doesn't this violate the hippocratic oath? the "right of conscience" rule...

[clandestino]

bush just enacted this rule.

i thought the rules we already had in place covered this topic, but now i feel like a whole lot of bad is going to start happening.

i feel that denying health care and then refusing to refer to another doctor who will provide services goes against everything that we are supposed to do. aren't we supposed to help our patients make well informed decisions? and not throw them out on the street because "we don't agree with them"? it's not about US, it's about the PATIENT.

alas...i guess we are just becoming a more selfish nation.

any thoughts are welcome, pro or con. hopefully a lot of discussion will be had about this issue from medical folks to everyday citizens because it will be affecting EVERYONE big time...

*update*

thought i would include this quote from the washington post article:

Because of such concerns, 28 senators, more than 110 House members and more than a dozen state attorneys general opposed the regulation, along with medical organizations including the American Medical Association, the American College of Obstetricians and Gynecologists and the American Hospital Association.

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Members don't see this ad.

 

[SouthernSurgeon]

If you want to get technical, this rule is actually protecting those who don't want to violate the hippocratic oath. Since the oath says all that stuff about "no abortions" and all...

Edit: On a non-sarcastic note, the majority of states (I think >40 of them) already have regulations of this sort protecting docs from violating their own morals. While a federal regulation would obviously be a pretty big deal, this isn't too far off of the current standards.

Also, I plan on taking the best care of my patients that I possibly can. But I don't expect that practice to include sacrificing/compromising my own beliefs. And I wouldn't expect any other physician to give up their own moral beliefs either.

 

[mmmcdowe]

I think doctors shouldn't have to do anything they feel isn't ethical or in the patients best interest. However, I also think that they have the responsibility to direct the patient to someone who will do what they desire, assuming its legal. I also think that they need to give the patient all available information on what they are asking, even if a doctor disagrees with it.

 

[Textuality]

Yeah, my main issue is that they can choose not to " inform patients where they might obtain such care."

I don't mind if a physician objects to a procedure and therefore refuses service (as long as it isn't discrimination or life endangering), but withholding information is absolutely not ok in my book. You are not there in a moral role, you are there to help educate people.
I'm worried that this might help protect people who are just discriminating towards homosexuals etc. What if it's against someone's religion to treat homosexuals in general? Then what? And I don't think it's ok for a physician to be imposing their religion on someone else's life like that, to the point where they are practically making decisions for the patient by not providing information in addition to refusal.

Also, the fact that it doesn't just apply to doctors could cause trouble. What if all of a sudden a crippling number of your nurses/staff refused to participate in some of your procedures, and you can't do it without them? Or what if you prescribed a drug that your pharmicists won't fill? But you can't fire them, and you can't hire people based on religious views.... I can see how this could cause a lot of issues..

 

[turkeyjerky]

My issue with the regulation is that it protects ANY health-care work who refuses to do ANYTHING that violates their moral beliefs.

Next are we going to "protect" a burger-flipper at Wendy's who refuses to serve a bacon-cheeseburger because it "violates their moral or ethical beliefs"?

 

[Monica Lewinsky]

The problem with this rule is that any hospital employee can essentially pull the civil rights card due to a religious belief so that they can prevent a procedure from being performed.

People are obsessed with stopping abortions, under any circumstance, but they happen everyday and will continue to do so. For example, ectopics are almost always terminated: those poor babies killed by the evil, g-d hating MTX.

 

[clandestino]

My issue with the regulation is that it protects ANY health-care work who refuses to do ANYTHING that violates their moral beliefs.

i agree.

here's a tongue-in-cheek commentary of that article written by an internist...

the ruling is just too open-ended. oh well...hopefully obama can fix this mess.

 

[cpants]

So this is basically only about abortion/birth control. The question is, should doctors/nurses have the right to not participate in these activities if they find them morally wrong? I would say unequivocally, yes. However, should their jobs be protected if they refuse to perform tasks required by their employer? No. That is why this law is wrong.

Any physician should be able to refuse to provide any treatment he feels is inappropriate, and I don't believe he should be penalized professionally for it--in the sense that he should not lose his medical license. However, why should employers be forced to employ doctors who refuse to perform required, legal treatment. If a doctor feels very strongly about abortion/BC, he is free to work at a hospital which shares his beliefs or to open a private practice.

 

[mercaptovizadeh]

Yeah, my main issue is that they can choose not to " inform patients where they might obtain such care."

I don't mind if a physician objects to a procedure and therefore refuses service (as long as it isn't discrimination or life endangering), but withholding information is absolutely not ok in my book. You are not there in a moral role, you are there to help educate people.
I'm worried that this might help protect people who are just discriminating towards homosexuals etc. What if it's against someone's religion to treat homosexuals in general? Then what? And I don't think it's ok for a physician to be imposing their religion on someone else's life like that, to the point where they are practically making decisions for the patient by not providing information in addition to refusal.

Also, the fact that it doesn't just apply to doctors could cause trouble. What if all of a sudden a crippling number of your nurses/staff refused to participate in some of your procedures, and you can't do it without them? Or what if you prescribed a drug that your pharmicists won't fill? But you can't fire them, and you can't hire people based on religious views.... I can see how this could cause a lot of issues..

Informing is seen as complicity in many scenarios. Abortion is such a controversial thing that I definitely would support this in that context. However, if someone thought it was immoral to treat patients of a different religion/race/language, I would find that harder to accept.

Again, according to my understanding of discrimination, it isn't about the service provided but the identity of those provided with the service. If you provide a service to everyone regardless of their identity, then there is no discrimination. If you refuse to provide a service (e.g. abortion) to anyone regardless of their identity, again, that is not discrimination. You are just refusing to provide a service because you don't agree with the service, not because you're discriminating against someone.

And, as someone mentioned, abortion IS forbidden in the original Hippocratic Oath - you know, the one the hypocritical medical school administrations edit to drop the "inconvenient" parts.

 

[Perrotfish]

So this is basically only about abortion/birth control. The question is, should doctors/nurses have the right to not participate in these activities if they find them morally wrong? I would say unequivocally, yes. However, should their jobs be protected if they refuse to perform tasks required by their employer? No. That is why this law is wrong.

Any physician should be able to refuse to provide any treatment he feels is inappropriate, and I don't believe he should be penalized professionally for it--in the sense that he should not lose his medical license. However, why should employers be forced to employ doctors who refuse to perform required, legal treatment. If a doctor feels very strongly about abortion/BC, he is free to work at a hospital which shares his beliefs or to open a private practice

I think the main reason they passed this law was to protect physicians and pharmicists, mainly pharmicists, who were in danger of being regulated into providing procedure that they objected to on moral grounds. Several states have already consdidered legislation that would force pharmicists to sell contraception, for example. Really I think it's the morning after pill that's at the center of this legislation.

Because of such concerns, 28 senators, more than 110 House members and more than a dozen state attorneys general opposed the regulation, along with medical organizations including the American Medical Association, the American College of Obstetricians and Gynecologists and the American Hospital Association.

You know, I think you meant this as an anti-legislation quote, but what this really means is that less than 30% of either house of Congress was willing to oppose the legilation. Maybe everyone else just hasn't noticed it yet, but that's pretty much a landslide victory.

 

[cpants]

I think the main reason they passed this law was to protect physicians and pharmicists, mainly pharmicists, who were in danger of being regulated into providing procedure that they objected to on moral grounds. Several states have already consdidered legislation that would force pharmicists to sell contraception, for example. Really I think it's the morning after pill that's at the center of this legislation.

Pharmacists should not be forced to sell the morning after pill. That doesn't mean that CVS should be forced to employ a pharmacist who refuses.

Basically, I think strategies on both sides are wrong, and it's a shame that politicians on both sides are sticking their fingers in this. Doctors/pharmacists/nurses should not be forced to provide abortion/BC. Nor should they be protected from consequences if they refuse to perform tasks required in the job description. There are plenty of like-minded hospitals/clinics for which to work, and for MDs/Pharms there is always private practice.

 

[Textuality]

Again, according to my understanding of discrimination, it isn't about the service provided but the identity of those provided with the service. If you provide a service to everyone regardless of their identity, then there is no discrimination. If you refuse to provide a service (e.g. abortion) to anyone regardless of their identity, again, that is not discrimination. You are just refusing to provide a service because you don't agree with the service, not because you're discriminating against someone.

They had an example of fertility physicians turning away homosexual couples (while doing it for straight ones presumably)...

 

[Perrotfish]

Pharmacists should not be forced to sell the morning after pill. That doesn't mean that CVS should be forced to employ a pharmacist who refuses.

I agree. The problem is that several independently employed pharmicists were facing legislation that would require them to perscribe the morning after pill. State governments were telling privately owned small businesses that they were required to sell a product they didn't want to sell.

 

[AggieSean]

Informing is seen as complicity in many scenarios. Abortion is such a controversial thing that I definitely would support this in that context. However, if someone thought it was immoral to treat patients of a different religion/race/language, I would find that harder to accept.

Again, according to my understanding of discrimination, it isn't about the service provided but the identity of those provided with the service. If you provide a service to everyone regardless of their identity, then there is no discrimination. If you refuse to provide a service (e.g. abortion) to anyone regardless of their identity, again, that is not discrimination. You are just refusing to provide a service because you don't agree with the service, not because you're discriminating against someone.

And, as someone mentioned, abortion IS forbidden in the original Hippocratic Oath - you know, the one the hypocritical medical school administrations edit to drop the "inconvenient" parts.

 

[8744]

bush just enacted this rule.

i thought the rules we already had in place covered this topic, but now i feel like a whole lot of bad is going to start happening.

i feel that denying health care and then refusing to refer to another doctor who will provide services goes against everything that we are supposed to do. aren't we supposed to help our patients make well informed decisions? and not throw them out on the street because "we don't agree with them"? it's not about US, it's about the PATIENT.

alas...i guess we are just becoming a more selfish nation.

any thoughts are welcome, pro or con. hopefully a lot of discussion will be had about this issue from medical folks to everyday citizens because it will be affecting EVERYONE big time...

*update*

thought i would include this quote from the washington post article:

Man. For open-minded people you folks are certainly a bunch of fascists in your zeal to stamp out the ability of anyone to dissent against anything you hold to be an absolute truth. Is your world going to spin out of control if a few physicians act according to their conscience?

Or, suppose you are in a state in whose public hospitals it is illegal to discuss abortion; the law being clear in this case that anyone who refers for an abortion is a criminal. Would you have the same zeal to uphold the law and get all self-righteous and smarmy about those who don't.

As for the Hippocratic Oath, it is meaningless and does not supersede religious belief or contractual obligations. The thing is rewritten by everybody all the time to reflect the political and social beliefs prevalent in the little enclave where a particular version is used.

 

[8744]

I think doctors shouldn't have to do anything they feel isn't ethical or in the patients best interest. However, I also think that they have the responsibility to direct the patient to someone who will do what they desire, assuming its legal. I also think that they need to give the patient all available information on what they are asking, even if a doctor disagrees with it.

This is an incredibly naive, unsophisticated opinion the parroting of which is expected of all pre-meds and medical students. You point of view ignores completely the concept that participation can include encouragement and referral and these things make someone complicit in the activity.

"I didn't rob the convenience store, Your Honor, I just supplied the gun and gave the defendant a ride to and from the place."

 

[Miami_med]

Pharmacists should not be forced to sell the morning after pill. That doesn't mean that CVS should be forced to employ a pharmacist who refuses.

Basically, I think strategies on both sides are wrong, and it's a shame that politicians on both sides are sticking their fingers in this. Doctors/pharmacists/nurses should not be forced to provide abortion/BC. Nor should they be protected from consequences if they refuse to perform tasks required in the job description. There are plenty of like-minded hospitals/clinics for which to work, and for MDs/Pharms there is always private practice.

This is the most logical response that I have ever seen on this topic.

 

[Miami_med]

As an aside, I have never taken the hippocratic oath. The oath prohibits all sorts of common medical practices, such as surgery. The oath said by some medical students at some institutions is actually part of the "oath of geneva" (atleast that's what I believe that it's called). My own institution had some ceremony where there was a public stating of a variation of this oath.

The point: The Hippocratic Oath is completely irrelevant today and has no bearing on modern medical practice legally, ethically, or in any context beyond historically.

 

[clandestino]

Man. For open-minded people you folks are certainly a bunch of fascists in your zeal to stamp out the ability of anyone to dissent against anything you hold to be an absolute truth. Is your world going to spin out of control if a few physicians act according to their conscience?

Or, suppose you are in a state in whose public hospitals it is illegal to discuss abortion; the law being clear in this case that anyone who refers for an abortion is a criminal. Would you have the same zeal to uphold the law and get all self-righteous and smarmy about those who don't.

As for the Hippocratic Oath, it is meaningless and does not supersede religious belief or contractual obligations. The thing is rewritten by everybody all the time to reflect the political and social beliefs prevalent in the little enclave where a particular version is used.

oh wow i got quoted by the famous panda bear, md, on a public forum! WOW. you're SO much nicer than i thought you were, and i loved your blog, by the way.

some of my concern behind this new "rule" or whatever you want to call it is that yes, i am from part of the country where people will automatically call you a baby killer if you just happen to mention that you are pro-choice. or tell you to your face that you are going to hell because you gay or of mixed races or not christian, etc. since where i am located has a major doctor shortage anyway, and most of the people around will condemn you just by wearing a certain color t-shirt, so yeah, this rule has me worried about quality of care for the local patient population. especially when some of the above examples come from the mouths of people in my med school class.

sheesh...if you don't want to do something because you don't want to, then whatever. don't do it. but put on your big kid panties and at least direct the patient to a different doctor. or at least have a sign out front that says "i don't like you". the end.

 

[8744]

oh wow i got quoted by the famous panda bear, md, on a public forum! WOW. you're SO much nicer than i thought you were, and i loved your blog, by the way.

some of my concern behind this new "rule" or whatever you want to call it is that yes, i am from part of the country where people will automatically call you a baby killer if you just happen to mention that you are pro-choice. or tell you to your face that you are going to hell because you gay or of mixed races or not christian, etc. since where i am located has a major doctor shortage anyway, and most of the people around will condemn you just by wearing a certain color t-shirt, so yeah, this rule has me worried about quality of care for the local patient population. especially when some of the above examples come from the mouths of people in my med school class.

sheesh...if you don't want to do something because you don't want to, then whatever. don't do it. but put on your big kid panties and at least direct the patient to a different doctor. or at least have a sign out front that says "i don't like you". the end.

I did not ask if you were going to be called a baby-killer. And I didn't ask for your opinion of the quaint yokels who live in flyover country who you hold in too much contempt to ever really take good care of as physician. I asked whether you would be so self-righteous in your zeal to uphold general moral principles if you didn't believe in them. There are states, for example, in which discussing abortion in the public hospitals is, in fact, illegal and if you referred a lady to planned parenthood for an abortion while working there you would be a criminal and subject to civil penalties.

 

[8744]

sheesh...if you don't want to do something because you don't want to, then whatever. don't do it. but put on your big kid panties and at least direct the patient to a different doctor. or at least have a sign out front that says "i don't like you". the end.

Morality would be so much easier if there were no moral dilemmas, wouldn't it? In other words, it is easy for you to put on your big kid panties and refer a woman for an abortion because this doesn't cause the slightest conflict with your moral or religious beliefs. But you might as well just say to me, "Gee Panda, your religion is meaningless, your Archbishop is a *****, there is no God, no heaven or hell, and I guarantee you will be alright if you help your patients procure an abortion."

The fact that you can't appreciate the seriousness, the importance, of conscience and morality is the point here. You are trivializing an important component of humanity and I just don't think you're qualified to do it.

I suppose you believe the many hundreds of Catholic hospitals in this country, most of which have a big picture of His Holiness the Pope in the main entrance should just throw in the towel, take down their "I don't like you" signs, and start aborting babies, all because you said so.

And the notion that physicians who refuse to participate in the abortion industry don't refer for abortions because "I Don't Like You" is ridiculous.

 

[8744]

As an aside, I have never taken the hippocratic oath. The oath prohibits all sorts of common medical practices, such as surgery. The oath said by some medical students at some institutions is actually part of the "oath of geneva" (atleast that's what I believe that it's called). My own institution had some ceremony where there was a public stating of a variation of this oath.

The point: The Hippocratic Oath is completely irrelevant today and has no bearing on modern medical practice legally, ethically, or in any context beyond historically.

Amen. I never took the stupid oath either, particularly because I don't swear to anything by pagan ancient Greek gods.

 

[clandestino]

I suppose you believe the many hundreds of Catholic hospitals in this country, most of which have a big picture of His Holiness the Pope in the main entrance should just throw in the towel, take down their "I don't like you" signs, and start aborting babies, all because you said so.

And the notion that physicians who refuse to participate in the abortion industry don't refer for abortions because "I Don't Like You" is ridiculous.

first all, i don't appreciate someone putting words in my mouth that i have not said (or typed, in this instance). but since some people have nothing better to do than to peruse public forums and start hate-throwing, i guess i'll have to respond and then leave the topic be.

secondly, catholicism has already publicly stated their particular stance on reproductive rights. the public knows where the catholic church stands. why on earth would anyone go to a catholic hospital to have procedures done that the church does not support? but at least people know to not go to that hospital. if physicians and other medical personnel decide to stop doing certain things without alerting the public, how will we ever know until we get back in the examination room or the pharmacy, etc, and have them say "sorry, don't do that". then everyone has wasted his/her time and money and effort and nobody gets helped.

and geez, "i don't like your signs" was supposed to be a funny sarcastic phrase. don't get your panties in a wad over account of little ol' me. and i didn't start this thread to argue abortion...nobody is going to win in that fight. i just wanted discussion on the bush rule.

and that is all i'll say. this thread is no good to me anymore, but thank you to all the others who expressed their thoughts in a mature fashion.

 

[Pharmavixen]

Convenience store clerks all over the US could improve the health of your nation and state they are morally opposed to selling junk food to fat people.

As a pharmacist, I'm morally opposed to selling Cialis, Viagra and Levitra to old people because it gives me mental pictures of old people having sex, and that's just wrong.

I'm puzzled, though, by all the objections to sterilization. Do people really want to get operated on by dirty surgical tools?

 

[Miami_med]

I'm a little bit confused. Is someone arguing on here that if you didn't refer a patient to an abortion providing physician because they came to you at random requesting one, that they wouldn't be able to procure one? I agree that some patients are pretty low as far as social register, but this really doesn't mean that people shouldn't have some responsibility to find legal medical interventions on their own. People who go looking for abortions know that they want abortions. Outside of a physician saying that abortion doesn't exist and misleading the patient in such an absurd way, what exactly is the issue?

With a very few notable exceptions, abortion is rarely medically indicated. It is a procedure which is usually done out of preference by the patient to prevent the conclusion of a very natural process that most people go through safely (and many people spend large sums of time and money to obtain). One really can't compare failure to refer for an abortion to failing to provide necessary medical care.

 

[J-Rad]

So, am I understanding correctly? A facility that might offer legal services to its patients, such as abortion, birth control, emergency contraception (or even plastic surgery for that matter) is not able to ensure that the personnel in its employ are willing and able to carry out their job duties, if the excuse for not doing such is under the umbrella of "moral objection"? However, many government organizations are able to legally (and rightfully) discriminate based on someone's inability to do a job. The military need not take someone with (any number of) disabilities. Most civilian jobs can even discriminate based on inability to do a job if "reasonable accomodations" cannot be made. Medical schools may employ the same judgement. But, if someone says "This is against my morals" and actively chooses to refuse to do what the facility routinely asks its employees to do, it is not the facility that is protected and allowed to hire those that are willing and able to do the job, but rather it is the person who chooses to refuse to do the job who is protected. I don't care about the people who refuse to dispense birth control, participate in abortions, etc. They are well within their rights to do as much, whether I agree with their principles or not. However, an employer should be able to hire those that are able to do the job that they ask of them. The same logic in Miami's last post applies here. If you don't want to do something you find morally objectionable, don't work for some place that offers the services you find objectionable in a role in which you would be asked to participate in those services. It's unreasonable to expect that other jobs that meet your moral criteria won't be out there. This is one of those laws that shows that big, bloated, invasive government isn't just the perview of the liberal.

 

[Miami_med]

So, am I understanding correctly? A facility that might offer legal services to its patients, such as abortion, birth control, emergency contraception (or even plastic surgery for that matter) is not able to ensure that the personnel in its employ are willing and able to carry out their job duties, if the excuse for not doing such is under the umbrella of "moral objection"? However, many government organizations are able to legally (and rightfully) discriminate based on someone's inability to do a job. The military need not take someone with (any number of) disabilities. Most civilian jobs can even discriminate based on inability to do a job if "reasonable accomodations" cannot be made. Medical schools may employ the same judgement. But, if someone says "This is against my morals" and actively chooses to refuse to do what the facility routinely asks its employees to do, it is not the facility that is protected and allowed to hire those that are willing and able to do the job, but rather it is the person who chooses to refuse to do the job who is protected. I don't care about the people who refuse to dispense birth control, participate in abortions, etc. They are well within their rights to do as much, whether I agree with their principles or not. However, an employer should be able to hire those that are able to do the job that they ask of them. The same logic in Miami's last post applies here. If you don't want to do something you find morally objectionable, don't work for some place that offers the services you find objectionable in a role in which you would be asked to participate in those services. It's unreasonable to expect that other jobs that meet your moral criteria won't be out there. This is one of those laws that shows that big, bloated, invasive government isn't just the perview of the liberal.

I agree. Bloated government is the purview of everyone these days. I'm not a conservative, much more of a libertarian. I agree that people operating private enterprises should be able to offer or not offer whatever they want, and they should be able to hire or fire employees based on whatever criteria they choose. If I own an abortion clinic in a place in which it is legal, there is no legitimate argument to make me keep an employee on who won't assist in abortions. If I do not offer abortions, no law should make me have to refer for them or perform them.

There. We solved the problem. People can choose to go to people who provide the services that they want, and people can provide the services that they want to.

 

[fyfanatic]

This is absolutely absurd!:

"In calling for limits on “conscientious refusals,” ACOG cited four recent examples. In Texas, a pharmacist rejected a rape victim's prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital."

http://www.latimes.com/news/nationworld/nation/la-na-conscience2-2008dec02,0,7013690.story

 

[Miami_med]

This is absolutely absurd!:

"In calling for limits on “conscientious refusals,” ACOG cited four recent examples. In Texas, a pharmacist rejected a rape victim's prescription for emergency contraception. In Virginia, a 42-year-old mother of two became pregnant after being refused emergency contraception. In California, a physician refused to perform artificial insemination for a lesbian couple. (In August, the California Supreme Court ruled that this refusal amounted to illegal discrimination based on sexual orientation.) And in Nebraska, a 19-year-old with a life-threatening embolism was refused an early abortion at a religiously affiliated hospital."

http://www.latimes.com/news/nationworld/nation/la-na-conscience2-2008dec02,0,7013690.story

Why didn't the 19 year old go to a different hospital? Did they refuse to treat the embolism?
Why can't someone who provides AI services provide them to whomever he wants? Refusing to service a portion of the population does a whole lot more damage to his business anyway than the people he refuses to service. If I'm correct, I believe that your AI case involves a couple that subsequently received AI at a different physician's office.

 

[drmwvr]

I agree. Bloated government is the purview of everyone these days. I'm not a conservative, much more of a libertarian. I agree that people operating private enterprises should be able to offer or not offer whatever they want, and they should be able to hire or fire employees based on whatever criteria they choose. If I own an abortion clinic in a place in which it is legal, there is no legitimate argument to make me keep an employee on who won't assist in abortions. If I do not offer abortions, no law should make me have to refer for them or perform them.

There. We solved the problem. People can choose to go to people who provide the services that they want, and people can provide the services that they want to.

The "Freedom of Choice Act" or FOCA, which PE Obama has promised to sign will prohibit any obstacle to health care (read:abortion) by facility or provider. It will sweep away any state enacted regulation such as parental consent or conscience clauses. Facilities such as Catholic run hospitals, it is feared, will be in violation of federal statute if they do not provide abortion services and will be subject to closure. In short, there will be nowhere to go if you have a moral objection to these procedures. That law is on the way. Problem just getting underway.

 

[Miami_med]

Apparently the first amendment and tenth amendment can be overturned by federal decree. There is clearly no more freedom of association, and I don't recall the menu of health services provided by a particular hospital being explicitly given to the federal government as a right in the constitution. I'm still not sure why federal law always seems to trump state law. In the original constitution, it's the other way around.

 

[Tired]

Apparently the first amendment and tenth amendment can be overturned by federal decree. There is clearly no more freedom of association, and I don't recall the menu of health services provided by a particular hospital being explicitly given to the federal government as a right in the constitution. I'm still not sure why federal law always seems to trump state law. In the original constitution, it's the other way around.

It may be a bit early to get worked up over this. While I'm not intimately familiar with FOCA, I find it hard to believe that the above interpretation of it is accurate.

Based on that post, all physicians would be forced to provide all range of medical services regardless of their specialty, facilities, and availability of support staff. That seems silly and unlikely.

 

[Miami_med]

It may be a bit early to get worked up over this. While I'm not intimately familiar with FOCA, I find it hard to believe that the above interpretation of it is accurate.

Based on that post, all physicians would be forced to provide all range of medical services regardless of their specialty, facilities, and availability of support staff. That seems silly and unlikely.

We'll see. It will clearly force some people to do some things. I doubt that there will be a lot of in office abortions at pediatrician's offices, but the specter of Medicare dollars (which the government now uses to control everything) will probably be used for some new political motive.

 

[EUA]

As a bit of a Libertarian myself, I do subscribe to the idea that private firms (including hospitals, clinics, pharmacies, etc.) have the right to say what services or products they will or will not offer. Goody for them. However, I take issue with those who feel it's professionally acceptable to leave a patient stranded in the dust by turning down a specific request, or not giving any assistance to help the patient find another provider. We -- as a society, as individual patients -- do not have the funds to throw away on sending that patient to go have an additional, unnecessary visit to a physician who will be willing to help. That patient may need to take another day off work, find another babysitter, pay another co-pay and rack up another office visit for her insurance (read: us) to pay for, all because Dr. Baby Brat High Horse wouldn't HELP the patient, you know, pffffft on that silly professional obligation and all.

Asinine! I am hardly a bleeding heart crybaby but come on. If you're not willing to set aside your own needs and ego for those you are supposed to assist, then perhaps medicine is the wrong profession for you.

 

[Miami_med]

As a bit of a Libertarian myself, I do subscribe to the idea that private firms (including hospitals, clinics, pharmacies, etc.) have the right to say what services or products they will or will not offer. Goody for them. However, I take issue with those who feel it's professionally acceptable to leave a patient stranded in the dust by turning down a specific request, or not giving any assistance to help the patient find another provider. We -- as a society, as individual patients -- do not have the funds to throw away on sending that patient to go have an additional, unnecessary visit to a physician who will be willing to help. That patient may need to take another day off work, find another babysitter, pay another co-pay and rack up another office visit for her insurance (read: us) to pay for, all because Dr. Baby Brat High Horse wouldn't HELP the patient, you know, pffffft on that silly professional obligation and all.

Asinine! I am hardly a bleeding heart crybaby but come on. If you're not willing to set aside your own needs and ego for those you are supposed to assist, then perhaps medicine is the wrong profession for you.

It really isn't all about the patient all the time. Physicians ARE people, and telling a person that they need to engage in an activity that they feel puts them at risk for eternal hellfire or damages his immortal soul in the name of preventing the patient from hiring a babysitter is what's asinine. Becoming a physician does NOT mean that one agrees to be all things to all people, and we really ought to be fighting for what little choice about anything that we have in our profession left. This isn't about me aside from the right of choice as an individual. I don't really care about referring people for much of anything, but I do believe that practice owners ought to have sovereignty over their own practices, including referrals and services provided.

Also, over the things that we keep arguing about, it is not clear what helping the patient actually is. It is subjective. Is an abortion best for the patient? The patient thinks yes. The physician thinks no. That's just the way of it sometimes. "Better" is not always obvious, and this question has nothing to do with professional obligation.

 

[Tired]

However, I take issue with those who feel it's professionally acceptable to leave a patient stranded in the dust by turning down a specific request, or not giving any assistance to help the patient find another provider. We -- as a society, as individual patients -- do not have the funds to throw away on sending that patient to go have an additional, unnecessary visit to a physician who will be willing to help. That patient may need to take another day off work, find another babysitter, pay another co-pay and rack up another office visit for her insurance (read: us) to pay for, all because Dr. Baby Brat High Horse wouldn't HELP the patient, you know, pffffft on that silly professional obligation and all.

You're not a bleeding heart crybaby, but you have fallen into the typical trap of assuming that patients are complete and utter fools who should never be expected to take any responsibility for themselves.

If I needed a used Honda Accord for under $10,000 with less than 40k miles, I would look up the phone number of a car dealer, and call them to ask if they offer such a car. Or I would look at advertisements. Or I would look in the newspaper.

But apparently, in your world, when a woman needs an abortion, she is only able to ask a single physician, and then only by making an appointment and going in. And if that physician doesn't do abortions, she will be completely stranded, unable to figure out how to find another doctor, use a telephone, talk to her friends who have had abortions, or take any other proactive steps to discover the information she needs.

Why do you think so little of the average American?

 

[michaelrack]

I'm still not sure why federal law always seems to trump state law. In the original constitution, it's the other way around.

It's because of the Civil War and the 14th amendment

 

[Miami_med]

It's because of the Civil War and the 14th amendment

Only the supreme court could make equal protection under the law mean unequal protection under the law in order to make everyone equal ( or to do whatever the federal government feels like that has nothing to do with equality)

 

[Pharmavixen]

The focus in this thread has been on abortion, but what about the implications for end of life care?

As of this year, my parents are both over seventy. They are in pretty good health thus far, but I have started to think about end of life care, as have they, and they have both been vocal about not wanting extreme measures taken to extend their lives.

But what if, God forbid, my atheist dad ends up under the care of a hyper-religious doctor who insists on life-extending measures for "moral" reasons? At that point, how much freedom does my dad have to search for another doctor?

And besides, in a world that is pathologically over-populated, how "moral" is it to deny people birth control? Surely it's immoral not to provide birth control.

I mean, if I had beliefs that meant I couldn't dispense birth control, I wouldn't have become a pharmacist.

What is with all these people deliberately putting themselves in a position where they get to deny medical care? Could it be they have an agenda?

 

[Miami_med]

The focus in this thread has been on abortion, but what about the implications for end of life care?

As of this year, my parents are both over seventy. They are in pretty good health thus far, but I have started to think about end of life care, as have they, and they have both been vocal about not wanting extreme measures taken to extend their lives.

But what if, God forbid, my atheist dad ends up under the care of a hyper-religious doctor who insists on life-extending measures for "moral" reasons? At that point, how much freedom does my dad have to search for another doctor?

And besides, in a world that is pathologically over-populated, how "moral" is it to deny people birth control? Surely it's immoral not to provide birth control.

I mean, if I had beliefs that meant I couldn't dispense birth control, I wouldn't have become a pharmacist.

What is with all these people deliberately putting themselves in a position where they get to deny medical care? Could it be they have an agenda?

It is clearly different to force people to accept a service that they don't want and to be forced to provide one. Touching a patient who has refused care (either personally or through a surrogate) is assault.

 

[Tired]

I mean, if I had beliefs that meant I couldn't dispense birth control, I wouldn't have become a pharmacist.

So you're saying that, prior to deciding on a career, you checked the political viewpoints of the majority of their members to ensure that it fit with your personal notions of morality?

Sorry, this portion of your post is just semantic crap; a total lie. You went into the field because you had a passion for your own conception of it.

 

[drmwvr]

It may be a bit early to get worked up over this. While I'm not intimately familiar with FOCA, I find it hard to believe that the above interpretation of it is accurate.

Based on that post, all physicians would be forced to provide all range of medical services regardless of their specialty, facilities, and availability of support staff. That seems silly and unlikely.

Please don't take my word for it. If it's worth your time, just go to the NARAL homepage. FOCA has to do with "reproductive" services, not all range of services. The statement that you don't have intimate familiarity with FOCA implies you do have at least some. What do you see this law doing, if not what I asserted?

 

[Tired]

Please don't take my word for it. If it's worth your time, just go to the NARAL homepage. FOCA has to do with "reproductive" services, not all range of services. The statement that you don't have intimate familiarity with FOCA implies you do have at least some. What do you see this law doing, if not what I asserted?

Looking through a few of the websites from both the right and the left, it looks like only the right (NRLC, for example) are claiming that it will mandate the provision of services by physicians and nurses. I see no similar claim from the left.

More interesting is the text of the bill, which is only 9 pages long (House version, anyway), and is largely concerned with a brief, poor description of the history and effects of abortion in America.

In fact, the only actual "law-making" contained in the bill is this:

"(b) PROHIBITION OF INTERFERENCE.—A government may not—
(1) deny or interfere with a woman’s right to choose—
(A) to bear a child;
(B) to terminate a pregnancy prior to viability; or
(C) to terminate a pregnancy after viability where termination is
necessary to protect the life or health of the woman; or
(2) discriminate against the exercise of the rights set forth in paragraph
(1) in the regulation or provision of benefits, facilities, services, or
information"

Clearly a sweeping bill. No more bans on federal funding of abortion. No more banning abortions in public hospitals. No more bans on contraception funding.

And yes, conscience clauses go out the window.

But what is conspicuously absent is any compulsion to provide services. No discrimination means no providing for some but not others. But there is nothing that I see that would compel private entities (ie - doctors) from refusing to perform abortions. Nor do I see anything that would force a pharmacy to provide birth control if they choose not to.

 

[Pharmavixen]

Sorry, this portion of your post is just semantic crap; a total lie. You went into the field because you had a passion for your own conception of it.

I don't think so; dispensing drugs is the most basic function of a pharmacist. Did all these pharmacists who have moral objections to OCs really have no idea that it was part of the job? They're among the most commonly-prescribed drugs in America. Up to eighty percent of women take these at some point in their lives, and about thirty percent of women of child-bearing age are on it currently.

It is clearly different to force people to accept a service that they don't want and to be forced to provide one. Touching a patient who has refused care (either personally or through a surrogate) is assault.

Thanks for that! You are totally right.

 

[Tired]

I don't think so; dispensing drugs is the most basic function of a pharmacist. Did all these pharmacists who have moral objections to OCs really have no idea that it was part of the job? They're among the most commonly-prescribed drugs in America. Up to eighty percent of women take these at some point in their lives, and about thirty percent of women of child-bearing age are on it currently.

Your failure to answer the question is duly noted.

 

[Pharmavixen]

Your failure to answer the question is duly noted.

Okay, so here's the question:

So you're saying that, prior to deciding on a career, you checked the political viewpoints of the majority of their members to ensure that it fit with your personal notions of morality?

We have personal values and professional ethics, and part of being a professional is keeping those separate.

If somebody doesn't like OCs, they can choose not to take them. But if you refuse to dispense them, you're forcing your morality on another person. Sure, it's not a big deal, practically speaking; the patient can just go to another pharmacy. But refusing to provide a service for which you were trained for reasons that have nothing to do with health care is unethical because it's a violation of the trust placed in health care professionals when they are licensed.

In the US and Canada we have separation of church and state. More than anything, Bush's bill is about eroding that separation by way of giving religious people special protections under the law. It's not about protecting anybody's rights -- it's about power for the religious right. Is that a precedent you want to be setting?

I remain suspicious of the motives of pharmacists who protest that they can't dispense a drug that 80% of women take at some point in their lives. Did these pharmacists really have no idea what they were getting into?

 

[J-Rad]

There. We solved the problem. People can choose to go to people who provide the services that they want, and people can provide the services that they want to.

What problem did we solve? Cordiality to each other? That is fine and appreciated. But the problem, as I see it, has not been solved. There is still a law on the books that states that employers are unable to select those employees will do the job that they asked them to, if the employee plays the "morality" card, if they somehow accept federal funding. Since most hospitals and primary care doctors dealing with adults take Medicare, and in primary care doctors seeing children take Medicaid (i.e. federal money) than there are plenty of employers who could be unfairly affected by this absurd intrusion into the way they conduct business. If I had gone into general pediatric practice I most certainly would be prescribing birth control pills, for both contraceptive and other medical reasons. As I see no scientific or humanistic reason to consider pre-viable fetuses a "life", I would be gladly referring early pregnancies for termination if that's what the patient desired (I would also be gladly giving guidance on parenthood or adoption if that was the patient's desire). And if I were in charge of hiring for my practice I should have the right to hire those who are willing to do the job that I asked them to do. The way I perceive it, is still that this law prohibits me from being able to exercise that discretion. I agree with all of the posters who have said that anyone has the right to exercise their moral judgment in what they will and will not do in the course of their career. As I stated before, just as someone seeking an abortion can open a phonebook to look for someone to provide it, a prospective employee who is not willing to do the job that I ask of them, is free to open a phonebook and seek employment somewhere else that jibes better with their value system. This law would seem to defy that common sense.

The "Freedom of Choice "Act" or FOCA, which PE Obama has to sign will prohibit any obstacle to health care (read:abortion) by facility or provider. It will sweep away any state enacted regulation such as parental consent or conscience clauses. Facilities such as Catholic run hospitals, it is feared, will be in violation of federal statute if they do not provide abortion services and will be subject to closure. In short, there will be nowhere to go if you have a moral objection to these procedures. That law is on the way. Problem just getting underway.

What problem?

Looking through a few of the websites from both the right and the left, it looks like only the right (NRLC, for example) are claiming that it will mandate the provision of services by physicians and nurses. I see no similar claim from the left.

More interesting is the text of the bill, which is only 9 pages long (House version, anyway), and is largely concerned with a brief, poor description of the history and effects of abortion in America.

In fact, the only actual "law-making" contained in the bill is this:

"(b) PROHIBITION OF INTERFERENCE.—A government may not—
(1) deny or interfere with a woman's right to choose—
(A) to bear a child;
(B) to terminate a pregnancy prior to viability; or
(C) to terminate a pregnancy after viability where termination is
necessary to protect the life or health of the woman; or
(2) discriminate against the exercise of the rights set forth in paragraph
(1) in the regulation or provision of benefits, facilities, services, or
information"

Clearly a sweeping bill. No more bans on federal funding of abortion. No more banning abortions in public hospitals. No more bans on contraception funding.

And yes, conscience clauses go out the window.

But what is conspicuously absent is any compulsion to provide services. No discrimination means no providing for some but not others. But there is nothing that I see that would compel private entities (ie - doctors) from refusing to perform abortions. Nor do I see anything that would force a pharmacy to provide birth control if they choose not to.

Exactly. This is the same type of hyperbole that posters who jump all over those who want to refuse to prescribe birth control, refer for abortions, etc. engage in. They have mistaken a prohibitive law for a compulsory law. But it is convenient to paint that bogeyman to rile the masses.

Okay, so here's the question:

We have personal values and professional ethics, and part of being a professional is keeping those separate.

If somebody doesn't like OCs, they can choose not to take them. But if you refuse to dispense them, you're forcing your morality on another person. Sure, it's not a big deal, practically speaking; the patient can just go to another pharmacy. But refusing to provide a service for which you were trained for reasons that have nothing to do with health care is unethical because it's a violation of the trust placed in health care professionals when they are licensed.

In the US and Canada we have separation of church and state. More than anything, Bush's bill is about eroding that separation by way of giving religious people special protections under the law. It's not about protecting anybody's rights -- it's about power for the religious right. Is that a precedent you want to be setting?

I remain suspicious of the motives of pharmacists who protest that they can't dispense a drug that 80% of women take at some point in their lives. Did these pharmacists really have no idea what they were getting into?

PharmVixen: you and I are probably on similar wavelengths when it comes to specific issues regarding birth control and abortion (although for the latter, I freely admit I don't fall into one particular camp very well as I am very pro-choice in pre-viability stages, but believe that after that point only the mother's life is acceptable reason for terminating the pregnancy). I think you're wrong on this issue. Someone who refuses to dispense birth control is just, in the moment, an @$$4ole. But it is not illegal, and not necessarily unethical to be an @$$4ole. All they've done is inconvenience the seeker of the desired service. The inconvenience may be severe, but inconvenience (even if severe) is not a crime. As I've made the case for, above, if I were the owner of the pharmacy and I felt that dispensing birth control and emergency contraception was a service that I desire to provide, I should be able to fire the involved employee; but since I likely take Medicare drug payment I would not be able to.
There is a less morally charged analogy here. Family practice doctors trained to be generalists and, by training, are able to provide services including care for adults, children, pregnant women, perform minor surgery, and deliver babies. Many family practice doctors choose not to deliver babies or provide other obstetric care. It could be argued that there is a great need for them to provide the service especially in rural areas or family practitioners tend to dominate the caregiver landscape. Are they unethical if they choose not to, given that need? I would argue that they are not. They are merely tailoring their practice in a way that they desire. Just because their cause for doing so is likely financial (the heavy liability that obstetric practice can entail) and not "moral" doesn't make the situation much different than the one described above.

 

[Miami_med]

I agree that the law is stupid. My idea was that we had actually found a workable solution that was much better than the law.

 

[drmwvr]

And yes, conscience clauses go out the window.

But what is conspicuously absent is any compulsion to provide services. No discrimination means no providing for some but not others. But there is nothing that I see that would compel private entities (ie - doctors) from refusing to perform abortions. Nor do I see anything that would force a pharmacy to provide birth control if they choose not to.

In my mind, no conscience clause equals compulsion to provide services. If I can conceive of it, a NARAL (or whomever) attorney can.

This isn't a problem?

 

[Tired]

In my mind, no conscience clause equals compulsion to provide services.

Then your mind lacks basic logical skills.