The Right To Refuse

Listen to this 'Talk of the Nation' topic

Can your doctor tell you no?

Can your doctor tell you no? Source: trp0 hide caption

itoggle caption Source: trp0

Recently, there's been a lot of action on the so-called "right to refuse" front. HHS Secretary Mike Leavitt has a strongly-held belief in "the legal right medical practitioners have to practice according to their conscience," meaning, if a doctor has a moral opposition to something like abortion, he or she should not be legally compelled to perform one. To that end, the Bush administration has promised to implement a rule designed to protect healthcare workers from having to perform procedures to which they object. But in California, the state supreme court ruled against two doctors who refused to artificially inseminate a lesbian, due to their own religious beliefs against homosexuality. Justice Joyce Kennard ruled the Christian fertility doctors were protected neither by free speech nor religious exemption. So where do you draw the line between the right of the doctor and the right of the patient? Is it fair to force a doctor to perform a procedure to which he or she morally objects? Conversely, is it fair to deny a legal procedure to a patient who needs or wants it?

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In cases of non emergency, life threatening, or basic medical needs a physician should have the right to defer and refer a patient on moral or religious grounds. I would hope that a physician who did not ethically or morally believe in the procedure or treatment he or she was asked to complete would have the strength and ability to refer the patient to another physician. I personally would not want a physician who was not fully committed to me to treat me.

Sent by Jamie in Wentzville, MO | 2:44 PM | 9-15-2008

There are many other doctors who could accommodate them.Everyone has a right to their own conscience.When we each meet our maker We will be standing alone!No lawyer can protect or defend us anymore!

Sent by Alberta | 3:06 PM | 9-15-2008

do I hear situation ethics?

Sent by Mike | 3:12 PM | 9-15-2008

Look, if health care professionals don't want to provide legal health care services, they should find another line of work. Pharmacists who don't want to give out the morning after pill, should sell their pharmacies to someone who will. After all they choose that line of work. If they don't want to do their jobs let them get another one.

Health care professionals are by Licensed by the state and have a monopoly on providing health care services. With this monopoly comes the responsibility to provide legal health care to those who request it.

What if I owned a river ferry that linked two state owned roads and said that it violated my morals to transport Japanese cars because Japan killed my uncle during WWII? Should all toyotas be stuck on one side of the river?

What if a firefighter refuses to put out a fire at a hospital because he/she is a Jehovah's witness and the hospital performs transfusions a practice that he finds morally objectionable. Should that be allowed?

Remember 90% of all counties do not have reproductive services within their borders. If providers can choose to withhold medical services, where can women and couples go?

Sent by Richard Wang | 3:12 PM | 9-15-2008

My husband is finishing medical school and I am currently applying for jobs. Due to financial circumstances, we decided to terminate an accidental pregnancy. Being pro-choice and extremely liberal, I did not expect to be affected. However, the emotional toll this took on me is indescribable. I feel it is one of the biggest mistakes I have made - and I have certainly made my share. I am still pro-choice, but I now better understand the feelings of those who are pro-life. Most importantly, I feel we MUST respect the choice of the woman and the doctor. It is unfair to force a physician to perform an act they consider immoral. A physician's oath is to protect and preserve life, and if they feel that an abortion ends a life, this could go against the core belief of their personal practice of medicine.

Sent by Shanna | 3:13 PM | 9-15-2008

maybe not a parallel argument... but... can i opt out of paying taxes because i'm against the war in iraq? or because i don't believe in torturing prisoners.... because i don't believe in the death penalty?

Sent by jenny ignaszewski (sounds like -ignaschefski) | 3:14 PM | 9-15-2008

no doctors should not be able to refuse service on moral grounds I go to them for medical assisents not moral advise. I have my mother and church for that, and both give it freely and unsolisted

Sent by Mitch | 3:15 PM | 9-15-2008

Should this right of refusal also apply to doctors who are members of certain religious sects who may not believe in any number of generally accepted medical interventions?

Sent by Linda Willcoxon | 3:16 PM | 9-15-2008

In taking a job, such as a position as a doctor, there are regulations in place that need to be followed. While the people working this type of job are hardly automatons, personal morals should not play a role in determining whether birth control pills are distributed or a woman (lesbian or not) is artificially inseminated.
People frequently visit doctors for what are called "second opinions," but opinions of doctors should not be based on moral judgements.
People should do their jobs to the best of their ability. Refusing service of any type based on an internal emotion or religious belief is wrong.
I work for a company that sells commissary items to prison inmates. I personally do not believe that inmates should have a right to a TV set, for instance, but I perform my job duties regardless. If a duty is abhorrent, but it is part of your job, then it is your job. A doctor who does not want to do a specific duty should not hold a job that requires it.

Sent by Jamie Petty | 3:20 PM | 9-15-2008

All professions have ethical standards that are law bound. A civil engineer can not choose to build a bridge out of unsafe "recycled" materials because of religious convictions. You either do the job as agreed or do a different job. If you don't like filling birth control prescriptions or building safe bridges get another job.

Sent by Rocky | 3:20 PM | 9-15-2008

These are professionals that are offering service to the public. These folks need to practive medicine and pharmacy as licensed or surrender their licenses. A decsision of the individual is sacrosanct in this society. Any fetus unborn still does not have the rights bestowed upon a living, breathing,functioning human. Fetal rights have not been established in the courts.

Did we learn nothing from the Shivo debacle when the government tried to intervene in a human decision.

This is also another example of a country willing to try and grant rights to fetuses when denying rights to a person because of their sexual orientation.

Sent by Dan Fahy | 3:21 PM | 9-15-2008

Good grief! I am a computer programmer. If I found out that software I am expected to use for my job was developed by someone affiliated with a hate group and told my boss I would not use it on those grounds, I'd be out the door, and rightly so. Individuals who are unable to fulfill the responsibilities of their chosen career need to choose a new career...

Sent by Steve | 3:21 PM | 9-15-2008

What about other professions? Should science teachers who object morally to the theory of evolution be exempt from teaching it in public school?

Sent by AnnMarie | 3:24 PM | 9-15-2008

If a health care provider refuses to provide a patient/customer with a *legal* medication or procedure, wouldn't the patient have very solid legal standing to pursue a suit against the non-provider for a violation of their civil rights?

More so, it seems to me that the non-provider would be acting in violation of section 25 of the Universal Declaration of Human Rights, which states, "Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

Sent by Glenn C. Devitt | 3:24 PM | 9-15-2008

Easy fix - prohibit health care providers from requesting or recording information for which patients can be discriminated against.

I can't see any reason anyone would ever want to make a decision for another person, that seems like an immoral act to me.

Sent by GreyMud | 3:25 PM | 9-15-2008

I think anyone electing to choose the health care profession needs to determine in advance whether or not they can fully participate in all procedures regardless of the ethics you personally follow. make your choice before you are forced to make choices with real patients in real settings. Don't go to places where you are the only one (the pharmacist scenario you presented), don't work in a rural hospital or more isolated area and then feel like you can now refuse procedures that are within the limits of the law. The harder issue is the division between elective and required services. People have a responsibility to live their lives morally and ethically...why should medicine be the "bail out" for reckless behavior?

Sent by Lieutenant Colonel Terrence Flynn | 3:25 PM | 9-15-2008

If health professionals are unable to preform the full scope of their duties due to conscience, they should position themselves in settings where those duties are not required. Their refusal to do so not only harms and inconveniences potential patients, but also their colleagues forced to take over these presumed objectional duties, are often treated with distain for doing so. Health care ethics are messy and involve many grey areas, like life itself. Perhaps not of us are not all cut out to deal with these issues.

Sent by margaret peterson arndt | 3:25 PM | 9-15-2008

Wouldn't it make sense for health care professionals who wish to decline to treat certain condtions, requested by a patient, ensure that they enter a speciality or sub-speciality where that dilemma would never happen?

submitted by Jim in Anchorage, AK

Sent by Jim Spalding | 3:26 PM | 9-15-2008

My husband & I were newly married in 1975 & still in school. Due to a failed diaphram I became pregnant. We went to the local state medical facility which we had been using for primary care to seek an abortion. The Dr who attended us was Morman & argued with my husband (I was hysterical) about the sanctity of life. He refused to recommend us to another Dr. On our way out a nurse gave me the number of the local women's clinic.
I feel as if the Dr should have excused himself & recommended another Dr. He should not have tried to convince us. This was a state insitution.
Please do not use my name.
We went on to have 2 beautiful planned & much loved children when we were mature enough. Thank you.
MG, Charleston, SC

Sent by Marian | 3:26 PM | 9-15-2008

If one's ethics are in opposition to the legal conduct of a chosen occupation, then one should find another occupation. There are too many situations that could prevent themselves that leave a doctor open to personal ethics, Enemies on an a battlefield, HIV victims, drug users, racial ethnicity are all potential examples.

Sent by Jim Fansher | 3:27 PM | 9-15-2008

I guess I feel like I am missing the boat on this debate because it just doesn't make sense that the medical practitioners have a right to refuse services based on their OWN personal Views--- It seems to me like they just
need to quit and not be the service providers if they can't separate their biases. It seems to go against the pledge they take and role. It also feels like an imposition of their own ideas on the patients.
They have a choice not to be in this field.

I think the rule is unconstitutional. Listening to the ideas of the practitioner being a human with feelings is all just however, it isn't okay to not provide the services I think their better route is to get another job.

Sent by Deborah Figueroa | 3:28 PM | 9-15-2008

I fully agree with Steve. If you don't agree with something you will be required to do in a career, don't choose that career! If you are against abortion, don't become an OB/GYN. If you don't want to dispense birth control as a pharmacist, then work in a research lab. If you object to part of a job, aren't you in fact objecting to the profession as a whole?

Sent by Rachel T | 3:29 PM | 9-15-2008

Exactly HOW ridiculous can one get? Can a Scientologist pharmacist
refuse psychiatric medications to a patient?
How about a physician who is a Jehovah's Witness refuse to save a
patient's life with a blood transfusion?

Sent by Matt Gates | 3:29 PM | 9-15-2008

No, absolutely not. A doctor's primary function is to abide by and practice the Hippocratic oath, next, they are to perform all legal procedures, to the best of their ability. The notion that a physician can cherry pick what procedures they'll perform on which patients is abhorrent. If I need a blood transfusion, I don't need to ask my doctor if he/she is a Jehova's Witness. Surely, a student of medicine is all too well aware of what is required of them. If they find that the requirements are contrary to their religous/moral convictions, they are free to choose another professin.

Sent by Dennis Csatari | 3:30 PM | 9-15-2008

I would like to stress that medical workers who provide abortion also may be acting according to their conscience, particularly in cases of rape and incest, but also when a mother is not able or ready to care for a child.
It is as important to protect the ability of a medical worker to act according to his or her conscience if it means providing abortion as it is to excuse other practitioners from providing abortion if it is against their conscience.

Sent by Gert Weil | 3:30 PM | 9-15-2008

Individual conscience may be sacrosanct - where that choice is confined to that individual. But where it affects a multitude of people OR limits the choice of another individual, this is a form of coercion as well. If someone does not wish to perform certain tasks (such as health care professionals), they should not demand work from organizations (such as clinics, pharmacies) that do. In fact, they may be disqualified from such positions. For this reason, conscientious objectors should be disqualified from military service that directly involves killing - but they can still serve in non-military ways.

Sent by Monica Rokicki | 3:30 PM | 9-15-2008

Perhaps health care providers who have refused service on the basis of their personal beliefs need to revisit the moral obligations spelled out in the Hypocratic oath. Doctors, in particular agree to abide by these requirements of service before beginning their practice as physicians. If they cannot square their personal beliefs with the fundamental requirements of the job, perhaps another career choice is appropriate.

Where do we draw the line? Do we begin allowing police officers to enforce only those laws they agree with morally? How about soldiers in the field refusing to inflict harm on another human being?
The roles being discussed are all voluntary-- no one is required to accept a role as health care provider. At some point, once you have agreed to serve a particular role in society, your personal beliefs do not give you license to rewrite that role to your liking.

Sent by Cheryl | 3:30 PM | 9-15-2008

If you cannot fulfill the requirements of the job then it is your duty to NOT to pursue that line of work despite your desire to do so. It is not societies responsibility to accommodate your moral proclivities.

Sent by Kyle | 3:30 PM | 9-15-2008

This is an issue of patient vs physician autonomy.
A competent patient's autonomy trumps physician autonomy. Physicians can get another job but health care is less optional

Sent by jamesjng | 3:31 PM | 9-15-2008

This is a solution in search of a problem. There's no huge upsurge in doc-firings that this rule has to address. And face it -- almost ALL clinics and hospitals do NOT do abortions. Any worker who seeks and takes a job with an abortion-providing institution is not in need of a law that lets them refuse to do the job they accepted.

Sent by stella shaffer | 3:31 PM | 9-15-2008

Listening to the program, it seems to be focused on Abortion.

I've worked in health care for many years, and I have witnessed that a patient in need of an organ transplant can be refused, or knocked to the bottom of the list, based on life-style risk factors.

It seems there are many examples of physicians and other health care workers making moral judgments regarding treatment plans for their patients.

At what point do you draw the line?

Sent by Rhonda Konicki | 3:31 PM | 9-15-2008

The only way Professionals can be orthodox in their lives and also live in America is if they can object for moral or religious reasons. I am a family law attorney and regularly defer cases because I don't feel good about the motives or behaviors of my client. I did not attend law school merely become the "hired gun" for another person.

Sent by Mary Brown Boren | 3:32 PM | 9-15-2008

Isn't this conversation a slippery slope? What about AIDS patients who can't get drugs from a disapproving pharmacist? What about drugs for lung cancer in cases where the person is a smoker? Who gets to say a patient lives or dies?

Sent by Sharon Marshall | 3:32 PM | 9-15-2008

Can a health care professional conscientiously object to treating a black patient, a Arab patient, an "enemy" based on nationality? A person's "conscience" is not necessarily a high moral standard. Health care professionals have been given a professional credential, with which comes a professional obligation to offer professional care. The appropriate path for a conscientious objector, whether military or medical, to find another profession.

Sent by Jeff Byers | 3:32 PM | 9-15-2008

What is the difference between a doctor refusing to treat or refer a procedure that they don't morally agree with and a doctor to refuses to treat someone based on race or religious beliefs?

Sent by Tracy Elsey | 3:32 PM | 9-15-2008

I'm well beyond an age where refusal of service would be applicable. But I wouldn't/don't want a doctor to touch my body who has issues with my believes. I believe it is the responsibility of that doctor to refer me to other physicians in the area who would treat me without judging me. One other thought -- I believe in taking personal responsibility for my medical problems, including searching out the appropriate physician for my needs.

Sent by Phyllis | 3:32 PM | 9-15-2008

If doctors can op out of this, why can't preachers, priest, and the like? I'm addressing beyond the hot-button abortion only issue, but the everyday issues. Will a pharmacist not give Viagra to an elderly man, who is a widower, single, etc.? What happens with the police person, the fireman, etc.

Sent by Curtis | 3:32 PM | 9-15-2008

I am an Army Surgeon. I spent time in Afghanistan from 2006 to 2007. One incident struck me as being relevant to this conversation. We got a Taliban casualty in our BAS. He had life threatening injuries and needed immediate care. He was also the person responsible for the IED production in the region in which we were stationed. I am positive I had to care for soldiers that were wounded as a result of his actions. According to your arguments, I should have the right to refuse care for this gentleman because what he was doing was morally wrong and I shouldn't have to care for him. Fortunately I remembered that I was a Doctor and that I took an oath. If you don't want to follow your oath then leave the profession. Major Ronald Hyde

Sent by Major Ronald Hyde | 3:32 PM | 9-15-2008

As a medical professional, it is your responsibility to provide the services that are part of the job. I certainly think that it is okay for a health care professional to refuse to do a job they feel immoral- but it should be treated as a refusal to do their job, and so they are putting themselves at risk of repercussions as they would get from any other type of refusal of service.

It sounds like part of the problem is the lack of free market imposed by insurance companies. Perhaps laws need to require insurance companies to allow customers to seek physicians willing to perform treatment.

Sent by Charles Bosse | 3:35 PM | 9-15-2008

Save a life-threatening medical emergency, there should be no instance where a medical professional should be required to provide services that are contrary to his or her conscience. Within our history we have occurrences of forced sterilization and medical experimentation without consent, amongst other blatant malpractices. How many of these atrocities could have been avoided if the medical personnel would have felt they had the right to refuse to participate?

Sent by Jefferson Edward Donald | 3:35 PM | 9-15-2008

In the case of pharmacy staff, the issue here includes the basic fact that they are attempting to countermand the advice of the patient's physician(s). Their own values do not entitle them to usurp the role of the physician; if they won't follow physicians' directions, they should not work in a pharmacy.

Sent by James McNelis | 3:36 PM | 9-15-2008

Doctors, indeed all medical professionals (pharmacists, nurses, etc) should be able to refuse. HOWEVER, since medical specialties are not rights, but privileges (subject to liscensure by state in their role of protecting citizens right to quality/available service), nobody who elects to refuse to provide service should have a valid license to practice in those specialties where they may be expected to provide those services. Anti-abortion? Go into geriatrics, oncology, male urology, podiatry, radiology, proctology, etc....

Sent by mark Boundy | 3:36 PM | 9-15-2008

This is raising red flags for me. As an Intensive Care Unit nurse, I frequently am faced with families making end-of-life decisions that I may not support. Medical professionals can often see the couse a person will take long before the family catches up the that reality. It sometimes becomes a tricky and often morally distressing situation when the care I am providing is painful to the patient who will certainly not make it, yet, the family wants 'everything done'. If nurse and doctors were allowed to refuse care in these situations... what then? We use our ethics committee when things get really out of hand.

Sent by Susie, RN | 3:36 PM | 9-15-2008

Hello Neal and guests. I am enjoying the show as I usually do. I agree with the gentleman guest completely in the respect that every individual should be free to abstain from any act he or she deems immoral, be it in the social, political, professional or any other sphere. I feel that this is one of the most fundamental cornerstones of true liberty. With that being said I feel that pharmacies or hospitals should have the right to not hire individuals who are not willing to provide certain services. The most refreshing thing to me about this issue is the fact that it is bringing philosophically poignant issues into the public sphere. If these issues of morality and freedom were discussed every day in main stream forums, we as humans would undoubtedly reap the benefits or free and intelligent thought and discussion. Thank you for this Neal, you are providing a great service, and I hope you are not morally opposed to it!

Sent by John Guthrie | 3:37 PM | 9-15-2008

According to the US Constitution the first right recognized in the the Bill of Rights is religious freedom. This is labeled "free exercise". Free Exercise could arguably be the right to do refuse to do some practice based on religious grounds. Throughout the years other rights have been added, however shouldn't the right to religious freedom trump the supposed "right to services." Many Christians and people of other religious faiths find various practices deplorable (abortion, euthanasia, etc.). Are some suggesting that only pro-choice person's be doctors, or are we diverse enough to tolerate a range of views.

Sent by Jason Miller | 3:40 PM | 9-15-2008

I am a physician and you have no option but to either treat the patient or find someone who will. Once you have that Dr/patient relationship you no longer have the option to not treat. That you feel so strongly about your religion then you should take another position. Perhaps you would be better off (and so would your patients) in an administrative postition where you no longer have any patient contact. Forcing your opinion and how you live your life is NOT an option for a physician. A moral obligation for a physician is to do no harm and to turn your back is not appropriate and nor should it be accepted.

Sent by Lynn | 3:41 PM | 9-15-2008

If a doctor can not perform the requirements of their oath on religious or moral grounds don't they have an ethical obligation to resign as doctors?

If you take an oath as serious as that taken by a doctor and then refuse to keep it shouldn't there be some ramification?

Sent by Jim Swearingen | 3:41 PM | 9-15-2008

I think this medical service argument overlooks the fact that some people view a fetus as a living being. Furthermore, as a fetus becomes viable, there is a question of whether one must be obligated to become involved with what they see to be a murder of the viable being, in favor of some putative "right to chose" whether to terminate a viable being.

I think that there should be a requirement to disclose the physician's viewpoints on these issues, and that there should be perhaps better information about services and organizations. Shouldn't Planned Parenthood, for example, be able to inform potential patients, or is an abortion generally so urgent that there is not enough time to investigate?

I am "pro-choice," but I do not think abortion is a carte blanche right of one being over another. I think there is a real issue of rectitude in taking the life of a viable fetus. I also think there is some point at which no person has the right to take the life of a fetus.

Sent by Derek | 3:42 PM | 9-15-2008

should the doctors and pharmacist not provide any service related to the service they are denying it would be like a conscious objector willing to use a hand gun but not a rifle

Sent by Kirk Stratton,Laramie Wyoming | 3:43 PM | 9-15-2008

The fine line between conscious objection and judgment appears to be intentionally blurred by proponents of refusal of care. A judgment has often already been made about "why" a person is requesting a service. An example would be the possibilities of a patient talking birth control pills. This would be a medication prescribed for birth control, or control of acne, or management of excessively heavy or painful menstrual periods- to name a few indications. Refusal to fill such a prescription on the grounds of ethics presumes the provider refusing knows why this medication is being prescribed. I can't imagine it is either ethical or legal to request that information, and refusing to provide a medicine on the basis of an assumption is abhorrent.

Sent by Sue | 3:44 PM | 9-15-2008

I find this whole line of discussion amazing. Would you want a vegetarian waiter who refused to bring you the hamburger you ordered off the menu because he was against eating meat?Raise your hand if you DON'T think that waiter needs to get a different job where his "conscience" will not be assailed.

Sent by Jim Barfuss | 3:45 PM | 9-15-2008

What about the case of a patient who requests that the physician cut off her breast? Does her or she have the right to chose not to participate?

Sent by David | 3:47 PM | 9-15-2008

What parallels can we draw between the pharmacist or doctor imposing their beliefs on their patients by withholding medication or treatment and extremists bombing those who disagree with them? And how many of these instances involve male pharmacists and male doctors denying treatment to female patients?

Sent by Kirk | 3:48 PM | 9-15-2008

Okay. I have a real-life experience with this. My daughter was engaged to an abusive man. She broke off the engagement, and he broke into her apartment and raped her.

She got a prescription for the morning after pill. She was a grad student at the time, and she was pretty broke. She needed to put the prescription on a charge card, and she had just one charge card.

The only pharmacy in her isolated college town refused to fill the prescription.

My daughter was too embarrassed about what had happened to her to either tell anyone or ask for help. (I'd have been there in a flash, and the pharmacist would have gotten an earful from me -- before we took my daughter's business elsewhere.)

Fast forward: Again, because of the shame often felt by abuse victims, my daughter put off doing anything until past the time when she felt an abortion was something she could consider. On the bright side, we have a lovely granddaughter. On the other side, the baby's father stalks my daughter, and if you think an ordinary stalker is hard to get rid of, you ought to try getting rid of a stalker who is also the father of your baby.

I spent hours this last weekend on the verge of calling the police in the city where my daughter now lives. The father had flown across country to beg my daughter to come back to him, and was lurking outside her door, leaving notes that were alternately threatening and imploring. My daughter called the police several times, but he had already disappeared each time they showed up. (She has, of course, turned the notes over to them.)

Ultimately, do I regret the birth of my beautiful granddaughter? No. How can you regret a baby once she's here?

But if the maniac who fathered this child winds up killing my daughter and granddaughter, I hope the pharmacist who refused to fill my daughter's prescription never gets another decent night's sleep.

Sent by Anonymous | 3:48 PM | 9-15-2008

An important aspect is being overlooked. People can choose a profession. It is not unreasonable to know that certain professions - such as health care - will pose potential conflicts. One should not become a police officer if one is unwilling to shoot a firearm. There is a personal price that one should be willing be accept as part of their conscience when it comes to choosing a profession. This is simply the nature of certain professions. Opting out of the profession is a viable suggestion to those who would not recognize the responsibility to others for whom they should have no say in matters of choice. Unfortunately, some people choose to enter a profession specifically to impose their belief structure on others.

Sent by Pam Dunker | 3:52 PM | 9-15-2008

I live in Tulsa, Oklahoma, the buckle of the bible belt. I must say I have encountered health care workers refusing service to me several times, and have yet to understand it. I have visited an OBGYN for birth control when I was 18. The very busy and professional seeming doctor was very kind until I told her I would like to start taking birth control. She asked if I was married, when I said no, she and her nurse took my hands, and recited the Serenity prayer. She then told me I had the strength to "wait until the right time," and told me her office does not participate in the prescription of birth controlling medications. After the shock, I found another doctor who gave me a prescription just fine, but, the pharmacist refused to fill my prescription at the drug store. Young women are not going to abstain from sex because the doctor or pharmacist would not help them. How morally correct will these self-righteous people feel when the same people they denied birth-control end up terminating an unwanted pregnancy that could be prevented?

Sent by Natalie | 3:53 PM | 9-15-2008

I am adamantly pro-choice, and my thinking on this is leading me to the following:

Choice means we *each* get to choose, according to our conscience. A physician in private practice should be free to choose not to perform non-emergency procedures that violate their ethics. A physician employed by a clinic or health organization should be willing and able to perform any service the organization chooses to offer, and if they refuse, should be subject to discipline, up to and including losing their job. This would also make the willingness to perform certain procedures relevant in hiring decisions.

The serious issues of access to procedures should be addressed either through NGOs like Planned Parenthood, or if the citizens decide, by governmental support. So if you're passionate about access, put your energy and money here. County health services, for example.

In the case of the refusal to perform artificial insemination based on the sexual orientation of the patient, I suspect the court's decision is based on the logic that the doctors do not object to performing the procedure itself, but are refusing based on the identity of the patient, which is discrimination and therefore illegal. So, for example, a doctor may not choose to not treat a patient based on their race, religion, etc. If the doctors refused based on objecting to artificial insemination as a procedure, that would be different.

No system is going to meet everyone's needs all the time.

Sent by Kathryn Burlingham | 4:18 PM | 9-15-2008

As an ICU physician I am often required by families to keep a loved one alive on life support who has no chnace of recovery and the maintenance of the life support involves painfull and/or uncomfortable care. These are patients who have no capacity to refuse this terminal support and are helpless to unilateraly end their suffering. Families who make the decision to keep a loved one alive beyond any rational expectation of recovery are frequently waiting for a 'miracle' or struggling to resolve long standing family conflicts - circumstances that interfere with making humane decisions. Although I object to some of the futile care I provide I do not obligate these families to find another doctor. If the family chooses to keep the patient alive then the patient deserves my care. To do less, or to limit my service to what fits some inner moral compass would compromise me as a physician. My abandoning the patient (and family) would not create a right from a wrong, it mearly offers me a convenient escape from one of the painful aspects of my chosen career.

Sent by Dr. C in SF | 4:25 PM | 9-15-2008

Insurance companies only have certain doctors on the plan. If you have doctors limiting care to what they feel is ethical. Are the patients suppose to call up each of the doctors to find out if they will treat you for each disease. They may find an ethical objection to diseases that effect different ethnical groups or people with certain intelligence. It becomes a slippery slide that will cause the patients to suffer.

Sent by Sheri | 4:27 PM | 9-15-2008

"I am still pro-choice, but I now better understand the feelings of those who are pro-life."
-Shanna, if you didn't understand or lacked respect for women who are pro-life then you probably were not pro-choice to begin with. Being pro-choice means protecting the rights of pro-life women. It means respecting ALL women enough to allow them control over their own bodies. Over 90% of pro-choice women have never had an abortion, nor would they CHOOSE it for themselves. They however are committed to those who have a different belief from theirs.

Being anti-choice means FORCING your personal views and choices UPON others. It's standing on the same side of countries like China who FORCE women NOT to have more than 1 child. It means you want to have the right to CONTROL others.
-If sounds that your personal decision to have an abortion was not done with care and consideration. It appears that the pressures and stress that med school puts on marriage might have caused enough friction for you to make a decision that in your heart of hearts was against all along. Lots of marriages fall apart during med school, the spouse of a medical student has to know that they will be a single parent and need to create an independent life from their med student spouse. In my medical school, all female spouses had 1 or 2 child(ren) with the help of support groups set up by the administration as well as play-groups, and family housing. It's unfortunate that you didn't have access to such a supportive environment.
"It is unfair to force a physician to perform an act they consider immoral."
Many people in medicine consider it immoral to treat patients who develop lung cancer due to their CHOICE in continuing to smoke regardless of the danger. Or people who develop heart disease and smoke due to over-eating. Or liver disease due to excessive drinking. However, as doctors we still have to treat these people regardless of our personal moral judgement.

"A physician's oath is to protect and preserve life, and if they feel that an abortion ends a life, this could go against the core belief of their personal practice of medicine."
You are correct on the first point, that is why doctors don't kill children. Until able to survive outside of the womb, a fetus is incompatible with life. If your husband is in medical school, he should have learned that biological reality during his first quarter. Laymen deal with ideals of life, Doctors as scientists have to deal with facts. If your definition of life were true then most science labs are experimenting with life children daily and should all be arrested.

Many doctors also think it's immoral to allow pre-term children to be born and left to survive my artifical means (breathing tubes, painkiller, living in germ-free plastic tubes)until the die 11 months later (60-70% of them). Apart from the pain in seeing these tube babies made of just skeletal and a couple of layers of skin, is the millions of dollars spent monthly to keep them alive. The same AMOUNT of money can provide better health for thousands of other children.
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Yes, doctors are people too with their own morality and religion. But as soon as you take the oath to care for all in need, you are AGREEING to leave your personal views as the door. When you step into the treatment room, you are there as a professional with an ethical obligation to the patient in the room.

Sent by J. Gesundheit | 4:44 PM | 9-15-2008

I'm curious. If and when euthanasia becomes legal (as it is in some European countries), should a physician, who objects on moral grounds, be forced to commit euthanasia against his/her will?

Sent by Isaac | 5:53 PM | 9-15-2008

do we give viagra to sex offenders? do we give liver transplants to alcoholics with cirrohsis, lung transplants to chronic smokers, cosmetic surgery to kids? should doctors be required to perform sex change operations? should doctors be required to perform lethal injections in death penatly cases? do we require researchers to perform embryonic stem cell research?

Sent by j normand | 7:55 PM | 9-15-2008

If the male commenter wants to make the argument that he believes that the practical aspects of finding another doctor/hospital/provider/pharmacist is not sufficient to require that a provider cannot refuse to treatment on the basis of conscience, then I think that the same argument can be applied to providers who object on moral grounds to certain procedures: they should find a different line of work. The practical aspects of finding a new line of work should be as trivial as those faced by a health-care seeker working with the confines of their insurance provider's plan.

Sent by CSJ | 1:30 AM | 9-16-2008

I can only hope that Sartwell was being a provocateur and that he doesn't genuinely believe the crap he was slinging. He also seems to suffer a bad case of hyperbole, as he declares the forcing of individuals in the healthcare industry to make available (either directly or through referral) those legal services to which they are entitled the 'greatest moral dilemma of our time' - which, if it is, frightens me, because I see many other issues quite higher on that list. It amazes me that he places the moral rights of the refuser above those rights of the refused. And it seems to me that the greater moral danger is in one individual being able to impose their own standards upon those that they have sworn (not merely agreed - SWORN) to serve. It's incredulous that this is even discussable - I'm so tired of people's legitimate rights being trampled by those who believe themselves to be superior. If you can't stand the heat, get out of the kitchen. If you can't serve your patience - through their very active participation in their own healthcare and life choices - get out of medicine. I would suggest to Sartwell the same approach for his educational responsibilities - if he can't engage in honest dialogue, perhaps tenure was too great a gift to bestow upon him. Perhaps he should resign his professorship, and stick to writing articles and books on his athiesm and support of anarchy.

Sent by S. Maul | 7:36 AM | 9-16-2008

i believe na dr should be able to avoid unneccessary elective medical procedures based on his or her conscience and thus avoid attrocities that have happened in the past ie forced sterilization because a individual was retarded or euthenasia because a person does not want to live or abortion the premediated murder of the helpless unborn child no dr because of conscience should have to do theese disgusting immoral practices also invitrofertilization of lesbian couples is a violation of Gods laws and principles if they were meant to have children they would bve so equiped to do so the 1st ammendment to the Constitution give freedom of religious conscience ie you cant force a person to do what violates his or her religious conviction there have been a number of supreme court rulings to this effect but the highest law Gods law says we dont have to do this there are plenty of people who would do such things see them if you must but dont try to force a good Christian person to violate their Bible trained conscience for you whims that is not legal, fair right just moral or ethical to do so history has examples of such attrocities hitler the chineese who only want male kids the pharoh of egypt 3500 yrs ago who gave instructions to his drs and midwives to kill evey male child born the midvives because of a conscience did not do so hopefully health care providers today will have the same COURAGE OF CONVICTION AS THOSE WOMEN DID AND STAND UP FOR THEIR RIGHTS AND BELIEFS TO FOLLOW THEIR CONSCIENCE AND NOT BE BULLIED OR INTIMIDATED TO DO M SOMETHINNG THEY KNOW IS WRONG

Sent by joe | 11:44 AM | 9-16-2008

It is their JOB. They CHOOSE to work in an industry and they would have to be naive to think they would never be placed in this situation.If a health care provider can't seperate work from their personal beliefs, then they are not only failing their industry, but their patients and fellow workers. What gives them the right to FORCE people to be limited by someone elses beliefs? At the very least, if a doctor or pharmacist has a huge objection, they should first do the legwork and find someone to fill the perscription or perform the procedure - why should the patient suffer because of views that are not their own - and then that person should take a hard look at why they are in the industry that they are in and find another job. It is awful that this is even a discussion. NO other industry has this luxury.

Sent by niki | 12:31 PM | 9-16-2008

What other constitutional rights will Christians be able to ignore? Will this "moral" objection exemption extend to other religious beliefs? Other jobs? Equal protection and the separation of church and state continue to erode.

Sent by C. Conner | 1:04 PM | 9-16-2008

j.gesundheit what about the oath that says your supposed to save peoples lives not destroy them could some one say that their pateint to is a fetus and aborting them would not be saving a life instead destroying life woman shouldn't interfere with their doctors own right to do with his/her body whatever they want to do its hyprocrytical of pro-choice people to say a woman has control of her body but a doctor doesn't

Sent by rkd | 1:18 PM | 9-16-2008

If the woman is to have a "choice", then the doctor should have a choice.

If you disagree with a war, you still have to pay taxes, but you do not have to volunteer to fight in the war, or if you do, you are not required to shoot non-combatents.

Babies are the non-combatents in our culture war. A doctor should not be required to kill them.

To the nurse who claims she sees people making end of life decisions she does not agree with. We are not talking about diseased people who face a questionable future, we are talking about healthly babies.

The solders in Nazi Germany were required to take an oath, but that did not stop many of them from disobeying orders when it came to killing Jews.

It is bad enough for people to make a claim that a woman have a choice to kill a baby, but to want to force others to join them goes beyind the pale. Perhaps, with all the financial crisis, the hurricanes, etc. Obama's old preacher Rev Wright is right. The chickens are coming home to ROOOOST.

Sent by Clifford | 1:42 PM | 9-16-2008

Artificial insemination is legal. So is lesbianism. Unless there is a valid medical reason why the procedure should not be done, the doctor should not have the right to refuse the patient service.

Sent by Kate | 1:56 PM | 9-16-2008

Sorry, I just can't let this statement from above go "It means respecting ALL women enough to allow them control over their own bodies. " So does this mean if the doctor is a woman she should have control over her own body and not perform an abortion if she does not want to?

Sent by Clifford | 1:58 PM | 9-16-2008

do we give viagra to sex offenders?
-j normand

Actually, that was recently a big case where NY Medicaid was supplying sex offenders with ED medication.

What I find most disturbing about all this is that these refusals are against WOMEN - male pharmacists refusing birth control/day after pills to women, a male doctor refusing artificial insemination to lesbians, groups refusing women the (very difficult) choice of an abortion. We never hear about female pharmacists refusing viagra to male patients, refusing to sell condoms because they don't believe in birth control.

This is just makes me wonder if the "religious right" are trying to take away the hard won rights of women for reproductive care.

Sent by atalanta | 2:56 PM | 9-16-2008

I feel a doctor should only be able to withhold a procedure from a patient if he or she is able to refer them to someone else who will perform the procedure, and is within a reasonable distance from the patient's home or work. If you are the only provider of that service, say in that county, you hold a monopoly and it is your professional obligation to provide that service to all patients. In that situation you do not have the right to pick and choose whom you will provide the service to. If there are other doctors in your area who will provide the service, then you may have the luxury to refer patients to another provider and can refuse the service if you refer them.

The Hippocratic oath (if I remember correctly) basically states that the doctor obligation is to do what is in the patient's best interest, NOT what is in the doctor's best interest! That should be the goal in all interactions with a patient.

Sent by Dr. William Lyden | 7:29 PM | 9-16-2008

In cases where there are other recourses to get the same service, other recourses which don't cost the person seeking the service anything except possibly a quibbling amount of time spent looking up the second name in the phone book, then I don't see a problem with it.

It's when someone's refusal to perform the service *functions as an actual barrier to getting the service at all*, that it becomes a problem. If you are the only doctor in town, you must perform abortions if asked. If there are 50 doctors in town and you are the only one who has a problem with performing abortions, then I think there should be some leeway.

Likewise, the pharmacy issue. If you have a problem with contraceptives, let someone else man the counter and go sweep up in aisle 7. But if it's late at night, you're the only one minding the store, your store is the only one open, and a woman comes in needing a "morning after" pill in order to prevent contraception, your refusal to sell it to her constitutes a deliberate barrier to her obtaining that option *at all*. And no matter how you pretend it's not your fault she fails to get what she's after, you know perfectly well you were the obstruction.

Fair is fair. Freedom does not include the freedom to restrict others' freedom.

Sent by Kasreyn | 7:47 PM | 9-16-2008

If there is no danger for the abortion not to be perform and the doctor will not be willingly to perform because of religious beliefs he/she has the right the freedom to chose in the U.S. how to believe and if it affects their morals they should not be forced to do an abortion unless the patient had an emergency to do to save her own life.

Sent by Sally | 10:19 PM | 9-16-2008

While I sympathize Prof. Sartwell's viewpoint that medical practitioners should not be coerced into providing care against their conscious, I believe some of the analogies he raises, and the recourse he implies are erroneous.

Sent by Aaron | 12:44 AM | 9-17-2008

of course we hear about females refusing to aid an abortion not all females are pro-choice duhhhh

Sent by efewf | 10:40 AM | 9-17-2008

Killing a baby is not a reproductive right no matter what the Supreme Court says. They have been wrong before. Can you imagine giving people the right to kill anyone that might be an inconvenience? Our highways would be strewn with bodies. It is hard to believe that abortion is allowed in America.

Sent by Cliff | 1:59 PM | 9-17-2008

If a doctor chooses not to perform an abortion, one would expect that he makes no value judgment on the patient, just on the procedure. He would presumably refuse to performing an abortion whether the patient was gay, straight, Christian, Buddhist, Muslim, or Atheist.

The doctor in question in this case had no moral objections to performing artificial insemination, just to performing artificial insemination on lesbians. In that case he was making a value judgment of the patient, not the procedure, and that is very, very wrong.

Sent by Pam Rudd | 2:41 PM | 9-18-2008

What about the people, like me, who refuse to go to a doctor who performs abortions? If all doctors are required to perform this procedure where do we go for our medical treatment?

Sent by Kevin | 1:47 PM | 9-19-2008

Hey Pam, I am guessing that, as gay is the description of a male while lesbian is a description of a female, that the doctor would refuse to do an abortion on a gay person as men do not have babies.

Sent by Cliff | 11:03 PM | 9-19-2008

The argument about medical and other professionals "right" not to violate their personal morality is totally specious. The discussion mentioned doctors who believe that 'abortion is holocaust' are not required to perform a service for which they are trained.
Suppose that a doctor believes that blacks, or whites, or Muslims, or Christians, or Jews, or atheists, or women, or men, are subhumans unworthy of receiving treatment. Are they entitled to refuse to perform their professional duty?
If I go to a gas station owned by a Muslim who believes that any atheist deserves to be killed, I am not only protected by law against being killed, he has to let me buy gas, oil, or whatever else.
Why don't we hold medical professionals to account the way we do gas station owners?

Sent by Nat Ehrlich | 7:29 AM | 9-20-2008

why does this come down to abortion again and again? can't i just go to my doctor (internist or ob/gyn) without getting a morality lecture? how can i put any faith in their diagnosis and treatment if i have to wonder whether i'm actually getting their comlpete medical knowledge? why would i tell my doctor any symptoms if i have to worry about what they'll withhold because they object on moral grounds? as far as i know, there are other medical services one can be deprived of from a "health professional." what about a nurse refusing to give the Gardasil vaccine to your teenage daughter because she doesn't believe that your child should not be having sex until marriage (whether the child is having sex or not is beside the point and never mind that some states have tried to make a Gardasil vaccination mandatory) or the receptionist at the pediatrician's office refusing to make the appointment for the shot (because there are so many receptionists at this huge office). how can we be sure that staff members is a physician's office won't use this as an excuse to decline any service? i can't tell you how frustrating and infuriating it is to have some ignorant bible-thumper in the White House decide that he's morally right and the rest of us have to abide by it. i guess i shouldn't worry too much anyway, our health insurance is through a catholic university that doesn't cover birth control or sterilization anyway-but then again, sex is only for procreation right-glad i didn't have ANY sex ed in school but was definitely taught to say no (not sure if that was for drugs or sex though). one small step forward for moral objection and ten giant steps backward for quality medical care!

Sent by akc | 2:52 PM | 9-20-2008

Nat wrote "If I go to a gas station owned by a Muslim who believes that any atheist deserves to be killed, I am not only protected by law against being killed, he has to let me buy gas, oil, or whatever else."
Nat you are being protected from being killed for an idealogical reason. Why not extend this protection to the unborn. At least you could avoid going to a gas station. A baby does not have this opportunity.
To akc, governments decide all the time what is morally right. Our laws such as the law against murder are dictated by someone, do you find that objectionable too. You know, most of our laws originated from our moral underpinnings found in the Bible. And what would you do with this statement found in one of our founding documents "we hold these truths to be self evident, that all men are Created equal and endowed by their Creator with certain inalienable rights, amoung these the right to life, liberty, and the pursuit of happiness" Get rid of these Bible-thumping words, which in effect say that our rights are not granted at the whim of our government or anyone else, but granted by God himself, and the underpinnings of our republic will be gone, and you will truly be subject to the decisions of someone.

Sent by Clifford | 10:18 PM | 9-22-2008

This is a conversation between ethics and morals. The ethical person denies the existence of moral absolutes and finds purpose and guidance in the pursuit of consensus. An ethical person denies God and looks to the community to develop ethics to live by. They believe the needs of the community always trumps the needs of the individual. This is a desperate attempt to find meaning at the expense of the individual and a denial of the existence of truth.
On the other hand, a moral person finds their purpose and meaning in the existence of truth and of a moral God who sets the standards for creation. The individual has a high standard of value and of responsibility in this view. This view is absolute, the ethical view is arbitrary and constantly changing by the needs and wishes of the community. The ethical argument becomes not only arbitrary but also dictatorial - hence political correctness roams the world looking for individuals to consume for the greater good of the community. Last week my wife gave testimony to the President's council on bioethics. Here is part of her testimony:

In a Los Angeles Times op-ed from last week, Crispin Sartwell identified himself as a "pro-choice atheist", but supports Secretary Leavitt's proposed regulations designed to bolster existing laws supporting conscientious refusal. I couldn't agree more with his statement and I quote: "The extent to which an institution seeks to expunge individual conscience and moral autonomy is the extent to which it is totalitarian -- and dangerous. The idea that I resign my conscience to the institution or to the state is perhaps the single most pernicious notion in human history. It is at the heart of the wars and genocides of this century and the last."
In closing, last week, I read about Randy Stroup of Oregon who was diagnosed with metastatic prostate cancer. His application to the state for healthcare coverage was denied because they calculated that he had less than a 5% chance of surviving his cancer. But, the State did offer to pay for his 'physician-assisted suicide'. In short, the state deemed his life not to be worth saving and in fact was prepared to put him to death. Brave New World here we come. We have fallen so far from the moral principles that the practice of medicine was founded on. If medical professionals continue to be pressured to practice contrary to their convictions, they will leave or never enter certain fields and our society will be the worse for it.

Sent by kyle christiansen | 11:33 AM | 9-25-2008