From the time my older daughter was in middle school, she appeared destined for a career in medicine. She used the editor’s comments from one of my research papers as part of her eighth grade career project. She spent two summers in high school in paid research positions at Cleveland Clinic. Thanksgiving morning of her senior year in high school was spent observing a heart transplant with one of her research mentors. She completed her certification as an emergency medical technician this past summer because she wanted experience in caring for patients prior to applying to medical school.

She hopes to start med school in 2017 or 2018, graduate in 2022 and finish her residency and fellowship sometime between 2027 and 2030…given her research interests and temperament, she’s likely to end up in cardiology, cardiovascular surgery or cardiovascular anesthesia. While I’m confident that God is guiding her path, as her dad, I fear she’ll be required to do something that wasn’t required of me…violate the sixth commandment in order to practice as a physician in the United States.

Two weeks ago (on September 11), the California Legislature approved a bill to legalize physician-assisted suicide, following a precedent established by Oregon, Washington, Montana and Vermont.

Leaders of the “death with dignity” movement said they hoped the passage of the California law could be a turning point.

“It allows for individual liberty and freedom, freedom of choice,” said Mark Leno, a state senator from San Francisco who compared the issue to gay marriage.

The California legislator quoted by the New York Times is spot-on. The very same arguments made in the same sex marriage debate – arguments for individual dignity and personal autonomy are being used to advance a right to physician-assisted suicide. Given the widespread popularity of physician-assisted suicide (according to the most recent Gallup poll, 68% of Americans – and 81% of 18-34 year-olds approve), and the reality that nearly 20% of Americans may reside in states where physician-assisted suicide is legal, the time when the “right to die”

Bruce Abramson wrote an essay (highly recommended) in last month’s Mosaic Magazine titled How Jews Can Help Christians Learn to Succeed as a Minority in which he describes the evolution of how our leaders view the concept of religious freedom…

Berkowitz rightly casts religious freedom as but one front in the philosophical—and political—battle between liberalism and progressivism. A clear line of difference, beginning with the classical liberal preference for freedom and the rule of law versus the progressive preference for equality and justice, and continuing to manifest itself in the classical liberal preference for “negative” rights that no government may legitimately infringe (as in the U.S. Bill of Rights) versus the progressive preference for “positive” rights like housing, food, and health care that someone must provide (as in many European constitutions), has fed into the practical debate between the liberal view of government as protector (emphasizing military, policing, and the courts) and the progressive view of government as provider (emphasizing entitlements and the welfare state).

Peter Berkowitz, writing in the same magazine, supported the observation made by the California legislator that pertains to our discussion of Christians in medicine…

The larger truth is that we have reached a watershed moment in American law, society, and culture: for the first time, avoiding participation in a given event or activity can now be construed as violating someone else’s civil (or human) rights—and can be actionable as such—even when the avoidance has been dictated by a religious conviction.

Physician-assisted suicide was mandated last year in Canada by a decision of their Supreme Court. The response of the Canadian Medical Association to attempts to enact conscience protections for physicians unwilling to assist their patients in ending their lives was consistent with the new paradigm that religious conviction is a secondary consideration to the rights of others to demand a service…

Conscientious objection was a contentious issue, with 79% of delegates voting against a motion to support conscientious objectors who refuse to refer patients for medical aid in dying.

“What we expect from physicians, at a minimum, is that they provide further information to patients on all the options including the spectrum of end-of-life care and … how to access those services,” CMA Vice President of Medical Professionalism Dr. Jeff Blackmer told reporters at a press conference Aug. 26.

Given two converging trends in society…the perspective that individual conscience must take a back seat to the desires of persons demanding a product or service made available to the public and the determination among activists that accommodations not be made available to public employees, the right-of-conscience exceptions present in assisted suicide laws in the U.S. won’t be in place for long.

Kim Davis has been in the news for her refusal to sign marriage licenses in her position as an elected county clerk in Kentucky. Because she is a public employee in a state where the legislature has not been in session to approve accommodations for employees who cannot comply with the recent Supreme Court decision addressing same-sex marriage, she has been sent to jail and become the target of a very public #DoYourJob Twitter campaign.

All practicing physicians in the United States are required to maintain a medical license in each state in which they practice. The vast majority of physicians (and essentially all hospitals) receive government payment for services provided from Medicare and/or Medicaid. What will happen when activists insist that willingness to provide assistance with suicide is a precondition for licensure or the ability to participate in government-funded healthcare programs?

Our existing religious freedom laws require a “balancing test” in which the government is required to demonstrate a “compelling interest” in enforcing laws that might result in religious believers violating their consciences. What hope do physicians have from maintaining a right to object to assist patients in committing suicide when the “compelling interest” of the government would appear to be far stronger than the interest in forcing bakers and florists to provide goods and services for same-sex marriages?

Right of conscience objections in medicine have primarily been a concern to this point for OB/GYNs and medical students and residents required to rotate through OB/GYN as part of their required training. A mandate for physicians to assist patients demanding help in ending their lives would potentially impact most physicians involved with direct patient care. Lest we think pediatricians and psychiatrists will be exempt, physician-assisted suicide for children was legalized in Belgium last year, and a clinic specializing in assisting psychiatric patients who want to die opened in the Netherlands in 2012. For that matter, here’s a news story published yesterday in which a doctor in the Netherlands was reported to the Medical Board for the equivalent of malpractice for refusing to help a 19 year-old woman with depression and lupus to end her life.

But what about the Hippocratic Oath? All but one U.S. medical school has stopped using the traditional oath (that prohibits abortion and physician-assisted suicide). The reasons why the Oath is no longer used are summarized by the Chief of Medical Ethics at Cornell…

“Do you want to impose an oath on students that probably half of them could not agree to?

“The prescriptive oath, in a sense, is one that purports to have all the answers,” he added. “This breaches the notion of a community. What should mark the professional community today is the willingness to engage ideas and be reflective, all in the service of advocating for patients.”

Consider the consequences when requirements imposed upon physicians to assist patients requesting help in committing suicide become incompatible with an understanding of the sanctity of life as understood from traditional Biblical teaching and principles…

• What happens when all the Christians are gone from medical school and hospital ethics committees?

• What happens when all the Christians are gone from government agencies and insurance bureaucracies that determine what medical treatments will and won’t be paid for?

• What happens when the Christian hospitals close their doors because the faith precludes them from assisting patients who demand help in committing suicide or referring patients to physicians or hospitals that will help them?

• Who will stand up to defend the dignity and value of persons with disabilities, the elderly, or those in need of expensive medical treatments who aren’t well-connected politically when the cost competes with other societal priorities?

Shannon will be sharing a series of posts in October on the topic of abortion as it relates to our work in disability ministry. The horror of the recent videos describing practices at Planned Parenthood in which organs were being harvested from pre-born children (and in a few instances, children who had been born alive) and being sold for profit has led to many in the Christian community to consider more carefully what it means to be “pro-life.” But sooner than many of us would like, we’ll need to consider the costs of championing the sanctity of life among those with chronic or painful illnesses when society offers the “right to die” …followed inevitably by the duty to die.

God loves my daughter immeasurably more than my wife and I will ever be able to and I’ll have to trust that He’s in control if the doors are opened for her to practice medicine in the fields for which she has interest and passion. I hope she won’t have to choose between violating her conscience or relocating to another state or country if she is to pursue her calling with the gifts, talents and training God plans to give her.

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