Unconscience
I was at a doctor’s appointment the other day, and I noticed the nurse had posted a printed-out e-mail chain letter on the wall – so that I couldn’t help but stare at it while she ran my vitals. The picture was a surrealist painting of crucified Jesus; the message said that if I didn’t forward it to everyone I know, something bad would happen – e.g. the President of Argentina’s didn’t, and his son died a week later.
And as I sat there, I thought: “How cruel is this nurse, to show me this email knowing full well I can’t forward it? Obviously, she wants something bad to happen to me!” I’ll let you know if it does, but in the meantime count yourself lucky that I couldn’t find the same picture to post here; then you’d be screwed, too.
Point being, I am not in a sympathetic mood when it comes to religious belief and health care. Which brings me to Kim at Emergiblog, who is sad to see the “Conscience Clause” go; here’s a few key quotes, minus superfluous hard returns, from her note “To my patients”…
There might be an occasion where I cannot participate in an aspect of your care that results from a decision you have made. To do so would be to violate my deepest convictions of what is moral. Or just. Or right.
[...]
But, Mr. President, you rescind that clause and you destroy part of a fundamental American right. My right. To the freedom of religion. What comes after that, Mr. President? What right of mine will you chisel away next?
Kim isn’t specific on what she objects to, but apparently she’s trained to assess patients’ decision-making skills to determine whether or not their concerns are morally suspect. Nurse, psychologist, theologian, ethicist – truly, Kim is a woman for all seasons.
I’m a Christian – not a very good one, but I try. I’m sympathetic to Kim’s beliefs, and agree we’re entitled to protection for those beliefs. But that protection is in whether or not we’re hired to the job, whatever the job entails. If our beliefs are in tension with the job, the legal and moral remedy is clear: don’t take the job. Or quit.
It’s okay, even admirable, to be a conscientious objector. But if you join the army, cash the paycheck, and then insist your religion prevents you from killing: people are going to call you a coward. At best, it’s a weaselly way to obey your conscience. The problem with the “Conscience Clause” is that it legitimates the weasels, making them indistinguishable from the many responsible medical professionals who are in fact willing to do the job they get paid to do. However “right” it seems to some providers, it’s harmful to patients; we’re a captive audience, especially in the ER.
The strength of a person’s beliefs is in what she herself is willing to endure, not what she forces other people to suffer. Kim’s entitled to a job regardless of her beliefs; but she’s not entitled to dilute the job to suit her beliefs.
Duncan -
I could not agree more, as a student nurse there are things related to healthcare that I myself do not particularly care for. However, my job is to provide the best care I can for that particular patient. The “conscience clause” is just another way of pushing religious conservative ideas upon others where it should not be, in the case of healthcare. The conservatives don’t want government to be included in healthcare regulations…so why do they want this?
I do not particularly care for abortions, but it is not my right to push that belief on other people, it is my belief, my personal choice, I do not feel that by providing care for a individual who does feel an abortion is okay has any effect on my conscience. I am not the one doing it, I am the one doing my job.
Thank you for this wonderful post.
“Kim isn’t specific on what she objects to, but apparently she’s trained to assess patients’ decision-making skills to determine whether or not their concerns are morally suspect.”
Nope, didn’t say that. I don’t judge, I can’t. I only know what my beliefs are and where acting would cross the line for me, individually.
I was trying very hard to distinguish between my patients’ rights and mine.
You, however, make some valid points here.
What I did not put into the post, was that I have kept myself out of the position of having to make these decisions by not working in specialties where they are likely to arise to any great degree. I have never “diluted” any job. I don’t think I have, anyway.
The post was, by nature, a general response to the idea of weakening the conscience clause. And I tried very hard to keep it as neutral, and respectful, as possible.
And I never thought you considered me a “weasel” before. ; )
I guess I need to figure out how to number my comments.
Kim 1 – thanks for your comments. I feel about the same way on abortion, and I do try to appreciate how uncomfortable it must be for providers in that situation.
Kim 2 (ie Emergiblog Kim) – For the record, I don’t consider you a weasel. I probably shouldn’t post with a headache; it makes me punchy and argumentative.
I think there are entirely noble impulses behind the “Conscience Clause”. I also think those impulses are misguided, and that ends up being largely a refuge for weasels – which is probably too uncharitable a word, especially in a post where I claim to be Christian. Suffice to say, I don’t think the “Conscience Clause” protects religious freedom, so much as it allows people to avoid the necessary task of hashing out their beliefs in the world as it is.
I do think it’s reasonable – entirely unweaselly – to avoid specialties that involve morally questionable activities. That said, I think the way you framed the dilemma – “an aspect of your care that results from a decision you have made” – does imply an element of judgment, however latent or indirect. It’s perhaps more a problem of inference than implication, but that’s how I read the post.
Amen brother! The one that has bothered me the most in all of the the conscience clause discussion has been the pharmacists who don’t agree with dispensing emergency contraception. Because apparently pouring the pills out of the big bottle and putting them into the small bottle with a label on it will promise their eternal damnation.
If you don’t agree with the nature of your job find another job, pretty simple concept to me. I lean toward the pacifist side of the spectrum so joining the Marines would not be a good idea. If you object to prescribing medications and you are a pharmacist take up research or become a drug rep or something and stop blaming it on your faith.
I find it interesting that in the feedback comments a portion of the argument against Kim’s stand seems centered on whether or not she’s being judgmental towards her patients. I’m wondering why it’s not ok for her to tactfully say she has rights too (show judgment)? The author of this blog seems to imply that while Kim should not show judgment, it is in turn ok for the author to show judgment against Kim.
Aftercancer – the pharmacist/pill one strikes me as the most egregious abuse; I have way more sympathy for the provider struggling with abortion. If the FDA approved it, a doctor prescribed it, and the patient can pay for it, I don’t think a pharmacist has the right to deny it.
RN q – It’s entirely okay for Kim to say she has rights, and for us to talk about what those rights mean and how best to protect them in our society. But there’s a big difference between “showing judgment” (which is a good thing) and judging others based on moral criteria to which they do not assent (which to me is fine if you’re a priest, but not if you’re a nurse). I don’t actually think Kim is doing this latter thing, but I worry that her beliefs end up being an implicit judgment on people who need her help.
Interesting. Potentially a foundation for a debate about the subjects you talk about. I wrote about it, and the post can be found here:
http://manchmedic.blogspot.com/2009/04/whos-judging-who.html
I do not find comparing nurses to soldiers a fair comparison. Soldiers certainly know what they get into when they enlist, with killing part of the job. However, medical ethics changes at warp speed. Nurses encounter moral dilemmas that we would not have dreamed of when we went into nursing school. With that said, I am against the conscious clause. No care provider is forced to actively provide an abortion (because, yes abortion is what this debate is about), but we are obligated to provide resources to the woman if that is the decision she makes. This will not change in Obama’s revision of the clause. Nurses also have the option of not working in institutions that provide abortions. Patients do not often have the luxury to choose the hospital/pharmacy/clinic that will care for them.
Reality – it’s not so much a comparison as an analogy, but I grant you that medical ethics has changed pretty quickly over the last several years. That is an important and relevant fact, but most of what we’re talking about has been part of medicine for decades.
I should point out that while debate is indeed mostly about abortion, the regulation as written also includes “sterilization procedures” – which apparently also includes vasectomies, IUDs, implantable birth control, and dispensing birth control pills. If we were in fact just talking about abortion, I would be more conflicted about the rule. But whatever my feelings about abortion, I’m not the least bit conflicted about birth control.
The reductio ad absurdum of the “conscience clause” is that it seems it would protect a Christian Scientist pharmacist or a Jehovah’s Witness phlebotomist who refuses to do any work at all! However we don’t see those conflicts b/c members of those religions don’t seek them out. It’s interesting how these religious conflicts only ever seem to crop up when it’s to do with the choices women make around their sexuality and fertility.
I can see the “conscience clause” being abused by people who, far from avoiding a medical field of practice where they can expect to have ethical disagreements with patients, may seek out such a field in order to thwart the will of patients who don’t share their views.
Patients rely on medical professionals to inform them of all their legal medical options. When it comes to abortion and emergency contraception, some providers want to withhold that information, and keep the patients in the dark about the fact that they’re withholding anything. That’s not fair, and IMO should not be legal for a licensed medical professional. Part of being an ethical professional in any field is to provide your full expertise and to respect the autonomy of your clients to make decisions for themselves, even if they choose not to take your advice. If you want to enforce your values on other people, find a different job.