Wednesday, April 1, 2009

A word from my soapbox

A note from Kat: I'm making a rare venture into politics today. Coming from a family of health-care providers, it's a topic I feel pretty strongly about. I promise I won't make this a habit.


To her dismay, Patient X discovers she's pregnant.

Patient X decides she's not ready to be tied down and asks her doctor to either abort the pregnancy or refer her to a clinic that will.

On one hand, Dr. Y has an obligation to treat her patient.

On the other hand, Dr. Y is a Christian. To take part in the termination of any pregnancy -- even indirectly through referral -- violates her ethical code.

What's a health care professional to do?

Well, since the enactment of Roe v. Wade in the mid-1970s, a national conscience clause law has protected doctors from performing abortion and sterilization procedures. The Church Amendment exempted private hospitals receiving federal funds from any requirement to provide abortions or sterilizations when they objected on the basis of religious beliefs or moral convictions.

Some subsequent conscience clauses protect pharmacists, physicians and other health care providers from discrimination and disciplinary action for not providing certain medical services that violate their conscience or ethics.

Just before George W. Bush left office, he proposed the Provider Refusal Rule that was enacted on Jan. 20 -- the day Barack Obama took office. The rule expanded the "conscience clause."

Under the rule, all workers in health-care settings (from doctors to techs) can refuse to provide services, information or advice to patients on subjects such as contraception, family planning, blood transfusions and vaccine counseling -- if the service goes against the provider's ethics. The rule cuts off federal funding for thousands of state and local governments, hospitals, health plans, clinics and other entities if they do not accommodate doctors, nurses, pharmacists or other employees who refuse to participate in care they feel violates their personal, moral or religious beliefs.

Rep. Diana DeGette (D-Colo.) said she believed the rule was so broad even cashiers at Walgreens could refuse to provide medication for someone if the cashier had a religious objection.

Last month, the Obama administration began its move to overturn the policy. (The 30-day public comment period on the measure ends this week.)

Opponents of Bush's Provider Refusal Rule say the regulation is so broad that it could allow workers to decline to participate in many other types of sensitive medical procedures -- from blood transfusions to end-of-life care. In certain areas of the country where medical providers are scarce, those refusals could put patients at risk.

Officials with the Obama administration have stressed that the president remains committed to protecting the rights of health-care workers who do not want to participate in abortions.

Tony Perkins, president of the Family Research Council, said to CNN: "Protecting the right of all health-care providers to make professional judgments based on moral convictions and ethical standards is foundational to federal law and is necessary to ensure that access to health care is not diminished, which will occur if health-care workers are forced out of their jobs because of ethical stances."

Now, no one is saying the conscience clause isn't important. Heck, if the government stripped the conscience clause altogether the health care system would collapse.

Catholic hospitals would cease operations if health-care providers were required to perform abortions. (That's 12.5 percent of all community hospitals nationwide and accounts for 15.5 percent of all hospital admissions.) You could just about imagine that other faith-based hospitals would follow suit.

But I'm not talking about stripping the conscience clause altogether. I'm talking about Obama rescinding Bush's Provider Refusal Rule.

I understand where Perkins is coming from. I don't think any health-care worker should be forced to make a professional judgment that goes against their moral convictions and personal code of ethics.

What do you think?

Should health-care workers be required to provide services/products that go against their personal code of ethics? Should a nurse be required to administer morning after emergency contraception treatment? Or do all health-care providers have a duty to treat their patients regardless of moral objections?


Crimogenic said...

That's a very sticky topic, Kat. I would assume that for every doctor that won't do conceptions and such, there is a doctor who doesn't share that same view. But I dunno... it's just not something I ever had to think about.

Anonymous said...

Yikes. This one is tough. I was a counselor in an treatment center, secular, and I wasn't allowed to bring up Christ at all unless the client did......
But I was a Christian.....I know there's someone out there who can heal an addiction, yet I couldn't talk about it.

It's a touchy topic, Kat.

I think I would want the law to read that I could talk about Christ with someone who is considering abortion. You know? For instance, if someone wants an abortion, they are going to find out where and how regardless.

So....if I'm a Christian, whether it's a doctor or whatever, I'd rather them ask ME about it, because then I can talk with them about all their options.....

I know, I danced around your question, didn't I?

Politics scare me, girl. **smile**

Rosslyn Elliott said...

Very interesting. The inclusion of the vaccination counseling probably has to do with the newish vaccine against that STD that predisposes women to cancer - I forget what it's called. HpV?

Anyway, I'm not sure how I feel about it, on the whole. I don't like laws that are too broad. For example, if you are a Catholic healthcare provider, can't you go work in a Catholic hospital in order to avoid some of these problems?

On the other hand, the threat is to "cut off federal funding." What exactly does that mean? I've always objected to people squalling about losing their government money because they don't want to comply with rules. If you care about it that much, I want to tell them, do without the federal money! Then again, if it means no patients with Medicare or Medicaid can go to a hospital, that does present significant problems.

Kat Harris said...

Crimo -- Like I said, the only reason I care so much about it is because almost everyone in my family is in the medical profession in some way or another.

Lynn -- Counseling is certainly a horse of a different color in this situation. Yikes. I'm not sure I'd want to tackle that topic.

Rosslyn -- By federal funding, they mean Medicare/Medicaid reimbursements (among other things). In my hometown, we have a faith-based regional healthcare center. (It was actually a merger between a Lutheran hospital and Catholic hospital to form a giant non-denominational, faith-based regional medical center.)
The last procedure you would ever see taking place there is abortion. I truly believe that if it came down to either having to do abortions or closing because of a loss of federal monies, the hospital would close.

I don't know. I agree that Bush's addition to the bill seems a little far-reaching. I worked in a pharmacy for two years, and ethics never crossed my mind whenever I rang up birth control pills. But I still think people should never be discriminated against or disciplined for following their conscience.

Do we need a law to state that? I don't know.

gzusfreek said...

Wow. It is all pretty overwhelming. But there is one part puts me on edge. Should a nurse be required to administer morning after emergence contraception treatment? I was a nurse for many years and I would not have done it.
I think the thing that scares me is all the things tied up into one Federal money, code of ethics, abortion and it makes one so confused they don't know where to fight.
Good post, Kat. I learned a lot. Thank you, thank you.