Of all the terrible policies enacted by the Bush Administration, the eleventh hour “Medical Conscience” ruling is one of the most deplorable. The New York Times reports that the move is heralded by supporters as a necessary step to prevent medical practitioners from having to choose between their morals and their professional standing. Like many citizens and patients, I see right through that logic to the truth: it seriously undermines public health in the name of allowing individual health care employees to impose their own moral code on their vulnerable patients.
I seriously doubt that it will prevent the obstetricians who refuse to perform abortions (and other doctors who keep quiet about legally approved procedures in their own field to their patients’ detriment) from losing some sort of standing amongst their peers. A staunchly scientific community, it is already difficult for religious extremists to find colleagues who share literal interpretations of the Bible or a belief in miracles. Additionally, doctors ALREADY have the right to refuse to perform an abortion under the Civil Rights Act of 1964, which prohibits discrimination based on religion. In this tightly-knit professional community, doctors know of each others’ reputations, and these personal opinions- which make or break careers- are not likely to change just because the few outcasts now have the law behind them.
The new ruling is not going to smooth out the wrinkles in the relationship between morally-torn doctors and their colleagues- although even if it could, this would be heavy-handed big government interference at its worst. What the ruling WILL do is prevent patients from around the country from receiving all of the legal options available to them in their individual health situation. Given the limited availability of medical choice in rural areas- in addition to the restrictions placed on individuals by health insurance policies- this rule sets the US on a course to even more unequal access to care.
Imagine being pregnant in Nebraska, in a small town with only one clinic. Perhaps you would like to take the emergency contraceptive Plan-B, perhaps you would like to have an abortion, or perhaps you would like to carry the baby to term and either raise it yourself or give it to another family through adoption. All of these options are legally permitted in this country, and yet, because you live in X town or Y town, you may not have a full range of choices. Not because your city or township or county laws prohibit you from making an informed decision, but because your doctor doesn’t approve of your lifestyle or doesn’t approve of one of the options.
Under the new law, the doctor may not only refuse to perform procedures he or she disapproves of, but can also withhold ANY information with you that he or she wishes not to share. Maybe as a patient, you would like to discuss the likely physical or emotional side effects of an abortion. As soon as you begin talking, the doctor can simply hold up his or her hand and prevent the discussion from going further. Their moral values will be forced upon you, making care even more unequal than it was before.
If you lived in a metropolitan area, you may have had the opportunity to scout around to different hospitals and clinics. However, even if you did live in an area with multiple options, it sounds like a wild goose chase to call multiple practitioners a day with your list of questions, just to find a pharmacist that will fill your medication or a doctor who will follow your care by YOUR preferences AND who is covered by your health plan.
While the law was undoubtedly crafted to address concerns by doctors and pharmacists who have been unable to separate their professional and political feelings on the divisive topic of abortion, it will affect EVERYONE- men, women and children, young and old. I can imagine a couple that would like the husband to take Viagra, that would like growth hormones to be prescribed (or not) for their child, who would like to try a more holistic approach for serious illness over radical pharmaceuticals. In each case, the doctor in question could simply deny one or more options based on his own personal beliefs. Perhaps he doesn’t believe in sex over fifty, in hormone treatments or in “touchy-feely medicine”.
What of a couple that wishes to have a vasectomy or other irreversible procedure preventing further children, making the choice for their own family that they have enough children? A doctor who believes otherwise may simply not perform the procedure. What about a doctor who believes that vaccines cause autism? Will they abstain from delivering certain ones? Will the elderly be permitted to make painful end of life decisions without the moral authority of the doctor bearing over them?
Medical ethics- a growing and critical field- has barely begun to deal with many of these issues under the old atmosphere. This new mandate throws a wrench into the entire process, skewing public ethics in favor of an individual doctor’s own religious beliefs or political views.
All of us will be patients at some point in our lives- at least at the beginning and the end. How we make our decisions is a personal and complicated process, and one in which we take into account our OWN religious beliefs. However, the only person who should matter in patient decisions is the one whose body and health is being affected: the patient. Instead of wringing our hands over doctors who chose to enter a profession so seemingly at odds with their own rigid beliefs, we should be concerned with the rights of patients. Alongside the Hippocratic Oath should be the right to have the best care possible, without the interference of anyone else’s religion. A separation of church and hospital. Now that would be progress.