"It's A Very Disturbing Trend"

by DemFromCT

The Washington Post has an interesting and important article (not that it's the first best thing on the topic, but it's a reminder of the context that the Schiavo fiasco took place and the ongoing presence of this issue) on the rise of assertive religious conscience in the practice of health care.

In Chicago, an ambulance driver refused to transport a patient for an abortion. In California, fertility specialists rebuffed a gay woman seeking artificial insemination. In Texas, a pharmacist turned away a rape victim seeking the morning-after pill.

Around the United States, health workers and patients are clashing when providers balk at giving care that they feel violates their beliefs, sparking an intense, complex and often bitter debate over religious freedom vs. patients' rights.

I won't rehash every incident and example (see Trapper John's Pharmacists Against Medicine from March '05), but given the current state of affairs of religion in public life, this is a topic that's bound to get more and not less contentious the closer we get to election season. One thing that might put the brakes on this at the national level is the disastrous Terry Schiavo debate in Congress. While Americans of all faiths and stripes want freedom of religion, the vast majority of voters want this out of their bedrooms and homes.

The unseemly sight of Bush cancelling vacation plans and rushing to DC (not for Katrina, not for Middle East war, not for Iraq but for a religious right overreach in meddling with the Schiavo family's personal affairs) has put the breaks on aggressive GOP Congressional action. In the 11/05 Pew Poll, only 17% thought Congress "did the right thing" and 72% thought Congress "should have stayed out".

But at the local level, there's clearly room for some expression of faith and conscience. Doctors are not required to perform abortions nor are they required to help the state execute prisoners. In fact, Missouri can't find a doc to perform the process of lethal injection.

The Missouri Department of Corrections established its first written procedure for lethal injections Friday but was unable to meet a federal judge’s Saturday deadline to find an anesthesiologist willing to perform lethal injections.

The issue is that of whether the health professional (including nurses or pharmacists) or the patient comes first. Many times, there's room for compromise (such as transferring a nurse out of an abortion suite, or agreeing that City Hospital and not St. Elsewhere would perform the procedure). But with the advent of Plan B and simpler technology, moving the issue from the large institutions (hospitals, city government) to the arena of small business (e.g.,. pharmacies or free-standing medical offices) is inevitably going to cause conflicts and flare-ups. Small business doesn't have a history and tradition of ethics committees and other institutional proicess to resolve such contentious issues, and throwing it to either the courts or the local political process is both inevitable and predictable (see Missouri and stem cell research for what happens).

To many socially conservative Republicans and religious leaders in Missouri, however, a new political campaign to legalize and protect such research is an evil to be fought in courtrooms, churches and polling stations.

Lawrence Weber, executive director of the Missouri Catholic Conference, called it "morally reprehensible science." Bishops instructed priests to deliver pointed homilies.

Voters may be asked to decide. After the courts weigh in, that is.

Religion belongs in the public arena, but it needs restraint and secular compromise to allow the body politic to function. Secularists need to understand that people of faith are rquired to follow their conscience, but not to the extent that the public is put at risk.

The idea that this will be worked out with comity and sober realism in an era of Republican pandering to the religious right to stay in power is, alas, impossible for these current Republicans to implement. And while Democrats are used to major internal battles on policy, the ones that don't take place on the Republican side are often worse for the country than the ones that do amongst Dems.

Comments

[DemFromCT]

All politics is local.

Earlier this year, U.S. Sen. Joseph Lieberman '64 LAW '67 (D-Conn.) was quoted in the Hartford Courant as telling rape victims that, "in Connecticut, it shouldn't take more than a short ride to get to another hospital." Planned Parenthood issued a eulogy for the bill that called it "a setback for all women." And backed into a corner by the defenders of reproductive rights and religion, legislators chose to run out the clock, introducing the bill with 17 minutes left to get it out of committee. Unpassed and tabled for a full year, the bill became something short of victory for the alliance of Catholic hospitals and pro-life activists that fought the measure, and a heartbreaker for the women's rights organizers, both on the Yale campus and off, who supported it.

[Canis latrans]

But at the local level, there's clearly room for some expression of faith and conscience. Doctors are not required to perform abortions nor are they required to help the state execute prisoners.

But those are not the same type of moral decisions. Execution violates the Hippocratic Oath; abortion does not. A doctor who does not want to perform abortions should not learn the procedure. An anesthesiologist who has chosen that career must operate consistently with the Hippocratic Oath, as must a pharmacist with their code of ethics. Refusal to assist in execution is not a personal "expression of faith and conscience." It's required.

Also, this comment at MyDD has some additional useful local detail.

[DemFromCT]

''Execution violates the Hippocratic Oath; abortion does not.''

Not to you or me, but it does to others and you're missinbg that. The post from MyDD is excellent. Joe should, however, not have opened his mouth on the local CT issue, and he will pay a political price for it.

[Canis latrans]

No tears for tone-deaf Joe, here.

I'm not missing the issue of perception, just pointing out that your post treated two acts as equivalent that are logically (perception aside) different. That distinction underlies the crux: a person unwilling to dispense Plan B should not become a pharmacist.

[DemFromCT]

A senior pharmacist who became a pharmacist prior to the advent of Plan B, who is a right-to-lifer, should retire now because plan B was invented? Fat chance.

Ultimately, the med needs to be available. The pharmacist will have to find a solution. If not, the state will. But if the state won't? What if the state is MS or MO, not MA? What then?

[Canis latrans]

Fat chance.

I said "should," not "will." Of course there will be many who profess an absolutist moral position but lack the courage to follow it to its logical consequences. I'm not the one putting our senior pharmacist in this dilemma; she has put herself there by her extremism.

[Sara]

Actually, I've been thinking that virtually any properly structured and staffed womens clinic could begin a home delivery service for Plan B, and perhaps turn a profit on it. If Plan B is "over the counter" for 18 and over -- by prescription under 18 which is what it looks like in some state laws, -- what is to stop activist women from founding "Home Delivered Plan B" as a cash transaction using ID only to establish age? Particularly in small towns where folk gossip, buying Plan B over the phone, and then delivered would be far more private that getting it at the town druggist who is a deacon at the local church.

I think it is an opportunity for well targeted free enterprise.

[melonhead]

That would be like a clerk in a convenience store deciding that he would not sell cigarettes to customers because he did not approve of smoking. My guess is that he would be fired for that decision. It should be part of the employment agreement with healthcare workers that should they decide to withhold legal health services from patients, they will be fired.

[The J Train]

Over at my place, I posted a story about a similar execution conundrum in California back in February.

Physicians (and most other medical personnel) are explicitly forbidden from participating in executions by most if not all of the major professional organizations and licensing boards. So even if a doc were gung-ho about gassing some felons, he would be risking his license to be involved in any way short of pronouncing death. As I say in my post above, there are very good reasons for this.

Back before he gave us so many more interesting things to talk about, there was discussion about whether our Governor, Ernie Fletcher, should lose his medical license because he was signing death warrants. I was torn; on the one hand, that clearly isn't the situation they had in mind, and he isn't acting in his capacity as a physician. On the other hand, them's the rules.

[Arbulus]

I'm with Sara on this. A Pharmacist is required to dispense the medications prescribed. If they disagree with the medicine, they should not be a Pharmacist. Same goes for ambulance drivers, or Doctors. If you are considering being in a field that will encounter situations that you will find morally objectionable, then you should choose a different field. And, if you are in the field, and say for example, as a pharmacist you refuse to dispense Plan B, you should be fired. It's not anyone's right to impose their beliefs onto others, especially when they are in a position where that imposition of faith will affect another's health and well-being.

[Arbulus]

I apologize, I misread the signature on the comment. It was melonhead that I was refering to.

My apologies, Sarah.

[jesme]

Abortion doesn't violate the Hippocratic Oath? You're joking, right? Performing abortions is explicitly forbidden in the version of the oath that was used in US medical schools prior to Roe v. Wade. After the court legalized abortion, med schools began editing this particular passage out of the oath. Apparently they did such a good job that some people never knew the passage was once in there.

[Canis latrans]

Thanks for making my point. You see, I believe it is the current version that is used ... errm ... currently.

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