What Care Should Doctors Have to Provide?

My article last week on the increasing problem of church-owned hospitals sparked a debate that I want to address in more detail. Several religious commenters were aghast at the idea that a doctor should have to perform an abortion even if it went against his personal beliefs, like this one from commenter Cheri:

Do I understand correctly that people here feel that if someone believes abortion is murder and that there are moral issues with sterilization and contraception, that person has no right to practice medicine?

I certainly don’t think a person who believes those things should have no right to practice any branch of medicine, but yes, I do believe that a person who holds those beliefs shouldn’t be, say, an obstetrician. And I don’t think that’s an outrageous idea at all. It flows naturally from the nature of medicine as a profession and the moral duties that it imposes on its practitioners. If you ask me whether a doctor should be allowed to pick and choose what care he wants to give people in need of it, my answer is categorically No!

After all, medicine isn’t just any profession. Doctors have immense power over the lives and well-being of their patients, and in exchange for the power we give them and the resources we invest in them, we expect them to live up to professional standards for how they do their jobs. We expect them to be competent, providing care that’s up to accepted standards, and fair, treating people based only on the urgency of their need. That’s why there’s such a concept as malpractice. When a doctor provides care that’s grossly incompetent, or withholds care for no good reason, they can be held liable for this, because they work in a profession where an error of judgment can do serious harm and we want to give them every incentive to avoid making those errors.

There’s no reason why we should treat an intentional violation of professional duty any differently. If anything, you could argue that those cases should be treated even more harshly! Surely a doctor who’s capable of providing life-saving care, but chooses not to and deliberately lets a person die, is even more odious than a doctor who kills his patient because of a foolish blunder.

Another comment that was confused about the nature of a doctor-patient relationship was this one from James:

The healthcare that these hospitals are providing is a service, not a right. They do not have an obligation to provide any kind of known treatment to anyone that walks in the door.

This is false. American hospitals do have that obligation, under a 1986 law called EMTALA, which requires any hospital that accepts federal funding (which is essentially all of them) to treat anyone who arrives in need of emergency care. This includes emergency abortion, if a woman is suffering from pre-eclampsia or other life-threatening complications that can only be treated by ending the pregnancy. (In 2011, the Republican-controlled House actually did pass a bill that would partially repeal EMTALA, so that hospitals could refuse to act and let a pregnant woman die on their waiting room floor, but it failed in the Senate.)

And we should all be glad that doctors can’t use their religious beliefs as an excuse to deny us care. If you were in a serious car accident and were rushed to the hospital bleeding to death, would you want the law to be written so that, if the E.R. doctor was a Jehovah’s Witness, he could refuse on religious grounds to give you a blood transfusion? What if your doctor was a fundamentalist Muslim or an ultra-Orthodox Jew, and they told you that they weren’t going to help you because they had religious objections to examining a patient of the opposite gender? What if you were having a diabetic crisis and your doctor had a moral objection to insulin?

As I’ve said in the past, if you have a religious objection to performing the duties of a job, then religious freedom means you don’t have to take that job. It doesn’t mean that you have the right to take that job, refuse to perform your duties, and then demand to be exempt from the consequences. If we allow people to refuse to do their jobs on religious grounds, where will it end?

The “religious objection” that would allow an ob/gyn to refuse to perform abortion would just as well cover a doctor who refuses to give antiviral medicine to a person infected with HIV because he believes that AIDS is God’s just punishment of sinners. It would allow doctors to blackmail their patients by demanding they attend church or read the Bible in exchange for medical treatment. It would make a mockery of the idea of a standard of care if a doctor could arbitrarily pick and choose which kinds of medicine to perform, based not on proof of efficacy but on his idiosyncratic personal beliefs. The only rule that’s compatible with a secular society is that there’s a single, uniform professional standard, and all licensed doctors have to adhere to it, no matter what their personal feelings on the matter are.

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About Adam Lee

Adam Lee is an atheist writer and speaker living in New York City. His new novel, Broken Ring, is available in paperback and e-book. Read his full bio, or follow him on Twitter.

  • http://songe.me asonge

    You’d be surprised, but this stuff happens. I’ve talked to so many people who were seeking fertility-related treatments (sterilization for health reasons, etc) only to have religious doctors impose their religion on them in one way or another, including requiring them to have “religious counseling” before offering services!

  • http://criticallyskeptic-dckitty.blogspot.com Katherine Lorraine, Tortue du Désert avec un Coupe-Boulon

    Maybe those commenters are just confused and think “doctor” is a cover-all job. So any doctor can do anything.

    Doctors specialize for a reason. It’s hard to be an expert on any one thing, let alone an expert on the endocrine system, womens’ reproduction, cancer, bones and muscle, the nervous system, psychiatry, mens’ health, nutrition, blood, usw.

  • Freak

    While current insulin is derived from genetically modified bacteria, for several decades, insulin was obtained from slaughtered pigs.

  • http://bethclarkson.com Beth

    My last pregnancy, my obgyn was a catholic and did not perform abortions or sterilization procedures. As he was in private practice in a mid-sized city, this refusal was not an issue. He was a wonderful obgyn in terms of the care I received during my pregnancy. Afterwards, because I wanted to have my tubes tied, I had to use a different physician. It was not a big deal.

    I can see the issue you are describing in emergency situations and doctors that refuse to perform life-saving procedures in that situation should not be allowed to work in E.R.s, but outside of that situation, I don’t see a problem with allowing doctors freedom on conscious to not perform procedures they consider immoral.

    I can also see issues arising when people live in areas without any physicians who are willing to provide that care, but I don’t think that refusing to allow those doctors to practice medicine is going to be advantageous for the populations living in those areas are they are likely to be areas with insufficient medical practitioners. It’s better for residents to have a doctor that refuses to perform abortions than no doctor at all, Those may be the only options available in rural areas of the bible belt.

  • GCT

    I can also see issues arising when people live in areas without any physicians who are willing to provide that care, but I don’t think that refusing to allow those doctors to practice medicine is going to be advantageous for the populations living in those areas are they are likely to be areas with insufficient medical practitioners.

    Actually, I think what Adam is saying is not that we should refuse to let them practice medicine, but that they should be professionals and bound to actually give out treatment based on the dictates of their profession instead of getting to force their religious beliefs on all of their patients. Yes, it’s better to have a doctor that doesn’t perform some procedures than no doctor at all, but there’s no reason why that doctor should be allowed to opt out of doing their job on a whim.

  • L.Long

    I did think that if a doc was willing to put up a big sign stating ‘Yes I’m a religious bigot who thinks wimons are just phuck holes for mens to make babies’ that he can pretty much do what he/she wants. BUT there is another problem that I just ran into. Sometimes you can’t choose your doc because the awful insurance that you can barely afford states that you must use the APPROVED doc only (HMOs do this).
    SO I back to the original ‘You signed up to do MEDICINE not practice your BS mythical delusion. And that goes for the hospital as well.’
    I was going to add another statement but you know big brother is watching.

  • Azkyroth

    Do I understand correctly that people here feel that if someone believes abortion is murder and that there are moral issues with sterilization and contraception, that person has no right to practice medicine?

    Do I understand correctly that if a person is from the Amish tradition and believes using electrically powered machinery is immoral, that person shouldn’t have the right to apply for a job as the head of a machine shop, cut power to the shop and refuse to run it, and not be fired for it?

    Fucking idiots.

  • allein

    >>>Afterwards, because I wanted to have my tubes tied, I had to use a different physician. It was not a big deal.
    I don’t necessarily have a problem with this, as choosing sterilization isn’t an emergency sort of thing. (Though if you’re having a c-section and want to have it done while they’re already in there, it might cause hardship, both physically and financially, if the doctor refuses to do it and you have to then have a second surgery for no real reason.) In a healthy pregnancy with no serious complications, a doctor who doesn’t do abortions isn’t a big deal (as long as the doctor is up front about their position; I would be very upset to choose a doctor who I thought had my best interests in mind and months later find out only when there’s a problem that their “conscience” will prevent them from properly caring for me – which I find unconscionable). The problems I have are what arise in the other parts of your comment. Emergencies during pregnancy and childbirth don’t just happen in the ER. And yes, it’s better to have a doctor than no doctor, but that doctor should uphold the accepted standards of care, and that is all the more important when there aren’t other options available. It’s all well and good to tell someone living in a big city to find another doctor, but when you live in a rural area with only one small hospital around for miles, that’s not a viable option and you shouldn’t have your access to health care further restricted by someone else’s superstitions.

    (And L. Long makes a good point about insurance plan restrictions on what doctors you can actually see, too. I’m lucky in that I live in a densely populated state between 2 major metropolitan areas and have a broad network of doctors available, and my insurance lets me see anyone outside the network for a little more out of pocket, but a lot of people don’t have that luxury.)

  • Bdole

    Exactly. I have a personal qualm with being a lying, moneygrubbing sleezebag. Knowing this, I chose not to pursue a career in politics, the legal profession, or chiropractry, choosing instead a different career that wouldn’t conflict with my eccentric personal peccadilloes. Freedom means getting to choose what’s best for you, not dictating the choices available.

  • PhiloKGB

    And, as usual, any arbitrary restrictions on health care are massively inequitable in their applications. A hospital that refuses to perform abortions will only force births (or deaths) upon those who can’t afford to go to another city. A state that bans abortion will only force births (or deaths) upon those who can’t afford to go to another state. You can see where this goes.

    Those who wish abortion illegal, or who wish for the overturning of Roe v. Wade and the decision-making handed back to the states, need to be reminded at every turn that, no matter what they say in principle, the result in practice will be to make (safe) abortions unavailable only to poor people.

  • http://bethclarkson.com Beth

    @ CGT: I don’t think that religiously based refusals to perform abortions, sterilization procedures, etc. should be termed ‘whims’. I agree with you wrt doctors are are employed by hospitals, centers, etc. that have such procedures included in their job description. But independent practitioners should be able define their jobs as they like as long as patients are informed.

    @L.Long and allein: Yes, the lack of available doctors (including a lack of HMO approved providers) willing to perform those procedures is a serious problem. I’m not aware of it being an issue in urban areas but it certainly is in rural locations. But requiring independent doctors to perform procedures they consider immoral does strike me as making things better for people living in those locations. Seems to me the effect would be more likely to reduce the availability of health care in those areas rather than increase it. Why would you want to do that if the area is already underserved? How will they replace those physicians who decline to practice medicine rather than comply with those requirements?

    @Bdole: I agree with you for doctors working in positions that require performing such procedures. But I’m talking about independent obgyns in private practice. Why should they be compelled to perform procedures they consider immoral?

  • http://bethclarkson.com Beth

    Oops.
    I should have said But requiring independent doctors to perform procedures they consider immoral does NOT strike me as making things better for people living in those locations.

  • GCT

    @Beth,

    I don’t think that religiously based refusals to perform abortions, sterilization procedures, etc. should be termed ‘whims’.

    I disagree, unless you’d like to call them bigoted actions. I’d agree with that.

    I agree with you wrt doctors are are employed by hospitals, centers, etc. that have such procedures included in their job description. But independent practitioners should be able define their jobs as they like as long as patients are informed.

    I’m not seeing why there should be any reason for a distinction between a doctor in a hospital and one that is independent. Both should be providing the best care they can for their patients, regardless of their own religious feelings. Period. They don’t get to force their religion upon other people anymore than anyone else does. How would we feel about a restaurant owner that puts up a sign that only people who are Xian are allowed to eat at their establishment? Or that people must pray when their food is brought to them, or else be ejected from the restaurant? I think we would not accept that, even if the store owner claimed to have a conscientious objection to serving non-Xians. So, what about being an independent doctor allows them to be a bigot and force their religious ideas on all those around them?

    And, I would be remiss not to point out that your idea would leave open the loophole that the hospital could choose to say they won’t perform abortions, which would leave the doctors in the clear – a situation that should also be unacceptable for the many reasons that Adam has described in the OP.

  • Seomah

    I think the best analogy would be with a law enforcer such as a policeman. Should I be allowed to get a job as a policeman and then refuse to prevent thefts because I don’t believe in the right to own private property? Maybe you can just call another policeman and not me when a burglar enters your house or your bussines.

    In this case and in the doctor’s case I think the individual rights of the citizens and the common good trumps the rights of the doctor. In places where you have separate public and private medical services available to everyone for the same prices, surely private doctors can open clinics dedicated to partial procedures such as a dental clinic, but for that you have to have an effective public health service.

  • http://misoriented.blogspot.com Mike Blyth

    First, I realize that because abortion is such an incredibly polarizing issue, 90% of those reading my comments will be turned off at once. No problem, just skip the rest; I’m mainly addressing the 10% who are less polarized.

    I do think that it’s reasonable to consider ethical questions involving killing at a different level than, say, giving a life-saving tranfusion. I don’t know what the applicable laws are in prisons, but I would be sympathetic to a guard who refuses on ethical grounds to carry out an execution, despite the fact that it is part of his job description and is perfectly legal. Likewise, I think it is very reasonable that we should have different standards for oversight in intelligence operations involving killing than for other operations. So I think it’s specious to dismiss the issue by comparing it to other issues of medical care.

    As a pediatrician, I have never been required to perform an abortion. However, medical infanticide is already legal in the Netherlands, and there have been calls for it to be practiced in the US as well. I would certainly support a physician’s conscience-based refusal to participate in killing a newborn, regardless of the legal issue and the social climate.

    I wonder how the ardent supporters of forcing doctors to perform abortions would feel about forcing them to perform male circumcisions–we’ll limit that thought experiment to male circumcision to keep it simple. There is a substantial group of people who consider circumcision to be unethical, though it is accepted legally and socially and in fact has some arguable health benefits. If a such a person becomes a physician, must she limit her specialty choices to those where she would not be expected to perform a circumcision, or would it be reasonable to allow her to opt-out of the procedure and let someone else do it?

  • http://bethclarkson.com Beth

    @GCT I’m not seeing why there should be any reason for a distinction between a doctor in a hospital and one that is independent. Both should be providing the best care they can for their patients, regardless of their own religious feelings. Period.

    Because it’s more than reasonable for an employer to insist that their employees perform all functions that a duty/requirement of the position. Physicians that do not wish to perform abortions can seek other employment There’s nothing controversial about that.

    An independent practitioner is self-employed. They are working for themselves, so it’s reasonable for them to define what their duties are. I don’t see why they should be compelled to include procedures they do not wish to offer as long as it’s clear to their patients they do not offer those services. I don’t see it as impinging on their patients right to the best possible care with respect to the services that are provided. Emergency situations would be handled by E.R. doctors, not the patients personal obgyn.

    In regards to hospitals, again, I’m not sure that they should be compelled to offer services that they find morally unacceptable in non-life-threatening situations. Yes, I agree, there are serious problems with allowing hospitals to ‘opt out’ of such services. But I’m not convinced those problems outweigh the problems that come from compelling hospitals to offer those services. Any idea what the current US laws are in that regard? Are there states that currently compel hospitals to do so? If so, what was the actual effect of such laws?

    I am undecided about whether it is more ethical to permit such hospital emergency rooms to refuse to offer potentially lifesaving care versus require they perform abortions when needed in order to save the woman’s life. That’s a more difficult ethical conundrum. I’d need a better education on the types of situations that might require such care and what the available options might be before I would feel comfortable expressing a firm opinion on that matter.

    BTW, I don’t object to hospitals or physicians offering such services. I’m adamantly pro-choice, not anti-abortion. It’s the idea of compelling them to do so that I find problematic. To be pro-choice for pregnant women but not obgyns seems inconsistent to me. We wouldn’t force an abortion or sterilization on a woman who thought such procedures were immoral. Why should obgyns be forced to perform those procedures if they feel that way?

  • GCT

    Because it’s more than reasonable for an employer to insist that their employees perform all functions that a duty/requirement of the position. Physicians that do not wish to perform abortions can seek other employment There’s nothing controversial about that.

    An independent practitioner is self-employed. They are working for themselves, so it’s reasonable for them to define what their duties are.

    Not only are you fundamentally misunderstanding what it is to be a professional, but this opens the door to all kinds of abuse. Can private practitioners decide that they have the right to refuse service to people who are black? If a restaurant owner can’t do it, why should a doctor be allowed?

    I don’t see why they should be compelled to include procedures they do not wish to offer as long as it’s clear to their patients they do not offer those services.

    Because it is part of being in the profession to begin with. IOW, they are providing a public service, and that service comes with certain expectations.

    I don’t see it as impinging on their patients right to the best possible care with respect to the services that are provided. Emergency situations would be handled by E.R. doctors, not the patients personal obgyn.

    I’m not so sure that’s the case. Perhaps you have more experience on this than I do, and perhaps someone else who has experience can chime in? Either way, I don’t see why this should work as a loop-hole. Can JW doctors refuse to do blood transfusions for their patients and cover it up under the guise that ER doctors can do it if there’s an emergency? I don’t think anyone would find that acceptable, yet we should find refusal to do abortions or hand out contraception as acceptable? Should a woman who needs an abortifacient be required to go to the ER to get it?

    Any idea what the current US laws are in that regard? Are there states that currently compel hospitals to do so? If so, what was the actual effect of such laws?

    I confess to not knowing. I will say, however, that I am strongly on the side of not allowing hospitals to pick and choose which services they will provide for the many reasons brought up in the OP and in the recent threads on this topic. That people actually die because hospitals refuse to administer life-saving treatment should be criminal.

    I am undecided about whether it is more ethical to permit such hospital emergency rooms to refuse to offer potentially lifesaving care versus require they perform abortions when needed in order to save the woman’s life. That’s a more difficult ethical conundrum.

    It shouldn’t be. It should be a no-brainer.

    BTW, I don’t object to hospitals or physicians offering such services. I’m adamantly pro-choice, not anti-abortion. It’s the idea of compelling them to do so that I find problematic.

    Yeah, I get that. Your position on the coercion seems rather clear. I would argue, however, that it’s the role and function of government to compel such things when necessary for the public good.

    To be pro-choice for pregnant women but not obgyns seems inconsistent to me. We wouldn’t force an abortion or sterilization on a woman who thought such procedures were immoral. Why should obgyns be forced to perform those procedures if they feel that way?

    In cases where it is a choice, it’s the woman’s choice, not the doctor’s. In the cases where there isn’t a choice due to complications, then it’s still not the doctor’s choice.

  • allein

    >>> I do think that it’s reasonable to consider ethical questions involving killing at a different level than, say, giving a life-saving tranfusion.

    What about when the “killing” (ie, an emergency abortion) is life-saving? (And I don’t think your average prison guard is going to be the one carrying out an execution. There are protocols and, I assume, special training involved in that. Also, an execution can’t really be compared to an emergency medical procedure.) I don’t know under what circumstances a “medical infanticide” would be carried out, but I would think it also wouldn’t be comparable to a situation where the mother would die if it wasn’t performed (since infanticide, by definition, implies an already-born baby). That is an entirely separate question from abortion, in my opinion.

    >>> An independent practitioner is self-employed.

    Most doctors (especially obstetricians) would have admitting privileges at one or more hospitals. Is it unreasonable for the hospital to expect them to provide a certain standard of care to maintain their privileges, even if they aren’t directly employed by the hospital?

    >>> We wouldn’t force an abortion or sterilization on a woman who thought such procedures were immoral.

    We don’t force those things on women because it would violate their bodily autonomy; the woman’s personal opinions on the morality of such procedures don’t factor into it. The forcing is what is immoral. If a woman finds sterilization immoral, she’s not likely to choose to have it done. (Though there’s ample evidence that plenty of women who claim to find abortion immoral have them anyway, because when it’s themselves they find in the position of needing one, they are able to justify it.) I don’t think every obgyn practice should be required to offer abortion services, but I do think that every obgyn should have the proper training and judgment to be able to handle an urgent situation should it arise, and their primary concern should be the patient’s needs/wishes, not their own.

  • http://misoriented.blogspot.com Mike Blyth

    Allein, your point on emergency, life-saving abortions is well-taken. However, that is very much an edge case, thus more suitable for footnotes and exception clauses to a legal or ethical policy than to be the foundation of such a policy.

    Naturally, I am not trying to make a direct analogy between abortion and execution, or doctors and guards, etc. The point is just that in many situations involving life-or-death (whether killing, exposing to risk, or whatever), the law and society are perhaps more cautious in their demand that people leave their personal conscience behind. That’s my impression, anyway.

  • http://bethclarkson.com Beth

    @ GCT: Can private practitioners decide that they have the right to refuse service to people who are black? If a restaurant owner can’t do it, why should a doctor be allowed?
    We aren’t talking about refusing to provide a service to some individuals while offering it others, but refusing to offer a particular service at all. The situation we are discussion is analogous to a vegetarian who opens a restaurant who decides against offering meat dishes. He or she wouldn’t be refusing to serve meat eating customers, just refusing to serve certain foods.

    Can JW doctors refuse to do blood transfusions for their patients and cover it up under the guise that ER doctors can do it if there’s an emergency?

    Can you give me an example of a situation where this would come up? Non-emergency situations can be resolved by finding another practitioner to perform that function. If it’s an emergency situation, then either they are employed by a facility with the means to do such transfusions and it’s a part of their normal job duties and they agreed to do so when accepting the position or they aren’t in a facility with access to the resources necessary to do a blood transfusion. How do JW doctors in our society currently handle this dilemma?

    In cases where it is a choice, it’s the woman’s choice, not the doctor’s. By what reasoning should an self-employed physician in a free society be denied the ability to choose what services they will offer their patients?

    @allein: Is it unreasonable for the hospital to expect them to provide a certain standard of care to maintain their privileges, even if they aren’t directly employed by the hospital?

    It’s quite reasonable that they expect a certain standard of care, but how do you apply a standard of care to services they do not perform? For example, I can see that a surgeon would be required to perform blood transfusions during operations when necessary regardless of the personal feelings on the morality of such procedures. I can see that JW’s would be unable to offer surgical procedures AND refuse to perform blood transfusions as such procedures are often necessary during surgery. But I don’t see how a doctor refusing to do abortions or sterilizations would be violating the hospital’s standard of care. Can you elaborate on why you feel it would?

    The forcing is what is immoral. I agree. Why is compelling the doctor to perform what he/she considers immoral actions acceptable?

    I do think that every obgyn should have the proper training and judgment to be able to handle an urgent situation should it arise, and their primary concern should be the patient’s needs/wishes, not their own.

    I agree, but I am uncertain as to what urgent situations are going to arise that would require an independent obgyn to perform an abortion immediately rather than being able to delegate it to someone who does not share their convictions regarding abortion. Could you describe such a situation?

  • MountainTiger

    “Allein, your point on emergency, life-saving abortions is well-taken. However, that is very much an edge case, thus more suitable for footnotes and exception clauses to a legal or ethical policy than to be the foundation of such a policy.”

    Those cases are (properly) the entire root of this discussion. They also aren’t all that uncommon; ectopic pregnancies alone account for 1-2% of all pregnancies. Pushing these cases to the side may be comfortable for some, but anyone involved in obstetric care must be prepared for cases where pregnancy is a direct threat to a woman’s health.

  • http://misoriented.blogspot.com Mike Blyth

    MountainTiger, do you know of any physician who refuses to terminate ectopic pregnancies? As far as I know, this is a totally different category altogether, so I’m not sure why it would be included in a discussion of abortion. I don’t think the issue of an extremely rare case which is both life-threatening and emergent should govern policy, any more than an extreme ethical dilemma should be the *primary* way we think about other areas of ethics. Good thought experiments, yes. The foundation of policy, no. I’m sure you can find exceptional cases where a woman died in the ER simply because someone refused to give her an abortion, maybe one or two such cases, but it’s hardly a national dilemma.

  • MountainTiger

    Mike, I’m not sure why you consider terminating pregnancies to be unrelated to abortion. The Catholic Church makes a particular point that “in cases of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.” In practice, they do allow abortion, but they require that it be performed by an invasive surgical procedure that can cause later fertility problems rather than the preferred non-invasive chemical method. Miscarriage management is a problem in general at Catholic hospitals, a problem rooted in abortion policies that don’t take emergency situations seriously. Fortunately, many doctors evade institutional attempts to interfere in patient care and modern medicine is fairly good at preventing the blood loss and risk of infection that frequently accompanies these cases from turning deadly. This does not excuse hospitals or doctors who refuse to treat pregnant women according to best practices.

  • allein

    Quoting from MountainTiger above: ” but anyone involved in obstetric care must be prepared for cases where pregnancy is a direct threat to a woman’s health.” You never know what might go wrong even during what seems to be a routine pregnancy, and sometimes things go south very quickly. Saying “I’m sorry, I know it’s killing you but we don’t do that” should not be acceptable. An obstetrician should be able to handle an emergency situation in the best interest of, and according with the wishes of, the patient (meaning the pregnant woman), whether or not a needed procedure is something they would choose to do in the normal course of their everyday practice. If you’re going to be in certain areas of medicine, you should have the knowledge and ability to deal with the unexpected without resorting to “sorry, you’ll need to find another doctor.”

    >>> I’m sure you can find exceptional cases where a woman died in the ER simply because someone refused to give her an abortion, maybe one or two such cases, but it’s hardly a national dilemma.

    Perhaps not, but it shouldn’t happen at all, least of all because of someone else’s superstitions. I’m not willing to die for someone else’s religion.
    As to the case of ectopic pregnancies, in some countries the law requires a woman to wait until the fallopian tube ruptures, at which point they can perform emergency surgery, which unnecessarily puts her life (and fertility) at risk. Granted, that’s not the law in the US, but no doubt we have plenty of people who think that way. Catholic doctrine would have the entire tube removed rather than just the embryo, which is OK because of what I believe they call “double effect,”…the purpose is to remove the “damaged” fallopian tube (even though there’s usually no reason to), not to terminate the embryo (which is safer and less likely to cut a woman’s fertility in half in the process). There are a LOT of Catholic hospitals in this country so that it is not exactly an edge scenario.

  • Highlander

    See the Declaration of Geneva which is a modernization of the Hippocratic Oath. Specifically clause 8 of the declaration which states: “I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.” Now I grant you that it is not required for any physician to make the declaration but this is something that was agreed upon by the General Assembly of the World Medical Association in 1948 and has been revised and agreed upon numerous times since then (most recently 2006). Seems to me that the consensus in the medical world is a physician needs to put aside personal moral considerations in favor of the duty to the patient. If a physician can’t do that then perhaps they need to be a chiropractor or holistic practitioner instead. Those professions seem more compatible with superstitious nonsense.

  • http://misoriented.blogspot.com Mike Blyth

    Thanks for the info, Allein and MountainTiger. I wasn’t aware of the Catholic position on ectopic pregnancy and agree that it’s troubling. The situations still break down into those that are either emergent, in which case even the Catholic doctor would do the abortion to save a life, or non-emergent, so that the doctor could refer the patient to another physician. It does seem, though, that refusing to do an earlier abortion (before the ectopic becomes acute) could be putting the woman’s life in danger so would be ethically problematic. Remember, though, I’m not arguing against abortion but saying that the conflict between the conscience of the physician and the needs of the mother are serious enough in the case of abortion that they should be considered rather than dismissed.

    The vast majority of abortions, however, do not involve such life-threatening conditions, so to argue that any ob/gyn should be obligated to perform any abortion, at any time, for any or no reason, seems to me as extreme as position as to argue that they always have a right to refuse.

  • http://bethclarkson.com Beth

    @ allein: An obstetrician should be able to handle an emergency situation in the best interest of, and according with the wishes of, the patient (meaning the pregnant woman), whether or not a needed procedure is something they would choose to do in the normal course of their everyday practice.

    I agree, but I’m not aware of situations where that would come up. Can you indicate what type of situation you are talking about? My understanding is that ectopic pregnancies do require an abortion. I agree that hospitals or laws that impose restrictions such as you describe above are a serious problem. But I’m asking about independent self-employed physicians. Why should they be required to perform such procedures? When is it going to be a danger to the patient if the obgyn refuses to perform an abortion and refers them to another physician for that service?

  • http://misoriented.blogspot.com Mike Blyth

    (I didn’t mean to ignore the problem that refusing to terminate the ectopic pregnancy could also affect the woman’s fertility and cause otherwise-unnecessary invasive surgery … those are both problems as well, to be sure)

  • Azkyroth

    MountainTiger, do you know of any physician who refuses to terminate ectopic pregnancies?

    YES, YOU PRIVILEGED DIPSHIT, THIS IS ROUTINE IN CATHOLIC HOSPITALS, ESPECIALLY IN THIRD WORLD COUNTRIES.

    Who the fuck do you think you ARE that you think you’re entitled to just flop in here and try t0 dominate this discussion without even marginally informing yourself about it? Especially since, as a man, it doesn’t fucking affect you?

  • MountainTiger

    Mike: I’m not sure where you got the idea that anyone is arguing “that any ob/gyn should be obligated to perform any abortion, at any time, for any or no reason.” I certainly haven’t seen any such argument, though perhaps someone else has made it. I recommend that you follow Adam’s first link and familiarize yourself with the context of this discussion. This comes out of a very real situation, in which arbitrary Catholic objections to abortion are institutionalized in many hospitals in ways that compromise emergency care for pregnant women. This is not an acceptable practice at the institutional level, and it is no more acceptable at the individual level. A willingness to perform emergent abortions in situations with severe risks to the woman and no chance of carrying the pregnancy to term is a pretty minimal standard for obstetric practice, something like a willingness to provide blood transfusions in a surgeon.

  • Azkyroth

    (Dear tone trolls – do your damn jobs and find a way to distance yourself from me while saying the same thing differently instead of throwing the actual issue under the bus for the sake 0f your pearl-clutching grandstanding).

  • http://bethclarkson.com BethC

    @MountainTiger

    My interpretation of the OP and some of the comments is that an obgyn should not be able to refuse to provide abortions to their clients. Not necessarily at any time, but if they have a patient who requests an abortion, they should be compelled to provide that service or they should not be allowed to practice as an obgyn.

    If this is not what is being argued, my apologies for mistaking the intent. On rereading the OP, perhaps it is only that doctors be required to do so in emergency situations when it is necessary to save the life of the pregnant woman. I agree that doctors working in hospitals providing emergency care must be willing to provide that service in such circumstances.

  • David Hart

    Beth:

    Why is compelling the doctor to perform what he/she considers immoral actions acceptable?

    This happened a bit upthread, but it’s still worth pointing out, because if the state requires doctors to perform all aspects of healthcare (or all aspects within their specialization), that is very different from the state forcing a woman to continue an unwanted pregnancy because the doctor has not been forced at any point to become a doctor. If they had ethical objections to performing some of the duties of a doctor, they should have gone down a different career path. There is nothing unreasonable about the state compelling people who enter a profession to meet certain standardized requirements in the carrying on of that profession. Whereas women by definition do not choose to have unwanted pregnancies (and in case there are any people lurking here to say ‘they can just choose not to have sex’, I submit that this is not applicable because expecting someone to refrain from physical intimacy all their lives except at the points they might want children is a vastly less reasonable ask than expecting someone to refrain from taking a job an aspect of which they have a taboo against performing).

  • Adam Lee

    My interpretation of the OP and some of the comments is that an obgyn should not be able to refuse to provide abortions to their clients. Not necessarily at any time, but if they have a patient who requests an abortion, they should be compelled to provide that service or they should not be allowed to practice as an obgyn.

    Let me just state clearly, for the record, that I am arguing that a doctor with the appropriate training should be required by the standards of their profession to perform abortion for patients who request it, even if it’s not an emergency. No doctor should be permitted to refuse a legal, safe medical procedure based purely on their personal religious objections to it; if they can’t abide by that, then they should surrender their medical license. The emergency scenario makes this principle most obvious, but what applies there applies in other cases as well. If you grant that the right of personal conscience is not absolute, then the rest, as they say, is just haggling over details.

    I’ve said in the past that a pharmacist shouldn’t be permitted to refuse to fill a prescription because he dislikes the medicine being prescribed, nor should a city clerk be permitted to refuse to solemnize a marriage because the couple is same-sex and he has religious objections to that, nor should a modesty-obsessed sect be allowed to segregate public sidewalks by gender. I consider this a straightforward extension of that same reasoning. Even if you can go to another pharmacy, or get married in the next town over, or move to the other side of the street, there’s no good reason why a person should be allowed to cite their personal religious beliefs to deny you access to a service that you have the legal right to avail yourself of. To say otherwise is to say that one person’s religious taboos trump the law of the land.

    Beth, you raised the question of what will happen to already-underserved areas if we start disbarring (is that the word?) doctors who won’t put professional duty ahead of personal beliefs. I agree this is a problem, and I don’t have a solution ready to hand. But it comes down to a matter of what you are and aren’t prepared to tolerate. After all, if a rural doctor refused to treat blacks or Jews, we surely wouldn’t countenance his refusal as a “matter of conscience”, on the grounds that at least some people in his area would have access to medical care they wouldn’t otherwise be able to get. There has to be somewhere we draw the line, if only because this kind of prejudice will never end otherwise.

  • Tak

    I am surprised that none of the comments have mentioned the recent case of Savita in Ireland where superstitious nonsense and forcing religious beliefs on others resulted in a woman dying from a miscarriage because the fetus had a heartbeat and even though the pregnancy was doomed the doctors wouldnt abort. Such things do happen in this day and age and if proper standards of care were adopted it would not have happened. Yes it was outside the US but such situations are a very real possibility if hospitals are allowed to pick and choose, ignoring their duty to the patient and excusing themselves based on their religious beliefs. I’d rather force doctors to do their JOBS than allow the murder of women due to some bronze age superstition.

  • Bdole

    @Beth,
    My ever-evolving view is this:
    The need of society for a return on investment in medical schools and medical research in the form of reliable and predictable service from the doctors that are produced by them outweigh an individual’s conscience.

    I believe this was covered in Spock vs Captain Kirk in the fusion reactor core of Enterprise:
    “The benefit of the many outweigh the benefit of the few, or the one.”
    In a choice between the life/health of a patient and a doctor’s hand-wringing about ethics, though I may sympathize with both, I side with the patient. Though, I think a little judiciousness in penalties for the doctor may be thought up by people far smarter than myself. Not every infraction needs to lead to the ending of a career given the dearth of doctors in many areas.

    @whoever brough this up:
    If I were in a land where pointless infanticide, or whatever, is the law of the land, I’d eithert stay out of professions where it would be incumbant on me to perform them or take my chances that I’ll never have to deal with those scenarios while maintaining a rainy day fund for the day I am forced out of my profession, i.e. a contingency backup plan.

    @Azkyroth
    Get a grip, we’re all just making conversation.

  • http://anexerciseinfutility.blogspot.com Tommykey

    I wonder what’s going to be next, evangelical postal carriers getting to decide they can refuse to deliver mail to Planned Parenthood facilities?

  • http://avoiceinthewilderness-mcc1789.blogspot.com Michael

    Well said, Adam. I notice people don’t say this stuff about other religious groups who have sincere moral objections to laws, for instance Quakers opposing having part of their taxes go to military spending. This may be in part because Quakers are progressive by and large, even non-Christian in some cases. However, if an evangelical Christian or Catholic’s conscientious objection to dispensing contraception or performing abortions is given this protection, constitutional equal protection of the laws mandates that other groups such as Quakers receive it as well. Somehow I don’t see Republicans giving the Quakers an opt-out on paying taxes for military spending somehow.

  • Azkyroth

    Get a grip, we’re all just making conversation.

    First, given that this is a real issue that affects real people, the fact that you see it as something to “just make conversation about” is a problem.

    Second, given that this conversation is happening in a larger context, people are not “just making conversation.” The fact that you are privileged enough that you can afford to ignore that context doesn’t change facts.

    Third, see here, and silencing tactics are not “making conversation,” they’re a passive-aggressive and cowardly attack.

    I am surprised that none of the comments have mentioned the recent case of Savita in Ireland where superstitious nonsense and forcing religious beliefs on others resulted in a woman dying from a miscarriage because the fetus had a heartbeat and even though the pregnancy was doomed the doctors wouldnt abort.

    That’s because the rest of us either have been discussing it for quite a few of Adam’s posts now, or are “Just Making Conversation.”

  • Azkyroth

    Why is compelling the doctor to perform what he/she considers immoral actions acceptable?

    Why is it acceptable to take a job and then refuse to do it?

  • http://bethclarkson.com Beth

    @Azkyroth: Why is it acceptable to take a job and then refuse to do it?
    It isn’t. I agree that doctors working in facilities where they are required to provide such services should either do so or not take the position. I have been limiting my discussion to self-employed physicians.

    @Bdole: I’m not a utilitarian. Sometimes the needs of the one outweigh the needs of the many. I think Spock may have said something like that too.

    @Adam: Thanks for your response and clarification. I wonder if you could respond to Mr. Blyth’s earlier question:

    There is a substantial group of people who consider circumcision to be unethical, though it is accepted legally and socially and in fact has some arguable health benefits. If a such a person becomes a physician, must she limit her specialty choices to those where she would not be expected to perform a circumcision, or would it be reasonable to allow her to opt-out of the procedure and let someone else do it?

    I would like to ask about other medical services legal only in some places – female circumcision and assisted suicide. Is it unreasonable to allow physicians to ‘opt out’ of providing such services where they are legal? Or is it unreasonable to tell practicing doctors that if they are unwilling to perform all legal services a patient might choose that they should not be allowed to practice their speciality?

    I think issues of this nature might also be resolved by making the obligation to provide all currently legal medical services limited to those services that were legal when the physician began practicing. It’s one thing to make it clear to people prior to embarking on their profession that these things will be expected of them. It’s another to change the rules mid-stream and expect people to change their beliefs about the morality of such actions just because they have been legalized.

  • GCT

    @Beth,
    Adam summed up my position pretty well, so I’m not going to respond as thoroughly as I had been. I do wish to bring up a couple points.

    1) Why is it that we only have this sort of hand-wringing when the subject is the reproductive rights of women? In no other context would we allow such religious transgressions. Imagine a Xian Scientist who becomes a doctor and refuses to issue any medication. I don’t think anyone would allow that.
    2) I keep going back to the issue of discrimination, because this situation is an issue of discrimination. It’s not analogous to a vegetarian restaurant. In this instance, the doctor is claiming an ethical duty to not perform some health care measure which is completely legal, which is a breach of the doctor’s professional ethics. But, even worse (and here’s the discrimination) the doctor is providing a service but only based on religious grounds (i.e. the doctor is forcing his/her religious sensibilities on the patients). It is NEVER the doctor’s choice what the woman gets to do in regards to her reproductive choices, and especially not the choice of the doctor’s religion.

    When it comes to circumcision, I don’t see why you think that’s a good question. The patient in question is the child, not the parents who request a circumcision. There’s no issue with allowing assisted suicide, and FGM is right out (not legal anywhere in the western world that I know of).

  • http://bethclarkson.com Beth

    @GCT: I think that currently it comes up with reproductive rights because that is where what is currently legal conflicts with some traditional moral values. You say Imagine a Xian Scientist who becomes a doctor and refuses to issue any medication. I don’t think anyone would allow that. I disagree. I don’t think such a physician would have clients outside of his religion, but I don’t think he or she would be disallowed from setting up a medical practice that caters to people who do not want to take medications.

    I do see the vegetarian restaurant as a good analogy and I don’t follow your objection to it. The doctor is no more forcing his/her religious views on patients than the vegetarian restaurant owner is forcing his dietary restrictions on his customers. No is forcing patients or diners to go to a provider that does not offer what they want. I don’t see this as a discrimination issue because the refusal is with respect to a service being offered, not a class of people that are refused as clients.

    Why is it a breach of professional ethics for a doctor to refer patients to a different physician for services they don’t want to provide?

    Why do you say there is no issue with assisted suicide? Is is not the same breach of ethics for them to refuse to offer that service to clients who request it? Some doctors find it as morally problematic to assist a suicide as to perform an abortion. Legal and moral are not (and IMO should not be) considered equivalent. Why should they be forced abandon their morality or leave their profession because the law has changed?

  • MountainTiger

    Adam: I apologize if I put words in your mouth; I meant only to point out to Mike that this came out of an ongoing conversation over the refusal of care in emergency situations and that his formulation allowed no room for medical judgment.

  • GCT

    @Beth

    I disagree. I don’t think such a physician would have clients outside of his religion, but I don’t think he or she would be disallowed from setting up a medical practice that caters to people who do not want to take medications.

    That person would not be licensed.

    I do see the vegetarian restaurant as a good analogy and I don’t follow your objection to it. The doctor is no more forcing his/her religious views on patients than the vegetarian restaurant owner is forcing his dietary restrictions on his customers. No is forcing patients or diners to go to a provider that does not offer what they want. I don’t see this as a discrimination issue because the refusal is with respect to a service being offered, not a class of people that are refused as clients.

    So, a restaurant owner puts up a sign that says, “Whites Only.” No problem, right? I mean, no one is forcing non-whites to eat at that restaurant.

    The reasonable expectation is health care. The service being offered is health care…by a supposed professional. This supposed professional has no more right to impose his/her religious ideas on others than the restaurant owner above who claims that it’s part of his/her religion to only serve whites. When one is in the public sector, providing a public service, one must abide by the public expectations and rules. Just as catholic adoption agencies are no longer allowed to refuse to place children with gay or lesbian couples. The doctor does not have veto power over the choices of the patient, and it is not the doctor’s decision to make.

    Why is it a breach of professional ethics for a doctor to refer patients to a different physician for services they don’t want to provide?

    Because the doctor is refusing to be a professional and carry out the services that the patient needs. It’s a huge breach of professional ethics (as a professional myself, I take this matter seriously). If the doctor signs up to do a job with a specific ethics set, then refuses to do that job, it’s a breach of the doctor’s ethics.

    Why do you say there is no issue with assisted suicide? Is is not the same breach of ethics for them to refuse to offer that service to clients who request it?

    What I meant was there was no reason to treat it any differently than abortion. If the law allows it, then there’s no reason the doctor should be allowed to veto the wishes of the patient.

    Legal and moral are not (and IMO should not be) considered equivalent.

    No one is claiming that they are. What we are claiming is that doctor’s do not have the right to impose their religious beliefs on their patients.

    Why should they be forced abandon their morality or leave their profession because the law has changed?

    For the same reason any professional should find a new line of work if they are unwilling or unable to perform the duties of their job.

  • http://bethclarkson.com Beth

    @CGT: So, a restaurant owner puts up a sign that says, “Whites Only.” No problem, right? I mean, no one is forcing non-whites to eat at that restaurant.

    Why do you find this situation analogous to the situation we are discussing while the vegetarian restaurant owner refusing to serve meats is not? I’m not following your reasoning here.

    The vegetarian analogy would place the restaurant owner as analogous to the independent self-employed physician and ‘serving meals with meat’ as analogous to assisted suicide or abortion.

    In your analogy, you are likening not providing abortion services to not serving a particular class of people rather than not serving a particular class of meals. I don’t think your analogy fits the situation nearly as well because such doctors aren’t saying they won’t provide services to a certain class of people. The doctors aren’t providing those services to anyone just as the restaurant owner isn’t serving meat.

    If the doctor signs up to do a job with a specific ethics set, then refuses to do that job, it’s a breach of the doctor’s ethics.
    I’m not following your reasoning here either. Why do think that physicians who refuse to do abortions or assisted suicides signed up to do a job with a specific set of ethics and are now refusing? If that was the law when they started practicing, you would have a point. But it hasn’t been our law, so I don’t think that we can consider physicians currently practicing as having ‘signed up to do a job’ and are now refusing to do so. They started their practice under a set of ethics that did not include their having to participate in treatments designed to result in the death of human being.

    What I meant was there was no reason to treat it any differently than abortion. If the law allows it, then there’s no reason the doctor should be allowed to veto the wishes of the patient. But the doctor isn’t vetoing the wishes of the patient anymore than the vegetarian restaurant owner is vetoing the wishes of people who want to eat meat.

    What we are claiming is that doctor’s do not have the right to impose their religious beliefs on their patients. I agree. What I’m saying is that society does not have the right to require physicians to foresake their religious beliefs in order to practice their profession.

    For the same reason any professional should find a new line of work if they are unwilling or unable to perform the duties of their job. This doesn’t match what we’ve been discussing. We are talking about actions not currently considered a duty of their profession and you are advocating for a change in the ethics as they currently are rather than asking professionals to live up to ethics that were in place when they started working in the profession.

  • Figs

    Here’s why the vegetarian restaurant analogy doesn’t work. If I want to come into your restaurant and you say you won’t feed me what I want, I’ll go to the restaurant down the street that will. If I go into your medical practice with an emergency that requires a medically necessary abortion to facilitate my survival and you say that you won’t give me that service, I DIE.

    You get that? We’re talking about life and death. We’re not talking about shopping around. We’re talking about doctors, whom people trust with their lives, placing their own personal feelings over those lives they’re supposed to be protecting.

  • GCT

    Why do you find this situation analogous to the situation we are discussing while the vegetarian restaurant owner refusing to serve meats is not? I’m not following your reasoning here.

    Because it’s a case of one person forcing religion upon another, which is discrimination. You want to insist that what health care someone provides is an a la carte type deal, but it’s not. If someone is unqualified to perform a certain procedure, that’s one thing, but doctors should be required and expected to be able to perform the procedures within their specialty, and that includes abortion for ob/gyn doctors.

    Why do think that physicians who refuse to do abortions or assisted suicides signed up to do a job with a specific set of ethics and are now refusing? If that was the law when they started practicing, you would have a point.

    For the vast majority of doctors, abortion has been legal their entire career. But, the ethics they sign up to are not to do X, Y, and Z specifically, but to provide the best health care for their patients, generally. If abortion were illegal when a doctor signed up, the doctor was not specifically signing up to be a doctor that doesn’t perform abortion, but to provide the best care for the patient. When the abortion law changes, they are still obligated to provide the best care. That’s what it means to be a professional. These doctors are claiming that they want to be a professional unless they see a conflict with their religion, at which point they want to avoid having to be a professional so that they can dictate their “morals” onto the people around them, and then resume being a professional when it suits them. This is unethical.

    But the doctor isn’t vetoing the wishes of the patient anymore than the vegetarian restaurant owner is vetoing the wishes of people who want to eat meat.

    When the patients asks for an abortion and the doctor refuses, that’s vetoing the wishes of the patient. That’s the doctor putting their religion above the needs of the patient. It’s discrimination.

    I agree. What I’m saying is that society does not have the right to require physicians to foresake their religious beliefs in order to practice their profession.

    Then, you believe catholic adoption agencies should be allowed to refuse to allow gay and lesbian parents to adopt or provide contraceptive devices in their health care? This is a case of the doctor imposing religion on others.

    This doesn’t match what we’ve been discussing. We are talking about actions not currently considered a duty of their profession and you are advocating for a change in the ethics as they currently are rather than asking professionals to live up to ethics that were in place when they started working in the profession.

    I’m sorry, but this is just plain wrong. Providing health care for their patients, which includes abortions and other legal procedures like sterility procedures, is part of the duty of their profession. Period. They are claiming that they don’t have to follow their duties whenever they don’t feel like it, and that they get to do this simply by citing some religious objection. It can and does lead to all kinds of abuses, up to and including death of the patient. It’s intolerable and flies in the face of what it means to have a professional duty. If an ob/gyn doesn’t want to perform abortions, they should get the hell out of the profession, because they have a duty to their patients that they are refusing to follow through with.

  • Bdole

    @Beth,

    @Bdole: I’m not a utilitarian. Sometimes the needs of the one outweigh the needs of the many. I think Spock may have said something like that too.

    After consulting the scriptures…It was Captain Kirk who said that. The irrational, red-blooded human who suffered much, including losing his only son, to recover Spock. I don’t subscribe to any particular philosophy (utlitarian or otherwise), that’s just where my sympathies lay.

    @Azkyroth
    “silencing tactics?” Are you for real? I have no desire to silence you or anyone else. Your cursing at and calling people names smacks of verbal abuse. Have you considered your own modus operandi?

  • http://bethclarkson.com Beth

    @Figs: I’m not talking about emergency situations. That was discussed earlier. Currently, I’m only talking about obgyn’s in private practice. Abortions have to be scheduled in facilities with the equipment to perform them. A pregnant woman seeking an abortion can go to another doctor.

    @GCT Because it’s a case of one person forcing religion upon another, which is discrimination. You want to insist that what health care someone provides is an a la carte type deal, but it’s not.

    I don’t think one person forcing their values, religious or otherwise, on another person is discrimination. It’s abhorrent, but it’s not discrimination as I understand it.

    Since we are discussing physicians in private practice, who if they did perform abortions would need to schedule them in a facility with the proper equipment and support staff, I don’t see declining to perform abortions as the doctor forcing religion on his/her patients. I do, however, see your insistence that obgyn’s must perform abortions when requested for non-emergency situations as forcing your moral values on obgyns.

    If someone is unqualified to perform a certain procedure, that’s one thing, but doctors should be required and expected to be able to perform the procedures within their specialty, and that includes abortion for ob/gyn doctors.

    Being able to perform the procedures is a separate matter from being willing to perform the procedures. I’m not sure what requirements exists that obgyn’s in training learn to perform abortions, but if it is a requirement, then I would agree that training requirements should not be waived because a potential doctor has moral objections. They either accept that they must learn how to perform the procedure or train for a different specialty.

    If abortion were illegal when a doctor signed up, the doctor was not specifically signing up to be a doctor that doesn’t perform abortion, but to provide the best care for the patient. When the abortion law changes, they are still obligated to provide the best care. Sure, they are obligated to provide the best care, but I don’t see this as conflicting with referring the patient to a different provider for services they don’t want to provide in non-emergency situations.

    When the patients asks for an abortion and the doctor refuses, that’s vetoing the wishes of the patient. Is a vegetarian restaurant owner is vetoing the wishes of a patron that asks for fried chicken by telling them no, they will have to go elsewhere? You may claim that constitutes a veto, but I don’t think it does.

    That’s the doctor putting their religion above the needs of the patient. It’s discrimination. No, it’s not discrimination. See above. It seems to me that if you insist the doctor has an obligation to perform the procedure when they have moral issues against doing so, it is you who are imposing your moral values on the doctor.

    Providing health care for their patients, which includes abortions and other legal procedures like sterility procedures, is part of the duty of their profession. Period. They are claiming that they don’t have to follow their duties whenever they don’t feel like it, and that they get to do this simply by citing some religious objection.

    I am in agreement with Mike Blyth above who wrote:

    I do think that it’s reasonable to consider ethical questions involving killing at a different level than, say, giving a life-saving tranfusion. I don’t know what the applicable laws are in prisons, but I would be sympathetic to a guard who refuses on ethical grounds to carry out an execution, despite the fact that it is part of his job description and is perfectly legal. Likewise, I think it is very reasonable that we should have different standards for oversight in intelligence operations involving killing than for other operations. So I think it’s specious to dismiss the issue by comparing it to other issues of medical care.

    It can and does lead to all kinds of abuses, up to and including death of the patient.

    I’m don’t think this is true for self-employed obgyn’s who won’t provide abortions. Can you give me an example of a patient who died because their obgyn told them they would need to get another doctor to perform the abortion?

    It’s intolerable and flies in the face of what it means to have a professional duty. If an ob/gyn doesn’t want to perform abortions, they should get the hell out of the profession, because they have a duty to their patients that they are refusing to follow through with. I have to disagree with you here. I don’t think that every physician has a duty to offer every single procedure that might be considered part of their general area. Not all dentists handle root canals and it isn’t a dereliction of duty for them to refer a patient to someone who does.

    OTOH, I do think it would be intolerable to force physicians to choose between committing what they consider murder or leaving the profession they have invested their life thus far into. As Mr. Blyth put it, it’s reasonable to consider ethical questions involving killing at a different level than other types of procedures. If a dentist can choose not to offer root canals, why cannot an obgyn choose not to offer abortions?

  • Figs

    Also: if you go to a vegetarian restaurant, you have no reason to expect that they’re going to sell you fried chicken. If you can read. Same as if you go to a pizza restaurant and demand General Tso’s Chicken. But if you go to an ob/gyn, it’s reasonable to expect that you would be able to get ob/gyn services there.

    More, the standard that you outline above, whereby doctors should be able to withhold ANY DAMN TREATMENT THEY WANT as long as it’s not an emergency, is absolutely rife with opportunities for abuse. What if it just so happens that all of those times you have “moral objections” coincide with whenever a black person walks in your door? You can tell them that you’re exercising your moral right to withhold treatment in a non-emergency situation.

    Let’s abandon the silly vegetarian restaurant thing, shall we? Let’s look at a much more applicable circumstance: pharmacists who want to reserve the right to not dispense medicines to which they have a moral objection. How is this different? What if the next closest pharmacy is 50 miles away? Is it reasonable to make a person have to truck all that way to get their prescription? Why or why not? Now let’s say the nearest ob/gyn is 50 miles away. Is it reasonable to say, “It’s not an emergency, hope you have the gas money sucker, get out of my office”?

  • Figs

    BTW, the comparison with dentists and root canals is nonsense. You must know this.

  • GCT

    I don’t think one person forcing their values, religious or otherwise, on another person is discrimination. It’s abhorrent, but it’s not discrimination as I understand it.

    It is, because it’s going to be detrimental to anyone who doesn’t share the doctor’s religion. You keep claiming it’s not discrimination, but not explaining why it isn’t. Those who do not subscribe to the doctor’s religion have a right to health care and a right to certain services under law. When a doctor refuses to serve certain people who have certain needs because of his religion, then it is discrimination.

    Since we are discussing physicians in private practice, who if they did perform abortions would need to schedule them in a facility with the proper equipment and support staff, I don’t see declining to perform abortions as the doctor forcing religion on his/her patients. I do, however, see your insistence that obgyn’s must perform abortions when requested for non-emergency situations as forcing your moral values on obgyns.

    Rubbish. When I say that pharmacists should be required to fulfill prescriptions, even when they claim to have religious reservations, is that similarly forcing my moral values on them? They signed up for the profession. They have to abide by the duties of the profession. If I’m forcing a moral value on them, it is that I’m telling them they need to follow their professional ethics. This is something that you seem unable or unwilling to grasp or deal with. Until you can accept that professional doctors have standards based on providing health care and not a la carte care, then there’s not much else I can say.

    Being able to perform the procedures is a separate matter from being willing to perform the procedures.

    I only put that in there because I wouldn’t expect a doctor who specializes in shoulders to have to perform knee surgeries.

    I’m not sure what requirements exists that obgyn’s in training learn to perform abortions, but if it is a requirement, then I would agree that training requirements should not be waived because a potential doctor has moral objections. They either accept that they must learn how to perform the procedure or train for a different specialty.

    And, that should be a clue that it’s part of the job description.

    Sure, they are obligated to provide the best care, but I don’t see this as conflicting with referring the patient to a different provider for services they don’t want to provide in non-emergency situations.

    Because they aren’t providing the best care but are passing off their professional responsibilities. This is especially true in more rural areas where the closest abortion provider may be hundreds of miles away. Too bad for those women, right? Doctors get to tell them to go somewhere else and toss them out on the street.

    Is a vegetarian restaurant owner is vetoing the wishes of a patron that asks for fried chicken by telling them no, they will have to go elsewhere?

    Again, the vegetarian analogy does not work. Vegetarianism is not a protected class. Religion is.

    I am in agreement with Mike Blyth above who wrote…

    And, I disagree for all the reasons I’ve stated previously and continue to state. Doctors are not allowed to discriminate, they must uphold the duties of their profession, etc.

    I’m don’t think this is true for self-employed obgyn’s who won’t provide abortions. Can you give me an example of a patient who died because their obgyn told them they would need to get another doctor to perform the abortion?

    We do have cases where doctors would not provide abortions, and the idea that unless it’s a non-emergency that it somehow doesn’t count is absurd (or that it must end in death). The culture that accepts professionals not doing their jobs leads to these abuses and deaths. It’s enough for me to condemn it if the patient has to travel to another (real) physician and go through the extra strain, financial hit, etc. Those are real harms that come from these non-professionals forcing their religion on all those around them.

    I have to disagree with you here. I don’t think that every physician has a duty to offer every single procedure that might be considered part of their general area. Not all dentists handle root canals and it isn’t a dereliction of duty for them to refer a patient to someone who does.

    That’s why I put in the disclaimer about things that don’t fall under a doctor’s expertise.

    OTOH, I do think it would be intolerable to force physicians to choose between committing what they consider murder or leaving the profession they have invested their life thus far into.

    Oh, I get that. How do you separate it from the pharmacist or a doctor refusing any other medical procedure by claiming it’s against her religion? How about the actual costs and harms that come to the patients from these doctors deciding which treatments they will and won’t give?

    Other than that, I don’t know how I can explain it any better to you. When we allow special rules for people based on their religion, we are engaging in discrimination (it occurs to me that it’s discrimination against other doctors that don’t get to simply decide not to do X because they happen to be irreligious or a different religion). Why should certain doctors get to play by special rules? Why should they be allowed to foist their religion on others? I outright reject such a notion.

  • GCT

    Here’s a good question for Beth as well:

    Can a county clerk in a state that recognizes gay marriage refuse to process a marriage license on the grounds that it’s against her religion?

  • Figs

    After all, their getting married isn’t an emergency, and they could get a license from the next county over.

  • http://bethclarkson.com Beth

    @GCT: Can a county clerk in a state that recognizes gay marriage refuse to process a marriage license on the grounds that it’s against her religion?

    No. I think that employers have the right to determine the duties of a position. People who are unwilling to perform their job duties, for whatever reason, can be let go.

    You keep claiming it’s not discrimination, but not explaining why it isn’t. I’ve explained why I feel that way several times now. It’s not discrimination because they aren’t refusing service to a class of people, but refusing to provide a particular service.

    Those who do not subscribe to the doctor’s religion have a right to health care and a right to certain services under law. When a doctor refuses to serve certain people who have certain needs because of his religion, then it is discrimination. No, it’s not. He/she is not refusing to serve certain people but refusing to provide certain services. That is not discrimination against a protected group.

    Because they aren’t providing the best care but are passing off their professional responsibilities. Are dentists who don’t do root canals passing off their professional responsibilities? What if the closest place to get a root canal is hundreds of miles away. Does that obligate the dentist to take on the responsibility of doing root canals?

    Again, the vegetarian analogy does not work. Vegetarianism is not a protected class. Religion is. So you agree with me that the doctor’s religious beliefs should be protected? :)

    The doctor is not refusing to treat patients that not members of his/her religion. He/she is refusing to provide a particular service regardless of what the patient’s religious beliefs are. She might even be a member of his religion. The issue is whether a professional obgyn is obligated to provide abortions himself or allowed to refer patients to other physicians for that service because he/she does not want to perform that procedure.

    That’s why I put in the disclaimer about things that don’t fall under a doctor’s expertise. I don’t see why root canals wouldn’t fall under a dentist’s expertise. Some dentists do them. Others don’t. Why do you consider it ethical for doctors in some areas (dentistry) to decide against offering all possible procedures in their area of specialization while doctors in another area (obgyn) are not allowed to make a similar choices for themselves?

    How do you separate it from the pharmacist or a doctor refusing any other medical procedure by claiming it’s against her religion?

    I don’t separate it by whether or not the objection is religious in nature. I separate it by whether or not the person is self-employed. If they work for someone else, they must either accept the terms of their employment or seek other employment in line with their moral standards.

    If they are self-employed, then they have to right to decide for themselves what services they will offer to the public. This right can be modified by statute though. If there are laws requiring them to offer such services, when they must obey the law or close up shop. I don’t know the relevant laws regarding what medicines pharmacies are required to stock for customers, but doctors are commonly allowed to refer patients to other physicians in non-emergency situations.

    How about the actual costs and harms that come to the patients from these doctors deciding which treatments they will and won’t give?

    How about the actual costs and harms that would come from requiring people to perform tasks they consider immoral or be barred from practicing medicine?

    Would the policy/law changes you advocating increase or decrease the medical services available to p0eople in rural locations? If there were only one obgyn in a small rural town, the effect might be to make abortions easier to obtain or it could have the effect of making obgyn services no longer available locally because the doctor decided to retire early rather than offer abortion services. Women would then have to travel elsewhere to get prenatal care and other services as well as abortions. I don’t think the net balance of costs and harms versus benefits for is clear cut.

  • Adam Lee

    Addressing Beth’s earlier questions:

    There is a substantial group of people who consider circumcision to be unethical, though it is accepted legally and socially and in fact has some arguable health benefits. If a such a person becomes a physician, must she limit her specialty choices to those where she would not be expected to perform a circumcision, or would it be reasonable to allow her to opt-out of the procedure and let someone else do it?

    I believe that doctors only have a professional obligation to perform procedures that provide a clear benefit to the patient. As far as I’m aware, the evidence for a medical benefit from circumcision is weak and unclear at best. If circumcision could be proven to confer an unambiguous health benefit with no significant side effects, then I’d agree that doctors should perform it when requested, the same way that we vaccinate young children. But I don’t think the evidence for that claim even comes close to constituting a practical proof.

    I would like to ask about other medical services legal only in some places – female circumcision and assisted suicide. Is it unreasonable to allow physicians to ‘opt out’ of providing such services where they are legal? Or is it unreasonable to tell practicing doctors that if they are unwilling to perform all legal services a patient might choose that they should not be allowed to practice their speciality?

    Female genital cutting is a harmful mutilation with no health benefit whatsoever – its only purpose is to enforce archaic cultural norms of female chastity – so not only should doctors not perform it on demand, it should be outlawed. As for assisted suicide, I’d say that if it’s the patient’s clear-minded wish, then yes, doctors should have a professional obligation to assist them in it. To do otherwise would be to say that even a terminally ill person in great pain can’t make a choice which would end their suffering. If anything, the obligation should be even stronger in this case, since a terminally ill person is likely to be even more helpless and to have even fewer options than a woman seeking an abortion and even more vulnerable to a doctor who wishes to override their choices.

    I think issues of this nature might also be resolved by making the obligation to provide all currently legal medical services limited to those services that were legal when the physician began practicing. It’s one thing to make it clear to people prior to embarking on their profession that these things will be expected of them. It’s another to change the rules mid-stream and expect people to change their beliefs about the morality of such actions just because they have been legalized.

    I don’t agree that there should be any such grandfather clause. As GCT said, becoming a doctor doesn’t mean signing up to perform a specific set of procedures, it means committing to do one’s best for one’s patients in accordance with the ever-advancing state of the art. Again, the issue is that an individual doctor shouldn’t be permitted to interpose his judgment and deny a person access to legal, needed medical care, just as a city clerk shouldn’t be able to deny people the ability to obtain a marriage license, even for types of marriages that didn’t exist when he started out in his job. Your proposal here would mean that doctors could effectively block any new medical procedure from being available for the span of their entire career.

  • Adam Lee

    I also wanted to address this “vegetarian restaurant” analogy, because I think the dissimilarities between a restaurant owner and a doctor are so great as to make this a difference of kind rather than of degree. Restaurants are plentiful and easy to find, access to food is cheap and widespread, it’s easy to become a restaurant owner, and no one stands to incur serious harm or to be deprived of a constitutional liberty if they don’t eat meat for a single meal. None of these things are true of the medical profession.

    Now, if owning a restaurant was a highly specialized profession requiring extensive training, professional licensure, and and a significant investment of society’s resources; if these barriers to entry were so substantial that restaurants, and access to food generally, were often limited and hard to come by; and if many people needed to consume meat on a regular basis to avoid death or serious harm; then yes, I would agree that restaurants could be ethically and legally required to serve meat to patrons. But none of these things are true in the real world.

    However, note that in the one area of the restaurant business where human health is a concern, namely the area of hygiene and safety, society does set professional and legal standards which even private business owners have to obey. I don’t think anyone here would defend a restaurant owner who tried to cite a personal, conscience-based objection to carrying out any of the sanitary procedures required by the health department. (Would we tolerate a Jain restaurant owner who had religious objections to exterminating any life, even a rat or a cockroach?)

  • Bonnie

    There are plenty of OB’s who choose not to perform Cesarean sections at all, due to the high cost of malpractice insurance. C-sections are needed in emergency situations far more frequently than abortions. Another doctor needs to step in under those circumstances to do the surgery. Is this unacceptable as well? Or do financial considerations carry more weight than moral convictions?

  • Gail

    If you have a moral objection to slaughtering animals and eating meat, don’t become a butcher. If you have a moral objection to war, don’t join the army. If you have some kind of moral objection to letting women choose what to do with their bodies, don’t become an ob/gyn.

    I’m not sure any analogy actually fits, though, because doctors hold women’s lives in their hands. Even if the situation isn’t life or death, it has a strong bearing on a woman’s future fertility and birth control options/requirements, which is a very big deal. Doctors are supposed to do what’s best for the patient without judgment.

  • Figs

    Bonnie, if your ob/gyn has a readily available person to perform your C-section, such that you won’t have to go to extraordinary lengths to get one should you need it, then I hardly see that as a violation of the dictum to provide care to patients.

  • allein

    >>>There are plenty of OB’s who choose not to perform Cesarean sections at all, due to the high cost of malpractice insurance.

    I think all OBs should be able to perform a c-section as well. This is more an issue with our legal and insurance systems, which definitely need some overhauling. Being denied care because the doctor is afraid you’ll sue is wrong, too.

  • plutosdad

    I do think that it’s reasonable to consider ethical questions involving killing at a different level than, say, giving a life-saving tranfusion

    Then explain why religious hospitals refuse to terminate ectopic pregnancies, guaranteeing the death of the mother (and the baby), unless she has other means. If she lives in a rural area, she is at the mercy of the doctor’s religion. The woman that recently died in Ireland is no fluke.

    Saving lives has nothing to do with it. If it did, pro-lifers would be for free contraception and sex education, since there is no greater way to lower the number of abortions than those two steps.

  • plutosdad

    C-sections are needed in emergency situations far more frequently than abortions. Another doctor needs to step in under those circumstances to do the surgery. Is this unacceptable as well?

    If there is a doctor right there to do it, then it is ok. If there is not, then the doctor has to perform the surgery, or he contributes to the death of the woman. And one who barely ever does them and is out of practice won’t be as good. I would not want my wife to see such an ObGyn, especially considering everything that can go wrong with delivery.

  • GCT

    @Beth,

    No. I think that employers have the right to determine the duties of a position. People who are unwilling to perform their job duties, for whatever reason, can be let go.

    So, let’s look at the marriage clerk case. The clerk’s boss is the mayor. If the mayor says, “Don’t give marriage licenses to gays, because I disapprove of it,” does that give cover to the clerk to not fulfill their duties? Or, better yet, does it mean that the scope of the duties of the clerk no longer includes issuing marriage licenses to gay and lesbian couples who are legally able to obtain one? And, what about the point that Adam brought up that the clerk might have gotten the job before gay marriage was legal? What then?

    And, this also brings me to a broader point. Doctors are professionals that are required to be licensed, serve the public/public good, and are an investment of society’s resources. It is not someone’s right to be a doctor. It is a privilege that is granted upon those who do the studies and agree to the rules of the profession in order to obtain a license that allows them to serve the public. There is no such thing as a doctor that has no one to answer to. In order to keep their license, they certainly should have to uphold their professional obligations, which would include fulfilling their patients’ wishes on medical needs, including abortions. When they abstain from fulfilling their professional duty because they wish to put a religious veto on their patients, they certainly are engaging in discrimination and unethical/unprofessional behavior.

    I’ve explained why I feel that way several times now. It’s not discrimination because they aren’t refusing service to a class of people, but refusing to provide a particular service.

    My mistake, I was confused by another conversation. You have said that.

    But, if we went by this logic, gays are not discriminated against when it comes to states not allowing gay marriage. It’s the same argument. Gays are allowed to get married just as straights are, provided it’s to someone of the opposite sex. They are both being granted access to the same level of service by the state, so there can be no discrimination according to your argument.

    Are dentists who don’t do root canals passing off their professional responsibilities? What if the closest place to get a root canal is hundreds of miles away. Does that obligate the dentist to take on the responsibility of doing root canals?

    The reason this is an analogy fail is because you fail to note that there are specialists in dentistry. I’ve already headed this one off with my comment about specialties. I do not want a GP to do ACL surgery on my knee. I want an orthopedic doctor that specializes in knees. Same with root canals. Dentist is to GP as endodontist is to orthopedic surgeon.

    So you agree with me that the doctor’s religious beliefs should be protected? :)

    Yes. (I know you think you were clever there…)

    The doctor’s religious beliefs should be and are protected. But, so are the (ir)religious beliefs of the patients. The doctor is free to think that abortion is murder and not like performing the action. The doctor, however, is not free to force that opinion on her patients. The doctor’s religious protections end where the protections of the patient begin.

    The doctor is not refusing to treat patients that not members of his/her religion.

    You seem to be stuck on the idea that discrimination can only happen if one is denied all services based on a protected class status. This is inaccurate.

    I separate it by whether or not the person is self-employed.

    Whether the person is “self-employed” (see above) or not is immaterial to the fact that the person works for the public good and is a licensed professional. People who are self-employed don’t magically gain the right to disregard their professional duties or discriminate.

    If they are self-employed, then they have to right to decide for themselves what services they will offer to the public. This right can be modified by statute though. If there are laws requiring them to offer such services, when they must obey the law or close up shop.

    This directly contradicts your grandfather clause argument from before.

    How about the actual costs and harms that would come from requiring people to perform tasks they consider immoral or be barred from practicing medicine?

    That’s part of being a professional. They signed on the dotted line to incur those costs if need be when they signed up for the job and applied for their license. Honestly though, I find this reply of yours to be callous and thoughtless. I’m sure the woman who dies because a doctor won’t perform an abortion should be less of a consideration than the feelings of the poor doctor that has to do her job and is getting paid to do so.

    Would the policy/law changes you advocating increase or decrease the medical services available to p0eople in rural locations?

    Increase. As of now, women in certain parts of the country have to travel hundreds of miles in order to obtain reproductive care, because local doctors refuse to do those services. This is intolerable. It’s well past time we tell those doctors to do their damned jobs.

  • http://OneFamilyManyFaiths.blogspot.com Y

    Well-reasoned and well-said. Bravo!

  • Radi

    There’s one thing I’m seeing in a lot of the arguments against requiring doctors to follow professional standards set by their own licensing authority – they have more than just a whiff of JAQ-ing off. I see “doctors shouldn’t have to perform abortions on demand if they are morally against it”.

    And There’s one thing that I don’t see in any of these arguments.

    Would any of these armchair philosophers who are so reluctant to force the poor doctors to do what their professional ethics REQUIRE them to be ready to do, and thus violate said doctors’ so-called right to withhold treatment, care to answer this question:

    WHAT ABOUT THE RIGHTS OF THE WOMAN NOW BEING FORCED TO BEAR AN UNWANTED CHILD? Are HER rights not being violated, HER health not being put in jeopardy, possibly long-term? And against her stated will, too.

    No fucking two-faced language about “doctors’ religious beliefs” either – the fact remains that a woman denied medical care that she’s seeking IS having her rights violated, against her will.

    Do those armchair philosophers have any reasonable answer to that, or is it going to be the fucking two-faced dipshit asshole-ish “if she doesn’t want to risk a pregnancy, she shouldn’t be having sex – but in no case must the doctor be required to provide an abortion if it is against their religion” kind of answer?

    Yes, in case it is unclear – I am being extremely sarcastic about the – usually male – armchair philosophers who would never be in this situation in the first place. Or in the case of female armchair philosophers, who would never countenance abortion, unless of course they themselves need it. In which case, it would be “rationalized” in their mind why THEY deserve the access to abortion on demand, but those sluts over there don’t.

    For those still unclear about my position: I completely agree with Azkyroth. And where zhe chooses to express hirself forcefully, using language that the pearl-clutchers are offended by – I totally agree with and support that too, because I have read Azkyroth’s comments here and on other blogs, and zhe has never been anything but cogent, concise and very rational in hir comments. Remember, rational does not mean unemotional, and being emotional in expressing your argument does not in any way rule out its rationality.

    Any person who tries to rationalize denying people the medical care they need, for whatever reason, is a fucking dipshit asshole of the first order. Even if they are a sainted doctor.
    Do NOT bring up spurious arguments like “should a doctor opposing circumcision have to perform those (where it is legal) against their will” either – if it is an adult requesting it, hell YES. If it is parents requesting it for a minor child, hell NO! In either of the cases I have stated here, it is still an ethically compatible with the standard of medical care.

  • http://bethclarkson.com Beth

    @Adam: Thanks for clarifying your views. I may not agree but I appreciate your taking the time to respond to my questions.

    With regard to the restaurant analogy, that was in response to a comment from GCT: Can private practitioners decide that they have the right to refuse service to people who are black? If a restaurant owner can’t do it, why should a doctor be allowed? The analogy was with made to illustration that while it’s illegal discrimination to refuse service to non-whites, it is not discrimination for a business owner to decide they don’t want to offer a particular service.

    @GCT So, let’s look at the marriage clerk case. The clerk’s boss is the mayor. If the mayor says, “Don’t give marriage licenses to gays, because I disapprove of it,” does that give cover to the clerk to not fulfill their duties?
    Yes, it gives cover to the clerk. The clerk would simply be following the orders of his/her supervisor and should not be prosecuted or fired for that reason. The Mayor, on the other hand, would be in serious trouble and the city could be sued for failing to comply with the laws of the state.

    And, what about the point that Adam brought up that the clerk might have gotten the job before gay marriage was legal? What then?
    It would be a difficult situation. Because there is typically a delay between the time a change is decided on and when it goes into effect so it would be best if a new position could be found for the clerk. If that isn’t an option, the clerk would have to be let go for being unable to do the job.

    In order to keep their license, they certainly should have to uphold their professional obligations, I agree.

    which would include fulfilling their patients’ wishes on medical needs, including abortions. Currently, this isn’t true. You are advocating for changing licensing requirements in order to make this the case.

    When they abstain from fulfilling their professional duty because they wish to put a religious veto on their patients, they certainly are engaging in discrimination and unethical/unprofessional behavior. We’ve previously covered this. I don’t agree that an obgyn not doing abortions is engaging in discrimination or unethical/unprofessional behavior.

    You seem to be stuck on the idea that discrimination can only happen if one is denied all services based on a protected class status. This is inaccurate. One doesn’t have to be denied all services for discrimination to occur. But I do think that discrimination is treating some people differently than others based on who the individual is. Can you give some other example of discrimination that is based on what is being provided/requested without regard to who the individual is?

    People who are self-employed don’t magically gain the right to disregard their professional duties or discriminate. I agree. Where we disagree is whether ALL obgyn’s have a professional duty to perform abortions when requested. Currently, that isn’t the case. Obgyn’s in private practice may refuse to perform abortions, C-sections, etc. for whatever reasons they feel appropriate. It’s their business, not ours.

    This directly contradicts your grandfather clause argument from before. It’s not an easy issue. If the law were to change, I think that it would be better to apply it only to new doctors than current ones. But if the law were to change in the way you are advocating, then I agree that obgyn’s would either have to offer abortion services or cease practicing. In fact, that’s one reason why I don’t support your proposal. I think it would be both unfair and unwise to force practicing obgyn’s to either perform what they consider immoral procedures or give up their practice altogether.

    I find this reply of yours to be callous and thoughtless. I’m sure the woman who dies because a doctor won’t perform an abortion should be less of a consideration than the feelings of the poor doctor that has to do her job and is getting paid to do so. I will remind you that we are not talking about situations where the woman’s life is in danger. We are talking about the ethics of obgyn’s in private practice who don’t do abortions on demand and instead refer patients to another provider.

    I asked: Would the policy/law changes you advocating increase or decrease the medical services available to people in rural locations? GCT responded: Increase.
    It’s nice that you have faith that the change in professional standards you are recommending would have the effect you want to achieve. I think there would be serious unintended consequences to such a heavy-handed approach and am not convinced that it would lead to an increase in access to such services.
    As of now, women in certain parts of the country have to travel hundreds of miles in order to obtain reproductive care, because local doctors refuse to do those services. This is intolerable. It’s well past time we tell those doctors to do their damned jobs. While I agree that access in some areas is a serious problem, I don’t think you will solve that problem by requiring all obgyn’s to do abortions on demand. There are the additional considerations of equipment, facilities and support staff in addition to the willingness of the physician to perform the procedure.

    Finally, let me ask you this: Do you seriously want to insist that someone stick a knife up your vagina and give you an abortion if their opinion is that if they do it correctly, they will be sending themselves and you to hell for all eternity?

  • Figs

    Discrimination does not always need to be focused on inequality of intent. Often it can come about through inequality of impact. For instance, policies that penalize crack cocaine possession far more than cocaine possession. That’s not explicit discrimination, right? Except everybody damn well knows that the harsher penalties fall disproportionately on black people. By your lights, this would be completely fine.

  • Figs

    Also: I think you just disqualified yourself from discussion with your last point. Good job!

  • Bdole

    Beth said:

    Finally, let me ask you this: Do you seriously want to insist that someone stick a knife up your vagina and give you an abortion if their opinion is that if they do it correctly, they will be sending themselves and you to hell for all eternity?

    You know, that thought occurred to me as well. I expect that doing it INcorrectly would also guarantee them a spot in hell in their minds and that the 2 notions would cancel each other out and they’d just do the job they were trained for. I doubt that too many people who made it through med-school are really that fanatical that they’d consider executing or damaging a woman in their care. More likely they’d simply bite the bullet, refuse to perform, and take whatever consequences the state/muni dishes out.

  • GCT

    Yes, it gives cover to the clerk. The clerk would simply be following the orders of his/her supervisor and should not be prosecuted or fired for that reason.

    One word: Nuremburg. But, this does give a good glimpse into why you are having issue with this.

    It would be a difficult situation. Because there is typically a delay between the time a change is decided on and when it goes into effect so it would be best if a new position could be found for the clerk. If that isn’t an option, the clerk would have to be let go for being unable to do the job.

    OK, so grandfathering is right out. Next.

    Currently, this isn’t true. You are advocating for changing licensing requirements in order to make this the case.

    You know it isn’t true, or you suspect? I don’t know whether it’s true or not. But, I would argue that it should be true. So, yes, I would argue that part of obtaining a license to practice should include giving the health care to your patient that your patient desires.

    We’ve previously covered this. I don’t agree that an obgyn not doing abortions is engaging in discrimination or unethical/unprofessional behavior.

    And, I pointed out that when the state uses the same argument to bar gays from marriage, we see it as discrimination. So, you’ve got an issue to work out.

    But I do think that discrimination is treating some people differently than others based on who the individual is.

    Or it is giving preferential service based on religious ideas.

    Can you give some other example of discrimination that is based on what is being provided/requested without regard to who the individual is?

    Gay marriage.
    Soup kitchens that proselytize after receiving public funds
    The pledge of allegiance/In god we trust on coins
    Manger scenes/crosses/10 commandments plaques on public land
    You get the idea.

    Obgyn’s in private practice may refuse to perform abortions, C-sections, etc. for whatever reasons they feel appropriate. It’s their business, not ours.

    That’s right there is why you are wrong. You are clinging to this idea that once someone becomes a doctor, that it’s their right to be a doctor, that they can do whatever the hell they want and it’s their right. Sorry, it doesn’t work that way. Once again, one does not have a right to be a doctor. It’s a privilege, and the public costs associated with training doctors for the public good is neither zero nor negligible. We have a vested public interest to have doctors, so we support them, and in return we expect them to support us and perform certain duties to meet their professional duties. This idea that they can tell us all to fuck off once they get their license is completely wrong-headed. This is why your argument doesn’t work. This is why I say you fundamentally misunderstand what being a professional means.

    It’s not an easy issue. If the law were to change, I think that it would be better to apply it only to new doctors than current ones.

    But not other public servants. No, you simply make an exception for this particular issue. Sorry, but you’re inconsistent on this issue and it’s not going to work. The grandfather clause is just not going to work anyway.

    I will remind you that we are not talking about situations where the woman’s life is in danger. We are talking about the ethics of obgyn’s in private practice who don’t do abortions on demand and instead refer patients to another provider.

    Yeah, I get that and I’m still crying crocodile tears. Honestly, fuck those doctors that refuse to do their job and claim that the harm to them is worse than the harm to their patients. Those doctors are not in the right line of business and are bad professionals.

    I think there would be serious unintended consequences to such a heavy-handed approach and am not convinced that it would lead to an increase in access to such services.

    Noted. Yes, I’m sure that most doctors would rather resign and give up their jobs than actually do them. And, I fail to see why it’s heavy handed. They already have a lot of things that they must do in order to be licensed. Telling them that they have to actually provide care? Oh the horror.

    Finally, let me ask you this: Do you seriously want to insist that someone stick a knife up your vagina and give you an abortion if their opinion is that if they do it correctly, they will be sending themselves and you to hell for all eternity?

    Honestly, I would not want that doctor because I would think that doctor is a huge idiot and probably not competent. If the doctor is actually competent, and I need that procedure, yes, that doctor damned well better do it and damned well better do it right. If the doctor is unwilling or unable to do the procedure, then that doctor should seek another job. Period. I don’t give a fuck what the doctor thinks about hell.

  • http://bethclarkson.com Beth

    @Figs: Your point about discrimination is valid. I’ll mull it over a bit. I’m not sure why you think my last point disqualified me from the discussion. I wasn’t aware any qualifications were necessary to post. But I generally try to avoid imposing myself into places I’m not welcome, so this will be my last post in this thread.
    Bdole: I agree with what you say. I don’t think it likely that doctors would intentionally do damage to patients even under those circumstances. I do, however, think that possibility is one of the unintended consequences of such a policy.
    GCT: One word: Nuremburg. Nuremburg? Really? From the person who described doctors who do not do abortions or assisted suicides as being allowed to opt out of doing their job on a whim and later said It’s well past time we tell those doctors to do their damned jobs. and then later in this very post said fuck those doctors that refuse to do their job .
    It seems to me that your basic argument throughout this thread has been: When professional responsibilities have been redefined by the appropriate authorities to include killing other human beings, people should either do their job or give up practicing the profession they have devoted their adult life to pursuing. Nuremburg seems a lot more appropriate to apply to that situation than to a county clerk obeying a mayor’s order not to issue marriage licenses to same-sex couples.
    I don’t think there is much else to discuss in your post that we haven’t previously gone over. I don’t agree with your definition of discrimination nor do I understand why you consider doctors to be public servants. Just because someone is a health care professional, they are not automatically public servants. Not in the U.S. anyway.

  • Figs

    Beth, I’m not claiming that you lack some prerequisite to post. I’m saying that your phrasing in that last question was inflammatory enough to reveal, I believe, that you weren’t actually trying to have a conversation about the point.

  • GCT

    @Beth,
    There’s a huge difference between doing one’s professional duty to help patients and claiming, “I was just following orders” in order to “justify” discrimination. Nice try though.

    It seems to me that your basic argument throughout this thread has been: When professional responsibilities have been redefined by the appropriate authorities to include killing other human beings, people should either do their job or give up practicing the profession they have devoted their adult life to pursuing.

    I don’t appreciate when people lie about their stances. You claimed to be pro-choice, and now you’re claiming that abortion is “killing other human beings.” You’re obviously not arguing in good faith.

  • Ohtobide

    Daylight Atheism

    I agree with just about everything in your post and thank you for posting it. These things need to be said.

    My one problem with what you have said is your mentioning Jehovah’s Witnesses. They are nearly always mentioned when people discuss the duties of doctors and hospitals but it is very unfair. Witnesses do not, as far as I know, insist on other people accepting their rules and their restrictions on treatment. They understand that most people are not Witnesses and do not see things their way.

    Roman Catholics do insist that non-Catholics should suffer because of Catholic teachings. They want to impose their rules on everyone. But Witnesses do not want that. Please do not compare Catholics to Jehovah’s Witnesses.

  • Louloubell

    This is rubbish. A doctor is obliged to provide life-sustaining, or life-supporting care, so blackmailing patients to go to church or refusing anti-virals to an AIDS patient is ridiculous as it contradicts his/her professional responsibility of care. In relation to abortion or contraceptive provision, this is a different case altogether. A doctor (OB/GYN) refusing to take life is not negligent in his/her responsibility of care. There are also many women who would like their pregnancies managed by a doctor who respects life in the womb and who doesn’t ask them 5 minutes after delivering their baby if they are now ready for a sterilization, as they have a big enough family! It should not be obligatory that only doctors who are prepared to kill the unborn, or provide abortifacient contraceptives should be permitted to become OB/GYNs.

  • http://www.patheos.com/blogs/daylightatheism Adam Lee

    A doctor is obliged to provide life-sustaining, or life-supporting care…

    Precisely. And abortion is life-sustaining care when continuance of the pregnancy poses a threat to the life or health of the mother. Therefore, OB/GYNs are obliged to provide abortion.

  • ethical dilemma

    Only, if the mother’s life is threatened. What about the healthy pregnancies? Your argument falls to pieces when a healthy pregnancy example is used.

  • GCT

    All pregnancies are health risks.


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