Posted on 06/16/2005 9:01:37 AM PDT by hocndoc
The Celestial Fire of Conscience — Refusing to Deliver Medical Care R. Alta Charo, J.D.
Apparently heeding George Washington's call to "labor to keep alive in your breast that little spark of celestial fire called conscience," physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
Largely as artifacts of the abortion wars, at least 45 states have "conscience clauses" on their books — laws that balance a physician's conscientious objection to performing an abortion with the profession's obligation to afford all patients nondiscriminatory access to services. In most cases, the provision of a referral satisfies one's professional obligations. But in recent years, with the abortion debate increasingly at the center of wider discussions about euthanasia, assisted suicide, reproductive technology, and embryonic stem-cell research, nurses and pharmacists have begun demanding not only the same right of refusal, but also — because even a referral, in their view, makes one complicit in the objectionable act — a much broader freedom to avoid facilitating a patient's choices.
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(cont'd) At the heart of this growing trend are several intersecting forces. One is the emerging norm of patient autonomy, which has contributed to the erosion of the professional stature of medicine. Insofar as they are reduced to mere purveyors of medical technology, doctors no longer have extraordinary privileges, and so their notions of extraordinary duty — house calls, midnight duties, and charity care — deteriorate as well. In addition, an emphasis on mutual responsibilities has been gradually supplanted by an emphasis on individual rights. With autonomy and rights as the preeminent social values comes a devaluing of relationships and a diminution of the difference between our personal lives and our professional duties.
Finally, there is the awesome scale and scope of the abortion wars. In the absence of legislative options for outright prohibition, abortion opponents search for proxy wars, using debates on research involving human embryos, the donation of organs from anencephalic neonates, and the right of persons in a persistent vegetative state to die as opportunities to rehearse arguments on the value of biologic but nonsentient human existence. Conscience clauses represent but another battle in these so-called culture wars.
Most profoundly, however, the surge in legislative activity surrounding conscience clauses represents the latest struggle with regard to religion in America. Should the public square be a place for the unfettered expression of religious beliefs, even when such expression creates an oppressive atmosphere for minority groups? Or should it be a place for religious expression only if and when that does not in any way impinge on minority beliefs and practices? This debate has been played out with respect to blue laws, school prayer, Christmas crèche scenes, and workplace dress codes.
Until recently, it was accepted that the public square in this country would be dominated by Christianity. This long-standing religious presence has made atheists, agnostics, and members of minority religions view themselves as oppressed, but recent efforts to purge the public square of religion have left conservative Christians also feeling subjugated and suppressed. In this culture war, both sides claim the mantle of victimhood — which is why health care professionals can claim the right of conscience as necessary to the nondiscriminatory practice of their religion, even as frustrated patients view conscience clauses as legalizing discrimination against them when they practice their own religion.
For health care professionals, the question becomes: What does it mean to be a professional in the United States? Does professionalism include the rather old-fashioned notion of putting others before oneself? Should professionals avoid exploiting their positions to pursue an agenda separate from that of their profession? And perhaps most crucial, to what extent do professionals have a collective duty to ensure that their profession provides nondiscriminatory access to all professional services?
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(cont'd) Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth. But the assumption that one's own conscience is the conscience of the world is fraught with dangers. As C.S. Lewis wrote, "Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience."
Professor Charo teaches law and bioethics at the University of Wisconsin Law and Medical Schools, Madison.
An interview with Professor Charo can be heard at www.nejm.org.
N.Y. hospitals to deny choice on abortion training
At least the left is honest enough to let us know their real intentions.
FReepmail me if you want on or off my health and science ping list.
physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
This raises the question of what medical care may be refused under the cover of concience. Abortion seems the main one discussed; perhaps birth control pills; maybe blood transfusions. Could a doctor refuse to prescribe a particular drug because she considers the drug company to be sleazy? How about denying care to illegal aliens, smokers, drunks, drug addicts, soccer fans? (That's a bit different, one isn't denying care under because the care is problematical but because the patient is.)
Actually, I do know a Pulmonologist who will not care for people who continue to smoke.
However, matters of conscience are not that complicated: the first priority is to do no harm, while the second is to do good. *Elective* abortion is not done to save life, while abortion to save the life of the mother (rare as they are) and blood transfusions are.
Even in the case of ectopic or tubal pregnancies - when treatment is an emergency and not elective - the doctrine of double effect has long led physicians to remove the entire fallopian tube. The child dies as a result of this action, but his death is not intended. Newer techniques intended to preserve the mother's fertility (opening the tube and removing only the child or administering drugs to kill the child in place) turn out to be more dangerous for the mother and more likely to result in later, repeat tubal pregnancies or infertility.
And, of course, Charo begs the question as to whether or not "emergency contraception" is "emergency," "contraception," or, whether in fact, it causes an abortion.
I believe that when you compel healthcare providers, especially physicians who took some version of the Hippocratic Oath, from which the clause, "First, do no harm", has been distilled from the Latin, "Primum non nocere", to act against their conscience is the essence of tyranny.
Compelling actions by healthcare providers which is against their conscience is different from discriminating which patient is worthy of treatment.
I remember reading a story in the British Medical Journal about a smoker who needed coronary artery bypass surgery whose surgery was delayed because the patient still smoked. After the patient managed to quit, the patient died shortly before the scheduled surgery.
Personally, I believe in free will, and that we are all sinners.
Please FreepMail me if you want on or off my Pro-Life Ping List.
It would have been great if Nazi Germany had doctors with consciences.
"Personally, I believe in free will, and that we are all sinners."
And so does Alta Charo, or she wouldn't constantly be trying to change things. She just doesn't recognize her own bias - or the natural source.
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