Conscience clause laws undermine appropriate care for patients

Regarding "Broader conscience clauses would expand physicians' right of refusal" (Article, March 6): As a gynecologist supportive of reproductive rights, I am extremely concerned by attitudes expressed by several physicians in your article.

While I'm certainly respectful of any colleague's personal beliefs, we all have obligations to provide appropriate health care to our patients. We might not always agree with our patients' decisions, but when we insert our own personal morals into the picture, we may no longer be providing evidence-based standard care.

I'm particularly troubled by the opinion expressed by the executive director of the Assn. of American Physicians and Surgeons that a potential undesired pregnancy is not an emergency and that "a mother's life is not going to end if she gets pregnant and she was careless enough to not take the proper precautions." In some cases, that is not at all true.

Women are victims of sexual assault, incest, condom breakage and sexual coercion on a daily basis. Undesired pregnancy should be prevented as early and effectively as possible through a widespread availability of emergency contraception. Emergency contraception can significantly reduce the need for abortion.

Our colleagues on both sides of the abortion issue should be able to find common ground and not develop unnecessary and potentially harmful "opt-out" clauses that would impede the availability of emergency contraception.

I am horrified by the thought that any of us can insert our own morality and religious biases into patient care, and even more so that some physicians would desire to see this codified in the law in the form of conscience clauses. This is unethical, will impede the delivery of evidence-based health care and have a disastrous effect on public health.

David Toub, MD, Wyncote, Pa.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/04/03/edlt0403.htm.