No Choice for Hospitals : Medical schools--even those opposed on religious grounds--may soon be forced to teach abortion technology.

A while back, I overheard a conversation between two young physicians in residency training. One was an enthusiastic feminist fresh from medical school, eager to begin practicing her pro-choice beliefs. The other, a war-weary veteran, said that she would not be doing any more abortions. “I support a woman’s right to choose,” she said. “But yesterday I aborted a baby, and it tore me up. You could see his little fingers and toes. . . .”

There is real concern in the pro-choice community that doctors will not be available to meet the future demand for abortions. Though most physicians support choice in theory, many are turned off by the abortion procedure itself. Some nurse-practitioners have proposed that they or others be permitted to do first-trimester abortions to take up the slack. But there’s a problem with this. According to the Alan Guttmacher Institute, statistics from 1988, the latest year available, indicate that 167,680, or more than 20% of abortions in this country are done after the first trimester. Second- and third-trimester abortions require considerable surgical training and expertise: In the third trimester, for example, one technique involves evacuating the brain contents from the skull in utero and compressing the emptied skull to facilitate vaginal delivery. (Termination of the third-trimester child must be carried out in utero, as termination after live delivery is against the law.)

To meet the expanded need for abortions, the Residency Review Committee for Obstetrics and Gynecology, which accredits training programs for obstetrics and gynecology specialization, has proposed that residency-training programs in ob/gyn must provide broad training in abortion technology. But what if the training institution’s religious or ethical beliefs forbid the taking of a human life, in or out of the womb? Although individual residents can forgo abortion training for ethical reasons, there is no such “conscience clause” for the training hospital or institution.

More than 1,000 protest letters have been received by the residency review committee since the proposal was announced last October. A spokesperson says these objections will be taken into consideration when its subcommittee meets this week in Laguna Niguel. A compromise has been proposed by the committee wherein training institutions with moral objections to teaching abortion skills can refer trainees to other institutions that don’t object.

Well, on a moral plane, this won’t work either. It would be tantamount to refusing to turn in a Jewish family to the Gestapo, while making sure someone else with a less tender conscience did so. The family would still be killed, and the first person morally culpable.

When we talk about physician-training institutions that object to abortion, we’re talking mainly, but not exclusively, about Catholic hospitals. There are about 600 of these hospitals, often in underserved areas. Fifty of them have training programs in obstetrics/gynecology. Three medical schools also are Catholic institutions. None of these will participate in the active taking of a life, at any stage. Should they be forced to do so to qualify for accreditation, they will most likely close down their ob/gyn programs.

Obstetrics and gynecology has been defined as an important primary-care specialty. The loss of 50 programs would adversely affect medical care for many of the more than 50 million people Catholic hospitals serve each year. Without obstetric and gynecologic training for their students, medical schools cannot be accredited, and most clinical training of medical students is done through affiliated residency programs. How would the mighty AMA feel about three medical schools biting the dust?

And it may not stop there. Will Catholic institutions in the future be forced to provide “euthanasia training” to be accredited? Will family medicine and surgery residency-accreditation committees also require mandatory abortion training? And if institutions that still believe life is a good thing are forced out of the field of medical education, how can medical students or their teachers have a “choice” that meets their own moral expectations? Remember, the student who wishes to learn abortion techniques can easily choose to train at one of the many hospitals that have such programs in place.

Though Catholic institutions aren’t politically correct these days, freedom of religion is still a national value. The proposed requirements for training, inasmuch as they are under the aegis of an institution with broad public responsibilities, are a clear affront to this freedom.

Leaving religion aside, there is still this in the Hippocratic oath, to which we doctors have sworn for two millenia before it was abridged in 1957: “I will give no deadly medicine to anyone if asked, nor suggest any such counsel; furthermore, I will not give to a woman an instrument to produce abortion.”