We have a new euphemism and a potential new regulation from the Bush administration: "provider conscience rights". What this is about is providing religious doctors with loopholes so that they can avoid responsibility for treating patients with the best possible care — so they can use religious excuses to justify neglect. You can read the press release, Regulation Proposed to Help Protect Health Care Providers from Discrimination, and of course the odious Mike Leavitt has mentioned it. This is a proposed new rule that if, for instance, a doctor with superstitious scruples is treating a rape victim, he would not only be allowed to refuse her emergency contraception, he wouldn't even be required to refer her to someone who could give it to her, or even mention that the option existed. Apparently, the ignorant dogma of the health care provider supersedes the right of the patient to informed consent and appropriate care.
This is open for commentary for the next few days. Again, I notice the web page has a bizarrely twisted title: "Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law". Now asking that doctors behave ethically with respect for the rights of the patient is now "coercive". Who cares about the patient, though? Isn't medicine all about the doctor imposing his or her will, right down to his arbitrary beliefs about deities, on the patient?
Lois Uttley, a well-known defender of patient rights, has spelled out a few general principles which are being defied by this new regulation. Maybe you could use some of these when expressing your objections.
Principles of a Progressive Response:
- The welfare of the patient must be at the center of medical
decision-making and treatment.- The religious/moral beliefs of a caregiver or religious doctrine of a
health care institution cannot be allowed to obstruct a patient's access to
care.- Patients must be able to make treatment decisions based on accurate
medical information and their own ethical or religious beliefs.Protecting Patients' Rights: Five Key Principles
- A patient's right to informed consent must be paramount. No information
may be withheld.- Health care institutions must provide emergency care immediately, without
exception.- For non-emergency care, referrals must be made if treatment is refused.
- The ability of non-objecting health practitioners to serve their patients
must be safeguarded. No physician "gag rules" should be allowed.- Institutional treatment restrictions must be disclosed to patients in
advance.
Get out there and speak out for your right to not be bound by your doctor's freaky religion. This is especially important for women, since anything to do with reproduction seems most likely to induce gibbering meltdowns among the religious right — and they're going to use their delusions to deny you good healthcare.
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Some days I like to think I'm living in a badly-written Disney movie with the religious people trying to destroy humanity and the atheists struggling to hold this country together.
Hear, hear!
I'm sick of doctors who think their delusions are more important than their patients' health. If you get into medicine, you'd damn well be ready to provide the necessary care at the appropriate time. Doctors should have their licenses stripped for malpractice if they allow someone to die when they could have been saved, due to their own fucked up beliefs.
This is absolutely terrifying. When did The Hippocratic Oath become the ten commandments?
Kobra:
Does this mean we'll have to break out into song?
Doesn't informed consent imply that the patient was actually *informed* of all the relevant, reasonable, and legal treatment options before they gave their *consent* to receive, or not receive, a particular treatment?
If they aren't fully informed of their options, then it isn't *informed* consent. This legislation is (functionally, if not intentionally) an effort to turn the entire idea of informed consent on it's goddamned ear.
I'd like to place my hands around a religious moron's head and yell out, "Heal, you heel".
OT, but there's poll on Sarah Palin's fitness for the office at PBS, and the Republican's are organizing a response that currently has her at %50:
http://www.pbs.org/cgi-registry/poll/poll.pl
*sigh*
one of those moments I wish I weren't merely an "alien" and actually had a say in the things going on around here. I think I'm gonna have to get the boyfriend to deal with this.
#4: http://uk.youtube.com/watch?v=qd9zVsWm4oA
Those who vote for this better make sure that their doctors are not Jehova's Witnesses or something like that. They may need a transfusion some day and the doctor wouldn't have any obligation of even telling them about it.
Every physician I go to in Baton Rouge is either an atheist or ignostic (not a typo). If I can find them in Baton Rouge, you can find them anywhere in the country... I still think these rules are completely bogus. Patients matter, if you are in the field of medicine and are not willing to do what is best for the patient in the eyes of the patient, then you should not be in that field. Same goes with the pharmacies. In situations an individual feels as an emergency which should be taken care of, it doesn't matter what the physician feels about it. It's how the patient feels about it that matters.
Something quasi-related in which the Catholic Church objects to wording that will force "conscientious objectors" to refer patients to other doctors if the necessary medical procedure may include abortion.
They are not being forced to perform abortions, mind you. Only, if they have a problem with it, they have to refer the case to a doctor that isn't a conscientious objector and will then not be performing malpractice by refusing to discuss all relevant medical practices.
Kind of like many pharmacy's have conscientious objector policy with the pharmacists. In this case, the other pharmacist dispenses the pill, preserving the medieval morality of the backward pharmacist.
My personal opinion is that it is malpractice and the doctor/pharmacist that refuses should be on the hook for child support/damages/etc. If you're going to take a "high and mighty principled stance," you need to fully experience the consequences.
Oh yeah, great idea, let's allow doctors to avoid providing healthcare for STDs because they might deem them God's wrath upon the immoral.
I'm sorry, but this is fucking retarded, if you're not going to do your very best to aid your patient because of your own prejudices then by all means, feel free to pursue another line of work.
Dude, that was painful...
Today is not a good day. I commented, for all the good it will do.
And Jadehawk, speaking as a natural citizen, let me say that being one doesn't help much.
Kobra @9
awesome song!
($DEITY) forbid this actually passes.
As written, I get the impression that somebody could decide that he is really a Christian Science faith healer, and let people who walk into the ER with heart attacks die while he prays over them, and be completely protected.
This is not a good policy.
Jared, isn't the population of Baton Rouge something like 750,000? I think you may be overestimating the diversity, and resulting limits on choosing a provider, in towns that are 10 to 100 fold smaller than yours. Women in small communities with homogenous religious ideologies have always had a difficult time getting access to the full menu of reproductive health care. This legislation will compound that difficulty significantly, and allow it to pervade larger communities in certain parts of the country, as well.
(PS, PZ we had some spirited discussions on this topic during your vacation.)
Well, yes, Moses, it could have been better sung and slightly better lyrics, but it is one of the first like that I've heard...
Medical care should not be the product of a dictatorship lorded over by a capricious and arbitrary physician. Medical care is customer-service oriented -- the desire of the patient is what matters.
#18 (Danio) is to thank, indeed, for some very spirited discussions on the subject, and she's owed major kudos for bringing this thing to the forefront of such a large audience.
I've listed my own comment, the one I e-mailed to them, here. While HHS says that they "discourage duplicate comments," if anyone wanted to just copy & paste my comment into an email to "consciencecomment@hhs.gov," I wouldn't object. If you want to send a comment, then, but don't really know what to write, please feel free to use mine linked above, or modify it to claim it as your own. What's most important is just that HHS hears the outcry from the likes of you and I.
PBS Poll on "the Blessed" Sarah Palin:
Please consider doing this. It takes less than 30 seconds. PBS NOW is running a poll which asks if Palin is qualified to be VP. The right wing has organized a "yes" campaign and at the moment, "yes" is winning.
http://www.pbs.org/now/polls/poll-435.html
Boy are they going to be surprised the first time they visit a Jewish or Muslim doctor when they get food poisoning from undercooked pork chops.. whoops.
"Sorry I can't help you. You ate unclean food, whattaya expect, sympathy?"
Thats soooo cool !So a doctor can just let anyone bleed to death and then claim to be a Jehovahs Whitness and transfusion is against his faith?
#14: I didn't even watch it. I just googled "atheist song."
Danio, the Greater Baton Rouge metro area encompasses a little over 4,000 square miles, population density of 515/sq mi. Yes, it's a fairly large city, but it is in the south. Also, I have a few in Opelousas, as well, from when I lived there; all except a good dentist: a cardiologist, general physician, poison specialist (I studied snakes, I needed this one), and emergency physician.
I was 12 years old and I had a paper route. While I was doing my job, a huge dog ripped away from the owners grasp, ran up to me and attacked me by biting me in the stomach.
My parents were not home at the time but I did manage to get a ride to the hospital. No doctor would see me, because I had no adult in my family to give permission. Yes, they clean and taped the wounds up, but I sat their for a good period of time waiting to see a doctor...Eventually, I did get a whole of one of my relatives who gave their permission and I was then treated by a doctor and given a shot.
Now if I was a girl who wanted an abortion, I would have been able to see a doctor right away or way sooner than I did with the dog wounds...
You call that the best health care possible? There I sat for a long, and nobody knew the health of the dog if it has some sort of disease like rabies. It seems that liberals in here tend to focus on politically correct medical treatment rather than practical treatment.
Weird thought, but maybe we should import some bearded Muslim doctors. I bet these Christians too would feel uncomfortable when someone else tries to shove down another belief system down their throat. They are for this law because they know the law means "Christian law"; and know doesn't know Christians would jump at every opportunity to covert everything into a Christian wasteland.
My letter to them:
I think I'll just sleep all the time I'm at work and claim my religion requires me to sleep when I feel "God's calling" to do so. I'll tell my boss where to stick it and tell him my religion requires it. Then I'll go down to the DoL and demand they pay me, since I was fired do to religious discrimination.
#27
The doctor was probably a dog worshipper and didn't want to remove your blessing.
The same people who brought you Ignorance-Only Sex Education are now bringing you Ignorance-Only Health Care.
Can the people who keep bringing up that PBS poll please calm down?
I still can't understand why there needs to be "provider conscience rights." If you hate medicine so much WHY ARE YOU A DOCTOR (pharmacist, etc.) This drives me up the wall. Argh!
You're mistaken if you think 12 year olds can get any kind of medical care--including abortions--without parental involvement in this country. Do your homework.
This is scary, obviously. But how does one ensure that his/her doctor isn't a religious nutter? When shopping for a new doc, what kinds of questions are appropriate to ask? I've seen tips on finding a new doc, usually they talk about the usual stuff--ask about experience, education, etc. But does anyone have any suggestions on how to make sure a new doc isn't going to deny me or my family the right to make our own choices based on his/her religious views?
And what about emergency situations? Dog forbid I end up in the ER under the circumstances of needing a rape exam or any other type of treatment that these morons could screw up with their delusions, but if something like that were to happen, how does one ensure that the doc will offer the right treatment options, when for many of us, the options that are available may not even be known beforehand?
Haha, Michael @ 27, the dog bit you in the stomach? That's kind of funny, sorry. You were 12, assuming you are not a moron and did not run from the dog, it would probably bite a limb. In any event, you have 24 hours no matter what infection the animal may have. It also probably wasn't permission they were after, but a "how ya gonna pay for this" response. They wanted insurance, etc. On a further note, emergency rooms rarely do abortions unless it is the result of pregnancy complications and the woman's life is at risk. Specialty clinics usually do abortions. Also, the following errors were found in a brief review of your statements:
"owners" should be "owner's"
"a whole" instead of "a hold"
"clean" should be "cleaned"
"If I was" should be "If I were"
"for a long"? for a long (what)?
Also, as I stated previously, clinics deal with abortions, emergency rooms deal with trauma, they may deal with rape, emergency contraception, or abortion when the life of the woman is in danger..
abeja @ 35, I blatantly ask if they adhere to any religious ideology that may interfere with any medical procedures I may or may not require.
A pox on this tyrannical system which insist on competence for their physicians. Making medical care based on evidence restricts the options patients have.
In fact, I am sure that all of those caring "doctors" dissected the bodies of humans. We all know that those bodies needed to be intact to that they may be resurrected by the lord for judgment day. How could those heartless "doctors" condemn all of those people.
Better to keep one's mouth shut and be thought an idiot, than to open it and remove all doubt. No twelve-year-old girl in America can get an abortion without adult consent or court order.
So to hell with your false equivalency, out-right lie and strawman attack.
It is my sincere hope that , as much as I despise malpractice lawyers, they hop right up to sue these misogynist doctors with the "informed consent" principle as opposed to this bush-inspired insanity of letting the doctor decide, based upon his misogynist belief system that women must be controlled. As a woman I spit on these cretins who still adhere to the "women are evil and so must be controlled" meme. As a physician I disdain them for keeping these "second class persons" in their rightful, pregnant and barefoot status. One of many fantasies is a pregnant Pope Ratz or even one of the male ministers having a GOOD menstrual flow while he's preaching his trash. Sorry for this rant, but these bigots really piss me off. I first became an atheist because a perfect god could not be a women hater.
Comparing Baton Rouge to Small-Town, Middle-of-Nowhere is disingenuous. I live in one of the bigger *coughcough* towns in North Dakota, and it's already difficult to get regular health-care (we have a hospital in town, but they're disturbingly BAD at their job); I drive 2 hours to Bismarck if I need to see a doctor, and even then, all I get is various flavors of very-very-Christian. I'm thinking if a law like that passed and I suspected that I might need an abortion or emergency contraception of any kind, I'd have to hop on the train to Minneapolis for it.
so, now we have to question any physician we come across regarding their particular religious beliefs, possible oddly interesting ethical notions, or whatever, before one can be sure they'd refuse to give a blood transfusion, or write us a prescription for holy water?
well, not everyone, thank goodness, i'm not american :-)
Jadehawk; North Dakota has the largest church per capita ratio of any state, doesn't it?
@37
Thanks, Jared. I guess I'll just have to be assertive (not my strong point)and do that. Then I'll have to hope they give a truthful answer...
this is hilarious. talk about scenarios that are so far removed from reality. i'm sorry, but maybe i missed the point at which becoming a public servant requires the waiving of personal rights? and as a group that typically is in such vocal support of personal rights, i find the argument against this regulation disingenuous and plainly dishonest. and correct me if i'm wrong here, but i didn't see anything in this reg that precludes a comprehensive informed consent.
You are deeply, morally committed to the belief that it would be wrong, even if perfectly legal, to sell assault-style rifles in your sporting goods store. It is, however, permissible. There are customers who request that you sell them these weapons. They're not sure what their alternatives are for dealing with the raccoons in their yard and they don't realize that there is a store just down the block where they can easily make this purchase. What are your moral obligations? What are our social obligations?
My comment:
I am ashamed to note that Ontario has a similar issue. I don't understand how not providing the best possible care, or at least referring for the best possible care, is not malpractice.
No one could ever be assured of any treatment ever again. Got a Jehovah's Witness nurse? Good luck getting a blood transfusion. Medication made from (or tested on) animals? My PETA-informed conscience prevents me from dispensing it to you. Why did I go into medicine at all if I'm a Christian Scientist? So I can watch you die, infidel.
Others have said it, but religion should cost the believer, not the rest of us. I defend everyone's right to go crazy in his or her own way--I have. But I don't expect anyone else to pick up the tab. This is obviously the most serious breach of that simple, fair principle, but I even think, hey, if you can't drive a Seeing Eye dog, you don't get to drive a taxi. If you can't sell ham, you don't get to work at the deli.
We can make reasonable accommodations for people's faith, where no one is substantially inconvenienced, but if someone's beliefs prevent them from doing a job, they have no expectation of holding that job. That is just insane.
Isn't it possible to add that GUTforsaken poll to the spamfilter? Stop people from being able to even post it? PLEASE?!
Yeah - sorry - I can't deal with the utterly ridiculous fascist stupidity of this 'regulation'. It almost makes me wish we had more nutters here so that I could yell at them in person. Almost.
@#40 - "One of many fantasies is a pregnant Pope Ratz or even one of the male ministers having a GOOD menstrual flow while he's preaching his trash. Sorry for this rant, but these bigots really piss me off."
uh, wow, bigoted much? talk about the pot calling the kettle... two words - anger management.
Jared, that sounds about right.
What I posted on the reply site:
==
From the press release regarding this proposed change:
'"This proposed regulation is about the legal right of a health care professional to practice according to their conscience," HHS Secretary Mike Leavitt said. "Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience. Freedom of expression and action should not be surrendered upon the issuance of a health care degree."'
I cannot disagree more, or more strenuously. "According to conscience" is Trojan language that essentially means "according to religious belief". Despite propaganda to the contrary, the US is a secular nation. Science is an utterly secular pursuit. And medicine is science. Allowing a physician to object to a medical procedure on the basis of "conscience" is tantamount to allowing a biologist to reject the fact of evolution on the basis of personal discomfort.
This change is not an improvement. It's merely an opportunity for some healthcare providers to impose their personal moral beliefs on patients, essentially taking on the role of passing judgment without having to live with the consequences. A physician who does not believe a given procedure is morally acceptable might want to consider changing professions to something more appealing to his or her squeamish nature.
my comment:
So, how silly can this get?
- Baptist orthopedic surgeon refuses to set broken foot because injury was sustained while patient was dancing?
- Hindu doctor refuses to administer Heimlich manuever because food lodged in victim's windpipe is a piece of beef?
- Rapture-believing oncologist refuses to come up with a therapy plan because she expects to be swept up into heaven at any moment?
Oh, I know ... let's apply this idiotic thinking to other professions.
- An old-earth creationist lawyer won't represent a young-earth creationist doctor in a malpractice suit brought by the family of a gay man who died because the doctor disapproved of the man's lifestyle and refused to treat his burst appendix.
- A born-again insurance company executive refuses to underwrite a malpractice policy for a Catholic doctor because the doctor believes salvation is earned through works when the truly saved know it's given through God's grace.
- A white landlord refuses to rent property to a black family because she believes blacks are cursed by God.
Is there an expiration date on our government's bottle of silliness?
JP Said:
but maybe i missed the point at which becoming a public servant requires the waiving of personal rights?
I must have missed that, too, JP. Care to point out who made that claim?
Also, can I ask - do you believe in a patient's right to adequate medical care? Does a physician's 'personal rights' trump those?
Stupid much? Being angry at bigots isn't bigotry. Two words: Mo ron.... ;)
"Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience. Freedom of expression and action should not be surrendered upon the issuance of a health care degree."
I absolutely agree. Don't be a doctor then. Try dress making.
Morons.
If medical professionals are going to make medical decisions based on superstition and dogma, it should be required for them to clearly advertise their religious beliefs to all potential clients.
"If medical professionals are going to make medical decisions based on superstition and dogma, it should be required for them to clearly advertise their religious beliefs to all potential clients."
I agree, by adding the moniker "Charlatan" after their title.
I submitted an appropriate comment with adequate snark, I hope. Thanks for the link that made it easy to do.
I'm really sorry the dog didn't bite Michael in the nuts.
"sorry, Doc, but paying this medical bill would be against my sincere, strongly-held moral and religious beliefs"
[/wondering if it'll fly]
A moron says:
but maybe i missed the point at which becoming a public servant requires the waiving of personal rights?
Ahhh... I see why one of the many reasons you're so off-base with your ludicrous position. Being a doctor is NOT A RIGHT, it's a privilege -- so saith the Supreme Court -- and the State has the right to regulate said privilege.
A drivers license is another privilege. Being a Certified Public Accountant is a privilege. Being a lawyer is a privilege.
I posted my response, for all the good it'll do. But you have to try.
and, jp? You do give up some of your "personal rights" when you become a professional. Specifically, you give up the right not to act as that professional. A doctor has an obligation - obligation, dammit! Not "it would be nice..." - to stop if she is the first on the scene of an automobile accident. In return, doctors are granted all sorts of rights and privileges in society. Don't want them? Don't be that professional. But all professions have obligations, and there is no promise that those obligations will not impinge on your sacred right to do whatever you damn well please.
Oh, and nice try at moving the goalposts. "Medical professional" is not equal to "public servant."
To expect this administration to respect the rights of the individual, at this point, is a little absurd.
Still, I did send a note expressing frustration to those involved (thanks for the link to do that, PZ). We'll see if it bears any fruit.
I read the thing several times, and it seems that this is a lot of uproar after the fact... i still rather this didn't pass, but it seems the real problems are laws enacted in 2005 and 1996. I gues they're just piling it on more an more..
and as a side-note... why can doctors refuse performing a medical procedure, but vegan waiters would be guaranteed to be fired for refusing to serve someone a steak? this is ridiculous;
@#55 - "I must have missed that, too, JP. Care to point out who made that claim?
Also, can I ask - do you believe in a patient's right to adequate medical care? Does a physician's 'personal rights' trump those?"
oh please, let's not play this game. this is clearly what's being posted here. the physician's rights are secondary to those of the patient merely because that's the career choice that was made?!? sorry that doesn't fly, especially coming from this crowd. we're all about protecting rights until it's for something you don't agree with?
and of course i do believe in a patient's right to adequate care, but, please tell me how this reg would prevent that. again, this does not preclude an informed consent. it does not prevent the patient from seeking out a provider who will give the patient's preferred treatment, at least from what i read on the linked page. where is the problem here?
This is so stupid. It really is. Are you sure those...things...governing your country are people, and not an alien invasion force that's trying to introduce policies like this to weaken the human race so we can be more easily enslaved or something?
Really, how can this even be considered? *baffled*
I really hope this is an American thing we're NOT going to imitate here...(sadly, things have been getting more and more American-ish lately...and I don't consider that a good thing..{no offense to any Americans induvidually, just to Americans in general ;) })
I know how we can mark the potentially offending physicians so we can avoid them:
"There's a dead vicar on the landing."
"How do you know it's a vicar?"
"It's tattooed on the back of 'is neck!"
Are you sure those...things...governing your country are people, and not an alien invasion force that's trying to introduce policies like this to weaken the human race so we can be more easily enslaved or something?
I asked Kodos, and he said no.
Actually, what you describe is not a new rule, but rather long-standing law (one that I find repugnant as written). What the new rule does is require health providers to provide written certification of compliance with the existing law, as well as expanding the definition of what "assisting an abortion" means.
As existing law currently stands, the government or its accrediting agencies can't refuse to or remove the license or accredation of a health care provider based upon their decision of whether to perform, assist in performing, or referring abortions (either way, past or future). Also, employers are prohibited from discriminating against individual members of the workforce based upon acceptance or refusal to perform or assist in performing an abortion.
Under the existing scheme, a doctor that refuses to give a referral for an abortion can't lose his license, but can be fired by his employer (or sued by the patient).
To me, the disturbing part about the new rule is the broad extent to which "assist" is defined.
A side note: emergency contraceptives may not be included under the law. The law is limited to sterilization and induced abortion. A good case can be made that em-cons do not actually induce abortions (in the end it will depend on the legal definition of abortion).
jp, the reg would prevent patients from obtaining care if providers did not provide the needed care. Rural areas often have only a few physicians in a 50 mile radius; if all three of them refuse to provide, say, Plan B contraception to a 17 year old* without a car, guess what? She can't get it. Informed consent doesn't help a bit.
It also allows providers to refuse to refer patients, which is often needed by insurance to cover specialists, and it is consistent with the reg for a provider not to even mention certain options on the grounds that she opposes them. There, informed consent would not be provided, but since one's conscience doesn't allow providing full and informed consent, the fact that it is a professional obligation doesn't matter. It's "discrimination" to criticize this doctor for failing to mention, e.g., Plan B to a rape victim in the ER.
* Yes, it's available over the counter, if your pharmacy carries it, but only to people 18 and up.
@17
I read this and just had to skip down and shoot of my mouth............
in CS there are not "faith healers", there are "practitioners". They do not pray over you but rather lead you to properly pray for yourself. Of course in the scenario presented (heart attack sufferer at an ER) this might be a bit tough to pull off (pain might just be interfering with "clear thinking"). My mom tried to get me to "think clearly" about my medical problems until I was 20 when my father was able to focus things for me: "..go see a doctor this year while you are still covered by (fathers) medical insurance or wait until you can pay for it yourself."
Oh well, it clearly was all part of "Gods Plan" for Jim: untreated childhood condition disqualified my ass for service in 'nam. Preys the lord!
If this passes i'll consider converting to "Christian Science" so i can get a job in medicine and receive pay for doing nothing.
JS Mill - sorry but i just don't see it that way. you act like this is a well known and professionally accepted obligation and you are wrong. it may be your personal opinion, but nothing more. please show me one professional code of conduct that even addresses this issue and we'll have something to talk about. until then, it's your opinion and you are entitled.
and moving the goal posts? ooooh, you got me. come on now... (if there was ever an over used term around here.) seriously not my intent in using "public servant" and "medical professional" interchangeably. in the context, medical professionals are public servants. nice try though.
but let's be honest here. the only reason this is causing such an uproar is because it's a belief issue. and the only ones taking umbrage are atheists. it has nothing to do with worries of bleeding to death at the hands of a JW nurse or not being able to get an abortion on demand from a Muslim doc. this is a religious freedom issue that has everyone's panties in a wad.
"... and the only ones taking umbrage are atheists ..."
this is demonstrably false, since i'm not an atheist
No no no ScottD, you do not understand; you do not get to do nothing, you just have to spend much time thinking and talking about stuff that does nothing. It still will take up a bunch of your time (oh, and, of course, it is billable by the hour).
And the moron keeps it up...
This is one of the stupider arguments I've seen in years. Rights constantly conflict in society. My right to listen to loud music at 11:00PM is subordinate to your "right" to get a good nights sleep and if I keep it up, the Police will confiscate my stereo and issue me a citation.
With this simple, real-world example we can clearly see the subordination of "rights" in conflict is, in fact, a normal part of the American way. And nobody, unless they're a lunatic, would argue otherwise.
Now, when it comes to medicine, being a doctor is NOT A RIGHT. It is a PRIVLEDGE, a STATE PROTECTED AND REGULATED PRIVLEDGE.
That is the way it is. That is the law of the land. There is NO ESCAPING THAT FACT. And no matter how many times you try to assert there is some RIGHT attached to being a doctor that allows him to, somehow, escape the reasonable burdens the State places upon him, there is no such right.
In this case, you're actually arguing the physician has the "right" to withhold ordinary, proper and/or necessary care to a patient without an over-riding or necessary medical reason. We call that MALPRACTICE.
Which is really what this issue is about. Some physicians, being of the medieval mindset, wish to be escape the legal and financial consequences of their MEDICAL MALPRACTICE.
However, in order to preserve a well-run society, the State says that if you want to be a Doctor, in America at least, you must provide the best medical care possible at all times. Period. REGARDLESS of your religious beliefs.
I'm sorry jp, but when YOUR religion endangers MY life, I tend to get irritated!
And once again, what makes religious convictions so special that they get special exemptions from doing what they find morally wrong, but vegans, environmentalists, and other secular ideologues get told "suck it up or quit?"
Jim, you were indeed lucky. God's Plan for keeping people out of 'nam included fatal or crippling diseases as well. Treated and untreated.
Mysterious ways, mysterious ways.
Seems like this legislation is just one more shove of the camel's nose into the tent.
Every time this BS comes up, I ask a simple question:
Should a practicing hindu working at a burger place be allowed to not serve customers who ask for beef, or should he/she get another job?
It's not that hard: you either do your damn job, or you get another one. Or for our good christian friends who don't understand why a hindu might have a beef with beef (stupid pun intended), here's another one example:
Last I checked there wasn't protection for a group of pacifists joining the military, and then when a war comes around them refusing to fight.
This issue isn't that hard.
jp,
Very well, I'll accept that "public servant" or "medical professional" doesn't really matter. I thought it was going to, but in future comments it didn't. There is a big difference between a professional and a non-professional, which I focused on, but which hasn't been important in the discussion.
If you think the codes of ethics of medical societies is the end all and be all of the ethics of a profession, you've got a sadly stunted view of medical ethics. But if you want them, why worry about first responders? How about the professional code of ethics that explicitly contradicts the intent of this reg? The International Federation of OB/GYN states clearly that:
FIGO affirms that to behave ethically, practitioners shall:
* Provide public notice of professional services they decline to undertake on grounds of conscience;
* Refer patients who request such services or for whose cares such services are medical options to other practitioners who do not object to the provision of such services;
* Provide timely care to their patients when referral to other practitioners is not possible and delay would jeopardize patients' health and well-being; and
* In emergency situations, provide care regardless of practitioners' personal objections.
(http://www.figo.org/initiatives_conscientious.asp )
I would argue that the third principle justifies my claim about first responders, but in any case the second and third are explicitly rejected by this policy.
This is not merely an issue of religious freedom. It is an issue of professional obligations which are provided in an agreement between the professional and society, for which there are both obligations and privileges.
Coriolis said what I was trying to say, just much much better :-)
re: #83 Excuse me, I meant the second and fourth principles are explicitly rejected by this policy.
I caught amoebic dysentery in Ecuador in 1965. The ambulance took me to American Hospital in Quito, which was run by Seventh Day Adventists who don't believe in medicine (but do believe in ersatz food). A real doctor heard about the case from an insider and came in to treat me. The nurses would go so far as to pack me in ice, but the doc had to bring in his own antibiotics.
It helps to think of people like these as organized serial killers.
FWLIW, here's the message I posted:
Not true. You could get paid to work on your golf game.
There was an excellent Point of Inquiry episode on this topice with Ronald A Lindsay. Well worth a listen.
Z
Medical (i.e. scientific, i.e. real world) decisions need to be based on the best available empirical evidence. There simply is no room for biased sensitivities. jp, your arguments are ridiculously shallow and slanted. This regulation basically wants to allow a care-giver foisting their ethics, morality, and world-view however crazy it may be, onto their patients while disregarding sound medical and ethical practice. Plain and simple.
Most people seem to be missing the point that the non-discrimination requirements are already the law. You can look them up yourself at 42 USC 300a-7.
http://www4.law.cornell.edu/uscode/html/uscode42/usc_sec_42_00000300---…
I did find a document that provides a history on the subject:
http://www.law.umaryland.edu/marshall/crsreports/crsdocuments/RS2142801…
I noticed a trend of slipping these gems into appropriations bills rather than letting them stand on their own merits.
If they aren't fully informed of their options, then it isn't *informed* consent.
Don't forget that these are the people who try to weaken consumer protections while calling it "choice", and to wastefully overconsume natural resources while calling it "wise use."
Assuming the patient knows what treatment he needs. That is why we go to doctors, to determine the appropriate care. They are not shopkeepers who people come to with lists of the items they want to buy. That is what makes them obligated to work in the best interest of the patient regardless of their personal beliefs. Patients do not know what treatment they want, they trust the doctor to choose the correct one. It may possibly be acceptable for a doctor to refuse a particular treatment if he immediately refers you to one that can, but apparently this law would absolve them from that responsibility also. So a patient could go to a doctor who says, "sorry, nothing can be done, period" and the patient trusts that to be so. Then after suffering the consequences of not being treated would not be able to sue him for malpractice for refusing to provide the proper treatment (either directly or by referral).
Here's an idea: make a law that any health-care professional who by refusing services causes a rape victim to remain pregnant even two seconds longer than she wishes, shall be guilty as an accessory to rape and punished by not less than five years incarceration.
"but maybe i missed the point at which becoming a public servant requires the waiving of personal rights?"
Try rereading that sentence you typed and pay special attention to the words "public servant".
DaveS at #91 and everyone else who's mentioned this:
Yes, we know the non-discrimination requirements are already law. Yet it still remains a significant source of debate, in particular but not exclusively in state legislatures. If you think this proposed regulation will make no difference in how this sort of policy gets enforced, I've got a bridge in Alaska to sell you...
#94 SoMG
How about this:
If anything about performing the duties of a health care provider might make you feel uneasy with regard to a deity/deities or unsubstantiated magical philosophy you may espouse, then seek another profession.
jp,
i'm sorry, but maybe i missed the point at which becoming a public servant requires the waiving of personal rights?...and correct me if i'm wrong here, but i didn't see anything in this reg that precludes a comprehensive informed consent.
True, you totally missed the point. Physicians are granted a monopoly by the State to practice medicine according to, you know, the scientific standard of care.
Being a physician requires taking care of the patient in a competent, professional manner, personal beliefs, rights, and funny feelings in the tummy notwithstanding.
As to comprehensive informed consent, you might have missed that part but fear not. If these regulations are enacted you'll be fully able to experience the joys of divinely inspired consent.
Like when your JW surgeon consents you before surgery and 1) omits to mention the part about the availability of transfusion, 2) never sends a T&C sample to the blood bank, and 3) fails to have a non-JW colleague on stand-by, and you start hemorrhaging on the table.
Outstanding ema.
My comments on the proposed rule, just sent:
----------
Comments on Docket: HHS-OS-2008-0011-0001
The basis of medical care must rest on the following ideas:
1.The welfare of the patient must be at the center of medical decision-making and treatment.
2.The religious/moral beliefs of a caregiver or religious doctrine of a health care institution cannot be allowed to obstruct a patient's access to care.
3.Patients must be able to make treatment decisions based on accurate medical information and their own ethical or religious beliefs.
4.A patient's right to informed consent must be paramount. A patient cannot make a good decision about their own health and future if information regarding them is withheld. No information may be withheld.
5.Health care institutions must provide emergency care immediately, without exception.
6.For non-emergency care, referrals must be made if treatment is refused.
7.The ability of non-objecting health practitioners to serve their patients must be safeguarded. No physician "gag rules" should be allowed.
8.Institutional treatment restrictions must be disclosed to patients in advance.
The proposed rule violates these principles.
If the regulations were revised as proposed, then a physician could willfully impose their own religious prejudices upon their dependent patient. They could do this by refusing treatment, refusing to refer the patient to a doctor who will treat them, and even refuse to inform the patient of the options they have for treatment. (Section 88.4(a)(ii) and (iii)(2) and (3)) This would be a clear abuse of power. It would also be a clear abuse of the trust relationship between doctor and patient. A doctor has no right to stand between a patient and access to: legal, indicated, safe, and desired procedures. The doctor does not have the right impose their personal prejudice on their patients.
In these days of "managed" health care, many patients are at the mercy of their primary doctor for access to any and all health care. And many have a restricted ability to change that primary care doctor. This can give the doctor a rather autocratic control of the patient's choices for their care. To permit (and legally insulate) a doctor's choice to follow their personal religious prejudice rather than the needs of the patient would be unconscionable.
The proposed rule (Section 88.4(d)(1)) would prevent any health provider from "[r]equir[ing] any individual to perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions." This is patently absurd. This would logically allow a physician who happened to join a religion that didn't believe in vaccination to refuse to vaccinate their patients or refer them for vaccination, with impunity. I use this example to indicate the absurdity of the provision. This provision can be rendered absurd by many similar examples, which would be covered by it.
The "Church Amendments" were specific to protecting an individual who refused to perform abortions, sterilizations, etc. for moral or religious reasons. These are fine and appropriate provisions. We should not require an individual to perform services they are not comfortable with.
However, the "Church Amendments" do not address an individual medical professional's "right" to interfere with the patient's access to any legal, indicated, and desired service. The proposed rule makes such an extension of power for an individual doctor: it would allow them to control the patient's access to services, not their own participation in those services. In this, the proposed rule crosses the moral line and it would allow the medical professional to decide for the patient, based on the medical professional's personal prejudices rather than the needs of the patient, what services the patient can have access to. This clearly violates the principles that all medical professionals have operated under.
The right not to be required to perform a service does not include the right to block a patient from access to a legal service.
All versions of the Hippocratic Oath emphasize that the physician must put the needs of the patient foremost and never allow their personal prejudices to affect their treatment of the patient or cause them to withhold treatment.
If a medical professional finds that they cannot provide the care needed by the patient for reasons of personal distaste, then they should recuse themselves (as a judge would when they have a conflict of interest bearing upon the outcome of a case) and allow another professional to aid the patient: they should simply stand aside and allow the patient to seek the care they need in an unencumbered way. The medical professional should be obligated to simply get out of the way.
The proposed rule is an unnecessary and illegal extrapolation of the principles of the "Church Amendments." The proposed rule should not become law. I request that this proposed rule be withdrawn.
----------
I disagree with this interpretation. Leavitt did remove all specific mention of contraception from the final draft of the policy under discussion, but the language that's left certainly doesn't rule it out. Lots of phrases like 'procedures such as...' or 'for example...' surround nearly every mention of abortion or sterilization.
As to the 'legal definition of abortion', I doubt the lawmakers could even agree on what would constitute such a definition. Moreover, if they did somehow manage to craft one that was approximately in line with the MEDICAL definition, the conscientious objectors would ignore it anyway, as they are currently doing with the medical standard of care and the preponderance of medical evidence against the 'contraception = abortion' belief.
(not to keep plugging myself, but my PZMinion post of August 11th, entitled "Blurring the distinction between contraception and abortion" deals specifically with this topic).
I hope that everyone who commented here also went to the link and contributed their voices to the process. Who knows what type of impact it will have? Maybe none, but certainly more than not speaking out at all.
You know, they clearly haven't though this all the way through. A doctor could insist that an abortion is the only way and that it is morally wrong to bring a pregnancy to full term. He'd be bound by this to perform the operation. Or to administer a blood transfusion to a Jehovah Witness, because to not force blood upon him would amount to death by inaction which a doctor may be morally opposed to.
Or if you have moral qualms with the duties needed to carry out your job, you can get a new one.
The medical profession doesn't want this. It was run by some doc organizations and they just went WTF.
It is a bunch of Death Cultist sick nonsense. It is written in Orwellian Doublespeak because in plain English it looks ridiculous and fascist.
Leavitt is proposing this now because the country is preoccupied with the collapse of the economy. The Greatest Financial Crisis since the Depression. Which the christofascists caused. They are likely to be out of power in 2 months so this is their last chance to destroy the USA. Expect more of this.
Leavitt is a hardcore Mormon from Utah.
jp said:
"and the only ones taking umbrage are atheists."
Another horrible strawman. BTW, I'm Jewish.
Ema,
no, i don't think i missed anything in regards to your opinion on this matter. omitting anything from a consent is not a fully executed consent. you know that, and i know that. where does this reg allow a doc to not give a full consent? it merely respects his/her right to not perform procedures found to be in conflict w/ religious beliefs. i enjoy the argument, but only when both sides are being honest.
Oh, a fundie moron. You can tell because he is lying.
The medical profession has already given their take. They don't want it and think it is stupid nonsense.
The rest of the population doesn't like it either.
The divide is between normal people religious or not and Death Cultist nihilists. This is just another way for religious extremists of the christofascist movement to annoy everyone else. It isn't even about religion, it is about anger, hostility, power, and money.
January 20, 2001
jp-
Let's be honest here. Do you think that a cab company (employer) should be allowed to discipline or even fire a driver for refusing to drive passengers who are carrying alcohol? How about passengers who require assistance from a guide dog?
OK jp, since you say you value honesty, please respond to the apparent conflict between your statements in post 45 about having to "give up" rights, and the fairly obvious replies you have received. You know, the ones that generally think that your right to swing your fist ends where my nose begins.
How do you square the idea that a physicians has a "right" to decide that some people will in fact receive demonstrably inferior health care?
I'll stick with *real* doctors.
Dr. Jack Daniel and Dr. Captain Morgan.
OK, that just made no sense at all.
Clearly, more medicine is required. :)
I can't wait until the police get similar "conscience rights." Do you believe that honour killings are justified? Then you can forego arresting a husband who killed his adulterous wife. Do you think usury is immoral? Then it's just too bad if a bank gets robbed, 'cuz you won't help their unsavoury practice. Is homosexuality an abomination? Then we'll just forget about making arrests for gay bashing.
Yes sir, conscience rights for all!
Instead, you're living a badly-written Kafka novel.
Moses - seriously, get a grip. little too much caffeine this morning or what?
i'm well aware of who regulates medical practice. i don't know how you wound up so far in left field over this "rights" issue, but i've never asserted being licensed to practice medicine is a "right". i've merely made the observation that becoming a doctor does not require waiving personal rights. you do assume obligations as previously acknowledged, but again, please show me a professional code of conduct or ethics that insist on subordinating religious beliefs. and JS Mill, your OB/GYN code is not in any way affected by this reg, at least as i read it. if you think it is, please expound.
as a patient you are entitled to a comprehensive consent and the best care available. yet again, how does this reg preclude a patient from this?
and still no one has addressed my claim that this is more about anti-religious viewpoints than actual patient care? anyone???
jp said:
and still no one has addressed my claim that this is more about anti-religious viewpoints than actual patient care? anyone???
The whole point of this ENTIRE discussion is that patients have the right to DEMAND full, proper care from their health care providers. This may include something such as offering Plan B contraception to a rape victim.
You are arguing that a doctor should not be required to treat the victim as requested.
This is ONLY about patient care. Religion (aka conscience) has nothing to do with it, and it shouldn't!!!
So a fundamentalist Muslim ER surgeon could refuse to treat traumatically-injured women (because it would involve touching them and potentially seeing them uncovered) and that would be ethical?
JP -
Being a public servant does indeed require you to give up some of your rights as a private citizen. I happen to be a public servant - as in an employee of local government - and upon hire most public servants happen to be sworn in. Which means we take an oath, which we sign and is legally binding, saying that we will do certain things. For an example of rights given up - many public servants are automatically classed as disaster workers and are required to show up should a disaster occur. I am in IT and yet, should a flood occur I will be out there, whether I want to be or not, filling sandbags and generally being used in any way the authorities in my County see fit. It's not in my job description and it abridges my rights as a private citizen to choose to work in a disaster or not but there it is. I knowingly entered into an employment situation where this was a possibility (and indeed, it has occurred) so I've got no leg to stand on to object to it... even if I happen to think the folks who built homes in a flood plain with inadequate protection get what they deserve when the flood comes. My personal opinion doesn't enter into it - it's part of what I, as a public servant, am expected to do. I made the decision to let go of my right to not help in a disaster in exchange for excellent benefits, stable employment, and being close to home.
A doctor makes a similar conscious decision to act for the benefit of their patients when the become a practicing MD - even if the patient happens to be an idiot and probably deserves whatever ailment they have - see the Hippocratic Oath. The fact that the doctor personally thinks they should probably be left to get what they deserve for being an idiot doesn't enter into it. The doctors job is to treat people. Period. If its in the doctor's power to fix the issue, or send the patient to someone who can, it is their obligation to do so - no matter what their personal beliefs may be.
it's been addressed at least twice in this very thread
Raven-
"Oh, a fundie moron. You can tell because he is lying.
The medical profession has already given their take. They don't want it and think it is stupid nonsense.
The rest of the population doesn't like it either."
LINK please???
oh, and would love to have you point out exactly where i lied.
"please show me a professional code of conduct or ethics that insist on subordinating religious beliefs"
This is a strawman.
If you are Hindu there are many professions that involve beef that would require you to set your religious sensitivities aside. If you are a xtian, then keeping Saturday holy would cause most American xtians to set aside their religious proclivities. It goes on and on. Was answering that suppose to be a challenge? Just about anyone wanting to work in banking, finance, food, legal, medicine - the list goes on and on where there is bound to be some religious conflict at some level.
Here is my comment:
A patients right to medical service must take precedence over a doctor's belief in a god or gods. But I understand that a doctor may have problems with his or her conscience following standard medical guidelines. Therefore I propose that any doctor who can not follow normal patient care guidelines MUST be required to state to any prospective or current patient the following before offering any medical treatment: "I am a member of X cult and or religion that prevents me from providing quality medical care to you. I strongly recommend that you find a doctor whose religious beliefs will not prevent you from being provided the high quality medical care that you have a right to expect. Since I will not be following AMA guidelines, your life may be placed in danger." In order to avoid malpractice, doctors must be required to carry in their files a signed and notarized statement from each of their patients stating that they have been informed and understand that their lives may be placed in danger because of the doctor's religious beliefs. This same statement should be read to anyone calling to make an appointment with this doctor. Patients have the right to know that there doctor does not accept the standard AMA guidelines for treating their patients.
oh, and would love to have you point out exactly where i lied.
No problem:
and the only ones taking umbrage are atheists.
That's a lie, unless you're claiming ignorance...
The simple solution is to say "I only want atheist doctors to work on me."
Ooooooooooooh can you imagine the wailing and gnashing of teeth that'd cause?
JP you lying sociopath. You just move the goal posts when people point out your lies. You don't have the slightest interest in the truth and would just move the goal posts again or ignore it.
Google it yourself, I'm not wasting my time on death cultist trash. It is people like you that give xians a bad name and drive normal people out of the religion.
"and still no one has addressed my claim that this is more about anti-religious viewpoints than actual patient care? anyone???"
I'll take that one jp.
You live in a small town. There is only one doctor, a devout Jehovah's Witness (Using the Jehovah's Witness example as it's easiest, though far from unique).
You accidentally put your leg through a glass window,
severing a major blood vessel.
While being driven to the doctor, you bleed copiously.
In fact, you nearly die of blood loss.
Ocne you arrive at the clinic, this situation is not going to be alleviated, because under this legislation the doctor is not obliged to give you a transfusion or even refer you to someone who will. In fact, if you didn't know there was such a thing as a transfusion, they would have no obligation to tell you.
Put simply; The doctor has a right to be a JW.
And you have a right not to die because they're a JW.
(Or to genericise it;
Point 1: The doctor has a right to hold a ($OPINION)
Point 2: You have a right not to be harmed by the doctor acting on ($OPINION).)
Whose rights should win out here?
"He goes on about the wailing and gnashing of teeth. It comes in one verse after another, and it is quite manifest to the reader that there is a certain pleasure in contemplating the wailing and gnashing of teeth, or else it would not occur so often." [Bertrand Russell, "Why I Am Not a Christian"]
Stark -
"A doctor makes a similar conscious decision to act for the benefit of their patients when the become a practicing MD - even if the patient happens to be an idiot and probably deserves whatever ailment they have - see the Hippocratic Oath. The fact that the doctor personally thinks they should probably be left to get what they deserve for being an idiot doesn't enter into it. The doctors job is to treat people. Period. If its in the doctor's power to fix the issue, or send the patient to someone who can, it is their obligation to do so - no matter what their personal beliefs may be."
i'm aware of what a doctor's job is and i know the hippocratic oath. please tell me how this reg violates anything in either one? this reg does not, at least in my understanding, allow a doctor to withhold information from an informed consent or allow a doctor to refuse to make a referral. this isn't about your vegan waiter, this isn't about muslim cabbies, it's about health care professionals being asked to perform procedures they morally object to. the notion that this reg will spark a rash of ER room deaths due to religious objection is unfounded and overblown.
Jp, come on now. The entire thread consists of just the sort of discussion you pretend to want, but instead of engaging with it you pretend to know what motivated everyone's opinion and address that instead.
And then you have the stones to talk about honesty?!?
Travis -
quite a vision you paint. i just don't buy this worse case scenario. i'll admit i can't rebut it, but being a resident of a small rural community (pop. ~13k), i just don't see it.
and the doctor does have a right to opinion, but the patient also has a right to a full consent. this reg would not prevent either.
jp:
"i'm aware of what a doctor's job is and i know the hippocratic oath. please tell me how this reg violates anything in either one?"
You have been given about 15 examples in this comment thread. I'm guessing you're going to post again and ask me to list them, but I'll just request that you go back and read the comments.
this isn't about muslim cabbies
This is proof that you HAVE been reading the comments. You just pick and choose which arguments you'd like to rebut, then ignore the rest?
I have not yet read all the comments thus far, but I will eventually.
I would just like to note how pissed off I am about this and how thankful I am not to live in that country. No offense, but I'll take Holland over the US any day. That said, Holland isn't exactly free from this kind of thing.
The worst Dutch example I know of is this (fortunately, we have no trouble with doctors... yet). Gay marriage is not illegal in Holland. But the people that deal with the legal aspects of these marriages (notaries? Not entire sure of the English term there) can opt out because it goes against their conscience.
There are certain parts about my job I don't like either. But why is not liking something on religious grounds more important than dislike on any other ground?
I do the stuff I don't like because it's part of my job, why can't they?
My view on it is this. In Holland, legally, you have to be in school until 16 (could be 18, not entirely sure). Regardless, very few actually stop at 16 and keep getting educated in whatever area they chose.
I do not understand how people can choose a subject of study that they have moral qualms with.
Be a doctor and do all the doctor-stuff. Or be something else...
I don't know how anyone can think it ethical that a doctor's religion should be above the well-being of the patient. Just how far would some take it? Would they not work on a Sunday when there is an epidemic on? Would they deny blood transfusions? Would they not perform an abortion on someone who's life is in danger?
The doctors are there to do what's best for the patient, if they don't like what they have to do in their job then they shouldn't be in that field. Same goes for pharmacists who refuse to stock certain medication *cough*contraceptives*cough*, they are part of a profession, we are in a secular society and thus the needs of the many outweigh the individual's own beliefs.
The act of consent to practice medicine does not confer any duty on the person who is a trained medical professional. There is no absolute right for the patient to be treated by the doctor, for the doctor can, as has been suggested repeatedly above, simply quit without having violated some presumed patient right. The person who is the doctor has no duty, by virtue of her training, to treat anyone. Does that doctor have a duty to treat a patient qua doctor, i.e., inasmuch as that person has joined the profession? That depends on the professional code, the legal stipulations and such. The suggestion here is that, out of respect for certain well specified areas of conscience, the doctor should not be held responsible for failure to provide certain services. If one finds these exceptions so objectionable that you believe that anyone authorized to practice medicine should be required to provide these services, then you'll want to oppose the bill. You just can't pretend that it's is somehow a matter of the sort of fundamental human right that places an absolute duty upon the person of the doctor. It does not.
Jared @ 19
This song is much better IMHO, the video has an 'adult' Youtube warning because of a hot FSM babe in the bathtub, definitly worth a peek just for that kink.
http://www.youtube.com/watch?v=IIYVfyZV72A
Ahh... there we go - you have a flawed understanding of this regulation. It does indeed allow a doctor to refuse to make a referral for a treatment which they find morally objectionable. This by itself destroys the concept of informed care.
See http://www.hhs.gov/news/press/2008pres/08/20080821reg.pdf to read the entire regulation. The first part of the regulation which is causing outrage (but by no means the only part) is on page 14 of that document. This happens to be the part that allows a provider to refuse referral. Much of the document preceding page 14 refers to previous regulations as is background information.
Here is the specific text from page 14 of that document :
It goes on to further allow for refusal of "counseling" about an objectionable procedure - on page 33 I believe - which completes the destruction of the idea of informed care and informed consent.
So, there we have it, in black and white, why this would be an issue. You cannot seek care you don't know exists and withholding referral for services that can benefit the patient but bother the sensibilities of the physician violates the first tenet of the Hippocratic Oath - namely "Do no harm". Withholding access to beneficial care most definitely does harm.
week of Editorials Globe Editorial
A new attack on birth control
Email|Print|Single Page| Text size - + July 30, 2008
WITH JUST a few months left in office, President Bush is still doing the bidding of social conservatives who oppose women's reproductive freedoms. Under the guise of rules to protect antiabortion nurses and doctors from discrimination in hiring, a proposed new regulation would expand the definition of abortion to include any form of contraception that can work by stopping implantation of a fertilized egg in the uterus. This can include common birth-control pills, emergency contraception, and the intra-uterine device, or IUD. Doctors who refuse to perform abortions for reasons of personal conscience already are protected by law.
The potential impact of this new rule on the more than 500,000 hospitals, family planning clinics, and medical offices that receive any form of federal funding could be dramatic. The rule could also undercut many state laws - including one in Massachusetts requiring hospitals to provide emergency contraception for rape victims - and laws requiring prescription drug insurance plans to include contraceptives. Massachusetts passed such a law in 2002.
The draft proposed rule highlights the fact that many antiabortion groups also oppose one good method of preventing the unplanned pregnancies that lead to abortions - birth control. At some point in their lives, 98 percent of US women use birth control.
The proposed rule, while claiming to protect the rights of nurses and doctors, would interfere with patients' rights. A woman seeking treatment could be denied birth control and not even be aware that the service was available - only denied to her because of the unexpressed personal beliefs of the practitioner.
Last November, the American College of Obstetricians and Gynecologists said gynecologists must provide "accurate and unbiased information" to patients and "have the duty to refer patients in a timely manner to other providers" if the doctors do not want to perform an abortion or prescribe birth control. The US secretary of health and human services, Michael Leavitt, said he thought this statement went too far in forcing doctors to choose between their beliefs and the prospect of professional sanctions.
The administration does not need approval of Congress to put this rule into effect. But about 100 members of the House, including all representatives from this state except Stephen Lynch of South Boston, have signed a letter protesting it. In the Senate, Patty Murray of Washington and Hillary Clinton of New York are leading the opposition. The administration should take heed and drop its ideological attack on contraception.
The American college of OBGYNs said Leavitts lets annoy normal people rules were crap. Lots of congress people spoke up as well as many newspapers. Leavitt is just being a Death Cultist moron.
Time for JP to move the goal posts again and keep lying.
JP SAYS:
REGULATION SAYS:
I say those laws are intending EXACLY what you deny they intend. And this new regulation is just another layer of difficulty of removing these horrid, biased rules.
Also, explain again how a christian doctor's morals are more worthy of protection than a pacifist soldier's or a hindu vets when it comes to refusing to do things that are part of the job description?
I'm having the nightmare vision of a bunch of pro-lifers applying at Planned Parenthood and then screaming "discrimination!!" when PP actually expects them to hand out condoms and emergency contraception etc....
Jadehawk@137,
I was just about to quote the very section you did!
jp - just another liar for Jesus. (An orthographically challenged one at that.)
Victoria, Australia seems to be doing well on this issue.
Aussie catholics are complaining about legislation that will compel doctors to refer women who want a termination to another doctor, saying it infringes their human rights and makes them complicit in abortion. The Victorian govt, and more importantly the general public, is having none of it. Ironically, any mention of anything relating to abortion as a human right was removed from the govt's charter of human rights at the request of the catholic church.
http://www.abc.net.au/news/stories/2008/09/23/2372460.htm
These conscience clause laws really piss me off (you have no idea how many fundies go into obgyn just so they could refuse abortions). Because any sane arguments to the government will not be heard, I will use this law to my advantage. From now on my conscience tells me that sulfur is an evil element and it belongs in hell... not an innocent person's body. Therefore, I will refuse to prescribe (or even tell patients about the existence of) drugs that contain sulfur. ... that's about how much sense this law makes.
@#37 good idea. I suggest everyone ask their health professionals about whether their religious beliefs affect their work... and don't be shy to ask hypotheticals (i.e. would you be against performing (or referring someone for) an abortion). If they say yes, find another physician. Things get noticed when a doctor starts losing patients.
I was reading about that. It's just another case of the Catholics wanting submission. I remember a few years ago when the NSW parliament was doing the stem cell debate, that wanker George Pell threatened excommunication for any Catholic politician who voted for it. Luckily the politicians had nothing of it, they voted away and left the Catholic Church and especially George Pell looking archaic and manipulative.
Apparently George Pell is a joke among other Catholic priests, out of 42 bishops who had to vote for the leader of the Catholics in Australia, only 5 voted for Pell... including Pell himself. So yeah, 4 of the remaining 41 bishops think that Pell is worthy as a representative of Australian Catholicism.
Tell me where the following goes off the tracks:
Supposing that female circumcision were legal, but I, as an OB/GYN oppose it as a matter of conscience. The patient makes an appointment to arrange for this procedure. Should I be liable to prosecution were I to refuse to perform this procedure? Would it be reasonable to enact and enforce a law that exempts me from having to perform this while allowing me to remain in the profession.
Where is the disanalogy? Why is it so difficult to recognize the reasonableness of this request?
Hi Jadehawk! I just commented on this odious proposed regulation. It makes my blood boil.
Tell me where the following goes off the tracks:
Supposing that female circumcision were legal
Easy. It isn't. Supposing it were makes as much sense as saying "Suppose robbing banks was legal..."
NBHope - an idiot for Jesus.
You are able to refuse the procedure. You are not legally able to misinform the patient about the procedure, its consequences, or alternatives. That's the difference. Also, that procedure is more cosmetic than life threatening. Blood transfusions are. Refusing critical care because of non-scientific religious sensitivities is morally reprehensible. A person confronting such conflicts needs to get out of that line of work.
Abeja @ #35:
I ask. Literally. I ask what their viewpoint is on abortion. I've never had one myself, and my current age/lifestyle suggests that I won't need one anytime soon, but watching the doctors' reactions and listening to what they say (even if it's "that's personal, but I can keep my private beliefs and medical responsibilities separate) are good hallmarks for how appropriately they will support my medical choices.
@#143, then a law should be made to make female circumcision illegal. Your "conscience" (i.e. religious beliefs) should have no say it in (you chose to be an OB/GYN and you know what it involves).
Because your argument is strawman bullcrap and senseless. It is basically the same as,
"Suppose cannibalism was legal and the patient made an appointment to be killed, cooked and eaten."
Female genital mutilation is done on babies and young girls by their parents. Adults rarely or never volunteer to have their reproductive organs cut off. If they do, the proper course of action is a referral. To a psychiatrist and/or a secure involuntary lockup for treatment.
Suppose nose piercing was legal and a patient made an appointment. Well it is legal and lots of young women and some young men have them including the one that served me coffee this morning at Starbucks. Who knows why. Do it if you feel like it and are capable or refer them if you don't.
Nick, go with me here. We're trying to find a principle we can live with.
Alex, I want to agree with you. I'll extend the hypothetical and stipulate that there should be a law that says it would be illegal to misinform the patient (it is). But why suppose it's merely cosmetic. Suppose that it is a matter of inclusion/exclusion in your community, not a matter of life and death but rather of deep cultural/religious significance. What then?
Question: is there any bill that exempts an ER doc who refuses to give a blood transfusion?
Agreed, it would be morally reprehensible to refuse critical care. Is it a matter of critical care for an OB/Gyn to perform an abortion. It may be for an E.R. doc.
-an idiot for Jesus
Comment in opposition to the proposed regulation submitted to HHS.
No kings,
Robert
"i'll admit i can't rebut it"
Thanks for that glimmer of honesty.
You assert that you don't buy it because it's a 'worst case scenario' and I agree- it is. I didn't set out to describe a typical situation but an illustrative one.
And when considering legislation, aren't worst case scenarios relevant? You seem to be arguing that if a negative impact is uncommon it isn't significant.
"the patient also has a right to a full consent"
Yes. They do. Please explain how removing a doctor's obligation to even discuss some treatment options could fail to impact informed consent. If I don't know all of my options my consent is by definition not 'informed'.
My argument would be that any legislation that has the potential (not a guarantee, never said it was) to cause preventable harm needs to be very closely examined for necessity.
this legislation appears to-
a) have the potential to cause preventable harm;
b) lack any significant upside for the public, including most doctors.
So I would caution against it.
Raven,
All right, its bull crap.
Suppose piercings are legal (they are) but for me its a matter of conscience. Should I be procsecuted for refusing to offer this procedure. (Answer, no because it's not a matter of life or death. Right?) So, supposing the abortion, or the birth control, or whatever, is not a matter of life or death. Is it reasonable to enact a law that allows for refusal on the basis of conscience?
Suppose if it were legal and a mandatory requirement of your job then "yes", you should have to perform it; or at the very least refer the patient to someone who will.
But the example is one of poor reasoning. You deliberately picked an illegal and abhorred practice by western standards to make a point about legal practices that the vast majority want. You are just trying to appeal to emotion; to our gut reaction in order to make a point. And by doing so, you can dismiss anyone who says "yes" to the proposition because that would make them immoral scumbags. The simple fact is that quality of care for the patients is vital, and the religious beliefs of those who do it should not be above patient care.
Pero?! oh wow, the internet is such a small place :-p
I'm telling you, I'll have to stuff The Boy in my suitcase and flee back home if stuff like that keeps up *sigh*
Kel,
But that's the question. Should everything that is legally permissible be a requirement of the job or is there room for exemption. So if required, "yes," but should it be.
Of course, I chose FGM because it is abhorrent, and elicits just the right sort of emotions, just as abortion is to many. You have to view it as a matter of conscience. Nothing I say is judgmental ("scumbags"?). It is a question of exemption (are you equally offended by pacifists or vegan or others who hold strong views as a matter of conscience -- that their refusal to participate constitutes an accusation against those who do?).
But I'll agree on the claim that quality of care as paramount, but recognize that the heart of the dispute has to do with what constitutes quality of care. If not life threatening, then is it reasonable to exempt?
Fine NBHope. Then don't do abortions. Just don't get a job working for Planned Parenthood or an abortion clinic and pull out the conscience card. That is dishonest and manipulative. You are expected to be active in those kinds of situations at those kinds of places. If you don't like those kinds of procedures, then don't get involved with a situation where you will be expected to perform them. The end result is that your choice of conscience should only affect YOU, not your patients. If not, it's like being a fry-cook who doesn't like to work with spatulas.
Nick, go with me here. We're trying to find a principle we can live with. - NBHope
Why not try a bit of honesty? I don't believe you're arguing in good faith. I believe you want to stop women getting abortions, and you'll favour any proposed legislation that makes it more difficult. If a doctor (or nurse, or surgical instrument cleaner - check out the text) objects to abortion strongly enough to refuse to perform it or take part in it when it's legal and the patient wants it, they've no business taking employment in a clinic which provides them.
Nothing here says that any particular hospital or clinic must hire someone who refuses to perform procedures central to their very mission. So, of course, if I don't do the abortion, then I should be working for PP. But should I be allowed to work for, say, myself without fear of prosecution. A patient's expectation does not bind me; a profession's expectation should. So, there's the question -- should this expectation be a matter of law. If so, then I would get out of the profession. But why should it? Isn't it reasonable to allow for such exemptions as a matter of conscience? Why not (remember, not a matter of life and death).
NBhope, you're being facetious. For one, if you work in a piercing studio, refusing do do piercings is idiotic; secondly, it's one thing to refuse and refer, and another to have the right to pretend the option doesn't exist just because it'll make you feel funny for referring someone or counsel someone about something you don't agree with: the former protects the doctor's conscience, the latter gives the doctor the right to decide for the patient by lettimg them exclude important information
and don't say that won't be happening. it already is. doctors in poland regularly refuse to prescribe the pill for religious reasons, and it's rather difficult to find a non-catholic doctor in Poland.
I don't want to see someone's religiosity imposed on anyone else. You want to be a doctor but don't want anything to do with abortions? Become a dermatologist or something, and leave the messy stuff for those who have the guts to deal with it.
Also, your FGM example is stupid. I'll give you a counter-example. one of my mom's friend is a plastic surgeon. whenever someone comes in for liposuction, she does her best to discourage them from it because it's a dangerous procedure that she believes is pointless and potentially harmful. but if she can't "talk sense" into the patient, she does it anyway, because that's her job. It's a part of the job she'd rather not do, but she doesn't think that her concerns trump the patient's.
Nick,
I'm giving you that much -- they don't have any business (whatever that means) working in an institution that performs the procedure. Again, suppose they don't? Should they be protected? Suppose the institution refuses as a matter of policy. Should they be protected?
sorry. Should read "then I should not be working for PP." Or maybe that was a freudian slip and Nick is right -- I'm really a dishonest saboteur. Ha.
Here's another comment I made on the DHHS site:
Every day in this Holy month of Ramadan, I've been coerced by my fellow secular physicians to provide my ICU patients with food, even though it is forbidden to eat between the hours of sunrise and sunset. Now, I will finally be free to give my patients the gift of fasting for the glory of Allah.
To keep christians from passing crazy laws, you just have make them think it'll make muslims happy.
NBHOPE SAYS:
REGULATION SAYS:
last I checked, "discrimination" includes hiring practices. just like it's against the law to not hire someone because of their race, gender etc, it's against the law to not hire someone based on their religion. If refusal to do abortions etc. is qualified as protected under religious laws, organizations like planned parenthood could face discrimination charges if they didn't hire a pro-life christian. on the grounds that he/she is a pro-life (christian)
and how many times do i need to quote the same passage before the info sinks in...?
Jadehawk,
OK. I won't work for a piercing clinic. Suppose the patients wants the procedure performed by a certified medical professional.... I agree even then -- It would be wrong to pretend that the procedure doesn't exist. I'd refer you to a peircing clinic. What of abortion? Remember, if its not a matter of life or death, the question is whether the law should be written such that I'm obligated. If it is a matter of life (or grave harm, or great discomfort, or what I don't know), then I would sent the patient to the E.R. Do I have to refer -- make the professional contact, ensure that the procedure happens?
Is the plastic exempt from prosecution? She should be. That is the salient question, not whether you think she's doing the right thing (I agree with that).
Grendlesdad -
you're kidding right? this entire thread is full of indignant horror that somehow this reg will result in a wave of deaths at the hands of religious zealots in the ER. there is little discussion on what this reg will actually entail, actual evidence to warrant the uproar... just hyperbole and exaggeration in the name of protecting patients rights.
Travis -
"Yes. They do. Please explain how removing a doctor's obligation to even discuss some treatment options could fail to impact informed consent. If I don't know all of my options my consent is by definition not 'informed'."
i've asked several times where in this proposed reg does it preclude or even allow for less than informed consent? i didn't see it. if it doesn't, than many of the posters here wouldn't seem to have a dog in this fight.
NBHope, actually the health of women has apparently been risked already on several occasions in regard to abortions. apparently it has happened to several women with ectopic or otherwise dangerous pregnancies that their doctors didn't TELL them the pregnancies are dangerous and possibly deadly, because they didn't want them to have an abortion. granted, this is anecdotal, but I'd rather not give people like the the right to be free from consequences when they act like that.
And also once again, if there's only 3 doctors/pharmacies in town, and they all refuse to help you, you're screwed.
Jadehawk,
I'm a little dense, but doesn't 245 ensure that the gov't won't discriminate, saying nothing about whether the institution must hire. If not, I stand corrected but insist that no institution should be forced to hire an individual who refuses to perform the job for which they were hired.
NBHope@161,
The patient's right to the treatment should be paramount. In fact, that can only be provided by a UHC system, and one which ensures that, specifically, contraception and abortion are readily available to all women who want them. Given that, a private practitioner or clinic can as far as I'm concerned do what they damn well please, so long as they make it absolutely clear what services they will and will not provide, and neither actively nor passively obstruct women's access to those services.
Isn't it reasonable to allow for such exemptions as a matter of conscience? Why not (remember, not a matter of life and death).
It (and by "it" I mean potentially anything) is a matter of life and death until proven otherwise. The last mentality I want my doctor to have while considering my treatment, for anything, is "ho hum, not a matter of life and death." We should hope it's not, but the one who needs to remain open to the possibility that it is is the doctor. One who doesn't, and especially one who doesn't and takes advantage of his la-de-da attitude to provide cover for inappropriate consideration of his religious preferences, is a shitty doctor, and shitty doctors should be sued blind and barred from the profession.
JP
any further questions?
Jadehawk,
Agreed, this is unconscionable. To refuse to inform a patient of a condition for fear that they may (or may not) choose a legal procedure that would save their life is wrong, wrong, wrong in every way. I don't know the law, but would be surprised if any of the regulations standing would allow the doc a get out of jail free card on this. What should she have done? Let her know fully what the problem is and send to another doc. Suppose she dies on the way? Should the doc who "refers" be liable to suit? Tough call. I think I have to bite the bullet and say no.
But, I gotta go feed my 12 kids so better end my participation. (lame humor)
jp,
You're a shameless liar. The regulation makes quite clear that employees can refuse to do anything connected with a particular procedure. I quote:
"When applying the term "assist in the performance" to members of an entity's workforce, the Department proposes to include participation in any activity with a reasonable connection to the objectionable procedure"
- which, clearly, could include telling patients about it, or about the medical risks or benefits of having or not having it.
NBHope, it says that organizations which receive any form of government funding cannot discriminate on the basis of their stance on abortion. discrimination includes hiring practices, unless they've included some exception in the document, which i haven't seen (and which could be removed very easily in the near future)
NBHope - You are missing the point here. A physician can already refuse to perform an abortion on conscientious grounds. What they cannot do is refuse to refer you to a doctor who will or inform you of the option of abortion at all. It's called informed care and consent. As it currently stands the practice is that patients are to be given as much information about all the possible procedures/treatments available to them as is practical to do so.
The new regulations would remove that requirement from doctors. It would allow them to simply decide for you that options X Y and Z are off the table - not because they are not viable medical choices - but because they object to the treatment personally.
Doctors do have the right to refuse treatment where the immediate safety of the patient is not at stake. They do it all the time. They must, however, be willing to refer the patient to a care provider who can help them. This new regulation would remove that last requirement and even remove the requirement for a physician to perform a procedure they find morally offensive (like the much touted blood transfusion example) that is needed immediately to save a life. So, is it OK for a doctor to let you die on the table because HIS religion says blood transfusions are bad even though your personal belief is that there are fine?
This law would make that OK - he'd walk away consequence free from your death because it was a personal moral issue. The hospital couldn't even fire him for it - that would be discriminatory.
I'm a little dense NBHope
Can't agree there: I'd say either very dense, or very dishonest.
NBHope, you keep harping on the piercing example. Do you honestly believe that getting a piercing is on the same level of physical/medical/psychological concern and importance as getting abortion? Really? Because it's not.
jp,
You need to be familiar with the topic under discussion before you can, you know, opine on the opinion of another allegedly opinionated commenter.
you know that, and i know that. where does this reg allow a doc to not give a full consent?
Here (emphasis mine, throughout):
When applying the term "assist in the performance" to members of an entity's workforce, the Department proposes to include participation in any activity with a reasonable connection to the objectionable procedure, including referrals, training, and other arrangements for offending procedures.
Here:
Section 88.2 Definitions
"Assist in the Performance" means to participate in any activity with a reasonable connection to a procedure, health service or health service program, or research activity, so long as the individual involved is a part of the workforce of a Department-funded entity. This includes counseling, referral, training, and other arrangements for the procedure, health service, or research activity.
Here:
[W]e propose that the term "health service program" should be understood to include an activity related in any way to providing medicine, health care, or any other service related to health or wellness....
Here:
(2) discriminate against or deny admission to any applicant for training or study because of reluctance or willingness to counsel, suggest, recommend, assist, or in any way participate in the performance of abortions or sterilizations contrary to or consistent with the applicant's religious beliefs or moral convictions.
Here:
(d) Entities to whom this subsection 88.4(d) applies shall not:
(1) require any individual to perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions.
Here:
(2) discriminate in the employment, promotion, termination, or the extension of staff or other privileges to any physician or other health care personnel because he...refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.
[Heh, so if the physician/other health care personnel is female, it's OK to discriminate.]
it merely respects his/her right to not perform procedures found to be in conflict w/ religious beliefs.
Incorrect. It "respects [the] right" of:
(A) AN ENTITY (defined as an individual physician or other health care professional, health care personnel, a participant in a program of training in the health professions, an applicant for training or study, a post graduate physician training program, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, laboratory or any other kind of health care organization or facility. It may also include components of State or local governments.) to:
AI) not undergo training in the performance of abortions, or to require, provide, refer for, or make arrangements for training in the performance of abortions; (B) to perform, refer for, or make other arrangements for, abortions; or (C) to refer for abortions, FOR ANY REASON WHATSOEVER
AII) be granted a license/accreditation even if it fails to comply with the accrediting agency's accreditation standard or standards that require an entity to perform an induced abortion or require, provide, or refer for training in the performance of induced abortions, or make arrangements for such training, regardless of whether such standard provides exceptions or exemptions, FOR ANY REASON WHATSOEVER
AIII) not provide, pay for, provide coverage of, or refer for, abortion and not provide, pay for, provide coverage of, or refer for abortion as part of the federal program for which it receives funding, FOR ANY REASON WHATSOEVER
and
(B) AN INDIVIDUAL to:
BI) apply for training, be employed, promoted, granted staff privileges, etc. if he is reluctant to or unwilling to counsel, suggest, recommend, assist, or in any way participate in the performance of abortions or sterilizations or if he refused to perform or assist in the performance of a lawful sterilization procedure or abortion because doing so would be contrary to his religious beliefs or moral convictions, or because of his religious beliefs or moral convictions concerning abortions or sterilization procedures themselves
BII) NOT perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions.
i enjoy the argument, but only when both sides are being honest.
[Pardon me while I discreetly LOL for a moment.]
This proposal on doctors' 'conscience rights' reminded me of young Ronald Reagan waking up and screaming "Where's the rest of me?"
Dating the surgeon's daughter from the wrong side of the tracks will never have been more risky.
Stark,
Point taken. I'm not so much missing the point as responding to the thread where the fundamental issue remains as to whether it is reasonable to allow this exemption. I gather Nick thinks not. You provide a compelling argument for requiring full and informed consent. You base your plea on the danger posed to the woman's life. Here's the tough one for your position (if you allow that a doctor can recuse himself from performing this procedure herself, so long as she informs, refers, etc.). What if, as has been repeatedly posed, there are no abortion providers in the town, state, available at all. Consent and referral then means nothing -- the woman's life will be in danger if the doc refuses for any reason. I'm guessing you're not going to like that implication, so should we work to repeal that law? If so, then my comments are on point.
I don't think I could deliberately kill someone... that's why I didn't join the Armed Forces.
If you can't perform your duty to its full potential as it is legally required, you should look for another job.
jp at #114 said: the "OB/GYN code is not in any way affected by this reg, at least as i read it. if you think it is, please expound."
Oh, for the love of ($deity), jp, the code says that physicians must:
Refer patients who request such services or for whose cares such services are medical options to other practitioners who do not object to the provision of such services;
and
In emergency situations, provide care regardless of practitioners' personal objections.
The proposed regulation says a physician is not obligated to do either. No, I'm not going to go find the locations for you; they're repeated multiple times above.
Let me try it simpler: the code says P. The policy says not-P. Got it?
not to be bound by your doctor's freaky religion.
Is there a way to find out when you're shopping for a doctor if he/she is a right-winger? I had a dermatologist several years ago who I thought was okay until one day Christian "Family Values" magazines and framed Bible verses began appearing in his waiting room. I switched doctors. I hear that most doctors in this country are Republicans or Libertarians, but is there any way to find out beforehand so you're not supporting such people?
@184, you can always check which political party they donated to (if they donated). it won't tell you whether they are a religious zealot, but it may point you to the right direction.
If a regulator (in this case the government) deems a practice as part of the procedures for medical staff, then to be medical staff they have to perform it. To raise objections to the patient is one thing, to deny them the treatment is another.
You shouldn't appeal to emotion, it's a terrible way to argue. In a modern liberal democracy, most people actually favour abortion as being legal and something covered by doctors. The extreme objections of the few do not outweigh the will of the many. Yes people find abortion abhorred, but nowhere near as many as find female genital mutilation. In our society, female genital mutilation is almost universally immoral. I wish it were the same for male gential mutilation, and in places where there is universal healthcare that seems to slowly be the case. Yet with abortion, while there are some very strong objections there is a large majority who think the practice should be there to those who seek it. If a particular doctor doesn't want to perform the elective surgery then they should at least refer to someone who would. It's denying the duty of care on the moral grounds of an individual; and in a social system that would defeat the purpose.
No, it's not. Again, it's putting the individual's religion ahead of the needs of the population. And in a secular democracy, no one person should be above the rights of others.
Of course I'm talking of a social system where all services should be equal in treatment, where people should have access to the same services no matter where they go; i.e. universal healthcare. What we have in Australia, what they have all over Europe, what they even have in Cuba. Where one goes should not mean they are denied treatment. In a capitalist healthcare system, then it's a different story. When each hospital competes against each other on services and abilities, then the argument could be made that individual doctors or medical establishments could have the right to refuse to help, because as long as there is demand for a procedure then there will be an establishment that provides it. Though this fails for reasons of cost and proximity; if a poor person can't afford to get the treatment at the only place that provides it; dangerous alternatives are sought out.
So for me, I come from a socialised medicine perspective. I come from a point of view where everyone has the right and affordibility of quality of care no matter where they are.
It is shocking that a doctor, who should be well trained in evidence based medicine, would even let the "right to life" belief affect his medial judgment.
However, from a legal perspective there is absolutely nothing wrong with this regulation. Generally, there is no duty for a physician to provide care to any person. Unless the patient is in an emergency or the doctor begins treatment, there is no duty to actually treat or provide the patient with alternative care. With respect to informed consent, it is irrelevant. Also generally, informed consent is only an issue when one wants to determine whether the patient has all information that would be material to his decision to undergo treatment.
Indeed, this regulation only attempts to put in effect federal appropriation statutes already in existence. (Which were passed over 30 years ago.)
I am not saying the law is perfect or that patients don't deserve more rights than they already have. The more progressive approach should try to ensure a patient would be told where s/he could get treatment if the doctor should refuse treatment based on one of these "against conscious" beliefs. Is that too much to ask from our supposed secular government?
I am in the midst of reading everything a bit more closely and putting together a more in depth analysis for my class blog. I'll provide a link once it is posted.
Docs don't want these wingnut regulations. They already told Leavitt who is a hardcore Mormon fundie and not remotely a doctor what they thought. The docs most likely to be affected are, OBGYNs.
MDs already have a right of conscience by law. No one can be forced to perform an abortion. It's been this way for about forever. They have no right though, to prevent a patient from seeking an alternative provider or imposing their superstitions on a patient.
I don't know where this anti birth control nonsense is coming from. Chances are most of these anti BC nuts have 2 or 3 or 4 kids rather than 10 or 20. Because they use BC of some sort like most rational, responsible adults. Robertson has 2, Dobson 4, Bush 2, Cheney 1, and so on. The amount of hypocrisy and lies among the American Taliban is extraordinary.
Kel,
I'm misunderstood when using innocuous examples (piercing) and again when appealing to an emotionally loaded example. So, yes, let's talk abortion -- a highly charged emotional issue. I'm not sure its the best strategy for lending clarity to the underlying principle of our various positions.
If there is a duty toward the patient to provide abortion, then it is the duty of the government and all who consent to work for the government to provide that level of care if appropriate. So I think I agree with you there. It is not the duty of any individual within that society. So, as you might insist, if you can't stand the heat (or won't use a spatula) then get out of the kitchen (if it's a stipulated requirement of the job).
Should it be a requirement of the job? This is a practical consideration -- that is, do we suppose this duty so important that no individual in the system should be exempt? Consider that we might be able to work around the requirement (at no danger to any individual) out of respect for personal conscience. But this would be decided on practical grounds -- could the government continue to fulfill is duty while allowing providers this exemption. To the point: unless you suppose that majoritarian opinion establishes rights, there is no right to have any individual provide one with an abortion. So, as the OB/Gyn, I have no duty to perform that procedure except that duty which is stipulated by the requirements of the job.
But here's where the many responses go wrong: "no one should be above the rights of others." This holds only with respect to fundamental rights -- the sort of non-negotiable demands placed on every member of the society to treat others in a certain manner. So, the question is whether providing abortion (or even full informed consent), in that situation where the life of the mother is not (by any reasonable measure) in jeopardy, is the sort of right that makes a claim on any other citizen (effectively making it their individual duty to provide that service). This would be true of the right not to be harmed by another -- it directly imposes a duty on each individual regardless of whatever else they may believe. Whether or not you agree that abortion should be permissable, few argue that it rises to the level of this kind of fundamental right. So, it is not the sort of "need" of the population that trumps any other right, for instance, the right to freedom of conscience. On this we achieved fundamental disagreement.
jp-
"i didn't see it."
And yet, it's there, as Nick Gotts and others have illustrated with commendable detail.
That's missing the point by a long way. Whether it's a fundamental right or not is irrelevant; if it's in the job description, then it should be performed. This is what people here are arguing against, whether or not it should be in the job description is another matter entirely.
If society dictates it is in the job description (through our elected officials and independant advisory boards), then it has to be performed. If it's elective, then there's nothing to discuss. If a job required people to work on a Sunday, then they would have to do that. But if the job offered them the option of working on a Sunday and they felt it wasn't appropriate to work on Church day, then they have every right to say no. It's not a big deal to say no if there is an option.
Whether or not abortion is a fundamental right is a separate issue. If the doctors have to do it, then they have no grounds to refuse treatment. If they don't have to do it, then there's no issue at all.
Kel,
To be clear: if it's in the job description, then they gotta do it. Agreed.
The discussion centers on whether it should be in the job description (the law effectively says no, that it is not a requirement of the job of being an OB/GYN).
How do we decide whether or not it should. If it is a fundamental right, then it should be required. If not, then it is reasonable to forward legislation that exempts docs.
As it stands, it is not required, although it is permissible. Most commentators argue that it should be required, that a matter of personal preference, conscience, and especially religious conviction should never trump the desires of the patient.
Ema,
LOL... so how many posts did it take you before you decided to actually go over and read the reg? and now you're gonna pretend you were some kind of expert on the subject all along? classic. whatever.
and yeah, i saw all that the first time i read it, and i'll give you the referral bit, but as far as informed consent goes, i just don't think this is a specific exemption. let alone, most professional codes of conduct/ethics call for an adherence to patient autonomy mandating a proper informed consent.
"The patient's right of self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice....The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice." --American Medical Association, position statement on informed consent
if this regulation does indeed exempt a proper consent, then i would wholeheartedly disagree with it. and i think i've made that clear all along. i'm just not sure it does or even can.
i also don't see the horror show that is being portrayed here as a reality. who knows, maybe i'll be the unlucky one that finds myself in the hands of the sole MD in some podunk backwoods ER and he/she happens to be a JW. guess i'd be screwed. but honestly, i'm not too worried about it and i don't think anyone should be. this just seems more like a baseless scare tactic than an actual issue to be concerned with.
NickGotts -
LOL. shameless liar?!? wow. you kiss your mother with that mouth. maybe i'm a little dusty in legalese, but liar? whatever.
this reg protects the religious views of practitioners. if it exempts them from informed consent, it's not good. i think i've been clear as far as my opinion on the importance of proper consent. my reading of this reg didn't lead me to the conclusion that it was exempted. health care providers should have the right to refuse treatment based upon issues of conscience, but i don't think that includes informed consent. again, most codes of ethics/conduct mandate an informed consent.
To quote Homer Simpson "The reason we have elected officials is so we don't have to think"
Basically we are in a democracy, what is required or not is decided by the officials we elect, the independent boards they set up and the experts in the field. These requirements are kept in check by qualifiers such as the UN Charter on Human Rights or a constitution. While the government may not (and most of the time doesn't) make the right decision for the population, those inside have to live with it. If they think it's unfair, they can strike, they can lobby politicians, try and convince the general population. Now coming back to your gential mutilation example: if doctors felt strongly enough about the issue, they could strike and find a huge amount of public support. They would have politicians onside and the vast majority of the population. Now why wouldn't that work for abortion? Turns out the majority is pro-choice. And while appealing to the population is no indicator of an action being right (it's a logical fallacy in itself), it is the qualifier we use to keep our democratic system running.
you kiss your mother with that mouth
wait... you think 'shameless liar' is a dire insult?
really?
you pusillanimous puerile puking punk.
I'll kiss YOUR mother with this mouth.
i think i've been clear as far as my opinion
oh, that's never been in question.
you're simply, horribly, wrong, and too stupid to admit it, or else merely trolling for gags.
the only thing that kinda irks me is that several people actually bothered to take you even remotely seriously, like Emma, and actually took a few minutes of time to detail the arguments for you, which you then promptly either misinterpreted or ignored. OTOH, while wasted on the likes of you, no doubt the brief analysis and repeat of the relevant bits of the legislation will be of value to those who honestly want to know more about it.
We call people liars here who obviously aren't arguing honestly, and you, troll, are not.
even this is wasted on you.
I'm waiting for the insurance companies to get involved in this one, you know, having to pay HUGE bills for health issues that could/should have been handled simply and easily but were not for 'religious/conscientious' reasons.
Watch a few doctors lose their reimbursements and see how long this sort of thing lasts.
As for the bruhaha over abortion (and lets face it, we all know that's REALLY what this is aimed at, reproductive rights) Not all doctors perform them nor should they.
No one is demanding a family (PCP) doctor pull out the stirrups and do a D&C. I work in a large teaching hospital and of the OB/GYNs there, I'd say a quarter or less perform abortions and the other OB/GYNs refer to them. Several OB/GYNs do have signs in their offices/waiting rooms stating that abortions are not performed by them however referrals will be made if necessary. HOWEVER, I know for a fact that if ANY doctor on staff is found to NOT give full, informed and complete consent to their patient their rights at the hospital will be TERMINATED IMMEDIATELY. That is regardless of personal feelings, religious views or any other reasons a practitioner might 'think' they have for withholding information from a patient.
There are a LOT of checks and balances in health care (at least in accredited hospitals) I don't like the idea of the government getting involved, especially as they've pretty much destroyed everything they've touched over the last few years.
As for people stuck in states where there is no real option...I don't know what to say. I've read (and in two cases, spoken) with women who had to travel to other states to have procedures performed on them. One woman was forced to carry her dead fetus for nearly two weeks and was hospitalize and treated with IV antibiotics due to it. It was wrong for her to be placed in that situation; emotionally, physically and medically and I wish she had some sort of recourse.
If this law passes that poor woman could have died and no one would have been held responsible. Anyone care to break THAT news to her family?
Yes, that will help counter perceptions that the deeply religious are selfish and insane. A doctor's first priority must be the life of the patient. If you don't want to do your damn job, than you shouldn't be a doctor - or in the very least, switch to a field where you won't be expected to go against your silly superstition on a regular basis.
The legal argument for this seems fairly straight forward as well. You want to right to refuse dying people blood transfusions? That's fine, since no one has a "right" to practice medicine. You want the privilege of being a doctor, then you have waive your that selfish little right of yours.
Remind me again - have the Armed Forces ever had a volunteer soldier sue for the right to not violate that one commandment about not killing?
@ 139 :
The Catholic Church in Australia is actually threatening to close maternity wards in Catholic hospitals if the legislation is passed.Thats called extortion,its unbelievable.
As a Physician myself I find it hard to grasp that deluded religionists that are prejudiced against certain treatments can practice their specialty,especially in the operative specialties.Remember we had a similar discussion here a few months ago regarding pharmacists not giving out contraceptives.
//provider conscience rights// Thats just brilliant,Goebbels would be proud.
Ah - another opportunity to link to the informative Emergency Contraception Website:
"Can I get emergency contraception at a Catholic hospital?"
http://ec.princeton.edu/questions/echosp.html
Why the hell should anyone care what you don't see or how things seem to you? Your statements are based on nothing, and you've shown yourself to be less than perspicacious.
Here's mine, just sent:
The welfare of the patient, not the religious beliefs of the doctor, must be at the center of medical decision-making and treatment. Patients must be able to make treatment decisions based on accurate medical information and their own ethical or religious beliefs.
Doctors and other health providers must, therefore, be obligated to provide treatment, or at the very minimum, information, even to patients who do not live up to the doctor's ideals of proper living. If the doctor does not wish to provide care, he must refer the patient to someone who can.
To live up to his responsibilities, a doctor must tell the patient, truthfully, about treatment options. This includes telling a rape victim about emergency contraception even if the doctor is a practicing Catholic whose religion forbids contraception. The decision whether to use such a drug should rest with an informed patient, not the religious beliefs of the doctor who happens to be on call in the emergency room.
Similarly, a pharmacist must fill the prescription a patient brings him, even if the prescription is for an anti-psychotic, and the pharmacist's religion classifies mental illness as demonic possession. The decision to use this treatment is not the pharmacist's to make.
This proposed regulation seems primarily aimed at preventing women from receiving reproductive health care. Precisely because there are so many different religious views on sex, contraception, and abortion, the religion of one (the doctor) should not be imposed on another (the patient). Religion must not be used as a cover for negligence.
The American College of Obstetricians and Gynecologists says that doctors whose religious beliefs call for them to "deviate from standard practices" (such as providing contraception or abortion) must nevertheless tell patients in advance of their religious commitments, give them unbiased information, refer them to another doctor, or, in an emergency, provide the service themselves.
Now go write your own.
It's generally pointless to attempt a drive-by interjection during an intensive effort to educate a troll, but perhaps this roughly parallel situation from the antipodes will shed some light:
The state government of Victoria, Australia, is attempting to legalize abortion in that variegated domain. The legislation passed the lower house of the state legislature after heated debate, but seems to be paused in the upper house because the ever-ethical Catholic Church is threatening to close all its hospitals if women are allowed to control their own bodies.
One wonders if the saintly bishops have asked their medical employees to estimate the increased Victorian death toll (among Catholics and non-Catholics) should they stand on their "pro-life" principles in this situation. One knows better than to ask that of Mr. Leavitt and his Bushevik fellow-travelers...
Given the risk by closing emergency services, how is the Catholic Church's position there any different to a terrorist threat?
I hope the Victorian government does the right thing and doesn't bow down to extremists. It's not the place of the Catholic Church to decide the laws of the land.
Correction: Clinteas @ # 199 has it right: the immediate extortion attempt is a threat to close maternity wards, but the Archbishop involved doesn't seem to limit his blackmail to just that: "This poses a real threat to the continued existence of Catholic hospitals." (from story linked to @ # 201)
The death of the first Catholic mother and/or infant elsewhere who had been scheduled for delivery at a facility closed by the Archbishop's "morality" will overload irony meters around the world.
Correction correction: (from story linked to @ # 203).
A really brilliant deadpan parody in one of the comments (unfortunately my own submission was blandly straightforward). Had me going for a while but ultimately went so far off the deep end I had to call Poe's law:
"Dear Secretary Leavitt:
I am writing to express my support for the draft proposed regulation, presently
being circulated by the U.S. Department of Health and Human Services, which
would protect the right of employees to refuse to facilitate any abortifacient
chemical or activity. Under the draft proposal, the federal government will use
its grant-making power to compel private employers to respect this right of refusal.
In particular, I commend the language of the draft, which would define abortion
as "any of the various procedures--including the prescription, dispensing 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 bir th, whether before or after implantation."
This definition protects the right of employees to withhold oral contraception,
which could prevent implantation of an already-conceived embryo.
My concern, Mr. Secretary, is that the proposal does not go far enough.
As you know, the risk that oral contraception will prevent implantation of an
embryo is purely theoretical. There is no documented case of such a tragedy,
since we have no way to verify conception inside a woman's body prior to
implantation without causing the embryo's death. Even theoretically, the risk is
vanishingly small, since the primary effect of oral contraception is to prevent
ovulation, and the secondary! effect is to prevent fertilization. To classify
oral contraception as abortifacient, one would have to posit a scenario in which
the drug fails to block ovulation, then fails to block fertilization, and yet
somehow, having proved impotent at every other task, manages to prevent
implantation.
It is a tribute to the president's courage that despite this profound
implausibility and total absence of documentation, he is protecting the right of
employees to refuse to facilitate any such risk, no matter how small.
Based on this generous standard, I hope you will agree that employees deserve
protection when they decline to facilitate additional activities that pose an
equal or greater risk to the embryo. Specifically, I call to your attention the
problem of breast-feeding.
Thousands of people working at hospitals, lactation centers, maternit y-product
retailers, drug stores, and supermarkets are presently required by their
employers to participate in breast-feeding, either by teaching it or by
providing products that facilitate it. Those who refuse can be terminated at
will. They endure this discrimination despite clear scientific evidence that
breast-feeding poses the same abortifacient risk as oral contraception.
Breast-feeding, like oral contraception, alters a woman's hormonal balance,
thereby suppressing ovulation, fertilization, and, theoretically, implantation.
These results were documented in a 1992 research paper, "Relative Contributions
of Anovulation and Luteal Phase Defect to the Reduced Pregnancy Rate of
Breastfeeding Women." The authors concluded: "! The abnormal endocrine profile
of the first luteal phase offers effective protection to women who ovulate
during lactational amenorrhea within the first 6 months after delivery." In
other words, breast-feeding prevents pregnancy despite ovulation.
Note that the authors described this effect as "protection" despite the fact
that they worked for a Catholic university. This illustrates the urgent need for
specific regulatory language with regard to breast-feeding. Technically, the
current HHS draft proposal would guarantee the right to withhold breast-feeding
products or assistance, since it defines abortion as encompassing "any other
action ... that results in the termination of the life of a human being" prior to
implantation. Catholic health providers, however, specifically endorse, promote,
and facilitate breast-feeding despite its abortifacient risks. Employees of such
providers who cannot in good conscience engage in these activities require
specific protection from coercion by Catholic authorities.
In addition, millions of Americans in the food-service industry face the threat
of discrimination if they decline to participate in the provision of caffeinated
beverages to women of childbearing age. Earlier this year, the American Journal
of Obstetrics and Gynecology published a study showing that "an increasing dose
of daily caffeine intake during pregnancy was associated with an increased risk
of miscarriage." The evidence suggests that drinking 10 ounces of coffee per day
could double the probability of misc! arriage.
It is not sufficient to protect the right of food-service personnel to refuse
caffeine to women who are visibly pregnant. Pregnancy is not externally visible
until well into gestation. Nor is it sufficient to protect caffeine refusal to
pregnant women only. The stated purpose of the draft proposed regulation is to
protect human beings prior to implantation--in other words, prior to pregnancy.
As mentioned above, there is no way to determine, prior to implantation, whether
a woman is carrying a newly conceived human being. Therefore, to avoid the
theoretical abortifacient risk, employees must be guaranteed the right to refuse
caffeinated beverages to any woman who appears to be of childbearing age.
Furthermore, millions of Americans presently work at gyms, swimming pools,
parks, or other recreational facilities where they may be required to encourage
or collaborate in exercise by women. Research published last year in a British
journal of gynecology demonstrated that, as with caffeine, "exercise early in
pregnancy is associated with an increased risk of miscarriage." Again, to avoid
abortifacient risk in women who are not yet pregnant, the draft regulation must
guarantee the right to withhold any collaboration in exercise by women of
childbearing age.
Thank you for your steadfast pro-life efforts and for expanding the definition
of abortion to include any activity that results in the termination of human
life prior to implantation. This expanded definition will save the lives of more
and more unborn human beings as we advance from conscience protections to legal
restrictions on abortion. As research uncovers additional causes of miscarriage
or preimplantation embryo loss, I look forward to further legislation against
caffeine consumption, exercise, and other abortifacient activities among
premenopausal women.
Sincerely,
William Saletan"
jp,
this reg does not, at least in my understanding, allow a doctor to withhold information from an informed consent or allow a doctor to refuse to make a referral.
This has already been addressed.
the notion that this reg will spark a rash of ER room deaths due to religious objection is unfounded and overblown.
Please support your assertion with data.
NBHope,
The act of consent to practice medicine does not confer any duty on the person who is a trained medical professional.
Why was I not informed about this???!!
There is no absolute right for the patient to be treated by the doctor, for the doctor can, as has been suggested repeatedly above, simply quit without having violated some presumed patient right.
And a bazillion malpractice lawyers are smiling at this naive pronouncement. [When you quit, it is your professional responsibility to insure continued coverage for the patient.]
The suggestion here is that, out of respect for certain well specified areas of conscience, the doctor should not be held responsible for failure to provide certain services.
No, the suggestion is that, out of respect for an entity's funny feelings in the tummy, the doctor should not be held responsible for failure to provide proper medical care.
You just can't pretend that it's is somehow a matter of the sort of fundamental human right that places an absolute duty upon the person of the doctor. It does not.
Your honor, apparently, the parents of the child I delivered 18 years ago, have no standing to sue for malpractice since there's no absolute duty for me to, you know, provide proper medical care. So, case dismissed and then lunch?
Tell me where the following goes off the tracks:
Supposing that female circumcision were legal, but I, as an OB/GYN oppose it as a matter of conscience. The patient makes an appointment to arrange for this procedure. Should I be liable to prosecution were I to refuse to perform this procedure? Would it be reasonable to enact and enforce a law that exempts me from having to perform this while allowing me to remain in the profession.
Where is the disanalogy? Why is it so difficult to recognize the reasonableness of this request?
It starts off the tracks and never recovers.
Just because something--FGM--is legal does not mean it's the medical standard of care. Your professional obligation is to provide proper medical care. While legal (in your example), FGM does not fall into that category. Refusal to provide FGM does not deprive your patient of competent care.
Contrast that with a refusal to provide (counsel, perform, refer, etc.) abortion. You are depriving your patient of safe, effective, and indicated medical care. [Can you say malpractice?]
Should everything that is legally permissible be a requirement of the job or is there room for exemption. So if required, "yes," but should it be.
You are confused. The requirement for the job isn't what's legally permissible; it's what is in accordance with the medical standard of care.
And no, there is no room for exemption. If there were we wouldn't need to carry malpractice insurance.
Agreed, it would be morally reprehensible to refuse critical care. Is it a matter of critical care for an OB/Gyn to perform an abortion.
Yes, it is. As a rule, the morbidity and mortality associated with carrying a pregnancy to term > terminating a pregnancy.
JP, here's where you lied: "but let's be honest here. the only reason this is causing such an uproar is because it's a belief issue. and the only ones taking umbrage are atheists. it has nothing to do with worries of bleeding to death at the hands of a JW nurse or not being able to get an abortion on demand from a Muslim doc."
Several lies in one, in fact. I'm not an atheist, in fact I'm a devout Christian, and I'm horrified by the idea that a rape victim will have to shop doctors, or even hospitals, trying to get emergency contraception. Which brings me to lie #2, your assertion that we're not worried about subpar health care, but instead about Oppressin' teh Poor Christians.
Bullshit. Christians are a clear majority in the country. NOBODY's oppressing you, buddy. You just don't like the undeniable fact that we think you far-right fundies are crazy. Too damn bad. You are crazy, and what's more you're damnably unAmerican in your viewpoint about, well, everything.
You have every right to be a fundie nutcase. We have every right to tell you your viewpoints suck.
What you DON'T have is the right to let your fellow fundie nutcases in the medical profession prevent the most vulnerable among us from receiving quality medical care. Rape victims, poor people, and folks who don't have my mad google skillz (to research appropriate treatments) don't need to be at the mercy of those who put their ideologies ahead of the human being who's right in front of them.
Chris @207
A really brilliant deadpan parody
It's called a satire.
in one of the comments (unfortunately my own submission was blandly straightforward). Had me going for a while but ultimately went so far off the deep end I had to call Poe's law:
It is a brilliant satire, more Swift than Poe. Thanks for posting that here, and anybody who scrolled by the long post, go back and read it, the one signed by William Saletan, the Slate guy.
jp,
LOL... so how many posts did it take you before you decided to actually go over and read the reg? and now you're gonna pretend you were some kind of expert on the subject all along? classic. whatever.
Relax jp, we're all grown-ups here; no need to project.
and yeah, i saw all that the first time i read it, and i'll give you the referral bit, but as far as informed consent goes, i just don't think this is a specific exemption.
...
if this regulation does indeed exempt a proper consent, then i would wholeheartedly disagree with it. and i think i've made that clear all along. i'm just not sure it does or even can.
Your lack of comprehension notwithstanding, it does and it can.
i also don't see the horror show that is being portrayed here as a reality.
This is understandable. It is sometimes difficult for a lay person to appreciate how utterly dependent they are on the ability and willingness of their physician to practice proper medical care.
who knows, maybe i'll be the unlucky one that finds myself in the hands of the sole MD in some podunk backwoods ER and he/she happens to be a JW. guess i'd be screwed.
According to the proposed regulation, all that's required is for any medical personnel you come into contact with, directly or indirectly, during your ER visit to deem ANY PART of the health care services you'd be in need of contrary to his moral convictions and, viola!, a "screwed" jp.
but honestly, i'm not too worried about it and i don't think anyone should be.
Good for you, but might I point out that wishful/magical thinking is what's at the root at the problem to begin with.
this just seems more like a baseless scare tactic than an actual issue to be concerned with.
Agreed. Professional competence, proper patient care, and state-imposed, ideological standards of care do not appear to be issues you actually concern yourself with.
For what it's worth, submitted this comment to HHS:
The last dregs of the insanity of the Bush adminstration have found a home with the Orwellian-speak for this rule change. This kind of change will obstruct access to proper medical care. The religious beliefs of a doctor, nurse or pharmacist do NOT trump the well-being and beliefs of a patient. A patient must be given access to ALL accurate medical information so that they may make the best decision possible based on their OWN beliefs. How dare you dictate that the standard of care I receive could be based on some kooky cult which calls itself a religion? How can you possibly distinguish between a "legitimate" religion and someone who claims they are a religion of 1-100 people? If you are going to allow such so-called health care providers to run clinics then you must have the clinic publicly post that they will not provide expected services. At least then a patient can make their own decisions and not trouble the clinics with their requests for a higher standard of health care.
Leigh -
come on now, who's the liar? devout christian? if you say so...
and how can an opinion be a lie anyway? you can disagree with it, but to insist it's a lie???? interesting to say the least.
i stand by my notion i think it's bullshit that anyone here is actually worried about bleeding to death because a "fundi nutter" nurse or doc refuses to treat. please, one of you just fucking admit you are honestly worried about not receiving proper care at a med facility. could it happen, sure. is it a problem of such magnitude as to warrant these ridiculous claims? i say hardly.
and OMFG!!!, did you seriously post "mad google skillz"?!? wtf, are you 12? does your mommy and daddy know you're playing on the internet? you should probably run along and finish your homework now.
Ema-
you want me to post a link substantiating the lack of evidence to support the wild claims made here on this forum? wtf are you talking about? how about you substantiate your claims for the wild bs scenarios that are being posted here??? as these conscience clauses have been in effect for decades, shouldn't there be evidence of their horrifying effects? hoards of dead patients at the hands of objecting providers??? couldn't seem to find much when i looked... but maybe you can get Leigh to use some of those "mad google skillz" and find something.
looks to be much ado about nothing...
jp, are you that naive or just plain stupid?
we're talking about fundie christians. you know, the group of people who REGULARLY shows up in the news because another child died because of parents religious belief made them NOT give them the help they needed. and now we're about to extend the same right to doctors? keep in mind that those are people who think a woman shouldn't have the right to terminate an ectopic pregnancy, on the off chance it'll work out (the far more likely result is suffering, health problems, or even death of the woman).
Ema -
"Relax jp, we're all grown-ups here; no need to project."
- hmm, didn't think i was the one getting worked up, but whatever. i just enjoy the debate.
"Your lack of comprehension notwithstanding, it does and it can."
-please cite one legal opinion supporting this claim.
"This is understandable. It is sometimes difficult for a lay person to appreciate how utterly dependent they are on the ability and willingness of their physician to practice proper medical care."
-layperson? don't think i ever posted my professional background, but okay, we'll go with your assumption. so what are your credentials and how do they enable you to be so discerning in these medico legal matters?
"According to the proposed regulation, all that's required is for any medical personnel you come into contact with, directly or indirectly, during your ER visit to deem ANY PART of the health care services you'd be in need of contrary to his moral convictions and, viola!, a "screwed" jp."
- yeah, it appears that's what it says. but since i have yet to go to an ER with only one nurse or doc on staff, not sure just how "screwed" i'd be here.
"Good for you, but might I point out that wishful/magical thinking is what's at the root at the problem to begin with."
- no, respect for personal rights is what's at the root of this. again, not sure how you can be in support of rights for some, but not for others... but that's an argument for another day.
"Agreed. Professional competence, proper patient care, and state-imposed, ideological standards of care do not appear to be issues you actually concern yourself with."
- in fact, i concern myself with these daily. but that's neither here nor there. this issue has little to do with competence, or state imposed anything other than respect for the conscience of both the provider and the patient. too bad the california courts seem to agree with my point of view on this as well as a recent challenge to similar conscience clause was thrown out... " March 20, 2008 SACRAMENTO, Calif. -- In a decision released late yesterday by the U.S. District Court in San Francisco, Judge Jeffrey S. White ruled in favor of the Alliance of Catholic Health Care and a host of co-defendants and intervenors and rejected a constitutional challenge by the State of California to the Hyde-Weldon Amendment, a federal law which protects hospitals and health care workers from being forced to perform abortions.
In a nine-page ruling, Judge White rejected arguments by the California Attorney General's Office and Superintendent of Public Instruction Jack O'Connell that the Hyde-Weldon Amendment was an unconstitutional infringement on state sovereignty and a woman's right to an abortion. He said the state had failed to show any conflict between state and federal law or that anyone had been harmed or prevented from receiving medical services as a result of the Hyde-Weldon Amendment."
i'm not a lawyer, but i'd say you're gonna be hard pressed to find any legitimate evidence that these conscience clauses have killed, let alone even harmed anyone, as so many here seem to be insisting.
so is the sky still falling chicken little???
here's an example of what i'm talking about:
prolifeblogs on ectopic pregnancies
jadehawk -
seriously? they "regularly" show up in the news w/ dead kids??? seems all i get are the car chases and talk of the economy, but maybe it's just where i live. the courts disagree with your appraisal of this apparently dire situation.
nighty-night all...
the courts actually deal with cases like that quite often. here's a small sampler:
and like I said, it's been already happening that women were refused abortions for dead or dying fetuses, or have been misinformed about the dangers of their pregnancies; now the doctors won't even legally have to inform the mothers that abortion is an option.
it's nice that you live in a world where people don't do shit like that. but the rest of us has to deal with people who try to impose their morals on us, even at the risk of our health and wellbeing. and i don't see how they should have a right to do that.
Maybe we should apply this to other fields of work.
* At a courthouse:
You want a divorce? I'm sorry, I can't let you go through with that. There's a heathen judge next town over.
* At a bank:
You want a loan? But you aren't Jewish, I can't lend you money. Perhaps if you one of your ancestors were an Egyptian...
* At a pharmacy:
No, you can't have the morning after pill. You should have thought of the consequences before being a little slut and got knocked up. Oh, and may God bless your child
Given the nature of the medical system, how can anyone think it's a good idea to deny care on the basis of religion? It's just another case of allowing religion to infringe on the liberties of others. It's not a doctor's place to run the other people's lives or make choices for them, their job is purely to treat the patient.
oops. let's try this again :-p
here
here
and here
JP says - the notion that this reg will spark a rash of ER room deaths due to religious objection is unfounded and overblown.
Now why is it that I, a vile atheist, feel that even ONE death due to this abominable legislation is one too many and yet you, a supposed good (insert religious affiliation here), seems to imply that this should only be a concern if it causes a "rash" of deaths? I know that life is held cheap in the more fundamentalist religions, and that the afterlife is more important than the one you live now, but just how many have to die before YOU would reconsider your position? 10? 1000? Your mother?
What is the price in OTHER peoples suffering that you are willing to pay so that you can feel morally superior?
It's way, way back in the thread, but no one seems to have picked this up:
jp @#106 said: "...where does this reg allow a doc to not give a full consent?"
Huh? It's not the DOCTOR who has to give consent, you moron.
I came in a bit late and I've had a lot of reading to catch up on, but I think I've got a pretty clear idea now.
Let's try an example, and I'll keep it really mundane:
A pregnant woman goes to see her doctor and asks for an abortion. The doctor is male, Catholic and totally opposed to abortion on moral grounds.
Under the current system, he can try to persuade her not to go ahead but he is obliged to provide her with all the necessary information she needs to make the decision herself. If she chooses to have an abortion he doesn't have to perform the procedure but he must give her a referral to someone else who will.
Is that a fair summary?
Under jp's new regulations, the doctor can give his (fully-informed) consent to his patient not having an abortion. He knows she is in a vulnerable state so he can spare her the trauma of having to discuss her options. He is not forced to deliver her into the hands of a godless murderer who doesn't care if she burns in hell forever.
Sounds fair enough to me. Don't know what you're all worried about.
you kiss your mother with that mouth jp the shameless liar
Actually, since my mother's been dead five years and I'm not Norman Bates, I don't.
This is a very timely issue for me, as I recently ran into such a superstitious doctor. I was diagnosed with an ectopic pregnancy a month ago, and I knew there were 2 ways of treating it - medication that stops embryonic growth (methotrexate) and surgery. When the Dr. - not my Dr., but the on-call one - diagnosed the ectopic via ultrasound, she told me immediate surgery was my only option, and refused to inform me that methotrexate was an option, as I wasn't having any acute symptoms. I almost left the ER against medical advice to get a 2nd opinion - this was at a Catholic hospital - when I finally got ahold of my Dr. and gave her the news, and she told me I could have methotrexate, but that I had to go to a different hospital.
The difference here -beyond patient preference - is that surgery has more adverse effects on future fertility, on top of all the other inherent risks of surgery. And 2 physicians confirmed that I was a perfect candidate for methotrexate injection instead - but the Catholic Hospital denied this treatment to me.
Having religious based medicine forced on me was more traumatic than losing a wanted pregnancy!
Please everybody, stop feeding the troll.
One thing I love about this board is the amount of people who will go out of their way to try to inform and re-educate the plebs. But some of them are beyond help. They cannot assimilate information in the same way normal people do because they are brainwashed. (see here for some examples of brainwashing http://www.cracked.com/article_16656_6-brainwashing-techniques-theyre-u… )
I just can't bear how they repeat themselves ad nauseum (not fun when you're off sick with food poisoning I tell you!)
I think that those people who are concerned about what kind of doctor they are seeing should either come right out with it and ask them directly, or take advantage of one of the many doctor review sites to check up before you go.
Deride and conquor!
I thought this was very relevant:
From http://news.independent.co.uk/world/politics/article2859077.ece
Forwarded your piece to the American Humanist Association, and Americans United for Separation of Church and State. Once their "call to action" e-mail lists kick in, the HHS comment boards will be overflowing!
Thank you for posting this, PZ. I have sent in my comment and blogged about it on my own site. This issue hits close to home for me, and I'm sure for many other women and the men who love them.
Right now we're hearing rumbles about this from Ontario, too.
There is no place for religion in health care, aside from in the waiting room. A doctor is ethically bound to use his or her expertise to its limit and without limitation to assist patients.
No one would require a pro-life doctor to provide abortions on demand, but that doctor must inform patients about all available options, and put patients in touch with people who will provide the service the patient requires.
Doctors who do otherwise should have their licenses suspended.
Colin @#222 - LOL at this one... doctors routinely "give" a patient informed consent. good to know i'm not the only one a little slow on the uptake around here. moron indeed.
NickGotts - i bet you're the life of the party with your "snarky" repartee. and so sorry to hear about dear ol' mother gotts, i'm sure she was a lovely woman.
from the rest of the posts in this thread, i'm noting a distinct shift from "we're all damned" to this being more of a woman's health issue. and as most of these conscience clauses seem rather focused around the abortion issue, this seems like a more likely scenario. that is, as opposed to the numerous scenarios presented here of patients dying at the hands of a JW nurse who refused to transfuse or whatnot.
again, these types of regs have been on the books for decades and as the courts have found time and again, the claims of reduced access to care haven't held up. nor have the claims that these clauses will cost countless lives.
and to foilhatgrrl - having religious based medicine forced on you? how so? you got a second opinion and were able to chose the treatment you wanted. it is sad however, that the first doc didn't convey all of your treatment options, and i think anything less that a complete informed consent is unethical. i know there are arguments as to why these clauses should excuse a less the thorough consent, but personally, i don't accept them. i should be able to opt out of providing the treatment i don't morally agree with, but i think the patient has every right to know all available treatment options.
jadehawk - none of your links worked.
off to lunch....
As I see it, physicians are professionals who practice their trade under a license that requires them to render services to the public, within a legal framework that does not provide for selective use of interventions, depending on the physician 's religious or other delusional ideations. That's why physicians have a monopoly as decision makers in medical care.
If we allow physicians to provide or deny care based on [euphemism] metaphysical [/euphemism] criteria, there is no reason to treat xtians preferentially, and there is no longer any basis for upholding the monopoly. We are then looking at a situation where persons in need of medical care will be further burdened with having to sort physicians by the kind of woo they practice.
If any of my colleagues tried to deny or denature medical care, they should be fined or have their license revoked ASAP. If they end up out of a job, it would be a consequence of their own unprofessional and unethical behavior.
If you really believed what you said jb (i think the patient has every right to know all available treatment options), then why on earth aren't you against this bill?
As has been pointed out numerous times, the bill address "any part of a procedure" and specificly mentions referals.
Without a referal many insurance policies will not cover a procedure.
Without the ability to pay for a procedure, it is much less likely to be performed.
You don't think this gives the physician unwarented control over the patient? It doesn't matter what the patient wants. It doesn't matter what the insurance company wants (though they may be happy in th short term to not pay for many things). The outcome of medical situations is to be left to the "conscience" of whatever doctor the patient has? This is your idea of the correct way to run things?
so sorry to hear about dear ol' mother gotts - jp
Liar. She'd have loathed you, you horrid little creep.
from the rest of the posts in this thread, i'm noting a distinct shift from "we're all damned" to this being more of a woman's health issue.
*yawn*
the resident moron for the thread is STILL at it?
pathetic.
grendelsdad - said it before and i'll say it yet again... this reg is broadly worded, but if it indeed abrogates a full consent, it's not a good reg in my opinion. i'm just not sure it constitutes a "gag order" that would preclude an informed consent. if it did, it would be in direct opposition to generally accepted notions of what even constitutes consent (Principles of Medical Ethics of the American Medical Association; President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research). i do however think the principle, protecting health care professionals personal rights, is legitimate.
and contrary to the portrayal here, there is scant evidence (peruvian ectopic pregnancies excluded) that these conscience clauses have cost lives, or prevented access to care.
i'm just not sure it constitutes a "gag order" that would preclude an informed consent. - jp
Try not to use phrases you don't understand - it makes your idiocy even plainer.
Nick - aww boohoo... ol' goat Gotts would've loathed me? really you flatter me. i'm much much worse in person.
and if that's the best you've got, why bother?
gredelsdad - forgot to add, my idea of the correct way to run things is to respect both parties rights.
i'm much much worse in person
I can well believe it, scumbag.
Nick - scumbag? aww how cute... somebody likes me!!!
sorry nick, but i don't think i'm your type. but seriously, i am flattered.
somebody likes me jp
You're quite wrong, but I can see why you'd need to fool yourself into believing it.
jp, you seem to have a novel idea of the definition of 'informed consent'. Its meaning is far from controversial, except, apparently, to you. Either that, or we can add 'piss poor communicator' to your growing list of shortcomings. Would you care to explain your interpretation, if it won't interrupt your intellectual discourse with Nick overmuch?
(http://www.ama-assn.org/ama/pub/category/4608.html)
While you're at it, jp, perhaps you could tell us what you think a "gag order" is - because the phrase made absolutely no sense in the context where you used it.
Nick - oh, come on now. who's fooling whom here? why would you waste all these oh so clever one liners and witticisms on little ol' jp? i was in kindergarten once too and when immature personalities want to show someone interest... they shower them with insults and punches. ergo, you like me. we only hurt the ones we love nick. but alas, i'm taken. please feel free to weep softly at your keyboard. and take solace, there's more than one fish in the sea....
we'll always have this thread nick.
I see you don't know what a "gag order" is, or the meaning of "informed consent". You'd better look them up. Then you can come back and pretend you knew all along.
Danio - where did i contend informed consent is controversial? maybe go back and read through the thread, but i'm pretty sure i got my definition for informed consent where you did (http://www.ama-assn.org/ama/pub/category/4608.html). but here's a good summary:
The patient's right to self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice....The physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice.
Nick - i'm sorry, and you were saying i had the comprehension issues...
correct me if i'm wrong here, but the contention is that this reg would allow health care entities to censure disclosure with regard to informed consent. thus the term "gag order". perhaps i could have used a clearer term... but i think the intent was clear.
jp,
What on Earth is "allow health care entities to censure disclosure with regard to informed consent" supposed to mean? What do you think "censure" means? Whose disclosure of what to whom are you talking about?
Nick - what, i don't reply within 3 minutes and you get all clingy on me?
and that you've been relegated to arguing semantics just tips your hand... or rather lack thereof.
jp,
I'm "arguing semantics" because what you say is literally incomprehensible - apparently because you don't know what quite ordinary words mean. I'm requesting an English translation of "censure disclosure with regard to informed consent", because I don't speak very good Scumbagese.
Nick - you're kidding right? probably not, but that's okay.
might i refer you to sec 88.2 (line 12) of the proposed reg?
you really are funny.
"Whose disclosure of what to whom are you talking about?"
disclosure by the doctor/health care worker of a fully informed consent to the patient is what we are talking about here. it has been alleged that this reg would enable a health care entity to censor a fully informed consent on the grounds of conscience.
** ah, i think i just saw where you may have been confused. i misspelled "censor" as "censure". i'm sure that really threw your ol' bean for a loop huh? i'll offer a mea culpa on that one...
Nick - "scumbagese"? wow... and yet another incredible zinger from the NG! did you really make that up yourself?
a comedian and a wordsmith, impressive combination.... i bet you were voted most likely to succeed in high school, no? seriously, you should write sitcoms. no bs, you're that good.
jp,
So, you don't know the difference between "censure" and "censor", and you don't know what "informed consent" means. "Informed consent", ignoramus, is not something a doctor/health care worker can "disclose" to a patient; it is what a patient is supposed to give to the doctor/health care worker before a course of treatment begins, or a decision is made that no treatment will be given. Now, halfwit, i'm done with you and am adding you to my killfile.
Nick - i've got to go, so don't go getting all depressed on me. i'll be back later, i promise.
going to see if i can get in 9 holes before sunset... duty calls.
as always, it's been fun!
It seems that jp would prefer to ignore the plain effects likely to result from, and a significant portion of the stated intent of this matter, due to his perceived bias in the motivations of the majority of posters here.
Sad.
You didn't, but you seem to be using the term in a way that is contrary to what everyone else on this thread (and, as far as I know, the planet) interprets it to mean. To be plain,
'Informed consent' refers to the information, disclosed by the physician, that guides the decision of the patient to undergo (or not) a particular treatment. This definition seems incongruous with your use of the term in several of your above comments. Similarly, while a 'gag rule' is commonly defined as a policy that prohibits the physician/provider from discussing a certain treatment option with a patient for fear of losing, say, Federal funding, you appear to be using the term in a hitherto unknown context. Just sayin'--complaints of incomprehensibility vis a vis your comments are not entirely unfounded.
jp:
"The patient's right to self-decision can be effectively exercised only if the patient possesses enough information to enable an intelligent choice..."
OK, with you there.
"...disclosure by the doctor/health care worker of a fully informed consent to the patient..."
Huh? And we're back to my moron comment from earlier.
The doctor does not give "informed consent". Stick with me here, it's quite simple. The doctor gives the patient the information they need so that they (the PATIENT, not the DOCTOR) can give informed consent. Consent as in agreeing to the doctor's proposed course of action/treatment.
This regulation allows the doctor to withhold information purely on the basis of their (the DOCTOR'S, not the PATIENT'S) personal beliefs. No compulsion, no "gag orders" (where the hell did that idea come from?), it's all down to the doctor's conscience.
If you honestly believe that informed consent is important and uncontroversial how can you support this?
Tulse@116, there can be little doubt that would eventually happen. For those who think otherwise, remember what PZ has posted before about Muslim doctors in the UK who refuse to scrub because it would involve baring their arms. Reports also come in about female Muslim doctors refusing to remove their veil even though it interferes with treatment, of medical students refusing to learn about certain diseases or answer certain exam questions, and of doctors of several faiths refusing to honor a patient's living will.
Taking measures to protect health care providers "rights" before and above the rights and needs of the patient is a dangerous road to go down. Those who feel they cannot in good conscience fulfill the standard and accepted requirements of a profession should pursue an alternate career path.
zy @258 "Taking measures to protect health care providers 'rights' before and above the rights and needs of the patient is a dangerous road to go down. Those who feel they cannot in good conscience fulfill the standard and accepted requirements of a profession should pursue an alternate career path."
While I agree with your second sentence, the first is not correct. The rights of providers and patients should be equally protected (and neither should be enclosed within ersatz quotes.) This is especially the case with non-emergency care. As a patient, you have the right to expect that I will provide medical care to community standards and that my moral or religious beliefs shouldn't be injected into your health care. However as a health care provider I have a right not to have to suffer your religious or moral beliefs either.
Say I tell a woman panicked at the thought that she's pregnant that she has the option to terminate the pregnancy. If she is morally/religiously offended by the fact that I make that statement, I don't have to listen to her lecture and proselytizing. (And yes that's happened to me.) I also don't have to listen to religiously inspired sexist, racist or homophobic remarks from patients. (Also happened to me.) I shouldn't be expected to have to pray with or for patients or make spirituality part of my practice of medicine.
So while I agree with you that the proposed rules are repugnant, I disagree with the idea that the rights of patients always trump the rights of providers. The relationship between providers and patients, both of whom are human beings and should expect to be treated respectfully and to have their basic human rights respected.
Nick - awww, come on now... the killfile? really? i knew you were a bit fragile, but are you really that insecure?
Danio and i guess Colin too- hmmm... not sure where to go with this one except that, the process of providing the patient with the information they need to make an informed consent is routinely refer to it as "consenting" a patient or "providing an informed consent". again, i understand the confusion for those who don't often deal with the subject or process. but lets not become distracted with these trivial "technical" issues.
as to your unfamiliarity with "gag rules" being relevant to the conversation, i use it in the context that similar conscience clause regs (church, weldon, etc.) are often alleged to have been used as gag rules by hospitals to prevent their doctors from offering all treatment options (aka - NOT GIVING THE PATIENT ENOUGH INFO TO MAKE AN INFORMED CONSENT) whether or not the doctor had a moral issue with the specific treatment option. might i refer you to the following guttmacher institute article that mentions the same...(http://www.guttmacher.org/pubs/tgr/01/1/gr010101.html) again, this is an often stated complaint/concern about these types of clauses as you can see from this article, but they are largely unfounded, at least as far as legal challenges are concerned.
you seem to want to split hairs on this but the bottom line is, these regs seek to provide health care providers with protection of their rights. the notion that patient autonomy somehow trumps physician conscience is ridiculous. certainly, patient autonomy often outweighs physician beneficience, but it has never been absolute, so why are we demanding it now? and is it even ethical to consider it absolute?
and to zy - why are health care providers not entitled to protection of their rights? and you do realize, these protections have been on the books for decades right?
hey, can any of you tell me how to edit a post here? thank you in advance...
Hit preview before you hit post to check for errors. After you hit post, you're screwed.
doh!
thanks kel...
in that case, in my post @#260 - "an informed consent is routinely refer to it as..." should have read "an informed consent is routinely referred to as..."
apologies for any confusion this typo may have caused.
JP @ 260 "you seem to want to split hairs on this but the bottom line is, these regs seek to provide health care providers with protection of their rights."
And if you read my post, you'll find that I said the regs were craptastic. However what I take issue with is the hyperbole in the other direction. I recently saw a drunk (underage), malignantly entitled college student vomit on a nurse. He could have easily turned his head the other way... but he didn't. His response to her question about why he barfed on her was "if you didn't want to be puked on, you shoulda been a plumber."
I agree fully that patients need to be fully informed of all reasonable options. But I disagree that the rights of patients universally trump the rights of providers. In every situation its a shade of gray... its just a matter of how gray the shade is.It is as wrong to take black and white thinking in one direction as it is in the other. This thread has shown way to much hyperbole in the other direction, so that was my comment. So sorry, but pointing out dogmatic views in one direction is not fragile. Its reasonable.
Though this example is actually a poor example. Take a flu pandemic and you have a much better theoretical argument.
NickG - hey, my bad. i think my response was for nickgotts, i didn't even see yours until after i posted. you seem like a very reasonable voice on this issue.
NickG, I think the rights you're talking about are more akin to basic human rights than those specifically related to the doctor-patient interaction. As a human being, you should certainly not have to stand for unsolicited lectures, abuse, etc. from anyone. As a physician (as your reply suggests you are), I'm guessing that part of your training has included strategies for keeping the primacy of patient's needs and wishes in mind when considering every and all medically valid options, regardless of whatever personal conflicts might arise during the course of treatment.
I don't understand the 'theoretical argument' that the flu pandemic scenario provides. I assume that you are referring to quarantine situations which, while they may be against patient wishes, are most certainly in the best interest of the patient and the community at large. This seems like a huge departure from a situation in which various treatment options are not presented by a caregiver owing to his or her moral judgement of said treatments.
I haven't had any caffeine yet today, so I may be missing the point. I'd welcome any clarification you'd care to offer.
jp,
- hmm, didn't think i was the one getting worked up, but whatever. i just enjoy the debate.
Me too, no problem [except when RL intervenes and keeps me from reading/replying to comments].
-please cite one legal opinion supporting this claim.
How about 13 opinions?
"The proposed regulation completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider's right to claim a personal moral or religious belief," the attorneys general said in a letter to the Department of Health and Human Services.
-layperson? don't think i ever posted my professional background, but okay, we'll go with your assumption. so what are your credentials and how do they enable you to be so discerning in these medico legal matters?
"Layperson" as in patient, not professional background. And, while you are correct that I don't know your background, based on your comments, there's one thing I do know. You are not an Ob/Gyn; I am.
- no, respect for personal rights is what's at the root of this. again, not sure how you can be in support of rights for some, but not for others... but that's an argument for another day.
According to several medical associations (emphasis mine):
"Implementation of this regulation would effectively allow health care providers' personal beliefs to override patients' right to full disclosure of accurate information and available health care resources...."
this issue has little to do with competence, or state imposed anything other than respect for the conscience of both the provider and the patient.
The current professional standard (emphasis mine):
"[D]octors and nurses are already not required to perform abortions or sterilizations. They can refuse to do so. But each health care professional is ethically bound to inform patients about all of their treatment options. If health care professionals cannot or will not provide a certain service, they are ethically obligated to refer patients in a timely manner to someone who can."
The [state] proposed regulation: Allow health care entities to practice in an incompetent manner (no informed consent, no referral, in violation of the standard of care).
too bad the california courts seem to agree with my point of view on this as well as a recent challenge to similar conscience clause was thrown out.
I'm not familiar with the case, but, as presented by you, it has nothing to do with what we're discussing. The ruling rejected a challenge to a federal law which protects hospitals and health care workers from being forced to perform abortions.
That's already the professional standard (you don't have to perform abx), and it's not what the proposed regulation is about.
i'm not a lawyer, but i'd say you're gonna be hard pressed to find any legitimate evidence that these conscience clauses have killed, let alone even harmed anyone, as so many here seem to be insisting.
so is the sky still falling chicken little???
Umm, pay close attention. The current patient protection, such as it is, against receiving substandard care because of conscience clauses is the professional requirement for informed consent and stand-by/referral. The proposed regulation is aimed at removing those protections.
As to your flippant attitude towards the morbidity and mortality of patients, that is your prerogative. Should you decide to be a bit more serious about this matter, it would be helpful if you did some research before venturing an opinion.
ema -
"How about 13 opinions?
"The proposed regulation completely obliterates the rights of patients to legal and medically necessary health care services in favor of a single-minded focus on protecting a health care provider's right to claim a personal moral or religious belief," the attorneys general said in a letter to the Department of Health and Human Services.""
-i'll concede those "13 opinions", but might i remind you that similar "opinions" have not held up in court. there is a difference between opinion and standing... and challenges to these conscience clauses don't seemed to have done well in court.
""Layperson" as in patient, not professional background. And, while you are correct that I don't know your background, based on your comments, there's one thing I do know. You are not an Ob/Gyn; I am."
-i absolutely LOVE the condescending tone of your posts. it makes me feel all tingly... "You are not an Ob/Gyn; I am." all together now... ooooooo, a real live ob/gyn? well, i'm sorry my background isn't nearly as illustrious, but i will say it is a professional background nonetheless.
"According to several medical associations (emphasis mine):
"Implementation of this regulation would effectively allow health care providers' personal beliefs to override patients' right to full disclosure of accurate information and available health care resources....""
- wow, all this from one article. impressive. "several medical association" huh? check out the latest PCOB. i'd say there's far from a consensus on these conscience clauses.
"The current professional standard (emphasis mine):
"[D]octors and nurses are already not required to perform abortions or sterilizations. They can refuse to do so. But each health care professional is ethically bound to inform patients about all of their treatment options. If health care professionals cannot or will not provide a certain service, they are ethically obligated to refer patients in a timely manner to someone who can.""
-no, they are not ethically obligated to refer. that's what these conscience clauses protect. they are obligated to transfer, to provide for informed consent. and "current professional standard"? from where? let me guess, the ACOG?
"The [state] proposed regulation: Allow health care entities to practice in an incompetent manner (no informed consent, no referral, in violation of the standard of care)."
-where did you get this from? this is a federal proposed reg right? whose opinion is this and what regulation is it referring to?
"I'm not familiar with the case, but, as presented by you, it has nothing to do with what we're discussing. The ruling rejected a challenge to a federal law which protects hospitals and health care workers from being forced to perform abortions."
- oooh, i see. if you're not familiar with it, it can't be relevant. riiight. and fyi, the case was a challenge to the weldon amendment (aka a federal conscience clause) if i'm not mistaken. seeing as how the proposed reg is a conscience clause, it would seem to be quite relevant.
"That's already the professional standard (you don't have to perform abx), and it's not what the proposed regulation is about."
-you know as well as i do that in spite of the fact there are already regs that would allow a physician to opt out of procedures like abortions, state and local govts as well as professional associations continue to try to subvert those regulations (see bloomberg's attempt in new york city). and that is what i believe to have prompted (necessitated?) the broader language in this proposed reg.
"Umm, pay close attention. The current patient protection, such as it is, against receiving substandard care because of conscience clauses is the professional requirement for informed consent and stand-by/referral. The proposed regulation is aimed at removing those protections."
-wrong. the notion that conscience clauses result in substandard care is bogus and you know it. i already know what your professional association's opinion is on this, but when actually legally challenged, the courts seem to agree. they have been found to have no impact on access or quality of care. so why you continue to purport this opinion as a fact is beyond me.
"As to your flippant attitude towards the morbidity and mortality of patients, that is your prerogative. Should you decide to be a bit more serious about this matter, it would be helpful if you did some research before venturing an opinion."
- my "flippant" attitude is in direct response to the various and ridiculous scenarios presented here proposed as the result of this regs passing. the notion that patients would be injured, mortally or otherwise, at the hands of "nutter" nurses and docs is just completely unfounded. that was my prerogative. and i certainly didn't see you calling anyone else out for their lack of seriousness on this issue. i'm sorry if i'm not sincere enough to engage someone of your stature in debate on this issue, but regardless, it's been interesting. we may have to agree to disagree here, but i feel my opinion has been validated in the courts while yours is upheld among various associations.
jp.
-i'll concede those "13 opinions", but might i remind you that similar "opinions" have not held up in court. there is a difference between opinion and standing... and challenges to these conscience clauses don't seemed to have done well in court.
There haven't been any similar opinions litigated yet, since the regs haven't been implemented yet. [The whole point of this discussion is that the proposed regs are unprecedented in scope.]
-i absolutely LOVE the condescending tone of your posts. it makes me feel all tingly... "You are not an Ob/Gyn; I am." all together now... ooooooo, a real live ob/gyn? well, i'm sorry my background isn't nearly as illustrious, but i will say it is a professional background nonetheless.
Heh, then clearly my job is done, seeing how I always strive, in my professional capacity, to make pts tingly. But seriously, now:
First, go thorough all my posts, save the last one, and point out where a) I mentioned anything whatsoever about what I do, and b) used an appeal to authority to make an argument.
Second, you are the one who asked so what are your credentials and how do they enable you to be so discerning in these medico legal matters? Hence, my mentioning of, you know, what I do in my last post. Answering a direct question with a statement of fact is not condescension; it's common courtesy.
- wow, all this from one article. impressive. "several medical association" huh? check out the latest PCOB. i'd say there's far from a consensus on these conscience clauses.
For the last time, this is not about conscience clauses. It's about proposed changes to existing conscience clauses. It is precisely because there is a professional consensus that these clauses do not take precedence over providing proper care to patients (duty to give informed consent and refer) that the regulations we are discussing have been proposed. To insure entities can provide substandard care to patients without consequences.
-no, they are not ethically obligated to refer. that's what these conscience clauses protect. they are obligated to transfer, to provide for informed consent. and "current professional standard"? from where? let me guess, the ACOG?
I don't quite understand your point here. Are you denying the existence of professional standards from the specialty organizations (ACOG, etc.)?
-where did you get this from? this is a federal proposed reg right? whose opinion is this and what regulation is it referring to?
From the text of the proposed regulation.
- oooh, i see. if you're not familiar with it, it can't be relevant. riiight. and fyi, the case was a challenge to the weldon amendment (aka a federal conscience clause) if i'm not mistaken. seeing as how the proposed reg is a conscience clause, it would seem to be quite relevant.
Reading comprehension, it does a discussion good.
What I said was that, based on the facts of the case [a case I noted I'm not familiar with to make it clear I have no knowledge of the source material, you know, how you do in a grown up discussion], as presented by you, this case has nothing to do with what we're discussing. An assessment you, yourself, confirm with this: the case was a challenge to the weldon amendment (aka a federal conscience clause).
The Weldon Amendment is an existing regulation; we were discussing proposed regs about significant changes. The issues involved are different.
-you know as well as i do that in spite of the fact there are already regs that would allow a physician to opt out of procedures like abortions, state and local govts as well as professional associations continue to try to subvert those regulations (see bloomberg's attempt in new york city). and that is what i believe to have prompted (necessitated?) the broader language in this proposed reg.
This is an important point--the reason/need for the proposed regs--and I'm glad you brought it up. The reason given by Secretary Leavitt is a flat out lie and he's been publicly called on it.
From the text of the regs, here is the justification given:
There appears to be an attitude toward the health care professions that health care professionals and institutions should be required to provide or assist in the provision of medicine or procedures to which they object, or else risk being subjected to discrimination. Reflecting this attitude, in some instances the standards of professional organizations have been used to define the exercise of conscience to be unprofessional, forcing health care professionals to choose between their capacity to practice in good standing and their right of conscience.1
Now, read this carefully:
The political and ideological nature of this regulation is apparent in the fact that the "problem" section of the regulation provides no evidence that it is necessary. Only a single example of any tangible problem is offered, a policy by which DHHS claims that the American Board of Obstetrics and Gynecology (ABOG) has forced "health care professionals to choose between their capacity to practice in good standing and their right conscience."1 Yet, this charge--initially made by Secretary Leavitt in a press release in March2--was immediately and forcefully rebutted by ABOG in a letter send to the Secretary days later.3 ABOG sent another letter to the Secretary in August--after the Secretary repeated this charge in the release announcing this proposed regulation--restating its assurance that the charge is baseless and requesting that the DHHS make public any evidence it might have at a formal hearing on the introduced legislation4. The only citation provided for this charge by the DHHS is DHHS' own press release from March.
-wrong. the notion that conscience clauses result in substandard care is bogus and you know it. i already know what your professional association's opinion is on this, but when actually legally challenged, the courts seem to agree. they have been found to have no impact on access or quality of care. so why you continue to purport this opinion as a fact is beyond me.
I say again, reading comprehension is your friend. What I said was the current professional standards protect patients from receiving substandard care because of the existing conscience clauses. The proposed regulation is aimed at removing those protections.
the notion that [as the result of this regs passing] patients would be injured, mortally or otherwise, at the hands of "nutter" nurses and docs is just completely unfounded.
On what do you base this assessment?
i'm sorry if i'm not sincere enough to engage someone of your stature in debate on this issue....
Who said you're not sincere? And, despite your insistence of bringing up irrelevant matters (?my stature), I'd say we had quite the engaging debate, no?
ema -
"There haven't been any similar opinions litigated yet, since the regs haven't been implemented yet. [The whole point of this discussion is that the proposed regs are unprecedented in scope.]"
-yes, i understand the broadened scope of this reg and the lack of legal case history. however, as it is in principle, an extension of the conscience clauses already on the books, i think those serve as adequate examples.
"Heh, then clearly my job is done, seeing how I always strive, in my professional capacity, to make pts tingly. But seriously, now:
First, go thorough all my posts, save the last one, and point out where a) I mentioned anything whatsoever about what I do, and b) used an appeal to authority to make an argument.
Second, you are the one who asked so what are your credentials and how do they enable you to be so discerning in these medico legal matters? Hence, my mentioning of, you know, what I do in my last post. Answering a direct question with a statement of fact is not condescension; it's common courtesy."
-hmm, guess it's all about tone. yes, after you insinuated that my opinion was that of a layperson, of course i asked about your background. a mere "i'm an ob/gyn" would have sufficed i suppose. again, just how i interpreted it. if it wasn't how it was intended, i'll accept that.
"For the last time, this is not about conscience clauses. It's about proposed changes to existing conscience clauses. It is precisely because there is a professional consensus that these clauses do not take precedence over providing proper care to patients (duty to give informed consent and refer) that the regulations we are discussing have been proposed. To insure entities can provide substandard care to patients without consequences."
-again, i disagree here. i referred you to the latest President's Commission on Bioethics meeting as evidence that, no there is not a professional consensus regarding these clauses.
"I don't quite understand your point here. Are you denying the existence of professional standards from the specialty organizations (ACOG, etc.)?"
-not at all, my reference to ACOG's professional standards was in light of them haveing been specifically mentioned as motivation for augmenting these clauses.
"From the text of the proposed regulation."
-again, where in the proposed reg does it say "The [state] proposed regulation: Allow health care entities to practice in an incompetent manner (no informed consent, no referral, in violation of the standard of care)"? i don't recall seeing this and frankly it doesn't make sense.
"Reading comprehension, it does a discussion good.
What I said was that, based on the facts of the case [a case I noted I'm not familiar with to make it clear I have no knowledge of the source material, you know, how you do in a grown up discussion], as presented by you, this case has nothing to do with what we're discussing. An assessment you, yourself, confirm with this: the case was a challenge to the weldon amendment (aka a federal conscience clause).
The Weldon Amendment is an existing regulation; we were discussing proposed regs about significant changes. The issues involved are different."
-again, as this reg is in fact an extension of the conscience clauses, i used the weldon amendment merely as an example, since it is the most recent of the conscience clauses to undergo legal challenge. i'm not sure why you insist that we are talking about apples and oranges here. yes, the scope is broadened, but again, this proposed reg is a conscience clause. why do you consider these as incomparable?
"This is an important point--the reason/need for the proposed regs--and I'm glad you brought it up. The reason given by Secretary Leavitt is a flat out lie and he's been publicly called on it."
-by whom? and to say it's a flat out lie, you're going to have to offer some evidence.
"Now, read this carefully:
The political and ideological nature of this regulation is apparent in the fact that the "problem" section of the regulation provides no evidence that it is necessary. Only a single example of any tangible problem is offered, a policy by which DHHS claims that the American Board of Obstetrics and Gynecology (ABOG) has forced "health care professionals to choose between their capacity to practice in good standing and their right conscience."1 Yet, this charge--initially made by Secretary Leavitt in a press release in March2--was immediately and forcefully rebutted by ABOG in a letter send to the Secretary days later.3 ABOG sent another letter to the Secretary in August--after the Secretary repeated this charge in the release announcing this proposed regulation--restating its assurance that the charge is baseless and requesting that the DHHS make public any evidence it might have at a formal hearing on the introduced legislation4. The only citation provided for this charge by the DHHS is DHHS' own press release from March."
- look this is obviously the opinion of the ABOG, and i'll have to research the claims. but from a credibility standpoint, i don't give this much weight. what would you expect them to say in response to the allegations? the issue with the ABOG/ACOG position was that they require referral be made and Sec. Leavitt did not take kindly to this direct attempt to subvert existing conscience clauses. and read carefully here "In a letter sent to ABOG Executive Director Dr. Norman Gant today asking for clarification, Secretary Leavitt notes, "It appears that the interaction of the [ABOG Bulletin for 2008 Maintenance of Certification] with the ACOG ethics report would force physicians to violate their conscience by referring patients for abortions or taking other objectionable actions, or risk losing their board certification." what evidence could the ABOG/ABOC possibly want? this is an ethical position issue, what should Sec. Leavitt have provided?
"I say again, reading comprehension is your friend. What I said was the current professional standards protect patients from receiving substandard care because of the existing conscience clauses. The proposed regulation is aimed at removing those protections."
-again, that is your opinion and i disagree. you state that conscience clauses equate to substandard care and i've given you court rulings that say they don't. i think the current professional standards of the ABOG seek to deprive doctors of their rights of conscience. the only "protection" this reg seems really aimed at is the referral for treatment. i don't believe it removes informed consent, or transfer of the patient.
"On what do you base this assessment?"
- please provide evidence (not speculation) to the contrary. all i can offer is that legal challenges to previous conscience clauses were rejected by the courts. and i know, you'll say this is a different animal altogether and no comparisons can be made.
"Who said you're not sincere? And, despite your insistence of bringing up irrelevant matters (?my stature), I'd say we had quite the engaging debate, no?"
- you did "Should you decide to be a bit more serious about this matter..." and my stature comment was in reference (okay,a lame one) to the condescending tone i thought i was reading.
and of course i agree with you that this has been an engaging debate and i have certainly enjoyed the repartee. i definitely lucked out. i don't think i could have found a person more relevant to the issue to debate with. by virtue of my field of practice, these particular regs don't nearly impact me as they do you. while we may disagree on some aspects, i certainly recognize and respect your standing in this argument.
Are you all saying that atheists have no morals? While you might not have heard about these guys: http://www.godlessprolifers.org/home.html it appears that everyone here has an opinion about absolute right and wrong.
Y'all should consider the definition of "elective" abortion.
Remember Kathleen Kennedy's lobotomy to cure whatever it was that her father hated? That was perfectly legal at the time.
Where do you stop? Will you force your family doc to perform legal assisted suicide, ER docs to report drug addicts and drunk drivers, the orthopod or urologist to torture prisoners and cardiologists and neurologists to assisting with the death penalty.
How would you like this new motto for your Family Physician who depends on insurance and government payers: Trust me, I'll act against my conscience!
Beverly B Nuckols, MD, MA (Bioethics),
You've got plenty of credentials, but apparently you still can't read. As far as I know, nobody is suggesting forcing doctors to perform elective abortions. What they are saying is that, as is the case now, doctors should be obliged to give patients full information about their available options, and refer them to one who will perform an elective abortion when that is legal and is what the patient wants. Simple, really, Beverly B Nuckols, MD, MA (Bioethics) - do you think you've grasped it now?
The credentials are for background. ("Trust me.")
ACOG's ethics statement "Opinion #385, Limits of Conscientious Refusal in Reproductive Medicine," http://www.acog.org/from_home/publications/ethics/co385.pdf spurred the revision of the regs. That opinion defined abortion as "standard reproductive care," and stated that doctors who do not perform elective abortions "deviate from standard practices." It further required that "Providers with moral or religious objection should either practice in proximity to individuals who do not share their view or ensure that referral processes are in place."
The American Board of Obstetrics and Gynecology requires those it Board Certifies to agree to the ethics statements of the ACOG.
ACOG went even further. After the publication of the Opinion, the President of ACOG wrote letters to members of Congress encouraging laws to force doctors who object to abortion to either change their practice so that they don't take care of women and girls of reproductive ages, or move close to a willing abortionist.
Beyond the Board Certification of OB/Gyns, the actions of ACOG/ABOG would have affected Family Physicians and even docs Boarded in General surgery and Internal Medicine, as these are often called on to provide care in rural and isolated areas of the country. I know of rural areas where FP's and General Surgeons are the only docs for hundreds of miles, take turns in the little local ER and hospital, and are the only "options" for prenatal care and women in labor.
I've suggested that it might be better for ACOG to identify those areas with no "willing provider," and encourage those who are "willing" to either move to or take turns visiting under-served areas, rather than limit the "options" for - or force unwilling actions upon - the docs who do live under such conditions and provide all other aspects of medical care.
Beverly Nuckols, MD, MA(Bioethics)
I most certainly don't trust you - the fact that you think a few letters after your name makes you trustworthy is pathetic. I see nothing objectionable in the ACOG guidelines: the rights of the patient should come first. If you don't like that, retrain as a plumber.
Beverly - well played. been posting similar info for the last few days and with the exception of Ema, few here seem interested in the facts surrounding this proposed reg. and you can ignore Nick Gotts. This guy has a serious complex, in addition to an obviously limited knowledge on the subject, I've found the when he is confronted with facts, he immediately resorts to childish name calling and threats of adding dissenters to his "killfile" (whatever the hell that is). don't waste your time on him.
good to see another knowledgeable poster on here though. will be interesting to see how, outside of Nick Gotts, your viewpoint is received.
Nick, as I said, it was background. For some, positive, for some negative, for others null.
As I asked, since we know that not all atheists agree with you ( http://www.godlessprolifers.org/home.html ), do they not have consciences?
I assume that you have a belief that some acts are right and that other acts are wrong. On what do you base your decision to debate the conscience issue if that's not so?
How about grandmothering my right to practice Family Medicine in my small town, where Family Docs are too few and where there are no abortionists in the entire County, since abortion has become standard of care after my "training."
How would you force a physician to pick up dilators and knives in order to perform an abortion?
That would not be necessary. The doctors would be forced to inform the patient of all their options, and not withhold any information, abortion included.
Beverly Nuckols, MD, MA (Bioethics),
Why would you expect all atheists to agree on moral issues? Lenin and Ayn Rand were both fervent atheists.
You keep prating on as if anyone was trying to force you to perform abortions. They are not. You now have a legal duty to tell your patients of all available options, and refer them to those willing to perform an abortion if they want one. Do you have a problem with that? Because if so, you've either been breaking the law, or going against your conscience. The proposed regulations would remove this duty. That is what is being objected to. If you can't stick to the point, there's no purpose to further discussion.
Actually, I don't have any such duty to inform patients of "all available options." For instance, I'm not likely to mention the option of an elective C-section, a water birth or some of the other unusual birthing practices that I consider unhealthy. If they come to me for advice, it is my duty to explain how and why these practices are unhealthy, but I don't have to help them look for willing providers.
However, ACOG would like to insist that I do abortions or "either practice in proximity to individuals who do not share their view or ensure that referral processes are in place."
There's no one for 30 or so miles who performs abortions and I don't have any such referral processes - no problem, since abortion is not actually "standard reproductive care" and is "elective." I have many local reliable referrals for prenatal care and delivery. None of them consider abortion "standard reproductive care" and some are members of the American Association of Pro-life Obstetricians and Gynecologists, a subset of ACOG.
It would make more sense for the "willing providers" to move around, advertise in the phone book, and make all sorts of fusses in the media than to try to force the rest of us to speak and act in favor of or make partnerships with people who electively and intentionally kill human embryos and fetuses.
Nick, from reading all of the comments on those of us who oppose abortion, it appears that the Pharyngulites all believe morals and conscience are a function of religion, specifically Christianity.
(I've always wanted to watch the conversation between Ayn Rand and Robert Heinlein, both atheist libertarians. I don't think they ever met, and they might have gotten along, but for some reason, I imagine they wouldn't.)
Nonsense.
I imagine they wouldn't
well that's what happens when you let your imagination run away with you.
come back when you aren't high.
no problem, since abortion is not actually "standard reproductive care" and is "elective."
see?
you're high as a kite.
They'd have an affair, then Heinlein would get sick of her and go after a younger women so Rand would call him irrational and expel him from her cult.
act in favor of or make partnerships with people who electively and intentionally kill human embryos and fetuses don't wish to impose their own views on women, and put actual people before potential ones. - Beverly Nuckols MD, MA (Bioethics)
Fixed.
In addition, Beverly Nuckols MD, MA(Bioethics), it is almost always safer to have an abortion than continue the pregnancy, so your comparisons are otiose.
There is no evidence to prove that an abortion is healthier for the mother than pregnancy and delivery and the relative safety is questionable -- and debatable. (Don't rely on old numbers and question any conclusions from WHO http://www.thelancet.com/journals/lancet/article/PIIS014067360760676X/f… )
In the US, abortion stats are not complete, as they are compiled from voluntary reporting, and do not include all States.
In contrast, the maternal mortality rate is the number of deaths within one year of a pregnancy per live births. These numbers will be skewed because they include deaths for one year following pregnancy (as opposed to 30 to 45 days for post-abortive women). Also included will be miscarriages, still births, ectopic pregnancies and all the risky pregnancies, as well as bad outcomes from abortions. Prior to 2003, these numbers are unreliable, since that is the first year that the uniform death certificate included a question about pregnancy in the prior year.
There are no controlled prospective trials, rare attempts at retrospective reviews.
There is very real evidence that from 15 weeks on, it is statistically safer for the mother to continue the pregnancy and delivery than to undergo an interventional abortion.
You've probably heard about the high association between abortion, violent death (Gisler, American Journal of Obstetrics and Gynecology (2004) 190, 422e7) and depression (Fergusson, 2006, Journal of Child Psychology and Psychiatry, 47, 16-24). There are also, other associations, including the STD rate (Klick,http://jleo.oxfordjournals.org/cgi/content/abstract/ewm041v1 )and premature birth rate (Thorpe, Obstetrical & Gynecological Survey 2003; 58(1):67-79).
Of course, you are dismissing the death of the embryo or fetus in your equations as without value, the core of this discussion.
Nick Gotts -
"act in favor of or make partnerships with people who don't wish to impose their own views on women, and put actual people before potential ones."
and yet you're willing to impose your views upon the doctors... anyone else here find this even a mildly hypocritical viewpoint? since when did choice become a one way street?
Not really. The earlier the abortion, the fewer the potential complications, and the safer the end result.
Your statement "pregnancy and delivery" carries the hidden assumption of an absolutely unexceptional and uncomplicated pregnancy. Given that not all pregnancies are without complications, this begs the question.
Why should those be excluded?
Really, your argument is exceedingly dishonest. The statistics are "skewed" precisely because they record what they are supposed to?
The differing number of time periods does seem a bit odd, although, even without knowing the details, it does occur to me that they are meant to take into account post-partum depression, which would obviously not be applicable after an early abortion.
For an early abortion, the embryo is still a clump of cells.
For a later abortion, it is a more complex issue, which is examined in detail in this essay:
http://www.2think.org/abortion.shtml
Just think, 1/3rd of babies are miscarried anyway. If God is the one who does this, then God commits more abortion than the entire human race combined. The greatest abortionist is GOD!
What kind of state would the country be in if every profession had the "option" to do their job based on what they believe or feel like doing that day? Imagine if police officers, fire fighters, 911 dispatchers, and other professons of public service decided to take on only cases or people they personally believed 'needed' help. It would be as if every profession clicked their heels and magically became a politician.
question any conclusions from WHO - Beverly Nuckols MD, MA (Bioethics)
I think you missed off the end of your sentence, which should have been "because they don't support my conclusions".
You've probably heard about the high association between abortion, violent death (Gisler, American Journal of Obstetrics and Gynecology (2004) 190, 422e7) and depression (Fergusson, 2006, Journal of Child Psychology and Psychiatry, 47, 16-24). There are also, other associations, including the STD rate (Klick,http://jleo.oxfordjournals.org/cgi/content/abstract/ewm041v1 )and premature birth rate (Thorpe, Obstetrical & Gynecological Survey 2003; 58(1):67-79).
Any evidence that these associations are causal? My guess is not, or you'd have said so.
Of course, you are dismissing the death of the embryo or fetus in your equations as without value, the core of this discussion.
I am saying an actual person's rights and interests should take precedence over the hypothetical rights and interests of a potential person. I understand you don't share this view. Fine - but you have no right to impose that view on your patients. It's the sheer arrogance of your belief that you do that really gets my goat.
Remember the difference between negative and positive rights. There are very few, very limited positive rights recognized under law.
The risk that your doctor will follow the law in spite of his or her conscience should worry everyone. The assumption that all doctors who will not follow the ACOG ethics statement should cease practicing and/or lose their licenses would wipe out fully half of Family Physicians, and probably near that number of OB/Gyns, Pediatricians, Internal Medicine docs and General Surgeons. A far larger percentage of those in under served rural areas would be affected, since these are likely to be more conservative and religious.
Again, these are *elective* abortions. No one is obliged to refer for elective procedures.