The role of religion in the delivery of medical care

I'll probably invoke the wrath of most readers, but I think that some of these "conscientious objector" physicians are on firmer ground than most realize. Why? Because the specific interventions about which they were polled tend to fall outside the scope of medical indications. That makes it quite difficult to argue cogently that physicians have a _professional_ obligation to provide, inform and/or refer.

Dr. Hibbert: "That's monstrous! I'll have no part of it."
Homer: "Can you recommend someone who will?"
Dr. Hibbert: "Why, yes..."

Seriously though:

I think in cases where the patient's health is an immediate issue, a physician's professional obligations outweigh personal objections.

However, in cases where the patient wants advice or a non-vital procedure, the physician's professional obligation is honesty, even if the answerr is, "I won't be a part of it because [reason]." There is no obligation to assist or to refer the person to someone else.

As I understand, some people can't (financially) go to another doctor if they aren't referred by their primary doctor.

That raises an interesting question. If it were shown that practising religion (e.g. prayer) could help with certain conditions (for example depression) would an atheist doctor be ethically obliged to recommend them?

Of course.

If such a thing were showed in a non-bogus fashion.

- JS

Physicians absolutely have a professional obligation to provide the full spectrum of healthcare services, either personally or through referalls to other providers. To fail to do so is to unethically interfere with a patient's right to make informed decisions based on complete and medically accurate (not religiously-biased) information.

On another note, "crster" asks perhaps the least interesting question that could be asked about this post, not to mention makes the illogical assumption that "atheist doctors" have moral objections to prayer. I seriously doubt this is the case but have nothing on which to base that statement since this study had absolutely nothing to do with moral objections to religion.

There is not, as Mr. Marley says, "no reason to assist". There is absolutely an active duty to refer a patient to another doctor if one refuses to do one's damn job.

Doctors who are allowed the luxury of failing to provide the service they swore to provide when they were licensed have a moral and legal duty to refer a patient to someone who will provide it.

Doctors are first and foremost a source of health information, and that includes explaining what choices are available, and where a service or product may be obtained.

If your personal prejudices set you against something, or force you not to perform a procedure you have the right to say so, and why, and say where that procedure can be had. But there it ends. No get-out clause. No conscientious objector status.

You may not ethically keep a patient ignorant of their options. From a faith standpoint it's a lie by omission, and a "sin". From an ethical standpoint it's worse.

Please notice what I said about situations where the patient's health is an immediate issue.

As for "keeping a patient ignorant of their options"

That's what the Yellow Pages are for. A person who wants some procedure can do their own research very easiy.

I disagree John. That's what Doctors are for. Otherwise why would we need them?

Who will tell a 15-year-old whose parents haven't told her where babies come from that she has HPV if not a doctor?

Who will tell me I have six months before the tumour on my liver kills me?

Who will tell my diabetic friend he's going to lose his feet and to book an appointment now to avoid delays that might be harmful or fatal?

Verizon? I think not.

Sorry, Mike. I intended to hit "preview" and accidentally posted the comment above before it was finished. If I may complete my argument:

What about the "immediate threat" situations above might be seen as different from a refusal to provide information about birth control--the lack of which is unquestionably a threat to patient health?

If my doctor believes my case of liver cancer is terminal and may only be helped by divine intervention does he or she have the right to deny me information on other available treatment?

If my doctor believes that diabetes is god's punishment for alcoholism and gluttony, should he refuse to treat my friend?

Most importantly, if he or she refuses me treatment, is it then okay for them to refuse to provide me information on where to go and who to talk to in order to find treatment?

Doctors are trained and licensed to heal and to care for their patients. Period. Failure to provide that care is maorally wrong, and in some cases legally so.

Metro - You might want to temper your outrage, just a bit, and consider that physicians (and pharmacists) have professional obligations regarding the treatment and prevention of various pathological conditions. It isn't at all obvious that health care professionals are duty bound to provide desired assistance to people who are seeking "treatments" for non-pathological conditions.

Once again, read what I said about immediate health issues.

Here it is again, just in case you can't find my first comment:

I think in cases where the patient's health is an immediate issue, a physician's professional obligations outweigh personal objections

Thanks, Bob. That's what I was trying to say.

Right you are Bob & John. I got away with myself for a bit there. I apologise.

But I still disagree. In all cases, information is paramount to a patient's health. Even if they're being silly and worrying about nothing they have the right to make fully-informed decisions and express consent to procedures, treatments, etc. based on that info.

The very least a doctor must do, to do right by patients, is provide a reliable source of information on a health topic or idea, especially if he or she is unwilling to supply it.

Because this is the role we allow them to fulfill in society, the role that lets them be considered reputable professionals and respected, well-paid ones at that.

I wonder if any of this disconnect between us is due to a perception difference between the US profit-driven model and the Canadian universal-care model?

Metro - Yes, "information is paramount to a patient's health." But just what constitutes health, or its contrary, pathology? (And please, don't recite the stupid WHO definition of 'health,' which implies that all unhappiness and dissatisfaction are pathological.) Since many of the "controversies" here revolve around reproductive behaviors, it's probably relevant to note that pregnancy is not usually a pathological condition. So preventing it, or terminating it, while morally unobjectionable (to me), is not usually medically indicated.

To shift gears, I think a huge part of the problem here is that many aspects of human reproduction (or not) are inappropriately medicalized. Just a for instance... If Plan B was available in your corner grocery store, right next to the condoms, any conscientious objections about prescribing or dispensing it would be mooted. FDA scientists concluded that Plan B can be safely and effectively self-administered -- no need for a physician or a pharmacist to mediate a woman's choice. Unfortunately, the politicos have a different agenda.

I think the difference of opinion revolves around the question of whether medical professionals have a moral obligation to provide the most accurate information they can w.r.t. conditions that are not, in the medical sense, pathological. I think they do.

Medical professionals are equipped with highly specialised knowledge. They have an obligation - professional and ethical - to share that knowledge with any and all who desire it.

Can you imagine a physicist who, when asked about global warming, replies 'sorry, but I have ethical objections to answering that question'? Of course you can't. The very notion is absurd. Or imagine a biologist who, when asked how much fish it is safe to catch from a certain sea zone, replies 'sorry, my convictions prevent me from answering those questions.' Clearly absurd scenarioes.

To be even more blunt, the only reason we are having this discussion at all is because certain medical professionals desire to impose their primitive ideas of 'proper sex' on their patients. This, of course, should not be allowed, and would not be allowed if we were talking about any other profession and any other aspect of life.

- JS

JS - I respectfully disagree. It's not the information per se that is held to be morally objectionable, but its intended role in facilitating actions that are thought objectionable. The analogies with global warming and safe fish stocks don't throw much light on the issues, since it's unclear what those seeking the information intend to do with it, and why that might be seen as morally problematic by the physicist or the biologist in question.

You say some medical professionals are seeking to impose their values on others. They say are resisting the imposition of values they don't share. There's some truth on both sides. I say the reason this is a problem is because access to safe and effective contraception and abortifacients is inappropriately medicalized.

Bob -

I'm going to leave the argument to you. You make far better than I could.