I’m so angry I can barely type coherently. I have very strong feelings about abortion, but I believe it is possible to respectfully disagree about the ethical issues involved. I have an obstetrics colleague who does not perform abortions, but refers patients needing this service to others. That’s the ethical way for a doctor to oppose abortion—don’t do it, don’t prosteletize, refer out. My personal feeling is a woman has the right to control her body and all that dwells within, but I can see why others would disagree.
All that being said, if you chose a profession that will, by its very nature create an insoluble ethical conundrum, you need to get a new job. Pharmacists who refuse to dispense birth control when given a lawfully written prescription should be fired immediately and consider a change in careers.
The Religious Right is trying to protect these types of “acts of conscience.” Traditional passive resistance in the model of Thoreau and King emphasized the breaking of unjust laws and the acceptance of any punishment that goes with it. The religious right in this country is not content with this model—they would prefer to allow for acts of conscience without consequences. In this vein, the Church Amendment was passed. This amendment protects professionals who are trying to impose their values on others by mandating that health care providers who receive federal funds not require providers to provide services that to which they morally object. This has not been widely enforced apparently, because a draft is circulating at the Department of Health and Human Services that would step up enforcement, and broaden the services to which people could object, even protecting them if they refuse to refer to an alternate provider. This document terribly flawed for a number of reasons.
This draft misunderstands fundamentally the nature of health professionals. We serve patients, not ourselves. The draft document equates providers who refuse to provide or refer for services with conscientious objectors in time of war. This is patently ridiculous. We have a volunteer military. When we had draft, it was possible for someone who would normally have nothing to do with war be forced into a moral dilemma. The way out was CO status, which would allow pacifists to serve without taking life. Service wasn’t a choice—killing was.
I chose to be a physician, knowing full well that medicine is fraught with moral ambiguities. I could have opened a coffee shop instead. Professional organizations recognize the primacy of our patients’ needs over our own—our obligations are not to our own morals but to our patients. It’s part of our ethical code.
The HHS draft makes a mockery of this. It quotes a study that states that many physicians feel that they are obliged to present all options to patients regardless of their personal objections. The draft points out that this may be contrary to law. This may be true, but the fact is that WE ARE ETHICALLY OBLIGED TO PRESENT ALL MEDICALLY APPROPRIATE OPTIONS. No law changes these ethics, and in fact, it might be argued that any laws that directly conflict with our ethical obligations to our patients are immoral and require us to speak and act in opposition to these laws.
The draft attempts to create a conflict where none exists. Health care providers do not need their morals to be protected from discrimination. If we object to standard medical practices, we can find a position where our morals aren’t challenged (but that’s hard to find in medicine).
The draft seeks to more strongly enforce the Church Amendments. To justify this invasion of the doctor-patient relationship, it makes some very dubious claims. One is that Plan B, the pill that prevents embryonic implantation, is an “abortifacient”. More on this shortly.
Another claim is that forcing doctors to subsume their beliefs to their professional obligations will cause a shortage of health care professionals. What unmitigated bullshit.
But then comes the really sinister bit. They wish to redefine abortion for the purposes of the statutes. In order to do that they invoke a Zogby poll of American values, and two medical dictionaries. They mention the British and American Medical Associations’ definition as pregnancy occurring after implantation, and then toss away the professional definition for two dictionaries and a poll. They also propose to determine what constitutes abortion by the individual’s conscience “within the bounds of reason”. In other words, any health care professional can call anything an abortion and be legally protected from providing medically and ethically appropriate care. Let me quote the report:
“Abortion” means any of the various procedures—including the prescription, dispensing, and administration of any drug or the performance of any procedure or any other action—that results in the terminatino of the life of a human being in utero between conception and natural birth, whether before or after implantation.
Your federal government is giving doctors, nurses, and pharmacists the freedom to deny you anything they don’t like, including most forms of birth control. Heard of Griswold v. Connecticut? Forget about it. The government has decided that with regard to health care, the Establishment Clause is irrelevant, and the Free Exercise clause is more important than the rights of patients. You should be very afraid for your personal freedoms.
The theocrats who are attempting to make this law are too cowardly to give up their comforts for their beliefs. Rather than engaging in passive resistance, they wish to legislate their religion. If this becomes the law of the land, expect to see some real passive resistance from the health care community. Keep your eyes open, and vote wisely.
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