The pro-life maternal-fetal medicine physician. A problem of integrity.

During the course of professional practice, health care providers may find themselves in situations where they are called upon to perform actions that they cannot in good conscience do, or to omit actions that conscience dictates. Conscientious objection in such cases may be understood as motivated by a concern for one's integrity, but integrity is a complex concept and there are different ways of interpreting its requirements so as to yield different answers to the question of what sorts of actions are or are not consistent with the preservation of one's integrity. In this paper, we will focus on a particular problem of integrity that arises for certain medical specialists. The problem is whether or how a physician with pro-life, antiabortion views can maintain personal integrity in the practice of maternal-fetal medicine. To what extent, we will ask, can an individual with strong pro-life religious or moral convictions do the work that specialists in maternal-fetal medicine typically do without betraying these convictions? If the job of the maternal-fetal medicine physician is to help women and their fetuses with high-risk pregnancies, and if as part of this care women do and should have the option of terminating their pregnancy, should an individual with pro-life views enter the field in the first place? Now it may seem self-evident to some what the answer should be: an individual who is profoundly opposed to abortion on moral or religious grounds cannot be a maternal-fetal medicine specialist without losing his or her integrity, and only through self-deception or the like could such a person think otherwise. But while we believe that attempts to reconcile these personal convictions with professional practice are open to question, we do not think that the failure of this project is a foregone conclusion. A number of reconciliation strategies are possible, and at least some of these warrant careful attention. We will explore five such strategies in the course of this paper: the "I'm only providing information" strategy, the foreseeing versus intending strategy, the "Better me than someone else" strategy, the preventing unnecessary abortions strategy, and last and perhaps most promisingly, the harmonization of values strategy. We believe that physician integrity is a value of fundamental importance in the practice of medicine.[1] Although as professionals, physicians naturally identify with, feel responsible for, and take pride in the proficiency, skill, and technique with which they perform medical tests and administer treatments, these functions are not value free or value neutral. Physicians have moral responsibility for actions, recommendations, and counseling offered to patients. If the physician were only to attend to the technical aspects of professional behavior, he or she would be no more than "an engineer, a plumber making repairs, connecting tubes and flushing out clogged systems, with no questions asked."[2] This is a deeply unsatisfying and disturbing conception of the physician's role, for even if the doctor could refrain from bringing moral and other values to bear on the assessment of professional activities, this would hardly absolve the physician of moral responsibility for those activities. Moreover, by dissociating from personal values in this way - at least those values that reflect what one takes to be most important - one only succeeds in creating deep divisions within the self. If the physician has moral responsibility for actions and recommendations to patients, how can we expect professional practice to require the physician to set aside deeply held religious or moral convictions in the conduct of professional life? It would constitute an assault on physician integrity to require moral accountability and yet insist on value neutrality. To be sure, the possession of integrity by physicians still leaves much room for the moral criticism of their characters and actions. But integrity is not for this reason a matter of no moral consequence, and forcing physicians to act against their values and principles is deeply problematic. …