Pharyngula

Canoe’s recent poll asks: Do you believe physicians should have the right to refuse medical treatment if it is against their beliefs? Scroll down to the bottom of the right hand side of the page to find the poll.

To clarify, as it’s been brought up that this is a poorly worded poll: based on the story behind it, it is referring to doctors who refuse their patients medical treatment that will help them based on their religious beliefs.

But nevermind anyways. Apparently this poll was closed just after I posted it. So ignore the link, but feel free to comment on the topic if you like.

Now luckily common sense is already winning out with 61% of the ~2300 voters voting no. However, that still leaves close to 40% of voters who believe this practice is OK. Let’s get to work!

This poll brings up a good point of discussion, I think. I personally have heard of many stories of, for instance, unmarried women having to find a new family doctor because they wouldn’t prescribe her birth control, due to the doctor’s religious beliefs. Obviously, I think this situation is beyond ridiculous.

From LisaJ.

Comments

  1. #1 Bacopa
    August 18, 2008

    First!

    A doc who won’t give The Pill should work in a specialty where he won’t encounter patients who will ask for it.

  2. #2 Bad
    August 18, 2008

    “Obviously, I think this is beyond ridiculous.”

    Because… what? You think that people should be forced by law to give you whatever you desire? If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.

    Doctors provide a service that you and your insurance company purchase. If you aren’t satisfied with what they are willing to provide, take your money elsewhere. But there is no right to have OTHER people provide you with the services you want.

  3. #3 Mary
    August 18, 2008

    My mother was one of those women; hence the existence of my youngest sibling. In her case the doctor lied to her. He said birth control was not legally available to her and what was out there was dangerous. (This was some 40 years ago.) Now that I think about it, those lying-for-Jesus-guys have been around for a while. She finally found a friend that knew the truth (hence there are only 4 of us.)

  4. #4 DustPuppyOI
    August 18, 2008

    It looks like the poll has already been closed and relegated to past polls.

    Final results: Yes (36%), No (61%), Undecided (3%)

  5. #5 Yasic
    August 18, 2008

    While Doctors must be required to work if a persons life is at risk, I don’t think a Doctor should be forced into giving his services to someone that he does not wish to help for ANY reason IF getting help from someone else at a later time will not cause harm to the patient.

    I simply do not see why a doctor should have to help someone he does not wish too?

  6. #6 J-Dog
    August 18, 2008

    The link now goes to an updated poll asking for your opinion of Mussaref resigning – good for the fight against terror?

    No way to answer that kicking out GW and his henchmen is the best way to fight terror though.

  7. #7 Kobra
    August 18, 2008
  8. #8 Aphrodine
    August 18, 2008

    I always have conflicting feelings when it comes to this question. I obviously feel that it is wrong and dehumanizing to deny a woman contraceptives and abortion services, but I feel that there are other cases where a doctor should still have the right to not perform a service that they do not believe in.

    I am a student going into veterinary medicine and I have served as an intern at a veterinary clinic for about a year and a half. One of the doctors at my clinic refuses to perform onchyectomy (de-clawing) in all four paws of cats, and will only perform claw removal of the first two paws if the owner has exhausted all other alternatives (everything from nail trimming to nail caps) and agrees to opt for the laser surgery technique. I completely agree with her position on this and will probably adopt the same policy a million years from now when I finally graduate.

    Do I think that a doctor should deny a patient services for religious beliefs? No, especially when the service is vital for the patient to live a healthy and happy life.

    Do I think that a doctor should deny a patient services that they feel may cause serious harm in them? Absolutely.

  9. #9 Virgil
    August 18, 2008

    BADLY WORDED QUESTION !

    Everyone has the right to refuse medical treatment, this is written into the most basic patients rights bills.

    Doctors on the other hand do not have the right to refuse to GIVE medical treatment based on beliefs.

    The word “GIVE” is missing from the question. As worded, it is confusing. It sounds like a doctor can refuse a treatment offered to them, if they’re a patient.

  10. #10 negentropyeater
    August 18, 2008

    Too late, poll closed !
    Now as J-Dog mentionned, it’s an even more pointless poll…

    I wonder if there’s a poll somewhere about how pointless these polls are ?

  11. #11 Blondin
    August 18, 2008

    The encouraging thing is that the story behind this poll is about the Ontario College of Physicians desire to censure doctors who refuse to do their job.

    As for the comments about just finding another doctor – must be from Torontonians. The rest of us don’t necessarily have that luxury.

  12. #12 Jackal
    August 18, 2008

    Bad and Yasic,

    If you do not wish to do everything in the job description, don’t take the job. It’s as simple as that. If you don’t want to preform elective surgery, don’t become a plastic surgeon. If you don’t want to fill prescriptions for birth control, don’t become a pharmacist. If you don’t want to wash your hands up to the elbows, don’t become a nurse. If eating meat offends someone, should they be able to work at McDonalds and simply refuse to fill any orders containing meat? This is no different.

  13. #13 Tony Sidaway
    August 18, 2008

    According to The Independent, in April, 2007, the British National Health Service faces a looming crisis as more obstetricians opt out of abortion. Cited reasons are “distaste at performing terminations combined with ethical and religious convictions”. The Royal College of Obstetricians and Gynaecologists (RCOG) describes a “the dinner party test” factor: carrying out abortions isn’t something you can talk about in polite company.

    Religious grounds have always been an acceptable reason to opt out of abortions in the UK, but in the 1990s the Faculty of Family Planning and the RCOG introduced a “conscience” clause.

    However, this recent article in Spiked Online by gynaecologist and abortion rights campaigner Wendy Savage, suggests (using an analysis of hard figures) that the crisis is largely imaginary and the claims of growing numbers of conscientious objection don’t stand up either.

  14. #14 Kobra
    August 18, 2008

    #10: I just made one. Have at it!

    http://www.kobrascorner.com/voting-booth.php

  15. #15 tceisele
    August 18, 2008

    Bad [#2] wrote: “If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.”

    There are two problems with that:
    1. Doctors are booked solid around here, and I believe they are in most other parts of the US too. If you drop your doctor to find a new one, it can take months before somebody has an opening. Back when my wife and I were trying to line up a regular doctor, it took almost a year.

    2. Doctors don’t exactly publicize their beliefs in advance. You don’t have a directory where you can look up “Doctor A will perscribe full suites of birth control, Doctor B will perscribe anything except emergency contraception, and Doctor C is opposed to all birth control.” If there were such a directory, it would certainly make the position that they can refuse treatments for moral grounds a lot more defensible.

  16. #16 Aramael
    August 18, 2008

    Do I think that a doctor should deny a patient services that they feel may cause serious harm in them? Absolutely.

    I think that’s part of the job description, isn’t it? Of course, like anything in real life, it all gets a bit fuzzy; for example, a doctor might genuinely feel that the contraceptive pill is harmful to women.

    I mean, he would be wrong, but he could still hold that belief.

    It ultimately comes down to the patient being pro-active (although my poor understanding of the US medical system leads me to suspect that getting a second opinion is not covered by most insurance?)

    And bravo for refusing to declaw cats. I believe that tail and ear docking is illegal in Australia these days, and it’s about bloody time.

    A

  17. #17 Blondin
    August 18, 2008

    Trust the National Post to make it sound like a bad thing that the OCS wants doctors to obey the law:
    http://www.nationalpost.com/opinion/columnists/story.html?id=730473
    Nobody is suggesting that doctors should “be forced by law to give you whatever you desire”. If a procedure is legal and medically indicated I do NOT want to be lied to or told I can’t have that procedure because the doctor’s invisible buddy might not like it.

  18. #18 kryth
    August 18, 2008

    This type of religious BS makes me so mad, I can’t even find non-vulgar words to express my self.

  19. #19 Black Sheep
    August 18, 2008

    > Doctors provide a service that you and your insurance
    > company purchase. If you aren’t satisfied with what they are
    > willing to provide, take your money elsewhere.

    It is saddening to see how those on whose culture we built our modern world, society and medicine held themselves to higher standards than that for so long, just so we could get retarded libertarian but otherwise healthy pundits flinging manure at their ideals.

    That said, the classic hippocratic oath is in fact very much pro-life, and that fact troubles many physicians faced with this issue – possibly more in number than those who have problems with it due to christian or other religious doctrines.

  20. #20 Jackal
    August 18, 2008

    Aphrodine said

    “Do I think that a doctor should deny a patient services that they feel may cause serious harm in them? Absolutely.”

    I see your point about the vet. Many of the surguries performed on animals are cosmetic or for the owners’ convenience, and are not in the animals’ best interests. I don’t think a vet should have to perform those. However, when it comes to which services cause “serious harm,” some doctors might think perscribing the day after pill causes serious harm. Thus, “serious harm” would have to have a leagal definition – something that includes elictive amputations but not birth control.

  21. #21 raven
    August 18, 2008

    The hypocracy about birth control and abortion is astounding. Chances are those power tripping, wannabe dictator docs have a normal family size of 2 or so in the USA. With modern medicine and readily available food, most women could be walking incubators putting out 10 to 20 kids.

    So Robertson has 4 kids, Dobson 2, Bush 2, Cheney 2? and so on. They are obviously planning their families somehow. During one of the abortion flareups, someone “accidently” leaked the medical history of a far right pro life congresscritter from the south. While he was raving about how abortion is murder, his wife had 2 and his unmarried teen age daughter had one.

    If you think your doctor is a flake, find a new one.

  22. #22 Niobe
    August 18, 2008

    “find another doctor.”

    Sounds reasonable, but there are MANY cases of women who don’t have access to other doctors, by distance. There is also the case of the girl who after reporting her rape was jailed herself and the on duty nurse had objections to dispensing her emergency contraception. The point of emergency contraception is that it’s dispensed ASAP, having to take time to get to another dispensing point (that might give you the same grief) defeats the purpose. Which is the point.

  23. #23 Aquaria
    August 18, 2008

    If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.

    Spoken with all the arrogance and inhumanity of a serial killer. Oh yeah, every place in this bottom-feeding country has infinite doctors, with wide-open schedules. It’s a patient’s market out there! NOT!

    Sorry, but I’ve lived in places where the nearest doctor is 20 or more miles away. And the next doctor after that may be 30 or 40 more miles. Why should anyone have to drive dozens, maybe even hundreds, of miles to get an abortion or emergency contraception if the patient feels she needs it?

    It is fucking unbelievable that someone would actually try to say that doctors have the right to refuse service to someone. Why the hell become a doctor if you don’t want to treat people how they need to be, or even want to be? Who is a doctor to make moral decisions for me, anyway? Quit practicing if you want to make moral decisions for other people and become a preacher.

    Funny, though, how the sanctimonious prick doctors are often the incompetent doctors, as well.

  24. #24 giscindy
    August 18, 2008

    With my insurance finding a new doctor can take up to a year. What am I suppose to do? I just can’t walk away. Besides this is a rural area, if my doc went nuts and decided not to provide a service it’s an eighty mile round trip to the next nearest one.

  25. #25 Bad
    August 18, 2008

    Jackal: if you refuse to serve meat at McDonalds, its the resturant that’s going to fire you (or not, depending on if they care). Nothing wrong with that.

    But there’s no reason that you the consumer should be able to make up “the job description” to fit your preferences. Whomever is employing the doc, or if in private practice, the doc themselves, determines that. Lots of doctors have proceedures they aren’t certified in, or aren’t willing to do for all sorts of other reasons. What they do is refer people to another doc. They shouldn’t be forced to do something they disagree with. Doctors are not your servants. You are their customers.

    Now, Canada is somewhat different in that the government is often in some sense the employer. If they want to fire doctors that don’t perform this service because they think its a waste of money to have docs that can’t do it all, that’s fine with me. But I don’t agree that there’s any sensible general principle here that says that wanting to practice some sorts of medicine obligates you to practice whatever other sorts of medicine third-parties want to see them practice.

  26. #26 Orac
    August 18, 2008

    Doctors provide a service that you and your insurance company purchase. If you aren’t satisfied with what they are willing to provide, take your money elsewhere. But there is no right to have OTHER people provide you with the services you want.

    As a physician myself, I way to that: Bullshit!

    If a doctor has moral qualms about administering legitimate types of care required by his or her specialty that is within the accepted scientific norms and professional ethics accepted by that specialty, then he or she should not be practicing in that specialty. Period. He or she should go and do insurance physicals or consulting work instead–or find another line of work altogether that won’t cause them such crises of conscience on a regular basis.

    Ditto pharmacists who think they have some sort of “right” not to prescribe a legal and legally prescribed drug because their religion tells them it’s wrong. If their religion conflicts with their job, then they shouldn’t be pharmacists; certainly they shouldn’t inflict their religion on those who come to them for prescriptions.

  27. #27 bob koepp
    August 18, 2008

    Perhaps it would be in order to consider whether the services being requested have any sort of medical indication backing them. For example, some abortions are medically indicated, while many are not. Seems to me that a healthcare professional might draw distinctions of that sort.

  28. #28 Aquaria
    August 18, 2008

    That said, the classic hippocratic oath is in fact very much pro-life, and that fact troubles many physicians faced with this issue – possibly more in number than those who have problems with it due to christian or other religious doctrines.

    What utter nonsense. Pro-life is asking a woman to put herself at 10X the risk of dying, just to incubate some cells that MIGHT become a life…but might not?

    Pro-life is asking a woman to risk an illegal abortion that will as likely maim or kill her as remove the clump of cells feeding off her body?

    Pro-life is having millions of unwanted children born into…what? Few will be adopted, and it’s dang-well sure-fire that the vast majority of the children will be neglected or even abandoned. Most will end up in something that has become a rarity–orphanages. Yeah, those are great environments for children. What kind of adults come from them, on average?

    A doctor who cared about life would not put women at increased risk of injury and death. Period. A doctor who cared about life would not subject children to a life of misery, desperation and poverty.

    That’s why “pro-life” is anything BUT. It’s pro-DEATH and MISERY.

  29. #29 zer0
    August 18, 2008

    #19 – That said, the classic hippocratic oath is in fact very much pro-life, and that fact troubles many physicians faced with this issue – possibly more in number than those who have problems with it due to christian or other religious doctrines.

    Meh, the Hippocratic was written in 4th century BC. You know how fond we are of our ancient texts around here. Some parts of it are relevant, others are not.

    I feel that if you are incapable of providing all the services your field provides, you should have chosen another field. A Doctor must be able to compartmentalize their personal feelings and beliefs, and approach a patient’s needs with only their knowledge and expertise of medicine. This is in the best interest of the patient. You don’t go to a Doctor for a sermon, you go there for help.

  30. #30 Gene Goldring
    August 18, 2008

    Personal beliefs and values and cultural and religious practices are central to the lives of physicians and their patients. However, as a physician’s responsibility is to place the needs of the patient first, there will be times when it may be necessary for physicians to set aside their personal beliefs in order to ensure that patients or potential patients are provided with the medical treatment and services they require.

    From the draft proposal of “Physicians and the Ontario Human Rights Code”

    http://www.lifesitenews.com/ldn/2008_docs/HumanRightsDRAFT_081.pdf

    The bolded text above is how I feel about this and I’m sure 70% of my fellow Canadian’s feel the same way.

  31. #31 Black Sheep
    August 18, 2008

    @28:

    I was using the term in its newspeakish meaning as a label for “anti-abortion” of course. The classic hippocratic oath is explicitly anti-abortion and implicitly anti-anti-contraceptive.

  32. #32 Aquaria
    August 18, 2008

    And for the record, any doctor who thinks this is an acceptable outcome of their personal feelings needs to have his license revoked.

  33. #33 Bad
    August 18, 2008

    Aquaria:”Sorry, but I’ve lived in places where the nearest doctor is 20 or more miles away. And the next doctor after that may be 30 or 40 more miles. Why should anyone have to drive dozens, maybe even hundreds, of miles to get an abortion or emergency contraception if the patient feels she needs it?”

    I dunno: why should you have to drive hundreds of miles to get a Nintendo Wii? The reason is that you live in an area where there isn’t someone willing to sell you one. That sucks for you, but it doesn’t magically require that Walmart build an outlet right next to your door for your convienience.

    Would I like people to have universal access to birth control? Yes. But the belief that “there should be a law!” that forces other people to do something for you, especially when they don’t want to, is silly. There’s no such moral obligation.

    In fact, there’s a giant double standard here. You all think that people should have easy access to birth control. That’s a great value to have: but it’s a tall order, which takes lots of time and money. But when it comes time to actually bring that value into being, what’s your solution? “Somebody else must be made to do it!”

    If you want more access, great. Everyone who cares should find a way to make it happen. Raise money to hire and support BC-positive doctors to live out in rural areas where they otherwise couldn’t afford to practice medicine. Go to medical school and do it yourselves. But don’t ridiculously pretend that there is such a thing as a moral obligation that falls only on those who disagree with it, and not on yourself, equally.

  34. #34 zer0
    August 18, 2008

    Bravo #26

  35. #35 Konrad Talmont-Kaminski
    August 18, 2008

    Recent case from Poland: A 14 yo girl who was forced into sex tries to get an abortion, legal in Poland when the sex act was illegal (rape, incest, minors etc.) or the woman’s health is in danger. Hospital refuses the procedure and refuses to name another hospital willing to perform it. The first is legal, the second is not. Politicians get involved. Girl is taken away from her parents (!!!) on the grounds they may be influencing her to have an abortion and is forced to talk to priests who try to force her to keep the baby. Higher courts are sane. She is returned to her parents, the minister of health (a sane woman) finds a willing hospital and the abortion takes place a couple of days before is it too late to perform the procedure.

    A couple of years ago a similar case occurred where a woman lost her eyesight because no-one would give her an abortion even though the doctors knew she would probably lose her sight – that was under a semi-fundamentalist Catholic government which is why she wasn’t able to get help from the minister of health. Since then she has taken Poland to the court in Strasbourg and won sufficient funds to help her raise the child. No-one is going to give her her sight back, though. If Poland weren’t in the EU she’d be out of luck completely.

  36. #36 DrFrank
    August 18, 2008

    Bad and others actually make a reasonable point, although it’s not one that I like. These doctors *are* providing a service and it’s up to them which services they do and do not provide, and as a result they can choose to deny access to abortion and contraception.

    As such, there really does seem to be a weak spot in the system which allows those with strong religious delusions to force their will onto others, and I can’t see that much can be done about it, short of refusing to certify a doctor/pharmacist until they legally agree to provide a given set of services :(

  37. #37 Black Sheep
    August 18, 2008

    @19:

    Despite it being old, it has been very successful in helping to save lifes – and babies (if sometimes to the detriment of their mothers). If you (or the society you live in) set your priorities that way, why declare parts of it irrelevant?

    Point being of course, you will not solve that particular moral dilemma easily in this little debate. Better focus on other medical procedures to discuss the right for (refusal of) treatment.

    @28 (myself): That’s obviously one “anti” too many.

  38. #38 Black Sheep
    August 18, 2008

    @29:

    Despite it being old, it has been very successful in helping to save lifes – and babies (if sometimes to the detriment of their mothers). If you (or the society you live in) set your priorities that way, why declare parts of it irrelevant?

    Point being of course, you will not solve that particular moral dilemma easily in this little debate. Better focus on other medical procedures to discuss the right for (refusal of) treatment.

    @28 (myself): That’s obviously one “anti” too many.

  39. #39 John
    August 18, 2008

    IMO If Doctors and Pharmacists are to be allowed to make these decisions based on religion then they should be required by law to diclose that information publicly. This should also apply to Hospitals, that way patients can make an informed decision. I would think there would be quite a few people (even those claming to be pro-life) quickily looking for a new Doctor and that would not be good for buisness.

  40. #40 Bad
    August 18, 2008

    Orac: “If a doctor has moral qualms about administering legitimate types of care required by his or her specialty that is within the accepted scientific norms and professional ethics accepted by that specialty, then he or she should not be practicing in that specialty. Period.”

    Except that what is “legitimate” is, what: decided on by you, and not the doctors who don’t think it’s warranted or legitimate? This is inherently a political and ethical call, not just a medical one. I have a lot of respect for you, but in this case you seem to want to pretend that ethics and politics only matter when they’re yours.

    And its not like you’re unfamiliar with the reality of, say, Catholic Hospitals. They don’t provide abortions and they don’t prescribe birth control. That’s not my ideal or yours, but I’d rather have them there providing medical care than not, even if people do have to go elsewhere for birth control.

  41. #41 Michael Barrett
    August 18, 2008

    Equating the services of a doctor to a Walmart dispensing video game consoles is disingenuous.

    While there are obviously business and economic issues connected to the practice of medicine, it is not simply a business, it’s a critical part of society’s infrastructure – people we must trust and rely upon. Walmart will be replaced by a competitor if it doesn’t serve its customers. Doctors are a much more rare commodity.

    Simply put; the old “We reserve the right to refuse service to anybody” doesn’t apply to doctors. (or teachers, or bus drivers, or cops, etc)

    The prescription of birth control isn’t a highly specialized area of medicine. It’s common, legal, and a perfectly valid request. When a pharmacist or a doctor refuses a request for birth control on religious grounds, that doctor or pharmacist is infringing the civil and human rights of the patient. No person can be forced to endure religious indoctrination simply because the person doing the indoctrinating claims they might get their feelings hurt.

  42. #42 Black Sheep
    August 18, 2008

    @33:

    Congratulations for realising that health care indeed is held to a different standard than general commerce. Now try and understand why this is a good idea if you like to keep healthy.

  43. #43 Kevin Hower
    August 18, 2008

    If a panel of reasonable doctors, having evaluated the patient, would deem that it is in the best interests-medically speaking- of the patient to not receive “treatment x” whether it be an abortion or birth control or whatever, then that patient’s doctor could be said to have not let his/her personal religious beliefs get in the way of doing the job.

    If you go into certain jobs, whether it be pharmacist, doctor, politician, whatever, you should be expected to hang up your faith at the door and do your job, only picking it back up when you leave at the end of the day. Judge John Jones III was apparently capable of doing that in the Dover case and did the right thing, regardless of what he believed personally. If an individual is not capable of doing so, they should not hold that office or that job, whatever the case may be.

  44. #44 phantomreader42
    August 18, 2008

    Here’s a fair way to go about it:

    You want to refuse to provide medical services to a patient because of your religious beliefs? Fine, as long as you do these things:

    1. Refund every single penny that patient has ever paid you, and every penny their insurance has ever paid you, plus a fine of ten times this amount. If you can’t bear to part with the money, then fuck you, you can do your damn job if you want money.
    2. Locate another doctor (one covered by the patient’s insurance) who will perform such services, within the time of the patient’s original appointment. If no such doctor exists, do it your own damn self and go fuck your imaginary friend. Your patients should not be obligated to waste their own time finding a doctor who will do your job for you because you think some invisible man in the sky gets pissed off if you do your damn job.
    3. Provide transportation to said doctor at your own expense. If this is too much of a burden for you, do it your own damn self, the patient is already there. You’re wasting their time and ripping them off.

    Bottom line, if a doctor doesn’t want to practice medicine, they should get another job that doesn’t involve practicing medicine.

    And any doctor who gets caught lying to a patient about treatment options should be immediately and permamently stripped of his license and arrested for fraud and malpractice.

  45. #45 ben
    August 18, 2008

    If you think it’s OK for physicians to refuse to perform work which goes against their beliefs, do you also support extending the principle to other lines of work? Should postal carriers be allowed to refuse to deliver fundraising mailings for organizations they oppose? Should Barnes & Noble cashiers be allowed to refuse to sell a book that they disagree with the content of? Or should people who find that the routine duties involved in their line of work are in conflict with their beliefs find another job?

  46. #46 Bad
    August 18, 2008

    DrFrank: “As such, there really does seem to be a weak spot in the system which allows those with strong religious delusions to force their will onto others,”

    This is a fundamental difference we have here then. I don’t agree that someone not doing something you want to do, or not providing a service that you want, constitutes “forcing their will” on you.

    We certainly agree, though, 100% that our medical system is, well, one giant weak spot, and that lack of access to birth control is just one of its many flaws.

  47. #47 Armchair Dissident
    August 18, 2008

    I think the whole question is, and always has been, misleading – at least in the UK.

    In the UK, the debate centres around whether a GP should be allowed to refuse to refer a woman for an abortion because of the GP’s religious beliefs, not whether the GP should be required to perform the abortion.

    This is a very different debate. And, in this context, I would argue the answer is clearly, “No”. The job of a GP is to provide the best possible medical advice – paid for, incidentally (in the UK), by the tax payer. It is not the job of the GP to advance a particular theological theory. If it is so far beneath the GP to simply refer a woman for an abortion, then they’re in the wrong job.

    In the UK, of course, the situation is exacerbated by the fact that a woman requires a referral by two doctors before she can have an abortion. A simple resolution to the UK debate would simply to lift that restriction. The GP can’t really object to referring a woman for a procedure, if his referral isn’t needed.

  48. #48 Bad
    August 18, 2008

    ben:”If you think it’s OK for physicians to refuse to perform work which goes against their beliefs, do you also support extending the principle to other lines of work? Should postal carriers be allowed to refuse to deliver fundraising mailings for organizations they oppose? Should Barnes & Noble cashiers be allowed to refuse to sell a book that they disagree with the content of?”

    The bizarre unspoken premise of your argument here seems to be that all these people, indeed seemingly every person in world, is are somehow employed by you and must conform to your own ideas of what an employee can or cannot do. But they aren’t. They’re employed by their actual employers, and its their call, not yours, what an employee can refuse to do and whether that should be accomodated or not.

  49. #49 Interrobang
    August 18, 2008

    But the belief that “there should be a law!” that forces other people to do something for you, especially when they don’t want to, is silly.

    Oh, so you think people should be free to rape and murder as they see fit, then? That’s “doing something for me” (leaving me unraped and/or alive) that rapists and murderers don’t want to do… We have laws for reasons. One of the ideals behind the Canada Health Act is that the government (tasked with providing “peace, order, and good government” by the Canadian Constitution, and failing at 2/3 of those things right now) provides basic healthcare services to Canadians. The basic standard of care as it exists in Canada requires that physicians provide birth control and abortion services. If the physicians in question don’t like it, they can go be plastic surgeons or something that’s entirely in the private sector, where they’ll never have to worry about either providing women’s reproductive health services or complying with the single-payer components of the Canada Health Act. Really.

    I don’t get to go take a job at General Dynamics and then say, “Oh, I don’t want to do the job because I’m a pacifist, but you can’t fire me because that’s religious discrimination!” and then expect them not to can my ass; I as a Canadian citizen, voter, and taxpayer want similar freeloaders out of my healthcare system, thank you very much. (For what it’s worth, I’m also against the existence of Catholic hospitals; either provide all services, or turn your facilities over to the province or someone else who will.)

  50. #50 Matt Penfold
    August 18, 2008

    If doctors are going to be allowed to refuse to provide certain treatments, or prescribe certain drugs then at the very least there is a duty on them to ensure all potential patients, or others who may refer patients, are aware of that.

    Maybe they should be forced to put a disclaimer in all literature that indicates they hold religious views that may prevent them from always acting in the patients best interest. Force them to display large posters carrying the disclaimer in their practice, and ensure it is prominent in all brochures, letter etc.

  51. #51 Matt Penfold
    August 18, 2008

    The bizarre unspoken premise of your argument here seems to be that all these people, indeed seemingly every person in world, is are somehow employed by you and must conform to your own ideas of what an employee can or cannot do. But they aren’t. They’re employed by their actual employers, and its their call, not yours, what an employee can refuse to do and whether that should be accomodated or not.

    You previous arguments do not support this claim of yours. Employees are also providing a service, that of exchanging their labour in return for payment. You have already argued that they do have the right to decide what they do and do not do as part of that service.

    Do you think doctors should be able to refuse to treat patients based on their sexuality ? Their sex ? Their religion ? Their nationality ? Their colour ?

  52. #52 True Bob
    August 18, 2008

    Bad, the bizarre unspoken premise of your argument is that medical care is as available as gasoline. In this country, most people don’t really have a choice of doctors, as you’ve been told. I have to select from a subset of the doctors in my area, so that my insurance will cover costs. Many doctors aren’t accepting new patients.

    If doctors engaged in a truth in advertising campaign, i.e. identify the medicine they refuse to practice, and get some financial repercussions, a la return all past payments, and were more commonly available, I would tend to agree with you. But that’s not the real world.

    You also act like there’s no role for the gummint here. AFAIK, all doctors get board certified, and need some kind of governmental approval to practice. If that’s not so, how can “impersonating a doctor” be a crime?

  53. #53 Bad
    August 18, 2008

    Michael Barrett: “Equating the services of a doctor to a Walmart dispensing video game consoles is disingenuous.”

    Not at all. Doctors do have all sorts of professional obligations that are regulated by their profession. But these obligations are themselves the result of active debate: they aren’t some fundamental right you have to demand from anyone seeking to practice medicine. And currently it is not any sort of done deal that docs or hospitals have to provide elective birth control. Some states require emergency birth control in the case of rape.

    You’re right of course that medical care is darn important, to people. But if so, that’s yet another good reason for our society to take it more seriously, by, say, better funding it with tax dollars. But it’s not a good justification for demanding that doctors and doctors alone bear the burden of your politics and ethical beliefs.

  54. #54 Dan
    August 18, 2008

    No one should be forced to do something he or she finds morally objectionable.

    So if I (a physicist) find it morally objectionable to produce nuclear weapons, then I must not take a job as a nuclear weapons designer.

    If the holder of an M.D. degree finds it morally objectionable to provide birth control, then he or she must not take a job as a physician.

    The argument that the holder of an M.D. degree should have the advantages of a job as a physician (salary, stability, status, etc.) but should not be required to do the physician’s job (write prescriptions, etc.) is just silly.

  55. #55 DrFrank
    August 18, 2008

    Bad@#46
    This is a fundamental difference we have here then. I don’t agree that someone not doing something you want to do, or not providing a service that you want, constitutes “forcing their will” on you.
    I’m not sure, I’d consider refusing to supply the morning after pill to a woman when the next possible supplier is 40 miles away a damn good attempt at it. Fair enough if there always a handy doctor/pharmacist just next door that wasn’t crazy, it wouldn’t be an issue, but this is not how things are.

    But yes, it seems that we’re basically agreed that things would be better if this were not the case :)

  56. #56 Carlie
    August 18, 2008

    The other aspect of this is that legally, doctors are the only people who are allowed to practice medicine. That puts a higher level of responsibility on them to provide that service than, say, the B&N bookseller (I like the analogy, but it’s not strong enough). They are the only ones who can provide medical services, so can reasonably be expected to, you know, provide them. And, in most countries, there is no free marketplace for medicine, both because you have to pass a lot of hurdles to get into it in the first place and because each government is a major payor and because of insurance restrictions and etc. and etc. The medical industry is highly regulated, and therefore there is no simple freedom to just “go to another doctor” if you don’t like the fact that yours has picked and chosen what services to provide.

    I don’t understand what’s so difficult about “If you don’t want to perform the job, get a different job.”

  57. #57 Bad
    August 18, 2008

    “Bad, the bizarre unspoken premise of your argument is that medical care is as available as gasoline. ”

    No. The premise is that in asking for medical care, you are asking someone else to provide it for you. If you think you have a right to it, then that’s an obligation that falls on everyone: not just the random person you decide that you want it from.

    But I suppose if gasoline were really really important to you, you’d be here demanding that someone drill it out of the ground for you and offer it to you at a price that you liked.

  58. #58 gdlchmst
    August 18, 2008

    Bad, I can see where you are coming from. So let’s assume the fact that doctors provide an infrastructural service to the society is irrelevant. But what is happening here is that doctors are forcing medical decisions upon patients based on a non-medical reason. Essentially, they are discriminating based on religion. It is the doctors saying, “you don’t share my religious beliefs? That’s okay, because I am going to refused you a vital health-care service because I’m the doctor here, and it’s my practice.” By your reasoning, would this be okay? If so, would it be legal for a doctor to refuse to treat a patient of a certain race because it is the doctor’s personal belief that the certain race is inferior and should not have its lifespan increased?

  59. #59 zer0
    August 18, 2008

    But I suppose if gasoline were really really important to you, you’d be here demanding that someone drill it out of the ground for you and offer it to you at a price that you liked.

    We already do that, it’s called economics. Take a class.

  60. #60 Black Sheep
    August 18, 2008

    A final bit of food for thought:

    The argument that people in the medical profession should not let themselves be influenced by their beliefs and just do their (expletive) job is flawed.

    The job description that the pundits saying so want to see medical workers adhere to is a matter of doctrine and belief. If you want to keep belief out of medicine, you inevitably end up with Bad’s vision of medicine, which is nothing but a yet another service rendered, subject only to market and market regulations – probably not what you lot have in mind.

    The question really is not, in my opinion, about whether belief should or should not influence the rights and duties of the medical practitioner – the answer is – and has been for a long time – yes, it should.

    The question is what beliefs do we want our doctors to hold and how do we codify them into law so our doctors are forced to act according to those beliefs or otherwise are barred from the profession.

    So, to all those who always envied the religious types for their freedom to fabricate arguments out of good intentions, a firmly made up mind and a holy text of some kind (I recommend the Declaration of Human Rights for this occasion), here’s your chance to try your hand at that style of debate. Unless of course, you wanna join Bad and take bad medicine over a little non-scientific conviction.

  61. #61 bob koepp
    August 18, 2008

    In so many of the comments here, it appears to be taken for granted that a service provided by a healthcare professional is “medical care.” That’s a faulty assumption. I noted earlier that a procedure like abortion is sometimes medically indicated, and sometimes not. When it’s not medically indicated, what basis is there for calling it “medical care”? If the “reason” is simply that one has to go to a healthcare professional to obtain the service/procedure, maybe we should be asking whether that’s a reasonable state of affairs. Maybe, just maybe, pursuing such a line of questioning would lead reasonable people to object to the medicalization of reproduction.

  62. #62 Zombie
    August 18, 2008

    If someone finds providing health care objectionable because they’re confused about some backwards, ignorant superstition, they can resolve their problem by not being a health care provider.

  63. #63 wÒÓ†
    August 18, 2008
  64. #64 gdlchmst
    August 18, 2008

    @bob koepp #61

    Good point, I think I like that idea. But until that happens (which it won’t within the next century), we should be focusing on the problem at hand. And there is, of course, the fundamental issue of whether doctors should be able to impose their non-medical opinions upon their patients.

  65. #65 Freak
    August 18, 2008

    The licenses that give doctors and pharmacists the rights to carry those jobs carry responsibilities as well, and I consider performing time-critical operations that are within their area to be one of those responsibilities.

  66. #66 mothra
    August 18, 2008

    A re-phrasing of the ethical question is: Should the religious beliefs of ‘person B’ take precedence over the health and welfare of ‘person A’? Obviously, NO!” One has the right to ones’ own religious views (or not) but one does NOT have the right in the public sphere to force others to conform to ones’ religious beliefs. A doctor/ pharmacist refusing treatment/ prescriptions based upon their own personal religious beliefs is in itself unethical AND immoral. They are violating the public trust in refusing aid to another who has the legitimate right to expect it and by refusing aid, they are directly causing harm, physical and emotional to the patient.

    Bad set up a strawman (#2) and missed the point completely.
    @Bad, Yasic- Stop the world- you’ll want to get off!

  67. #67 Matt Penfold
    August 18, 2008

    Bad,

    Why do the doctor’s rights not to carry out treatment, or prescribe medication, they find morally unacceptable trump those of the patient to have medical treatment provided promptly and efficiently ? You have stated that patients have the choice to go to another doctor and have chosen to ignore those who have told you it is not that simple.

  68. #68 Bad
    August 18, 2008

    Carlie, you act as if deciding to go into medical school were like some sort of conscription into a nationalized army.

    I don’t disagree with you at all that our medical system is batty, and the insurance system is screwed up.

    But simply don’t agree that the hardship that people face in getting the medical care they want justifies treating currently lisenced doctors as if they were the only ones relevant to the lack of doctors.

    If I’m starving because there’s no food around, and someone opens up a grocery store that refuses to serve atheists, I’m no worse off than I was before. I might have a lot of envy and bitterness towards the grocery store, to be sure, but that obsession is misplaced. It isn’t the bigotted grocery store alone that’s allowing me to starve, it’s everyone with access to food. The grocery store isn’t more liable simply because they happened to spend their life savings building something that it just so happens I really need. They aren’t specially conscripted for the job of providing ME food, not even if the government makes it really really hard to open a grocery store. If anything, I should be mad at the government (i.e. at everyone) for either not making it easier, or failing to subsidize such an important resource.

  69. #69 Joel
    August 18, 2008

    the fundamental issue of whether doctors should be able to impose their non-medical opinions upon their patients.

    Yes, this is the root of the problem.

    I would think modern medicine would cause many more moral dilemma’s for the religiously inclined beyond birth control. Those who are so inclined, should learn to check these thoughts at the office door or stay out of morally confusing professions.

  70. #70 True Bob
    August 18, 2008

    If the “reason” is simply that one has to go to a healthcare professional to obtain the service/procedure, maybe we should be asking whether that’s a reasonable state of affairs.

    Maybe you didn’t follow the link Aquaria put in comment 32.

  71. #71 Tom
    August 18, 2008

    For most people, their doctor has effectively a monopoly on healthcare to include abortion and (emergency) contraception. Treating doctors like service providers competing in a free market is inaccurate to the reality of medical care for the vast majority.

    I believe people should have access to abortion and contraception, whether medically indicated or not. Given that, and also that doctors represent a monopoly in the manner shown above by many commenters, I believe the government should regulate that monopoly to ensure its citizens have said access. The best way to do that, in my opinion, is to require doctors to provide the full range of services as appropriate (medically indicated for nonelective procedures, doctor is competent, patient is willing) or find another profession. One where they can express their particular moral or ethical beliefs without denying people something I consider a basic human right, conscious/willful control of your reproductive/sexual functions.

  72. #72 Mold
    August 18, 2008

    A medical doctor should be held accountable to the strictures of the profession. Otherwise Dr Monica Goodling would prescribe lots n lots o’ prayer for your ectopic pregnancy.

    Sorry Libertards, most med professionals have known for years that they would have to provide services to all. That includes Libertards, child molesters, Uncurious George, Darth Cheney, et al.

    To pull this nonsense now means that they were either told to set a precedent (see Dover) or have lost it. Either way, they should not practice.

    For those so adamantly pro-life, let me point out that your wife and daughters will more than gladly have consensual sex with pro-choice men. For one thing, pro-choicers are far less sanctimonious. For another, they understand that women aren’t property. Keep that in mind when you spout about how every one of your “D” sperm is sacred…while the Liberal, and their “A” sperm, is providing recreational sex.

  73. #73 Woodwose
    August 18, 2008

    The present controversy is based on doctors and pharmacists basing their right to provide services based on religious beliefs. Religion gets a lot of traction in the press. However, what happens next? Will PETA supporters in the medical professions want to enforce their beliefs about the rights of tapeworms, round worms, liver flukes and such. Surly, they could argue, even micro-organisms causing typhoid, malaria and various STDs have a right to enjoy the quiet enjoyment of life? Goodbye prescriptions for worm powders and antibiotics.

  74. #74 gdlchmst
    August 18, 2008

    The grocery store isn’t more liable simply because they happened to spend their life savings building something that it just so happens I really need.

    I’m pretty sure if that were to happen, you can sue the grocery store and you would win. At least in most parts of the world.

  75. #75 Matt Penfold
    August 18, 2008

    If I’m starving because there’s no food around, and someone opens up a grocery store that refuses to serve atheists, I’m no worse off than I was before. I might have a lot of envy and bitterness towards the grocery store, to be sure, but that obsession is misplaced.

    In many countries it would also be illegal, and quite rightly. Discrimination of that nature should be tolerated in a civilised society. If you decide to offer services to the public, no matter in what sector of the market, you accept certain responsibilities and one of those is to not refuse service on the grounds of things like sex, sexuality, race, religion, colour and nationality.

  76. #76 Bad
    August 18, 2008

    Bad: “Why do the doctor’s rights not to carry out treatment, or prescribe medication, they find morally unacceptable trump those of the patient to have medical treatment provided promptly and efficiently ? You have stated that patients have the choice to go to another doctor and have chosen to ignore those who have told you it is not that simple.”

    I haven’t ignored that at all.

    I think your idea of rights is confused. A negative right against being forced to do something is not the same thing as a positive right to get something. The former is something that protects the individual from the government. The latter is something the individual demands from society.

    A doctor who refuses to proscribe the patch is not “trumping” the persons right. They aren’t fulfilling it, certainly, but it’s not their exclusive responsibility to provide it: its everyones. That’s what it means to have a right to something, after all.

    It doesn’t matter if “it’s not that simple.” I never said that it had to be simple. Life isn’t simple and people face all sorts of hardships. So how are we going to address them? Does anything go? Is any method legitimate?

    The question is not “should people have a right to expect this” but rather “who is responsible for making sure they get it.”

    I find it rather convienient that the apparent position of many people who think it is exclusively the responsibility of a doctor who thinks BC is immoral is “not me! someone else!”

  77. #77 sjburnt
    August 18, 2008

    Wow. Aphrodine and one other, above, do not want cats de-clawed?

    WHY?

    I want cats subject to the same leash laws as dogs. As I watch the damn things killing songbirds in my backyard, I wonder what kind of owner lets a killer go free with full claws?

    Come on, be fair. If other pets acted like that they would be caged.

  78. #78 Armchair Dissident
    August 18, 2008

    If I’m starving because there’s no food around, and someone opens up a grocery store that refuses to serve atheists, I’m no worse off than I was before. I might have a lot of envy and bitterness towards the grocery store, to be sure, but that obsession is misplaced. It isn’t the bigotted grocery store alone that’s allowing me to starve, it’s everyone with access to food.

    That’s a flawed analogy – and not just because it’s an analogy. Change it so that the grocery store is the only entity that is legally permitted to sell food, and you’d be getting closer. Add to it that it would be a requirement that anyone buying food from the store ate the food themselves, and you’d be a bit closer still.

    Medicine is not a free-marktet, and it is not a grocery store: it is a heavily restricted practice, that one must be qualified in first and fore-most, and must be certified by the government in to to practice. In theory, anyone can set up a grocery store; not everyone can set-up as a qualified doctor.

  79. #79 libarbarian
    August 18, 2008

    If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.

    If he doesn’t want to do his job then he should find another profession.

  80. #80 Matt Penfold
    August 18, 2008

    So Bad, can we be clear about your position.

    Does a doctor have a right to refuse treatment for any reason ?

    Does a doctor refusing treatment on non-medical grounds have a duty to refer the patient to a doctor who will carry out the treatment ?

    If yes, what should happen if no suitable alternative can be found ? If no, what should the patient then do ?

    Does it not worry you that your position would force woman into carrying on with pregnancies they do not want to carry on with ? As an advocate of doctors rights over patient rights, does it worry you that you will in part be responsible for that happening ?

  81. #81 The Chemist
    August 18, 2008

    It’s a bit disingenuous to compare being a doctor that objects to abortion to being a weapons designer that objects to war etc.

    Abortion is not all a doctor does, you don’t walk up to your cardiologist and ask him to perform an abortion. A doctor who refuses to perform abortions, or sign contraceptive prescriptions is still 97%-99% competent. This notwithstanding the applications of the belief to decisions about whether the mother and/or baby lives or dies.

    The argument that doctors should be compelled to provide abortions/contraception because there may not be another doctor willing to do so, is weak in connection to the first argument: If you don’t want to do part of the job, don’t do the job. Then people would simply not be enough doctors, and the problem of finding a doctor would persist, and apply globally to all ailments and conditions instead of a subset. In other words, compelling doctors to perform certain tasks does nothing to alleviate the current situation, and creates a worse one.

    In a heuristic sense, refusal to act as a doctor all of the time is worse than a refusal to act as a doctor most of the time. The latter situation may not be ideal, but is improved overall for all involved.

    Of course this is pragmatics of it. Of course I personally believe people should be free to decide when and whether life begins at a certain point, since it’s always going to be arbitrary. That said, because it is so arbitrary, you cannot trump one person’s belief on the matter against another’s. Many people earnestly believe that certain actions are tantamount to murder, and while religious arguments abound, this does not preclude secular arguments from arising.

    I admit I vacillate on the issue. At first I was going to post the reverse argument, but then thought better of it. It’s complicated, and I will go so far as to state for certain that anyone who denies that much has failed to consider the issue long enough.

  82. #82 Robert Baden
    August 18, 2008

    I’m beginning to think contraception and the morning after pill need to be taken out of the local physician’ and pharmacists’ hands. Internet pharmacies, anyone? Maybe get the morning after pill before you actually need it?

  83. #83 Rev. BigDumbChimp, KoT
    August 18, 2008

    WHY?

    I want cats subject to the same leash laws as dogs. As I watch the damn things killing songbirds in my backyard, I wonder what kind of owner lets a killer go free with full claws?

    Come on, be fair. If other pets acted like that they would be caged.

    The neighbors cat tried that once. My husky solved that problem.

  84. #84 Mike from Ottawa
    August 18, 2008

    Now, Canada is somewhat different in that the government is often in some sense the employer.

    Not really. Government health care plans are merely the payers, not employers (and I know doctors who would dearly love to be able to be just employees and not have to bother with the business side of running a practice).

    BTW, Interrobang at #49 misrepresents the legal effects of the Canadian Constitution and the Canada Health Act. Neither requires that any individual physician provide any and all (legal) services that any patient requests. The requirement under the CHA to provide basic health care services is a requirement of the system, not of each individual involved in the system.

  85. #85 gdlchmst
    August 18, 2008

    A doctor who refuses to proscribe the patch is not “trumping” the persons right. They aren’t fulfilling it, certainly, but it’s not their exclusive responsibility to provide it: its everyones. That’s what it means to have a right to something, after all.

    Okay. I know of a similar situation, see if you agree with this.

    A driver who refuses to drive black people is not “trumping” the person’s right. They aren’t fulfilling it, certainly, but it’s not their exclusive responsibility to provide it: it’s everyone’s. That’s what it means to have a right to something, after all.

  86. #86 Bad
    August 18, 2008

    Matt Penfold: “In many countries it would also be illegal, and quite rightly.

    “Discrimination of that nature should be tolerated in a civilised society.”

    Many people seem to take this for granted. But I don’t think there’s a good case to be made for it.

    “If you decide to offer services to the public, no matter in what sector of the market, you accept certain responsibilities and one of those is to not refuse service on the grounds of things like sex, sexuality, race, religion, colour and nationality.”

    I don’t think there is any sensible justification for these imaginary “responsibilities” that only apply to people offering particular things for sale.

    In fact, I think these are essentially a way for people to beg off of moral obligation. In our country’s history any many racist people denied African Americans the use of their businesses, which was deplorable. But no MORE deplorable than all those people who likewise did nothing to offer African Americans the same services and good they lacked access to.

    People’s focus on the grocery store as specially responsible for me is not a moral principle. It is a means of AVOIDING the implications of a moral principle: i.e. declaring something an important moral concern, and then quietly slipping out the back door before anyone takes them too seriously and asks THEM to do something about it.

  87. #87 Armchair Dissident
    August 18, 2008

    Bad; you really are confusing the hell out of me. Earlier you stated:

    They’re employed by their actual employers, and its their call, not yours, what an employee can refuse to do and whether that should be accommodated or not.

    But you appear to be arguing that a Doctor has a right to withhold medical advice that conflicts with their religious views. And you appear to be arguing that this is absolute.

    But the whole debate exists because, as it stands in some areas, the employer is not allowed to fire an employee who is unwilling to do their job because of religious practices.

    So what are you actually arguing? Are you arguing that it is the doctor’s absolute right to refuse to provide medical care based upon religious objections, or are you arguing that sanctions for the doctor are the job of the employer?

  88. #88 Tom
    August 18, 2008

    I want cats subject to the same leash laws as dogs. As I watch the damn things killing songbirds in my backyard, I wonder what kind of owner lets a killer go free with full claws?

    Cats are animals. Animals often kill other animals. It’s unfortunate that the animals they kill are sometimes the animals you like, but that’s nature, red in tooth and claw. Enjoy the songbirds while they last, but don’t demand that someone cut their pets digits off (look into what declawing really entails) because they fill their niche as a predator.

    If you want your own songbird, get one as a pet. You can’t claim the wild ones killed in their habitat as your own and then demand protection for your “property”.

  89. #89 Bad
    August 18, 2008

    The Chemist:”In other words, compelling doctors to perform certain tasks does nothing to alleviate the current situation, and creates a worse one.”

    You seem to be laboring under the misapprehension that this is, for everyone, really about helping people get more and better access to medical care, as opposed to just satisfyingly beating up on people with stupid beliefs.

  90. #90 Matt Penfold
    August 18, 2008

    I’m beginning to think contraception and the morning after pill need to be taken out of the local physician’ and pharmacists’ hands. Internet pharmacies, anyone? Maybe get the morning after pill before you actually need it?

    There are potential problems with that.

    The pill is not risk free, and should not be prescribed to some women as it could seriously endanger their health. Also a family history of breast cancer will restrict suitable options as some types of pill should not be given to woman at high risk. A competent doctor will check for conditions that are contraindicated for the pill and refuses other contrace to prescribed it. They should then discusption options with the patient.

  91. #91 True Bob
    August 18, 2008

    I think doctors should be like mechanics. I know that mechanic “A” will service foreign cars only, and only late models. I know mechanic “B” will only work on dometic cars. And I know mechanic “C” only does fluid changes and brake work.

    Unfortunately, what I am getting is I take my import to mechanic A, and he refuses to repair my car because he doesn’t like the way I dress.

  92. #92 its just science right?
    August 18, 2008

    could this blog do with a bit of rationality? me thinks so. cuntragfucktalk aint doin it right.

  93. #93 Tom
    August 18, 2008

    You seem to be laboring under the misapprehension that this is, for everyone, really about helping people get more and better access to medical care, as opposed to just satisfyingly beating up on people with stupid beliefs.

    Do I detect a hint of self-aggrandizement? So everyone who disagrees you holds “stupid beliefs”. That’s a constructive position for a debate.

  94. #94 Leigh Shryock
    August 18, 2008

    I look at it like this: reasonable accommodations can be made: for example, a pharmacist that objects to emergency contraceptives could defer it to another pharmacist on duty… however, if he’s the only one on duty, then there’s a problem.

    Let me put it another way: if I work at a gas station, but I don’t like dealing with customers, and thus don’t work the register, that’s fine, as long as there’s someone to work the register, but it would be absolutely ridiculous for me to refuse to work the register while the other guy goes to make the daily deposit.

  95. #95 Bad
    August 18, 2008

    ArmchairD: I’m 100% against laws that would prevent, say, CVS from firing someone who won’t fill a prescription for the pill. That’s not in the least the same thing as this bizarre principle people seem to be supporting, which is “If you don’t want to do the things that _I_ have decided for you are what defines your profession, then you must not be a part of it.”

  96. #96 thepetey
    August 18, 2008

    There is a growing concept it seems that doctors are the authority in the life of their patients and that the patient must follow their advice blindly. The patient hires a doctor to provide a service, just as he hires a hairdresser, gardener or house keeper. Granted, it is a much more highly skilled service. The patient is still responsinble for their OWN health and the doctor is there to provide the service they were hired to. If the doctor does not provide that service, the patient needs to find a new doctor. It’s a royal pain to do so, but its there. If more people interviewed their doctors before hiring them, this may not be as big an issue.

    On ther flip side, as a gardener can refuse to work for a client, I think a doctor can refuse to accpet a patient, assuming that that refusal does not put the patients life or health at risk.

  97. #97 gdlchmst
    August 18, 2008

    @Chemist

    In a heuristic sense, refusal to act as a doctor all of the time is worse than a refusalto act as a doctor most of the time. The latter situation may not be ideal, but is improved overall for all involved.

    But they most definitely won’t quit. Also, since we are short on doctors, does that mean more doctors of lesser quality is better than what we have now? Should we lower the requirements to become a doctor?

    That said, because it is so arbitrary, you cannot trump one person’s belief on the matter against another’s

    But we are, in this case, trumping the doctors beliefs over the patients. And in so doing, we are allowing the doctors to step away from their professional responsibilities and make medical decisions that their patients cannot contest based on nothing but the doctors’ personal religious beliefs.

    On another note, which university do you go to?

  98. #98 Bad
    August 18, 2008

    Tom:”Do I detect a hint of self-aggrandizement? So everyone who disagrees you holds “stupid beliefs”. That’s a constructive position for a debate.”

    Well, your detector does seem to be a little off, actually.

    The people with the “stupid beliefs” in that sentence are the people who believe that a chemical which reduces the chance of one cell sticking to some other cells is deeply immoral, or even murder.

  99. #99 Norman Doering
    August 18, 2008

    Robert Baden wrote:

    I’m beginning to think contraception and the morning after pill need to be taken out of the local physician’ and pharmacists’ hands.

    The morning after type pills might eventually be safe enough to buy over the counter like condoms.

    Internet pharmacies, anyone?

    No! Not the ones who spam my email. I don’t trust the product either. Too many fly by night operations.

    Alas, it seems like it will be a constant of the evangelical vote that they take life as an absolute regardless of the consequences. Regardless of the life of the mother. Regardless of the quality of life Terry Schiavo did not have. Even their newest voice, Rick Warren, seems to be going down that path.

  100. #100 William
    August 18, 2008

    At this moment, it’s legal and even encouraged (by the government) for psychologists to provide medical assistance to American interrogators at Guantanamo Bay, in hopes of increasing the effectiveness of torture and questioning techniques upon prisoners there. The American Psychological Association is right now debating whether to denounce such practices as unethical. Some members consider the practice perfectly legitimate; others do not.

    Suppose you were a psychologist. You got in to the profession with the urge to heal, individuals and society. You took a job with the Justice Department and put in years helping profile criminal suspects, build prison education programs, and all of that. Now you’re ordered to assist an interrogation based on torture.

    Don’t you want the right to say, “No.”?

    If so, put yourself in a doctor’s shoes. A religious doctor can have that same healing urge, and feel that he has a medical responsibility to the unborn child as well as his first patient, the mother. But you offer him the choice of leaving his profession, or participating in what he feels is the killing of a human being.

    There are certain situations where we require doctors to do things. Emergency rooms must take patients. If a woman’s life is in danger, a doctor can be required to treat with the most effective means possible. But otherwise, allowing doctors and patients their own choice of ethics, laid out as they build a medical relationship so everyone knows what’s what before a crisis strikes, seems lke the humane thing to do all around.

  101. #101 Matt Penfold
    August 18, 2008

    ArmchairD: I’m 100% against laws that would prevent, say, CVS from firing someone who won’t fill a prescription for the pill. That’s not in the least the same thing as this bizarre principle people seem to be supporting, which is “If you don’t want to do the things that _I_ have decided for you are what defines your profession, then you must not be a part of it.”

    Oh bullshit.

    It is not patients who get to decide what are and are not appropriate treatments for doctors in a particular speciality to carry out.

    Doctors have professional bodies who license them to practice medicine in general, and then to practice within a particular speciality. If a doctor refuses to carry out certain procedures that are part of his or her speciality then unless they ensure that those procedures will be carried out by others with a reasonable time then than doctor should be out of a job. if there is no other doctor the patient can be referred to for treatment with a suitable time period then that doctor has no business being in that speciality.

    A gynaecologist knows that he/she is likely to be asked to perform terminations. If they object to performing them they can either ensure that there is another doctor who will, and will do so within the time limits, or they should not be a gynaecologist.

    Your position seems to be it does not matter is there is not an alternative. A woman who has the misfortune to want a termination and ends up with such a doctor will have just have to accept her rights do not matter, and it is only those of the doctor we should consider.

    Am I right in thinking you are male ?

  102. #102 gdlchmst
    August 18, 2008

    Many people seem to take this for granted. But I don’t think there’s a good case to be made for it.

    I thought you were fairly sensible up ’til this point. Wait, are you saying that people should have a right to do discriminate as they like, and there should be no societal penalty against it? I’m guessing that you don’t exactly think social justice is worth fighting for. Feel free to correct me, I would hate to think an atheist could be this irrational.

  103. #103 Leigh Shryock
    August 18, 2008

    I should, perhaps, clarify: my objection is that people would go into a field where they could be reasonably expected to do something (like working at a gas station, I could be reasonably expected to work the register, if I’m able. Or, as a doctor, I could be reasonably expected to prescribe or refer the patient to one who can prescribe contraceptives, or an abortion)… yet refusing to do so. Not for any particularly good, objective reason, either. Simply because they don’t like it.

  104. #104 gdlchmst
    August 18, 2008

    @William

    First of all your analogy is way off. Assisting torture is nothing like prescribing birth control.

    If so, put yourself in a doctor’s shoes. A religious doctor can have that same healing urge, and feel that he has a medical responsibility to the unborn child as well as his first patient, the mother. But you offer him the choice of leaving his profession, or participating in what he feels is the killing of a human being.

    And not every feeling should be respected. A doctor’s non-medical opinions have no place in their medical decisions.

  105. #105 varlo
    August 18, 2008

    Ordinarily I abhor the excessive litigation so prevalent today, but I suspect that at lest in some jurisdictions it might be possible for an adept trial attorney to win a case for child support, should refusal to provide the birth control result in the birth of the unwanted child. Should that happen, it might have a salutory effect against other fundidiots.

  106. #106 Mike from Ottawa
    August 18, 2008

    If you go into certain jobs, whether it be pharmacist, doctor, politician, whatever, you should be expected to hang up your faith ethics at the door and do your job, only picking it back up when you leave at the end of the day.

    Fixed your post.

    I’m not entirely sure we want everyone only consulting their ethics at home. Certainly politicians who practise their profession in an ethics-free manner aren’t held in high regard (and I know that may be pretty much all of them).

    Just for a bit of fun, how about criminal defence lawyers who draw the line at defending rapists and child-molesters (and there are some) or who draw the line at aggressive cross-examination of complainants in such cases? Like medical services, one has a right to legal representation.

    Or how about the doctor who is asked to perform a termination on a healthy fetus carried by a healthy woman because the fetus is female. Could a doctor who otherwise provides abortion services refuse in such a case on the basis of their belief that to selectively abort to favour sons is unethical? That is a real issue in some communities (such selection is not illegal everywhere). Or consider the plastic surgeon who is asked to perform purely cosmetic and from the surgeon’s POV disfiguring surgery. Would they be required to perform that surgery on the model many seem to support here, that a doctor must perform any service within their competence that is asked for by the patient subject only to it not being illegal?

    I’ll also observe there is a different in the degree of distance involved in prescribing contraceptives (including the morning after pill) and carrying the procedure of an abortion. One is putting the means in another’s hands, the other is carrying out an action with one’s own hands.

    I’m pretty comfortable with requiring that physicians prescribe and pharmacists provide contraceptives as a condition of their licencing. I’m less comfortable with requiring a willingness to perform any and all abortions as a condition of licencing (subject as always to the legality of the action). Part of that is that there is a difference between a very early abortion and a very late abortion of a viable fetus, a difference even some atheists might recognize.

    Once you realize it isn’t entirely black and white but a question of where to draw the line between puppet of the patient supplying only technical skills on one extreme and self-appointed moral guardian making the patient’s ethical decisions for them on the other, it is a bit easier to accept that it is an issue on which reasonable persons might differ.

  107. #107 Matt Penfold
    August 18, 2008

    And not every feeling should be respected. A doctor’s non-medical opinions have no place in their medical decisions.

    And this is the crux of the issue. Reasonable people think that it whether to offer a woman the pill, or a termination, should be made only on medical grounds. Others, likes, Bad, think it is acceptable to deny treatment on religious grounds, and presumably any other grounds. Why should religion be privileged ? If a doctor happens to be a racist, or homophobe, or xenophobe, why should his decision to refuse treatment on those grounds not also be allowed ?

  108. #108 Coriolis
    August 18, 2008

    This really isn’t that hard:

    If a devout Hindu works at a burger place, should he be given an exception so he doesn’t have to sell beef hamburgers to people?

    No, he should get another job. It’s that was simple. For extra examples, replace hindu with {muslim,jew} and beef with {pork, non-kosher food}.

    It’s not even as if the job is forcing them, personally, to break their beliefs – they don’t have to take birth control or eat beef. They just have to provide it to other people.

  109. #109 Evolving Squid
    August 18, 2008

    Remember, for the most part, Canadian doctors are paid by the state, so any citizen should be entitled to any covered health care service without regard to the doctor’s religious conviction.

    Doctors who are unwilling to provide state sponsored service should not be allowed to collect a state sponsored pay cheque.

  110. #110 Bad
    August 18, 2008

    Matt Penfold:”Doctors have professional bodies who license them to practice medicine in general, and then to practice within a particular speciality. ”

    That doesn’t actually answer the question though. Those bodies still have to decide what the right approach to take, which takes us right back to the very question we are debating.

    “Your position seems to be it does not matter is there is not an alternative.”

    Well, you’re wrong. My position is that there should be an alternative. Where we disagree is in WHO is responsible for making sure there is an alternative. I think the answer is “taxpayers/everyone/activists who care.” You seem to think it is “doctors who I have decided should be made to do it.”

    “Am I right in thinking you are male?”

    Am I right in thinking that your motivation for asking is sexist?

    As it happens, I am male. More relevant perhaps, is that I’m a male who is married to a doctor who, among other things, peforms abortions for a living.

  111. #111 Matt Penfold
    August 18, 2008

    Well, you’re wrong. My position is that there should be an alternative. Where we disagree is in WHO is responsible for making sure there is an alternative. I think the answer is “taxpayers/everyone/activists who care.” You seem to think it is “doctors who I have decided should be made to do it.”

    No, it is the doctor who has either accepted a referral, or who has previously agreed to treat the patient.

    And please, do not claim to care about woman who are denied access to treatment if you had your way. If you did care you would not advocate the position you do.

  112. #112 bob koepp
    August 18, 2008

    Matt Penfold – You say, “Reasonable people think that it (sic) whether to offer a woman the pill, or a termination, should be made only on medical grounds.”

    If conraception and termination were available “only on medical grounds,” relatively few such services/procedures would be provided.

  113. #113 Matt Penfold
    August 18, 2008

    Bad,

    Do you really think doctors should be allowed to refuse to treat patients on ANY grounds ? For example should a white supremacist doctor be allowed to refuse to treat non-whites ? Only the logic you are using suggests you think that would be acceptable, even if you do not agree with the doctor’s views. If you do not think it is acceptable, why do you think religion should be privileged ? What happens if the doctor says his religion is what make him view non-whites as inferior ? Does his refusal to treat non-whites need to be respected then ?

  114. #114 Tom
    August 18, 2008

    Of course doctors have the right to refuse to perform certain functions of their profession for nonmedical reasons. They just don’t have the right to retain their position after making that choice. If your beliefs interfere with your job, choose between them. You don’t get to only do part of your job (and prescribing EC or performing abortion is part of the job in the cases we’re talking about), and expect to retain the status and privileges of that job.

    Whether we should consider abortion and EC an integral part of a doctor’s job is another debate. As it stands, I think the consensus is that this is the case. There’s a reasonable expectation that a doctor will do these things if certain conditions are met, and conforming to his religious belief is not one of them.

  115. #115 Matt Penfold
    August 18, 2008

    If conraception and termination were available “only on medical grounds,” relatively few such services/procedures would be provided.

    Are you aware of the risks of carrying a pregnancy to term compared to either using contraception or having a termination ?

  116. #116 Matt Penfold
    August 18, 2008

    Whether we should consider abortion and EC an integral part of a doctor’s job is another debate. As it stands, I think the consensus is that this is the case.

    Not according to Bad. He seems to think only each doctor gets to decide that. Of course he also thinks doctors should be free to refuse to treat black people, woman, gays, jews, etc, simply on the grounds of their religion, sex, sexuality etc.

  117. #117 Bad
    August 18, 2008

    gdlchmst:”I thought you were fairly sensible up ’til this point. Wait, are you saying that people should have a right to do discriminate as they like, and there should be no societal penalty against it?”

    I’m not sure what you mean: there WILL be a societal penalty against it, and I would gladly be a part of it. But I don’t think there’s good justification for having a LEGAL penalty against it. This is not, I grant, a popular idea, and in fact it’s one that I had a hard time with. But it is what I think is the right answer, ethically, and ethics isn’t about what’s pleasing, easy, or popular.

    “I’m guessing that you don’t exactly think social justice is worth fighting for.”

    You’d be wrong. I just don’t think social justice can justify forcing private businesses to not be bigotted jerks to their potential customers.

    “Feel free to correct me, I would hate to think an atheist could be this irrational.”

    Why? Atheists are just people. People can be irrational. You don’t need to be any degree of rational to NOT do something like believing in a God.

  118. #118 Matt Penfold
    August 18, 2008

    Bad,

    Does this right to discriminate extend only to doctors, or will landlords be allowed to refuse to rent to people who are black ? What if they are gay ? How about if they are women ?

    What about employers ? Should they be allowed to say they do not think Hispanics are trustworthy and refuse to employ them ?

    Once you start allowing people to refuse services based on their beliefs, where do you stop ?

  119. #119 Miko
    August 18, 2008

    As Thoreau said (regarding his disapproval of taxes for the War in Mexico, which he saw as a way of extending slavery):

    If the tax-gatherer, or any other public officer, asks me, as one has done, “But what shall I do?” my answer is, “If you really wish to do anything, resign your office.” When the subject has refused allegiance, and the officer has resigned his office, then the revolution is accomplished.

    Very well put: if you’re opposed to doing your job, you’re free to quit your job. But you’re certainly not allowed to continue being paid to do your job if you’re refusing to do it.

    In this case, it’s also worth noting that those who are refusing for religious reasons are just plain wrong: exactly as wrong, no more and no less, as would be a doctor who randomly decided not to prescribe a certain type of blood regulating treatment. The religious like to create the illusion that morality is somehow involved in the decision; really, it’s just following an ancient superstition that randomly bars certain medical treatments. Whether the doctor allows a patient in need of a blood transfusion to die because the doctor thinks transfusions are wrong (Jehovah’s Witnesses) or practices some equivalent nonsense regarding contraception is immaterial: the doctor is committing malpractice in both cases and should either shape up or stop being a doctor.

  120. #120 Peter Vesuwalla
    August 18, 2008

    Some other questions for discussion:

    Should a jewish ambulance driver be excused from driving the van on Saturdays?
    Should a catholic firefighter be excused from putting out a fire at a condom factory?
    Is it OK for a scientologist judge to reject an insanity plea?
    Can an Aborigine photographer refuse to do anything at all?
    Must a young-Earth creationist teacher teach evolution?
    Can a Hindu grocery clerk refuse to sell beef?

    Now here’s another one: Do you really trust a doctor who knows so little about biology he doesn’t know the difference between an embryo and a fully-formed human being?

  121. #121 Bad
    August 18, 2008

    “No, it is the doctor who has either accepted a referral, or who has previously agreed to treat the patient.

    And please, do not claim to care about woman who are denied access to treatment if you had your way. If you did care you would not advocate the position you do.”

    Well, thank goodness there is such an expert here who can lecture me on what I do or don’t care about, while boldly asserting that the lack of access is HIS responsibility, despite claiming to care so much.

  122. #122 Spinoza
    August 18, 2008

    Should a jewish ambulance driver be excused from driving the van on Saturdays?

    Um, practicing ones ARE. No practicing Jew would work on a Saturday.

    That’s really not a good comparison to refusing to provide certain services.

  123. #123 bob koepp
    August 18, 2008

    “Are you aware of the risks of carrying a pregnancy to term compared to either using contraception or having a termination ?”

    Yes, I’m aware that pregnancy is risky. I’m also aware that a biologically normal pregnancy is not a medical pathology. When pregancy does qualify as pathological, then prevention or termination is medically indicated. These are not idle distinctions when considering the duties of healthcare professionals.

  124. #124 Matt Penfold
    August 18, 2008

    Well, thank goodness there is such an expert here who can lecture me on what I do or don’t care about, while boldly asserting that the lack of access is HIS responsibility, despite claiming to care so much.

    Bad, I am not the one around here who’s position leads him to support racism. The person who has being doing that is you. It does not reflect well on your morality.

    Of course you claim to be against things like racism, but I do not accept your denials anymore.

  125. #125 Max Fagin
    August 18, 2008

    I’m afraid I’m going to have to side with the religious doctors on this one. If a doctor goes to medical school, and invests his or her own time in founding a practice, then they have the right to help or not help anyone they want. To have it any other way would be a violation of the doctors rights. You do NOT have the right to receive healthcare from any doctor you want.

    That doesn’t make it MORAL or RIGHT for a doctor to refuse to help someone for religious reasons, but it does make it LEGAL.

    And of course, if your doctor does refuse you treatment for religious reason, then by all means find a new doctor, just don’t take them to court because of it.

  126. #126 Matt Penfold
    August 18, 2008

    Yes, I’m aware that pregnancy is risky. I’m also aware that a biologically normal pregnancy is not a medical pathology. When pregancy does qualify as pathological, then prevention or termination is medically indicated. These are not idle distinctions when considering the duties of healthcare professionals.

    No, they are not idle considerations. However it is not that easy to see how a doctor can always make such distinctions. A gynaecologist is not a psychiatrist. Not all medical reasons are for physical problems. For some woman carrying to term could be seriously damaging to their mental health. What of the gynaecologist happens to be a Scientologist ? Should their religious belief that there is no such thing as mental illness allow them to refuse to carry out a termination ?

  127. #127 jess
    August 18, 2008

    I suppose if a KKK member with a “White Power” tattoo on his chest has a heart attack, an African-American ER doc can refuse to treat him, eh? Or perhaps a muslim doctor with a jewish patient?

    How about if a Christian Scientist becomes a pharmacist and then refuses to fill ANY prescriptions based on religious beliefs? It’s not common, but it is within the realm of possibility.

  128. #128 Armchair Dissident
    August 18, 2008

    I’m 100% against laws that would prevent, say, CVS from firing someone who won’t fill a prescription for the pill.

    Then, presumably, your answer to the question, “Do you believe physicians should have the right to refuse to provide medical treatment if it is against their beliefs?”, is, “No.”. Your only debate is who is entitled to sanction doctors who fail to do what their job requires of them.

    What you fail to seem to be grasping is that, in many areas – the UK is one – an employer is increasingly not allowed to sanction a person who fails to do their job, if they cite the reason that it is against their beliefs to do so. The question – and the debate – is about it being an absolute right to fail to do a duty purely because of a person’s religious beliefs. By “right”, here, we are talking about an absolute right, where no sanction can legally be applied against that person by any other person or organisation.

    That’s not in the least the same thing as this bizarre principle people seem to be supporting, which is “If you don’t want to do the things that _I_ have decided for you are what defines your profession, then you must not be a part of it.”

    Then you are apparently completely mis-understing the argument. The problem is that these doctor’s consider it an absolute right to refuse to provide birth control, or to refuse to refer patients for abortion, where no sanction may be legally applied against them by any body or organisation, including their employer.

  129. #129 Matt Penfold
    August 18, 2008

    I’m afraid I’m going to have to side with the religious doctors on this one. If a doctor goes to medical school, and invests his or her own time in founding a practice, then they have the right to help or not help anyone they want. To have it any other way would be a violation of the doctors rights. You do NOT have the right to receive healthcare from any doctor you want.

    And if there is only one general practitioner in town ? What does a patient do then ?

    It seems you would be quite prepared to let patients who do not have access to a doctor who will treat them simply go without treatment. How is that in anyway ethical or moral ? How is it less ethical or moral than restricting the rights of doctors ?

  130. #130 nobody
    August 18, 2008

    If the law protecting doctors from doing their jobs goes through, I’m going to medical school, getting a job, then converting to Christian Science. Then I can bring in a salary without ever raising a finger. Better yet, HMOs will love me. They’ll seek out Christian Scientist doctors to put on their lists of approved doctors and never have to spend another cent again, because no one’s doctors will treat them for anything. Dark ages, here we come!

  131. #131 Willy
    August 18, 2008

    I knew somebody was gonna do it:
    http://www.oktapodi.com/makingof.html

  132. #132 Chiroptera
    August 18, 2008

    Bad, #68: If I’m starving because there’s no food around, and someone opens up a grocery store that refuses to serve atheists….

    I actually had a little sympathy for your argument until you came up with this grocery store example. In my opinion, your example actually blows your argument out of the water. Although I already felt your opinion was wrong, your example has convinced me even further.

  133. #133 Matt Penfold
    August 18, 2008

    I would like to add that the issue of how a doctor is paid is not really relevant to their ethical responsibilities. Whether a doctor is self-employed or get paid a salary does not change their duty of care to their patients.

    Here in the UK most GP’s are self-employed. However in some rural or inner city areas where there would no GP coverage the health authorities can employed a salaried GP. Should the care they offer patients be any different as a result ?

  134. #134 syntyche
    August 18, 2008

    If a doctor goes to medical school, and invests his or her own time in founding a practice, then they have the right to help or not help anyone they want.

    perhaps someone Canadian can correct me, but medical school tuition in Canada is heavily subsidized by the state, no?

  135. #135 Tom
    August 18, 2008

    Let’s face it. Not everyone can have all their rights unrestricted. In practical terms, they’re going to conflict and someone’s not going to get what they want. I’d rather that person be the doctor who doesn’t get to refuse to help a patient, while remaining licensed and paid to do so, than the patient who doesn’t get the help they need or desire.

    Have the courage of your convictions and find a position that doesn’t conflict with your beliefs, or set your beliefs aside and earn your pay and status. You can’t have it both ways.

  136. #136 Willy
    August 18, 2008

    Oh, that was the Making of…

    Here’s the video short:
    http://www.motionographer.com/wp-content/uploads/2008/08/oktapodi-motionographer.mov
    (36MB…long d/l)

  137. #137 Just wondering
    August 18, 2008

    Hey Mary, number three comment, do you wish your younger sister did not exist?

  138. #138 Chiroptera
    August 18, 2008

    Just wondering, #137:

    Well, I can’t speak for Mary, but my family had a similar situation. My sister was the result of an unintended and unwanted pregnancy. Now my mother didn’t consider terminating (as far as I know), but even though I love my sister very much, I will say that my mother should have had the option to terminate and should have done so if that was what she wished.

    Does that help your understanding of how some of us feel about the issue?

  139. #139 Patrick ONeill
    August 18, 2008

    I am studying for my new career – pharmacy technician.
    As soon as I am certified I intend to convert to Christian Science.

    Then I will have my perfect job – I won’t give anyone their prescriptions, but I will promise to pray for them

  140. #140 Chiroptera
    August 18, 2008

    Just wondering, #137:

    And one more thing, your little sister that doesn’t exist because your parents didn’t have sex before they were married (or used birth control): are you sorry that she doesn’t exist? What is the difference between a person who doesn’t exist because the pregnancy was terminated and a person who doesn’t exist because she was never conceived to begin with?

  141. #141 Soybomb
    August 18, 2008

    Laws be damned, I think you’re better to just know your physician as best you can. As Mary’s post illustrates some doctors lack the ethics they should have and lie or mislead their patients. What good is a law forcing your doctor to give you medical treatment if he doesn’t even tell you that it is an option? Honestly I’d probably rather doctors be able to outright display their positions on stuff like that. With any luck their reptuation would at least be known and I could avoid them rather. Ideal, no, but better than going to the doctor who just omits treatment information he dislikes so he won’t be forced to use it.

  142. #142 Annapolitan
    August 18, 2008

    I don’t know if this example has come up yet because I haven’t read all the comments here, but how about if I was an obstetrician and parents expected me to circumcise their newborn son? (NB: OBs are typically the ones who perform circumcisions in most hospitals because obstetrics is a surgical specialty and pediatrics is not. Although more and more pediatricians and family practice physicians are training in and performing the procedure.)

    If I as an OB-GYN have qualms about performing newborn circumcision, shouldn’t I have the right to refuse to perform this procedure? Do you really want to force a physician to perform a procedure s/he is morally opposed to and believes is genital mutilation, not to mention not medically indicated?

    How about if I was a pediatrician or a family practice physician? Sure, as a pediatrician, I have chosen to work with infants and children, but the American Academy of Pediatrics’ official policy statement on newborn circumcision is that it is not medically necessary. Should the parents of a male child be able to force me to perform it on their child anyway because they may disagree with the policy, or it’s part of their ethnic or religious practice? Should they be able to go after my employment or medical license if I refuse?

  143. #143 Carlie
    August 18, 2008

    The morning after type pills might eventually be safe enough to buy over the counter like condoms.

    You mean, like they already are in countries that are not hamstrung by crazy religious people?

  144. #144 Graculus
    August 18, 2008

    Bad: I dunno: why should you have to drive hundreds of miles to get a Nintendo Wii?

    Because health care is EXACTLY the same kind of service as entertainment. Give your head a shake, see if something moves back into postition.

    Except that what is “legitimate” is, what: decided on by you, and not the doctors who don’t think it’s warranted or legitimate? This is inherently a political and ethical call, not just a medical one.

    Wrong country. In Canada there is no abortion law, it is considered an ordinary medical procedure. Therefor, by law, it IS just a medical call.

    But it’s not a good justification for demanding that doctors and doctors alone bear the burden of your politics and ethical beliefs.

    Rather, you demand that the public bear the burden of the doctor’s political and “ethical” beliefs. Talk about a tyranny of the minority.

    That’s not in the least the same thing as this bizarre principle people seem to be supporting, which is “If you don’t want to do the things that _I_ have decided for you are what defines your profession, then you must not be a part of it.”

    Horseshit. If an engineer doesn’t want to follow established practice in his/her profession then they are liable for the consequences, and that includes losing their license to practice engineering and possible jail terms. I’m sure you would be comfortable taking off the regulations on *that* profession… not.

    Would it be OK for a Jehovah’s witness doctor to refuse to give an emergnecy blood transfusion to a patient?

  145. #145 Michael
    August 18, 2008

    #2 Because… what? You think that people should be forced by law to give you whatever you desire? If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.

    I agree, I have seen patients switch doctors many times for non-religious reasons. I don’t see the religious convictions any different other than PZ who just likes to give those with strong religious convictions a hard time. The medical field in America is based on competition, a service that is provided, thus there are options (not enough to keep prices lower) so to force Doctors to perform a procedure or prescribe medication that is against his/her religion would be breaking the law on freedom of religion.

  146. #146 Carlie
    August 18, 2008

    No dice on that specific example, Annapolitan. As it is a recognized religious practice, rabbis can be certified to perform circumcisions. Nobody but doctors can perform abortions or prescribe drugs.

  147. #147 The Chemist
    August 18, 2008

    @gdlchmst

    I see your point, in this case, I see everyone’s point. Though a doctor refusing to do something, and advising a patient wrongly are two different things. A doctor who says, “I will not do this, but refer you to someone who will.” is a distinct species from “I will not do this, but that’s because of x, y, and z medical reasons” (when of course those reasons are bunk.)

    I see this as being a humanitarian issue, a social issue, and a liberty issue. Each of those perspectives pull in different directions unfortunately.

    Regarding the university I go to, my current policy is that it is one of a number of specifics I do not divulge on the intertubes.

    @Bad, I’m not under any misapprehensions, but perhaps just a dark cloud of, “Hmm…”

  148. #148 Armchair Dissident
    August 18, 2008

    Should the parents of a male child be able to force me to perform it on their child anyway because they may disagree with the policy, or it’s part of their ethnic or religious practice? Should they be able to go after my employment or medical license if I refuse?

    I would say that you have a different dilemma there than the usual birth-control and abortion religious objections. In most birth control and abortion situations, the patient is a legally competent individual, able to make informed decisions about their own care which is otherwise being over-ridden by a doctor. In the situation you state, the parents are not your patients – the child is. The child is not competent to consent to the operation.

  149. #149 Chiroptera
    August 18, 2008

    Annapolitan, #142:

    An interesting question.

    The important fact here is that carry a baby to term and giving birth is an important decision to make and will have important consequences to the life (and perhaps the well-being) of the mother.

    Let’s also consider cosmetic surgery as an example. Many cases are pretty trivial, and I think that a physician should be able to perform such a surgery. But there are also deformities and mutilations that may not pose a health risk but still have a serious impact on the mental well-being of the person. In these cases, perhaps a plastic surgeon should be required to intervene even if she has moral qualms about something that is not, in some opinions, a medical necessity.

    I don’t know where religiously required circumcision should fit, although I believe that where the religion requires it it is performed by a religious official (after all, it is the ritual not only the results that are important).

  150. #150 Andrew N.P.
    August 18, 2008

    Bad, I am not the one around here who’s position leads him to support racism. The person who has being doing that is you. It does not reflect well on your morality.

    So wait. Anything that he doesn’t think should be criminalized… he automatically supports? I suppose that means everyone here is firmly in favor of most brands of fundamentalist wingnuttery. Cool!

    Anyway, back on topic, a simple compromise. Allow doctors and pharmacists to refuse to provide certain services. But in turn, allow medical boards to yank the licenses of anyone who tries such a stunt. (And since those boards are governed by law, you could even get some measures passed to make that yanking mandatory.) If the doctor sues, explain that the medical board belongs to the First Church of Customer Service (Reformed), and that their religious beliefs require them to shun anyone who won’t obey their patients’ wishes.

  151. #151 Carlie
    August 18, 2008

    Allow doctors and pharmacists to refuse to provide certain services. But in turn, allow medical boards to yank the licenses of anyone who tries such a stunt.

    That’s the entire issue under discussion here. Please try to keep up. There is legislation right now under debate in the Senate that would bar any punitive action against doctors and pharmacists who do that.

  152. #152 Graculus
    August 18, 2008

    What is being also lost here is that we are talking about contraception, not abortion. No one is forcing a pharmacist or doctor to provide an abortion.

    Refusing to provide contraceptive services WHEN THAT IS THE BUSINESS THAT YOU ARE IN is a violation of the Ganadian Bill of Rights, which specifically prohibits discrimination on the basis of gender.

    And yes, private commerce is subject to the Canadian Human Rights Act.. you cannot refuse to serve someone for being black, gay or catholic, either.

  153. #153 LisaJ
    August 18, 2008

    syntyche @ #134. Perhaps the Canadian government has stepped in somewhat to help with medical school tuition, but not much. My husband just finished med school and he paid out $14000 – $15000 each year, for 4 years, just in tuition alone.

  154. #154 Annapolitan
    August 18, 2008

    Carlie:

    It’s an entirely legitimate example. A lot of infant circumcisions (in fact, most of the infant circumcisions done in the US) are done not for religious purposes but because of what I would term the aesthetic preferences of the parents: the father of the boy is circumcised and wants Junior to look just like him, Mom thinks a circumcised penis is easier to keep clean or likes the look better, or it’s “just what we’re used to”, etc., etc. So a religious practitioner of circumcision like a mohel would not be an appropriate or available choice for these parents who have chosen to have their son circumcised.

    Still think they should be able to demand their physician perform this surgery or else Get Out Of Medicine?

  155. #155 Zar
    August 18, 2008

    Let’s look at this the other way around. Let’s say that a doctor is a social darwinist or a eugenicist. Shall his beliefs allow him to refuse medical care to those he considers less fit? Can he refuse to treat a morbidly obese patient’s umpteenth heart attack? Maybe he’ll refuse to offer insulin to a diabetic. Why allow such a flawed trait to be passed along? Or why not refuse medical care to the retarded? They’re a drain on society. You’re taking life and death into your own hands. If you force someone to breed, why not engage in a little euthanasia?

    A doctor who refuses to offer contraception is not doing so for the benefit of the patient. The doctor is doing what he considers best for society. This is way out of bounds. The fact of the medical profession is sometimes you have to do stuff you’d rather not do. It’s part of the profession. To let your personal beliefs and prejudices and practice social engineering is what lead doctors to sterilizing indigenous women without their consent, what lead Waltraud Wagner and her compatriots to kill elderly patients.

  156. #156 Andrew N.P.
    August 18, 2008

    That’s the entire issue under discussion here.

    In my defense, the poll question was whether they should have the right to do it, not whether they should have the right to do it scot-free. Besides which, I figured the tongue-in-cheek nature of my response would have been clear around the time I brought up the First Church of Customer Service (Reformed).

    Seriously though, how is this even up for debate? If the people who say you’re allowed to dispense drugs also say you have to dispense birth control, then you damn well better dispense birth control unless you don’t want to be allowed to dispense drugs anymore.

  157. #157 Blondin
    August 18, 2008

    Let’s remember that we are not just talking about OB/GYN doctors who refuse to perform abortions. I wouldn’t have a problem with that if that’s all the issue was. Similary, I wouldn’t want airline pilots to be forced to fly 747s if they really only wanted to fly Dash-8s.

    It’s the GPs who lie or manipulate patients into conforming to their religious beliefs that the proposed changes are aimed at. The family doctor who refuses to advise or refer patients who are seeking IVF assistance or birth control or abortion because of non-medical biases.

    Some of the analogies and comparisons mentioned are better than others and some examples fall into gray areas that are maybe not so easily catagorized but a lot of this argument misses the main point. A doctor is a professional whose job is to provide medical advice and decisions based on the best of his medical training and experience NOT his religious or political beliefs or racial biases.

  158. #158 thepetey
    August 18, 2008

    I think if a doctor refuses to offer a service, and refuses to offer the service to ANYONE, than the doctor has a right to refuse to perform that procedure. It is up to the doctor to be forthcoming with that information and for the patient to actually interview their doctor and find out what services the doctor is unwilling to perform.

    Like in Annapolitan’s example, if a doctor is unwilling to perform the procedure for anyone, than the patient needs to find another doctor that IS willing to perform the procedure.

    The only time I feel that a doctor can be “forced” for perform a procedure and/or face legal consequences for not doing so mid when they provide the service for ONE group but not others because of personal beliefs.

    As far as the CVS pharmacist dishing out the pill, if doing so is in their job description than do so or be fired for not performing you job duties. If they give the pill to a married woman but not a single woman, they should be prepared to have charges pressed against them for discrimination. If they can’t do it under any circumstances, work for another pharmacy or find a new job.

  159. #159 Tom L
    August 18, 2008

    We need a well-known clearinghouse for this information, where a) doctors can register for the sorts of services they are willing to perform, and b) patients can report refusals of service.

    I think it would also be appropriate for the rest of the community to respond to a doctor or pharmacist known to refuse certain types of treatment by refusing to do ANY business with him. That means a) don’t go to him for medical services, and b) don’t sell him anything that you don’t feel like selling him. Even food. See how he likes going through extra effort to find service providers when the ones nearby don’t feel like cooperating.

    As to the legality of that tactic: last time I checked, “Because I think you’re a jerk” wasn’t a suspect class.

  160. #160 AxeGrrl
    August 18, 2008

    Gene Goldring kindly provided a link to the document ‘Physicians and the Ontario Human Rights Code’(comment #30) and I thought pasting an even larger portion of the document might be of interest:

    “Moral or Religious Beliefs

    If physicians have moral or religious beliefs which affect or may affect the
    provision of medical services, the College advises physicians to proceed
    cautiously.

    Personal beliefs and values and cultural and religious practices are central to the
    lives of physicians and their patients. However, as a physician’s responsibility is
    to place the needs of the patient first, there will be times when it may be
    necessary for physicians to set aside their personal beliefs in order to ensure that
    patients or potential patients are provided with the medical treatment and
    services they require.

    Physicians should be aware that decisions to restrict medical services offered, to
    accept individuals as patients or to end physician-patient relationships that are
    based on moral or religious belief may contravene the Code, and/or constitute
    professional misconduct.

    Contravention of the Code

    Within the Code, there is no defence for refusing to provide a service on the
    basis of one of the prohibited grounds. This means that a physician who refuses
    to provide a service or refuses to accept a patient on the basis of a prohibited
    ground such as sex or sexual orientation may be acting contrary to the Code,
    even if the refusal is based on the physician’s moral or religious belief.***

    The law in this area is unclear, and as such, the College is unable to advise
    physicians how the Courts will decide cases where they must balance the rights
    of physicians with those of their patients.

    There are some general principles however, that Courts have articulated when
    considering cases where equality rights clash with religious freedoms. They are
    as follows:

    ? There is no hierarchy of rights in the Charter; freedom of religion and
    conscience, and equality rights are of equal importance;
    ? Freedom to exercise genuine religious belief does not include the right to
    interfere with the rights of others;
    ? The right to freedom of religion is not unlimited; it is subject to such
    limitations as are necessary to protect public safety, order, health, morals
    or the fundamental rights or freedoms of others;
    ? The balancing of rights must be done in context. In relation to freedom of
    religion specifically, courts will consider how directly the act in question
    interferes with a core religious belief. Courts will seek to determine
    whether the act interferes with the religious belief in a ‘manner that is more
    than trivial or insubstantial’. The more indirect the impact on a religious belief, the more likely courts are to find that the freedom of religion should
    be limited.

    These principles appear to be generally applicable to circumstances in which a physician’s religious beliefs conflict with a patient’s need or desire for medical
    procedures or treatments. They are offered here to provide physicians with an
    indication of what principles may inform the decisions of Courts and Tribunals”

    *** This could occur if the physician’s decision to refuse to provide a service, though motivated by religious belief, has the effect of denying an individual access to medical services on one of the protected grounds. For example, a physician who is opposed to same sex procreation for religious reasons and therefore refuses to refer a homosexual couple for fertility treatment may be in breach of the Code.

  161. #161 Rik.
    August 18, 2008

    The way I see it, it’s very simple.
    Either Doctors are allowed to refuse medical treatment on religious grounds, or they’re not.

    If a Doctor would be allowed to refuse treatment based on religious grounds, this would go for -all- treatments. Like, say, chemotherapy. Or blood transfusions. Or . And then, more people would die.

    If could save a life, but would refuse to do so, what would that make me? 2nd degree manslaughterer, or something like that? I don’t know anything about legal terms but I’m quite sure it’s not legal…if it is, the legal system needs a reworking…unless you think just letting people die is not wrong at all.

    So, no, doctors should not be allowed to refuse treatment.
    The debate, however, has predictically (is that a word? I mean it was foreseeable) moved to abortion, and has turned into ‘should doctors be allowed to refuse to do an abortion’.

    It’s not relevant. The question is, is an abortion to be considered a normal medical treatment? If yes, then doctors cannot refuse, for whatever reason, to perform one if it’s in the patients best interests. I add the ‘if it’s in the patients best interests’ because this generally goes for all treatments – you don’t give someone a blood transfusion if you think it’s bad for them.

    If no, well, why not? But that’s something I’m not going to make an argument for or against, I’m sure someone else will do it though.

    Then, the only remaining question is ‘when can an abortion to be said to be in the patients best interest’?
    Well, in my (rather limited, I’ll admit – being a rather young and inexperienced male) view, this would be about always except when having an abortion would somehow endanger the health of the patient.

    All of this, however, is very abortion specific, and has nothing to do with wether doctors should be allowed to refuse to treat their patients.

  162. #162 Rik.
    August 18, 2008

    @myself at 161,

    what I meant by ‘thinking it’s not wrong just letting people die’ was ‘thinking it’s not wrong to let people die IF YOU CAN DO SOMETHING ABOUT IT’

    I’m sure someone is going to point out that I’m not living on the bare minimum to survive and send all money that I don’t require to poor people in a third world country thus helping them to survive and thus letting them die and not doing anything about it which is wrong according to my own ethics that I just wrote down now…

    But people in 3d-world countries aren’t going to do anything back. A doctor might refuse to treat me, however. Yes I’m a selfish hypocrite. But so is everyone else. I don’t see anyone else sending all of their money they don’t need to survive to the people in a 3d world country, and I honestly can’t imagine anyone agreeing that just standing by and letting a fellow human being die even if you could have – rather easily, I might add – saved his or her life is somehow -not- ethically despicable.

    It’s a strange world we live in.

    (Although I would argue that sending money to people in 3d world country’s doesnt really help them…why do my posts always end up being so damn long?)

  163. #163 gdlchmst
    August 18, 2008

    gdlchmst:”I thought you were fairly sensible up ’til this point. Wait, are you saying that people should have a right to do discriminate as they like, and there should be no societal penalty against it?”

    I’m not sure what you mean: there WILL be a societal penalty against it, and I would gladly be a part of it. But I don’t think there’s good justification for having a LEGAL penalty against it. This is not, I grant, a popular idea, and in fact it’s one that I had a hard time with. But it is what I think is the right answer, ethically, and ethics isn’t about what’s pleasing, easy, or popular.

    The only enforced society penalties are legal ones. A legal system reflects the social values of the society to which it belongs. I think your principle that people shouldn’t be force to do good, but rather be educated to do good and socialized to be good is an admirable one. I felt that way for a long time. But you must admit, people are not inclined to do what is not enforced via law. Therefore, the only solution would be to lobby for social justice and enforce it in a broad and diverse population through the legal system. In fact, that is why the legal system is created.

    “I’m guessing that you don’t exactly think social justice is worth fighting for.”

    You’d be wrong. I just don’t think social justice can justify forcing private businesses to not be bigotted jerks to their potential customers.

    Why not? We can force murderer not to be murderers, thieves not to be thieves, and slave-owners not to be slave-owners. Why can’t we force racists not to be racists, at least in their actions against others?

    “Feel free to correct me, I would hate to think an atheist could be this irrational.”

    Why? Atheists are just people. People can be irrational. You don’t need to be any degree of rational to NOT do something like believing in a God.

    Actually, you do, if you are a scientific atheist, which I assumed you, and most people here, are.

  164. #164 Bad
    August 18, 2008

    Graculus:”Rather, you demand that the public bear the burden of the doctor’s political and “ethical” beliefs.”

    Precisely backwards. A doctor that performs medicine but not every proceedure you want them to perform is not a “burden” on anyone. In fact, economically, their existence is almost certainly a net benefit even if you never see them.

    And yes, the public should bear the burdens of what it demands be basic positive rights.

  165. #165 raven
    August 18, 2008

    Hey Mary, number three comment, do you wish your younger sister did not exist?

    Gee that is a stupid comment.

    I don’t miss my younger brothers and sisters because they are hypothetical, never existed, and never will.

    I don’t miss my imaginary pet cheetah either or the pet bunny I never had.

    I do miss my imaginary star ship though. After reading some of these confused and bizarre comments, a vacation on Arcturus or Tau Ceti III would be welcome.

  166. #166 Bezoar
    August 18, 2008

    As a Physician Assistant in Family and Emergency Medicine I believe we have an oath to provide care to patients who ask for it religious beliefs be damned. If a Healthcare provider feels that strongly then he or she should post that info so the prospective pt or established patient won’t ask for BCP’s for instance. That way she doesn’t have to listen to religious drivel and the Doc doesn’t get the chance.
    There is a move afoot that Pharmacists are choosing not to fill BCP’s for women. This OK as they own their own stores but chain stores such as Walgreens or CVS have a policy to provid eofr everyone. If a Pharmacist at one of these chains denies a prescription, he can berelieved of his job.

  167. #167 Paul
    August 18, 2008

    I didn’t read every comment, so I may be repeating something already mentioned. An important part of this discussion is the fact that, in Ontario, medical services are paid for by a government run, universal, public health insurance program. Medical practice in Ontario (and most other Canadian provinces) is a government provided (and therefore by-definition) secular service.

  168. #168 Bad
    August 18, 2008

    Matt Penfold: “Bad, I am not the one around here who’s position leads him to support racism.”

    There doesn’t seem to be anyone around here that “supports racism.” But you are a liar if you claim that I do.

    “Of course you claim to be against things like racism, but I do not accept your denials anymore.”

    Well, no wonder. Here I am having the audacity to point out that instead of some moral obligation being someone elses problem, it might actually require something out of you other than expressions of self-righteousness.

    From your response to Max Fagin:”And if there is only one general practitioner in town ? What does a patient do then?”

    I don’t know Mr. Penfold: what are YOU prepared to do to help change that situation?

  169. #169 Armchair Dissident
    August 18, 2008

    Precisely backwards. A doctor that performs medicine but not every proceedure you want them to perform is not a “burden” on anyone. In fact, economically, their existence is almost certainly a net benefit even if you never see them.
    And yes, the public should bear the burdens of what it demands be basic positive rights.

    You’re not an economist, are you.

  170. #170 Armchair Dissident
    August 18, 2008

    I don’t know Mr. Penfold: what are YOU prepared to do to help change that situation?

    And you’re not a sane person, either, are you.

  171. #171 Natalie
    August 18, 2008

    Bad, why do you feel that the solution people here have proposed (requiring pharmacists/doctors to do their jobs) isn’t doing anything about the problem? You’ve repeated that command several times, but you appear to be making the assumption that a legal remedy is not actually a remedy. Why is that?

  172. #172 gdlchmst
    August 18, 2008

    I don’t know Mr. Penfold: what are YOU prepared to do to help change that situation?

    I can’t speak for Mr. Penfold, but I would be prepared to sue the living crap out of the doctor. What would you do? Say meh, and move on?

  173. #173 Bad
    August 18, 2008

    Armchair Dissident: I think you are mixing up a whole lot of different ideas here, and perhaps that’s because we are, indeedm dealing with different legal and medical systems to some extent. No one has the right to be employed by a particular someone else. But that’s not quite the same thing as this question:

    “Then, presumably, your answer to the question, “Do you believe physicians should have the right to refuse to provide medical treatment if it is against their beliefs?”, is, “No.”.”

    My answer is yes. But the missing information here is that by right, I mean that the government (i.e. the people) won’t pass a law preventing them from practicing medicine, or forcing them to do something they are morally opposed to as a condition of having a practice. That’s not the same thing as them having a right to be employed if they won’t do what their employers ask.

    It’s not that different from the distinction that I have the right to free speech, but I don’t have the right to demand that the New York Times publish my manifesto. I don’t think consumers have any legitimate grounds on which to demand, and then employ the state as bully, that doctors provide them with this or that service.

    Obviously that becomes a lot more tricky to work out when the government is to some extent the employer, as you note. But even there, I think erring on the side of pluralism and reasonable accomodation is to everyone’s benefit, because we need all the doctors we can get, and we need more of them, not less.

  174. #174 Carlie
    August 18, 2008

    Directly related to this discussion, California ruled today that no, fertility doctors can’t refuse to provide services to lesbians just because they think lesbians are icky. Of course, this has to be ruled on because someone actually did refuse to provide such services because their religion told them lesbians are icky. I would like to think this ruling will be used as precedent to knock down the other religious exemptions out there.

  175. #175 Bad
    August 18, 2008

    Natalie: “Bad, why do you feel that the solution people here have proposed (requiring pharmacists/doctors to do their jobs) isn’t doing anything about the problem? You’ve repeated that command several times, but you appear to be making the assumption that a legal remedy is not actually a remedy. Why is that?”

    If safe easy local access to physicians that can proscribe birth control is a right, then that is something that it’s the responsibility of everyone to help supply: i.e. by paying for additional medical access and coverage.

    Your solution is essentially saying that you think its really really important, but you don’t want to have to pay for it or incurr any of that burden yourself. Instead, you want to use the law to make someone else bear all the costs, and worse, you’ve chosen the very people for whom those costs are most dear (i.e. those who believe that it does great moral harm).

    It’s as if your mother tells you and your little sister to clean up the living room. Your response is to threaten your little sister with physical harm unless she does it all herself, and then sit back and say “ahhh, my job is done here.”

  176. #176 gdlchmst
    August 18, 2008

    Bad, now you are just repeating yourself. Many here, including myself, have already replied to your arguments in #173. Try reading them.

    It’s not that different from the distinction that I have the right to free speech, but I don’t have the right to demand that the New York Times publish my manifesto.

    This is not apt at all because NYT refusing to publish your manifesto is a)based on a relevant editorial decision; b)not violating your right to your own health; c)based on a employer-employee relationship as opposed to provider-consumer relationship.

    A more apt analogy: I become a doctor, based on my sexist religion, I do not treat or refer any women. Sure, some people frown upon this behavior, but thousands of my fellow religious doctors and I feel perfectly fine doing this. As a result, many women fail to receive proper care. People try to lobby for the government to step in. I cry religious intolerance and say it is my practice and I can discriminate as I like.

  177. #177 Natalie
    August 18, 2008

    If safe easy local access to physicians that can proscribe birth control is a right, then that is something that it’s the responsibility of everyone to help supply: i.e. by paying for additional medical access and coverage.

    Why do you assume that this is mutually exclusive with requiring physicians to prescribe birth control pills?

    Your solution is essentially saying that you think its really really important, but you don’t want to have to pay for it or incurr any of that burden yourself.

    Sorry, when did I say that this was my solution? And you are assuming again, by stating that anyone who thinks this is a moral right of physicians must not want to bear any burden themselves. You have no factual basis for this assumption, as far as I can tell.

  178. #178 Bad
    August 18, 2008

    Armchair Dissident: “You’re not an economist, are you.”

    I’m pretty confident that any economist you ask will agree that when an additional someone enters a particular labor market, both consumers of that service and employers stand to benefit, whether or not they actually employ that particular person.

    My hypothetical bigoted grocery store, for instance, may not serve me. But it coming into existence doesn’t do me any concrete harm. And, in fact, if it puts pressure on other local grocery stores, there’s the chance that I’ll benefit from the reduced prices of those that will serve me.

    “And you’re not a sane person, either, are you.”

    Pointless invective.

  179. #179 Armchair Dissident
    August 18, 2008

    My answer is yes.

    Then you are a liar.

    You cannot claim, at the same time, that the employer retains the right to dismiss an employee for failing to perform their duties, and at the same time claim that the employee does not have the right to dismiss an employee for failing to perform their duties. Which is what you’re claiming.

    My answer is yes. But the missing information here is that by right, I mean that the government (i.e. the people) won’t pass a law preventing them from practicing medicine, or forcing them to do something they are morally opposed to as a condition of having a practice.

  180. #180 Bad
    August 18, 2008

    Natalie: “Why do you assume that this is mutually exclusive with requiring physicians to prescribe birth control pills?”

    I don’t. One can certainly do both. But only one is, in my judgment, justified.

    “Sorry, when did I say that this was my solution?”

    You’re right: I should have said “the solution “people here” have proposed.”

    “And you are assuming again, by stating that anyone who thinks this is a moral right of physicians must not want to bear any burden themselves. You have no factual basis for this assumption, as far as I can tell.”

    I’ve responded directly to what people have described as the obligations in these situations. Are you really going to argue that people haven’t placed the responsibility for those lacking access to birth control squarely on the shoulders of doctors who don’t want to provide it?

  181. #181 Lynnai
    August 18, 2008

    The encouraging thing is that the story behind this poll is about the Ontario College of Physicians desire to censure doctors who refuse to do their job.

    As for the comments about just finding another doctor – must be from Torontonians. The rest of us don’t necessarily have that luxury.

    Ummm no we don’t have that luxury, once you find a GP here you hold on to them for dear life even if you have to end up going to New Market for your annual. My SO spent 8 years trying to find a GP with room enough on their roster. There are plenty of walk in clinics for all sorts of things but there are some things that walk in clinics simply can not do such as refferals to specialists, most won’t even do yearly physicals. Walk ins are fabulous and I think essential but are not GPs. The GP shortage is all over Ontario. And frankly even if everyone did have that luxury wouldn’t it still be wrong? Does it not mean they are incapable of being objective? Do you really want that quality of Doctor practising at all?

    I think if you read them and see refferances to insurance companies and business practices you might agree that most of those comments are probably from Americans.

    As for:

    “Obviously, I think this is beyond ridiculous.”

    Because… what? You think that people should be forced by law to give you whatever you desire? If your doctor won’t perform a particular proceedure that you want, or prescribe something you want, find another doctor.

    Doctors provide a service that you and your insurance company purchase. If you aren’t satisfied with what they are willing to provide, take your money elsewhere. But there is no right to have OTHER people provide you with the services you want.

    This is Canada, if private practices really were private I’d grit my teeth and say maybe. Provided they were up front and honest with the reasons a clear “No I find that immoral but that is my only objection you are free to go find a second opinion” would rankle but mollify. But here they are being paid by the Govornment, they are in effect Govornment representatives and the Govornment does not discriminate based on well… anything. The Charter of Rights and Freedoms is my friend. The moment a Govornment Employee of any removal so much as hints of discriminating against me baised by their religios beliefs (or gender issues or anything else of that ilk) I will channel Pierre Elliot Trudeau on their ass so hard and fast they’ll think the FLQ got off easy.

    There are some things I simply will not tollerate, being told I am a bad person for attempting to practice safe sex (the most commn version of what is being talked about) is most certainly at the top of the list.

    They knew the code of ethics when they signed on either specialize in something that won’t conflict or suck up and deal (by playing along and writing their MP and voting their consious to change the system of course, they are not without some recourse but refusing treatment with the system as it is is so far and away not on *shudder*).

    I’ll stop ranting now really I swear.

  182. #182 Armchair Dissident
    August 18, 2008

    (gaargh! Message got sent prematurely.)

    My answer is yes. But the missing information here is that by right, I mean that the government (i.e. the people) won’t pass a law preventing them from practicing medicine, or forcing them to do something they are morally opposed to as a condition of having a practice.

    Okay, you’re a “libertarian”. I understand now. Can I just take this opportunity to express – as a British citizen – my public hope that American Libertarians never, ever, get power. You guys scare me.

  183. #183 Chiroptera
    August 18, 2008

    Bad, #178: And, in fact, if it puts pressure on other local grocery stores, there’s the chance that I’ll benefit from the reduced prices of those that will serve me.

    Oh, there are other grocery stores? Why didn’t you say so? But now, since the problem in the real-life contraceptives cases lies in the fact that women may not have timely alternatives to that one pharmacist/physician it now becomes irrelevant to the discussion.

    -

    My hypothetical bigoted grocery store, for instance, may not serve me. But it coming into existence doesn’t do me any concrete harm.

    By this argument, my accidentally being present doesn’t obligate me to help a kid drowning in three feet of water, even when it poses on substantial danger to me. Since I can’t imagine anyone actually making this argument, I must not be getting your point.

  184. #184 Bad
    August 18, 2008

    “gdlchmst | August 18, 2008 4:48 PM

    Bad, now you are just repeating yourself. Many here, including myself, have already replied to your arguments in #173. Try reading them.”

    I have. I don’t agree that they’ve addressed my arguments.

    “This is not apt at all because NYT refusing to publish your manifesto is a)based on a relevant editorial decision; b)not violating your right to your own health; c)based on a employer-employee relationship as opposed to provider-consumer relationship.”

    No, it’s based on the fact that I don’t have any justification for demanding things from the NYT. And the idea that a particular individual is violating a positive right but not fulfilling it themselves is, as I have argued, absurd.

    “A more apt analogy: I become a doctor, based on my sexist religion, I do not treat or refer any women. Sure, some people frown upon this behavior, but thousands of my fellow religious doctors and I feel perfectly fine doing this. As a result, many women fail to receive proper care. People try to lobby for the government to step in. I cry religious intolerance and say it is my practice and I can discriminate as I like.”

    Note what you don’t mention anyone trying: paying for more doctors that will treat women… so that women will recieve proper care. Instead you just want to butt heads with, well, your hypothetical self.

    Planned Parenthood and other providers don’t run on hopes and dreams and messageboard posts. They run on people that care about access to birth control fighting for that cause and paying through the nose to make sure it happens as much as possible.

  185. #185 Lynnai
    August 18, 2008

    dagnabit!

    #181 seems to have formatting issues. Most of the second block quote didn’t get into the block quote.

    Oh well it’s too long to repost without creating clutter. But please read it with that in mind.

  186. #186 JJR
    August 18, 2008

    My former SO (now ex-wife) was in exactly the boat LisaJ describes; her GP before she met me was a strictly religious type and after we started living together it was out of the question to get BC from him; luckily she was able to get the RX from another provider in the area. Thanks to effective BC (and luck) no children resulted from that passionate-but-unstable relationship.

  187. #187 Bad
    August 18, 2008

    “By this argument, my accidentally being present doesn’t obligate me to help a kid drowning in three feet of water, even when it poses on substantial danger to me. Since I can’t imagine anyone actually making this argument, I must not be getting your point.”

    Actually, this is a classic ethics problem, and one worth thinking about.

    Here you are expressing the view that you must save that child. And I agree: you must. That’s what is moral, that’s what we all agree is moral, right?

    Just one problem: there are countless “drowning children” right now: i.e. kids dying of very easily preventable causes. This very moment. You are as “accidentially present” in regards to their situation simply by virtue of knowing about and having the means to help. You life isn’t even in any danger to do so: just don’t go see Dark Knight a second time, and you’ll have enough money to prevent a child’s death by diarreah.

    Now, can you imagine a good reason why you, me, and everyone else here isn’t like that guy that you can’t imagine not helping the drowning child every time we indulge in a trivial luxury that we ourselves admit we could be perfectly happy without?

  188. #188 Andrew N.P.
    August 18, 2008

    Can I just take this opportunity to express – as a British citizen – my public hope that American Libertarians never, ever, get power. You guys scare me.

    Wait a minute. In an America where George W. Bush can get elected, not once, but twice, you’re scared of the libertarians? Please tell me you’re joking. Or high. High works too.

  189. #189 Natalie
    August 18, 2008

    Are you really going to argue that people haven’t placed the responsibility for those lacking access to birth control squarely on the shoulders of doctors who don’t want to provide it?

    I didn’t say that. What I am saying is that, just because someone believes that a physician has an ethical obligation to provide any standard care, does not mean they are not willing to do their ethical duty, whatever that might be. That is, one may believe that it is wrong for physicians and pharmacists to provide birth control unless it is medically contradicted, and also want to expand access to medical care through some sort of government program or what have you. You appear to be making a false dillema out of these two positions.

  190. #190 Natalie
    August 18, 2008

    Planned Parenthood and other providers don’t run on hopes and dreams and messageboard posts. They run on people that care about access to birth control fighting for that cause and paying through the nose to make sure it happens as much as possible.

    They also run on such things being legally available.

  191. #191 Lancelot Gobbo
    August 18, 2008

    I happily prescribe contraception and morning-after pills. I refer people for termination and am the one physician in this rural Canadian community who does so. The other docs send me women who request a termination as they will not refer for that procedure. I have done hundreds of D&C’s in my days as an O&G resident and would be happy to perform terminations if I had the facilities and needed a change of job. It is not my job to persuade a woman to either have a termination or to avoid one. That’s her job, so mine is straightforward. If I were religious and had some hang-up about contraception I would be obliged to tell the patient, and ensure she had access to a doctor willing and able to help her with it. If it was an emergency situation such as the morning after, any delay could harm the patient and I would be obliged to do what was necessary despite my religious reluctance. Fortunately I am an atheist.
    But there is something missing from the discussion – the factor of professional responsibility. As far as I can tell, the thing that makes me a professional is that in return for the patient’s fee (OK, paid by the government here) I have to give my very best advice. This definitely does not mean giving the patient what they ask for – it means giving them what is best in my honest opinion. They might follow my advice, or they might tell me to get lost, but my best advice is just that. Having said that, I am not very didactic and expect patients to take part in decisions. Where there is some wiggle room, a patient may elect to undertake a treatment that is second best, or decline a treatment: as long as they understand there might be risks and those risks are not beyond my comfort zone (after all, I get the blame if things go wrong) I am prepared to go along. Where there is a real choice of treatments we will discuss it and come to an agreement as to what to do. Anyone who says a doctor is being paid to treat you and should provide whatever treatment you request just doesn’t understand the nature of a professional responsibility.

  192. #192 Chiroptera
    August 18, 2008

    Bad, #187: Just one problem: there are countless “drowning children” right now….

    I’m sure that the inherent contradictions and hypocrisies of my own moral framework are fascinating to some people, but let’s not get sidetracked from the topic at hand.

    The subject is whether physicians and pharmacists have these particular professional obligations in spite of whatever religious beliefs that they might hold. You claimed that you have an analogy that show that they don’t.

    A consequence that I see from your analogy (and your explanation of it) is that no one really has an obligation to help another. I may be misunderstanding your point; if so, you have the opportunity to clarify.

  193. #193 MTran
    August 18, 2008

    to force Doctors to perform a procedure or prescribe medication that is against his/her religion would be breaking the law on freedom of religion.

    This argument is simply wrong.

    A person may believe in any religion they wish to (in the US, at least) but a person’s behavior must conform to the law. In this instance, the laws that relate to discriminatory practices and regulation of professions.

    This morning, for instance, the California Supreme Court issued a unanimous ruling that (according to the SF Chronicle):

    [R]ejected a San Diego County fertility clinic’s attempt to use its physicians’ religious beliefs as a justification for their refusal to provide artificial insemination for a lesbian couple . . . In today’s ruling, the court also rejected the doctors’ claim that their freedom of speech was being violated, saying they remain free to criticize the anti-discrimination law as long as they comply with it.

    The case is North Cost Women’s Care Medical Group vs. Superior Court, S142892. The name of the real party in interest is Guadalupe T. Benitez.

    As for “ethical” or “moral” choices, for those who seek to be admitted to and maintain membership in the highly regulated (traditionally called “learned”) professions, they are obligated to accept the professional ethics that govern the professions. This often means that an individual’s preferred “ethical” or “moral” choices sometimes must take a back seat. It can be uncomfortable at times, to say the least.

  194. #194 gdlchmst
    August 18, 2008

    I have. I don’t agree that they’ve addressed my arguments.

    And I don’t agree your arguments are logical. Funny how I can just make claims.

    No, it’s based on the fact that I don’t have any justification for demanding things from the NYT. And the idea that a particular individual is violating a positive right but not fulfilling it themselves is, as I have argued, absurd.

    But I do have a justification for demanding *treatment* from my doctor. Doctors and the NYT are kind of different. And your last sentence didn’t really make sense, how do you fulfill a right, exactly?

    Note what you don’t mention anyone trying: paying for more doctors that will treat women… so that women will recieve proper care. Instead you just want to butt heads with, well, your hypothetical self.

    Yeah, because we can buy all the doctors we need. That’s why we don’t have a shortage of doctors. And when did civil rights lawsuits become butting heads?

    Planned Parenthood and other providers don’t run on hopes and dreams and messageboard posts. They run on people that care about access to birth control fighting for that cause and paying through the nose to make sure it happens as much as possible.

    They run on hopes and dreams and correspondence of people who care. Money is required, just like it is required for everything else. And you assume I don’t contribute?

  195. #195 gdlchmst
    August 18, 2008

    In 194

    “Planned Parenthood and other providers don’t run on hopes and dreams and messageboard posts. They run on people that care about access to birth control fighting for that cause and paying through the nose to make sure it happens as much as possible.”
    -Should be in blockquotes.

  196. #196 Jams
    August 18, 2008

    “Anyone who says a doctor is being paid to treat you and should provide whatever treatment you request just doesn’t understand the nature of a professional responsibility.” – Lancelot Gobbo

    Bravo! I agree.

    “I don’t agree that they’ve addressed my arguments.” – Bad

    I’m not convinced either.

    Perhaps we should consider it from this angle.

  197. #197 Rev. BigDumbChimp, KoT
    August 18, 2008

    I’m not convinced either.

    Perhaps we should consider it from this angle.

    Wow, that was a strange path to Godwin.

  198. #198 gdlchmst
    August 18, 2008

    @Jams

    “Anyone who says a doctor is being paid to treat you and should provide whatever treatment you request just doesn’t understand the nature of a professional responsibility.” – Lancelot Gobbo

    Bravo! I agree.

    Professional responsibility also requires a doctor to act on medical knowledge, not religious beliefs. And no one here is saying that you should get whatever treatment you request.

    “I don’t agree that they’ve addressed my arguments.” – Bad

    I’m not convinced either.

    Perhaps we should consider it from this angle.

    Did you just compare voluntary birth control to genocide? You are fucking insane. And I evoke Godwin’s law.

  199. #199 Jams
    August 18, 2008

    “Did you just compare voluntary birth control to genocide? You are fucking insane. And I evoke Godwin’s law.” – gdlchmst

    I did, but not in the way you think. I’m pro-choice. The issue is regarding whether doctors should or should not exercise a personal sense of ethics when prescribing treatment. The argument that they should not is completely without merit. Godwin’s Law isn’t appropriate, and the Nazi Doctors definitely ARE appropriate. And, it should be noted, that the reference supports your point. Nazi doctors DID exercise personal judgment. The linked book is, to a large degree, a documentation of their arguments supporting experimentation on Jews (and others). But hey, if you don’t think the ethical choices doctors have to make under government dictate is appropriate to the discussion, don’t let me get in your way.

    Oh, and look, you chose “voluntary birth control” rather than “abortion”. How cute. I call selective reasoning. Wackjob.

    “Professional responsibility also requires a doctor to act on medical knowledge, not religious beliefs.” – gdlchmst

    There is no medical knowledge that pinpoints the exact moment a soul/free will/self/person comes into existence (or even if one exists at all). Birth Control does have side effects, and so does abortion. Refusing treatment is perfectly reasonable given the extent of medical knowledge.

    What ISN’T reasonable, is outlawing abortion and birth control. At least, not until there is scientific knowledge supporting the existence of a magic self orb.

    You see how that works genius? No, no, don’t rush to answer. Think it over a bit.

  200. #200 articulett
    August 18, 2008

    God off money!

    MSNBC currently has a poll up about removing the God motto from American currency:

    [url]http://www.msnbc.msn.com/id/10103521/[/url]

    Y’all go play.

  201. #201 MTran
    August 18, 2008

    I don’t agree that they’ve addressed my arguments.

    I don’t actually see substantive arguments that can reasonably be addressed.

    Instead, I see woefully inadequate analogies, mistaken equivalencies, and a framework of assumptions based on a highly simplistic and idealized concept of ethics and economics.

  202. #202 MikeM
    August 18, 2008

    Meanwhile, in California, “Doctors in California must treat gays and lesbians the same as any other patient, regardless of religious objections, the state Supreme Court ruled today.”

    http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/08/18/BA2212D6H4.DTL&tsp=1

  203. #203 Malcolm
    August 18, 2008

    Bad,
    So, if a biology teacher refuses to teach a part of the curriculum because it contradicts their religious beliefs, the school board should not fire them, but should instead just hire more teachers.

  204. #204 MTran
    August 18, 2008

    Malcolm suggested: So, if a biology teacher refuses to teach a part of the curriculum because it contradicts their religious beliefs, the school board should not fire them, but should instead just hire more teachers.

    If we stick with Bad’s examples, the parents who object to the teaching of creationism could simply find another school where their child can be educated in a manner that the parents approve. Then they wouldn’t be forcing their own morals on the teachers.

  205. #205 gex
    August 18, 2008

    And when all the physicians freely decide that they won’t provide a service as is their right, Bad? What becomes of the patients’ rights?

    Have you ever stopped to notice that the services these guys do not want to provide are related to queers and women? I can’t get birth control covered by my insurance company, even though it was prescribed for menstrual/health related reasons and not family planning. But Viagra sure as hell is covered.

  206. #206 D
    August 18, 2008

    I don’t think these have been linked yet.
    http://www.searo.who.int/LinkFiles/Regional_Health_Forum_Volume_10_No_1_01-Professionalism_in_Medicine.pdf
    http://www.cirp.org/library/ethics/geneva/

    Not all physicians take that latter oath of course, but they all take some sort of oath to be vetted. They break that oath when they refuse care or treatment to the intentional detriment of their patients. To be a physician, one must already be licensed by the state. Requirements must be met and maintained to be licensed. The contended example here would already be covered if religion, more specifically christianity, wasn’t given undue regard.

  207. #207 Brine Queen
    August 18, 2008

    I would like some clarification on the issue. I can see why practitioners might refuse abortion and maybe the morning after pill, based on the fact that they feel that they are ‘killing someone’ (not that I agree), but why birth control? As the previous post pointed out the primary purpose is not to prevent implantation of a fertilized embryo, but to prevent the fertilized embryo from ever coming into being.

    In that case, is the objection to providing birth control that unmarried women might be having sex outside of marriage? Does that mean that they’ll let married women have BC (provided you were married in a church)?

    Point of interest: Are there any unmarried men out there that are being denied viagra?

  208. #208 Carlie
    August 18, 2008

    Oh, and look, you chose “voluntary birth control” rather than “abortion”. How cute. I call selective reasoning. Wackjob.

    WRONG. The new exemption clauses are being written specifically to include standard birth control, and PZ has written entire posts here on this very site explaining in great detail why EC has no effect on fertilized eggs. I’m not even going to link to it, because you ought to do your own damned research.

  209. #209 Carlie
    August 18, 2008

    Sorry. Only the first word was supposed to be bolded.

  210. #210 Rowen
    August 18, 2008

    Too bad many of these analogies fall pretty far from the mark. Just about everything you can get at Walmart can be bought online, the only difference being that you won’t get to walk out of the store with it in your hand. As for the grocery store, legally, it won’t be able to do that, unless it becomes some sort of private club like Sam’s. And, we the patients aren’t just the consumers, we are also partially the employers, since we pay for part of the medical services AND we pay the insurance companies who then pay the doctors.

    So, by that account, a doctor refusing me treatment solely on religious grounds is offending me as consumer and employer.

    This is more complicated then the basic economics that that Bad is espousing, and so far, none of his suggestions seem feasable. How are we, as the minions of the earth, supposed to influence both insurance companies and health care providers when we can’t even get them to actually provide us with service half the time? If I can’t rely on my doctor to give me what I need, when I need it, then why shouldn’t I seek outside help in making sure this doesn’t happen again? (And yes, contraceptives can be and are neccesities. If you think they are luxuries, I’d like to hear a good reason why. Beyond “people can just stop fucking.”)

  211. #211 Ace of Sevens
    August 18, 2008

    There seems to be an assumption from many commenters that any objection to performing abortion must be religious. I can see hwo this is the case for birth control, but it strikes me that while there is a strong correlation between abortion opposition and religiosity, the arguments against abortion are mostly not religious in nature and there are peopel who object for non-religious reasons, though not exactly a lot.

    The other issue is some people seem to be operating under the assumption that it is the duty of any doctor to perform any legal procedure they are qualified to perform that is medically indicated (with a very broad definition of indicated, meaning the patient thinks they need it and there’s no good medical reason to deny it). My question is who says? Peopel who are doctors right now certainly didn’t enter under this assumption. Are you seriously saying we should tell a guy who just got out of med school we just changed our minds abotu what your job is and you must now either committ what you believe to be murder on a regular basis or face financial ruin from your student loans? The same goes double for all you people wanting to make long-practiing doctors forfeit everything they’ve made.

    If you want to eliminate a bunch of otherwise useful doctors (many probably by suicide, which is a common reaction to professional ruin among older males). It’s a huge step from the idea that a procedure should be legal to performing it should be a requirement to hold a medical license. The sort of step slippery slopes are made of. This is sort of like the jump between legalizing gay marriage and forcing all churches to perform them. (What if there’s no Unitarian church in town?)

  212. #212 Nomad
    August 19, 2008

    I think the idea of teachers refusing to teach evolution because of religious issues has already been brought up.

    Actually I have more direct experience. In high school I had to take one semester of “health” class. Overall it was a decent enough class, but I had a teacher who stated that he was against sex before marriage for religious reasons but claimed that what he taught in class had nothing to do with those beliefs and then proceeded to teach abstinence only education, going so far as to lie about failure rates of condoms to support his position. I still remember one of our class projects, to make a poster about why we shouldn’t have sex until marriage. I absolutely refused to go along with that, I made a pro condom poster instead. I was a much more meek, less confrontational person then than I am now, but I still wasn’t about to go along with that BS.

    Understand that our district was not a fundamentalist abstinence only sort of place. The school district’s approach clearly included a certain amount of scare tactics with regards to the possible results of having sex and an attempt to suggest that abstinence was the best plan (I dislike the scare tactics, I think they’re insulting to the student, but would agree that abstinence is generally the best option), but it wasn’t like what I’m seeing being pushed today. We were supposed to cover the concepts of birth control, not just say they’re all rubbish and then discard them. This wasn’t following orders, this guy was out doing his own thing. Curiously enough we had another health teacher who was an open lesbian, in a relationship with another woman. I think she’d had a child through artificial insemination.

    Aside from issues of procreation (or prevention of procreation) he was a very competent teacher. However in that one area he failed to fulfill his duties because of religious conflict. But rather than opt out of that particular area of conflict (which would have meant not taking the job teaching the class), he proceeded to substitute his own religiously dictated curriculum.

    Let’s just be honest. This is a case of the religiously motivated trying to subject the entire country to their rules. Having failed to dictate the laws, they want to get into positions of power so that they can dictate the behavior of others directly. If, say, the law were written such that a practitioner (be it a doctor or a pharmacist or whatever) is allowed to opt out of areas of religious conflict IF there is another practitioner available to fulfill that duty, then I’d be okay with it. The rights of the patient are protected as well.

    Without such a provision a law like that would basically mean that anyone living in rural America was on their own in terms of trying to find non religiously dictated medical care. It’s not bad enough that the cost of health care can be prohibitive in and of itself (especially for lower class rural Americans), now it’s supposed to be their problem if they can’t find a doctor who thinks that an invisible man in the sky dictates their behavior?

    It’s an attempt to establish a De Facto theocracy.

  213. #213 Matt Penfold
    August 19, 2008

    There doesn’t seem to be anyone around here that “supports racism.” But you are a liar if you claim that I do.

    “Of course you claim to be against things like racism, but I do not accept your denials anymore.”

    Well, no wonder. Here I am having the audacity to point out that instead of some moral obligation being someone elses problem, it might actually require something out of you other than expressions of self-righteousness.

    From your response to Max Fagin:”And if there is only one general practitioner in town ? What does a patient do then?”

    I don’t know Mr. Penfold: what are YOU prepared to do to help change that situation?

    You have made it clear that you think doctors have the right to deny treatment to anyone on any grounds. Thus you will support doctors denying treatment to people based on race.

    I am guessing that you did not originally set out to support the right of people to engage in racism in their jobs. It seems that in your eagerness to allow the religious an exemption from civilised behaviour you failed to properly think through the consequences.

  214. #214 Bad
    August 19, 2008

    No, Matt, as I made fairly clear, I have thought through the consequences. It is and always has been my position that private individuals should be able to engage in discrimination, and that the legal system is the wrong place to confront this issue. The reasoning for alleged harm, other than psychological, is faulty, based on the idea that people deserve, by right, certain things from certain other specific people.

    However, that’s not really even the issue here, and you’re merely engaging in reducio to try and get there. The issue in this case is whether the role of doctors should be defined to adhere to your politics/ethics or pro-life politics/ethics. You insist that medical ethics conform to your vision, and that there be standards that kick out anyone who doesn’t agree. Pro-life doctors disagree. It isn’t simply a matter of “don’t do the job if you can’t do X” because they don’t agree that X is a legitimate part of the job.

    But hey, don’t believe me: just go to a Catholic hospital and ask for a vasectomy or tubal ligation and see what happens.

    Furthermore, the justification given as to why these doctors should be forced to perform proceedures and proscribe medications that they consider unethical is flat out junk. Lack of access is not a problem for which individual practitioners are exclusively responsible for solving.

  215. #215 Bad
    August 19, 2008

    Malcolm :”So, if a biology teacher refuses to teach a part of the curriculum because it contradicts their religious beliefs, the school board should not fire them, but should instead just hire more teachers.”

    I don’t know how people could miss the distinctions here. Public schools are a different matter entirely, legally and ethically, than private individuals. Of course they can fire, and should fire, such a teacher.

    Private schools, on the other hand, can, and many do, choose to employ, or not, teachers that teach creationism.
    However, there is no justification for parents demanding that the law force the private school to teach or not teach creationism, according to their desires, nor is lack of access to non-religious education the problem of the religious school.

  216. #216 Matt Penfold
    August 19, 2008

    No, Matt, as I made fairly clear, I have thought through the consequences. It is and always has been my position that private individuals should be able to engage in discrimination, and that the legal system is the wrong place to confront this issue. The reasoning for alleged harm, other than psychological, is faulty, based on the idea that people deserve, by right, certain things from certain other specific people.

    Then I will have just to disagree and hope I never live in the type of society you advocate. I just hope you are never the victim of the type of discrimination you seek to allow.

    If you cannot see the harm discrimination does then there is no point arguing with you.

  217. #217 Bad
    August 19, 2008

    “Armchair Dissident: You cannot claim, at the same time, that the employer retains the right to dismiss an employee for failing to perform their duties, and at the same time claim that the employee does not have the right to dismiss an employee for failing to perform their duties. Which is what you’re claiming.”

    I can and do claim it. And in fact, I already explained what you got wrong in understanding what I am saying, and yet you’ve gone on to repeat it AND call me a liar in the same comment you repeat the misrepresentation. Charming.

    I never argued that people have the right not to be fired. I argued that there is no legitimate right to have OTHER people, specific other people, provide you with the services you want or assert that you deserve by right. Employers should be able to hire and fire anyone they want based on whether or not what they are willing to do fits the service they want to provide. That’s not even remotely the same thing as consumers demanding that the government force employers to fire someone, or force them to perform some service, which is what I’m talking about.

  218. #218 Bad
    August 19, 2008

    Chiroptera: “I’m sure that the inherent contradictions and hypocrisies of my own moral framework are fascinating to some people, but let’s not get sidetracked from the topic at hand.”

    Oh, but I think they are very relevant here. The issue is “who has the obligation to provide X, if we decide that its a right.” It’s the same question, in a way, as who is responsible for saving or not saving that drowning child. Your example sets it up such that only a single person is around to even know about the problem and have a chance to act. My point is that this setup is both rare and misleading when thinking about moral obligations generally. In reality, there are often millions of people watching that child “drown” with their fingers easily within reach of the button that could save it.

    Same here. We all agree that access to medical care that includes reproductive choice is an important value. But for some reason people seem to think that providing it is the exclusive responsibility of a nearby doctor who happens to be opposed to reproductive choice.

    “The subject is whether physicians and pharmacists have these particular professional obligations in spite of whatever religious beliefs that they might hold. You claimed that you have an analogy that show that they don’t.”

    Several actually.

    “A consequence that I see from your analogy (and your explanation of it) is that no one really has an obligation to help another. I may be misunderstanding your point; if so, you have the opportunity to clarify.”

    Sure: you’ve gotten it precisely backwards. The consequence is not that no one has an obligation, but that everyone does. People here seem to be arguing that moral obligations are best dealt with by using the law to force other people to deal with them even if the people in question think they are doing great moral harm rather than good. I think that’s simply wrong, on top of very likely being a lousy and counterproductive way to try and solve the problem in the first place.

  219. #219 sjburnt
    August 19, 2008

    Tom @ 88:

    Respectfully, you have it backwards. The cat is an animal, but it is only there because one of us thought it was a ‘pet’. Animals kill other animals, yes, and that is why I protect natural predators from those who are less informed.

    I don’t demand that someone cut their pets digits off (I am well aware what declawing entails) because they fill their niche as a predator. I demand it when they decide that their pets can have free reign over the rest of the neighborhood. Keep the damn things indoors, or keep them on a leash. Using your logic, I should be able to let loose another domesticated pet, a pig, and let it root up your yard.

    The problem is not the cat, it is the idiots who let them roam free, ignorant of the damage they cause.

    Maybe I need a husky, too! I guess I will have to resort to trapping them. That should get your undies in a bundle. But wait! I guess I am an animal, so I am entitled to kill indiscriminately?

  220. #220 Natalie
    August 19, 2008

    Same here. We all agree that access to medical care that includes reproductive choice is an important value. But for some reason people seem to think that providing it is the exclusive responsibility of a nearby doctor who happens to be opposed to reproductive choice.

    Bad, who has said anything like this, other than yourself? You keep making this claim but you don’t seem to have anything but your own leaps in logic to back it up.

  221. #221 Leigh Shryock
    August 19, 2008

    Bad, as a libertarian, do you agree with the current restrictions at obtaining new doctors? Keep in mind that the industry is heavily regulated – for our own health. If you’re going to object to a heavily regulated industry, that a few elite can enter having obligations, yet not object to the heavily regulated industry, then you are a master of the fine art of hypocrisy. Now, what happens if we lower the bar, or remove it entirely? Can crystal healers and homeopaths practice and call themselves doctor, and do you really believe the free industry will weed them out?

  222. #222 Leigh Shryock
    August 19, 2008

    Also, considering that the article in question is about Canada, and that Canadian doctors suck on the teet of the Canadian government, wouldn’t the same logic apply, in regards to teachers teaching evolution as applies to doctors/pharmacists and birth control/abortion?

  223. #223 Bad
    August 19, 2008

    Natalie:”Bad, who has said anything like this, other than yourself? You keep making this claim but you don’t seem to have anything but your own leaps in logic to back it up.”

    Virtually everyone here is arguing that we should penalize someone for not being willing to do what they think is immoral, or require by law that they must do it.

    Leigh Shryock:”Bad, as a libertarian”

    I find it odd that people should think that I’m a libertarian given that I don’t think childishy smacking around people who won’t offer services you want them to offer is a good idea, or even any sort of sensible solution to a problem of limited resources and access. Or that I’m not happy with the ethical implications of the idea of scapegoating.

    Given that I favor the heavy subsidy of things like education and health care, and my whole argument here is that the proper solution is to fund more doctors, I have a hard time seeing how any libertarians would allow me to participate in their reindeer games.

    “Also, considering that the article in question is about Canada, and that Canadian doctors suck on the teet of the Canadian government, wouldn’t the same logic apply, in regards to teachers teaching evolution as applies to doctors/pharmacists and birth control/abortion?”

    Insofar as the people are essentially the employers, and they have a democratic process to set whatever rules they want for this employment, then sure, it would.

    But I don’t think most of the people arguing against me here care whether or not the government is supplying the service or not when it comes to what they think doctors should be made to do.

  224. #224 Leigh Shryock
    August 19, 2008

    Bad, all the same, you advocate a more ‘hands-off’ approach to the matter… in a heavily regulated industry. You seem to think that the problem will solve itself with more doctors, but what if the newer doctors, as expected, are in the same proportion of supporters and non-, as exists now, and the issue of localities providing biases, et. al… what really makes you think that encouraging more doctors will solve the issue? Also, unless doctors are required to display their biases against certain things that might be expected for a doctor in their field to do, it is highly inconvenient, and sometimes ridiculous (in cases where emergency contraceptives are needed) to force people with insurance to find new doctors?

    Also, since you support subsidizing health care and education for health-care professionals, would you agree that the government can set regulations on money received, prohibiting discrimination, if they receive said money?

    Here we have a system where a few elite are allowed to become doctor… and as such are held to higher standards, and are given certain obligations. Would you object to future doctors, but not necessarily current doctors, being required to sign non-discrimination agreements in order to practice? It’s already a regulated system, and allowing discriminatory behavior in the few that pass the bar could severely limit the amount of health-care available to those discriminated against.

  225. #225 Matt Penfold
    August 19, 2008

    The idea that the right of bigots not only to hold bigoted beliefs but to put those beliefs into practice does seem very odd.

    It would seem Bad thinks the right of people to hold such beliefs takes precedent over those such people owe a duty of care to. Happen to black and get a doctor who does not want to treat you ? Well Bad would support the right of that doctor not to treat to you, and thus would also not care if you died as a result.

    Bad comes across as a pretty contemptible person.

  226. #226 Paula Hall
    August 19, 2008

    I’m new to the discussion, very interesting. There was a lot to read and I’m sure I missed something, and perhaps what I’m going to say is repetitive.

    FWIW: I’m not sure I have seen anyone address the fact that there is no law requring X number of people to become physicians. Becoming a doctor in countries like Canada and the U.S. is still a matter of free choice. If no-one chose to become a doctor (or other healthcare provider), what would it mean to have a right to medical care? No-one doubts that an objecting physician has the right to simply close up shop, stop becoming a government employee. But then — what’s the plan for replacing that person? There’s an unstated assumption made by some commenters that once we throw the bum in jail for refusing to provide certain services, that the right to health care of that doctor’s former patients can still be easily met, as if doctors grew on trees. They don’t.

    Which brings me to the issue of licensing. If licensing were an entirely private affair, such that one could practice medicine without seeking a license from any given group or authority, then this would be a non-issue. Anyone could hang up a shingle, claim to provide some type of care. No-one would go to them for medical care unless some reputable body had provided some accreditation. This accrediting body would have standards for maintaining the license, and they could withdraw their imprimatur from practitioners who didn’t meet their standards. Once the person without a license went out of business, someone else down the street could open up a shop and seek accreditation and make some money providing the services the first practitioner refused to provide. Similarly, if a given organization tended to license incompetent professionals, that organization’s license would be worthless, and some other licensing organization could step in to give their Good Housekeeping seal of approval to different practitioners.

    The problem comes in when you consider that only government-licensed doctors can prescribe contraceptives, or perform abortions, or provide whatever the government decides is a medical service. In these circumstances there is forced one-stop shopping. And so you end up with the dilemma being discussed here: legislating one set of ethics. Legislating one set of ethics will have the effect of reducing the number of doctors. But there is no way to force someone to become a doctor to replace the doctor you’ve had to throw in jail for ethical violations, or to replace the doctors that never come into being because they’ve taken the advice of some commenters and chosen a profession in which they won’t face these kinds of ethical conflicts.

    So now I’d guess you know where I’m coming from: keep the government out of medicine altogether. Use laws like theft and fraud to prevent people from claiming they will provide a service they have no intent of providing. Use laws like assault and battery against charlatans that harm people’s health. And let the free market take care of the rest.

  227. #227 Andrew N.P.
    August 19, 2008

    Well Bad would support the right of that doctor not to treat to you, and thus would also not care if you died as a result.

    Actually, I’m pretty sure a decent criminal case could be made if you died as a result of the doctor’s bigotry. Depraved indifference, reckless endangerment, or something like that. Point is, a doctor can be expected to know your odds of survival without treatment, so refusing to treat someone who might otherwise die would be a Bad Thing, regardless of whether that refusal comes from his religious beliefs, his other prejudices, or because it’s five o’ clock and tee time is 5:15.

  228. #228 MTran
    August 19, 2008

    Paula Hill,

    You seem to be proposing a “free market” vision of what you think is an ideal system for access to health care. But that does not answer the question regarding patient rights vs doctor obligations as they exist within the existing framework of laws in Canada.

    I don’t know anything about Canadian health care laws, so I don’t want to make assumptions about what might be workable or authorized in that country.

    What I have seen in the regulation of health care in the US makes me think that very few people are familiar with the rather extensive efforts by medical regulatory boards to ensure that patients are not unfairly discriminated against while attempting to provide reasonable and safe alternatives for medical practitioners who have strong religious or ethical beliefs that are at odds with certain medical choices.

    Typical work-arounds for “legitimately” conflicted medical care givers permit them to opt out of performing certain procedures if they can assign the task to another qualified professional within their organization, refer the patient to another professional outside their organization who can act promptly, or, if no other qualified professional is available, to perform the procedure or a part of a multi-stage the procedure that will be taken over by another professional at a later stage.

    These are not unreasonable burdens on medical practitioners and they provide rather clear guidance when confronted with highly personal religious objections.

    A more immediately practical approach to defeat religious extremists before they start is for a patient to complain to the medical board or to their insurer about the doctor or for interest groups to make sure that health care plans insist that their doctors provide all the medical services associated with a typical practice. And contraception and pregnancy termination are quite predictable medical needs.

    As to your “free market for health care” fantasy, that’s all it is, a fantasy that has so much evidence against its viability or desirability that it’s hard to imagine that anyone with much experience in life or real world markets, let alone the health care industry, could propose it with a straight face.

  229. #229 Paula Hall
    August 19, 2008

    MTran –

    Thank you for your feedback. I am not an expert in health care matters, but here is a link to a doctor, an expert, who has a lot of experience in the health care industry, who argues that a free market is the solution: http://www.westandfirm.org/blog/index.html. He also has written an article, complete with a ton of research, here: http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-universal-health-care.asp.

    Dr. Hsieh has adduced much, much evidence in favor of a free market for health care.

  230. #230 MTran
    August 19, 2008

    Paula Hall,

    Thanks for the links. They didn’t work, but that’s fairly common on these blogs!

    However, I’m afraid you have mistaken an ideologue for an economist and have assumed that the “morality” he espouses is the only legitimate morality. He has not shown that he knows what choices made by social groups or individuals are more “moral” or “ethical” at all. He has simply made assertions about moral choices, like anyone else on usenet or teh intarwebs.

    Aside from Hsieh’s clear dislike of what he calls “socialized medicine”, he has not provided any reason to think he knows jack about economics. Socialized medicine was not a position I have advocated here, so it’s not clear why you would send me off to an article that features an anti-socialized medicine rant.

    Still, none of Paul Hsieh’s self satisfied “research” addresses the question “What rights do patients in Canada have today?” His research is of a decidedly ordinary (high school student or freshman college) level. It’s clearly written, though, which is more than can be said for most of these sorts of position statements.

    But as far as I’m concerned, a fanatic, economic ideologue is no better than the religious whack jobs who spout off about “morals,” ethical choices, and public policy.

  231. #231 Nerd of Redhead
    August 19, 2008

    I think the ultimate answer would be to allow doctors/pharmacists to say “no” to a procedure or pill, but make them legally responsible for consequences of that decision, unless a quick referral is made to another doctor/pharmacist who will take care of the issue. The religious want to be able to say “no” without any consequences. There should be consequences. Nothing like paying half the cost of raising a child to 18 to make one question whether not filling a plan B prescription really goes against your morals.

  232. #232 Billie Schnopp
    January 2, 2010

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