The New Assualt on Patient's rights.

In yet another 11th hour decision from the Bush administration, we see a further assault on individual rights, this time, under the guise of "religious tolerance". The federal health care conscience protection statutes, or The Church Amendments (42 U.S.C. 300a-7) proposed earlier this summer, and finalized just now, on December 19th, 2008 ensures that health services do not support coercive or discriminatory policies or practices with regards to refusal of participation or assistance with morally objectionable health services or research not limited to abortion or sterilization based on the medical practitioner's religious beliefs.

In the document itself, the issues regrading the broad sweeping and vague terminology of "any medical services or research" were swept under the rug as being intentionally broad, and "self explanatory". The final draft excludes specific and inflammatory language included in the draft defining abortion as:

“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 termination of the life of a human being in utero between conception and natural birth, whether before or after implantation.

Sparking a wide controversy implying that hormonal contraceptives would be included in the category of abortifacients. The finalized document fails to include any definition of abortion, and is even broader in terminology, expanding the right of doctors, medical employees, and all "workforce" in the medical industry (including pharmacists) to deny standard medical procedures or prescriptions or "health services" on the basis of religious affiliation, or moral objection.

At what point in time did the right to practice a religion become the right to refuse to fulfill all or part of a job for which you were hired? When did the right to practice or believe in a religion become the right to force those beliefs and moral judgments onto others by way of denying services to patients, customers, and clients?

You have a right to personally practice your religion, not the right to practice your religious beliefs on others.

The main argument from supporters of such a proposal is that doctors have the right to work according to their conscience. Yes, they do, in fact they have every right to refuse to personally engage in actions they find morally reprehensible, or at the very least, against their religion. They do not have the right, however, to train for a job, apply for a job, and then refuse to do the job they intentionally acquired. For example:

A Mormon or Muslim has every right to refuse to drink or serve alcohol. In which case, applying for a job at the local Chillies or watering hole would seem like a bad idea.

A strict Christian has every right to avoid taking or prescribing birth control, in which case applying for a pharmacists or gynecological job where it is likely they will have to prescribe birth control would be a bad idea.

A Scientologist has every right to refuse to have or give psychological care, in which case, studying to be a psychologist would seem to be a poor career choice.

A Jehovah's Witness has every right to refuse to have or give blood transfusions, in which case applying to work in an ER where the likely hood of giving or assisting in blood transfusions would be a poor choice.

A modest Christian, Jew, or Muslim has every right to shun immodest dress and behavior, in which case they should not apply to work in a lingerie shop or strip club. Or even a local department store that sells "unmentionables".

Am I making myself clear yet?

This proposal has greater ramifications of the field, as noted in the LA Times:
"This kind of rule could wreak havoc in a hospital if any employee can declare they are not willing to do certain parts of their job," she said.

Refusal to act, to refer patients, and to administer time sensitive emergency care to patients in need is a detriment to patients and in contradiction to the Hippocratic Oath doctors are required to take. The article goes on to state instances where religious beliefs cause undue harm and discrimination:
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.

Another argument stated for supporters is that patients can choose the doctors that best fit their beliefs. This is only partially true. First and foremost, many patients are restricted by their insurance providers (who, by the way are also listed as being able to refuse insurance coverage of any procedure they deem morally objectionable). Furthermore, there can be long waiting lists for doctors or facilities that are in high demand, and if clinics and offices decide to go the moral route, you can be certain that the waiting lists for clinics and offices that do offer all medical options will grow exponentially, leaving many patients out in the cold.

In hospitals, and often in doctors offices with more than one doctor you don't get to choose which doctor you see. They work on a rotation, and you have to see all of them at one point or another. What happens to the woman who goes into her normal gynecological office for her birth control renewal, only to face a doctor who refuses to renew her prescription based on religious belief? That doctor also has the right not to defer to another doctor at that time. The woman then has to make a special appointment, hoping she won't get another morally righteous doctor so she can get her birth control pills or IUD fitting? Who will pay for the unnecessary visit? What about rotating doctors in the ER? You come into the ER and you're bleeding out and get the only Jehovah's Witness in the place who refuses to give you a much needed blood transfusion. You die, neither the hospital nor the doctor are legally liable under this law.

How is this acceptable?

At what point did moral guidance and moral judgment become the duty of a physician?

Where are my rights as a patient to receive the medical care that is acceptable to me?

What if a doctor decides to ignore a DNR, because he or she believes it is a form of assisted suicide, and suicide is against his or her religion? This isn't acceptable. You can't go against patient's wishes in this manner.

All too often people forget that professionals such as doctors are servants. They are public servants. They are not Gods, they do not have the right to force the patient into medical care or health positions against their will. There are only a few reasons a doctor or medical professional can deny treatment, service, or prescriptions:

They are not legally licensed to prescribe, treat, or diagnose a particular medical problem.

They are obligated to not prescribe medications that counteract with other medications, or medications for patients who do not need them due to the harm it can cause. (Think, nitroglycerin pills for someone with a healthy heart).

They cannot give a false diagnosis to pacify a patient.

That's it. There is nothing about personal opinion or religious belief, the legal or medical need to deny a patient a service is not based on belief but licensing, and medical science.

I have noticed that many complain of religious protections in every employment area but the medical industry. I beg to differ. What field or profession allows employees to refuse to do their job because of religious belief? The restaurant industry? The movie industry? Sales? Production? Lending? Brokerage industries? Attorneys, mechanics, architects, plumbers, contractors, suppliers? Designers, artists, writers, singers, actors/actresses, athletes? No, they can't refuse to do their jobs.

This is not about protection of religious beliefs. This is about limiting, restricting, and possibly eliminating "objectionable" medical services. Objectionable to a select few people, that is. Just read a snippet from Secretary Mike Leavitt's blog:
Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?

No, Mr Leavitt, it would not be an important social statement. It would be a detrimental comment from the select few who become physicians, not the will of the people. It would be a harmful and forceful restriction of individual liberties based on the moral righteousness of a small percentage of the population who claim absolute moral authority.

LA Times
Proposals, draft
45 CFR Part 88
LA Times
Senate letter opposing the HHS proposal
LA Times
White House Considering Contraception Restrictions
HHS Moves to Define Contraception as Abortion
MoveOn.org Urges Opposition to HHS Regulations Redefining Contraception as Abortion
Final proposal
42 USC 300 - Sec. 300a-7
Hat tipThis Time This Space


Anonymous said...

Well Buddy what can I say If You have said it all!! Oh I can give some thanks for all your Great work and time.. I really do enjoy reading Your articles and have fun!

Norman Flecha

Alberto said...

Doctors need to leave their religions at the door, period. They need to be able to perform their jobs regardless of religious or moral belief really. I know that's hard to do, but that's how it is.

SillySoul said...

History is in the process of repeating itself. The merging of church and state. With all the technology in world, most have forgotten all the wisdom we've been blessed with. However, even being knowledgeable is frowned down upon. We are in challenging times.

In conclusion, doctors should help people who want to be help and avoid what people don't want to be helped with. I won't tell you how to do your job as long as you don't tell me what to do with my body.

Awesome blog. Thanks for the info.

Anonymous said...

nurse: orderly jones, could you go clean mr so-and-so in room 5? he soiled himself again.

orderly: uh, sorry nurse but my religious beliefs dictate that i handle no poo other than my own. and i shouldn't even be handling my own poo, amen!

8 years in and bush throws the pro-lifers a nice big bone. they want to chip away at abortion rights or get the issue back up before the supreme court. and if enough people follow up on this "right to refuse" shit, the supreme court is where it'll probably end up. again.
i, by the way, support abortion all the way up to the 225th month.
i'm kidding of course. or am i?

myundiary@gmail.com said...

I completely agree that doctors should leave their religions at the door. But what can I say...Bush is just making it really hard for President-Elect Obama to fix! Perhaps that is his goal anyway

Anon-Paranoid said...


Merry Christmas and Happy New Year or any other Holidays you follow to you and all your loved ones.

May the New Year be filled with nothing but love and joy for you and yours.

God Bless.

Naj said...

Just hi!

Gabriel - Gadfly Revolution said...

This seems to be a well-researched and rational argument. I haven't looked over the amendments myself, but if what you say is true, it's a troubling idea. I was glad to see you mention the Hippocratic oath -- when I was reading your post, I kept thinking about that oath myself.

a very public sociologist said...

Is there much of a chance this crap will be repealed when Obama takes office? Is he likely to be inclined to do so?

Btw, belated happy new year!

Anok said...

I'm sorry I haven't responded to all of the comments here...I somehow got all lost during the holiday season, and have been trying to cut down my internet obsession a bit.

Thank you all for the great comments, and contributions.

And Naj, Anon - Hello! Long time no see, I hope you are all doing well {{hugs}}

AVPS, I do believe that Obama has stated that he will be investigating, and probably repealing all of Bush's 11th hour policies. I'm hoping that this one will be quickly repealed, but with all of the other problems we are facing, it could be put on the back burner.

I hope everyone had a wonderful holiday season, and best and warm wishes for everyone in the new year - may you keep your jobs, your homes, and your sanity ;)