2026 Moral Leadership in Medicine: "The Conscience of Care: Navigating Health in the Culture Wars"

I'm Rebecca Brindell. I'm the director of the center for bioeththics at Harvard Medical School. And I am delighted to introduce my colleague Susanna Bouche who is the executive director of the Petri Flom Center at Harvard Law School. And I've been told this week I you can learn something new every day. I learned uh this week that the most Harvard thing you could possibly ever do would be to introduce the person who's going to introduce our speaker. My job is done for the day. Susanna. >> Thank you, Becca. Um, my name is Susanna Barouch. I'm the executive director of the Petri Flom Center for Health Law, Policy, Biotechnology, and Bioeththics at Harvard Law School. Uh, we are a multi-issue, multiddisciplinary research center, and our current work spans many legal and ethical issues from psychedelics to medical AI to aging and the law to embryo law and ethics. Um, I hope everyone will visit our website, sign up for our newsletter, read our blog, Bill of Health, and follow us on social media. Um, thank you to my friend Becca Brendelle for her vision for today, for her to her team and for the team behind the scenes um, from Petri Flom as well. Um, we are also thankful to the Oswald Deian Cayman Fund for at Harvard University for support of this event. Now my real job is that I have the privilege of introducing professor Dove Fox. He is the Herzog research professor of law at the University of San Diego where he directs the center for health law policy and bioeththics and has been named university professor which is the university's highest academic honor bestowed on faculty in any field. Dev's accomplishments are hard to summarize, but he has produced three research documentaries, published four scholarly books, and over 80 articles in leading journals of law, medicine, and public health. His research has appeared in many um more uh public uh minded um venues like The Atlantic, the New York Times, and the Wall Street Journal. And his audio series called Donor 9623 was named Audible's podcast of the year. and nominated for a Pulitzer Prize in investigative journalism. Dove will deliver um his speech, his lecture today based on his book, The Conscience of Care: Navigating Health and the Culture Wars, which could not be more timely or relevant. In it, he meticulously describes the asymmetry um between a clinician's conscientious refusal to provide care, which gets legal protection, while conscientious provision of prohibited care does not. Um, Professor Fox urges us all to reckon with our deepest values as we all of us in this room and on the Zoom uh consider the relationship between medicine and law um and how the idea of conscience might play a more equitable role. So with that, it's my pleasure to welcome Professor Dove Fox. I got in this big beautiful uh Boston super moon lighting up the sky. Uh today I feel like I am right over it. Uh thank you to the dazzling organizers, distinguished panelists and commentators. Uh all of you here this morning and everyone watching on Zoom. Uh I ask you to uh indulge me trying to think through talk about some of these medical conflicts that divide us today. I want to consider the lost promise of a contentious ideal conscience. It goes back to the first code of medical ethics that the American Medical Association published in 1847. The AMA said that the mission to care for patients draws its moral force from a physician's conscience. It's a concept that resonates especially deeply today, I think, when clinicians have never faced so many restrictions on whom they treat or how. In September 2021, a Texas law called SV8 banned abortion at about six weeks. Days later, Dr. Alan Brad confessed to having violated that law. His op- ed in the Washington Post explained that he had been a young OBGYn resident in San Antonio in June 1972, 6 months before Roie Wade would go on to legalize abortion nationwide. In that short time, he witnessed three teenagers die from self-induced abortions that the state for had forbidden them from getting safely. one, he recalled, arrived to the ER already septic, her vaginal cavity packed with rags. These memories haunted Braid. He warned that preventable deaths would return, and they have since the Supreme Court overturned Row in June 2022, exactly 50 years later. A dozen states quickly joined Texas to criminalize abortion at zero weeks and impose harsh sentences for providing one up to life in prison. Braid was adamant that this time he couldn't just stand idally by. He knew that he would face the barrage of lawsuits that followed for violating the state's ban. He didn't care for Brave. This wasn't just about meeting his professional obligations. It was a matter of conscience. Dr. Barbara Morris appealed to her conscience, too. She specialized in elder care for over 40 years in Colorado, one of the dozen states that allows physicians to assist patients seeking to hasten their own death at the end of an agonizing terminal illness. In 2019, Morris was fired for trying to help a patient die sooner after incurable stage 4 cancer had reduced a man's body to a skeleton shrouded in painful leings. Morris worked at a Catholic institution that forbade assisted suicide as contrary to its mission to preserve the sanctity of life. But Catholic hospitals nationwide strictly prohibit a range of legal practices like this. Not just aid and dying, but abortion, sterilization, emergency contraception, IVF, and IUDs. Decades of market consolidation among religious health care systems have now left Catholic institutions in control of more than one quarter of all acute care beds in the United States. Morris's hospital was the only facility for miles equipped to provide paliative care. So losing her job meant giving up her practice. Morris told me she had no choice but to disobey the ban. Being forced to abandon her suffering patient inflicted a wound to her soul. It violated her conscience. Conscience is an individual's deeply held moral beliefs. This definition has three parts. First, conscience is for clinicians with a human faculties to think and feel. Second, these individual beliefs must concern matters of right and wrong. These moral convictions arise all the time in medical practice with its intimate probing and profound decisions about impairment and identity, life and death. Finally, these aren't just take or leave preferences. The beliefs of conscience mean having the courage of your deeply held convictions. And that requires a willingness to stand by them even when that requires a sacrifice of yourself. So why value clinician conscience in the first place? There are two reasons. The first is for the individual conscience holder herself. Protecting conscience preserves the moral integrity that spares a doctor or nurse or physician's assistant from burnout or trauma if forced to practice medicine at odds with her convictions. Second, respecting conscience promotes the social pluralism that enables the dynamic profession of medicine to embrace its moral diversity and to adapt to moral change from within. Appeals to conscience might seem too easy to fake, too susceptible to bias or misinformation. But our legal system routinely adjudicates such subjective states of mind like intention or a knowing disregard of risks. See, objective evidence can corroborate whether a clinician's appeal to conscience really does concern right and wrong. For example, if an OB/GYN says that he opposes abortion on moral grounds as murder, but turns away only Medicaid patients, well, that's about money, not morals. Even for genuine appeals to conscience, there are two kinds that don't deserve our respect. First, our objections grounded in invidious attitudes like refusing to prescribe the prep medication that prevents HIV because a clinician believes that facilitating gay sex is a sin. Second, are clear factual mistakes like refusing the morning after pill on the grounds that it ends a pregnancy when really it prevents one from starting. Conscience claims that are rooted in bigotry or demonstrable far falsehoods aren't worth protecting. But most claims of conscience are not so nasty or illinformed. Conscience clauses shield clinicians who invoke the sanctity of life, the dignity of marriage or the unity of sex and gender at birth from the penalties that they would otherwise face for refusing care that their profession or their state or their employer requires. Refusers don't lose their jobs. They don't lose their licenses and they can't be held liable for malpractice or convicted of negligent homicide. Conscience clauses in this country shield even non-clinians who object to a practice from a distance, refusing, for example, to check patients in at the hospital or to file their claims for health insurance. And yet there's no protection for their practitioners directly involved in performing a medically indicated procedure. These nurses, physician assistants, anesthesiologists, doctors like Brad and Morris, call them conscientious providers. They get no legal relief to treat patients in clinically beneficial ways that honor their wishes, not override them. Providers get fired and sued at will, even prosecuted under the threat of decades behind bars. Lopsided conscience laws selectively burden providers. They harm patients, too. Amber Thurman was a Georgia woman who died when clinicians denied her an emergency abortion for over 20 hours while she was seven. Her doctors feared punishment in a state that makes abortion a firstdegree felony to provide and offers no leniency for conscientious providers. Brent Sloan was a 40-year-old father from Kentucky who relied on high doses of opioids to manage his excruciating chronic pain from a car crash that required multiple surgeries and skin grafts. Opioid crackdowns drove Sloan's doctors to slash his dose and decline his plea for an early refill. Unable to bear the pain, Sloan texted his wife. script denied, "I'm done. Love you." and took his own life. Kathleen Brownfield was raved in LA and rushed to a Catholic hospital. There, her doctors wouldn't even tell her that emergency contraception was an option to avoid pregnancy. By the time they released her 3 days later, Plan B no longer worked. California's conscience clause immunized her doctors and the hospital itself from malpractice or breach of informed consent. Can a hospital like this one in LA itself appeal to conscience? Our laws say yes. Common sense tells us no. Institutions lack the free will and practical judgment required to hold moral beliefs of their own. People have a conscience. Corporations don't. That said, hospitals and health care systems can have other interests in religious expression and freedom to associate, say, with only providers or just refusers. These expressive and associational interests weigh in the balance against employee claims of conscience. Importantly though the strength of these institutional interests ba are vary based on its size and internal cohesion. Legal scholar Elizabeth Seper has shown that stronger interests lie with a closeknit, very small hospital whose staff and patients consciously self self-identify around a faith-based mission, for example, natural fl family planning methods. Whereas these institutional interests are weaker for the sprawling conglomerate that employs and treats thousands of people, many of whom may not even be aware that of its religious affiliation, let alone how that limits the care that the institution makes available. Now, it's no accident that conscience protection spread from direct participation to remote and from inst individuals to institutions. A bit of history. Conscience was popularized in American public life amid rising discontent in the Vietnam War. Small and insular minorities like Quakers and Menanites appealed to conscience as a shield from discrimination by draft laws that were indifferent to their pacifist beliefs. After row, however, conscience morphed into a sword against complicity that powerful groups could wield to refuse even negligible involvement in care they opposed. Conscientious objections are in fact governed very differently in medicine than they are in the military where objectors are exempted from battle only if the country can feel the fighting force without them. And conscience object objectors still have to pitch in to make up for opting out. Back in the Civil War, objectors had to pay $300 to recruit replacements. In Vietnam, they had to serve as combat medics or civil volunteers for at least as long as they had had would have had to serve in battle. In medicine, by contrast, refusers get a free pass even if they're denying care would leave patients unable to meet their basic medical needs. refusing doctors get conscience without any real conditions or consequences. The US is a global outlier in protecting conscientious refusal. So absolutely some countries like Bulgaria, Ethiopia, Finland and Sweden, they just offer no protections at all for anyone. If indicated care is legal, then clinicians must provide it. Others, Turkey, Venezuela, South Korea, and the Czech Republic, let refusers off the hook only if that's consistent with maintaining broader access to standard treatment. In the US alone, can clinicians refuse to provide routine legal care, no questions asked. Reproductive medicine is ground zero for conscience conflicts. And it's not just abortion. Some clinicians oppose IVF because it involves creating human life that might end up being destroyed. Other doctors won't prescribe IUDs out of concern that they promote non-marital sex. Some pharmacists refuse to dispense plan B because they think it works after an embryo has already implanted, not before. I've also spoken with clinicians who have conscientiously provided all of these practices and procedures, too. Their convictions compelled them to violate restrictions on patient care. Death and dying pose wrenching conscience dilemmas as well. Some states forbid physicians, honoring the advanced directives of a pregnant woman who ends up in a persistent vegetative state, thereby keeping her on life support against her will to continue growing the nasonent life inside of her. Other states have indicted ICU doctors for murder on 25 counts of murder, no less, when they risked hastening death by administering highdose painkillers or sedatives to keep their patients comfortable after they'd agreed to withdraw life sustaining care. We dying and newborn youth in Asia raise similar conflicts of conscience about how doctors respond the suffering of their vulnerable patients. Clinicians have also claimed conscience to treat patients for a range of chronic conditions. Should doctors transplant paid for organs when that's the only way to save a life? Should they provide dialysis to undocumented immigrants with kidney disease by miscoding their medical status as an emergency so they qualify for the Medicare funding they need to get that routine care? Conscience affords total protection to refusers across all these contexts, but providers meanwhile get none. What gives? Let's consider the five strongest way to try justifying this radical asymmetry. First argument, refusal alone avoids complicity, the gravest evil of all, that is killing a human being, for example, an abortion or assisted suicide. That's what makes refusal more important to protect. except conscience clauses don't rank the strength of different moral beliefs. They're all protected the same for refusers anyway. The complicity argument doesn't explain why we also protect the refusal of practices that don't involve any killing at all. Things like contraception and gender affirming care. Nor does it explain why we failed to protect doctors who conscientiously provide that dialysis or transplant that would save a patient's life. This concern about complicity and killing is too overinclusive and too underinclusive to justify our lopsided law of medical conscience. Second justification is that refusals merit special protection because they are rooted in religion while provision claims are not. But again, refusal clauses protect secular and religious beliefs equally so long as they're moral in character about right and wrong. And besides, secular claims can be just as sincere and verifiable as religious ones. Also, many religious traditions compel us to minister to the sick and the vulnerable. Plus, some refusal claims are secular themselves. For example, when they appeal to species typical human functioning or the natural giftedness of human life. The religion argument can't make sense of the conscience asymmetry either. Argument three, forcing clinicians who refuse care to provide that which they object to is worse than making providers decline to treat patients in the ways their conscience demands. This distinction between doing and allowing looms large in American life and law. You can't push someone off a bridge, but you're allowed to let them drown. But this moral difference between doing and allowing matters less in the context of medicine where profound disparities of in of information and power between providers and patients demands more of clinicians than just negative duties to refrain from performing ill-advised surgeries or from prescribing dangerous medications. Clinicians by virtue of that special relationship with patients also have positive duties to them to undertake preventive screenings and carry out a host of treatments in order to comply with medical standards of care. This line between doing and allowing, whatever moral work it does do, isn't nearly enough to justify the extreme legal asymmetry between refusing care and providing it. Argument four, IT COSTS less to accommodate refusers. They don't ask third parties like hospitals and states to pay for the expensive facilities and equipment required to make room to provide the care that they'd rather not wouldn't otherwise. A couple things. Many prescriptions are cheap. Birth control, puberty blockers, medical marijuana. What does that cost an institution? a prescription pad, an entry of the electronic health records. Also inexpensive is a tubal lation operation that follows an already scheduled C-section. These things don't cost a great deal for conscientious providers to offer, not to the institution, not to the state. Also, some procedures, many, while pricey, may nevertheless cost less than the necessary alternative. For undocumented immigrants with chronic renal insufficiency, standard dialysis is less expensive than the emergency form of dialysis that Medicare will foot the bill for when their kidneys inevitably fails. And a conscientiously provided abortion costs less than the labor and delivery imposed by its conscientious refusal. Finally, and most importantly, accommodating refusals imposes serious externalities, too. They're not cost-free. They pose externalities on, for example, patients who must travel or wait or go without care, on co-workers who have to cover for the refusers, on institutions that lose staff, and on regions that experience health care deserts when refusals are widespread. So this cost differential argument that doesn't explain either why we should protect refusers so much and providers so little. The fifth justification is the strongest. It says that accommodating refusers is consistent with a background interest in making care available since non-objectors can step in to still provide it. By contrast, when a state or hospital restricts treatment, when that's the background policy at stake, allowing anyone to provide it can't help but defeat the whole point of that ban. But practical realities complicate this argument, too. Where refusals are concentrated, widespread exemptions can leave care unavailable or unduly burdensome for people to access when a hospital or state wants them to be able to access it if they want to. And under a regime that restricts treatment, we'll see how institutional workarounds and partial defenses can make a measure of space for the provision of care without riding roughshot over the state or hospitals prohibition of it. The law's radical asymmetry is unjust and indefensible. So why not abolish conscience objections altogether? It's not just that they're woven so deeply into the fabric of American law and medicine that we well we just can't uproot them now. Extinguishing object exemptions wholesale would also deprive medicine of its moral dynamism. We should protect conscience for handson refusers too. We should balance these protections out. Accommodate refusers less than absolutely and providers more than not at all. Their claims also operate against two levels of authority. First, employment policies. Second, government laws. At the hospital level, a clinician's bonafide appeal to conscience should be accommodated to refuse care or provide it so long as there are reasonable alternatives to make room for its exercise. So limitless exemptions can't leave, for example, medically standard care unavailable or just too burdensome for people to access. nor can it force small religious practices to close their doors altogether. To offset burdens on patient access, large sectarian hospitals should take steps to preserve access more generally. For example, by setting aside a room in the hospital for either conscientious employees or independent outside contractors to provide care using outside supplies and equipment. And close-knit clinics should be free to fire conscientious providers to qualify for employment protections in the first place. Objectors must be upfront about their medically indicated options available to patients. They don't get a break if they don't tell patients what their options are ahead of time. And subject to free speech protection, she must also tell patients and her employer too which services she will provide and which she won't. Note, this isn't on a public database available for everyone, but in private protected conversations with an employer and with patients. Now, I'm under no illusion that any of this is free or that it wouldn't cost a great deal of money. Disclosures, distancing measures, expensive. Who should pay to accommodate clinician conscience? I think for these profound goods of individual integrity and social pluralism, I would spread these costs widely among us, among states, large hospital systems. Another option, however, is objector fees to offset the impact on vulnerable patients and small employers. To exercise conscience, an individual objector would have to pay a modest price. Like in the military, whether in the form of financial contributions to accommodation offsets or volunteer services toward the same goal, subject, of course, to limits that the Supreme Court cases like Hobby Lobby have set on government burdens of religious exercise. Let's turn from hospital policies to state laws. On one side are mandates to secure informed consent and avoid malpractice or patient abandonment that refusers seek to override. Then there are the civil and criminal bans on providing legal otherwise legal or standard care. That is that makes this care unlawful and for conscience providers would face civil or criminally criminal penalties to provide it against this deeply divided background legal regime. How can we value clinician conscience without imperiling legal order? Here I propose a partial defense to legal violations of medical conscience. Clinicians who break the law on conscience grounds would still be subject to liability or conviction. That wouldn't be expuned or wiped away, but the defense would operate to substantially reduce their fines or prison time to a small fraction of the penalty or punishment they would otherwise face for breaking the law. Besides these prices and consequences that lawbreaking conscience holders would still have to pay, the conscience defense would also come with conditions. Conditions that derive from the core pillars of bioeththics, autonomy, beneficence, non-maleficence, and justice. Let's start with the distinct conditions for refusers to qualify for the defense. There are three. First, they must disclose their objection in advance to give people at least a chance to seek care elsewhere before an emergency arises. Second, refusers to get the defense couldn't just drop an existing patient who lacks continued care without seeing to their ability to see someone else for the care that the refuser had previously been providing. Finally, clinicians can't turn patients away for reasons like race or sex. Meeting these three conditions about notice, abandonment, and discrimination would res reduce the penalty substantially for refusing care in ways that violate duties and harm patients. But this would be a whole lot less than the protections available to refusers today. Three different protections would qualify conscientious providers for protections that are non-existent at this time. First, treatment must not coers, exploit, or deceive competent patients or their surrogates. The defense wouldn't be open to provide genital cutting to pressure young girls into getting that care by family members or community or physicians clinicians themselves. They couldn't claim conscience to provide that. Second is compliance with professional standards of care. The defense wouldn't be available to provide conversion therapy, for example, or ivormectin to treat COVID because reliable medical evidence shows that they are more likely to hurt patients than to help them. Finally, providers can't hoard scarce resources for their own patients at the expense of others who would gain more from costly dialysis or a paid for organ that's in short supply. There has to be a reasonably fair allocation of these scarce resources in order to qualify for the conscience defense to breaking the law for conscientious providers. Now, this conscience defense for refusers and providers too, notwithstanding those conditions and the consequences for invoking it would still raise three challenges for American democracy. First is the risk of eroding respect for the rule of law by making exemptions to the law available any time that a refuser or provider pledges allegiance to a higher moral ideal. That's a serious concern. But we take the edge off it with the narrowing conditions and offsetting consequences just like we do in the military con uh uh context where we the law requires people to serve but we provide limited narrow exemptions to that law without thinking that we have no law at all. That's what I would propose with our conscience defense in medical practice. Besides the rule of law, we might ask, "Will the defense be deployed in arbitrary or discriminatory ways before row, there were medical exemptions to provide an abortion that states banned, but those exemptions tended to be used on the basis of patient race, class, and connections. There was a break, but it was given to people with greater means and not less. Would that happen here? No, I don't think because the conscience defense would be available only not just to groups that a hospital favors or ones that or to favored practices by the state. It mitigates this risk the defense does by requiring claimants to allocates allocate scarce resources fairly, not in arbitrary ways or based on race or class alone. The final concern is about the separation of powers. Can courts really slash an offender's sentence for providing the very care that her legislature has strictly prohibited? Yes, the conscious defense falls squarely within the judicial authority to reduce punishments for things like duress, provocation, and diminished responsibility. In all these cases, judges have exercised their common law authorities to establish either total defenses like self-defense or excuses like insanity, duress, like other defense like necessity or here by not excusing or justifying altogether there is no punishment but rather merely to reduce the punishments for the convictions required under the law. So there's plenty of legal precedent under established doctrine in criminal law and elsewhere for establishing a defense for medical conscience that would accept the penalties or punishments for violating the law but reduce substantially the consequences for violating them. Where does all this leave us? Let's start with patience. Educate yourself about how conscience rules apply to your state and your health care institution. For example, Illinois is the only state that mandates disclosures of care options. The only one. And just Georgia requires refusing pharmacists to refer patients elsewhere. Just in Georgia. New Hampshire is a lone state with no conscience policies on the books whatsoever. Not for refusers, not for providers. And Vermont alone flips the prevailing asymmetry on its head by prevent by protecting just providers and not refusers. Institutional policies vary even more. Ask your hospital if it restricts standard services and ask your treating physician if she objects to any on moral grounds. Complicity concerns may prevent objectors from making direct referrals like those pharmacists are required to in Georgia. In that case, contact specialty organizations for help connecting you with willing providers or matching refusers to your values and needs. The government in turn should subsidize professional groups to undertake this enormous work like the American College of Optitians and Gynecologists that would be responsible for assuming this intermediary role, a new one for them of matching patients with providers for clinicians. Understand your conscience related rights and duties. Negotiate for relevant contract terms with your employer. Disclose moral objections to your patients and employer upfront. Recognize that collective action is more likely to achieve structural change than individual exercises of conscience alone. You know, the threat of punishing sanctions may be too much to expect of individual clinicians standing alone. So, take part in ethics committees and professional groups to stand shouldertosh shoulder with objectors and colleagues to express support for the other objector's commitments. Stand behind them. say that you will follow in their shoes or you got their back at a minimum by covering their lawyers fees if not joining together with them in collective action, collective objection in order to fight what you regard as rules and policies so unjust, so egregious that they can't be abided. They cannot be tolerated. Lawyers should challenge over broad complicity based comp uh refusals based on existing legal tools like MTA, the Emergency Medical Treatment and Active Labor Act and employment safeguards that protect people for engaging in lawful activity elsewhere on their own time. Lawyers should also use antirust statutes to challenge proposed mergers and acquisitions that would reduce a community's access to standard care. These existing legal tools are limited but must be used to the extent possible to do this work. Finally, lawyers should urge judges to recognize a partial conscience defense to reduce the penalties and punishments for medical disobedience. Lawmakers for their part should condition hospital mergers on the direct provision of standard treatments or adequate alternatives to access them. Enact disclosure mandates on hospitals and individuals. Fund accommodation offsets to defay third-party costs and codify protections for conscientious providers too. may start with judges and the law and then lawmakers can weigh in to codify those by statute. Lawmakers should also shore up those distancing measures to mitigate institutional complicity in providing care that a hospital opposes. Fund hospital set aides where restricted procedures can be performed using outside personnel and supplies. subsidize specialty organizations to help patients find willing providers or matching refusers. To make space for conscientious refusers, for example, preserve protections for individuals directly involved in performing a procedure that they morally oppose. Provided that the wider impact isn't undue on patients in need of receiving that care within the institution or that region. States should also expand scope of practices scope of practice rules within reason. Let nurses, physician assistants, and midwives perform certain practices that are traditionally reserved to MDs alone. Allow teleaalth to do work where in-person appointments aren't necessary. Health care institutions especially should promote transparency given the outsized impact that these larger providers have on the practice policies on patient access. Disclose conscience policies on their websites on intake forms in waiting rooms in real time conversations. Today they're a secret. patients don't know until they face an emergency and ask for care that they're denied. Make those rules explicit in employment contracts as well so they're not surprised for employees who work there as well. eliminate DAG rules that explicitly bar clinicians from dis from discussing medical medically standard options with patients and require them to disclose conscientious objections to patients too. Not just to protect those patients from surprise denials that cause them the greatest harm, but also to reduce an institution's own legal exposure for failing to inform patients about their medical options. There's no easy fix or perfect compromise here, but we've protected conscience in principled ways before. The church amendment of 1973 was passed shortly after Row versus Wade. It said that clinicians couldn't be forced to perform an abortion or a sterilization that they opposed on moral grounds, but they couldn't refuse or they could refuse to take part only if their participation would be handson, not at a great distance from that procedure. The law also barred employers from firing conscientious providers for supplying or advocating for these practices elsewhere on their own time. Moonlighting, for example. That wasn't a lot, but it was something. The law provided protections for conscientious refusers and providers, too. And the law didn't just squeak through Congress. All but one vote. It was unanimous in the House and Senate sweeping bipartisan reform ranging from pro lifer James Buckley to committed feminist Bella Absa. Now today's America is far more polarized. But I hope that even now we can recover this more inclusive vision of medical conscience by equipping ourselves to navigate the controversies of our time and the ones that lie ahead. Thanks so much. I look forward to your thoughts.