(no subject)

[kuangning]

Sometimes, I really think that the biggest problem this administration has is their collective lack of imagination. The inability to look beyond their goal of the moment to see any consequences to their actions is just astounding.

Here's today's outrage.

And here's why it's fucking stupid, beyond the obvious.

While they probably (almost certainly) mean to target only abortion and contraception, that's not all the language says.

The third conscience provision, contained in 42 U.S.C. § 300a-7(c)(2), prohibits any entity which receives a grant or contract for biomedical or behavioral research under any program administered by the Department from discriminating against any physician or other health care personnel in employment, promotion, termination of employment, or extension of staff or other privileges “because he performed or assisted in the performance of any lawful health service or research activity,” or “because he refused to perform or assist in the performance of any such service or activity on the grounds that his performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of his religious beliefs or moral convictions respecting any such service or activity.”

The fourth conscience provision, 42 U.S.C. § 300a-7(d), provides that “[n]o individual shall be required to perform or assist in the performance of any part of a health service program or research activity funded in whole or in part under a program administered by [the Department] if his performance or assistance in the performance of such part of such program or activity would be contrary to his religious beliefs or moral convictions.”

A little broad, isn't it? Do you really think that abortion and contraception are the only issues where a health care provider might be asked to do something against their personal convictions?

* What happens when (not if, but when) we have another Terry Schiavo case and the doctor refuses to prolong life by artificial means because that's thwarting God's will?

* What happens when (not if, but when) a patient has a "do not resuscitate" order that the doctor refuses to honor?

* What happens when (not if, but when) a doctor refuses to treat a gay patient who is HIV-positive because they believe it's God's punishment?

* What happens when (not if, but when) a doctor refuses to excise a uterine cancer in a nulliparous female because doing so would require a hysterectomy?

* What happens when (not if, but when) a surgeon refuses to perform a transplant for a patient whose morality they disagree with? ("I'm not giving a good heart to that man; he's a ___.")

Does a Democrat surgeon get to refuse care to a Republican patient, or vice-versa? Do Christian doctors get to refuse care to atheists? How about Wiccans? Or not even the doctors: under these, your ambulance driver can refuse to take you to the hospital if you don't meet their standard for care.

Here's the test for whether you should be okay with this or not: if the issue isn't abortion/contraception, do you still think those are good rules? Are you going to be okay with it when it's one of those other issues? Or are you going to feel, when the issue is something you care about, that a doctor who doesn't want to provide care to everyone should be shunted into someplace where s/he can, by his/her action or inaction, do no harm, and let someone willing to do the work have the slot? If you think that doctors shouldn't be able to deny care for any of those other issues, then you should be just as outraged when it's abortion in question.

Comments

[therealocelot.livejournal.com]

Having just read a post on allnurses.com mentioning a student nurse who only wanted to provide care to fellow Christians, reading this has a certain...non-hypotheticalness to it.

[kuangning]

Oh, I know. It's inevitable. Because people are people, and when you basically tell them "you can act badly and I'll support you every step of the way," they will act badly. That's all there is to it.

Hrm.

[dputiger.livejournal.com]

The inability to look beyond their goal of the moment to see any consequences to their actions is just astounding. ++

I agree with the moral behind the proposed rule, or at least what I caught by skimming the PDF and reading your post. I believe, in general, that no one should be forced to act against their own beliefs. Unfortunately, however, some people have batshit crazy beliefs. This law, as written, is a terrible idea for all the reasons you've stated.

I think the bill could be saved, if properly amended:

• No healthcare provider shall refuse care to a patient if doing so would violate that patient's right to equal protection under the 14th Amendment. This includes situations where the person is locked into a certain HMO that requires them to see one particular doctor as well as patients who have had to go to the emergency room.



• A physician may not withhold care on moral grounds if doing so could reasonably result in either death or permanent unnecessary injury before a replacement physician could be found. The doctor is responsible for locating his own replacement, (possibly in cooperation with the family). During this period, the attending physician is required to treat the patient as he would any other if not for his moral disagreement.



• Failure to treat the patient appropriately is potential grounds for a criminal or malpractice lawsuit.



• No doctor may violate the express wishes of the patient or the patient's appropriate/legally appointed caregiver. This includes situations where a DNR order has been issued, as well as scenarios in which a doctor might wish to end a person's suffering but has been left with orders to attempt resuscitation. A doctor may request replacement on such grounds, but the patient must remain appropriately cared for at all times.



• Physicians are not allowed to give special consideration to their own personal feelings vis-a-vis their patient's morality when determining the viability of a life-saving procedure, organ transplant, organ priority, or overall quality of care. A doctor who feels he cannot evaluate a patient's status under the above considerations due to a moral issue may recuse himself, presuming that the patient's care does not suffer and an appropriate decision-maker can be found. Physicians found to be in violation of this provision can be held criminally accountable for their actions.

I believe this covers all the examples you raise, as well as some additional potential problems. The uterine cancer scenario is a bit unique, but I *think* I covered it in the above under either "Cannot refuse emergency care," or "Cannot alter quality-of-care."

My intent here was to create a clearly defined buffer zone, within which a health care provider is allowed to follow their own personal moral constraints. I may not have hit every single scenario, but I think my proposed amendments are consistent enough to allow for extrapolation that would cover any scenario—I am, after all, having a conversation, not actually writing law. ;)

As an aside, I wonder if one way to deal with this situation is to place additional emphasis on the role of a doctor (historic and perceived) as a caregiver regardless of the identity, race, color, or creed of his patient. Obviously one can find ten billion practical exceptions to this ideal, but the modern version of the Hippocratic Oath states the following:

Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God...

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. [emphasis mine]

Louis Lasagna wrote that updated version of the ol' HO back in 1964, and I think it perfectly expresses what it means--what it should mean--to be a physician. So long as the spirit of the precepts held within that document are kept, I believe a doctor is free to exercise moral discretion where appropriate.