Mark Hoofnagle has a MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.
A number of us in the blogosphere have been outraged by Bush's Department of Health and Human Services' desire to put the arbitrary wants of doctors before the needs of patients. At first it was just a draft proposal, but now Mike Leavitt is pushing to implement the changes. Soon, it may be legally acceptable to deny you a needed health service because the health care provider thinks your decisions are immoral.
I've already written several times about why there can be no "conscientious objectors" in health care. This law would essentially allow doctors to ignore the standard of care set by their professional organizations. Let's hear a bit from Leavitt himself:
I have on two previous occasions written in my blog about the principle of health care provider conscience. Federal law is explicit and unwavering in protecting federally funded medical practitioners from being coerced into providing treatments they find morally objectionable. This became a topical matter when the American College of Obstetricians and Gynecologists (ACOG) issued guidelines that could shape board certification requirements and necessitate a doctor to perform abortions to be considered competent.Physician certification is a powerful instrument. Without it, a doctor cannot practice the specialty. Putting doctors (or any one who assists them) in a position where they are forced to violate their consciences in order to meet a standard of competence violates more than federal law. It violates decency and the core value of personal liberty. Freedom of expression and action are unfit barter for admission to medical employment or training.
As Secretary of Health and Human Services, I called on the organization that oversees Ob-Gyn board certification to alter its guidelines to assert that refusal to violate conscience will not be used to block board certification. Their answer was dodgy and unsatisfying.
What a load of bullshit. This is only one example, but performing a D & C is a basic skill of obstetricians. It isn't just used for elective abortions. According to the AMA News, this is the ACOG position (ACOG's site is members-only):
The ACOG Committee on Ethics opinion says doctors whose personal beliefs may require them to "deviate from standard practices" such as providing abortion, sterilization or contraceptives should:* Give patients prior notice of their moral commitments and provide accurate and unbiased information about reproductive services.
* Refer patients in a timely manner to another doctor who can provide the requested service.
* Provide medically indicated services in an emergency when referral is impossible or might affect a patient's physical or emotional health.
* Practice close to physicians who will provide legal services or ensure that referral processes are in place so that patient access is not impeded.
This doesn't even require an OB to perform an abortion! The Theocratic Right will not be satisfied until women are controlled. This isn't a disagreement on ethics, it is a fundamental disagreement about human rights, specifically women's rights. It is a blatantly misogynistic piece of discriminatory legislation that turns health care providers into preachers.
In fact, I can't help thinking it's the Bush administration's final "fuck you" to the American people. The Theocratic Right knows it's finally lost it's battle to turn America into a legally Christian nation, and in its death throes, it's taking one more fascist swipe at the American people.
They should be ashamed. But of course, they have no shame.
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Hey! Just think, though: this could solve the financial problems of so many inner-city hospitals. Right now, they're being swamped by the mandated cost-shifting of pro bono services, which they (try to) pass on to paying patients, which makes them non-competitive with hospitals in wealthier neighborhoods, with the resulting downward spiral.
This policy would change all that.
Now, when someone shows up at an inner-city hospital with an OD, the ER staff can declare their moral disapproval of drug abuse and refuse to treat. When a streetwalker comes in cut up by her pimp or a john, they can refuse to treat based on moral objections to prostitution. When a woman comes in beat within an inch of her life by her boyfriend, they can refuse to treat based on disapproval of extramarital sex. When her baby comes in beaten near death by that same boyfriend, they can refuse to treat based on bastardy. That's just the beginning of a very long list.
This could save a lot of failing hospitals. It's brilliant, I tell you.
Posted by: D. C. Sessions | August 23, 2008 11:26 AM
I appreciate the physician's take you've been giving your readership on this issue, PalMD--particularly in contrast to Michael Egnor's logic-free bleating.
By the way, a PDF of the Ethics committee report can be found here if anyone's interested.
Posted by: Danio | August 23, 2008 11:29 AM
This allows a doctor to refuse to treat pediatric HIV because the child's mother sinned and God is punishing her by dooming her child to die.
Posted by: WTFWJD | August 23, 2008 11:50 AM
This one is easy, IMO. If a prospective doctor finds that s/he is offended by actions required by standard of care in the profession, then find another profession.
Posted by: Lee | August 23, 2008 11:58 AM
I'm betting they have several more in store. They're prolific in that regard.
Posted by: decrepitoldfool | August 23, 2008 12:24 PM
I am grateful to you for posting on this so elegantly and succinctly. It also applies to nurses and other licensed care providers, and Leavitt is a domestic enemy, as far as I'm concerned. This turns individual rights on its ear.
One of the problems is that Leavitt keeps a personal blog (on taxpayers' dime, natch) in which he comes across all warm and fuzzy. The public thinks his propaganda is policy, and then, KERPOW, he makes that so.
I don't think this is the final attempt to subvert health care and professional autonomy, either. These Bush-aholics are drunk and are still drinking because no one (Congress) will turn off the tap.
Posted by: Annie | August 23, 2008 12:31 PM
The bulk of people that post on Leavitt's blog are religious idiots. I suggest we post on his blog in full force.
Posted by: Katharine | August 23, 2008 12:46 PM
I think the fact that the Doctor is practicing in exchange for compensation obligates him/her to perform whatever legitimate medical procedure is required by the patient. Its not unreasonable to expect a professional to be able and willing to perform the required procedures of their field. Even more so when a patient's health is on the line.
Its not too hard to imagine the bottom of this slippery slope, unfortunately the voting religious are aiming precisely for it.
One more good reason for secular people to organize behind a useful banner.
Posted by: Steve | August 23, 2008 1:25 PM
Much of what the right doe's these days is taking left wing ideals, and applying them narrowly where it favors their agenda. E.g. the ideal of equal rights they apply to prevent racial diversity. The ideal that nobody should be forced to perform acts that go against their conscience, they now want to apply selectively and narrowly to control women reproduction. But soldiers who refuse for partake in what they consider to be an immoral war, are to be punished. What about applying this principle in the corporation. Employers would be forbidden to punish employees that refuse to perform acts that go against they conscience.
Posted by: eduxrox | August 23, 2008 1:42 PM
thanks for the link! And, i'm planning to draft a comment to submit; everyone else should too. Doesn't matter how short!
Posted by: Ames | August 23, 2008 2:44 PM
agree with Katherine; holy jihad on leavitt's blog. Problem: he screens them all. Good luck getting through.
Posted by: Ames | August 23, 2008 2:49 PM
He seems to let through everything that is polite.
Posted by: PalMD
| August 23, 2008 2:58 PM
The right-wing motherfuckers infesting the administrative branch are despicable hateful scumbags.
Posted by: PhysioProf | August 23, 2008 4:15 PM
If doctors play their cards right, they'll get paid never to work again. As a future historian, I envy their position.
Posted by: I am so wise | August 23, 2008 6:04 PM
Leavitt is correct that "Federal law is explicit and unwavering in protecting federally funded medical practitioners from being coerced into providing treatments they find morally objectionable." Both those who appeal to this body of law to justify their refusal to provide certain services and those who object to legal protections for such "conscientious objectors" should exercise care when discussing what the law says about specific cases. Note that the law refers to _tretments_ that a practitioner finds morally objectionable. It does not say that a particular class of _patients_ can be refused service. Under the law, conscientous objectors can pick and choose their services, but not who will be a recipient of those services.
Posted by: Anonymous | August 23, 2008 6:31 PM
Juxtaposition. Yagotta love it!
Followed immediately by:
Posted by: D. C. Sessions | August 23, 2008 6:48 PM
Hmm. Now will we have the courts defining morality? Because if you choose to judge another's worthiness for treatment, you open yourself up for all kinds of judgments against yourself. Seems all the dead patient's lawyer needs to do is show that you really aren't as "moral" as you claim--that your "objections" are hypocritical. Fun stuff.
There are always unintended consequences.
Posted by: John H. | August 23, 2008 7:14 PM
If Bush/Cheney/McBush get the fires stoked sufficiently in the Georgian region, McCain might get enough votes to continue this insanity.
Posted by: trog69 | August 23, 2008 7:14 PM
Here's my thoughts on this: the people who are pissed off at this offense far outnumber the people who are implementing it. Bush is getting his final "fuck you". When do we get ours?
Posted by: The Nerd | August 23, 2008 8:19 PM
Any chance a patient could sue the practitioner who refused to provide treatment and did not refer the patient to someone else? Say a rape victim is denied access to a "morning after" type of medication and becomes pregnant as a result. Could this be brought to court?
Posted by: Gerry L | August 23, 2008 11:29 PM
Bush is getting his final "fuck you". When do we get ours?
When Obama/Biden are elected to the White House?
Posted by: rich F | August 24, 2008 12:42 AM
At least you could be honest and mention that the rules are to administer an existing law.
Posted by: William Wallace | August 24, 2008 1:47 AM
"When Obama/Biden are elected to the White House?"
Almost enough to make an atheist pray isn't it?
This kind of thing just makes me furious... I can't even think of a rational thing to say.
Posted by: jba | August 24, 2008 1:48 AM
I think i made it clear in my previous post that this applies to the implementation of the Church Amendments, but it's irrelevant.
Posted by: PalMD
| August 24, 2008 1:52 AM
Yeah, um... Wally? Those blue words that are underlined? Those are "links". You can "click" on those for more information. Perhaps one of those "links" leads to a "website" where it discusses that this is to implement (some may argue extend) an existing law.
By golly, it does! Wow!
Ain't technology grand! Now if only we could teach literacy.
Posted by: LanceR | August 24, 2008 4:58 AM
New to your blog....but I've never thought about that! Thanks!
Posted by: Andrew | August 24, 2008 7:34 PM
"Note that the law refers to _tretments_ that a practitioner finds morally objectionable. It does not say that a particular class of _patients_ can be refused service. Under the law, conscientous objectors can pick and choose their services, but not who will be a recipient of those services."
Yes, BUT, Levitt intent goes far beyond that. He basically wants to protect "conscience objectors" from even refusing to REFER patients to other providers.
What the dimwit does not seem to grasp, is the fact that this is tantamount to professional negligence. The courts are replete to the gills of precedents about that, and I'm willing to bet my last n'gwee that said Courts will butcher and quarter this whole Charlie-Fox. Otherwise, kiss medical care as we know it goodbye!
It's all so simple: health care providers have no right to objection of conscience when it comes to assist a patient. If they can't stand the heat, throw them out of the kitchen ASAP!
Posted by: Anonymous | August 25, 2008 2:50 AM
I swear, if a pharmacist ever refuses to refill my birth control prescription, I will punch him/her right in the kisser. You know, to object to the objector...
Posted by: Fruitfly | August 25, 2008 3:16 PM
I am an MD and recently overhead this story in the physician's lounge. The woman in question - who happens to be an married OB/GYN doctor - took her birth control pill script to a local pharmacy. The male pharmacist refused to fill her script and would not give it back to her to take somewhere else. He must not have known she was an MD and also did not know that she has a medical condition that would make pregnancy difficult and perhaps even dangerous. So she promptly complained to the state board. We will see what happens.
Posted by: Reply to Fruitfly | September 8, 2008 11:34 AM
I'm not sure about the terminology, but my mom was pregnant and the fetus died and wasn't expelled immediately. This was before abortion was legal. Her doctor told her he would have to wait until she miscarried before he could perform a D and C. She eventually expelled the fetus and then he did the D and C. I don't understand all of this, but it sounds like if my Mom's body had retained the dead fetus she could have gotten very sick and died, and there wouldn't have been a thing anyone could legally have done about it. If abortion is illegal, we would be facing crap like this. It's like once a woman gets pregnant, her life is secondary to the fetus'. - women are simply baby-making machines. If the machine breaks, who cares, just get the baby out.
I know plenty of single Southern Baptist women who are on BCP and have sex, yet still support Bush and these policies. All I can say is DENIAL!
Posted by: Moldau
| September 27, 2008 5:16 PM