What Care Should Doctors Have to Provide?

What Care Should Doctors Have to Provide? March 10, 2013

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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