Medical Choices  

Friday, February 22, 2008

So this article is in response to two posts I've read recently: MO - we gots teh sigh-ense! and Is There a Catholic Doctor in the House?.

The first article deals with the Missouri bill that will give pharmacies immunity from liability for refusal to perform, assist, recommend, refer to, or participate in any act or service in connection with any drug or device that causes an abortion. Except they define Plan B drugs as a drug that causes an abortion, which is clearly not the case. (If you don't want to follow the link then I'll give you a little spoiler. In brief, Plan B only suppresses the women's ability to produce an egg or not produce an egg. It doesn't interfere with pregnancy. So it's more like super birth control than abortion.)

The second article deals with doctors that refuse to prescribe any kind of birth control under the made the claim that birth control is bad for women and also doesn't fit in with their religious belief. So they're no longer going to offer women contraceptive options under any circumstance.

The question The Exterminator raised is what is the ethical responsibility that a doctor owes to his or her patient. I'm going to expand that to apply to a pharmacist as well, though I'm not sure they're quite the same, they're similar enough to discuss together.

The way I see it, one can view a doctor’s responsibility in five ways:

1. A doctor has a responsibility to do what a consensus of well-informed medical professionals, based on the best scientific data, would think is right for the patient.

2. A doctor has a responsibility to do what he believes is right, regardless of the patient.

3. A doctor has a responsibility to give his patient the best advice he can. But then he should follow his patient’s wishes, whatever they are, as long as they’re not illegal.

4. A doctor has a responsiblity to think of the greater good, even if it means acting against a particular patient’s best interests.

5. A doctor has no more responsibility than any other person who performs a service. He ought to be able to pick and choose the specific jobs he does.

Within that framework, or outside that framework if you care to expound, do you think a doctor or pharmacist should work?

Here's my take on the matter. I want the doctor to be able to refuse a service that he or she feels is harmful to the patient. In the case of circumcision, which is an accepted practice on men in the West, but not on women, should the doctor be able to refuse to perform the operation? What about risky procedures that might put the doctor in great liability?

Regardless of how the doctor or pharmacist comes to the decision, I don't think they should be required to do something they're against. Of course part of the sticky situation comes in with insurance. What if the doctor or pharmacy is the only one available to a patient under insurance? Why should the doctor or pharmacy or insurance company be the ones to decide the care of the patient without another opinion or option?

If I was faced with either situation, I would no longer give my patronage to the doctor or pharmacy. I believe, at least where I live and with the insurance I have, I do have that choice. So wouldn't have that big of an impact on me that either would refuse the service. I personally find it backwards, but it's only going to be a minor convenience as long as I can go to another doctor or pharmacist that will offer to treat me.

Chaplain brought up emergency situations, and I think in that case Philly is right. If someone refuses to treat me based on religious grounds because I'm a woman or an apostate or some other reason, then that person should not be allowed to work in the emergency room. In a life and death matter, there is no room for debate. Someone's personal beliefs do not trump someone's life.

So for me, probably a combination of #1, 3, and 5. As long as the doctor or pharmacist doesn't impinge on my choice or the choice of others, then I don't care. As long as the doctor or pharmacist is clear in what services they will offer and what services they won't then I can make a choice to not give them my patronage. When my choice is taken away, that's where it becomes an issue.

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9 comments: to “ Medical Choices

  • Vistaluna
    Friday, February 22, 2008 at 2:08:00 PM CST  

    Wow OG, this is about as messy of an issue as there can possibly be in modern society.

    I can imagine a doctor who's religion is "Christian Science", and they refuse all treatment except praying. You sit up on the table and he just prays with you. Surely that doctor would lose customers once they found out. :)

    The problem is that most of us have health plans where all you get is a list of doctors to pick at random. There's no list (I know of) that gives the doctor's personal philosophy on medicine. It's almost never as clear-cut as the example I gave above.

    I had surgery some many years ago where one doctor refused to be any part of it because of the risks, but another doctor let it be my decision. That's not even a religious difference but rather a risk-taking difference.

    Not only is there a difference from doctor to doctor, but even from patient to patient. If a doctor is faced with a patient who is a bit scatter-brained or afraid or confused (as often happens with the elderly), then that doctor will probably be more forceful in making decision for the patient. But if the patient is smart and insightful and showing clear judgement, then the doctor might be willing to do what the patient wants.

    Next you throw in malpractice suits and overused prescription drugs and escalating costs across the board....and medicine is just a MESS. :)

    Now...take all of the above...and add a cup of religion...and the mixture explodes.

  • PhillyChief
    Friday, February 22, 2008 at 3:54:00 PM CST  

    I think a responsible insurance company might pass on such doctors and pharmacists, further alienating such religiously conscience docs. The thing that gets ignored lately in this country is yes, we all have the right to make such choices as some of these doctors are making but those choices come with repercussions. Yes, there's a price for your choice. You may become ineligible for certain jobs and might not get picked up by insurance companies.

    I know, this whole responsibility and consequences for your actions thing seems foreign, especially to you damn millenials.

  • The Exterminator
    Friday, February 22, 2008 at 4:19:00 PM CST  

    Philly refers to a responsible insurance company.

    Hey, Philly, correct me if I'm wrong, but I thought you didn't believe in any supernatural entities.

  • the chaplain
    Friday, February 22, 2008 at 5:10:00 PM CST  

    Philly said: The thing that gets ignored lately in this country is yes, we all have the right to make such choices as some of these doctors are making but those choices come with repercussions. Yes, there's a price for your choice.

    I don't have anything witty or brilliant to add, I just like what he said.

  • Ordinary Girl
    Friday, February 22, 2008 at 5:54:00 PM CST  

    I know, this whole responsibility and consequences for your actions thing seems foreign, especially to you damn millenials.

    Are you talking to yourself there, Philly? I'm guessing I'm older than you (or you're not older by much). Besides, I grew up sheltered in a closet so I never learned much about self-esteem.

  • Venjanz
    Friday, February 22, 2008 at 7:29:00 PM CST  

    I agree with the OG and most of the comments here- this is a free-market issue, and our economy abhors a vacuum even more than nature. There will always be an enterprising person to provide the service, even in rural areas.

    I can't seem to recall a recent case in the US were somebody died or was permanently injured because they were denied treatment by a doctor for religious reasons, but there is a growing problem in the UK where doctors and nurses are refusing to treat patients (or doing so improperly) for *ahem* religious reasons.

  • PhillyChief
    Friday, February 22, 2008 at 10:40:00 PM CST  

    I'm talking to the damn millenials, whoever they may be who are reading along. Millenial or not, I don't think you, OG, need a lesson on that stuff.

  • Infidel753
    Saturday, February 23, 2008 at 7:22:00 AM CST  

    Oh, please. This is a raw primate assertion of power and dominance, plain and simple. These laws are designed to empower religious nuts who want to use their positions of authority (as medical professionals) to impose their religious taboos on their patients. They need to be smacked down, and hard.

    What's the moral position of someone who joins the army, and then, on the eve of his first battle, reveals that he's a pacifist and will not fight? What's the moral position of someone who gets a job at a bank and then refuses to do certain parts of the job because they involve collecting interest and he considers that to be sinful?

    If you're not willing to perform the full range of duties of the job, don't apply for the job. If you're not willing to dispense Plan B, don't get a job in a pharmacy. If you're not willing to refer a patient for an abortion, don't get a medical job where that possibility might arise.

    It's interesting that the only time this kind of hand-wringing over religious fanatics' precious right to bully and abuse people arises is when women are the victims. If a doctor were, say, refusing to treat black people or Jews because he sincerely believed them (even on religious grounds) to be an inferior or evil race, he would rightly be condemned out of hand and there would be no such agonizing over possible justifications for his position.

    If we as a society ever do establish the principle that doctors can refuse women certain treatments based on their personal religious taboos, though, it will serve us right when the first racist brings a court case demanding the same kind of privilege.

  • PhillyChief
    Saturday, February 23, 2008 at 9:22:00 AM CST  

    I think it helps certainly to make parallels. Think of it logically. Let's draw it out...

    (Job Requirements) - (Religious Belief) = Ok

    Now what's really at question here is whether this is a valid formula. Now these yahoos are banking not necessarily on accepting the formula but on sympathy for their religious belief. This also goes to what I said about their being consequences for your actions. That's seeing the big picture, the formula if you will, and the religious never do. I mean, take their biblical arguments. They cook up something to fit in one place then they cook up something else to fit in another place and never care if the two jive.

    Anyway, if the formula is true, then you should be able to pop in ANY religious belief and the formula would hold. As Infidel753 pointed out, it doesn't hold. As Chaplain said before, what if a muslim wouldn't treat her because his belief would be she's unclean? I think the angle to take here is pile on the examples of where the formula fails, and if the formula keeps failing, then the formula has to be scrapped. No exceptions.


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