No Freedom of Religion in the practice of medicine

[Surfer]

http://www.signonsandiego.com/news/metro/20080818-1237-bn18couple2.html

Apparently the California Supreme Court does not believe that you have a constitutional right to freedom of religion with regards to your medical practice.

This case is of fertility doctors who refused to inseminate a lesbian couple in San Diego. They said it was against their religion to do so, but provided a list of alternative doctors that would perform the procedure for them. The couple went to one of those alternatives, and became pregnant. The couple then sued the fertility doctors for discrimination, and the CA supreme court agrees that this is discrimination.

In my view this is a horrible trend for medicine. We are being reduced to simply government agents, doing what we're told, when we're told to do it, and how they tell us to do it.

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[Pilot Doc]

Have to think this'll end up in the supreme court.

 

[dfk]

i find this similar in doing TOPs.

 

[coprolalia]

In my view this is a horrible trend for medicine. We are being reduced to simply government agents, doing what we're told, when we're told to do it, and how they tell us to do it.

I agree. This case will get to the U.S. Supreme Court. Bet money on it. Outside of EMTALA, you currently have no responsibility to provide care for a patient and are well within your rights to refuse care provided you arrange for appropriate follow-up after you've initiated a relationship with a patient. Outside of the specifics of this case (and any individuals opinion about whether what this fertility clinic did was right or wrong), if that changes we are truly f***ed as a profession.

-copro

 

[Planktonmd]

Our job is to provide health care not religious guidance.

 

[Gas]

If I do something that is against my religion, this means I am biased, and I think this could impact patient care since I am not 100% comfortable with what I am doing. If I were a patient, I would want a physician who is unencumbered by any bias to provide my care. The fact that these patients sued is ridiculous, and the fact that the court sided with them is preposterous. The patient should be thanking the physician for being honest, up-front, and for arranging appropriate referrals.

It better be appealed and overturned in Supreme Court.

 

[deleted126335]

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[deleted126335]

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[UCFMOP]

The only problem with this is simple: Define homosexuality.

Race, nationality, gender and even religion are more concrete than sexuality.

If a man is married and dreams about having sex with men, but still has sex with his wife, is he gay straight or bisexual? Does bisexual mean 50/50 men and women or 30/70 or even 99/1? I could just claim "Hey, you fired me because im gay." Even though I was really just late and irresponsible as an employee, there would be no way for anyone to disprove that I am not gay or bisexual. Sexuality is so ambiguous, so gray.

Meanwhile, the freedom of religion is one of the most sacred liberties held by this country that I cannot see why the cal supreme court would even dare challenge it.

 

[deleted126335]

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[milrisome]

When can you refuse care in medicine? When the risks are too high or the benefits are too low. This doc just has a conscience. What is the likelihood that a child will have a normal productive life? I don't know the stats, but I bet this doc does. The chance of this kid having a stable home life in 5-10 years is probably abysmally low. In other words, the risks are too high. The chance of doing harm is too high. First do no harm, right? I wouldn't want to feel responsible for sticking someone in a broken home. It's the job of a doctor to make judgment calls.

 

[UCFMOP]

1. I suppose that is would be a question of fact for the jury as to whether or not someone was homosexual and was that the reason for the doc chose not to care for someone.

2. Suppose that your religion held that African Americans or Jews were inferior and that you couldn't care for those patients because of your religious beliefs?

And which religion holds that Jews or Black people are inferior?

The answer is obvious, there is no religion like that. However, every abrahamic faith holds that people who practice a sexuality deviant from the way God/Allah intended is wrong. (Man and woman in marriage)

Now on the other hand, If I were that doctor I would just refer her to other doctor and let it be. It is misleading to say that this doctor refused to provide medical care. That implies this woman had cancer or was bleeding to death and the doctor refused to treat her.

 

[deleted126335]

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[Planktonmd]

When can you refuse care in medicine? When the risks are too high or the benefits are too low. This doc just has a conscience. What is the likelihood that a child will have a normal productive life? I don't know the stats, but I bet this doc does. The chance of this kid having a stable home life in 5-10 years is probably abysmally low. In other words, the risks are too high. The chance of doing harm is too high. First do no harm, right? I wouldn't want to feel responsible for sticking someone in a broken home. It's the job of a doctor to make judgment calls.

Based on this logic and knowing that a significant percentage of heterosexual married couples out there don't qualify as good parents and their kids are destined to a life of misery (I am sure each one of us could think of a few examples), this means we should not help these people procreate and maybe we should refuse to provide them with prenatal care.
Would that be OK?
Isn't that what Hitler wanted to do?

 

[deleted126335]

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[Southpaw]

Pretty sweet the state of California thinks we're just another button pusher. Becoming a physician is becoming less and less appealing thanks to what is being called "progress" in America.

 

[fakin' the funk]

When can you refuse care in medicine? When the risks are too high or the benefits are too low. This doc just has a conscience. What is the likelihood that a child will have a normal productive life? I don't know the stats, but I bet this doc does. The chance of this kid having a stable home life in 5-10 years is probably abysmally low. In other words, the risks are too high. The chance of doing harm is too high. First do no harm, right? I wouldn't want to feel responsible for sticking someone in a broken home. It's the job of a doctor to make judgment calls.

I haven't been on SDN as long as some of you but this is one of the stupidest things I've ever read on here.

 

[Forkit]

Pretty sweet the state of California thinks we're just another button pusher. Becoming a physician is becoming less and less appealing thanks to what is being called "progress" in America.

Religion is everything but progress.

 

[aphistis]

"Protected status" doesn't matter. The First Amendment is the original anti-discrimination law, and it says the doctors can't be legally compelled to violate their religious beliefs. Suppose the current, conservatively-leaning Supreme Court holds that discrimination due to sexual orientation is Constitutionally protected? They could strike down the law completely. I doubt they would, but this couple may be about to find out the hard way that the Bill of Rights cuts both ways. I'd be astonished if this ruling is upheld.

 

[deleted50478]

Religion is everything but progress.

Arguing this as freedom of religion is very questionable. Performing a medical procedure on a lesbian doesn't actually violate his religious beliefs in any way. It's not as if he was going to make her stop being a lesbian or keep her from having a child. He was just being holier-than-thou with no hope of any meaningful change with respect to his religious beliefs.
That said. He isn't a tool for her to use as she sees fit. He should be able to refuse whatever patients he wants period. It doesn't matter why because he has the right to think and act however he wants. You could argue against this point of view if he was the only fertility doc available, and therefore limited her access to care, but that is not the case.

 

[JLM]

thank god i didnt get into medicine to help people in their time of need. its against my personal beliefs to treat unwed mothers, drug users, gamblers and catholics.


but if you are a heterosexual, married, wealthy, young WASP -- bring it !!

the rest of you can head down to walgreens and see the NP in the redi-clinic.

YEA MEDICINE !!!

 

[LongSnow]

Does anyone know if there were monetary damges with this verdict?


I personally hope this verdict is overturned - assuming that the doctor did indeed refer the couple to another physician. I don't want to argue whether or not a lesbian couple is an appropriate set of parents. But, I do think a physician can decline such an elective procedure based on his or her moral beliefs and not be forced to provide care in this instance.

Is having a child then a state sponsored right? Tough questions, tough questions....

Now, I am no holy roller, but anytime I see religion bashers I get a little worked up - as indictated in a previous posters remark - "Religion is anything but progress" Tell that to my grandfather who stood up to the KKK, helped the Native Americans tremendously, also my church that provides housing and care to the indigent, meals in the wintertime, and the list goes on and on. Religion, yes, has its demerits, but on a whole I feel its merits far outwiegh it merits.

 

[Southpaw]

You could argue against this point of view if he was the only fertility doc available, and therefore limited her access to care, but that is not the case.

How could you argue against it if he was the only doc in the area? It's an elective procedure, of which no one can demand he provide. If it's an emergent appendectomy or any situation in which her life is in danger, then yes you're correct, he's abandoning care. In this case, he is perfectly within his rights to not provide this elective therapy to whomever he chooses.

 

[Southpaw]

thank god i didnt get into medicine to help people in their time of need. its against my personal beliefs to treat unwed mothers, drug users, gamblers and catholics.


but if you are a heterosexual, married, wealthy, young WASP -- bring it !!

the rest of you can head down to walgreens and see the NP in the redi-clinic.

YEA MEDICINE !!!

Cool...since you're in medicine to "help" people then you can marry the unwed mother so she can take your cash, line all the drug abusers up and starting writing percocet scripts til the cows come home, and give whatever cash you've got left over after the previously unwed mother cleans you out to all the gamblers in the hopes that they can hit the big one and help themselves. Right? You're here to help people, go right ahead.

 

[jetproppilot]

In my view this is a horrible trend for medicine. We are being reduced to simply government agents, doing what we're told, when we're told to do it, and how they tell us to do it.

How do all of you feel about performing anesthesia for abortion?

How would you handle it if wanna your gyns had one on the schedule tomorrow?

 

[Planktonmd]

How do all of you feel about performing anesthesia for abortion?

How would you handle it if wanna your gyns had one on the schedule tomorrow?

I am here to give anesthesia to people who are having surgery, that's my only job.
I leave religious issues to people who practice religion, I practice medicine.

 

[JLM]

Cool...since you're in medicine to "help" people then you can marry the unwed mother so she can take your cash, line all the drug abusers up and starting writing percocet scripts til the cows come home, and give whatever cash you've got left over after the previously unwed mother cleans you out to all the gamblers in the hopes that they can hit the big one and help themselves. Right? You're here to help people, go right ahead.

well, yes. this would certainly be the only way to go about helping these people.


YEA LOGIC !!!

 

[deleted126335]

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[core0]

"Protected status" doesn't matter. The First Amendment is the original anti-discrimination law, and it says the doctors can't be legally compelled to violate their religious beliefs. Suppose the current, conservatively-leaning Supreme Court holds that discrimination due to sexual orientation is Constitutionally protected? They could strike down the law completely. I doubt they would, but this couple may be about to find out the hard way that the Bill of Rights cuts both ways. I'd be astonished if this ruling is upheld.

Can you show me where the first amendment says that a physician can't be legally compelled to violate their religious beliefs?

Here is the entirety of the first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Broken down there are two parts that pertain to religion. The first:
Congress shall make no law respecting an establishment of religion
The second which follows it:
or prohibiting the free exercise thereof

Taken together these are known as the establishment clause and the free exercise clause. Depending on the interpretation most constitutional scholars think that these clauses means one of two things. Either the government may not establish an official religion or the government may not show preference of one religion over another. With the first the government may not aid any religion even if it does not differentiate by denomination. With the second government may aid religion as long as the aid is equal.

The free exercise clause has been used to limit religious practices. In particular this was used to outlaw polygamy in the late 1800's. The government ruled that religious opinions could not be outlawed but religious practices could.

David Carpenter, PA-C

 

[deleted126335]

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[Kubed]

Does anyone know if there were monetary damges with this verdict? ...

This wasn't a ruling in the actual case of the patients vs the doctor. It looks like when the couple sued the physician, the physician's lawyers made a motion for dismissal of the suit saying this was a first amendment issue (back in 2003). Now that the CA supreme court has ruled that this isn't a first amendment issue, it's been kicked back down to the lower courts and the actual trial will start. Hopefully when the physician shows that they provided alternatives and that there's legal precedent for doing so (maybe?) the actual case will go in favor of the physician.

Either way, one side is not going to be happy with the eventual verdict and it will at least be submitted to the federal courts.

 

[aphistis]

Can you show me where the first amendment says that a physician can't be legally compelled to violate their religious beliefs?

Here is the entirety of the first amendment:
Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.

Broken down there are two parts that pertain to religion. The first:
Congress shall make no law respecting an establishment of religion
The second which follows it:
or prohibiting the free exercise thereof

Taken together these are known as the establishment clause and the free exercise clause. Depending on the interpretation most constitutional scholars think that these clauses means one of two things. Either the government may not establish an official religion or the government may not show preference of one religion over another. With the first the government may not aid any religion even if it does not differentiate by denomination. With the second government may aid religion as long as the aid is equal.

The free exercise clause has been used to limit religious practices. In particular this was used to outlaw polygamy in the late 1800's. The government ruled that religious opinions could not be outlawed but religious practices could.

David Carpenter, PA-C

David,

1) The body of fact, as far as we're aware in this thread, paints a very consistent and internally valid picture of conscientious objection. Any suggestions otherwise would need to overcome a substantial burden of proof.

2) I agree with what you're saying about religious practices, but that argument doesn't apply here. There are no religious "practices"--i.e., rituals, ceremonies, any deeds at all--to outlaw in this case. The "opinion" (quotes merely to help keep our arguments aligned) is all that exists.

Any law that can compel them to perform the service is prohibiting them from freely exercising their religion. Regardless of arguments over what the Consitution means, that's what it says. Given the current Supreme Court makeup, it's pretty likely (not guaranteed, obviously) that the majority view would be sympathetic to that argument.

3) The doctors were exercising their religious beliefs by simply not doing anything, which is the most benign form of expression possible, and by freely directing them to someone else who would willingly perform the service, which strongly implies a good-faith interest in seeing the patients' wishes fulfilled. Stranger things have happened, particularly in California, but I just can't see how this case would survive a trip to Washington.

 

[MilesMayhem]

The legal arguments are interesting, but I am not a lawyer, so I'll pass.
The moral arguments don't interest me a bit, as I subscribe to emotivism.

What's left is whether this ruling benefits me or not. It looks as if it doesn't. If religious zealots were allowed to deny non-emergent procedures, they would be losing clients, and coming to all the nice non-religious folks instead. Now, people will have a harder time telling the die-hard christian f00ls from the nice non-theist ones.

What a shame.

 

[Carmengia]

My understanding is that the law was written to protect people from businesses that discriminate against certain groups. If you offer a service, you can't deny it based on race/sexual orientation/religion/etc.

It brings to mind laws written to protect blacks against businesses (such as restaurants) that wouldn't serve them. Just because blacks could go to a different restaurant didn't make the discimination okay. So I don't think that just because a patient could go elseware makes discrimination based on sexual orientation okay.

Personally, I'm glad the lesbians won. The injection of religion in to healthcare gives me the heebie jeebies. Not everywhere has a reasonable range of healthcare services - I understand that the couple had to go outside their preferred provider network and pay a lot more, and they were from a non-rural area.

"Freedom of Religion" sounds good, but I don't like it when religion is shoved down my throat. In my town, there are a lot of worried docs because a large catholic entity wants to buy one of our larger hospitals. They won't let docs do sterilizations, etc. They can get away with it because they deny those services to everyone, but it still pisses me off.

 

[OB1🤙]

There's a whole lot of noise in this thread but my thoughts:

1) No physician should be ever be forced to do an elective case like this if they morally object. They provided names of other docs who could do this procedure, and as such met their obligations.

2) If asked, I would do this case no problem.

3) (I'm looking right at milrisome) Anybody who essentially argues that lesbian couples are by definition unfit parents are uninformed. I personally know a couple just like this, they're fantastic people and parents, and their kid is very happy and being brought up in a stable, loving household.

 

[deleted126335]

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[core0]

First I forgot to congratulate Plankton on waiting until post 14 to invoke Godwin' Law.

Second I'm not a lawyer and don't play one on TV. However, as a relic of a misspent youth as a political science major I have a little different view of the constitution and personal rights.

David,

1) The body of fact, as far as we're aware in this thread, paints a very consistent and internally valid picture of conscientious objection. Any suggestions otherwise would need to overcome a substantial burden of proof.
Except its not consistent. Its judgmental. It is perfectly within the rights of a physician to object to a procedure for example. What you can't do is pick and choose who you object to. Essentially you aren't allowed to impose your values on other people.

A corollary would be in the rulings about polygamy. Its OK to believe in polygamy, just not OK to practice it (although constitutional purists would state that this is imposition of one religious dogma over another).

2) I agree with what you're saying about religious practices, but that argument doesn't apply here. There are no religious "practices"--i.e., rituals, ceremonies, any deeds at all--to outlaw in this case. The "opinion" (quotes merely to help keep our arguments aligned) is all that exists.

To some extent. However, the physician claimed a religious exemption. The religious claim was that his religion did not condone homosexuality.

Part of the issue is that to practice as a physician is not a right. It is a privilege allowed by the state and regulated by the state to protect the public. As part of this the physician agrees not to violate the laws of the state. One of the laws in California is that you cannot discriminate against homosexuals. It is no different than a shop refusing to serve a homosexual. If you are open to the public you have to be open to the entire public not selected portions. As above physicians have a right to not do procedures but they may not exclude selected individuals or populations.

Any law that can compel them to perform the service is prohibiting them from freely exercising their religion. Regardless of arguments over what the Consitution means, that's what it says. Given the current Supreme Court makeup, it's pretty likely (not guaranteed, obviously) that the majority view would be sympathetic to that argument.

3) The doctors were exercising their religious beliefs by simply not doing anything, which is the most benign form of expression possible, and by freely directing them to someone else who would willingly perform the service, which strongly implies a good-faith interest in seeing the patients' wishes fulfilled. Stranger things have happened, particularly in California, but I just can't see how this case would survive a trip to Washington.

See above. The doctor can choose not to practice medicine or they can choose not to do a specific procedure. Its hard to predict what SCOTUS would do but I hardly see them choosing this case to make major policy on religious freedom.

David Carpenter, PA-C

 

[jetproppilot]

Interestingly enough one of the online CMEs I just completed included some info on patient abandonment and how to handle it in order to protect yourself.

The vignette was concerning a drug seeking pain patient but in substance theres no difference between the CME case and the case being discussed here....

The CME was sponsored by LAMMICO, my malpractice company.

They described, if you wanna exit a patient's care, to not acutely abandon them.....but to give them written notice of a finite (i.e. 30 day) window of your care, after which you cannot provide service anymore, but heres-a-list of similar providers.

Sounds like the fertility docs did what they had to do as recommended by the malpractice companies that represent us.

Oh...and on a side note...

"GIMME A FRIKKIN BREAK, MRS. and MRS. SMITH."

"SO YOU'RE A GAY COUPLE, HUH?"

"THATS FANTASTIC."

"I think you can provide a home to a child just as nurturing as a heterosexual couple."

"I DO NOT appreciate you filing a FRIVOLOUS, UNNEEDED lawsuit against a couple of probably-fine doctors just because they chose to bow out of your care because of personal reasons, especially since they referred your care to similarly-deft physicians."

Not that you really give a s hit, but if you can file some b ulls hit lawsuit then I can certainly disseminate my opinion about it.

With hugs and love and rainbows,

Jet

 

[geogil]

And historically Abrahamic faiths condoned slavery and stoning to death for violations of rules that seem trivial today. By any modern standard of morality these beliefs and rules are just plain wrong. Another few hundred years and the discrimination against homosexuals may be viewed similarly.

By the way Mormons forbade African Americans from becoming priests till 1978. They bowed to the force of law and renounced this practice. The same way the renounced polygamy about 100 years before that.

The legal concept is known as evolving standards of morality.

In the interest of accuracy, there is no law that requires equal racial representation in clergy. Mormons believe that in 1978 God revealed to the prophet who leads the Church of Jesus Christ of Latter Day Saints, that all worthy male members of any race could hold the priesthood. (here)


We now return you to the debate at hand.

 

[Southpaw]

damn right, JPP

 

[aphistis]

First I forgot to congratulate Plankton on waiting until post 14 to invoke Godwin' Law.

Second I'm not a lawyer and don't play one on TV. However, as a relic of a misspent youth as a political science major I have a little different view of the constitution and personal rights.


See above. The doctor can choose not to practice medicine or they can choose not to do a specific procedure. Its hard to predict what SCOTUS would do but I hardly see them choosing this case to make major policy on religious freedom.

David Carpenter, PA-C

Fair enough, David.

 

[starsop93]

I haven't been on SDN as long as some of you but this is one of the stupidest things I've ever read on here.

I agree. There are some seriously deluded people on this thing.

 

[phillyfornia]

copro is absolutely correct.

i have nothing against the gays and i don't agree with what these docs did.

however, they should have a right to refuse to perform a non-emergent procedure on anybody they choose. it doesn't matter if it's based on religion, race, gender, etc.

 

[Planktonmd]

First I forgot to congratulate Plankton on waiting until post 14 to invoke Godwin' Law.

David Carpenter, PA-C

I don't see much difference between denying people services based on their sexual orientation and denying them services based on their religion or the shape of their noses, so the analogy is well justified.
One more thing to add: I am really surprised that this type of behavior came from fertility doctors (reproductive endocrinologists as they like to call themselves), these guys are usually business oriented cash or credit card only type of doctors, and to see them trying to teach us religion and morality is interesting.

 

[aphistis]

I don't see much difference between denying people services based on their sexual orientation and denying them services based on their religion or the shape of their noses, so the analogy is well justified.
One more thing to add: I am really surprised that this type of behavior came from fertility doctors (reproductive endocrinologists as they like to call themselves), these guys are usually business oriented cash or credit card only type of doctors, and to see them trying to teach us religion and morality is interesting.

Do you even know what Godwin's Law is?

 

[Planktonmd]

Do you even know what Godwin's Law is?

I think I do but since you obviously know more maybe you can educate me.

 

[Gern Blansten]

Godwin's Law:
As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one.

Nice pick up on that one. Getting all the way to 14 on a topic such as this is quite an achievement!

 

[Planktonmd]

Godwin's Law:
As a Usenet discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches one.

Nice pick up on that one. Getting all the way to 14 on a topic such as this is quite an achievement!

Yes,
http://en.wikipedia.org/wiki/Godwin's_law
And I was pointing out that the comparison to Nazism was not unwarranted in this discussion because denying basic rights to a certain minority in the name of higher causes is what Nazism did.
So I am happily complying with Godwin's law even If I am accused of not understanding it.

 

[Surfer]

I didn't realize there was a "basic right" to be able to be artificially inseminated by your local fertility specialist. Would this include people who can't afford to pay for it? What about a child molester? Hey, don't go denying "basic rights" to anybody!

I've got a basic right for you... how about the right to refrain from doing something that your closely held and MAINSTREAM religious beliefs tells you is wrong?? How about the basic right to not have the government tell you which religious beliefs are invalid?

The lawsuit filed by this couple is absolutely frightening. Did they get what they wanted? Nope, because what they really want is for society as a whole to tell them that their situation is perfectly normal, accepted, and mainstream. Unfortunately, for the majority of americans, this is not true, so this couple will never get their ultimate wish, no matter how many judges or courts rule on their side.

 

[Planktonmd]

I didn't realize there was a "basic right" to be able to be artificially inseminated by your local fertility specialist.

They have the basic right to have children like any other human.
If a single woman can walk into a fertility clinic, get IVF, and get pregnant with donor sperm no questions asked, then are we going to deny her that right if she decided to sleep with other women? What if we didn't know about it? is that OK?
Please don't turn this into a government against fire arm baring good Christian citizens type of conspiracy.