The Ethics of Refusal: Well, Should They?
From the New York Times, November 17, 2008: "WASHINGTON — A last-minute Bush administration plan to grant sweeping new protections to health care providers who oppose abortion and other procedures on religious or moral grounds has provoked a torrent of objections, including a strenuous protest from the government agency that enforces job discrimination laws.
The proposed rule would prohibit recipients of federal money from discriminating against doctors, nurses and other health care workers who refuse to perform or to assist in the performance of abortions or sterilization procedures because of their “religious beliefs or moral convictions.”
In addition, "It would also prevent hospitals, clinics, doctors’ offices and drugstores from requiring employees with religious or moral objections to 'assist in the performance of any part of a health service program or research activity' financed by the Department of Health and Human Services."
This rule has stimulated much bioethical discussion. Steve Miles, physician ethicist who has contributed frequently to my blog answers the following questions with his own questions:
Should physicians and other medical professionals be required to perform
procedures they view as morally problematic or prohibited?
Should physicians and other medical professionals be protected from employer
dismissal, sanction, or other disciplinary action if they refuse to perform
procedures they view as morally problematic or prohibited?
Doctor Miles wrote:
"And I add five more (and in the way of not privileging the conscience of
medicine):
Should Islamic cab drivers be forced to take someone from an airport if the
fare is carrying alcohol purchased in Barbados.
Should a Seventh Day Adventist be allowed to work in a lab facility and
selectively refuse to type blood for transfusions?
Should a Hassidic Jew be allowed to be a grocery cashier and selectively
refuse to handle, scan and ring up sales of pork chops?
Should a Mormon be allowed to wait tables in a restaurant and refuse to
carry hot coffee to patrons or bus coffee cups from tables?
Should a Baptist Creationist be compelled to teach Darwin?"
Does any visitor here want to answer the first two questions or any of Steve's questions? ..Maurice.
ADDENDUM; 11-21-2008 Steven Miles would like to add two more questions to his list of five posted above. Here they are:
Should an anti abortion banker be allowed to refuse to process payroll checks from a Planned Parenthood clinic?
Should a Quaker family be allowed to refuse to pay the portion of their taxes that go for war?!
posted by Maurice Bernstein, M.D. @ 9:51:00 PM
4 comments
4 Comments:
The comebacks by Dr. Miles are strawman arguments and not what the proposed law is saying. He is exampling private businesses. The proposed legislation is about the GOVERNMENT mandating medical procedures, tests or medicating that the physician or healthcare provider may not feel are ethical, moral or in the best interests of his patient. For medical professionals who understand what is being planned with nationalized healthcare, who want to preserve the patient-doctor relationship and autonomy of patients over their own bodies, and those who understand history, this law is more important than uninformed consumers may realize.
How about another example:
Should a doctor be required by the State to euthanize a disabled person who is seen as too costly to the State, under threat of losing his job, license, livelihood, and home?
Sandy
As a Mormon, I have to tell you, we wouldn't bat an eye at serving coffee. To hold the world to our dietary standards is ridiculous. To hold the world to our standards of life and death is something altogether different.
The first comment has a valid point. Doctors abhor the idea of being compelled to offer futile care, why is being compelled to participate in something your conscience tells you is murder any different?
That said, as long as there is someone else to refer patients too, I don't see the problem.
If there is a proviso in the law that the doctor must refer the patient to a colleague who is willing to offer the treatment, then patient autonomy is safeguarded.
How willingly that would be followed by dissenting doctors is another issue.
I’m confused; does a Hasidic grocery clerk have a professional fiduciary relationship with a pork buyer? I hope Dr. Miles can clear this up for me.
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