for the abortion rights people is that doctors and medical students are increasingly choosing to not participate in this area of medical training and practice. Whether by genuine conscientious objection or preference to avoid any third rail issues, the rising generation of medical professionals seems to want to opt out of all of this. The only thing that they can do to respond is to change the culture exactly as you described. It must be common understanding that abortion is part and parcel to medical practice and is nothing to turn your nose up at or get worked up over. In fact, the rights of women to access abortion providers means that you have no choice but to be part of a system that serves that right above even your own conscience.

This seems like a great argument against those who think that abortion ought to be pursued exclusively as a spiritual problem. I obviously support cross and gospel centered efforts, but political process, power, and political will must be respected and attended to as well. Or else you can see headway made by the proper application conscience (doctors refusing to participate) destroyed through tyrannical eradication of conscientious objection and forced participation in “normal and legal” medical practices.

Jay, I hadn't thought of that, but it goes along with something I'm often saying: Evil is endlessly innovative. The bad guys can always think of something new to do that's bad, that takes one's breath away, something where we never thought they'd go _that_ far. And this means that we have to be prepared to do what we can politically to fight it, that there's always a "point" in having pro-life legislators in office, for example.

I am of the firm opinion that the culture wars are entering a new phase. The bad guys are looking around and saying, "Okay, let's go in for the kill." They are, in a sense, rooting out those who disagree with them who thought that they would be left alone to tend their own hearths. Nope. Everybody has to get with the program. It may seem like bringing disparate things together, but I see this also in the controversy you probably read about here concerning Christian colleges that require their faculty not to participate in homosexual acts. Suddenly, after 20 years during which a "non-discrimination" policy has been in place concerning "sexual orientation," the lefties in the American Philosophical Association are shocked, shocked, to find that these Christian schools are being permitted to advertise without censure in Jobs for Philosophers. And they want that stopped, by golly. The intent to route out the Christians, to force them to get with the program, not even to be allowed to have their own private organizations and practices where they stick to their own standards, is absolutely blatant.

Lydia, you are correct in discerning that these developments are part of the pro-abort strategy for total victory; there is no room for those of us with rather quaint beliefs within the larger society. The powers that be understand full well that a referral provides material assistance in obtaining abortion and that mandatory consultations for “reproductive services” is only ethically intelligible only if the referring physician believes consideration of these services to be medically appropriate. This strategy is intended to engender complicity at every level of medical training. First, require acknowledgment of the reality of the option--“It’s a woman’s choice, not mine.”, then mandate express material support (and implied formal cooperation) via referrals.

When a physician ends a conversation by telling a woman whom she can pay to kill her child, any prior pleas for reconsideration, gentle education in biology and ethics, discussion of the risks of abortion, or offers of assistance in a crisis pregnancy are revealed to have been merely personal and without any real bearing upon the physician’s function qua physician. Once the behavior of all physicians demonstrates that they believe objections to abortion to be divorced from one’s professional duties and actions, we stand fully within the naked public square.

The time may soon come when one who truly opposes abortion may find it impossible to practice within the law, indeed impossible to become a licensed physician. (But that was no impediment for St. Luke; the Hippocratic Oath had not yet been bowdlerized to remove that unfortunate clause about never inducing an abortion.) Medical schools and medical specialties are increasingly required to demonstrate that each graduate has obtained facility in “core competencies” and essential procedures. Let abortion be defined as an essential reproductive service, and pro-life primary care, family practice, internal medicine, gynecology, and obstetrics practices have become self-contradicting. Let abortion be defined as an essential element of each medical student’s participation in a required OB/GYN rotation (as childbirth currently is), and the price of each medical diploma will be the death of a child.

Thanks, Lee. I appreciate your insight regarding the fact that a referral indicates that the service in question is medically appropriate. I think this understanding within the profession is something that laymen like me sense as patients--the normalization conferred by a referral. And the naked public square point is quite right. By requiring referral for abortion, they align professionalism, science, reason, etc., on the side of abortion and imply that whatever the doctor may have said against it was merely a matter of arational, personal feelings and had nothing to do with his professional opinion.

As to what is going to happen next, I simply do not know. I do believe, however, that every move towards the centralization of medicine makes it easier to impose the normalization of abortion, suicide, etc.

PRINCETON, NJ -- A new Gallup Poll, conducted May 7-10, finds 51% of Americans calling themselves "pro-life" on the issue of abortion and 42% "pro-choice." This is the first time a majority of U.S. adults have identified themselves as pro-life since Gallup began asking this question in 1995.

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