Austin, Texas, Jan 18, 2017 / 00:40 am
When it came time for medical student Ashley Stone to apply to OB/GYN residency programs, she was determined to remain true to her Catholic beliefs on contraception, sterilization and abortion.
"I'm normally really stubborn," said Stone, 27. "[I thought] 'It's my right to go wherever I want.'"
Still, she wanted to get some advice from her medical school program director before she turned in her application.
"Here's the thing: I don't want to do these things because of my beliefs," Stone told her director.
"Well," her director told her, "you can't come here."
To be rejected out of hand by her own institution was frustrating, admits Stone, now a second-year resident at the University of Texas at Austin. But it was a frustration she was prepared for.
The negative reaction to her pro-life beliefs was "always apparent," she said. "Even just going into the medical field in general [not necessarily OB/GYN specifically], you're not 'mainstream'" if you're pro-life.
And that's the inspiration behind the "Conscience in Residency" project. Created and managed by a small group of residency students scattered across the country, Conscience in Residency (CIR) is a web-based project that provides a network for residents "who want to practice medicine according to logical, well-formed, evidence-based judgments," the site explains. It also provides research on subjects ranging from contraception and sterilization to gender-identity issues and homosexuality, giving residents facts to rely on when they have a challenging conversation about their beliefs.
"[Residency is] the most difficult period in being or becoming a physician," said Cara Buskmiller, an OB/GYN resident at St. Louis University, who supervises the website.
"As a [medical] student, you're not responsible for prescriptions. You can say what you think, and it doesn't affect your becoming a physician. In residency, the program controls you a lot more. If your program is not open to you choosing things to do and not to do, you're stuck."
"Residents … are the bottom of the barrel: When the attending [physician] says, 'Jump,' they have to say, 'How high?' They have no protection," agreed Dr. Donna Harrison, executive director of the American Association of Pro-Life Obstetricians & Gynecologists.
Providers' Rights
"In many residency programs, there's tremendous pressure to participate in abortions. In some residency programs, even though it's not legal, they're actually required to participate. The laws in place right now have no private right of action [for residents]."
If "private right of action" is a phrase that rings a bell, it's because of the Cathy DeCarlo case.
In 2009, DeCarlo – a nurse at New York's Mount Sinai Hospital – was forced to assist in an abortion in violation of her religious beliefs. When she took her case to court, it was thrown out because she had no private right of action.
This is precisely why Harrison urges support for the "Conscience Protection Act," which would give health care providers the ability to file a civil suit if they feel discriminated against for their beliefs – as DeCarlo did, when she was threatened with charges of insubordination and patient abandonment if she did not participate in the abortion. Currently, health care providers who face discrimination for exercising their consciences have only one recourse: to file a complaint with the U.S. Department of Health and Human Services.
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The Conscience Protection Act is more needed than ever, in light of the recent redefinition of "sex discrimination." Section 1557 of the outgoing administration's Patient Protection and Affordable Care Act extends protections on the "basis of sex" to include – among other things – abortion. That means that a patient of a pro-life physician could sue for discrimination if the physician declines to perform a requested abortion.
"What we desperately need is a real protection of conscience, in law, that says we have the right to conscientiously object to the taking of human life – and a private right of action," said Harrison. "Then we, as citizens, can protect ourselves."
Foresight and Courage
In the meantime, CIR strives to provide solid research that residents can use to explain why they will not perform certain services or write certain prescriptions – and it provides support to medical students concerned about landing in a program that is receptive to their pro-life beliefs. In other words, said Buskmiller, it is a source of foresight and courage.
It was her own experience in medical school that showed her how desperately important foresight is for pro-life medical students and residents.
She was scrubbed up and prepared to assist on a caesarean section – but what followed was the patient's tubal ligation. "The attending physician handed me a clamp. Suddenly, I'm holding a tube while they're tying it off. Before I could do anything, it was over."
Horrified, Buskmiller went to confession and had a long conversation with the priest. "My will was not there, but I sure didn't say anything [to object]," she told him.
Grateful for the grace of confession, Buskmiller used that experience to spur her to have more courage – and to plan better for other situations that might try to force her to act against her conscience.
Though abortion, sterilization and abortifacients may be challenges specific to OB/GYN residents, many residents face similar challenges to their consciences, Buskmiller pointed out. Psychiatric interns might work with patients considering surgery to alter their bodies to resemble the sex they identify with, or recovering from it, for instance, and surgery residents might be faced with the surgery itself.
Recent legislation makes the situation seem bleak, but Buskmiller noted that it may actually be improving. An older attending physician once asked her how many pro-life residents were in training with her, and she counted between 15 and 20.
Pleasantly surprised, the physician said that there had been only eight during his own time as a resident.
And, Harrison pointed out, 85% of OB/GYNs do not perform abortions. "That's a very reassuring number," she said. "That tells me I am not in the minority; I am actually in the majority."
Those kinds of facts are vital for health care providers to keep in mind – and perhaps especially for residents. It gives them solid ground to stand on – and it helps them realize that they are far from alone.
"The big myth is that somehow abortion is needed for medical care. It's not needed for medical care," emphasized Harrison.
"Chile has one of the lowest maternal mortality rates in the world, and abortion has been illegal since '89. Same with Ireland – excellent maternal medical care, with no abortion [which remains illegal unless it occurs as the result of a medical intervention performed to save a mother's life]."
"You don't have to take the life of a patient to do excellent medical care," she added.
"And that's the truth."