Pharyngula

Protecting the Right of Conscience?

Guest Blogger Danio, sneaking a few more posts in:

Remember that execrable HHS policy document that proposes an extension of the current protections for health care workers who refuse to provide or assist in treatments that they personally find morally objectionable? I did a little back-tracking on this issue, and followed the trail of HHS Secretary Mike Leavitt, who requested this regulation after a “disappointing” interaction with the American College of Obstetricians and Gynecologists. He has since been unwavering in his support of the proposal–which he claims is not about abortion OR contraception, but about conscience rights–and has a recent blog post responding to the feedback he’s received from pro-choice activists as a result of the leaked document.

Here’s the money quote:

Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?

Social statement?” I can scarcely get my mind around the fact that he is so openly, unapologetically endorsing a policy in which pious opinion would trump secular law. Once again, though, it shouldn’t be a surprise. After all, he himself states that “The Bush Administration has consistently supported the unborn”. Ah yes, even as they indiscriminately leech the quality of life (if not the life itself) from countless other self-aware, functioning humans on the planet, each and every blastocyst they encounter is ceremoniously wrapped in a mantle of sanctimonious protection.

Somehow even more disheartening are the numerous fawning, unctuous comments on Leavitt’s recent blog entry. One wrote:

Secretary Leavitt,

It is beyond my comprehension that anyone would be offended by a health care professional who valued human life. But the tragedy is our culture has regressed to a form of barbarism unseen in centuries where progress in technology and science has poisoned our minds, hearts and souls where the intentional destruction of innocent and vulnerable human life has become more important than saving it.

Those of us living and working in a society where human life is expendable by government dictate but fail to stand up to protect and cherish life at any and all costs will live to regret it.

You are doing the right thing Secretary by allowing those of us in the health care profession live our moral and ethical consciences rather than forcing us to choose another profession.

Choose another profession like….a PETA supporter working in a meat packing plant?An auto mechanic who doesn’t support the use of fossil fuels?

Keep your eyes on this one. It has ‘lame duck’s parting shot’ written all over it.
______________________________________________________________________________
UPDATE: Leavitt has a new blog entry up today announcing that the proposed rule is being filed in the Federal Register. Although the final draft no longer contains the specific language broadening the definition of “abortion” to include anything from “conception” onward, it still threatens to withhold Federal money if health care organizations don’t allow their employees to exercise their rights of conscience.

Comments

  1. #1 I am so wise
    August 20, 2008

    I once knew a guy who dropped out of college because he did not expect to have to read as an English major. This crap is just more of the same, but stupider.

  2. #2 thepetey
    August 20, 2008

    Hopefully minds like the SC of CA will prevail in this medical fiasco waiting to happen.

  3. #3 Thepetey
    August 20, 2008

    Also, why are so many “pro-life” people also “pro-capital punishment”?

  4. #4 Hap
    August 20, 2008

    I would have figured Leavitt would have gone with the option that doctors can ignore the parts of the Hippocratic Oath that they don’t like (like the part about doing no harm). It’s worked out so well for W – just ignore those inconvenient laws and you’re off to the races.

    Actually, this would be a second try, the first being the suggested “catastrophic coverage” plan for health insurance – if nobody can afford to get care, you don’t have to worry about abortions and other such procedures (other than those wealthy enough to afford it, and we all know they would never have need of such care). Nobody quite bought that one, but like roaches and drug-resistant bacteria, the Bush Administration does persist.

  5. #5 SC
    August 20, 2008

    More evidence that we can’t ever let down our guard or stop working on the ground.

  6. #6 MAJeff, OM
    August 20, 2008

    Also, why are so many “pro-life” people also “pro-capital punishment”?

    Because the right to life ends at birth.

  7. #7 Glen Davidson
    August 20, 2008

    but about consciousness rights

    I don’t think you mean that.

    Glen D
    http://tinyurl.com/2kxyc7

  8. #8 Alex
    August 20, 2008

    So wait…

    What they’re advocating is for anyone to be able to remain employed, holding a position where they consciously object to the duties they are getting paid to perform, while not performing those duties!

    Are you all fucking crazy!? I’m voting for this one!! Hello lifetime of salary for not doing my job!! Here I come!!!

    I wonder if these idiots understand the concept of THINKING.

  9. #9 Kobra
    August 20, 2008

    Yes, it is a social statement. A big one that says, “We hate women.”

  10. #10 Danio
    August 20, 2008

    I don’t think you mean that.

    Gah! Thanks Glen. That’s what I get for trying to post and troubleshoot the confocal at the same time. King of Typos, I have your dominion in my sights :)

  11. #11 Katkinkate
    August 20, 2008

    I think part of the push to prevent abortions is economic. Today’s economic system relies on continuous growth to stay up and running. A contraction of the population would contribute to a contraction of the economy, which is commonly called a depression.

  12. #12 thepetey
    August 20, 2008

    To play devil’s advocate, I still say a doctor – in private practice – has a right not to perform any procedure they don’t wish to perform. These doctors need to be very up front about it. I say they ADVERTISE it. This way all the religious nut-jobs will go to religious nut-job doctors and free up appointment space for me.

    If a doctor is hired by a clinic/hospital though, and they refuse to perform a procedure that the clinic offers without sound medical reasons for refusing, they should be fired for dereliction of duty.

    Also, if they perform the service for one, they need to perform it for all – or that is discrimination.

  13. #13 Sui Generis
    August 20, 2008

    The authoritarian rule of fascism, patriarchy theocrats.

  14. #14 thepetey
    August 20, 2008

    #11 Katkinkate

    But that goes against Bush’s jobs program / war in Iraq where he is opening jobs for people by killing off the soldiers who formerly held them.

  15. #15 Leo B.
    August 20, 2008

    I propose a mental experiment: a Jehovah Witness E.R. doctor that refuses to give injured people blood transfusions.

  16. #16 Wowbagger
    August 20, 2008

    I have trouble with decisions that make people have to perform tasks that they are strongly opposed to – and which I would also be paranoid about them performing them well if they were doing them unwillingly – so I think the best option is, as mentioned before (in this thread and the other), that anyone who isn’t going to provide a full range of services is required to make that information public.

    Where there’s a situation such as a one-doctor or one-pharmacist town then it gets more complicated; maybe then some sort of law or regulation would help.

  17. #17 Danio
    August 20, 2008

    To play devil’s advocate, I still say a doctor – in private practice – has a right not to perform any procedure they don’t wish to perform. These doctors need to be very up front about it. I say they ADVERTISE it. This way all the religious nut-jobs will go to religious nut-job doctors and free up appointment space for me.

    This is assuming that you live in a community large enough to have a choice. The episode of “Frontline” from a few years ago called “The Last Abortion Clinic” is a real eye opener on how scarce such practitioners are in parts of the US.

  18. #18 Louis
    August 20, 2008

    It is, perhaps controversially, an issue of choice and choice alone.

    I’m a research scientist, my field is synthetic chemistry. I can make, and could be employed making, chemical weapons. I could work for the military in such a capacity. I don’t. Why? Because such a job would strongly conflict with my personal ethics, so I haven’t taken such a job. If abortion conflicted with my ethics (it doesn’t), I wouldn’t become a medic. Simple.

    I never said it was an easy or nice choice.

    These people need to either do their jobs or switch jobs. Sorry, but imposing their morality onto the people they are meant to serve is unacceptable.

    Louis

  19. #19 Newfie
    August 20, 2008

    Choose another profession like….a PETA supporter working in a meat packing plant?An auto mechanic who doesn’t support the use of fossil fuels?

    The use of logic against illogical people is retarded. Until you actually have separation of church and state, and stop electing religious nutbags to public positions you will never stop having these same batshit arguments.

  20. #20 SC
    August 20, 2008
  21. #21 Jackal
    August 20, 2008

    OT, but here’s another poll to Pharyngulate. They want to know who John McCain should chose as a running mate. You’ll need a junk email address to though, if you don’t want to hear from the AFAsshats. Or you can just spam filter them.

  22. #22 Alex
    August 20, 2008

    “…I still say a doctor – in private practice…”

    The private practice part is the crux of the matter. If you want to own and operate an auto-repair shop but choose not to do oil-changes, that’s fine. It’s your right and business decision. If you do oil-changes and hire a mechanic who refuses to do oil-changes, that person can take their sensitivities to their next employer. Moving this analogy to the medical field, or like Louis’ post about chemical weapons, it’s easy IMO to see where the lines should be drawn, employer versus employee. If you are a doctor that refuses to perform abortions working at an abortion clinic, then there are some questions about why you are working there.

  23. #23 Josh K
    August 20, 2008

    I think part of the push to prevent abortions is economic. Today’s economic system relies on continuous growth to stay up and running.

    I disagree.

    I think we can trace the roots of laws against birth control, abortion, homosexuality, masturbation…for brevity’s sake, call them the ‘pro-population laws’…all back to a time in which the name of the game was to outbreed the other tribe/ethnicity/sect/country.

    While I would agree that large family sizes are a hedge against old age and high infant mortality, I think the actual laws originate from the desire to spread ‘us’ over ‘them’.

    I could be wrong; I’ve only got a handful of half-remembered histories to go on, so I’ll listen if someone wants to cite sources otherwise.

    Anyone else just have a flashback to George C Scott at the tail end of “Doctor Strangelove”? :)

  24. #24 Qwerty
    August 20, 2008

    I’ve read the only practitioners in South Dakota who will perform an abortion are in Sioux Falls. Makes it quite inconvenient if you live on the other side of the state.

  25. #25 Danio
    August 20, 2008

    If you are a doctor that refuses to perform abortions working at an abortion clinic, then there are some questions about why you are working there.

    I think this would be an easier situation to solve, actually. The complex reality is that you have doctors (and nurses, and technicians, and ambulance drivers, and pharmacists) refusing to fulfill their patients’ requests for legal family planning procedures and prescriptions–not only refusing to do it themselves, but refusing to provide information on where to find someone who will, and often using their positions of medical authority to discourage patients from seeking these treatments at all. It goes way beyond what occurs within a designated ‘abortion clinic’.

  26. #26 skyotter
    August 20, 2008

    i can’t help but notice that the same level of support for “right of conscience” wasn’t given to those Muslim cabbies who refused to provide service to people carrying (unopened) alcohol

    where were these “right of conscience” heroes then, huh? they somehow condone their own refusal-of-service while condemning it in others. gotta love the irony

  27. #27 Zar
    August 20, 2008

    Josh K:

    “I think we can trace the roots of laws against birth control, abortion, homosexuality, masturbation…for brevity’s sake, call them the ‘pro-population laws’…all back to a time in which the name of the game was to outbreed the other tribe/ethnicity/sect/country.”

    Bam! On the nose! I totally agree.

    Surges in anti-family planning sentiment tend to happen alongside surges in immigration. They’re afraid of the “wrong” people out-breeding the “right” people.

    In the late 19th/early 20th century, abortion was sometimes called “race suicide”!

  28. #28 Alex
    August 20, 2008

    “…but refusing to provide information on where to find someone who will, and often using their positions of medical authority to discourage patients from seeking these treatments at all. It goes way beyond what occurs within a designated ‘abortion clinic’.”

    Clearly an outrage. Withholding or misrepresenting information in an attempt to force another person to comply with your conscious is abuse of authority. I have a hard time imagining that law makers, or even existing practices, don’t address this clear abuse of power. If that is the case, there is clearly some work to be done.

  29. #29 ERV
    August 20, 2008

    Whoa whoa whoa whoa.

    This is NOT about ‘forcing’ doctors to perform procedures they are against. No one is holding a gun to a med students head and forcing them to specialize in ‘abortions’. General OB/GYNs are never forced to perform abortions. It has nothing to do with what an MD does in private practice.

    What Levtwitt is trying to do is make it okay for a doc not to refer their patient to a physician who does specialize in abortions.

    Analogy– You go to your general care provider with migraines. He thinks migraines are the result of demons, so he REFUSES to refer you to a neurologist. Without the referral, your insurance wont cover even a consultation visit. Without the referral, even if you have to pay out-of-pocket, you have no idea who to go see. Even if you find the name of a neurologist, theyre booked for six months because… you dont have a referral.

    This is not about forcing MDs to perform procedures they dont agree with. Levtwitt appears to just be a pandering idiot “DURP! DOCTURZ HAZ A RITE TO CONCIOUSNESS!”

  30. #30 NE1
    August 20, 2008

    I think your outrage is a little misdirected. We have tax breaks for houses to encourage homesteads and nuclear families. It is reasonable for the state to discourage/punish contraception when a) blastocysts deserve all the rights of humanity or b) it is deemed better for the country (see above) for the attitude expressed in throwing away seeds of life to be punished. Which would be an appropriate observation if society treated newborns without care or respect.

    Here though, the cost is worse than the cure, because there is no disease.

  31. #32 Interrobang
    August 20, 2008

    Well, of course they didn’t support the Muslim cabbies, skyotter. First of all, those kind of Christians would never publicly agree with Muslims on anything, even though in private they’re all taking notes on what they should religiously regulate next, and secondly, allowing conscientious objection to carrying unopened alcohol doesn’t directly interfere with women’s bodily autonomy, so there’s no reason for them to support it. After all, 9.9 out of 10 religious nutjobs agree: you need to be told what you can do with your own body (that’s 18 out of 10 if you’re female).

  32. #33 Michael X
    August 20, 2008

    I suppose I should lobby all pious HIndus to take up work at the butcher shops in small town grocery stories. I bet entire communities would instantly be up in arms over their ‘right to eat red meat.’ But when it comes to a woman’s right to control her own body, well…

  33. #34 Nerd of Redhead
    August 20, 2008

    I don’t mind an OB/GYN who won’t perform abortions due to their religion. What I have trouble with is an OB/GYN who won’t refer a patient to an OB/GYN who does abortions when the patient asks to be referred. Personally, that is stepping over of the line into either malpractice, or forcing their religion upon the patient doing the requesting, which is even worse. The physician/pharmacist should then become responsible for the consequences of their actions. This means that they should help pay for the raising of the child that results from their malpractice/religious decision. If they aren’t willing to face the consequences, time to change jobs.
    By the way, most doctors pretend to be self employed, but most of their pay comes from insurance companies, so the line is fairly fuzzy.

  34. #35 Tater
    August 20, 2008

    Let’s see him defend Policemen and Soldiers who believe in the Christian tenet of non-violence.

    Yeah, that will be porcine aviation day.

  35. #36 Max Verret
    August 20, 2008

    Danio: comparing meat packing and fossil feuls with human life – shame on you.

    ThePetey #3 “pro-life and pro-death penalty”? Yes, there are many people like that and frankly I wouldn’t waste too much time with them. Yes, they do contradict themselves but through some sort of mental giration they value adjectives not nouns. They separate “innocent” life from “guilty” life. So life has to take a back seat to their adjectives.

  36. #37 Monado
    August 20, 2008

    Wow, Danio, what a quote! “Your right to wave your arm ends with my nose.” Then “your right to make a social statement ends before ruining my life!”

    I’m thinking a bad word at them.

  37. #38 Monado
    August 20, 2008

    It’s not as if the fetus has had a chance to refrain from knocking over a bank.

  38. #39 Michael X
    August 20, 2008

    Max, it isn’t to say that meat and human life are comparable, it’s the logic that would justify each situation is what’s comparable.

  39. #40 Mold
    August 20, 2008

    Oh great, just when the Chinese and the Russians discover the joys of rational thought, we get BibleBeleeeving KKKristians who want a return to the days of lynching, coathanger abortions, and legal snake oil.

  40. #41 Screechy Monkey
    August 20, 2008

    Surely we should also protect the right of doctors not to give referrals to oncologists? Cancer cells have a right to life, too!

  41. #42 Steven Dunlap
    August 20, 2008

    Hap @ #4

    Actually, the wealthy do not care about the abortion issue because they can cross borders very easily. They can send their wives, daughters, girlfriends to another country for the procedure. It’s like combining a brief vacation with an errand.

    The law punishes the rich and the poor equally for the crime of sleeping under a bridge.

    MAJeff, OM @ #6

    “Because the right to life ends at birth.”

    Thank you for that one. It made my day.

    Katkinkate @ #11

    Have you ever heard of immigration? The U.S. population has increased more from immigration than from birth (at least North of the Mason-Dixon line) for the last 20 years or so.

    As for economic growth, all we need to do to make sure we can take care of people in their old age is stop spending $2 billion a week killing brown people. Many of the Christians (not all by any means) have no problem with ending those lives (and lying about it afterwards). [Not intended as a blanket statement to insult all Christians everywhere - just the crazy ones. You know who you are].

    Danio @ #17

    Are the abortion clinics scarce because of the conscience issue or because the doctors don’t want to get shot? Causation is a tricky question applied to any issue, this one even more so. (I have no idea which and could not even opine).

    My own comment (feeling snarky today):
    I wonder if maybe it’s just easier to love a fetus. It has complete innocence. It has no opinions for you to hate (and by extension, the person holding them). It has no ability to mooch off the public assistance system (at least not on its own). It does not break into your house (at least not for a few years). It’s just so much simpler to love it. And, (here’s the great part) it can potentially be recruited into your cult (or religion – what’s the difference again? I can’t remember). However, once it leaves the womb but at some point comes to refuse to join your church and follow the dictates of your God ? then it’s OK for him/her to die. A fetus must have the chance to be “saved.” It’s a little like the Catholics in Eastern Europe who took in and hid Jewish children during the war but then refused to give them back to their parents who survived. Saving the children wasn’t the main point. Acquiring more Catholics was.

  42. #43 genesgalore
    August 20, 2008

    human DNA is as common as snot.

  43. #44 Nemo
    August 20, 2008

    The thing that really shocks me about this is finding out that this guy has a blog. Are any other Cabinet members doing that?

  44. #45 Patricia
    August 20, 2008

    Thankyou Danio for this heads up. Well said MAJeff.
    This is a subject that makes me mad as hell. Protect a gobbet of cells to the point of killing a doctor…but don’t make sure the rest of us have health care, mental health care, housing or food. Let old sick people die, children starve and the veterans suffer from neglect. Well done Bushco.
    I have no children, because in 1975 when I married I thought the world was going to hell, and no child of mine should suffer that. Since then about 300 natural spontaneous “abortions” – how about that christian freaks 300 living eggs “lost”. It’s called menstruation, god did it. Grrr! Stupid bastards burn me up.
    This is pure religious hatred of women. Why women won’t wake up and leave the churches en mass is beyond me. Shit, this is a rant. I beg your pardon.

  45. #46 ice9
    August 20, 2008

    Conscience, I salute you.

    No more taxes for me. And stop signs–they suppress my personal liberty to go. I won’t be teaching any more gerundives–they go against my philosophy of the noun. No, my conscience begins where my fist hits whatever the hell it wants to hit.

    ice

  46. #47 Ames
    August 20, 2008

    Danio, fantastic job covering this the first (and second) time it came around. If you ever want to post on similar issues again, you’re welcome anytime you want on my blog :). We’d be lucky to have you (just e-mail!).

  47. #48 Noni Mausa
    August 20, 2008

    Speaking of people who are both “pro-life and pro-death penalty”, it seems to me that the answer is even simpler than a biological drive to outbreed the competition.

    I would say that what these have in common is a drive to control and limit the major life choices of others. Putting people to death (within a legal structure or not) is the extreme form of this. Forbidding or mandating marriage, childbearing, where one can work or live are all forms of enforcing control — and because these are the most personal and visceral matters, the methods of enforcement must sometimes be very brutal, and success in such control would be a strong indicator of social power.

    I see it mostly in men, where the urge to control sometimes drives individuals to actions which destroy others and themselves. But I have seen it in some women too, I’m thinking of a few savage miniature dragon ladies I have known (Filipino? Indonesian?) whose urge to control transforms them into scary, focused opponents in civil and small claims courts (where I have seen them) and doubtless at home and in their communities too.

    I don’t share this drive to control, it’s foreign to me, which I guess makes me a golden retriever of the human world. Toss me a tennis ball and I’m happy for hours.

    But I can see the social and economic benefit of having access to this sort of drive. They may be unpleasant, and some of the controllers self-destruct, but many achieve a far better standard of living than this golden retriever does, by sheer force of refusing anything less.

    Of course there’s more to the topic than this, but I hope this adds to the understanding.

    Noni

    .

  48. #49 Keanus
    August 20, 2008

    Abortion is not widely available. In only 87% of US counties can one find a clinic or hospital that offers abortions. Granted nearly two thirds of the population lives in the 13% of counties that have clinics offering abortions, but that leaves roughly 35% of the population without reasonable access. And I’m willing to bet that those counties not offering abortion are among the poorest. And, yes, Qwerty is right, South Dakota has only one clinic, a Planned Parenthood one, that offers abortion and it’s in Sioux Falls, a good four or five hour drive from the Black Hills. The last local doctor working for Planned Parenthood had to quit under the threats of violence and constant harassment, leading to the clinic’s current doctor being a retired ob/gyn who flies in weekly from Minneapolis. The pattern is repeated in every state in the nation. And intimidation, harassment, legal challenges, and actual attacks are the reason they are so scarce. Insurance also plays a part.

    But back to the topic of the HHS draft order. I read the entire thing (you can find it here) In all forty of fifty pages (or whatever it’s overly long length) it bleeds at length about the crisis facing people of conscience who currently have to support the delivering of birth control or family planning services to women who seek them. Not once does it express the slightest concern for the woman needing birth control, with an unintended pregnancy, or with any of the many other reasons for seeking an abortion. The patient is completely lost in the proposed paean on conscience just waiting for Leavitt’s signature. If you don’t like the proposed rule, then go to Leavitt’s HHS blog, tell him you don’t like it and tell him why. He’s a dolt with one track mind.

  49. #50 llewelly
    August 20, 2008

    Keanus, #49:

    Abortion is not widely available. In only 87% of US counties can one find a clinic or hospital that offers abortions. Granted nearly two thirds of the population lives in the 13% of counties that have clinics offering abortions, but that leaves roughly 35% of the population without reasonable access.

    I think you mean ‘In 87% of US counties one cannot find a clinic or hospital that offers abortions’. Please re-check your figures. And link to a source.

  50. #51 genesgalore
    August 20, 2008

    i suppose the next thing this twisted society is going to do is prosecuted women who have not kept their vaginal tract squeeky clean with murder. yes, kill all those women who brought us fetal alcohol syndrome etc with murder… sheesh…. spontaneous abortions 30% or better????

  51. #52 Kela
    August 20, 2008

    I am a recent graduate from medical school and according to what we are taught, no physician is required/obligated to perform any medical procedure or service. A physician can refuse to write a prescription for any individual drug or class of drugs, they can not perform any procedure that they do not feel comfortable doing. For example, I plan to go into family medicine and, even though I am pro-choice, I will choose not to perform abortions in my office. I am well within my rights to do that and would still be even if I was an OB/GYN or a surgeon. What a physician cannot do is refuse to refer a patient to a physician who can/will provide that service. The same applies to pharmacists. Any individual can refuse to fill any prescription for any reason. Any pharmacy would be well within their rights to not hire or fire any pharmacist who refused to fill prescriptions because it would cost them business.

    From my point of view this is a non-issue. There are no physicians writing prescriptions or performing procedures against their will. This is nothing but posturing that make the extreme christian right feel like they are doing something.

  52. #53 kingjoebob
    August 20, 2008

    “The patient is completely lost in the proposed paean on conscience just waiting for Leavitt’s signature. If you don’t like the proposed rule, then go to Leavitt’s HHS blog, tell him you don’t like it and tell him why.”

    Too bad this will have absolutely no effect on his decision. And the fact that they totally disregard the patient should be absolutely no surprise. Because for them its not what is best for society, it’s what will make society conform to our beliefs?

    People in this mind set are hell bent on forcing their version of morality down everyone else’s throat. They have the same mind set in everything they do Might makes Right, and at the moment they have the might to do what they want and to be honest there is not a damn thing we can do about it.

    The only thing we get to look forward to is the massive backlash when this is signed into law. And people thought the speakeasies in the 20’s during prohibition were a problem. For some reason these people never learn that when they try and legislate morality it typically backfires in a grand way.

    kjb


    “The last capitalist we hang shall be the one who sold us the rope.” Karl Marx

  53. #54 Patricia
    August 20, 2008

    OT – We haven’t heard from PZ in too long. Are you OK PZ?

  54. #55 Azkyroth
    August 20, 2008

    Protecting the Right of Conscience?

    Protecting the Right from consciences, more like.

  55. #56 PZ Myers
    August 20, 2008

    No. I’m dead, or wish I were. My brains are draining down the back of my throat, and my lungs are oozing up my throat, both meeting in a nasty knot of phlegm.

    I’m seeing a doctor tomorrow, I think. Unless it’s the undertaker.

  56. #57 Thoracantha
    August 20, 2008

    PZ,
    What if the doctor as a moral objection to treating you?

    As for the Leavitt’s blog. It’s typical Bushit. It looks like an open dialog, but it’s obviously not. Notice how widely spaced in time the comments are. It would seem that there is a comment filter. None of the comments are critical.

  57. #58 SC
    August 20, 2008

    Oh, ouch. Get well soon. Drugs will help, I’m sure.

  58. #59 lacrimose
    August 20, 2008

    This is not a new strategy by the religious right. It started in the 80’s with homeschooling to “protect” their children from the perceived evils of public school. Children were indoctrinated then with the idea that the founding fathers and the Constitution of the U.S. set up a Christian nation and that God’s law trumps everything manmade. Because the voting booth has failed them to a certain extent, students are now encouraged to go into professions (like pharmacy, nursing and medicine), to infiltrate them, and then to protest doing their jobs when duties conflict with their beliefs. Since legislation supporting their position has floundered, Leavitt is only following the next step in the process.

    It makes sense not to go into a profession where you might have to provide medicine or procedures that conflict with your beliefs, but that is not their goal. The goal is to force ALL Americans to adopt their beliefs. If we fail to understand this and plan our responses and actions accordingly, our already fragile individual civil rights for breathing-humans will be completely lost.

  59. #60 zer0
    August 20, 2008

    Those of us living and working in a society where human life is expendable by government dictate but fail to stand up to protect and cherish life at any and all costs will live to regret it.

    5 bucks says they support the war 100%. Pro-life my ass.

  60. #61 gex
    August 21, 2008

    Yes – there is an important social statement there. And it is that they think that people in positions of power should be allowed to restrict the rights and freedoms of others. It is the social statement conservatives and the religions always push, just couched in different terms.

  61. #62 Rey Fox
    August 21, 2008

    Dunlap:

    The ever-insightful Tim Krider of The Pain had the same idea, and I think it’s actually quite true. He said that’s why they loved Terry Schiavo so much too, because she was a brain-dead blank slate that they could project their politics on.

  62. #63 Patricia
    August 21, 2008

    Oh shite PZ!
    I know you don’t believe in herbs and snake oil, but if I were anywhere near you I would offer you some tincture of Old Man’s Beard. Scientific names Usnea barbata, U. longissima, U. hirta, U. florida, U. certina, and U. dasypoga.
    Before you all jump me, and call me a three titted sow, there is evidence to back this up.
    Usnea is used clinically for fungus infections, acute bacterial infection, lupus, trichomonas, mastitis, varicose and tropic ulcers, second-and third-degree burns, plastic surgery, athlete’s foot, yaddah, yaddah – colds, flu, bronchitis, pleurisy, pneumonia, tuberculosis, sinus infections, staphylococcus, dysentery, and streptococcus. *Hale, Mason. The Biology of Lichens. New York: American Elsevier Publishing Co., Inc. 1974; Hobbs, Christopher. Usnea: The Herbal Antibiotic. Capitola, Calif.: Botanica Press, 1990.
    Usnea species are very effective in the treatment of tuberculosis. In fact, usnic acid (one active component in usnea) “completely inhibited the growth of [TB] in dilutions of 1:200,000 – 1:2,000,000. *Hobbs, Usnea. Other sources put the effectiveness of usnic acid at one part per million* bringing it into the effective range of streptomycin. *Ahmadjian and Hale. The Lichens, New York: Academic Press, 1973. (One part per million!? That sounds like bullshit to me.)
    The one warning I found while researching this lichen was to be careful if you have liver trouble.
    OK – now the howling mob can string me up as a witch. It was good enough for my ancestors – I’ll take it too.
    Get well PZ! :)

  63. #64 Zeno
    August 21, 2008

    World-O-Crap has a lovely take on this “conscience” nonsense. Here’s an excerpt, but check out the whole thing:

    Imagine that you are walking down the street, looking for a $20 hooker minding your own business, when you are assaulted by a big, burly man who says he finds you morally repugnant (yes, hard to believe I know, but in America there is no idea that is too dumb to be taken seriously). You left your Glock in your other suit, so you call for help. Fortunately for you, a police officer hears your cries and arrives within a couple of minutes. Unfortunately for you, he refuses to help you because, as a committed Christian who has read your columns, he believes that you are a horrible person and that you are receiving God’s just punishment for your many, many bad acts. He does, however, try to aid you within the framework of his belief system by reading you some Bible verses about “the wages of sin.”

  64. #65 Patricia
    August 21, 2008

    Posting that Old Mans Beard info has worn me out after standing guard all day, as a proper French soldier, on the other thread for the catlicks & demons…I’ll deal with your herbal defamation’s and three titted sow insults in the morning.
    Good night sweethearts!
    (Keep breathing PZ!)

  65. #66 Alan Chapman
    August 21, 2008

    #3 Indeed, and pro-lifers tend to be overwhelmingly jingoistic and vociferous advocates of imperialist foreign-policy, embargoes, and war. They’re pro-life only with respect to fellow countrymen. When it comes to dropping bombs and shooting people in other countries they express no outrage at the carnage, nor any concern over the high rates of infant mortality and squalid conditions in which children live. The abortion issue is contentious to be sure, but nobody likes a hypocrite.

  66. #67 JB
    August 21, 2008

    Should it not also “be part of secular law” that it is wrong to force someone to do something that is completely against his or her own ethics?

    I do support the right to abortion. I also support the right for health personel to not participate if they feel it goes against their ethics.

    I do not agree that it would be better that they don’t treat people at all, just because it is one or two not directly health related (I’m not sure how to word this better) they feel is wrong to do.

  67. #68 Nomad
    August 21, 2008

    I’ve said it before and I’ll say it again. It’s an attempt to establish a de facto theocracy in the less cosmopolitan red counties. The series of attempts to insert creationism into public classrooms is an attempt to indoctrinate other people’s children, to spread the influence of fundamentalism to other families. Court precedent forbids that, so they change the name and try to do it anyway.

    In this case, having failed to sufficiently outlaw abortion (I know this isn’t primarily about abortion, but it certainly figures into it), they act instead to deny access to it by filling doctor’s offices with people unwilling to perform the procedures OR refer patients to doctors who will (which is a moot point once this goes far enough). Once they get the numbers down low enough they can let the Christian terrorists take over to persecute the few remaining providers.
    Of course, as has been pointed out, that’s already occurred in many places. So I find myself wondering if this is more about protecting the positions of those doctors who have already accomplished this. Perhaps both that and also expanding their influence into bigger cities, preventing pharmacies from “discriminating” against someone unwilling to fill certain prescriptions.

    As for the attempts to quietly redefine things so that the typical, run of the mill birth control pill suddenly counts as abortion, that one puzzles me. Surely that will lead to a massive backlash. It doesn’t maintain the sort of warm and fuzzy cloak that the right of conscience stuff does.

    It’s as if the Bush administration suddenly announced “in support of our abstinence only campaign we’re outlawing the birth control method that allowed the sexual revolution to occur”.

    I’d expect people to stand up and take notice at such an attempt to turn the clock back.

  68. #69 Equisetum
    August 21, 2008

    Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?

    Oh, yes it does happen.

    The post is about emergency contraception, which is HHS is attempting to redefine as abortion, but the principle is exactly the same.

    As for there being “an important and legitimate social statement,” I would say it would be a significant and illegitimate social statement. The situation with the cabbies that Skyotter mentioned is exactly analogous to this, even though it doesn’t have the devastating impact on people’s lives. He’s advocating tyranny of the majority.

  69. #70 OldOne
    August 21, 2008

    I am firmly pro-choice, but I’m not sure that the generality about moral objection is such a slam dunk. How about female genital mutilation? Australian aborigines once had a custom of slicing the penis end-to-end, OK? Castrating sex offenders? Electric shock treatment of mental patients? Arguing “do no harm” is difficult because the societies believe such practices are good. Moreover, anti-abortionists certainly believe abortion does harm.

    Probably the best that can be done is to vote on what is allowable and not allowable, with the edge given to allowing the physician as much choice as is practical. We should not allow a pharmacy to decline to dispense drugs, but in general, I think moral objection should be allowed so long as it does not affect acute care significantly.

  70. #71 hje
    August 21, 2008

    It has ‘lame duck’s parting shot’ written all over it.

    Lame duck’s parting shot: International crisis precipitated on or before November 1. Frightened sheeple vote in droves for more of the McSame.

  71. #72 foxfire
    August 21, 2008

    Well, I submitted my response to Leavitt’s latest blog on this subject via a couple of questions at that website.

    Leo B. in #15 captures the essence of the first question with a perfect “for example”.

    Thepetey in #3 and MAJeff in #6 reflect a question I’ve tried to understand. I haven’t yet heard a good answer.

    Personally, I think Josh K in #23 has a big clue in solving this equation, particularly in light of a recent study that hypothesizes the future U.S. population (OMG -the Mezicans and other dark people will take over!).

    As usual, ERV in # 29 cuts through the crap:

    What Levtwitt is trying to do is make it okay for a doc not to refer their patient to a physician who does specialize in abortions.

    I wish I’d seen #29 before I posted on Leavitt’s blog because THAT really gets to the point: refusal to perform as a matter of conscience does NOT alleviate a medical practitioner from referring their patient to another medical practitioner who might be willing to perform a procedure.

  72. #73 Clemens
    August 21, 2008

    Dawkins in “The God Delusion” points out that the states with the highest rate of abortions are the more conservative states…

    You’d expect abortion rates in secular hellholes like the Scandinavian countries or the Netherlands to go through the roof, but no, it’s illegal abortions in Poland and Portugal.

  73. #74 Dana Hunter
    August 21, 2008

    Poor PZ. See what you get for leaving a tropical paradise and coming back to a place that’s, well, not? ;-) Summer colds suck. Here’s to finding a doc who’ll make you want to live again!

    And, Danio, when PZ’s up and running at full capacity… you and your fellow minions could, you know, sorta sneak some posts in here. I’m sure the blog owner wouldn’t mind…

  74. #75 MH
    August 21, 2008
  75. #76 SEF
    August 21, 2008

    There needs to be a crack abortion squad – the A-team. “If you have a problem, if no one else can help, and if you can find them, maybe you can hire the A-Team.” They could be reachable by telephone and then zoom in by helicopter to air-lift the oppressed pregnant woman away to safety to have the abortion she wants/needs carried out by fully qualified and sympathetic staff in a state-of-the-art medical facility in some secret location.

  76. #77 Logicel
    August 21, 2008

    Wowbagger writes: …that anyone who isn’t going to provide a full range of services is required to make that information public.
    ______

    Then those dogmatic, pious nuts won’t be able to be a position to make a woman wanting an abortion feel quilty, perverse, and awful, while they have her cornered in their office. How can you deny them the right to push their agenda on others?

  77. #78 Logicel
    August 21, 2008

    foxfire writes: refusal to perform as a matter of conscience does NOT alleviate a medical practitioner from referring their patient to another medical practitioner who might be willing to perform a procedure.
    ____

    There needs to be an information plaque in the lobby of these pious nuts stating that they do not do certain procedures because of their asshattery and present a list of competitors that do.

    They will resist this, because as I said earlier they will no longer be in a position to intimidate patients in their office with their nonsense, and in addition, they will lose business to others.

  78. #79 Michael
    August 21, 2008

    Keep your eyes on this one. It has ‘lame duck’s parting shot’ written all over it.

    Just a lot of hot air and hype in this story, if one goes to a heart specialist but needs his toenail removed, they are referred to the right doctor. If the doctor objects to performing an abortion, the patient goes to another doctor. So what is the problem? Is it like 10 people complaining, their doctor refused to give them birth control or an abortion because he or she don’t believe in those things? This is really a non-issue. The doctor has every right to practice his or her religion. It doesn’t mean we all have to agree with it, but they have that right.

  79. #80 Logicel
    August 21, 2008

    Clemens writes: You’d expect abortion rates in secular hellholes like the Scandinavian countries or the Netherlands to go through the roof, but no, it’s illegal abortions in Poland and Portugal.
    _____

    The pious hypocrites indirectly encourage abortions, because they resist sex education and contraception. The number of abortions can be significantly reduced through education, readily available birth control, etc.

    However, they are not serious about reducing the number of abortions, because all they want is to spread their irrational, non-evidential beliefs and their practice as far and deep as they can.

    The little dears are so frustrated because they live in a democracy instead of the theocracy about which they are panting. Fuck them and their ‘conscience.’

  80. #81 Nibien
    August 21, 2008

    Just a lot of hot air and hype in this story, if one goes to a heart specialist but needs his toenail removed, they are referred to the right doctor. If the doctor objects to performing an abortion, the patient goes to another doctor. So what is the problem? Is it like 10 people complaining, their doctor refused to give them birth control or an abortion because he or she don’t believe in those things? This is really a non-issue. The doctor has every right to practice his or her religion. It doesn’t mean we all have to agree with it, but they have that right.

    You don’t seen to be a particularly sharp fellow, so I’ll explain (since the number of other posts here you can’t understand apparently)

    The problem in general is not a doctor’s objection to doing a procedure, it’s the problem as to not referring to a proper doctor. Additionally, extending this to things like birth control pills and prescriptions not being filled due to bigots is a huge problem in arenas with limited alternatives. The “one abortion clinic in all of South Dakota” is a good example of that.

    So basically, another Christian doesn’t understand what the problem is with being a fascist, as long as they’re the ones being the bigots. Big surprise.

  81. #82 Dale
    August 21, 2008

    “Hello I am a doctor, and it is against my conscience to treat people who are stupid enough to believe in religion.”

    I wonder how long that would last for?

  82. #83 Matt Penfold
    August 21, 2008

    Just a lot of hot air and hype in this story, if one goes to a heart specialist but needs his toenail removed, they are referred to the right doctor. If the doctor objects to performing an abortion, the patient goes to another doctor. So what is the problem? Is it like 10 people complaining, their doctor refused to give them birth control or an abortion because he or she don’t believe in those things? This is really a non-issue. The doctor has every right to practice his or her religion. It doesn’t mean we all have to agree with it, but they have that right.

    You have clearly missed the point.

    The idea is to allow healthcare professionals to refuse to provide referrals to patients where that referral is for treatment that offends their religious beliefs. Your claim that there is always an option of going to another doctor is a silly one if there a refusal to refer.

  83. #84 negentropyeater
    August 21, 2008

    Meanwhile, “radio host Rush Limbaugh and right-wing pundit Ann Coulter each echoed a false claim on August 18 when they asserted, respectively, that Sen. Barack Obama ‘believes it is proper to kill a baby that has survived an abortion’ and that he ‘wants the doctors … chasing it through the delivery room to make sure it gets killed.’

    http://mediamatters.org/items/200808200007?f=h_top

  84. #85 Louise
    August 21, 2008

    OK…Im Pro Choice, but as a RN i have refused to assist in the Circumciscision of new born boys .. am i wrong? i think the individual Dr can refuse to perform a termination but not a pharmacist to dispense contraceptives.

  85. #86 Dancaban
    August 21, 2008

    “OK…Im Pro Choice, but as a RN i have refused to assist in the Circumciscision of new born boys .. am i wrong?”

    No you’re not. There is a difference here that I can’t really quantify. But why are they coming to hospital (I assume) to do it?

  86. #87 Louise
    August 21, 2008

    In Australia (1987 and prior) ‘circs’ were offered as a routine post delivery procedure. as an Rn our job was to hold down the infant …Barbaric!

  87. #88 Thoracantha
    August 21, 2008

    I wouldn’t mind a doctor exercising his moral choice, if alternative health care choice is easily available. But in most cases it’s not. Due to geography or insurance reasons a good percentage of Americans can only see only doctor in a reasonable amount of time. In some cases where time is a factor, like emergency contraceptives, the doctor’s and even more so the pharmacist’s ethical objections should play absolutely no role. While reproductive health care is a right, being a doctor is not — it is a privilege. No one should be forced to do what they find morally objectionable, but no one is forcing these people to be doctors, nurses or pharmacists. If you find birth control or abortions objectionable, don’t become a ob/gyn, become a surgeon.

    Furthermore, where does this slippery slope end. Do we allow Jehovah’s witnesses to refuse giving a blood transfusion to a patient who needs it? Can a doctor refuse to treat an illegal immigrant, because he has moral objections to the immigrant being in the country to being with.

  88. #89 SoMG
    August 21, 2008

    I have no problem with providers deciding what and what not to provide so long as they do not wield monopoly power within their communities. In NYC a “pro-life” pharmacy is no problem. One of the lies RTLs are telling about the Freedom of Choice Act (see the nrlc’s web site) is the lie that it would nullify freedom of conscience laws. In fact it would only do that if when and where the freedom of conscience laws were shown to be interfering with women’s right to abort. As long as women could get abortions SOMEWHERE, FOCA would have no problem with freedom of conscience or laws protecting it. It’s also not at all clear that FOCA would disallow parental notification laws for minors. You can still exercise an unrestricted right to get an abortion but your parents will be told. Or for that matter “partial-birth abortion” laws, unless that was the only available abortion method which is never true. Can’t you just see Scalia writing, you can still have an abortion just not a partial-birth abortion.

    I do wonder though: what if I go to work for a “pro-life” pharmacy and then I say MY religion requires me to refrain from promoting RTLism over the customers’ pharmaceutical needs and I demand non-discrimination and “reasonable accomodation” of my religious belief which includes the pharmacy selling all b/c including b/c they call “abortifacient”. Under the conscience laws do I have a case? They would say why did you go to work for a RTL pharmacy? Well why does the RTL go to work for a pro-choice pharmacy and then demand accomodation?

    Regarding the Born-Alive Infant Protection Act (BAIPA) I’ll tell you the effect it has had and will have: the relatively few docs who do labor-induction abortions at the edge of viability will make sure to cause and document fetal demise (that’s the technical term) in utero before inducing labor. If this sounds familiar that’s because it is exactly how the very-late-termers like Dr. Tiller have responded to the “Partial-Birth Abortion” Ban. That means either an ultrasound-guided intracardiac arhythmiogenic injection if the fetus is big enough to do that reliably and if not go up the cervix with a bladed laproscopic snake and up the fetus’ nose into its brain like an Ancient Egyptian mummy-preserver. Is that a better or worse way to die than in the “Comfort Room” from non-continuation of maternal support? I have asked Ex-Nurse Jill Stanek this but she does not answer.

  89. #90 Bad
    August 21, 2008

    “These people need to either do their jobs or switch jobs. Sorry, but imposing their morality onto the people they are meant to serve is unacceptable.”

    This just bothers me to no end.
    Choice choice choice! Except when its someone elses! Don’t force morality on anyone… unless of course it’s our morality we’re forcing, and we’re forcing it on someone we don’t like!

    And, as we learned in the last thread, when there is a shortage of doctors providing the health care we think everyone should have access to, the solution is apparently to make it someone ELSES problem and responsibility, or else we’ll beat them up!

    “If you find birth control or abortions objectionable, don’t become a ob/gyn, become a surgeon.”

    Because of course, the role and ethics of what those jobs entail must of course be defined exclusively according to your ethics, and not someone elses.

    Not, of course, because that’s actually going to help more women get more access to the health care they want and need. No no: just to teach those jerks who don’t believe the same things we do a lesson!

  90. #91 Umilik
    August 21, 2008

    One might almost hope that HHS Secretary Mike Leavitt would find himself in a car accident one day and in need of a blood transfusion – only to find out that his emergency doc is a jehova’s witness exercising his/her moral choice..

  91. #92 Bad
    August 21, 2008

    SoMG: I find it ironic that freedom of conscience laws are so heartily endorsed by conservatives, given that they are in practice essentially labor laws which ensure someone’s right to be employed even if they don’t want to do the job their employer wants them to do.

    But then, we’re talking about the same people who think it’s of great moral import whether or not a dead, hydrocephalitic fetus is remoevd via C-section or through the birth canal.

  92. #93 Flex
    August 21, 2008

    Katkinkate wrote, way back at #11, “I think part of the push to prevent abortions is economic. Today’s economic system relies on continuous growth to stay up and running. A contraction of the population would contribute to a contraction of the economy, which is commonly called a depression.”

    This is incorrect, economic growth can continue through improved efficiency, increased manufacturing capability, and increased consumer spending. The number of consumers is only a small factor.

    Think of it this way. If the level of wealth in a society is assumed to be a constant, a growing population reduces the average wealth per person. A shrinking population actually increases the amount of wealth per person. (Historically we saw this occur in Europe during the plagues. It’s a horrifc example, but the economic affect of increased personal wealth as well as a shortage of labor may well have been one of the reasons for the industrial revolution.)

    A growing economy means that the total level of wealth in the economy is increasing. With modern manufacturing methods, the amount of labor needed to increase wealth in an economy is declining.

    This isn’t the place to discuss the impact of the high cost of labor in the U.S.A. compared to the low labor costs in other countries. Suffice it to say that as far as I can tell it’s not the direct cost of labor (wages) which appears to generate the huge demand to move manufacturing jobs overseas. It’s the additional costs of health care and insurance which often doubles the cost of manufacturing labor to a company. (Which is one reason illegal immigrant labor is so common; no health care or insurance costs.)

    A national health care system may well return manufacturing jobs simply because it will reduce the cost of labor.

    As for the original point of the post, Danio appears to have it right. This policy would to allow the ethics of a health care provider to trump the ethics of a patient. In no other profession would we be even considering this. This is entirely about a faith-based view of reality.

  93. #94 Julian
    August 21, 2008

    Its not that he is claiming they have the right not to carry out abortions, of course doctors have that right, he’s saying that its wrong to expect them to even recommend where a person could find out how and who to get an abortion from, and that is what is preposterous. If you, as a doctor, feel you cannot carry out a specific procedure, that’s fine in my book, and legally protected; for instance, I wouldn’t want to force my family doctor to attempt a complex surgery just because I trusted him more than some scalpel-jockey from Houston. However, it is my family doctor’s duty, not his right, not his decision, his duty as a medical practitioner, to refer me to a medical profession with the experience and training to carry out that procedure.

    The same thinking applies to abortion. If a doctor doesn’t feel he can morally carry out the operation then that is his decision. If he feels that his patient shouldn’t attempt it, then it is his right as a physician to sit that patient down and express his concerns. But no matter how he feels about it, his duty as the individual primarily concerned with that person’s health and well-being is to refer them to a professional who can carry out the procedure without undo risk to his patient. This ignorant appointee is arguing that a doctor should be able to not only refuse treatment, but refuse to advise a patient as to how they could get treatment. The reason he makes this argument has nothing to do with abortion; he makes it to create a wider justification for druggists and doctors who refuse proscription of Plan B.

    If you can refuse even information about one procedure on moral grounds, you can do it for any procedure.

  94. #95 Celeste
    August 21, 2008

    A doctor is licensed to practice medicine, not sanctimony.

  95. #96 Bad
    August 21, 2008

    Celeste:”A doctor is licensed to practice medicine, not sanctimony.”

    Is that principle absolute in your opinion? Would it require, for instance, that doctors who objected to “hygienic” sterilization of the mentally ill and mentally challenged back when that was an accepted practice, find another profession?

    Back when homosexuality was officially classified as a mental illness, would you say that “sanctimonious” docs should either throw gay people in asylums and force hormone drugs on them to “fix” them, or else leave the profession?

  96. #97 Phoenix Woman
    August 21, 2008

    Comment by Bad blocked.

    Ahh, killfile, how I love thee.

    As has been said, it’s amazing how much the anti-choice folk love humans when they still have gills and a tail, but stop caring about them once they’re out of the womb — unless it’s to make sure that they’re not gay. (Hey, gay Pharyngula readers: Do any of you recall seeing something a few years ago about conservative anti-choicers deciding that they favored aborting gay fetuses, when it seemed that it might be possible to determine sexual orientation prior to birth? I do, but I can’t find it right now.)

  97. #98 MAJeff, OM
    August 21, 2008

    Hey, gay Pharyngula readers: Do any of you recall seeing something a few years ago about conservative anti-choicers deciding that they favored aborting gay fetuses, when it seemed that it might be possible to determine sexual orientation prior to birth? I do, but I can’t find it right now.

    Not sure about that, but I do recall the play, Twilight of the Golds dealing with that issue.

    I also recall some right-wingers over the past couple years who not only oppose the HPV vaccine, but would also consider opposing an HIV vaccine because it would remove a risk from sex.

  98. #99 Kate
    August 21, 2008

    Oh, look! A misogynist!

    Personally, it would make my day to have a pharmacist refuse viagra on moral grounds, or cancer treatment, or an asthma inhaler.

    …Would Leavitt be behind those pharmacists? (Probably not…)

    Look, if you aren’t willing to do your job… ALL OF IT… then go do something else and let a competent, willing person actually do the job. It’s really quite simple.

    I work as a Marketing Director for a smallish company. If I were to refuse to book shows in venues because of my personal beliefs, I would be fired. If I were to allow religion, or my lack of it, to interfere in my day to day business, I’d be out of a job. If I were to refuse service to someone because I felt it was against my personal beliefs, but it was still within the law, I would be out on my ass.

    This is the way the world works. Leavitt needs to get over himself, and fast.

    Religion does not deserve special treatment. Period.

  99. #100 Steven Dunlap
    August 21, 2008

    @ #84 negentropyeater

    It sounds like Limbaugh and Coulter have confused abortion with the creature bursting from John Hurt in the first Alien movie.

    The only come-back I can think of is that not everyone’s birth happened the same way as theirs did. Where’s Sigourney Weaver when you need her? Sheesh!

  100. #101 SEF
    August 21, 2008

    @ #90

    Because of course, the role and ethics of what those jobs entail must of course be defined exclusively according to your ethics, and not someone elses.

    No, it’s the collective ethics of the population as outlined in the law. If the laws of state or country X permit medical procedure Y, then it must be available without prejudice to anyone who needs it. In particular it should be available by any relevant medical personnel Z employed (including the fiction of self-employment if they are occupying the only licensed facility/job in the area!) by said state or country.

    Religious (or similar) nutters who take jobs they have no intention of doing properly are committing a fraud (taking money under false pretences) – and depriving their betters of that job as well as depriving the local population of the service they were employed to provide. There should be more prosecutions.

  101. #102 Tom (the UK one)
    August 21, 2008

    To Louise #85:

    OK…Im Pro Choice, but as a RN i have refused to assist in the Circumciscision of new born boys

    At least you are upholding the Hippocratic oath by refusing to harm the patient. I would support any doctor or nurse who takes this position.

    Circumcision of baby boys is (most often) performed for religious, cosmetic or superstitious reasons, not to improve the health of the patient.

  102. #103 Y. Esme
    August 21, 2008

    “You are doing the right thing Secretary by allowing those of us in the health care profession live our moral and ethical consciences rather than forcing us to choose another profession.”

    And of course, your moral and ethical consciences are the only ones that the rest of the world should abide to.

    Gah. There isn’t a single thing about that comment that I can even possibly remotely like.

    (She also missed a comma after ‘Secretary’)

  103. #104 Snitzels
    August 21, 2008

    My question is: the people who are pushing for this “doctor should choose what procedures to give”, are they doctors who routinely have to perform the procedure? If so, what percentage of the advocates for this policy are in the medical field and how many are simply politicians and right wing lobbyists? That would be an interesting statistic to see… I was horrified enough to learn that pharmacists were trying to make decisions for women about issuing them birth control pills, but this is much more disturbing.

  104. #105 Bad
    August 21, 2008

    Phoenix Woman: “Comment by Bad blocked.
    Ahh, killfile, how I love thee.”

    What’s the polite response to something like this?

  105. #106 Y. Esme
    August 21, 2008

    Oh shit. Ignore the comma comment. Read it too quickly…

  106. #107 Thoracantha
    August 21, 2008

    to Bad,

    Because of course, the role and ethics of what those jobs entail must of course be defined exclusively according to your ethics, and not someone elses.

    No, I am not forcing my ethics on the doctors and pharmacists. I am not forcing them to be doctors or pharmacists. It is their choice.

    When they deny a patient the right to preventative birth control, or the right to have an abortion, the doctors are forcing their morality on their patient. It a large percentage of cases, the patient doesn’t not have a choice to pick another doctor.

    Job descriptions and roles are rarely ever set by the individual preforming the job. Why should doctors be any different? It’s not like abortion and birth control are new. They knew that these issues were relevant in their field before they decided to enter that field. They are hired in most cases by hospitals or insurance complains. The hospitals and insurance companies should set guild lines of what procedures fall under what specialists domain. Birth control fails with in the domains of ob/gyns and pharmicists. If an ob/gyn or a pharmacist refuses to disperse birth control pills, he or she is simple not doing his/her job. His/Her motives are not issue.

    If you go to a diner and the waitress refuses to serve you a meat dish that is on the menu, because she thinks that meat is murder, does the diner have a right to fire the waitress?
    Of course, she is not doing her job. The same is true for pharmacists and doctors.

  107. #108 Equisetum
    August 21, 2008

    Quote from Bad:

    Celeste:”A doctor is licensed to practice medicine, not sanctimony.”

    Is that principle absolute in your opinion? Would it require, for instance, that doctors who objected to “hygienic” sterilization of the mentally ill and mentally challenged back when that was an accepted practice, find another profession?

    Back when homosexuality was officially classified as a mental illness, would you say that “sanctimonious” docs should either throw gay people in asylums and force hormone drugs on them to “fix” them, or else leave the profession?

    Too bad the examples you used are about forcing treatment on patients who don’t want it or can’t legitimately consent, whereas the current issue is refusing treatment to patients who desire it. Two entirely different concepts.

    Otherwise, you might have had a point.

  108. #109 Chiroptera
    August 21, 2008

    Dancaban, #86, responding to the previous post: “OK…Im Pro Choice, but as a RN i have refused to assist in the Circumciscision of new born boys .. am i wrong?”

    No you’re not. There is a difference here that I can’t really quantify. But why are they coming to hospital (I assume) to do it?

    I can put a couple of quantifications on this.

    One is that I am sure that there are other RNs available at that hospital/clinic that would assist in the circumcision, whereas when a doctor or pharmacist refused to offer abortion/contraception/”morning after” services, the woman may not have a timely alternate provider.

    Another is that a circumcision is basically unnecessary, mostly cosmetic (and, if required for religious reasons, usually performed by a religious official), while being pregnant and having a child is something that has a profound medical and emotion impact on the woman.

  109. #110 Bad
    August 21, 2008

    SEF:”No, it’s the collective ethics of the population as outlined in the law. If the laws of state or country X permit medical procedure Y, then it must be available without prejudice to anyone who needs it. In particular it should be available by any relevant medical personnel Z employed (including the fiction of self-employment if they are occupying the only licensed facility/job in the area!) by said state or country.”

    It’s one thing when one is employed by the state, because then the people are the employer and have a say in what they want to hire or fire. But you’re just doging the issue of who is or isn’t “relevant.” I would say that a doctor who won’t proscribe BC is pretty obviously not relevant to the task of proscribing BC, and as such is probably a poor choice to try and fill that need. Employers can take or leave them as they choose, but I don’t see a legitimate reason for them not to be able to practice medicine period.

    And “the only job in the area” is rarely some position anyone is appointed to or exclusively controls.

    “Religious (or similar) nutters who take jobs they have no intention of doing properly are committing a fraud (taking money under false pretences)”

    Of course, they don’t agree with your defintion of what “properly” entails, which only begs the question. Whose money are they taking under false pretenses, especially if they are upfront about what they will and won’t do?

    “and depriving their betters of that job”

    Again, a private practice is not some sort of appointment from on high.

    “as well as depriving the local population of the service they were employed to provide.”

    If they were employed by the local population, you might have a point. But if they are merely available to the local population, I don’t see how anyone has grounds to legitimately complain.

  110. #111 Hap
    August 21, 2008

    #42: Sorry, I forgot to set the irony flag on the parenthetical comment. I didn’t mean it literally, and your response was most of the reason (abortion vacations, I thought, were common before Roe v. Wade for those able to afford them).

    I would appreciate Leavitt’s support for conscience if it were uniform, but seeing how a variety of institutions he and his party have supported have shown no respect for it (suppression of results from scientific agencies on global warming and EPA regs., for example), it comes out as more than a little hypocritical. The refusal for doctors and pharmacists to provide information on procedures or drugs they find wrong seems questionable at best, and seems more directly to impose a pharmacist or doctor’s beliefs on his patient. I guess the patient’s conscience doesn’t really matter, right?

    I thought President Bush swore to protect and defend the Constitution of the United States. I guess he wishes to protect the jobs of those who would do their jobs as well as he has done his.

  111. #112 Phoenix Woman
    August 21, 2008

    If you go to a diner and the waitress refuses to serve you a meat dish that is on the menu, because she thinks that meat is murder, does the diner have a right to fire the waitress?

    Exactly.

    If anything, this analogy doesn’t go far enough: Doctors and pharmacists who refuse to do this part of their job are like waitstaff who take jobs at steakhouses and then suddenly announce that they won’t carry any meat dishes.

  112. #113 Bad
    August 21, 2008

    Thoracantha: “No, I am not forcing my ethics on the doctors and pharmacists. I am not forcing them to be doctors or pharmacists. It is their choice.”

    If you are arguing for forcing a definition on what those professions MUST legally entail, then of course you are.

    “When they deny a patient the right to preventative birth control, or the right to have an abortion, the doctors are forcing their morality on their patient.”

    Nonsense. By refusing to do something the patient wants they aren’t forcing anything on anyone.

    Levitt wants to force employers to retain employees that won’t do their jobs, which is ridiculous. But you seem to want to force doctors that refuse to perform certain proceedures on ethical grounds from practicing medicine period, which is equally ridiculous.

    The referral requirement is a perfectly reasonable and ethical standard.

    “It a large percentage of cases, the patient doesn’t not have a choice to pick another doctor.”

    That’s not the fault of the doctor that can’t or won’t provide the service the patient wants.

    “Job descriptions and roles are rarely ever set by the individual preforming the job.”

    That’s true. But they are not some sort of cosmic rule either.

    “Birth control fails with in the domains of ob/gyns and pharmicists. If an ob/gyn or a pharmacist refuses to disperse birth control pills, he or she is simple not doing his/her job.”

    If we were talking exclusively of employers defining what the job is, that’d be no problem. But many people seem to think that there is some sort of absolute principle of medicine that one cannot be a family doc and refuse to provide BC, or an ob/gyn and refuse to perform elective abortions.

    In fact, plenty of such doctors exist and work in the US already, right now.

    “If you go to a diner and the waitress refuses to serve you a meat dish that is on the menu, because she thinks that meat is murder, does the diner have a right to fire the waitress?”

    Of course.

    But if its a veggie resturant and they wont serve you meat, is there some general principle that they should not be allowed to exist as a business?

  113. #114 Ryan F Stello
    August 21, 2008

    Bad

    What’s the polite response to something like this?

    Ignore it, and accept that not everybody wants to hear from you?

  114. #115 Phoenix Woman
    August 21, 2008

    For those wondering what this marvelous “killfile” is that all the cool kids here are discussing:

    1) Download and use Firefox, if you don’t already.

    2) Get the Greasemonkey add-on.

    3) Go to http://userscripts.org/scripts/show/10791 and follow the easy-peasy instructions.

    Now whenever a trollie shows up at any of your favorite blogs, you can eliminate the temptation to give it the response it craves and feeds upon, and let it starve unheeded and unread, its greatest fear. Simply click the ‘kill’ link that now appears next to the trollie’s name. (You can, if desired, post “Comment by [name of troll] blocked” to let the trollie know that it’s being ignored, in order to hasten its departure.)

  115. #116 Bad
    August 21, 2008

    Equisetum:”Too bad the examples you used are about forcing treatment on patients who don’t want it or can’t legitimately consent, whereas the current issue is refusing treatment to patients who desire it. Two entirely different concepts.”

    You seem to be under the mistaken impression that analogies must be exactly the same in every way to be valid, as opposed to te same only in the relevant axis. The principle being advanced is that there is some sort of essential definition of what a doctor’s job is that they either fulfill or must get out of the profession entirely. I don’t think that principle makes any sense.

    The fact that we today consider those two examples unethical doesn’t change the fact that they were once considered to be so. In fact, that’s the whole point. Doctors of conscience refused to do those things, and their case, the profession itself changed to agree with their position. But the same principle you are trying to apply to pro-life doctors would have prevented those people back then from even practicing medicine in the first place.

  116. #117 Wardroid
    August 21, 2008

    “Those of us living and working in a society where human life is expendable by government dictate but fail to stand up to protect and cherish life at any and all costs will live to regret it.”

    I’m sorry, but human life ***IS*** expendable by government dictate. You guys gots the death penalty, you guys gots the Iraq war. Such stinking hypocrisy.

  117. #118 Bad
    August 21, 2008

    Ryan F Stello: “Ignore it, and accept that not everybody wants to hear from you?”

    Surely its possible for someone to simply not listen to what someone else has to say without being a sanctimonious jerk about it though, no?

    What sort of people run around comment threads sneering out loud about every post they don’t deign to read?

  118. #119 Ryan F Stello
    August 21, 2008

    That’s not the fault of the doctor that can’t or won’t provide the service the patient wants.

    “Doctors of conscience” don’t have one if they don’t/can’t weigh the pros and cons of refusing treatment of any kind.

  119. #120 Patricia
    August 21, 2008

    Are you still alive PZ?

    Now I’ll go make coffee…

  120. #121 Gavel Down
    August 21, 2008

    If you go to a diner and the waitress refuses to serve you a meat dish that is on the menu, because she thinks that meat is murder, does the diner have a right to fire the waitress?

    In this case, more applicable would be you responding to the vegetarian waitress that if she refuses to serve you meat, would she please flag down a waiter/waitress who will, and she refuses.

  121. #122 Ryan F Stello
    August 21, 2008

    Surely its possible for someone to simply not listen to what someone else has to say without being a sanctimonious jerk about it

    Take it up with him/her (which I guess you can’t, since he/she killed you), but I’d say there’s nothing sanctimonious about expressing your relief about not having to hear from someone you think is a scumbag troll.

    What sort of people run around comment threads sneering out loud about every post they don’t deign to read?

    I know I don’t read every post’s comments, but this seems like hyperbole to me. The person only expressed disdain for you. Why do you really care, either way?

  122. #123 Matt Penfold
    August 21, 2008

    To all those arguing with Bad.

    I would give up.

    He actually wants to live in a world where people are free to deny services to others on any grounds they like. He opposes anti-discrimination legislation because it impinges on the rights of bigots to be bigoted.

    He clearly does not see the rights of woman, blacks, jews, gays, catholics, muslims or any other group that has historically been denied access to education, employment, healthcare, housing and other services simply becuase of their sex, colour, ethnicity, religion (or lack of) or sexuality as being as important.

  123. #124 Mary
    August 21, 2008

    One does have to pity the poor right-wing pharmacist. Here he is, day after day, being presented with a definitive list of sluts in the community–never mind that business about birth control pills being useful for other purposes than contraception, that’s just an excuse, right? The insurance data even gives him the means to find out easily which ones are unmarried. Unlike the clients of a Catholic priest hearing confession, his clients don’t even have the grace to look guilty and apologetic when they ask him for the wherewithal to escape the consequences of their sins.

    Now, he already has the right to tell his employer that he can’t, in conscience, fill birth control prescriptions as long as one of his colleagues is available to dispense such drugs. However, what’s the fun of that? If it’s done according to current law, the slut may well never notice the switch in providers. If he takes the time to sermonize…er, explain his crisis of conscience…to his client before passing her off to his colleagues, she’s likely to look at him as if he were something noxious that just crawled out from beneath a rock. Then she’ll lodge a complaint with the manager, who just might take her side. In either case, his colleagues are more likely to view him as a sanctimonious pain in the posterior who makes more work for them than they are to respect him for the important moral statement he’s making about other people’s sex lives. At the end of the day he goes home, knowing that while he didn’t actually dispense any prescription against his conscience, he also didn’t succeed in preventing a single woman from having sex in ways that meet his disapproval.

    How much more satisfying it would be if his act of conscience were meaningful. Say, if he could be the final arbitrator of whether or not his customers could get birth control at all, from anybody. Think of the expression on a slut’s face when tears up her prescription in front of her eyes and tells her she’s going to have to stop sleeping around or face the consequences. That would be a power rush worthy of a true “act of conscience”. Of course, under current law, his boss would fire him instantly and he’d never find another position.

    Hence the current push to extend the “right of conscience” to such an absurd extent.

  124. #125 Matt Penfold
    August 21, 2008

    Here he is, day after day, being presented with a definitive list of sluts in the community–never mind that business about birth control pills being useful for other purposes than contraception, that’s just an excuse, right?

    What is the betting such a pharmacist has never suffered from abnormally heavily periods ?

  125. #126 True Bob
    August 21, 2008

    The irony for you, bad, is that you are posting on a blog owned by a guy who considers you deluded, and maybe more. Would you complain if his “right of conscience” led him to ban you? A dollar says you’d be a whiny-ass titty-baby about it.

  126. #127 D
    August 21, 2008

    I’m surprised most people are still ignoring the path that a person must take to become a physician and requirements they must meet in this discussion. All these comparisons to this or that job just fall completely flat. The regulation and licensing of physicians, as well as a few other professions, really change the dynamics and implications of refusing a beneficial treatment. These people have pledged to serve the health of their patients and supposedly have proven themselves to be competent enough in their knowledge to know what is good or bad for a person’s health as a condition of being recognized as doctors. They break that pledge and/or demonstrate a failure of their knowledge when they prevent a patient from receiving care. They do harm. Why should they have an exemption from ethical standards that they’ve already pledged to uphold by invoking contrary personal beliefs?

  127. #128 Natalie
    August 21, 2008

    And, as we learned in the last thread, when there is a shortage of doctors providing the health care we think everyone should have access to, the solution is apparently to make it someone ELSES problem and responsibility, or else we’ll beat them up!

    Bad, step away from the horse and put down the whip. We all know your opinion – you don’t need to repeat it ad infinitum.

  128. #129 Lilly de Lure
    August 21, 2008

    Dan said:

    But the same principle you are trying to apply to pro-life doctors would have prevented those people back then from even practicing medicine in the first place.

    They’re more than welcome to practice medicine, no one is suggesting that they shouldn’t be – the point being made is that their pro-life position should not interfere with the ability of their patients to access the health care they decide is appropriate and that they are legally entitled to access.

    If a doctor’s delicate little conscience is so upset by the notion of a woman having an abortion or accessing emergency contraception then that doctor can specialise in, well, anything other than Ob/Gyn and then the problem sorts itself out (I can’t imagine anyone having a problem being treated by a pro-life cardiologist for example, any more than they would have in hiring a vegetarian plumber).

    However if they do insist on going into Ob/Gyn they know in advance that they are going to be treating pregnant women who want and are legally entitled to end their pregnancies. If they really can’t handle this, to the point of not even being able to refer the woman on to someone who will do what she wants, then they are imposing their morality on to her medical treatment. She has the legal right to do whatever she thinks is best with her body and if a doctor thinks his/her conscience trumps his/her patient’s rights s/he has no business treating this, or indeed any other patient.

  129. #130 Hap
    August 21, 2008

    #105: There isn’t really a polite response – they are saying that you are tiresome and (probably) that your arguments and opinions suck. It depends on the source whether you believe their opinion on you has any value – if it’s someone who is likely to be rational and knowledgeable, then their opinion might be cause to consider your position, the logic justifying it, or its expression. If they are less knowledgeable or logical (or are not sane), then you can safely ignore it. You could always reply with “I’ll take that under advisement” or “Your opinion is noted and stupid” as well but since they can’t see your reply anyway, there really isn’t a point. Everyone isn’t going to like you and your opinions, and sometimes this happens.

  130. #131 John
    August 21, 2008

    “The doctor has every right to practice his or her religion. It doesn’t mean we all have to agree with it, but they have that right.”

    Indeed. If I were a doctor, my first question to a patient would be “Have you accepted Jesus Christ as your personal savior?” If they answer no, I would go ahead and treat them.

    If they answer yes, because of my great respect for their religious beliefs, I would have to tell them “Sorry. I can’t treat you. If you had faith enough, the holy spirit would heal you, as it says in the bible. I wouldn’t want to be a part of anything that would compromise your faith.”

    Then I would send their family a “Congratulations on your loved one’s acceptance into heaven!” card.

  131. #132 True Bob
    August 21, 2008

    Dead giveaway of an ideo(il)logical argument as opposed to a thoughtful one:

    pro-life doctors

    And where are their counterparts, the anti-life doctors?

    Yeah, I didn’t think so.

  132. #133 wÒÓ†
    August 21, 2008
  133. #134 Matt Penfold
    August 21, 2008

    I can’t imagine anyone having a problem being treated by a pro-life cardiologist for example, any more than they would have in hiring a vegetarian plumber

    Actually I can, although I imagine it is not an everyday occurrence for cardiologists. It could be for other specialities though.

    One could imagine a scenario where a woman is diagnosed with a serious heart condition and at more or less the same time become pregnant. If the specialist believes that being pregnant is likely to increase the risk to the patient, do they have duty to inform her of this, and refer her for an abortion if she decides not to continue with the treatment.

    Perhaps a more plausible scenario would be someone diagnosed with cancer. The treatment for some cancers can seriously effect fertility in both men and women. It is becoming more and more common for people undergoing such treatment, and who indicate they may want to have children in the future, to have either sperm or eggs frozen. A number of religious groups consider fertility treatments to be immoral. Does an oncologist have a right to not inform patients of the risk to their fertility, and refuse to refer to a centre with the facilities to carry out the collection and storage of sperm or eggs ?

  134. #135 BlueIndependent
    August 21, 2008

    “What sort of people run around comment threads sneering out loud about every post they don’t deign to read?”

    The only people running around here are people who’ve heard the religious apologetics 10^23 times, remain unconvinced, and are becoming evermore peeved at the notion of having to put up with the incessant illogic on a daily basis. Do you honestly think we haven’t heard it all by now? Trust me. The posts have been read, dealt with, and moved on from.

  135. #136 Bad
    August 21, 2008

    “They’re more than welcome to practice medicine, no one is suggesting that they shouldn’t be ”

    I’m not sure that’s true. Plenty of people seem to be saying that if an ob/gyn won’t do elective abortions, or a pharmacy fill certain prescriptions, then they shouldn’t be in that business in the first place. In fact, this seems to be what you, in particular, are arguing.

    I certainly agree that accurate referrals should be ethically required rather than flat out denials, and doctors should be upfront about these issues. But I don’t agree that a legal entitlement to do something should mean that a _specific_ person be, as a matter of course, mostly or solely responsible for providing it, simply because they offer related services.

    Positive rights in that sense are owed collectively: that is, they are everyone’s responsibility to make sure they are universally filled, and one might even add that they are the collective responsibility first and foremost of everyone who considers them a right.

    I don’t agree with the position of pro-life physicians. But I also don’t see why the medical system cannot accomodate their existence, or why people seem willing to place the burdens and responsibilities of access to BC and abortion on their shoulders. People don’t lack access to health care because some rural doctors are pro-life. They lack access because our medical system is way undersubsidized and does not include any sort of nationalized guarantee of availability as part of insurance.

  136. #137 raven
    August 21, 2008

    Bushco has only 6 months left to destroy the USA.

    That is what this is all about. The amount of damage the these dumb clowns have done to the USA is monumental and it will take decades to recover. If we have lost the will and ability, which is likely, we never will.

    Not going to go over the familiar litany of $4.00 gasoline, dead economy, dead dollar and so on. Most alarming, while we are being bled out and bankrupted by Vietnam II aka the pointless unsuccessful war in Iraq, the zombie formerly known as the USSR has got up out of its grave. That zombie is hungry. I’m a firm believer in the Reagan doctrine, “no one ever lost a war by being too strong.”

    I’m not a jingoist war monger but if madman Putin wants to start cold war II, we have to play the game whether we want to or not. As it is now, all we can do is put out press releases and have Bush make vague statements that no one even pays attention to because everyone knows he is retarded.

    Back to the original point. Bushco is also trying to gut the endangered species bill. Look for more such attempts by the theocrats to fold, bend, and mutilate the USA any way they can. In a just and intelligent world, Bush and Cheney would be tried for treason. Not that they are that malevolent but stupidity can be indistinguishable from evil.

  137. #138 Equisetum
    August 21, 2008

    Bad:

    You seem to be under the mistaken impression that analogies must be exactly the same in every way to be valid, as opposed to te same only in the relevant axis.

    No, I’m not. You are under the mistaken impression that the situations you noted are in some way analogous to the current situation. They are not. I said ‘entirely different’ and I meant ‘entirely different.’ The situations you describe are about inflicting measurable harm on individuals, whereas the current situation is about denying a safe and effective medical procedure or medicine. But I said that the first time and you refused to comprehend it.

    But the same principle you are trying to apply to pro-life doctors would have prevented those people back then from even practicing medicine in the first place.

    The principle I’m trying to apply is that the good of the patient is at the heart of medicine. That is precisely the principle that led the doctors of conscience back then to refuse those kinds of ‘treatment.’ Doctors today who refuse to prescribe emergency contraception, or prescribe it only if the patient ‘qualifies’ according to their personal criteria, or refuse to at least refer the patient to another doctor, and pharmacists who refuse to fill the prescription are violating that principle.

  138. #139 Lilly de Lure
    August 21, 2008

    Matt Penfold said:

    One could imagine a scenario where a woman is diagnosed with a serious heart condition and at more or less the same time become pregnant. If the specialist believes that being pregnant is likely to increase the risk to the patient, do they have duty to inform her of this, and refer her for an abortion if she decides not to continue with the treatment.

    Fair point, however in this case you’re faced with a situation where even most pro-lifers make an exception, where the woman’s health and possibly life is endangered by the pregnancy. Even the vast majority of pro-lifers do not expect women to risk death to continue a pregnancy.

    However if such a situation would arise and the cardiologist refused to provide information or referals to their patient then surely we’re into straight medical negligence territory. Refusing treatment that will eleviate the risk of injury or death to the patient is a medical no-no no matter what the reason and any doctor, no matter what their opinions on abortion, will know that.

  139. #140 True Bob
    August 21, 2008

    I don’t agree with the position of pro-life physicians.

    So you don’t agree with ANY physicians.

  140. #141 Matt Penfold
    August 21, 2008

    I certainly agree that accurate referrals should be ethically required rather than flat out denials, and doctors should be upfront about these issues. But I don’t agree that a legal entitlement to do something should mean that a _specific_ person be, as a matter of course, mostly or solely responsible for providing it, simply because they offer related services.

    And where there is no alternative ? You have already heard about one state in the US where there is only one doctor willing to perform termination, and he flies in from elsewhere. What about the rights of woman there ?

    You seem to think that there will always be someone willing to do what other doctors will not. You are mistaken in that belief. As a result you do seek to deny woman the right to abortions: Not directly maybe, but through indifference to their rights. I do not think that makes you much less culpable than the more direct anti-choicers. A right one cannot exercise is not really a right in the first place.

  141. #142 maureen
    August 21, 2008

    I recommend the UK where the General Medical Council’s guidance on good practice includes the following …..

    “Decisions about access to medical care

    The investigations or treatment you provide or arrange must be based on the assessment you and the patient make of their needs and priorities, and on your clinical judgement about the likely effectiveness of the treatment options. You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition. You must treat your patients with respect whatever their life choices and beliefs. You must not unfairly discriminate against them by allowing your personal views* to affect adversely your professional relationship with them or the treatment you provide or arrange. You should challenge colleagues if their behaviour does not comply with this guidance.

    If carrying out a particular procedure or giving advice about it conflicts with your religious or moral beliefs, and this conflict might affect the treatment or advice you provide, you must explain this to the patient and tell them they have the right to see another doctor. You must be satisfied that the patient has sufficient information to enable them to exercise that right. If it is not practical for a patient to arrange to see another doctor, you must ensure that arrangements are made for another suitably qualified colleague to take over your role.

    *This includes your views about a patient’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status.”

    It could not be clearer to anyone with a reading age above 10 – one hopes that includes all doctors – no-one is forced to carry out a procedure, no-one gets screwed by the abuse of power and the doctor can be struck off if s/he fails to follow the code.

    (Which could be another argument in favour of the NHS as against a profit-driven system.)

  142. #143 raven
    August 21, 2008

    About three months later, this born-again Christian called me to explain that he was against abortion but his daughter was only a junior in high school and was too young to have a baby and he was also afraid that if she did have a baby she would not want to put it up for adoption.

    There is a huge amount of hypocracy among the anti contraception and abortion crowd. The average woman with modern medicine and abundant food can produce 1o to 20 kids per lifetime.

    If you look at the theocrat’s family sizes, Robertson 4, Dobson 2, Bush 2, Cheney 2?, etc., they are all at the US norms. They aren’t walking their talk and they are planning their family size somehow, like responsible adults.

    During an anti-abortion flareup, someone “accidently” leaked the medical histories of a prominent prolife congressman from the deep south. Turned out his wife had had 2 abortions and his teen age daughter had one.

    If abortion was outlawed in the USA, it wouldn’t make much difference. The poor would get substandard outlaw ones somewhere, the middle classes would go to Canada and Mexico, and the rich would fly to Europe.

  143. #144 Matt Penfold
    August 21, 2008

    Fair point, however in this case you’re faced with a situation where even most pro-lifers make an exception, where the woman’s health and possibly life is endangered by the pregnancy. Even the vast majority of pro-lifers do not expect women to risk death to continue a pregnancy.

    I am not as familiar with the protestant style of anti-choicers(*) (I refuse to call them pro-life) but Catholic teaching is pretty clear. The Catholic position is to oppose abortion under all circumstances and if continuing with a pregnancy endangers a woman’s life then it endangers her life and there should not be an abortion.

    (*) Here in the UK the leading anti-choice advocates seem to be mainly Catholics, although there are some protestant evangelical types who are vocal. The Church of England takes a more pragmatic approach. Whilst not exactly approving of abortions, it accepts that where the mother is at risk they may be carried out.

  144. #145 Lilly de Lure
    August 21, 2008

    Bad said:

    I don’t agree with the position of pro-life physicians. But I also don’t see why the medical system cannot accomodate their existence,

    It’s really rather simple – Doctors can have any politics they damn well choose but if they let it get in the way of their duty to their patients then they cease to be doing their jobs properly. Hence if they feel so strongly about abortion that they cannot even refer a woman to an alternative practitioner then they should stay out of that particular field of medicine because otherwise their consciences are not merely their private affair, they are a menace to their patient’s rights.

    why people seem willing to place the burdens and responsibilities of access to BC and abortion on their shoulders.

    Because as doctors it’s supposed to be part of their job to ensure that medical presciptions and procedures are provided safely to their patients?

    People don’t lack access to health care because some rural doctors are pro-life. They lack access because our medical system is way undersubsidized and does not include any sort of nationalized guarantee of availability as part of insurance.

    Not to argue with you about the deficiencies of Healthcare provision, particularly to poorer neighbourhoods, but it really doesn’t help if the healthcare that you require is an abortion and the only doctor available for miles is pro-life and won’t give you a referal.

  145. #146 scooter
    August 21, 2008

    Oh yeah, Barry Crimmins talks about abortion 25 years ago, times they ain’t a-changin

    http://acksisofevil.org/audio/barry/02_Talk_Radio.mp3

    from
    http://acksisofevil.org/kill_the_messenger.html

  146. #147 Bad
    August 21, 2008

    True Bob: “Dead giveaway of an ideo(il)logical argument as opposed to a thoughtful one: pro-life doctors”

    Headslap. Yes, yes, you caught me. Lots of other people here are using the term “pro-life” with out without quotes, without anyone batting an eye, and PZ even uses the term, but somehow I’m a special case.

    Surreal. In fact, I not only agree that anti-abortion is a better term (just like “pro-abortion rights” is better than the ridiculous “pro-abortion” or the reasonable but vague “pro-choice”) but I even had an argument not a week ago defending that view. But sometimes we forget to make the extra effort to correct our language from the convention.

    It’s not like I don’t have a long blog history of explaining my views on abortion. But I suppose you think that, all in preparation for my devious comment postings here, I’ve spent almost a year lying about being pro-stem cell research, pro-choice, and atheist, and so on. All so I could fool you. But darn, you saw right through it! You’re a freakin’ mastermind.

  147. #148 Matt Penfold
    August 21, 2008

    It’s really rather simple – Doctors can have any politics they damn well choose but if they let it get in the way of their duty to their patients then they cease to be doing their jobs properly

    If we take what Maureen posted about the GMC’s position, it goes beyond simply providing a referral. Doctors in the UK would seem to have a duty to ensure that patient gets the treatment that they want, and is medically indicated for them. It less clear how the doctor should proceed if no referral is possible, and they cannot get another doctor to take over care of the patient. Given the tone of the document I would suspect the GMC would expect the doctor to puts the patient’s rights before his/her own.

  148. #149 scooter
    August 21, 2008

    Patricia #45

    Since then about 300 natural spontaneous “abortions” – how about that christian freaks 300 living eggs “lost”.

    God Hates Rags

  149. #150 raven
    August 21, 2008

    I don’t agree with the position of pro-life physicians. But I also don’t see why the medical system cannot accomodate their existence,

    BAD-ly made strawman. The medical system can and does. How many abortions does a cardiologist, pediatrician, or oncologist perform?

    Docs constantly refer patients for things they can’t or won’t treat. This is the entire basis of the medical system.

  150. #151 PsyberDave
    August 21, 2008

    This proposal or policy in general strikes me as a red herring.

    Health care providers provide services in which they are trained and equipped. What pro-life zealot is going to get trained in performing abortions only to refuse to perform the procedure when asked? If they have their own office, why would they even have any of the equipment? Nonsense.

    Any health care provider is free to specialize as their interest and talent dictates and they can always refuse to provide services especially if they are not adequately trained or equipped. They should, however, provide a referral to another appropriate professional.

    I wonder if this policy is just to make people feel like they are doing something to help their cause. It seems ineffective and purposeless to me.

  151. #152 True Bob
    August 21, 2008

    Actually, bad, that was Dan I “caught. I saw your equivalent later. And usually, I don’t care if people call themselves “pro-life” as opposed to “anti-choice”, “anti-abortion”, whatever. I do think medical care givers can ALL be considered “pro-life”, and as such, “pro-life doctors” does not make a subset of “doctors”.

    Nothing personal, it’s just a nonsense phrase that doesn’t specify anything, like “straight heterosexuals”.

  152. #153 Bad
    August 21, 2008

    Matt Penfold: “And where there is no alternative ? You have already heard about one state in the US where there is only one doctor willing to perform termination, and he flies in from elsewhere. What about the rights of woman there?”

    How many abortions have you performed lately? How many have you paid for via donations to PP? You purport to worry about the rights of women there, but for some reason your idea of “rights” seems to involve coercion of unwilling doctors (which will only, in fact, mean less doctors) instead of actually addressing the problem at hand and fighting to get more doctors out there and more money out there to actually supply what people need.

    You really are a trip, dude. I married a woman who spent the start of this week training in a per-term clinic for a career providing that service, and came home on Tuesday with electively aborted fetus juice on her clothing. I’ve spent years working to elect Democrats and fighting for health care reform while other people pointlessly pissed and moaned about them not being quite liberal enough in every respect. But no, no, I don’t care: in fact I must be an evil nutter in disguise because I don’t like to pretend that it’s all the fault of a couple of pharmacists. You, who’s idea of “doing something” is to rhetorically order other people to do it: you’re the hero here.

    “You seem to think that there will always be someone willing to do what other doctors will not.”

    No, I don’t. What I think is that we need to make sure there are many more doctors available, and that that doesn’t happen by magic, or even by ordering doctors that refuse to perform them to perform them. That isn’t going to make them any more available, or help fulfill anyone’s positive rights.

    “As a result you do seek to deny woman the right to abortions: Not directly maybe, but through indifference to their rights.”

    You’re truly full of it. I am not indifferent. I just don’t agree that anything goes when it comes to solving the problem, particularly not something unlikely to help much in any case.

    But, please, do explain to me how a rural town with a pro-life doctor benefits from having that doctor move away back to a Catholic Hospital in the city, leaving them with no doctor at all. Many places in the country are operating with 50% of the doctors they need, but no: your plan is to have even less of them?

    “I do not think that makes you much less culpable than the more direct anti-choicers.”

    As I have pointed out, you and I are equally responsible for lack of access as any anti anti-choice doc. That’s because positive rights are the responsibility of everyone, not just whichever scapegoat you choose to shift the burden off yourself.

  153. #154 Matt Penfold
    August 21, 2008

    How many abortions have you performed lately? How many have you paid for via donations to PP? You purport to worry about the rights of women there, but for some reason your idea of “rights” seems to involve coercion of unwilling doctors (which will only, in fact, mean less doctors) instead of actually addressing the problem at hand and fighting to get more doctors out there and more money out there to actually supply what people need.

    I have no idea what PP is.

    I live in the UK. Terminations here are available on the NHS. Y am also unaware of any Catholic hospitals here in the UK. Can you enlighten me as where Catholic hospitals are to be found in the UK ?

    Abortions in not available in part of the UK, Northern Ireland, and nor is it available in the South. In the past I have helped to pay for Irish women to come to the UK for terminations.

    Still, I am mighty amused by the fact you think UK cities have loads of Catholic hospitals. Talk about ignorance!

    So Sorry, I am not responsible for the lack of healthcare in the US, no matter how much you try to claim I am.

  154. #155 Danio
    August 21, 2008

    Matt Penfolds @147:

    In theory, we have that too. The official opinion from the ACOG Ethics committee (PDF here), acknowledges conscientious refusal to treat but places limits on how this can be practiced, stating explicitly that the primary duty is to the patient. This is the document that got Leavitt’s knickers in a knot about the ‘rights of conscience’ issue to begin with.

    I am not an MD, but I know that ethical conundrums arise in almost every field of medicine. It is appalling to imagine how different the health care field would be if most physicians did NOT subscribe to the principle that a patient’s beliefs, needs, and well-being–rather than those of the physician–should be the guiding force behind all treatment decisions.

  155. #156 Lilly de Lure
    August 21, 2008

    Matt Penfold said:

    I have no idea what PP is.

    PP = Planned Parenthood – it’s a charity that provides information on and referals for abortion, contraception and runs sex education classes.

    Abortions in not available in part of the UK, Northern Ireland, and nor is it available in the South. In the past I have helped to pay for Irish women to come to the UK for terminations.

    Kudos to you, Sir!

    Still, I am mighty amused by the fact you think UK cities have loads of Catholic hospitals. Talk about ignorance!

    We have a few Catholic-run hospices up here in Scotland but I’m not sure about fully-fledged hospitals, any other Ukers with more info on this?

  156. #157 True Bob
    August 21, 2008

    So how long does it take to get from one end of the British Isles to the other? Us Merkins have a friggin hayuge country.

  157. #158 Matt Penfold
    August 21, 2008

    I would also add that I think any gynaecologist who is employed within the NHS should be required to perform termination if required as part of their contract. If they are not willing to do so they can either seek work in the private sector (and I think they will find not performing terminations will limit the scope for them there as well) or re-train in another speciality.

    In addition all GP’s as part of their contract with the Local Health Board should be required to refer women for terminations if they asked to do so, and provide contraception advice and prescriptions.

  158. #159 Matt Penfold
    August 21, 2008

    So how long does it take to get from one end of the British Isles to the other? Us Merkins have a friggin hayuge country.

    Land’s End, the most westerly point in Britain to John O-Groat’s, the most northerly settlement, is about 750 miles if I recall. You can drive it in under a day, as except at either end the roads are pretty good. The most southerly and most Northerly points are only a few miles from Land’s End and John O’Groats so the times for either Journey do not differ much.

    I have never done Land’s End to John O’Groats, although I have done the longest (in time and distance) train journey in the UK, which is Plymouth to Aberdeen and takes about 17 hours.

  159. #160 Mold
    August 21, 2008

    You’ve left out the abortion fanatics that send pictures of the physicians kids with crosshairs on the child’s back. The firebombings of homes and clinics. The fake lawsuits that eat up the MDs earnings and make insurance difficult to obtain. The fact that idiots and unlettered boobs are making the choice for you.

    “Of course a physician can choose to provide elective abortions. We’ll just make their life hell until they make the RIGHT choice.”

    Every OB/GYN should be trained in abortion techniques. Not every sperm is sacred and not every pregnancy is safe.

  160. #161 Matt Penfold
    August 21, 2008

    Kudos to you, Sir!

    It started by chance. When I was at university and for a period afterwards I had a female friend who supported the Irish women by putting them up in their home when they came over for the termination. One day she asked me if I could lend her money to get in some food. After that I got into the habit of taking her to the supermarket before one of the women arrived and letting her stock up at my expense.

    It was not much, but I think it helped in a small way.

  161. #162 Andrew N.P.
    August 21, 2008

    As a result you do seek to deny woman the right to abortions: Not directly maybe, but through indifference to their rights.

    You confuse the right to a safe and legal abortion with the privilege of a quick, convenient, and cheap abortion. Or do you consider that a right as well? Should Planned Parenthood be legally obligated to make house calls, simply because it would cost more for a woman to have to drive to a clinic?

    (I can see it now: “We’ll terminate your pregnancy in 30 minutes or it’s free!”)

  162. #163 khan
    August 21, 2008

    Phoenix Woman: “Comment by Bad blocked.
    Ahh, killfile, how I love thee.”

    What’s the polite response to something like this?

    An apology.

    All hail the killfile.

  163. #164 Matt Penfold
    August 21, 2008

    You confuse the right to a safe and legal abortion with the privilege of a quick, convenient, and cheap abortion. Or do you consider that a right as well? Should Planned Parenthood be legally obligated to make house calls, simply because it would cost more for a woman to have to drive to a clinic?

    (I can see it now: “We’ll terminate
    your pregnancy in 30 minutes or it’s free!”)

    Look, I have only the vaguest idea who Planned Parenthood are. It seems they are an American charity. I am not discussing the US specifically, but I can understand how someone like you might be unaware of that.

    And yes, I do consider a woman has a right not only to an abortion but to one quickly and at no financial cost to her. In more civilised parts of the world than the US, woman do have that right.

  164. #165 Matt Penfold
    August 21, 2008

    I apologise to those Americans here who I know are decent people. It is not my intention to label you as uncivilised, just some of your compatriots and some aspects of your society.

    Of course I am pretty sure you think much the same anyway.

  165. #166 Kristin
    August 21, 2008

    Mike Leavitt’s blog is fucking nauseating.

  166. #167 Graculus
    August 21, 2008

    You confuse the right to a safe and legal abortion with the privilege of a quick, convenient, and cheap abortion. Or do you consider that a right as well?

    Why shouldn’t it be quick convenient and cheap?

    Your utility service pipes water into your house. Why shouldn’t health care be regarded as a public good, like water?

    Or, conversely, do you think that the utility company has the “right” to not provide water (or electricity or phone) to someone who is black?

    Anyhow, we aren’t talking about abortion, we are talking about contraception, and the refusal to refer to a practicioner that provides those services, not the provision of services themselves. An anti-abortion physician or pharmacist doesn’t have any ethical or moral objections to make because it is not abortion. The only explaination is that they are either misogynists or bugfuck insane, and in either case perhaps should not be practicing.

  167. #168 Danio
    August 21, 2008

    Graculus @166:

    Anyhow, we aren’t talking about abortion, we are talking about contraception, and the refusal to refer to a practicioner that provides those services, not the provision of services themselves. An anti-abortion physician or pharmacist doesn’t have any ethical or moral objections to make because it is not abortion.

    Ah, but the language in the new HHS policy makes it permissible for these conscientious objectors to decide for themselves what ‘abortion’ actually means, regardless of whether or not their opinion is science-based:
    (from the HHS proposal draft)

    Therefore, for the purpose of these proposed regulations…the Department proposes to define abortion as “any of the various procedures–including the prescription and administration of any drug or the performance of any procedure or any other action–that results in the termination of the life of a human being in utero between conception and natural birth, whether before or after implantation.

    Be that as it may, I wholeheartedly agree with your conclusion, and would only add that misogyny and bugfuck insanity are certainly not mutually exclusive :)

  168. #169 bernard quatermass
    August 21, 2008

    “I wonder if these idiots understand the concept of THINKING.”

    It’s entirely possible they do; however, good solid thinking is not easy, while “gut instinct” (also known by this sort of person as “logic” — this never fails to slay me) is.

  169. #170 Carlie
    August 21, 2008

    You confuse the right to a safe and legal abortion with the privilege of a quick, convenient, and cheap abortion.

    But quick = safe when it comes to abortion in particular. The longer the woman has to wait, the more the risks go up because the more involved the procedure is.

  170. #171 raven
    August 21, 2008

    “I wonder if these idiots understand the concept of THINKING.”

    Sure they do. They just don’t care.

    At this point, Bushco and Leavitt’s goals are simple.

    1. Do as much damage to the USA as they can in the next 6 months before they get forced out of office. The countdown is almost over and they don’t have to worry about being reelected again.

    2. Cause as many problems for normal people as possible as long as they have a hold of the club. Really, it is all about being religious fanatics. No point in being a nihilisitic, authoritarian Death Cultist if you can’t oppress and enslave people any way you can. Might as well join the Episcopalians or garden club otherwise.

  171. #172 Matt Penfold
    August 21, 2008

    But quick = safe when it comes to abortion in particular. The longer the woman has to wait, the more the risks go up because the more involved the procedure is.

    Oh Carlie, you are clearly an intelligent and sensible person (and I rather suspect from a male perspective hot as well!) but how little you understand the minds of the bigots and their enablers.

    The greatest damage to a woman who has an abortion comes not from the procedure itself, although we all know she will get breast cancer as a result, but from the damage to her soul.

  172. #173 Matt Penfold
    August 21, 2008

    Does anyone have any idea what proportion of the US is so fucked in the head from fundamentalism that they are beyond hope ?

    Only if McCain wins come November I think the rest of the world ought to consider offering those of you who are not beyond hope a refuge.

    I think the EU would be in, as would Australia and New Zealand. There are parts of Asia who are not beyond hope, and they could house some of you as well.

  173. #174 Annie
    August 21, 2008

    Leavitt has poisoned the well of science and research in healthcare. His “blogging” is slickly marketed poisonous propaganda and Mormon religious ideology. Which is why physicians are forced to provide government scripted false information to patients in South Dakota, why dangerous and worthless abstinence only dogma is mandated and causing unintended pregnancy, increased incidence of communicable and preventable disease, increased morbidity, and preventable harm and suffering. It’s why HIV gas been undercounted – deliberately – in the US. It’s why public health and safety measures have been intentionally gutted.

    Te Bush Administration is consistent, efficient and entirely predictable – whatever they accuse is what they are guilty of. Whatever they claim, the opposite is the truth.

    It is the projection and mirror image legacy.

    It is a lie perpetrated on us, and it is killing everything about and in the US.

  174. #175 Keanus
    August 21, 2008

    llewelly, you’re quite right, I miswrote. Indeed 87% of US counties lack an abortion provider, not the other way around.

    As for the source, it’s a section of the Guttmacher Institute web site. The Institute is the research arm of the Planned Parenthood Federation of America and the prime source for information on all things concerning reproduction. Even the anti-abortion crowd uses their data because of their reliability and faithfulness to accuracy, something the anti-abortion folks lack.

  175. #176 Matt Penfold
    August 21, 2008

    Just to add to what Carlie said, the evidence shows that abortion before 12 weeks is safer than abortion post 12 weeks, and both are safer than going to term.

    And given the earlier an abortion happens the safer it is, surely that is even more reason to ensure medical professionals do not delay access to slave their religious conscience ?

    Given some woman may not know they pregnant until at least four weeks, that does not leave at lot of time for a women to visit her general practitioner, find he is not willing to help her, find an alternative, have an initial appointment and then have the termination. Time, is these circumstances, is of the essence.

  176. #177 raven
    August 21, 2008

    Does anyone have any idea what proportion of the US is so fucked in the head from fundamentalism that they are beyond hope ?

    Not as much as it seem sometimes. Estimates for hardcore fundies range from 7 to 20% of the population. What we call fundies and evangelicals differ widely among themselves and the various sects have a hobby of accusing each other of being heretics. Some evangelicals don’t have a problem with evolution for example, and teach it in their colleges. They all hate the antichrist Catholics (largest sect at 23%) who hate them back.

    A recent poll said that 49% of the US population was sick and tired of fundie cultists trying to cram their religion up everyone elses ass. Most of those 49% describe themselves as….Xians.

  177. #178 Josh K
    August 21, 2008

    Dale @82

    “Hello I am a doctor, and it is against my conscience to treat people who are stupid enough to believe in religion.”

    I wonder how long that would last for?

    I’d hope now and forever, but only if you rephrase the above as: “Hello, I’m a doctor of science-based medicine. I cannot, with good conscience, condone your [insert woo here] treatments, nor will I participate in them, but I will be here to treat you with actual medicine when [insert woo here] doesn’t work. If you insist on a reference, the least damaging [insert woo here] practitioner I know of is [insert nutcase name here], he at least sterilizes his [woo tools].”

    Flex @93

    As for the original point of the post, Danio appears to have it right. This policy would to allow the ethics of a health care provider to trump the ethics of a patient. In no other profession would we be even considering this. This is entirely about a faith-based view of reality.

    I agree and disagree.

    A doctor who refuses to perform a circumcision should refer to a doctor who will. = A doctor who refuses to perform an abortion should refer to a doctor who will.

    In both cases, a doctor is using his own code of ethics to deny the procedure to the patient, yet providing them another avenue.

    The equation changes when immediate physical harm comes into question.

    Steven Dunlap @100

    Where’s Sigourney Weaver when you need her?

    She’ll be there in the nick o’ time, blazing full-auto in one hand and spouting flame-thrower in the other.

    Thoracantha @107

    When they deny a patient the right to preventative birth control, or the right to have an abortion, the doctors are forcing their morality on their patient. It a large percentage of cases, the patient doesn’t not have a choice to pick another doctor.

    I’m pro-choice. However, there is no duty that a physician perform an abortion, prescribe birthcontrol, perform cosmetic surgery….heck, they’re free to not prescribe aspirin if they feel it isn’t in the best interest of the patient. If there was a ‘right’, then you would be correct that doctors would have a collective ‘duty’ to meet that ‘right’. But as of this writing there isn’t. We *do* have a Supreme Court decision that prevents laws against abortion, that’s it.

    As a progressive, secular society I submit we *need* population control, so we must insist on making birth control available and abortion an option. I’m very, very leery, though, of taking individual responsibility and authority away from the physician and turning it over to laymen. If a doctor refuses on either moral or medical grounds, but is willing to recommend another doctor for the procedure, then I submit she has acted correctly. If there is reasonable evidence that the procedure is needed to preserve the life of the prospective parent, then the procedure is no longer elective and the physician has a duty to act.

    Note: I did not say religious grounds. “My church will excommunicate me if I perform this procedure.” isn’t a valid objection under the oaths taken by physicians. “I object to this procedure on moral grounds.” is.

    Equisetum @108

    Back when homosexuality was officially classified as a mental illness, would you say that “sanctimonious” docs should either throw gay people in asylums and force hormone drugs on them to “fix” them, or else leave the profession?

    Too bad the examples you used are about forcing treatment on patients who don’t want it or can’t legitimately consent, whereas the current issue is refusing treatment to patients who desire it. Two entirely different concepts.

    Otherwise, you might have had a point.

    How about refusal to perform cosmetic surgery? Or perscribe homeopathy? Chiropracty? Acupunture? What about physicians that refuse to perform cicumcisions, or participate in state-order executions?

    Bad’s essential point is, I submit, a valid one: we have a strong tendency to object to conscience in others when we don’t hold their views, yet demand the option of conscience regarding views we hold.

    This isn’t new to anyone on a science blog, right? A huge part of science is the elimination of our own bias so we can objectively examine the data.

    Phoenix Woman @112

    If you go to a diner and the waitress refuses to serve you a meat dish that is on the menu, because she thinks that meat is murder, does the diner have a right to fire the waitress?

    Exactly.

    If anything, this analogy doesn’t go far enough: Doctors and pharmacists who refuse to do this part of their job are like waitstaff who take jobs at steakhouses and then suddenly announce that they won’t carry any meat dishes.

    Disagree. The doctor who refuses to perform your abortion today may save your significant other’s life in a car accident tomorrow. The problem with this analogy is waitstaff serve, basically, one function…and one easily trained. A doctor can serve many, many functions in a community and has long training time.

    Bad @115

    Doctors of conscience refused to do those things, and their case, the profession itself changed to agree with their position. But the same principle you are trying to apply to pro-life doctors would have prevented those people back then from even practicing medicine in the first place.

    Exactly. “When does conscientious objection apply?” is a huge philosophical question for the atheist community as a whole, really.

    It certainly can’t be relative. We’ve got our current president stating as a matter of public record he doesn’t think atheists can discharge the duties of their office effectively. We’ve got religious service men discriminating against atheistic service men; there’s at least one law suit out there on the issue.

    This isn’t just a few nutcases out there who think atheists are by definition unreliable; there are scads of people who don’t think ‘an atheist’ can be counted on, as opposed to ‘a baptist’ or ‘a mormon’ or ‘a buddist’. They don’t understand how we feel obliged to execute our oaths, keep our word, or be there when the chips are down without a punishing/rewarding god who would make taking a strong moral stand worthwhile.

    Exhibiting extreme levels of moral relativism doesn’t help the cause.

  178. #179 Matt Penfold
    August 21, 2008

    Not as much as it seem sometimes. Estimates for hardcore fundies range from 7 to 20% of the population.

    I am sure we can still accommodate the rest of you. I have a spare room, and space on the living room floor in needed. All I ask is that if Patricia decides to escape I get first refusal on homing her. I want to see those petticoats!

  179. #180 Priya Lynn
    August 21, 2008

    Ethically speaking abortion should be prohibited after the fetus develops sufficiently to feel pain. Its an obvious ethical demarkating line that logically ends the debate. I had previously suggested to PZed that this was when he stated the neural tube was deveopled. He replied that the fetus couldn’t necessarily feel pain at that point but wasn’t courageous enought to volunteer at what point of development he thought the fetus could feel pain.

  180. #181 mas528
    August 21, 2008

    @pryia lynn/#180

    Ethically speaking, abortion should be allowed as long as it is using the woman’s organs to survive.

    That is approximately nine months.

  181. #182 Priya Lynn
    August 21, 2008

    Mas528, I disagree.

  182. #183 spurge
    August 21, 2008

    Then don’t get an abortion Priya.

    Other than that mind your own business.

  183. #184 Priya Lynn
    August 21, 2008

    Spurge if I find myself with an undesired pregnancy and the fetus hasn’t developed to the point of being able to feel pain I most definitely will consider an abortion. As to you’re dictating what I should or shouldn’t do, take your own advice.

  184. #185 Gwar
    August 21, 2008

    I’m all for ex post facto abortions, that is up until they graduate High School.

    :-)

  185. #186 Matt Penfold
    August 21, 2008

    There is a major problem with the foetus feeling pain criteria.

    Just because a foetus has developed sufficiently to feel pain does not mean it is viable.

    This issue came up recently here in the UK when there was attempt to reduce the limit for abortions from 24 weeks to 22 or 20 weeks. The MP who put forward the proposal seems to have ignored the scientific evidence.

    A significant number of developmental abnormalities do not become apparent until at least 20 weeks. There include abnormalities that will significantly reduce expected life span to range of hour, days or weeks. It is for this reason than scans are normally carried out at around 20 weeks and women offered terminations if the scan shows abnormalities.

    An important point to keep in mind is that when timing within pregnancy is talked about, it is what might be considered the “nominal” time. That is the time assuming the woman has been having regular cycles. Since a good a number of women do not have regular cycles the times can be off by a couple of weeks at quite easily.

  186. #187 Priya Lynn
    August 21, 2008

    I agree Matt that the fetus’s ability to feel pain wouldn’t be the only criterion as to whether or not abortion is ethical.

    And Spurge, societal ethics ARE my business.

  187. #188 Richard
    August 21, 2008

    Leavitt is a sneaky little weasel who needs watching.

  188. #189 Brian
    August 21, 2008

    What I’m having trouble understanding is that it seems that this HHS “Conscience” Proposal would protect even those who don’t want to learn how to perform abortions. I don’t know that they realize it, but knowing how to properly perform a D & C is pretty important, and has implications far beyond elective abortion. I wouldn’t consider a doc competent if he/she were unable to perform one.

  189. #190 Matt Penfold
    August 21, 2008

    One issue that occurs to me out of all of this, is how socialised medicine could help in increasing access to birth control and abortions.

    Here in the UK doctors can refuse to provide services on moral grounds. However they are not allowed to refuse to refer to patients to doctors who will provide those services, and do so within a reasonable time frame.

    However there is also a requirement that patients have access to services regardless of where they live. Thus if there are no doctors in one region willing to carry out terminations the local health authority must ensure that such provision is provided.

    There seems to be no such requirement within the US. And unless and until there is, the complaints and demands from such as Bad are tantamount to denying woman access to terminations. Either there should be a requirement from healthcare providers to ensure access to services, or absent that where there is no socialised provisions, the onus falls to the practitioners to ensure there is provision made. If private medicine does not provide a service to which there is legal entitlement then unless there is other reasonable provision, it must be forced to.

  190. #191 Matt Penfold
    August 21, 2008

    What I’m having trouble understanding is that it seems that this HHS “Conscience” Proposal would protect even those who don’t want to learn how to perform abortions. I don’t know that they realize it, but knowing how to properly perform a D & C is pretty important, and has implications far beyond elective abortion. I wouldn’t consider a doc competent if he/she were unable to perform one.

    I certainly would not consider a gynaecologist competent unless they knew how to perform abortions. Once can to some extent excuse doctors have gone into other specialities years ago. There does seem to be a way out of this. Refuse to certify people as qualified in gynaecology unless they can demonstrate competence in performing abortions.

    I know this will drive Bad mad (madder I should say, I question how sane he was to start with), but what is and is not acceptable practice does not depend on the individual doctor, but also on her/his peers not only nationally but internationally.

  191. #192 raven
    August 21, 2008

    I don’t know that they realize it, but knowing how to properly perform a D & C is pretty important, and has implications far beyond elective abortion. I wouldn’t consider a doc competent if he/she were unable to perform one.

    You don’t know what the hell you are talking about. How many D&Cs does an allergist, interventional cardiologist, or GP do? Zero, this is OBGYN territory.

    More to the point, the HHS isn’t trying to allow docs to refuse to perform abortions. They already have that privilege. They are trying to equate birth control with abortion so wingnut MDs can persecute more people and make them miserable. The medical profession doesn’t even want or need this crap, they are trying to force it on them from the government theocrat side.

    Calling Leavitt a little weasel definitely insults weasels. He is a Death Cultist trying to cause as many problems for as many people as possible for the usual christofascist nihilist reasons.

  192. #193 Josh K
    August 21, 2008

    Calling Leavitt a little weasel definitely insults weasels. He is a Death Cultist trying to cause as many problems for as many people as possible for the usual christofascist nihilist reasons.

    Amen.

  193. #194 Chiroptera
    August 21, 2008

    Matt Penfold, #190: And unless and until there is, the complaints and demands from such as Bad are tantamount to denying woman access to terminations.

    I think that this is actually close to Bad’s point: I think that he’s been trying to say we shouldn’t be trying to force doctors and pharmacists to practice their profession in ways they find objectionable, but, rather, we should be spending all of our efforts in establishing these other clinics and doctors where they are most needed.

    He hasn’t been very clear in this — you have to get lucky and read the very end of a very long post when he happens to drop it in. (I also think he’s wrong as well.)

  194. #195 Matt Penfold
    August 21, 2008

    You don’t know what the hell you are talking about. How many D&Cs does an allergist, interventional cardiologist, or GP do? Zero, this is OBGYN territory.

    In terms of carrying out, none I would hope. In terms of the number they have been present at, well they should have been present at some during some stage of training either in med school or when doing their hospital rotations.

    I am not certain about doctor training here in the UK, but I do know for nursing training, students are expected to present for D&Cs. They have the option to decline attending abortions, but I think that can affect their options to specialise in gynaecology later on.

  195. #196 Josh K
    August 21, 2008

    @Matt Penfold, #191

    Refuse to certify people as qualified in gynaecology unless they can demonstrate competence in performing abortions.

    That’s the neatest possible solution. Wholeheartedly concur.

    but what is and is not acceptable practice does not depend on the individual doctor, but also on her/his peers not only nationally but internationally.

    Agree and disagree here. Standardization of procedures is important in medicine. There will be times, however, when doctors disagree on what procedures should be performed and when. You can probably find pro-choice physicians who will refuse to perform a specific procedure or to terminate after a specific trimester based on moral (inhumane method, fetus well developed enough to feel pain, etc) or medical (risk to the woman involved) yet at the same time a majority may have no problem with the procedure or trimester involved.

    Medical concensus is huge and ever changing body of knowledge; I don’t like the idea of forcing a doctor to use a particular procedure if he’s got reservations about it. He should, though, always be willing to recommend another doctor on the procedure.

    Even in science based medicine, there are a great many variables, and…I hesitate to *force* a doctor who doesn’t *want* to be poking around in my innards or prescribing me medications to poke around in my innards or prescribe me medications, regardless of the reason.

  196. #197 Matt Penfold
    August 21, 2008

    I think that this is actually close to Bad’s point: I think that he’s been trying to say we shouldn’t be trying to force doctors and pharmacists to practice their profession in ways they find objectionable, but, rather, we should be spending all of our efforts in establishing these other clinics and doctors where they are most needed.

    He hasn’t been very clear in this — you have to get lucky and read the very end of a very long post when he happens to drop it in. (I also think he’s wrong as well.)

    Maybe I do him a disservice, but at the very least the availability must be in place first, before insisting on the rights of the practitioners. Practitioner rights come second. Health authorities can and do take into account the willingness of applicant for relevant positions to carry out abortions. If you will not carry out them, and the hospital wants someone who will in order to ensure adequate cover, then you unlikely to get job. Merely having one doctor is not enough, of course, as they need time off and during that time off cover must still be in place.

    There is also the issue of whether a person should be qualified in a position where they will not perform some of the procedures expected of them. Ther is also the issue of what is consider a reasonable moral or ethical refusal to perform procedures, and what is unreasonable. Some people have raised the issue of JWs. Can a JW work in trauma and refuse to administer a blood transfusion ? I would say no, and such a person should never get qualified to work in trauma unsupervised.

  197. #198 Dan
    August 21, 2008

    So are you trying to argue that doctors should be forced to perform abortions, or forced to take part in executions of criminals? Why not let employees live by their consciences? Wouldn’t this be more enlightened than saying that every employee MUST perform any task that the employer wants done?

    What about science professors being forced to teach creationism?

  198. #199 maureen
    August 21, 2008

    True Bob @ 157

    But surely god gave you Merkins a truly huge country to run because you are so much more rich and so much more capable than any other set of humans. (snark)

    Meanwhile in the benighted UK, one of the stated objectives of the system is that each one of us should have as close as possible to equal access – to local doctors and all other medical services. That’s a bit hard to achieve given the vast differences in topography and population density but the present lot, for all their many flaws, has come closer to achieving that than ever before.

    As an example, the three small towns in my very rural areas has a clinic in each town, all managed as a group. Mine has 6 doctors, 2 nurse practitioners and a part-time physio on site and advertises various clinics, minor surgery and family planning services on its (badly designed) website. The large general hospital is about 8 miles away, three teaching hospitals with specialist services, e.g. cancer, are within 40 miles.

    The distances here probably seem insignificant but someone living in a croft half way up a Scottish mountain has the right to the same service – just has to travel further and, yes, help with travel costs is available. Perhaps South Dakota could copy.

    And for the doubters here, none of those medics is starving in a garret nor running a 20 year old car!

    I believe that the USA has more doctors per head of population than anywhere in Europe. Would it be rude to suggest that you’re not using their skills very efficiently?

  199. #200 Carlie
    August 21, 2008

    What about science professors being forced to teach creationism?

    Are you really that stupid?

  200. #201 Matt Penfold
    August 21, 2008

    Agree and disagree here. Standardization of procedures is important in medicine. There will be times, however, when doctors disagree on what procedures should be performed and when. You can probably find pro-choice physicians who will refuse to perform a specific procedure or to terminate after a specific trimester based on moral (inhumane method, fetus well developed enough to feel pain, etc) or medical (risk to the woman involved) yet at the same time a majority may have no problem with the procedure or trimester involved.

    I take your point here. There will always be disagreement amongst specialists as to what is and what is not good practice. However I think in practice it is normally pretty east to tell those who who refuse on medical ground and those who refuse on non-medical grounds. Unless their practice is wholly out of line with their peers I would tend to grant probationers some leeway. Some practitioners are willing to take more risks than others for example. Not all surgeons will agree on the criteria for what is and is not an acceptable risk for heart bypass surgery. I think we would both find it unacceptable though for a doctor who do not think a treatment suitable to refuse to refer a patient to one who would.

  201. #202 Natalie
    August 21, 2008

    There is a huge amount of hypocracy among the anti contraception and abortion crowd.

    There’s an interesting essay called “The Only Moral Abortion is My Abortion” that discusses this phenomenon: http://mypage.direct.ca/w/writer/anti-tales.html

    Planned Parenthood, BTW, doesn’t just provide referrals for medical services. They operate sexual health clinics around the country, and are the largest single provider of abortions in the United States.

  202. #203 Chiroptera
    August 21, 2008

    Dan, #198: So are you trying to argue….

    I can’t speak for anyone else, but I am giving my opinions in a national/societal dialog that will, hopefully, reach some sort of consensus regarding what is required from professionals certified by the state and by the relevant professional organizations. In this case, I am saying that a person has the right to medical procedures that are necessary and proper for her physical and mental well-being. In areas where reproductive services are scarce, this means that health providers must provide these services unless and until alternatives become available.

    Executions of criminals and teaching creationism doesn’t quite fit into this.

  203. #204 Ryan F Stello
    August 21, 2008

    Matt Penfold (#197) asked,

    Maybe I do him a disservice, but at the very least the availability must be in place first, before insisting on the rights of the practitioners. Practitioner rights come second. Health authorities can and do take into account the willingness of applicant for relevant positions to carry out abortions. If you will not carry out them, and the hospital wants someone who will in order to ensure adequate cover, then you unlikely to get job.

    I could be completely wrong in this, but I took Bad’s argument to be of the sort, “why would you force a private practitioner to adopt ethics that are not in line with his/her own?” To which I would say, yes, it would be hard to make that case on grounds other than my own disdain for doctors who call themselves conscientious objectors, but instead, possibly do harm by their objection.

    Of course, nearly everyone else’s arguments have focused on hospitals and non-private institutions were specific types of care are supposed to be granted by law, so a person’s attitudes can’t and shouldn’t apply.

    IMO, he steered the conversation in a different direction, probably on accident.

  204. #205 Matt Penfold
    August 21, 2008

    I could be completely wrong in this, but I took Bad’s argument to be of the sort, “why would you force a private practitioner to adopt ethics that are not in line with his/her own?” To which I would say, yes, it would be hard to make that case on grounds other than my own disdain for doctors who call themselves conscientious objectors, but instead, possibly do harm by their objection.

    My answer to that would be that how the doctors are paid should not be an issue with regards the care they provide. It does not matter if a doctor is paid by the government, or by an insurer, or by the patient, the standard of care should be, must be, the same.

  205. #206 raven
    August 21, 2008

    Dan the idiot:

    So are you trying to argue that doctors should be forced to perform abortions, or forced to take part in executions of criminals?

    Dan you idiot. No. Docs can refuse to perform abortions right now and no one can force them to.

    Docs also cannot force you to visit the Wizard of Oz to get a brain but you would benefit from it greatly. The haze in your mind would clear up. You might be able to figure out what is going on once in a while and people would stop laughing at you.

    What Leavitt is trying to do is redefine contraception as abortion. In other words lying. Then to allow pharmacists to refuse to fill BC prescriptions and so on. No one much wants this in either pharmacy or medicine. It is just another attempt for Death Cultists to cram their religion up other people’s asses to annoy them.

  206. #207 Matt Penfold
    August 21, 2008

    Planned Parenthood, BTW, doesn’t just provide referrals for medical services. They operate sexual health clinics around the country, and are the largest single provider of abortions in the United States.

    I am not knocking the work done by Planned Parenthood as they clearly fill a gap in healthcare provision in the US.

    However is it not something of an indictment against a country when the largest providers of an important social service has to be funded by voluntary donations ?

    As I have said before here in the UK much of the provision for abortions, and almost all family planning, is done on the NHS. I am more than glad some of the tax I pay goes towards that. Northern Ireland is an exception, and a disgraceful one. I doubt it is a coincidence that Northern Ireland is also the only part of the UK where there is any political support for teaching creationism. As they used to joke when flying to Belfast “Welcome to Belfast. Please set your watches back 50 years”.

  207. #208 Josh K
    August 21, 2008

    @Matt Penfold, #201

    I think we would both find it unacceptable though for a doctor who do not think a treatment suitable to refuse to refer a patient to one who would.

    Yep yep.

    Hence:

    Josh K, #196

    He should, though, always be willing to recommend another doctor on the procedure.

    and

    Josh K, #178

    If a doctor refuses on either moral or medical grounds, but is willing to recommend another doctor for the procedure, then I submit she has acted correctly.

  208. #209 Dan
    August 21, 2008

    Raven dear, I’m not an idiot. I actually am a microbiologist. I’ve worked it healthcare for over 20 years. I would decscribe myself as ‘liberal’ in a lot of ways. What I am trying to say is that the bill introduced is a part of the democratic process – sometimes bills we don’t like get introduced. So get out and vote!

    What I am trying to say to you and other whiners is that I would like to see a world where workers have the right to live by their consciences and be allowed to refuse certain tasks that the employer wishes of them. Do you care to argue with this? I was around before “drug screens” were everywhere detecting every lost weekend that an employee had when they were NOT working. I am sad to see people becoming more and more enslaved to their jobs. How about you?

    Raven – I think you need a few more years of experience in life before you judge me.

  209. #210 Matt Penfold
    August 21, 2008

    What I am trying to say to you and other whiners is that I would like to see a world where workers have the right to live by their consciences and be allowed to refuse certain tasks that the employer wishes of them. Do you care to argue with this? I was around before “drug screens” were everywhere detecting every lost weekend that an employee had when they were NOT working. I am sad to see people becoming more and more enslaved to their jobs. How about you?

    There are some jobs that I know require employees to undergo testing for alcohol and other drugs. As far as I am aware they are all they type of jobs where alcohol or drug abuse can kill. Airline pilots and train drivers come to mind but then the testing of those is mandated by law.

    Where do you live that an employer can demand such tests from just any of their employees ? Pretty sure not the EU, as legislation would seem to prohibit that. Somewhere without regard to human rights I would guess.

  210. #211 Josh K
    August 21, 2008

    @Dan, #209

    I would like to see a world where workers have the right to live by their consciences and be allowed to refuse certain tasks that the employer wishes of them.

    Well said.

    I would add caveats that some professions have to suspend this rule simply to exist effectively (e.g. military, judiciary, police, etc), in that by definition their jobs involve serving a public concensus…by signing on, they acknowledge that they subordinate some (not all) of their rights to personal conscience in order to effectively serve the group.

  211. #212 Chiroptera
    August 21, 2008

    Dan, #209: What I am trying to say is that the bill introduced is a part of the democratic process – sometimes bills we don’t like get introduced. So get out and vote!

    What I am trying to say to you and other whiners….

    Part of the democratic process is engaging in a discussion to try to convince others toward you viewpoint. This is not whining; it is an important part of the democratic process.

    …I would like to see a world where workers have the right to live by their consciences and be allowed to refuse certain tasks that the employer wishes of them.

    So get out and vote, you whiner! (Your words, not mine.)

  212. #213 Matt Penfold
    August 21, 2008

    I would add caveats that some professions have to suspend this rule simply to exist effectively (e.g. military, judiciary, police, etc), in that by definition their jobs involve serving a public concensus…by signing on, they acknowledge that they subordinate some (not all) of their rights to personal conscience in order to effectively serve the group.

    I would add doctors, and nurses and some other healthcare professionals, to that list.

    I would not restrict their right as much as some of the others, but in being given licence to practice I would argue health care professionals should agree to put the interests of their patients ahead of their own. Not everyone is allowed to call themselves a doctor or nurse, and in return for being allowed so to so, one must give up some personnel rights.

  213. #214 Ryan F Stello
    August 21, 2008

    I would add caveats that some professions have to suspend this rule simply to exist effectively …by definition their jobs involve serving a public concensus

    In what way does a doctor not serve a public consensus.
    Like, say, a public that overwhelmingly agrees that birth control is expected to be made available?

  214. #215 Dan
    August 21, 2008

    Chiroptera – sure…. We agree – there should be discussions that attempt to engage in real conversation. What I am seeing in these blog comments & in the blog itself is name calling and derision towards all comments and attempts at any real different points of view.

    Oh and raven, don’t worry about offending me by your name calling, because I don’t believe you exsist! See, P.Z. may be an atheist, but I am a SOLIPSIST!

    Thank you Chiroptera!

  215. #216 crow
    August 21, 2008

    This is entirely consistent with the Republican platform, which believes the rights of the fetus are paramount even in cases where the mother will die without an abortion, as in the 2 to 3% of pregancies that are ectopic.

    http://query.nytimes.com/gst/fullpage.html?res=940DE3DE153CF934A1575AC0A96E948260

    Of course, it is NOT consistent with the wishes of the American public, since actually 85% of us believe that complications of pregnancy are a tragedy instead of the willful act of ‘wrongly gestating’ which deserves the death penalty.

  216. #217 Josh K
    August 21, 2008

    @Matt Penfold, #213

    I would add doctors, and nurses and some other healthcare professionals, to that list.

    My initial reaction was to add them, actually, but upon reflection I would not.

    The professions I cited require either:

    a) strict discipline and collective action to function effectively
    b) are so potentially damaged by personal bias that only the highest standards of objectivity are acceptable

    Doctors already hold themselves to higher standards than laymen, if the various physician’s oaths and licensing requirements are any indication. As in all true professions, they accept rules of ethics that bind them to a higher standards and give up a lot of the free passes the rest of us get. It isn’t just a job.

    iirc, there’s a movement to require similar ethics to anyone working in science…I’m not up on the topic, though.

    I submit, by the very nature of their work, that physicians require more autonomy that the other professions I mentioned, and, as mentioned in my posts above, I have strong reservations in dictating that they perform specific procedures…this is one of the reasons I don’t care much for managed care, as that format limits the ability of the doctor to do the job. I admit I don’t have an alternate solution re: health care costs.

    in being given licence to practice I would argue health care professionals should agree to put the interests of their patients ahead of their own.

    That’s the crux of the debate right there: a physician is suppose to put the welfare of the patient ahead of their own wishes…and, often, the wishes of the patient.

    @Ryan F Stell, #214

    In what way does a doctor not serve a public consensus.
    Like, say, a public that overwhelmingly agrees that birth control is expected to be made available?

    I would refer to my response to Matt above; I think I covered it.

    @Dan, #215

    What I am seeing in these blog comments & in the blog itself is name calling and derision towards all comments and attempts at any real different points of view.

    Yep yep.

  217. #218 Matt Penfold
    August 21, 2008

    That’s the crux of the debate right there: a physician is suppose to put the welfare of the patient ahead of their own wishes…and, often, the wishes of the patient.

    I agree with you here. Not all requests made by patients are appropriate.

    The usual example given is going to your doctor and asking for him to amputate your leg. I understand the point behind the example but it is not that good an example as amputation of healthy limbs is sometimes carried out in the case of people who have a rare disorder in which they regard one of the limbs as not belonging to them and have a real desire to remove it. Sadly a number of these patients will attempt self-amputation. In such cases medical amputation may be a better option.

    So we can see a surgeon who would never remove a healthy limb might harm a patient if they refused to do so in such a case. Of course there would need to be some serious support coming from the psychiatrists and if I was the surgeon I would like at least two psychiatric opinions.

    However in refusing treatment the doctors moral or ethical views should not have a role. What matters is a doctor’s medical opinion. There are grounds for refusing heart bypass surgery to patients who smoke and have not been able to quit. Here in the UK there is backing both legal and professional for such a position, providing the patient has been offered all available support to quit. Just telling them to go away and come back when they have quit is going to get you into trouble and quite rightly.

    When it comes to abortion I am not aware of any contra-indications. Any condition that threatens the woman’s health during the procedure is likely to put her at even more risk if the pregnancy continues. If doctor who either has responsibility to refer (as a general practitioner or is unqualified due to lack of training) or has the duty to perform the procedure (being both trained and accepting the referral), fail to provide the care expected they deserve to be struck off.

    If a doctor who is qualified, does not wish to perform a procedure an abortion but if they do not the patient will not have the abortion, then I consider the doctor has a duty to perform the procedure. The patient comes first.

  218. #219 Ryan F Stello
    August 21, 2008

    Josh K,

    Interesting strategy, there: Make one argument, and when that fails, restrict it to a ridiculous degree so that it might.

    Doctors already hold themselves to higher standards than laymen

    And one of those standards should be that personal or religious bias should not factor into a physician’s decision for what care to provide.

    What you’re failing to realize is that this is not a matter of simple paternalism vs. autonomy (where you’re erring on the side of paternalism), but about what grounds are viable for a doctor to refuse treatment.

    I submit, by the very nature of their work, that physicians require more autonomy that the other professions I mentioned

    Submit all you like, but you also need to provide your resoning. Why do physicians require more autonomy? What about if it conflicted with the tenets of carrying a license?

  219. #220 True Bob
    August 21, 2008

    Maureen, thanks for noticing our place here in God’s Country. I don’t know how he farked up and put all OUR oil under a bunch of filthy Arabs. Mysterious ways, I guess.

    Would it be rude to suggest that you’re not using their skills very efficiently?

    Not at all. I was really asking for my own edification. I would like us to have a (oh gawds, I’m actually going to write it) socialized medical system. Lots of momentum and $ pushing against it, though.

  220. #221 Josh K
    August 21, 2008

    @Matt Penfold, #218

    What matters is a doctor’s medical opinion…When it comes to abortion I am not aware of any contra-indications.

    Agree totally. The muddy part comes in when we decide when life begins; there’s a clear majority, but not (yet) a clear concensus…else issues brought up by the OP wouldn’t be coming up with such regularity.

    Any condition that threatens the woman’s health during the procedure is likely to put her at even more risk if the pregnancy continues. If doctor who either has responsibility to refer (as a general practitioner or is unqualified due to lack of training) or has the duty to perform the procedure (being both trained and accepting the referral), fail to provide the care expected they deserve to be struck off.

    We agree here wholeheartedly, see Josh K, #178

    If there is reasonable evidence that the procedure is needed to preserve the life of the prospective parent, then the procedure is no longer elective and the physician has a duty to act.

    @Ryan F Stello, #219

    Interesting strategy, there: Make one argument, and when that fails, restrict it to a ridiculous degree so that it might.

    Eh? I think you’re being a bit unfair here. The professions in my initial list have to do primarily with politics; I’d rather keep politics separate from health, though it seems terribly, terribly intertwined these days. If popular desire dictated medicine, wouldn’t the current problem the medical community is having with CAM be that much worse?

    what grounds are viable for a doctor to refuse treatment.

    I view both birthcontrol and abortion as elective procedures. (see Josh K, #178) The case can be made (and I personally believe) that society is better having them available than not, but the issue isn’t life or death; there’s no duty for a physician to perform these procedures, only a duty that they be performed safely. Condoms are available over the counter everywhere; other methods are not yet judged safe enough (I assume) to be administered without a physician’s prescription.

    If you hold a core belief that birthcontrol and abortion are not elective procedures, but are in fact rights, then we’ll have to part company unless we want to dig deeper into what each of us consider ‘rights’ vs ‘duties’ and…well, basically, I don’t have the energy to go deeper than that today on the topic.

    What you’re failing to realize is that this is not a matter of simple paternalism vs. autonomy (where you’re erring on the side of paternalism), but about what grounds are viable for a doctor to refuse treatment.

    I don’t understand what you mean by paternalism vs autonomy.

    Why do physicians require more autonomy?

    A physician is not a mechanic; they don’t have all the specs and parameters of the human machine written down and categorized. The field requires a huge, continuously changing body of knowledge, and even with that, they’re working with very individualized entities (us), in which a great many things can (and do) go wrong. We entrust our health and physical well-being to them. I don’t like the idea of forcing them, en masse, to perform specific procedures. I would much, much rather “first, do no harm” remained their primary objective and not drag them into politics. See Josh K, #196.

    What about if it conflicted with the tenets of carrying a license?

    I’m not well versed on the topic, but medical marijuana comes to mind. There are physicians who prescribe it because (I assume) this is the best and/or most cost-effective tool for pain management. Again, part of the fallout of the War on Drugs is the hunt for physicians that ‘over prescribe’ when doing pain management; this seems a fairly decent example of politics intruding on the profession.

  221. #222 SEF
    August 21, 2008

    @ Dan #198

    What about science professors being forced to teach creationism?

    It’s illegal. Hence any employee could appeal against the employer and expect to win. In contrast, the (relevant) employees should all be being forced to teach evolution. Yet they’re getting away with not doing so and with acting illegally instead.

    The stupidity of the situation is that in the US, the most litigious of countries, there are so few prosecutions against incompetent teachers. Ditto against doctors (and pharmacists) who render themselves deliberately incompetent by taking jobs they are not prepared to do. No-one forces them to specialise in those areas. Rather they actively choose those areas in which they can cause the most mischief with their evil religious views.

  222. #223 Ryan F Stello
    August 21, 2008

    Eh? I think you’re being a bit unfair here..

    Says the person who’s doing his damndest to ignore the simple facts of the case and arguing for strange exceptionalism.
    And not very honest about it, either.

    The professions in my initial list have to do primarily with politics; I’d rather keep politics separate from health, though it seems terribly, terribly intertwined these days

    Not just these days, but for the last century, at least, laws have provided a way to both protect the public from dangerous medical practices and to grant rights to treatments that were denied by people not unlike those you’re trying to protect (like this).

    If popular desire dictated medicine, wouldn’t the current problem the medical community is having with CAM be that much worse?

    What current problem? That people prefer woo to real medicine?
    If so, your statement doesn’t apply to the question, here.
    Again, since you are trying hard to overlook it: what factors should determine what treatment is made available?

    I view both birthcontrol and abortion as elective procedures.

    Duh, but not elective for a practitioner ordered by law to provide them.

    …only a duty that they be performed safely. Condoms are available over the counter everywhere; other methods are not yet judged safe enough (I assume) to be administered without a physician’s prescription.

    If they’re talking safety, then they have a real medical argument.
    Since they’re not arguing this for the patient’s safety, your argument is flaccid.

    If you hold a core belief that birth-control and abortion are not elective procedures, but are in fact rights, then we’ll have to part company unless we want to dig deeper into what each of us consider ‘rights’ vs ‘duties’…

    Patients have rights just as much as physicians, which have been upheld time and again.
    If you can’t bring yourself to acknowledge that, then yeah, you’re too much of an idealogue to bother discussing it further.

    I don’t understand what you mean by paternalism vs autonomy.

    Example

    rather “first, do no harm” remained their primary objective and not drag them into politics.

    I’d rather that be the case, too, which is why this proposal is so bad.

    Again, part of the fallout of the War on Drugs is the hunt for physicians that ‘over prescribe’ when doing pain management; this seems a fairly decent example of politics intruding on the profession.

    Oddly enough, your example shows a positive affect of politics in the medical community: the legalization of a formerly illegal product based on its medical value, not based on subjective personal bias.

    Maybe you should think about your examples more.

  223. #224 Josh K
    August 21, 2008

    @Ryan F Stello, #223

    Hmmmm…I think you’re right. No, I *know* you’re right. Excellent article, by the way (both of them); I’m waaaaaaaay too far over on the paternalist side of that.

    I’m pro-choice, wasn’t (intentionally) defending the article brought up by the OP, but a bit (ok, waaaaay) too far over in the individualist camp for a reasonable person to be.

    Thank you for taking the time to deconstruct me; you’ve given me a lot to think about. Seriously, one less stupid idea in my head.

    Oddly enough, your example shows a positive affect of politics in the medical community: the legalization of a formerly illegal product based on its medical value, not based on subjective personal bias. Maybe you should think about your examples more.

    No, I chose medical marijuana as a ‘good thing’ and chasing docs because of the War on Drugs as a ‘bad thing’…we’re agreeing, I think. I’m just back asswards on some things.

  224. #225 Josh K
    August 21, 2008

    @Ryan F Stello, @223 redux

    Says the person who’s doing his damndest to ignore the simple facts of the case and arguing for strange exceptionalism.
    And not very honest about it, either.

    Much as it pains me to admit it, I have to agree here, too.

    It is intellectually dishonest to … advocate? describe? outline? a social construct as apart from the society it serves, no matter the goal, and I apologize.

  225. #226 Nomad
    August 22, 2008

    Matt Penfold @ 210:

    I’ve seen plenty of jobs that come with mandatory drug testing. Sometimes trivial, near minimum wage stuff. Sometimes I think it’s actually more prevalent there.

    I used to work delivering pizza for a certain pizza provider. That particular chain was known because it did not require drug tests. I hate to admit this, because it provides fuel for those who want to push drug testing, but that chain appeared to become a haven for the neighborhood stoner kids. They knew they could get a job there without having to pass a drug test. I’m not talking about just the driver positions, you might consider the drug issue to be relevant there, but we had as many or more stoners working inside positions.

    In a similar way it’s supposed to be illegal to require lie detector tests except for a narrow range of job types. My father has a job in telecommunications. Nothing national security related, no government contracts. But he’s used to having to do a polygrip test (sorry, Beavis and Butthead joke, I know it’s a polygraph test) before he can finalize his employment at a new company.

    Sorry for the topic detour folks, but.. we’ve kind of done this “right to conscience” nonsense to death anyway.

    I can add that I’ve tried to comment on that Leavitt cretin’s blog. Last night’s post was apparently censored. Asking if the people in favor of right of conscience would support some of the more popular analogies, like a mechanic who refused to work on fossil fueled vehicles, was apparently not allowed. And I’m shocked, shocked I tell you.

    I’ve tried again, just to fight the good fight. This time I added an additional taunt to the moderator, suggesting he or she must have had no conscience to be able to censor disagreement on such an issue.

  226. #227 Naked Bunny with a Whip
    August 22, 2008

    Doctors already hold themselves to higher standards than laymen

    Obviously, since “laymen” generally don’t get to ignore parts of their jobs by saying “I don’t feel like doing that”.

  227. #228 Andrew N.P.
    August 22, 2008

    However is it not something of an indictment against a country when the largest providers of an important social service has to be funded by armed robbery?

    Fixed. (Or is the British government able to get all its taxes by just asking nicely?)

  228. #229 Josh K
    August 22, 2008

    @Naked Bunny with a Whip, #227

    Doctors already hold themselves to higher standards than laymen

    Obviously, since “laymen” generally don’t get to ignore parts of their jobs by saying “I don’t feel like doing that”.

    Point taken. My argument was willfully ignorant, and I apologize.

  229. #230 ThirtyFiveUp
    August 22, 2008

    Danio, did you see this?

    http://www.evolutionnews.org/2008/08/crackers_conscience_and_pz_mye.html

    Apology if this is old news.

  230. #231 skyotter
    August 22, 2008

    “dear IRS: sorry but it’s against my religious convictions to pay taxes. luckily, federal legislation that guarantees my protection for faith-based refusal-of-service is now in place. i will no longer be paying taxes, nor referring you to people who will pay taxes. thank you for understanding.”

    hey, it’s worth a try, right?

  231. #232 IceFarmer
    August 22, 2008

    It’s simple, if you have a problem with certain facets of the job, do something else. It’s no different than looking for a job that requires you work weekends and then turn about saying that you can’t because it’s the Sabbath but you should still work there. Or working the night shift when you are not allowed to work past sunset. If your moral obligations prohibit you from doing your work in full, do something else.

    As a minor example, I work in sales, now sales management. Almost always have, it’s how I paid for my schooling. We have had new sales people with limited experience that want to get into sales but can’t ask for the sale (close deals). We are supportive and comprehensively train all new hires. We don’t throw people to the wolves. When we tell them that they have to perform because their job is commissioned they say that they feel like they are putting too much pressure on the clients. At the end of the day it’s about doing things that are ethical and appropriate as well as being good at your job. To be in sales you must be able to close deals and there is always some pressure. High pressure is another story and something that I have never agreed with. But it’s simply about being able to perform your tasks at an acceptable level. I have, unfortunately, had to terminate some great people that I really liked and enjoyed working with but simply weren’t good salespeople. They could not produce profitable numbers. I wish them all the best but if you “can’t” do it, you need to be able to move on to another field. Some of these people are no longer friends because I have been labelled a “prick” among other things because I fired them. But I have the be that guy because it’s my job. Medical professionals and people in other areas of authority must make certain the rules are followed and people are doing their jobs. If they disagree with how things are done, they have two choices. Not like it and do it anyway or they need to go do something else and make room for people that can and will.

  232. #233 Danio
    August 22, 2008

    Thirty Five Up @230

    Wow! I made the Disco’s bigot list! I’m so honored :) Thanks very much for the link, it’s the first I’ve heard of it :) MAJeff and his sexed up Jesus are going to be soooooo jealous!

  233. #234 Sondra
    August 22, 2008

    Keep in mind that this rule will apply to pharmacists who don’t want to fill prescriptions for birth control pills and plan B pills after rapes and who knows what else they feel they must refuse on moral/religious grounds.

    I’m wondering how many of these people have been on the jobs or in their professions for many years; have they been refusing to perform procedures/fill prescriptions all this time? Has anyone ever sued them or made an this a legal issue? Or is this something new that the fundies have come up with lately?

  234. #235 PYRETE
    August 22, 2008

    I can’t get over this;

    If you don’t want to deal with raw meat – DONT BE A BUTCHER
    If you don’t want to be around cigarette smoke – DONT BE A WAITRESS (im still pissed that those laws got through)
    If you believe alcohol is evil – DONT BE A BARTENDER
    If you don’t want to hand out prescribed medication – DONT BE A PHAMACIST!!!

    You’re hired to do a job so DO IT!

  235. #236 Aquaria
    August 23, 2008

    My conscience objects to allowing insurance or Republican mail in the postal system. Ergo, I won’t process mail from them anymore. Of course, I don’t have time to look through every tray of mail I receive to insure that I’m not processing insurance or Republican mail, so I can’t run any mail.

    Plus, I shouldn’t be fired for that. I should still keep my position–and my pay. After all, it’s my conscience, and I have a right to exercise it. Why should health care workers get a privilege to practice their conscience that I don’t?

    Think the USPS will buy that argument from me?

  236. #237 Aramael
    August 25, 2008

    I don’t get it. 4000 actual, real people can die in Iraq, but we must protect the embryos? I cannot understand how anybody can hold these two ideas in their head at the same time without, I don’t know, exploding or something.

    I can only fall back on an internet cliché: the stupid, it hurts.

    By the way, from waaaaay above this comment, I voted for Mike Huckabee, and he’s totally winning! No way could that pair ever be elected … of course, that’s what I said about a bush and a dick in the white house.

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