Respectful Insolence

Via Kevin, MD, here’s a Washington Post article describing how the religious beliefs of health care practitioners result in the denial of care. Here are some examples:

Cynthia Copeland also had a run-in with a pharmacist in 2004. He wrongly assumed she was planning an abortion because she had a prescription for a drug that can be used for that purpose. In fact, Copeland had already had undergone a procedure to remove a fetus that had no pulse, and she needed the drug to complete the process.

“I was sitting there in the drugstore waiting and heard the pharmacist say really loudly, ‘I refuse to participate in an abortion,’ ” said Copeland, 39, who lives near Los Angeles. “I felt so violated. The miscarriage was about grief, and that was made public in a way that really compounded my grief.”

Such self-righteousness that this pharmacist would violate professional ethics (not to mention the HIPAA privacy requirements) in order to humiliate a woman who, to him, was doing something immoral should be grounds for a complaint to the state. Hasn’t this pharmacist ever heard of keeping a patient’s private information private? Even if I agreed with his refusing to fill such prescriptions for elective abortions, I would still consider this guy self-righteous scum for intentionally publicly humiliating a patient and, worse, for not having found out the reason for the prescription before doing so.

And:

Cheryl Bray, 42, a real estate broker in Encinitas, Calif., was flabbergasted that a family practitioner turned her away when she sought a routine physical needed to adopt a baby from Mexico. The doctor said he objected to a single woman’s adopting a child.

“He said something about how, according to his religious beliefs, children should have two parents,” said Bray, whose complaint against the doctor earlier this year was dismissed by the state medical board. “I was under a tight deadline. I started crying. I cried in his office, and then I went back to my car and cried for a long time before I could drive home.”

This is even worse. What is the harm of examining this child? Does this doctor consider life in an orphanage better than life with a single parent who will love and care for the child?

From my perspective, once you take on the role of a physician, patients must come first:

“As soon as you become a licensed professional, you take on certain obligations to act like a professional, which means your patients come first,” said R. Alta Charo, a bioethicist and lawyer at the University of Wisconsin at Madison. “You are not supposed to use your professional status as a vehicle for cultural conquest.”

Religious objections can be dangerous in emergencies and when health workers refuse to refer patients or inform them about other options, especially in poor or rural areas where there are fewer options.

“It’s a very disturbing trend,” said Lourdes Rivera of the National Health Law Program, a nonprofit patient advocacy group.

Doctors, nurses and other health-care workers who cannot find a way to fulfill their responsibilities should chose other professions, some say.

“If your religious orientation is such that you can’t discharge your professional responsibilities, then you shouldn’t take on those responsibilities in the first place,” said Ken Kipnis, a philosophy professor at the University of Hawaii at Manoa. “You should find other work.”

Exactly. Weighing freedom of conscience against one’s obligations can be difficult, and, yes, there are gray areas. However, if your religious beliefs are such that not only can you not carry out the obligations of your specialty but you can’t even at the very least inform a patient of certain medically appropriate options or refer that patient to another health care practitioner, then you shouldn’t be in that specialty–even more so if your “conscience” will result in the harm of a patient.

Comments

  1. #1 Fernando Schuh
    July 17, 2006

    I believe this people (the religious wackos, of course) should be prosecuted and denounced, and taken out of the job as soon the complaint went in. People should take anybody with them to serve as witness to this, so they can take them to court. Just to see if they┬┤re willing to loose their jobs or their money about their so-called “religious beliefs”. Start to hit them where it will hurt… :-)

  2. #2 Jim Lippard
    July 17, 2006

    “What is the harm of examining this child?”

    Actually, it was the 42-year-old woman who wanted to adopt who was trying to get the physical exam.

  3. #3 Ali
    July 17, 2006

    Wait – that woman’s claim against the doctor was dismissed? Outrageous.

  4. #4 bob koepp
    July 17, 2006

    I agree that any professional must be willing to discharge his/her professional responsibilities. The gray areas between personal conscience and professional conscience, however, might need some closer scrutiny. For example, among healthcare professionals, is there a professional duty to provide services desired by the patient/client that are not medically indicated? If so, what is the rationale for such a duty?

  5. #5 Sid Schwab
    July 17, 2006

    It’s everywhere: pretty soon firefighters will refuse to rescue gays from a burning building, on moral grounds. If pharmacists have a problem, they’re in the wrong profession.

    Relatedly, and upside down, very early in practice, I operated on a 40ish woman who was steadily exsanguinating from a bleeding ulcer. Other surgeons had refused to help, because she in turn refused transfusion for religious reasons. I thought that pretty lame on the part of the doctors; I operated and she survived. Looked a little pale for awhile.

    But it raises the obverse of the question at hand: what are the docs’ responsibilites (and liabilities) if they modify treatment based on the patients’ religious views and demands?

  6. #6 Orac
    July 17, 2006

    Sid, that’s a very good question. The way I understand it, as long as you carefully document that you’ve discussed the risks of not following medically accepted advice (i.e., getting a transfusion when needed) in nauseating detail, you should be in the clear if there’s a bad outcome that can be attributed to the person demanding that his religious beliefs be followed in his medical care. I don’t think it’s necessarily “lame” of other

    Bob, that’s also an interesting question. For example, IVF is, strictly speaking, not a medically necessary procedure. Indeed, although pretty safe, it has risks. The whole issue gets totally tangled up in morality and legalities and in the question of whether it is a right to have a biological child or whether anyone should be able to have a child this way.

  7. #7 Michele
    July 17, 2006

    I find reading about healthcare providers refusing to provide care to patients apalling. I am a registered nurse. When I started practicing I held some very strong beliefs about abortion. Since I work in the operating room it can be easier to trade assignments with someone who doesn’t share your views. However the few times I couldn’t trade and had to do the case I tried never to let the patient know how I felt. She had enough to deal with without my making things worse. Most of the patients I have taken care having abortions are having them for very “valid” reasons. These women are already devastated and don’t need the censure of others who think they would react differently in the same situation.

    I also worked in a trauma center where we patched up lots of gang bangers. Those I would have liked to be able to refuse to help. But I didn’t.

    When I was in nursing school the empasis was on treating the patient without predjudice. Has this changed? It isn’t my place to pass judgment on people. My patients all deserve and I hope receive the care they are entitled to without my personal views entering into it.

  8. #8 bob koepp
    July 17, 2006

    In the interest of clear thinking about the issues, I think it’s necessary to distinguish between cases where professionals claim to have moral objections to providing a particular service or procedure, and cases where they have moral objections to serving certains “sorts” of people. Traditional medical ethics makes allowances for the former sort of objections while rejecting the latter as incompatible with professionalism. Sickness, we’ve been told, descends on the just and the unjust. Physicians must be equally non-discriminating.

  9. #9 decrepitoldfool
    July 17, 2006

    This reminds me of a scene from my favorite TV show, The Simpsons. Homer misses a number of payments on their living room furniture, so the “repo-man” comes. As his workmen are carrying out the couch, he looks sympathetically on the sobbing Marge Simpson and says; “Repossessing stuff is the hardest part of my job”.

  10. #10 sconzey
    July 18, 2006

    The thing is, *those people are not doing their job*, so long as they understand that, and their bosses understand that, I don’t see the issue.

    Over here, (unless you’re an MP[news.bbc.co.uk]) if you don’t do your job, you get fired.

  11. #11 J Bean
    July 18, 2006

    I just saw a patient last week whose husband’s condom had failed. The SavOn pharmacist told this young MARRIED woman that Plan B wasn’t available over the counter and she would have to wait until Monday to get a prescription. In California (and 7 other states) that, of course, was a bald-faced lie (of the finest Christian sort, no doubt). Now, even if Christians believe that Plan B causes abortions, that doesn’t make it so, it is merely an example of truthiness and SavOn should insist that their employess should practice science or not at all. I’m sure that SavOn is not going to support that child for the next 18 years.

    This young couple was planning on having another child after the husband finishes his degree next year. I guess SavOn’s policy is that married couples should live together celibately until they are able to afford another child.

  12. #12 Chris Roske
    July 18, 2006

    Take a look at this.

  13. The previous posts all appear to presume (a) that the products/services in question are not morally objectionable, or (b) that one cannot be morally complicit by except by doing it oneself (ie, there is not such thing as moral complicity) , or (c) that it is either impossible or wrong to determine whether an act is right or wrong. They also appear to miss the distinction between the exercise of freedom of conscience (generally acknowledged to be a fundamental human freedom) and the manner in which it is exercised (which may, in some cases, be objectionable: as when a practitioner deliberately humiliates a patient).

  14. #14 James
    August 24, 2006

    Under pretty much any other circumstances I would agree with you Sean Murphy, no seller of goods or services is obliged to offer particular goods or services if they do not wish to. Medical services are an exception. Doctors, nurses etc. are bound by professional ethics that include not turning away a patient in need.

    While I don’t regard the stance of these health professionals as a violation of general morality ti is a violation of the ethical stanards they agreed to when they joined their profession. If they find those standrads unconscionable they should find a new profession.

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