On doctors who deny treatment

Richard Sloan, writing an op-ed column in today’s LA Times, waxes trenchant over the California Supreme Court ruling earlier this week that it was discriminatory for a medical group to refuse a woman treatment for her inability to get pregnant. At issue wasn’t the artificial insemination procedure itself, but rather the fact that the woman in question is a lesbian. I had to read Sloan’s commentary twice to determine what was the “welcome, if unusual, turnabout in a disturbing trend that has characterized American medicine over the last three or so decades” even though I’d heard about the decision on the radio–is anyone else accustomed to hearing “disturbing American trend” in a completely different context?

At any rate, Sloan reminds readers that “Freedom of religion is a cherished value in American society. So is the right to be free of religious domination by others,” and it turns out the disturbing trend is this one:

Recent studies have shown that 14% of U.S. doctors, when confronted by possibly objectionable but legal medical treatments, not only would refuse to deliver such care but also would refuse to inform their patients about it or refer them to physicians who would deliver the care. That translates to about 40 million people who would receive substandard care from these physicians, who believe that their religious convictions are more important than the well-being of their patients.

The tradition of religious freedom in the United States is one of the founding ideals of this country. But as our framers envisioned it, religious freedom referred to a right to practice one’s own religion free of interference from others. It did not refer to religiously based interference with the rights of others, who may have their own and different religious traditions. Even in the relatively religiously homogeneous era of the framers, such interference was not acceptable. It is even less so in 21st century America. With religious heterogeneity growing, the devotional demands of one group may be increasingly at odds with those of others.

And of course you don’t need to be in a different religion or even a different denomination to see that kind of heterogeneity in action.

Story is here.

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Category : The Lead

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  1. Kit Carlson

    Doctors hold public licenses to practice medicine. They are there to serve the public. All the public. If they can’t do that, they should find another line of work.

  2. bobbyt

    Sorry Kit. I couldn’t disagree with you more. Artificial insemination is an elective treatment. If a doctor doesn’t wish to artificially inseminate a patient that patient can go elsewhere. After all it is a free country. The only caveat would be if the procedure is covered by insurance and the insurance provider mandates the patient see the specific medical practice in question. In that case, and in that case only, might you have a point.

    – Robert Tomlinson

  3. Let’s take a hypothetical. You’re a doctor. A patient comes to you in need of life saving treatment. The patient is a notorious war criminal. S/he will commit genocide the second s/he recovers, no question about it. Wouldn’t you consider withholding treatment?

    I’m in no way equating homosexuality with genocide, of course. But for some folks, homosexuality is frankly worse than or equal to genocide. Let’s be a bit more understanding of the homophobes, please.

    (sarcasm off)

  4. The scary thing is that these doctors *did* refer the woman to another physician who would have been willing to do the procedure and the court *still* ruled against them.

    In other words the court says there is no freedom of conscience. If you are a doctor you must perform any procedure the law allows. Period.

    Imagine it this way: the law says that a war is legal. But you say your religion says you must say no. The court says now, if it’s legal, you have to allow it, support it, perform it. And nothing you teach in church can have any effect on what you do in your daily life.

    We should all be very afraid and churches – liberal and conservative – should be taking up the cause of these Doctors.

  5. B. Snyder

    I agree with Huw; this is a very scary precedent. If the doctor referred the woman to another physician, what in the world is the problem?

    Are the cops going to stand by in the treatment room and force the doctor at gunpoint to perform this procedure? This isn’t a matter of preserving a life; it’s a completely voluntary procedure, which the woman can get easily elsewhere.

  6. David Austin Allen

    HW and BS have their facts out of kilter.

    From the LA Times article on the ruling by the Cal Supreme Court;

    Benitez filed a suit after Dr. Christine Brody, an obstetrician and gynecologist at the North Coast Women’s Care Medical Group in Vista, said she would not perform an intrauterine insemination. In her lawsuit, Benitez alleged that Brody said her religious views prevented her from providing the procedure to a lesbian.

    Another physician at the clinic, Dr. Douglas Fenton, later told Benitez that the staff was uncomfortable helping her conceive a child and advised her to find another doctor outside the medical group, Benitez said.

    Not much of a referral was it? Basically they refused to do for her a procedure that the clinic would provide for another woman.

    California has a business law that says businesses cannot discriminate against the usual suspect classes of folks; race, religion, gender, sexual orientation, etc., in offering their services to the public. If a hotel, restaurant or a shoe store cannot discriminate, why can a medical clinic, hospital or pharmacy?

    No, the police will not force anyone to not discriminate, those who discriminate will lose their business license and be forced to close their doors.

  7. tgflux

    I’m frankly shocked that Huw and B. Snyder are defending this.

    By this standard, what the heck is wrong w/ “White” and “Colored” drinking fountains, as long as we “refer” the WRONG sort of person to the other facility?

    As DAA says, it ISN’T a question of what procedure (this isn’t an abortion forced onto a anti-abortion doctor). It’s merely a question of on whom it’s performed.

    And that’s discrimination.

    And that’s flat-out wrong (or, as we Christians quaintly call it, “sin”).

    JC Fisher

  8. Bryant A. Hudson

    Freedom of conscience means that one is free to act on one’s conscience. If one’s professional requirements and one’s conscience are in conflict, honorable people are free to resign from their profession.

    There is no right to earn a living in violation of professional requirements.

  9. B. Snyder

    Is anybody defending this decision going to answer Huw’s question about war and “freedom of conscience”? Should people who object to it and refuse to participate be forced to kill others – or else lose their livelihoods and their rights as citizens?

    Or how about this, instead: homosexuality is illegal in Nigeria. Peter Akinola wants to jail people for exercising their freedom of conscience to object to this state of affairs. Is that OK, too?

    It’s the law, after all.

  10. B. Snyder

    FYI, here’s the full version of this story, which shows that Huw was right: the clinic specifically referred the woman to another practice – and even (although I have to admit I’m not sure whether I believe this or not) offered to help her pay for the extra expense involved.

  11. B. et al:

    There is a long tradition, in fact, of people objecting conscientiously at the cost of losing professional practice and even some rights. I remember well the colleague (enough older that he faced the decision and I did not) who managed to get recognized as a conscientious objector during Viet Nam. That didn’t mean he didn’t serve someone somewhere. It only meant he didn’t serve in military service. In fact he served as an orderly in a state psychiatric institution, something he definitely preferred, but also a significant loss of personal choice – he did not have a choice not to serve in some capacity.

    For good and ill, in our society physicians are not public servants. There are few “public good” sorts of requirements on their practice, and artificial insemination would not fall within them. I personally have concerns about the common attitude that any couple (straight or gay) has a “right” to have a child at any cost.

    In general, I think doctors don’t express their moral autonomy often enough. That said, to express that autonomy should also require a good referral and loss of the income that patient might have brought to physician and practice. The decision should also reflect consideration of the other aspects of medical ethics, including the physicians professional responsibility to put the patient’s needs before the physicians; but, again, we would have to argue whether artificial insemination is a “need.”

    So, urban California isn’t really where this issue bites most deeply. It is more difficult for the woman in the small town where the only pharmacist within 100 miles believes birth control pills are really abortifacients, and refuses to dispense them; where the only emergency physician within 100 miles believes the same things about the “morning after” meds, and refuses them to the rape victim.

    We may not like the recognition that, despite our focus on patient autonomy, physicians and other professionals are not simply our employees. We can change that, by changing our health care industry into a true “system.” But we haven’t managed to do that yet.

  12. William Gilders

    In reply to B. Snyder’s reference to Huw’s question about war and “freedom of conscience”? Should people who object to it and refuse to participate be forced to kill others – or else lose their livelihoods and their rights as citizens?

    I think folks have answered the question indirectly. The analogy to religious pacifism is actually helpful for seeing that the court decision is correct: one cannot be a selective pacifist, picking and choosing which wars one will or will not support. If a Christian becomes a soldier, he cannot make his individual conscience the determinant of which legitimate orders he will obey. Likewise, if someone becomes a doctor who provides reproductive services to women, she cannot pick and choose whom she will treat based on individual religious beliefs. Just as Christians who don’t believe in killing shouldn’t become soldiers, so Christians who don’t believe in giving fertility care to lesbians shouldn’t become fertility care doctors.

  13. I’m shocked that we claim to be Christians and we’d side with the law against people who want to follow the same God we claim. We may disagree with their choices, but we need to speak to them – not side with the Gov’t.

    Thanks, B – I think there are clearly two versions of this story in the media. I’d not read the other one until David shared it so I’m not sure which one is right. I will side with the one that paints people in the better light rather than the worse light. The Doctors suggested another resource. But I may be proved wrong. I think we should allow our brothers and sisters in Christ the benefit of a doubt though. Honestly.

    William – we do have a Christian tradition of selective pacifism – it’s called the Just War wherein we kind of hold our breath and trust to God’s mercy that we’re doing the right thing. I think a person must make choices and some of those will make others uncomfortable.

    I agree, by the way, that there is a long tradition of people being forced to choose between their morals and their jobs. I just think the Church should be siding with the people being forced to choose – not the force. Because, eventually, Neimoller shows, they will come for even the good, politically correct and liberal Christians. Then we’ll be screwed.

  14. B. Snyder

    It’s true that people have conscientiously objected to military service, of course – but in at least some cases, accommodation has been made for them. They can serve behind the lines, for instance, where they won’t have to kill anybody, as Marshall Scott’s example shows. (I’m not aware that anybody loses professional standing for doing this, though. And of course it can be difficult to get this accommodation.)

    But accommodation was apparently made in this case as well; the clinic made a referral, it seems, and perhaps even offered to pay for the added expense. Doctors make referrals all the time.

    I really just don’t get this.

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