Written by: Prof. Bogdan Chazan

Jan Kochanowski University in Kielce (Poland)

(originally presented during the 2015 MaterCare Conference)

“Professional discrimination in Poland”

In the  previous year, Poland witnessed a number of cases related to obstetrics care, abortion physicians’ and midwives’ conscience clause. The cases illustrates a struggle between the civilization of life and the civilization of death and a professional discrimination in practice. I was involved in one of it and would like to present the background and the course of those events, as well as provide a  commentary. I hope, that you’ll find my story interesting and informative.

I am a doctor, a specialist in gynecology and obstetrics. Twelve years ago, I was dismissed from the position of National Consultant in the Field of Obstetrics and Gynecology in Poland and from the position of head of the clinical department of obstetrics and gynecology at the Institute of Mother and Child in Warsaw for defending the life of an unborn child. I expressed publicly the opinion that Down’s syndrome does not meet the criteria of a severe disease threatening the fetus’s life, which would justify, according to Polish law,  performing an abortion. Feminist organizations filed a complaint with the Public Prosecutor’s Office, accusing me of disrespecting women’s  “reproductive rights”. After the hearing, the Public Prosecutor’s Office dismissed the case, but in 2002 I was removed from clinical practice and scientific activity in the Institute.

After some time I found employment as an administrator, senior manager of the municipal specialist Holy Family Hospital in Warsaw, which I combined with my work in this hospital as a consultant and with academic work at the Kielce University, two hundred kilometres from Warsaw. I employed new, well-educated and experienced personnel; the hospital was completely modernized and expanded. In a year’s time, it was going to be transformed into a complete Family Health Center. The high standard of medical care, good atmosphere  in the hospital attracted many patients. The number of deliveries tripled, to 4,500 per year, and the perinatal mortality rate lowered to 4 per mille. In the hospital during last 10 years we did not perform abortions or in vitro fertilization (IVF).  The Hospital received many prizes and awards, because of high level of medical care and friendly atmosphere.

In early spring of the last year Dr. Wanda Półtawska addressed physicians with an appeal to sign a “Declaration of Faith”. According to the text of the Declaration abortion, contraception, in vitro fertilization and euthanasia are against doctors’ faith and that they recognize the primacy of God’s law over human law. The Declaration, the text of which was engraved on stone tablets, was placed by a delegation of Polish doctors at the feet of the icon of the Black Madonna of Częstochowa. For many years, Dr. Półtawska had cooperated with St. John Paul II; the Pope took her opinion into consideration when writing his encyclical “Evangelium Vitae”. When signing that Declaration as one of more than 3,500 physicians from among some 1610000, midwives, and medical students – I did not expect that it would raise any considerable confusion.

However, attempts were made in the liberal media to discredit the Declaration signatories. Because of what happened in the past, it was me who was attacked most often. It was argued, for example, that having declared respect for the sanctity of the human body, I will no longer perform Caesarean sections. The Undersecretary of State in the Ministry of Health suggested that doctors who signed the Declaration will now treat the sick with holy water and called for using the encyclical at home, but rather an encyclopedia at work. The liberal media would like to move me, as a “Catholic-Taliban”, to Afghanistan. Left-wing members of Parliament postulated that the doctors who signed the Declaration of Faith not be allowed to specialize in obstetrics and gynecology. A representative of the regional Boards of Physicians suggested that medical students who signed the Declaration of Faith should be dismissed from medical universities.  These are only a few  examples of, how severely and ruthlessly those doctors and midwives who want to be faithful to God’s and natural law and their conscience are now treated in my country. Under this brutal pressure some of the Declaration of Faith signatories asked for the possibility to withdraw they signs.

In April 2014, I refused in writing simultaneously as a consultant, as a director and as a man to give consent for performing an abortion at the Holy Family Hospital in Warsaw. The mother had experienced many obstetric failures in the past. The child was diagnosed with developmental defects within the skull. The referral center to which we sent the patient for a consultation suspected hydrocephalus. A professor of pediatric surgery offered to provide care for the child after it was born, claiming that surgical correction of the developmental defects after the childbirth could not be excluded.

After a long conversation, instead of an abortion, I offered the mother care during the pregnancy and birth in our hospital, as well as psychological assistance at a perinatal hospice. However, the patient did not give up her plans to get an abortion. The Polish provisions concerning the conscience clause stipulate that a doctor  who, due to his or hers  conflict of conscience, cannot participate in performing a procedure is obliged to refer the patient to another doctor. It is a very strange and impractical provision. A person who wants to exercise the right to the conscience clause is obliged to help in the performance of such acts by other persons – thus, he or she has to indirectly participate in them. As a doctor and director, I did not want to and could not fulfill this obligation. In Poland, there is no list of doctors who perform abortions and have no moral objections. I would have had to phone doctors one by one, possibly risking an allegation of obtrusiveness. Imposing such an obligation proves inadequate protection of a doctor’s conscience in Poland. A complaint concerning the defectively constructed legal provision regarding the conscience clause has been filed by the self-government of physicians with the Constitutional Tribunal.

The child was born in another hospital, by Caesarean section, with head defects more serious than had been expected (anencephaly). One professor described his appearance after birth in detail on television and called him a “monster” or “Chazan’s child”. He said: “ this is the life, dr Chazan was protected” The baby died within a couple of weeks.

A few weeks after the patient filed a complaint with the City Hall in Warsaw, which is the founding institution of the Holy Family Hospital. Immediately after, five simultaneous inspections were ordered and carried out in the hospital by various institutions, including the National Health Fund, Patient’s Rights Office, the Screener for Professional Liability of the Supreme Board of Physicians and  the Public Prosecutor’s Office. Such a number of inspections performed simultaneously is contradictory to the law. The National Health Fund fined the hospital with an equivalent of about 30,000 dollars. The patient is demanding about 300,000 dollars from the hospital for the suffering inflicted and is threatening me with a civil lawsuit.

The case was highly publicized in the media, where it became soon a leading topic. The uproar begun. I was ruthlessly attacked by  liberal politicians and journalists. The media published articles with false information, malicious comments and even assaults. The Minister of Health threatened me with prosecutors office and the prohibition to exercise the profession. All these because I followed my conscience and the Physician Oath doesn’t want to have a hand in killing unborn children.

In response to that, the conservative circles began to defend me. Statements emphasizing the necessity to defend human life were published by the Polish Episcopate and, independently from that, by many bishops. One of the commentators (rev. professor of theology Marian Machinek) wrote that “Doctor Chazan’s attitude has become a symbol of practicing medicine that falls outside political correctness. For supporters of the cultural revolution such an attitude has become extremely dangerous. It gives also support to the indecisive doctors, who have always wanted to behave in a similar way, but lacked courage. It is also becoming a matter of conscience for those who surrendered and gave in to the pressure of the “applicable standards”. Attitudes that are clear and accurate can tear down the sterile uniformity of the system”. Supportive people, patients and their families organized a rally of support for me in front of the hospital, with a few hundred participants. Some professors of law interpreted my point of view as a justified civil protest.

Poland’s Prime Minister Donald Tusk also weighed into the debate and said that physicians have to put their obligations to the patient and that law is more important then their religious beliefs. Regardless of what his conscience is telling to dr Chazan, he must carry out the law. Every patient must be sure that doctor will perform all procedures in accordance with the law and in accordance with his duties. – he said. A community fundraising event was also started in order to compensate the hospital for the fine imposed by the National Health Fund. The media abroad also became interested in this problem.

In this atmosphere of hot social debate, the Mayor of Warsaw and vice-president of the ruling party (Civic Platform) – Hanna Gronkiewicz–Waltz, commonly regarded as Catholic – dismissed me from my position. Earlier, she had not responded to my letter with a request for a conversation. She did not have the courage to personally hand me the document of dismissal, nor did she find the time to talk and to listen to any explanations. Later, in the media, she said that she shares my system of values, but she had to fulfill the requirements of the law. The archbishop of Warsaw diocesis, Henryk Hoser described this punishment as ethically unacceptable, unjustified, out of proportion, unjust and legally dubious. In my opinion, the dismissal resulted from the pressure of the Prime Minister and the demand of the Federation for Women and Family Planning expressed within the letter to the Minister of Health

The day after my dismissal from the position of the hospital director, a woman – pregnant mother – came with a referral for an abortion due to the child’s illness. She was accompanied by television cameras. In the hospital, where no abortion had been performed for eight years, an atmosphere of intimidating the personnel, fear and crying set in. The midwives were told by the new director of the hospital that it was a “disciplinary requirement”, “a woman’s decision”, “an employee’s duty”. The abortion did take place. Now abortions are being performed regularly in the Holy Family Hospital.

Some people accused me of disobeying the law, causing the suffering of the mother, who had to accompany her dying child, and causing the child’s suffering. According to their  opinion, abortion could have shortened that suffering. I think, that an abortion would have caused much greater suffering to the child . I believe that the mother, some time after or perhaps soon after having spent a few weeks with her ill child, will be happy that she did not kill as she planned, but she let the child peacefully die under the care of the medical personnel of the neonatal intensive care unit.

According to the statement of the American Asscociation of Pro Life Obstetricians and Gynecologists abortions at this gestational age are associated with the higher risk of immediate death for the mother as well as a higher risk of damage to her womb, causing premature birth in subsequent pregnancies. In addition, abortions during this stage of pregnancy are associated with higher risk of deep regret, including higher risk of suicide and depression requiring hospitalization than living birth. So, for the sake of the health of the mother Dr Chazan has made the correct clinical judgement and we stand behind his clinical judgment. The American Association says that my practice is consistent with the position of the International Committee on Excellence in Maternal Health Care and the Dublin Declaration on Maternal Health  Care which say, that prohibition of abortion does not affect I any way the availability of optimal care to pregnant women. At the end of the statement American Association commends dr Chazan for his integrity and courageous practice of Hippocratic Medicine despite political pressure.

Many people expressed their support for my decision to refuse to perform an abortion and showed their compassion for my situation. I received tens of thousands of letters and postcards, almost 200,000 declarations of support on the Internet from Poland and abroad through Citizen Go. According to these people, who I agree with, the life and human dignity of an ill child are even more worthy of protection than those of a healthy child. A disease, suffering, and physical weakness must not deprive human life of value. Human life should be respected as it is; its value should not be graded according to its subjectively assessed quality. Demonstrations took place in front of the Polish embassies in London and Budapest. In Poland and abroad, until now I was invited to have a lecture at almost one hundred  conferences or meetings  on bioethical issues, the conscience clause, abortion, euthanasia, and dignity of life.

The world is witnessing the process of depriving evil of its distinguishing features. Evil has been culturally tamed. In the past, it made the Holocaust possible; now it is assuming the form of mass crimes of abortion. I was fired quite ruthlessly and the whole situation bore the hallmarks of persecution. The aim was to demonstrate with my example to other doctors, nurses and midwives what they risk by applying the Decalogue and the principles of natural law in the sensitive and socially important practice of reproductive medicine. It was a warning for all health care employees who would decide to apply ethical standards to their professional decisions. If firing a well-known professor is so easy, what could stand in the way to doing the same with a doctor or midwife not willing to conform?

Those in power have achieved their aim by using a method which can be called management by fear. It is a well-known fact that fear kills the dignity of man, who is then more susceptible to manipulation. Recently, in one Polish city, an abortion was performed by Caesarean section, in fear that performing this procedure too far into the pregnancy could involve professional or criminal liability. The mother was thus exposed to the risk involved in a surgical procedure. In another Polish city, the court prohibited the defendant to say that in the local hospital, where eugenic abortions are performed, children are killed. But is spite of the management by fear we should remember the phrase “Be not afraid” which John Paul II uttered at the election to the papacy. It should alleviate our apprehensions.

The source of freedom of conscience is not statutory law, but a person’s constitutional rights. In 1993, the Polish Constitutional Tribunal  recognized the autonomy of ethical norms in relation to statutory law. It adjudged that “legal norms should have axiological legitimization, whereas ethical norms do not need legal legitimization”. In the justified criticism of paternalism in the doctor – patient relations, the doctor’s autonomy is often eliminated. Now, the doctor is expected to fulfill all of the patient’s wishes, even those not justified by his or her health-related needs. Nowadays, a model of morally and religiously neutral doctor is preferred, a doctor without a system of values and conscience, someone like a service agency carrying out orders: conceiving a child, selection, abortion, relieving pain, doing away with discomfort, shortening life. Doctors are  also used to control the demographic development, „create” people, give and execute death sentences, carry out a patient’s preferences, and as a tool of ideology. The conscience clause is most often cited in the above-mentioned medical procedures, which exceed the doctor’s vocation and the essence of the profession.

It needs to be said categorically that a doctor is not for hire for any work. The doctor is in the service of life, not death. Doctor is one of the last line of defence against the strident anti life forces. Interrupting human life is not in keeping with the essence of the doctor’s profession. By acting against his or her conscience, the doctor loses the appropriate relationship with the patient and the appropriate relationship with himself or herself. Perhaps, for performing abortions, new specialists should be hired, and medical executioners – tanathologists – trained. And doctors should be left in peace. We should also remember the words of St. John Paul II: “a nation that kills its own children is a nation without future”.

It seems that doctors in my country who want to observe the principle of a clear conscience and do not want– in the name of ethical principles – to observe the statutory law do not receive adequate help and support, which they have a right to. It may have impact on the future decisions of young doctors to choose or not the beloved specialization of obstetrics and gynecology. They face difficulties with work and specialization studies, are exposed to ostracism of some in their professional community, excessively and unjustly punished, ridiculed, pushed to the margin, forced to leave the profession or to compromise their conscience. Difficulty in a  specialization studies  in gynecology and obstetrics for doctors referring to conscientious objection will lead to a situation where the rights of women who would like to be treated by a doctor sharing their moral values will not be respected.

It is comforting and encouraging that the intense attack against me has awakened the dormant, or rather desensitized, consciences of many people, as well as their emotions and feelings. People have understood how important it is in many cases to adjust the statutory law to natural law and ethical principles. It also seems that this case has helped to expand the awareness of how important it is to defend human life at its every stage. The bishops express their gratitude to those persons who call for the full respect for the freedom of conscience, which is also guaranteed by the Constitution of the Republic of Poland. They also thank all those who give a testimony of faithfulness to their conscience, the truth and the good in the society and public life, and who for this reason frequently experience a stigmatization by the media and the society.

Therefore, besides the understandable – in this situation – sadness related to the loss of my job and professional position, as well as stress and sometimes doubt, a feeling of satisfaction and happiness prevails in me. People’s intense reaction, discussions in the press, on the radio and on television on the essence of humanity, parenthood, vocation of man, human dignity, and the essence of abortion are positive results of this story. Enormous friendliness, far exceeding hate, towards me personally, gives me joy and compensates for the discomfort. Perhaps evangelization is involved in it too.

I hope that my colleagues – gynecologists – will also wake up and follow a different and better path, for their own good, and for the improvement of health of present and future mothers and their children.

Warsaw, August the 12th, 2015

The Epilogue

How are the things now, in late 2015 that started last spring when I was judged and convicted, at first by fierce and biased media, then by politicians and officials? I have paid the price for the choices that I made. I am glad that the baby was born and could die in peace and dignity, I hope that in its own mother’s arms.

Patient’s Ombudsman, the official appointed by the Government, issued a negative opinion with regard to my refusal to perform abortion. His representatives refused to discuss with me about the rights of the unborn baby as a patient. In the report they stated that the doctor is obliged to inform  parents that they may exercise their right to abortion in case severe fetal malformation are determined before birth of their baby, even if they do not talk about it. That’s an absurd. Similarly, it could be argued that the doctor recognizing serious illness in an elderly patient is obliged to ask if he or she want to exercise their right to euthanasia if local laws permit euthanasia.

After a year-long investigation, the prosecutor found that the baby’s mother’s health and life was not endangered of what I was originally accused. According to experts, keeping the pregnancy and giving the birth to a baby with severe developmental abnormalities was not associated with the threat to the patient’s life. In course of the proceeding the prosecution examined also such issues as bullying, causing psychological injury, exposure to health risks, coercion, going beyond the scope of authority and negligence and did not find any such my activities.

The liberal media were very disappointed that I will not be convicted for criminal offence for refusing abortion. They put forward the opinion that if a person who performs an abortion against the law is punished, then likewise, the person who does not perform abortion permitted by law should also be punished. However, the conscience clause refers only to the second situation. Besides, there is no such thing as a right to abortion. There is only a situation when a doctor will not be penalized if he performs abortion in specific circumstances. I believe that abortion was likely to have similar or perhaps greater risk to the mother than the child birth. Psychological stress connected with being pregnant with the baby incapable of life was not greater than the stress associated with the decision to kill the baby and later likely remorse.

The Screener for Professional Liability of the Supreme Medical Council after a similar investigation came to the conclusion that my conduct did not breach the principles of good medical practice.

The case in the Labour Court against the president of Warsaw for bringing me back to work is still on. It will take another two years. I believe I will win this case. I do not mean the position of the hospital director, but to prove in court that the drastic decision to dismiss me from work was not legally justified. What I am about is a legal precedent, I am concerned about other directors of hospitals, doctors, nurses and midwives so they are not threatened with the same thing which happened to me when they want to be faithful to their conscience.

A reporter asked, Ms. Hanna Gronkiewicz-Waltz, the president of Warsaw if she does not consider bringing me back to my former position since the rulings of the Prosecutor and the Screener for Professional Liability were favorable for me. She replied with a citation: “Judge not, that ye be not judged”. She said she won’t take into account the decision of the Screener for Professional Liability, because professional associations generally defend their members. A journalist asked the spokesman of the President of Warsaw whether in the light of new facts his supervisor is not considering the possibility of restoring me to the position of director of the hospital and apologize, he replied that the journalist’s thinking is ideologically biased.

On 7th October, the anniversary of Lepanto battle and the Feast of  Our Lady Victorious,  the Constitutional Tribunal investigated a complaint of medical self-government on the part of the Medical Profession Act, which restricts the doctors’ conscience clause. The Lower chamber of the Polish parliament and the general prosecutor oppose amending the Act. These institutions want the Tribunal to admit these restrictions are compatible with the Constitution. According to the Supreme Medical Council, the provision that requires the doctor referring to the conscience clause to indicate the patient real possibilities of obtaining the service from another doctor or other medical entity makes right to freedom of conscience illusory. According to the Supreme Medical Council, it is the European standard that whole health care institution may refer to the conscience clause. According to the team of experts of the Polish Episcopal Conference, the right to refuse medical service due to conscientious objection is intrinsically affiliated with the personal dignity of man and the resulting freedom of conscience. The Marshal of the Lower Chamber of the Polish Parliament claims that restricting doctor’s  possibility to refer to freedom of conscience is a consequence of the recognition by the State the primacy of a guarantee of health services. Bioethics Committee of the Polish Academy of Sciences concluded that the conscience clause cannot be used as an instrument to impose doctor’s moral convictions on a patient. I am very happy that the Tribunal saved the doctor’s conscience in my country.

The media accused me that I protected my conscience for the price of the suffering of the woman and her baby. Yes, I protected my conscience and I had legal right to do, I referred to the conscience clause. I also protected the conscience of younger colleagues, I shouldered the burden myself, I thought that they might be hit by even greater repressions. I protected the baby from suffering related to the procedure of abortion, I wished it was baptized before natural death after birth.  I protected the mother against infanticide and remorse, if not now, then in the future, against the physical suffering associated with abortion. I think that I managed to protect all these good.

There is also something I regret. That decision of the president of Warsaw resulted in  the atmosphere of fear among the medical staff. In panic, abortion was performed in Poland by caesarean section. It increased the overall number of abortions in Poland. So conscience of doctors and midwives is violated more often. Nearly nobody supports them, they are left on their own. Unhappily, the Catholics in the Parliament, on senior positions in the state administration remain silent or take an active part in the promotion of abortion, in promoting the civilization of death.

From the time perspective, I  believe that maybe I’m still someone dangerous for the supporters of cultural revolution.  Clear attitude disturbs the effectiveness of the pressure conditioned by various dependencies, compromises and the disciplinary and moral violence which are exerted on doctors and midwives.

It is also a difficult for me to explain the fact that the many consciences are touched and the interest in this issue doesn’t fade away. In autumn this year I about 20 meetings around the country are arranged.  National and international conferences on various aspects of medical conscience, dignity and value of human life are organized.

Once again the belief that God brings some good from every evil, suffering and injustice proved to be correct.

Warsaw, October the 28th, 2015