January 20, 2009

• Provider Conscience Rights

  This week in ethics, we discuss an amendent to a provider conscience rights law, a law designed to say that physicians dont have to perform procedures they are morally opposed to (like abortion) and cant be discrimated or punished for such a refusal. Here are the links

  http://www.hhs.gov/news/press/2008pres/12/20081218a.html Press Release

  http://www.aamc.org/advocacy/library/teachhosp/corres/2008/092308.pdf AAMC response

  At first glance, this topic appears to be a great lead in from last weeks-an amendment protecting the right of physicians to refuse to give services they dont believe in. Obviously the major focus of said protection is abortion related cases, although I suspect one could make a good case for physician assisted suicide cases as well.

  Just as with the death with dignity act, the proposed HHS amendement is not the only law in place to protect "provider conscience rights." The article refers to the Church Amendments of the 1970's, which prevented hospitals from losing funding if their doctors didnt perform abortions due to relgiious reasons, Section 245 of the Public Health Service Act in 1996, which reiterated that the federal government could not discrimate or withold fund from participants in medical training programs due to moral opposition to a procedure, and the Weldon Amendement of 2005 did, well pretty much the same thing, but with larger coverage.

  The proposed HHS amendment, among other points, clarifies that the protections apply "to institutional health care providers as well as individual employees."

  Long story short, congress appears to be passing the exact same law every few years. The two questions that immediately come to mind in this case, then, are what does this amendement offer that the previous incarnations didnt, and how effective is this law likely to be if the others couldnt get the job done.

  Now, I have made my personal opinions clear on physician assisted suicide and by implication, abortion as well. For sanctity of life reasons, I choose not to perform these particular acts...however, that does not give me the right to refuse referral to another doctor who may be willing to provide such services. Medicine is a service industry, and since the service we provide is ultimately to keep people alive, the AAMC letter rightly states that "no individual or entity in this country has the option to pick and choose the laws to which he/she will adhere-a physician shall, while caring for the patient, regard the responsibility of the patient as paramount."

  Which is all well and dandy, and already protected-the problem with this regulation is, as noted by Rachel Egyhazi...the definition of who can refuse to participate becomes too broad, allowing people outside the immediate health care team to refuse services. The idea that a piece of equipment may not be sterilized, or an appointment not scheduled because a technician or receptionist objects to the procedure is patently ridiculous.

  The idea behind all these repeated iterations of the provider conscience right laws is both autonomy and justice. While we as physicians are required to respect the patients autonomy and inform or allow them to make or refuse their own healthcare decisions, the patient is under no such obligation to respect our autonomy in being willing to perform certain acts, when we are also in full knowledge of how it will turn out. Conscience laws protect our autonomy. Justice is the means of allocating scarce resources so as to best serve the community...that is to say, if this law passes, the available pool of services may shrink for the patient since the number of places a procedure can be refused will increase.

  Do I have the right to refuse a service to a patient I dont believe in? Absolutely. What about a nurse or someone else directly involved in the patients care...sure, no problem...as long as there remains options to replace those of us who refuse. But widening the umbrella to include those outside the decision making process is a mistake that ultimately will impinge the patients options and health, and thus violate the principle of maleficience, for by our own refusal to provide services, we risk causing harm

  -Almost Dr J

  • 9:34 pm
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