'Sup. Long time no see.
It certainly was not my intent when I started this blog to leave it untouched for six months. Life got busy, I guess, and arguing the hypothetical and theoretical took backseat to accomplishing/surviving the concrete and tangible. In other words, student teaching was hard work. And in truth, I have a couple of draft posts that I started in the interim that never got to a point of publishing. This post is not one of them. I do hope to get back to those posts soonerish, but this is something else.
I read an article on Reuters here, and it has me simmering. The topic, if you don't want to read it, is the right of health care providers, or their employees, to cherry-pick the services and procedures they will or will not provide or even talk about based on whether those procedures align with their religious beliefs. There's a pharmacy in Washington state that is resisting a state mandate requiring pharmacies to stock all time-sensitive medications in demand in their community. Why? Because they don't want to stock emergency contraception. Other examples given include ambulance drivers who refuse to take patients to abortion clinics, infertility specialists who refuse to conduct in vitro fertilization on a lesbian, and a group of nurses in New Jersey who refused to provide ANY health care - even checking blood pressure - to women who are in the hospital for pre- or post-op care for abortions. And then there are the doctors who refuse to conduct certain treatments, OR to provide referrals to other doctors who will.
The article also provides an overview of the current legal treatment of this right of conscience, which is fairly mixed. The infertility specialists were smacked down for discrimination, the New Jersey nurses settled with their hospital and do not have to deal with morally objectionable patients unless it's an emergency, and certain states have rules allowing everyone from the doctor to the operating room janitor opt out of working on, around or in connection to healthcare procedures they are not comfortable with.
You know what? Just read the article.
So how do I feel about this? Well, let me put it like this. If I were to go to an interview for a teaching position (of which I will hopefully have some soon, fingers crossed) and inform the administrators that I would be happy to accept their job offer, but only if I didn't have to teach students whose parents are divorced, because I don't agree with divorce, do you think I will get the job?
I sure hope not.
In short, I have no sympathy with these people and think that they should do their jobs or lose them. Freedom of religion is a wonderful thing, but when one's religious beliefs dictate that you cannot fulfill the basic responsibilities of your job, then you are not qualified for that job and need to find another career.
Since this is being framed as a question of the employees' freedom of conscience, let's look at another career choice that people frequently take moral stands against: the military. The right of conscientious objectors to refuse military service has been kinda-sorta recognized by the United Nations and is legally protected in America. Persons having strong and sincere moral objections to warfare and military service - not just a specific war - are exempt from service, even if drafted, and persons with specific objections to violence and bearing arms are permitted to serve on condition of being assigned non-combat roles. A couple have even won Medals of Honor.
When comparing this to the case of healthcare conscientious objectors, I think the key point is that COs cannot bow out of military service just because they oppose a specific war or conflict; it has to be all or nothing. Despite my very strong objections to the Iraq conflict, I would not have claimed CO status, because I agree in general principals with the war in Afghanistan (although I think it's time for it to be ended ... yeah, some other time). And, while other COs can agree to serve in non-combat roles, once they're in, the have to fulfill the responsibilities of their rank and duties, just like every other soldier. There is no pick-and-choose; if you can't do part of the job, you don't take the job.
Earlier, I mentioned a hypothetical conscientious objector teacher. Let's look at that a little more closely. For those of you who aren't aware, freedom of religion essentially does not exist for public school teachers inside the classroom. The courts have established that overtly religious speech, behavior, or dress by public school teachers is incompatible with the establishment clause of the first amendment. The thinking goes that even if the teacher does not overtly proselytize to students, by wearing their faith on their sleeve, as it were, they are using their position of authority to exert a coercive or repressive power against students who do not share that faith. You can wear a small cross or Star of David, but that's about it.
Although I tend to agree with this position, my initial reaction when I was told about it in my History of U.S. Schools class was of concern. "What about orthodox Jews who have to wear a yarmulke for religious reasons, or a Muslim woman with a head scarf? Shouldn't they have the right to religious exercise as well?" I asked. To which the teacher replied, "In that case, I think you're going to have to consider whether or not that candidate is capable, for religious reasons, of fulfilling the basic requirements of the position."
Huh. I wonder if that might at all be applicable to the argument at hand?
"But, William!" you will say, "teachers are agents of the government, which is why they are held to such strict standards! Surely the same does not apply to a pharmacist working for Mayo Clinic or John Hopkins School of Medicine or Granny Jo's Hillbilly Healthcare!" And to a point, you are correct; nobody is going to get on a doctor or nurse's case for praying aloud or wearing religious attire (so long as it meets the uniform and sanitation rules of the organization, which goes back to meeting the basic requirements of a position). But I'm pretty sure a teacher at a hypothetical secular private school would get in hot water if he tried to pull the stunt I mentioned before of declining to teach certain students because of their family circumstances, from his employers if not from the government. An integral part of the teaching profession is to be impartial and accepting of all students; if you can't do that, you are a bad teacher.
Take the example of the nurses in New Jersey, who sued their hospital over a requirement that they provide nursing care to abortion patients. "One of those nurses, Fe Esperanza Racpan-Vinoya,
said even a routine blood pressure check would be abhorrent to her if
the patient was in for an abortion. "Absolutely," she said, "there's a
big difference" between a patient in for an abortion and one in for an
appendectomy." Let's set aside for another day the question of whether she is right to feel this way about abortions and people who have them. Here is the question I want to ask. Since she feels that her religion prevents her from provide service to these patients, is she capable of fulfilling the basic requirements of her position? And looking back at our previous examples, I think it's pretty clear that she isn't. Remember the expectation for conscientious objectors: if you're opposed to all wars, that's fine, but you can't bow out just because you disagree with a particular conflict. Based on this principle, I would argue that when she accepts a position as a nurse, she is obligated to provide that care to all patients, regardless of how she feels about them. If she feels that she cannot do so, she should resign and find another, less morally repugnant career choice.
The profession of a physician in particular and a healthcare worker in general is a position of
public trust, even more so than the trust accorded to teachers. The
right of patient-physician confidence has been sacred ever since the
Hippocratic Oath was formulated. Remember what I said about
teachers needing to be impartial and accepting of all students? The
same applies to physicians, except more so. While healthcare providers are free to think whatever they want to about homosexuality, abortion, or God knows what else, professionalism demands that those feelings be held separate from their practice of healthcare. Because if a patient cannot trust their doctor, the doctor has failed. When a nurse refuses to take a woman's blood pressure because she had an abortion, that doesn't just hurt the patient's feelings; it establishes clearly for her that the people to whom she has entrusted her well-being do not think that she deserves to be healthy, which is unacceptable. Not only does this have real ramifications for her safe recovery, but it means that in the future, she will be less willing to seek medical counsel, or less willing to divulge potentially compromising information to her physicians, for fear of being judged and rejected, all of which could have potentially damaging implications for her health. We're coming back to the argument of whether or not a candidate is capable of fulfilling the basic requirements of his or her position; if a healthcare worker is unable for religious reasons to care for all patients without judgment or discrimination, then they have no right to care for any patients at all.
In the (classic, beloved and much-lamented) TV show Firefly, one of the characters is a doctor who is on the run from the law with his sister, and at one point, one of the crew members on board his ship sells them out to the authorities. The doctor and sister escape, and he later discovers who sold them out. In that same episode, the traitorous crewman is knocked out and needs to be restrained because of a potential spinal injury. Then he is left in the infirmary, immobilized, just him and the doctor, who knows exactly what this man has done. And after confronting the traitor with this knowledge, this is what Dr. Tam says: "No matter what you do, or say or plot, no matter how you come down on us… I will never, ever harm you.
You're on this table, you're safe. 'Cause I'm your medic, and however
little we may like or trust each other, we're on the same crew."
If I may wax philosophical for a moment, this is what medicine is supposed to be about. It's about putting the well-being of your patient above ALL other considerations, personal, public or political. If Dr. Tam in Firefly is committed to caring for Jayne, who has been an ass to him since the start of the show and has now betrayed him, how much less justification does a nurse have for refusing care to a patient just because the woman does not share some of her political and religious convictions? How petty. What if she was on duty in the cancer ward and had to care for a former convict who had killed a police officer? Would taking his blood pressure also be too abhorrent for her to handle? Can she also refuse service to married gays or lesbians? Or, in an example given by my mother, what happens when a doctor decides that diabetes is a punishment for sin and refuses to care for patients accordingly? Hell, what happens if a doctor refuses to treat AIDs patients because he disagrees with their morality? Would you trust a doctor who makes those kinds of decisions with your health care? I sure as hell would not.
In summation: I'm not opposed to freedom of conscience. Everyone has to answer to their own conscience (or God, if they prefer to use an external metric to measure their own morality) for their own actions. However, if a person has moral or religious strictures that prevent them from fulfilling the basic duties of a profession, they need to pick a different profession. Every employer has to make reasonable accommodations for their employees, but just as you don't hire a blind man to pilot airplanes or someone with severe vertigo to assemble skyscrapers, you don't hire someone for a healthcare position who believes that certain people are not worthy of healthcare. It just doesn't add up.
<whew>
Ok, I think that's out of my system. I can't promise when the next post will come, but hopefully I'll be a little faster this time around. I hope you've enjoyed my reasoning, whether you agree with it or not, and I'd love to hear what you have to (respectfully) say in the comments. Till next time, farewell, and think deep thoughts.
- William
P.S. A separate but related issue is whether or not the government has jurisdiction over the availability of medical care. In the case of the Washington pharmacy mentioned in the original article, "the state argues that it has a compelling interest in protecting the right of patients to legal medication." I don't know if there is a legal basis for that argument, so we'll have to see how the courts handle that, but I'm hoping the state wins. Because if healthcare providers have complete right of conscience, then rural and underserved populations with only one provider in their area are stuck with whatever meets the local doctor's and pharmacist's seal of moral approval; in effect, the providers are then not only restrict the freedom of choice available to patients, but, in the case of women for whom a pregnancy is not just inconvenient but medically inadvisable, potentially putting patient safety at risk because of their moral stand. Which is, you know, not cool.
EDIT 10/15/13
P.P.S. I notice, rereading this a year later, that I failed to carve out an exception to this, which is for doctors who choose not to perform abortions. This is legit. If you believe that aborting a fetus is murder, you should not do it; this is a valid interpretation of the Hippocratic Oath. However, if a patient wishes to have this done and a doctor don't want to do it, he/she needs to refer them to someone who will. Not only does this respect the right of the patient to make decisions about her own body and health care (not to mention probably making things easier for her in terms of insurance coverage), but it ensures the quality of her care; after all, a substantial percentage of women who choose to get abortions will get them whether their primary care physician approves or not; the only difference is that they might do something drastic and possibly highly unsafe to induce miscarriage on their own without professional assistance. It is her doctor's job to prevent this. If that doctor believes that because of this choice, this patient is not worthy of quality care in this situation, then we're back at the conclusion up above: you don't hire someone for a healthcare position who believes that certain people are not worthy of healthcare. The reason I separate this case from that of the nurses above is that the nurses had nothing to do with the actual abortion; they were just performing routine medical monitoring, from which there should be no opt-out for conscience.
Sources:
The original article: http://www.reuters.com/article/2012/02/21/us-usa-contraceptives-court-idUSTRE81K24W20120221
My material on conscientious objectors: http://en.wikipedia.org/wiki/Conscientious_objector
A guide to religion in public schools: http://www.freedomforum.org/publications/first/findingcommonground/B06.TeachersGuide.pdf
The Firefly Quote: http://en.wikiquote.org/wiki/Firefly_(TV_series)
