Conscience, Courage, and “Consent”

Mark A. Hall, Nancy M. P. King

The Hastings Center Report


How should we think about physicians who object to what law in North Carolina and many other states requires them to tell patients seeking legal abortions? A federal appellate court helped to place this situation in perspective when it struck down the part of the Woman’s Right to Know Act, North Carolina’s mandatory informed consent statute for abortions, that required physicians to show such patients real-time ultrasound images of their fetuses and describe the stage of fetal development. In this court’s view, the state’s WRTK Act forces physicians to express a viewpoint that may be contrary to their medical judgment. Moreover, the ultrasound-viewing provision “simultaneously threaten[s] harm to the patient’s psychological health, interfer[es] with the physician’s professional judgment, and compromis[es] the doctor-patient relationship.” The court continued, “Transforming the physician into the mouthpiece of the state undermines the trust that is necessary for facilitating healthy doctor-patient relationships, and through them, successful treatment outcomes.” Based on this reasoning, the court invalidated the ultrasound-viewing portion of the statute, but the other provisions remain in effect, mandating a long list of disclosures; similar laws exist in many other states.

In this essay, we want to consider what the abortion legislation says about the state’s regard for professional judgment. At the same time that these laws threaten patient trust in physicians – a point Mara Buchbinder and colleagues explore in “Reframing Conscience: Providing Abortion Care When Law and Conscience Collide” (in this same issue of the Report) – the laws display a deep-seated distrust by government in the integrity of medical professionals. The WRTK statute bristles with measures that control physicians’ interactions with patients. In addition to the most egregious example of coerced display and discussion of live ultrasound images, which has now been invalidated, this statute and others like it script in great detail what treating physicians must say to patients in specified settings at prescribed times.

Hall, M. A. and King, N. M. P. (2016), Conscience, Courage, and “Consent”. Hastings Center Report, 46: 30–32. doi: 10.1002/hast.546