The philosopher Karl Jaspers, who was also a psychiatrist, tells a chilling story (I recall) of how he visited a hospital at the end of World War II, and was trying to console a dying German soldier, a young man, who was very troubled in conscience over what he had done as a guard in a concentration camp. “What is it, my son?” Jaspers asked in a kindly tone, “What is tormenting you?” The soldier with difficulty explained that once when he was guarding a line of prisoners headed into the gas chambers, he saw a Jewish boy escape, and now, he explained, on the point of death, he felt deeply upset that he had failed to do his duty and had let that boy get away!
What the example shows is that moral fervor and self-righteousness are no guarantee of the goodness of one’s cause. As the old moralists used to say, one’s conscience must be well-formed. This requires that one’s judgment conform to objective reality. In a similar way, Peter Geach used to use the example of a firmly convinced Nazi gunning down civilians with a machine gun to illustrate that “sincerity” of conviction if directed at something bad only makes someone’s actions more evil.
I couldn’t help but think of these examples when I read a strident op-ed piece earlier this week in USA Today entitled, “Where Are the Doctors?” The thesis of the article, written by two doctors at Harvard Medical School (but of course!), is that politicians with their laws restricting access to abortion and contraception are infringing on the doctor-patient relationship; therefore, the medical profession needs to be vocal in protesting these restrictions, and doctors should simply break these laws. (I wrote to the USA Today ombudsman, asking how it was ethically responsible for his paper to publish articles which incited to illegal behavior, but got no response.)
An obvious first question is: where are all these restrictions? Women can get abortions for the slightest of reasons even to the point of birth (partial-birth abortion), and everywhere I look people are falling over themselves to hand out contraceptives like candy. Are these authors living in the same country as I am?
Ah, but (from the article):
Nine states require doctors to perform ultrasound examinations on women seeking an abortion, and to encourage women to view the images. (This requirement was justified by Alabama Sen. Clay Scofield in his deeply patronizing comment, “This bill just allows them to see the child inside of them, so it’s not just out of sight, out of mind.”) Three of these states also require women to listen to a description of the fetus.
So it’s better if a woman sees the ultrasound only later, during another pregnancy, when she is “keeping” her baby, and learns the terrible mistake she made when she had an abortion? That’s good medical practice? (It can’t be “my baby” one time and a “clump of cells” another.)
Counseling is now mandated in 35 states to dissuade women from having abortions.
So what kind of counseling do these doctors oppose? According to the Guttmacher Institute (Planned Parenthood’s research arm), these laws require that the woman be informed about the abortion procedure itself (Guttmacher: “along the lines of what would generally be provided patients in advance of surgery”), facts of fetal development, and health risks. What’s the problem with that? Do the doctors oppose this counseling precisely because, as their language concedes, its effect is to dissuade women?
Here is what is particularly objectionable to Guttmacher and I suspect the doctors:
In many of the states, the written materials include detailed descriptions of fetal development. All the states include at least some essentially objective information, such as the size or weight of a fetus at various stages. But in their descriptions of the fetus, many states use loaded language in an apparently deliberate attempt to “personify” the fetus. For example, the North Dakota materials note that fetus is “a Latin word meaning young one or offspring.” The materials also say that at 10 weeks’ gestation, the fetus “now has a distinct human appearance” and that “eyelids are formed.” At 14 weeks, according to the materials, the fetus “is able to swallow” and “sleeps and awakens.”
Of course everything mentioned here also happens to be true.
Another legal restriction the doctors are upset about is counseling in a handful of states that points out a possible link between abortion and breast cancer:
Five states require doctors to tell women that a link might exist between abortion and breast cancer, despite the fact that careful studies have not found any such link.
According to Guttmacher, what these states require is to say that “the data are inconclusive and that a link may exist between having an abortion and developing breast cancer.” But that’s also true, isn’t it? Many studies have found such a link, although many have not.
The doctors then say:
Similarly, eight states require doctors to tell women that abortion could cause psychological problems, despite evidence to the contrary.
Ah, tricky, tricky doctors! Indeed there is “evidence to the contrary”, but there is also “evidence for it” (including two very good studies by Fergusson in New Zealand).
(Actually, strictly there is not “evidence to the contrary” but rather studies which found no link. The good doctors have committed the fallacy, too, of arguing from “absence of evidence” to “evidence of absence.” But we’ll discretely let that pass.)
It’s right for professionals to resist laws that impinge on medical practice. But to argue against such laws, one needs to define what medical practice is, which the Harvard doctors in the article never do. Instead, they begin by invoking Supreme Court decisions and putative rights to privacy and abortion, which are not medical concepts or categories at all. That is why their article is ideological and political, rather than medical in spirit.
The correct consideration based on medicine is this. A physician is not a mere hired hand (a fancy biological plumber) but rather someone whose training has an inherently ethical component. He or she is someone who is generally in service to the life, health, and relief of physical pain for all human beings, not just those patients who are paying the bills. (That’s why a physician is obliged by his profession to help the stranger who falls down at a reception with a heart attack, or the accident victim by the side of the road.) So, when a pregnant woman comes into a doctor’s office, the doctor, by the profession of medicine itself, is bound to serve the life, health, and relief from pain not merely of the woman paying the bill, but also of the human being within her.
What doctors should be vocally resisting, then, as professionals, are not such “restrictions” on abortion as informed consent, but rather abortion itself! — as doctors used to do, and did for centuries, in those times when they professed allegiance unto death for the ideals of the old Hippocratic Oath.
So then, what is the answer to the question raised in the op-ed piece, “Where are the doctors?” That is, “Why are not other doctors side-by-side with us, joining in our cause?” The answer is this: Doctors in the true sense of the word are in the service of life and will have nothing to do with you.