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Conscientious Objector Policy Act attempts to further mutilates our basic rights
March 30, 2005 8:06 AM   Subscribe

Conscientious Objector Policy Act would allow Michigander doctors and health care providers to refuse treatment on moral, ethical or religious grounds. Yet another OMG MORALZ OMG sort of bill. But wait, what are morals? And does Nicole Kidman figure into this somehow?
posted by taursir (59 comments total)

 
As long as they're required to find a substitute...
posted by delmoi at 8:13 AM on March 30, 2005


I'm not sure what this post is about apart from the Michigan legislation. Nicole Kidman?

Anyway, it's hard to imagine how access to treatment could be degraded any further in the US. And it's interesting to see all the new and imaginitive ways that neocon thinking manifests. There's something inevitable about all this. "Freedom" is indeed on the march...
posted by 327.ca at 8:20 AM on March 30, 2005


As long as they lose their licenses to practice.
posted by blendor at 8:22 AM on March 30, 2005


Would that allow doctors to also refuse to treat Republicans? I'm sure that there are many doctors out there who are opposed to rabid warmongering.
posted by clevershark at 8:23 AM on March 30, 2005


that neocon thinking manifests.
posted by 327.ca at 8:20 AM PST on March 30


It would be really great if you would quit misusing that word until you make an effort to know what it means. When you do so, you will realize how confused you sound by using it here.

As to the Michigan doctor bill, forcing doctors to treat every patient that presents before them seems akin to slavery. Why should they be deprived of the freedom to engage in their profession with their own discretion any more than a carpenter or consultant? These people are not owned by the public. They are not indentured servants. Why should they be forced to treat everyone?

The Hippocratic Oath says to "do no harm." It doesn't say, "Give everyone who is in front of you treatment."
posted by dios at 8:26 AM on March 30, 2005


here is a trick i like to play on my moral majority sister. whenever she writes something ignorant about gays or lesbians (which is pretty much everytime,) i simply replace gay with black and she pretty much sounds like a kkk spokesperson.

for example:

Michigan Preparing To Let Doctors Refuse To Treat Gays Blacks.

(Lansing, Michigan) Doctors or other health care providers could not be disciplined or sued if they refuse to treat gay black patients under legislation passed Wednesday by the Michigan House.

or how about this?

Michigan Preparing To Let Doctors Refuse To Treat Gayswomen.

(Lansing, Michigan) Doctors or other health care providers could not be disciplined or sued if they refuse to treat gay women patients under legislation passed Wednesday by the Michigan House.

and on preview for clevershark

Michigan Preparing To Let Doctors Refuse To Treat Gaysrepublicans.

(Lansing, Michigan) Doctors or other health care providers could not be disciplined or sued if they refuse to treat gay republican patients under legislation passed Wednesday by the Michigan House.
posted by three blind mice at 8:27 AM on March 30, 2005


LOL... a vaguely-worded bill could indeed have all those (unintended?) consequences, couldn't it?
posted by clevershark at 8:28 AM on March 30, 2005


It would be really great if you would quit misusing that word until you make an effort to know what it means. When you do so, you will realize how confused you sound by using it here.

Gosh, thanks dios. I hate when that happens.

And what tbm said.
posted by 327.ca at 8:32 AM on March 30, 2005


on preview, dios

Why should they be forced to treat everyone?

well of course, it makes perfect sense that american doctors should be allowed to refuse to treat blacks and women and republicans.

"so what's the problem?"

"well, i've got chest pain doc, real bad"

"who did you vote for in 2004?"

"well, GWB of course."

"sorry, i can't help you. faith healers down the hall on the left. i only treat democrats here."

yep, sounds rational to me.....
posted by three blind mice at 8:36 AM on March 30, 2005


Given Catholic groups' pushing so hard for this bill, it'd be interesting to see Catholics being denied treatment by protestant doctors.

Also while (as has been pointed out) denial based only on race is nominally forbidden, it's pretty easy to imagine that many African-Americans and Arabs could be denied treatment on the basis that they are Muslim. Asians are also an easy target -- most of them aren't traditionally Xian in the first place, and of those that are one may easily exclude Moonies on a number of religious grounds.

Even within protestantism it's easy for one group to exclude another. You have a wide variety of obscure points to choose from.

Eventually you could end up with Balkanized little communities where outsiders dare not tread. Besides dios, would anyone here really be happy to see that sort of thing?
posted by clevershark at 8:41 AM on March 30, 2005


Apparently religious freedom trumps gay people's rights to live and breath.

dios: Why should they be deprived of the freedom to engage in their profession with their own discretion any more than a carpenter or consultant?

The difference between, say, a carpenter and a doctor is that if a carpenter refuses his services no-one's life is at risk. If a doctor refuses to treat a LGBT person life-threatening consequences ensue. A better analogy would probably be in order. For example, should we also respect the religious freedom of police officers and firemen?

I think this responsibility is made very clear to MDs when they take up the profession. If they didn't like it they should've become, well, a carpenter or something else instead.
posted by axon at 8:43 AM on March 30, 2005


dios: [...] forcing doctors to treat every patient that presents before them seems akin to slavery.

Yup, another oppressed minority.
posted by 327.ca at 8:41 AM on March 30, 2005


The Hippocratic Oath says to "do no harm." It doesn't say, "Give everyone who is in front of you treatment."

Indeed it does, dios, in the very same line that starts with "I will prescribe regimen for the good of my patients according to my ability."

It would be really great if you would quit misusing that passage until you make an effort to know what it means.
posted by XQUZYPHYR at 8:41 AM on March 30, 2005


The Hippocratic Oath says to "do no harm." It doesn't say, "Give everyone who is in front of you treatment."

What if witholding treatment from someone causes harm? Someone like, say...Terry Schiavo?
posted by The Card Cheat at 8:42 AM on March 30, 2005


would allow Michigander doctors and health care providers to refuse treatment on moral, ethical or religious grounds.

It's impossible for me to imagine how refusing someone medical treatment could possibly be considered moral or ethical.
posted by barjo at 8:45 AM on March 30, 2005


Dios: The Hippocratic Oath says to "do no harm." It doesn't say, "Give everyone who is in front of you treatment."

The Hippocratic Oath doesn't have a clause which says, "Except for teh gays because they're icky". It says "I will remember that I remain a member of society, with special obligations to all my fellow human beings," emphasis mine.
posted by nathan_teske at 8:51 AM on March 30, 2005


Methinks there is a misunderstanding of the contours of this policy.

This proposed law does not apply to emergency care. So what we are talking about here is elective and non-emergency care. In other words, care in which a patient has the ability to choose from a wide variety of doctors. As this isn't an emergency care issue, a lot of the histrionics about letting patients die when they present with chest pains, etc. is not applicable.

This issue is simply: should doctors be forced to treat every patient that presents to them in non-emergent circumstances. One must first explain why a doctor has no freedom to choose his own patients. What if the doctor decides his patient load is as full as he wants... can any person just show up and compel that doctor to take a new patient? No. Doctors in non-emergent circumstances have the right, as they aren't slaves, of choosing when and who they will treat.
posted by dios at 8:53 AM on March 30, 2005


Old news. The bill was sent to the health policy committee in the Michigan Senate in April 2004 and hasn't been seen since.
posted by monju_bosatsu at 8:53 AM on March 30, 2005


Just another example of how the USA is turning into a nanny-state.

People's morality is to be dictated by the government, or by representatives of the government (aka socially conservative doctors.)
posted by five fresh fish at 9:07 AM on March 30, 2005


Doctors have always had the right to refuse to perform procedures they have moral objections to, so long as they find a provider who will and, that the patient is not unduly burdened. This is right in the AMA's guidelines.

With respect to burdening the patient, as has been mentioned previously, in a rural area, where hospitals are more and more likely to be owned and run by the Catholic Hospital Association, the patient is almost certainly going to be unduly burdened, as the next-closest hospital may be 50, 100 miles away. And even then, that hospital may not treat the patient either.

What is most distressing are the gag rules that explicitly permit MDs and other providers not to refer a patient or to even discuss the existence of certain procedures or medications.

I empathize with these physicians and fully support their right not to conscienciously object, and I even somewhat empathize with their argument that by merely talking about something, they are somehow culpable, but the latter is not a good enough reason to completely sever the fundamental fiduciary responsibility they have to their patients.

This is the most basic premise of medicine. If, as a doctor, you cannot uphold it, please find another profession.

/physician who authored a study on emergency contraceptive use for rape patients in religious and nonreligious hosptitals
posted by ssmug at 9:22 AM on March 30, 2005


Dios, it's pretty clear that you've never been turned down for medical treatment because of who you are. I also doubt you know anyone who has. I do. "Non-emergency" covers an awful lot of things, some of which can be life-threatening. Getting a prescription for an antibiotic is non-emergency. And when you desperately need one is exactly when you want to hear that you've dragged yourself and your fever out of bed, travelled through the cold for as long as it takes, that they don't treat your kind there, and maybe you should get an appointment with someone else; perhaps another doctor will be able to schedule you. In a few weeks. Have a nice trip home.

As others have pointed out, maybe we should pass a law saying the police can choose not to help people who have had "non-emergency" crimes committed against them. Just a robbery? Were you hurt? Sorry, we don't like your kind.

Your analogy doesn't hold. There is a huge difference between "you have to take everyone who comes to your door" and "you can refuse people the care they need because they don't suit your tastes". Doctors obviously have to make decisions based on time, space, costs, and resources, which are already inadvertently discriminating in many ways. But simply saying that means they should be able to deliberately descriminate against whoever they like is a quick road to nightmare.
posted by kyrademon at 9:25 AM on March 30, 2005


dios: This proposed law does not apply to emergency care. So what we are talking about here is elective and non-emergency care. In other words, care in which a patient has the ability to choose from a wide variety of doctors. As this isn't an emergency care issue, a lot of the histrionics about letting patients die when they present with chest pains, etc. is not applicable.

Ah, just "elective and non-emergency care", eh? So we're talking about long-term care for people with chronic illnesses (AIDs, for instance)?

By "wide variety", do you mean "doctors with a wide range of personal beliefs." What happens when the pressure to conform to a certain set of conservative beliefs becomes insurmountable? Will that "wide range" always be there?

This issue is simply: should doctors be forced to treat every patient that presents to them in non-emergent circumstances. One must first explain why a doctor has no freedom to choose his own patients. What if the doctor decides his patient load is as full as he wants... can any person just show up and compel that doctor to take a new patient? No. Doctors in non-emergent circumstances have the right, as they aren't slaves, of choosing when and who they will treat.

Well, despite your attempt to frame this issue this way, that's not what the link is about. "The bill allows health care workers to refuse service to anyone on moral, ethical or religious grounds." It has nothing to do with doctors-as-slaves. It has to do with a doctor potentially saying, "You're gay, and my religious beliefs prevent me from treating your arthritis. Find another doctor."
posted by 327.ca at 9:26 AM on March 30, 2005


ugh... right TO conscientiously object...
posted by ssmug at 9:28 AM on March 30, 2005


But dios, should we refuse to listen to you because of who you are?
posted by gesamtkunstwerk at 9:51 AM on March 30, 2005


For m3e, Nicole Kidman figures into everything in the world.
posted by Postroad at 10:03 AM on March 30, 2005


This issue is simply: should doctors be forced to treat every patient that presents to them in non-emergent circumstances. One must first explain why a doctor has no freedom to choose his own patients.

dios, healthcare is a basic need. When a patient shows up to an office in non-emergency need of medical care, and the doctor doesn't have too many patients (a red herring that you threw in), a doctor shouldn't have legal protection for saying "I don't like some aspect of this patient and refuse to treat them."

My Vet doesn't refuse to treat pugs because he hates pug breeds and I hope my doctor doesn't refuse to treat me because I'm black or gay or middle eastern.
posted by mathowie at 10:22 AM on March 30, 2005


if they are going to refuse to treat because of some asinine (psuedo/quasi) 'religious', belief why be a doctor in the first place? Isnt getting ill/sick/dying all part of god's will, part of the grand plan. Who is a doctor to say 'i'll stick my nose into the grand plan, but only as far as it suits me'?
posted by MrLint at 10:32 AM on March 30, 2005


But the right to refuse to perform treatment is a right that doctors already have (I'm still not sure why Michigan felt it had to pass this law). I don't see why people assume that doctors have a burden to provide medical treatment. If "medical care is a basic right of a patient," why does he have the right to choose to compel a particular doctor to perform that treatment? I can't fathom why people can't see this from a Doctor's perspective. Why should a doctor be required to treat someone. There are millions of doctors. Doctors are not slaves to society. If a patient shows up and can't pay his bills, doctors have the right to refuse treatment. If a patient wants treatment by a particular doctor, but he has a full load, the doctor has the right to refuse to treat the patient. Why should doctor's ability to practice their profession in the manner they see fit be compromised? Until a physician-patient relationship is agreed to by both physician and patient, then a doctor has no duty to the public at large. He is a private individual who enters into relationships as he sees fit.

What's next: requiring lawyers to represent anyone who asks for help because "the right to legal counsel is a basic need"? If you ask me, it's nonsense and bad practice.

Until public support exists to implement socialized medicine where doctors become essentially workers for the government, then it inappropriate to place any requirements on professionals in their practice.
posted by dios at 10:52 AM on March 30, 2005


Eh, last sentence should read:
... any requirements on who doctors must treat in their practice.
posted by dios at 10:53 AM on March 30, 2005


Thankfully, this story is over a year old. The Senate Bill 0972, seems to be lying dead in committee (curiously, in September it had advanced to another committee whose name I have forgotten, but that's no longer noted in the bill and it now seems to have returned to the Health committee). Hopefully the Senate remains somewhat sane and leaves it there.

Michigan is a prime example of how states cannot be classified bright blue or red simply because of where their electoral votes went.
posted by schroedinger at 11:04 AM on March 30, 2005


Dios, you for some reason seem completely unable to distinguish between general difficulties that apply randomly to all patients (full case load) and specific discrimination against individuals simply because the doctor doesn't like them. Do you really think there is no difference?

Incidentally, many lawyers are required to do a certain amount of work for people who can't afford one. Because the right to legal counsel is, in fact, a basic need.

The idea that it's "inappropriate to place any requirements on professionals in their practice" is an astonishing one. I can only assume that you look forward to the return of segregation. You seem to cherish a belief that people have no obligation whatsoever to the general society from which they benefit. That seems entirely fair to me if the doctor in question inherited no money, works for no business, grows their own food, solves crimes, puts out fires, and never buys anything, sells anything, or has anything repaired. I can see why it might be "inappropriate to place any requirements" on that particular doctor. The rest of them can god damn well treat people who need their help in as fair and even-handed a manner as is possible within the confines of reasonable effort.
posted by kyrademon at 11:05 AM on March 30, 2005


Oh, and if this bill were to be passed, I would do all in my power to become a doctor and get visited by one of the politicians who voted for this bill, because telling them I couldn't give them care due to religious beliefs I held about politicians wold be awesome.
posted by schroedinger at 11:07 AM on March 30, 2005


XQUZYPHYR writes "Indeed it does, dios, in the very same line that starts with 'I will prescribe regimen for the good of my patients according to my ability.'"

Game, set, and check-mate to XQUZYPHYR.

(Ok, I should read up on scoring in tennis and chess.)
posted by orthogonality at 11:13 AM on March 30, 2005


barjo writes "It's impossible for me to imagine how refusing someone medical treatment could possibly be considered moral or ethical."

Er, what if that someone is in a persistent vegetative state?
posted by orthogonality at 11:15 AM on March 30, 2005


Do you really think there is no difference?

Not from the perspective of the doctor: he has the right to decide how he engage in the practice of medicine within his licensing requirements. Any requirement defining who and when he will treat patients makes him a slave of the state.

Incidentally, many lawyers are required to do a certain amount of work for people who can't afford one. Because the right to legal counsel is, in fact, a basic need.

That isn't true. I'm a lawyer, and I can refuse to represent whomever I want. And I frequently do refuse to represent people when I don't think they have valid claims/defenses. Any "pro bono" requirement that I have can be extinguished in many ways (including paying a fee to get rid of it). I am never required to help whomever asks me.

That seems entirely fair to me if the doctor in question inherited no money, works for no business, grows their own food, solves crimes, puts out fires, and never buys anything, sells anything, or has anything repaired. I can see why it might be "inappropriate to place any requirements" on that particular doctor. The rest of them can god damn well treat people who need their help in as fair and even-handed a manner as is possible within the confines of reasonable effort.
posted by kyrademon at 11:05 AM PST on March 30


So this is a class issue? Those rich bastards should have work for everyone who asks them? Unless they are poor doctors?

Doctors are people like you and me. They enter a profession.... a PROFESSION... they don't dedicate their lives to the state. And I think you are over-emphasizing your point when you suggest that this will return us to segregation. My guess is that very few doctors refuse treatment. Unless you believe that all doctors are closet racists and homophobes who are just itching at the chance to hate on those people.
posted by dios at 11:21 AM on March 30, 2005


My Vet doesn't refuse to treat pugs because he hates pug breeds


posted by quonsar at 11:21 AM on March 30, 2005


clevershark writes "it's pretty easy to imagine that many African-Americans and Arabs could be denied treatment on the basis that they are Muslim. Asians are also an easy target -- most of them aren't traditionally Xian in the first place

Most American blacks are Protestants. Many American Koreans are Protestant, many of those Presbyterian, and many of the remainder are Catholic. Most American Filipinos are Catholic.

(But I reminded of a check-up at a famous Catholic teaching hospital, in which the attending physician suggested that I give up smoking for Lent. I smiled and didn't bother to explain that his presumption offended me, an atheist. But I subsequently went to a doctor at the religious unaffiliated competing teaching hospital. And (ironic demonstration of unconscious stereotyping coming up) anyway, we all know that the Jew doctors are the best.)
posted by orthogonality at 11:23 AM on March 30, 2005


dios: Doctors are people like you and me. They enter a profession.... a PROFESSION... they don't dedicate their lives to the state. And I think you are over-emphasizing your point when you suggest that this will return us to segregation. My guess is that very few doctors refuse treatment. Unless you believe that all doctors are closet racists and homophobes who are just itching at the chance to hate on those people.

The test of any law isn't whether it's likely it will be abused, but whether abuse is possible. As a lawyer, you should know that. There's a huge distance between protecting minorities against discrimination and forcing doctors to become "slave[s] of the state." Clearly, it's the "slave to the state" thing that's got you so exercised...

Your "guess" may be that very few doctors would refuse treatment. Is the weight of your guess supposed to instill confidence? I keep thinking about doctors here in Canada who started to refuse to perform abortions because hospital boards were increasingly being taken over by right-wing nutbars with axes to grind. Personally, the docs had no issues with doing abortions, but their careers were being threatened.
posted by 327.ca at 11:32 AM on March 30, 2005


I really don't know where our little pest is coming from, but I assume it's from complete ignorance of the professional world. You'd think that someone as unpopular, and presumably unlikable as our derailer in chief would be sympathetic to exclusion.

I can't think of any professions that would allow a practitioner to disregard a segment of the population. If an ignorant troll came into my medical library, I would have to help him, even if I doubted his motives and ability to read medical documents. Likewise, when I was a teacher, I couldn't refuse to teach Republicans, or Islamic fundamentalists, or kids who liked White Snake. I don't even think restaurants can bar one group from entering without probable cause that doing so would endanger their business.

Professions are generally governed by a code of ethics as well as legal requirements. That's where the term professional comes from.
posted by gesamtkunstwerk at 11:33 AM on March 30, 2005


"So this is a class issue? Those rich bastards should have work for everyone who asks them? Unless they are poor doctors?"

Wow. The degree to which you misunderstood that statement was unbelievable. All doctors, and all people, rich or poor, derive benefits from living in society - no one exists in a vaccum. I'm not sure how you lept from "never buying anything and growing their own food" to "rich".

And I didn't say lawyers had to take anyone who comes to their door. I said there were pro-bono requirements, which you admitted to, although they can be gotten around in various ways.

And I don't believe all doctors are homophobes and racists. But I do know people who have been refused treatment, and nearly died, because of who they were. That's wrong.

Do you always only hear what you want to hear?
posted by kyrademon at 11:40 AM on March 30, 2005


kyra, I missed your point. My apologies. I see what you are saying now. I read and comment while at work, and at times I read too quickly and comment too qucikly to squeeze it in, so I am guilty of misreading your post

I understand where you are coming from. It's just a difference of opinion, which is allowable. We don't live in a socialized country in America. Medicine is still private practice. As long as that is the case, I don't see why Doctor's aren't free to exclude patients any more than lawyers.

gesamtkunstwerk - if you want me to respond to you, then don't be rude and insulting to me. Otherwise I will ignore you.
posted by dios at 12:09 PM on March 30, 2005


This bill pushed by the Catholics more likely focuses on the volitile "moral" considerations of prescribing birth control to women than refusing treatment to homosexuals. That actually requires that the doctor actively taking part in what some Catholics might consider murder, directly in conflict with Catholic edicts. I personally can't see very many direct functions required by the doctor to perform in terms of regular treatment to gays or any other groups that might clash with personal religious or ethical stances aside from this one and a few others. I personally agree with Dios on this one. Doctors are highly educated individuals. Education doesn't mean immunity from bias, but I have a bit more trust in the general medical community to make sound decisions.

I'm a premed at Georgetown University, the nation's oldest Catholic university. I'm not Catholic. I know that Georgetown, through it's healthcare provisions, will not pay for birth control unless it's specified by the doctor prescribing it as necessary for some other issue than birth control. I don't like this fact though I don't participate myself, many employers who are forced into this plan don't like it, but I think that some Catholics view it so ardently as a major ethical issue warrants respect and consideration into the matter.
posted by Mister Fyodor at 12:13 PM on March 30, 2005


There are certainly situations where a given doctor is the only access to health care in a geographical area. At that point, being able to be seen by the physician is a public access issue much like, say, black Americans at lunch counters in Birmingham in the 1960s.

The business owners at the time said that 'we should be able to serve to whomever we want to'* but there were too many impacts on interstate commerce (which is why the Civil Rights Act was allowable as a federal law) and the public sector to ignore that injustice.

*I mean, serving lunch to people is a profession, not dedication of their lives to the government. I apologize for the obvious snark, though, and chalk it up to further reaction to the word "histrionics."
posted by norm at 2:22 PM on March 30, 2005


This is legislated bigotry. We went around on this with the pharmacist who refused to dispense birth control.

They're wrong and should be publicly humiliated. Or better yet, let's hurt them and then deny them treatment because they're ignorant asswipes. That's a moral issue, isn't it?
posted by fenriq at 2:29 PM on March 30, 2005


The state does not own doctors, but it does license doctors. I can't open up a sidewalk booth and call myself a psychiatrist, even if I have had actual psychiatric training. I must meet licensing requirements. In the interests of all members of society, doctors have to pass various kinds of tests, normally as simple as proving themselves to have a medical degree from a reputable institution (and degrading academic reputability for short-term commercial gain is yet another problem the Repugs of the world have given us). That's where the state's opportunity to put conditions on doctors' practice comes in: at licensing.

A fact that dios's fellow-travellers largely overlook in the field of healthcare is this: rich people can actually catch diseases from poor people. Failure to provide affordable--which inevitably means free--medical care leads to diseases going untreated. This leads to those diseases propagating through the community. This leads to sickness, which, amusingly enough, costs more than the original health care would have, simply because more people get sick than were required to be treated to prevent all the sickness in the first place.

Asking questions about whether a person deserves their disease because of their actions, or whether a person is entitled to be cured because of their ability to fork over currency to a doctor, are just distractions that if indulged, will increase the spread of disease, because any answer other than "treat them" reduces the total number of people treated. It is best for us all that diseases are cured, and as a consequence, it is best that health care policy enables that goal.
posted by aeschenkarnos at 2:40 PM on March 30, 2005


I think that some Catholics view it so ardently as a major ethical issue warrants respect and consideration into the matter.

Say what?

They don't warrant any more respect than the creeps that believe children should be beaten, an ethical issue that can be cast in much the same light as this one.

Like it or not, the law of government do define how much your religious beliefs are allowed to interfere with others' health and safety. You don't get to decide to use the rod as prescribed in the bible, and you don't get to decide that you're going to engage in harmful discrimination.

It is perfectly correct for the law to disallow discrimination by physicians, just as it is perfectly correct for the law to disallow biblical-stength thrashings.
posted by five fresh fish at 2:57 PM on March 30, 2005


XQUZYPHYR:

"in the very same line that starts with "I will prescribe regimen for the good of my patients according to my ability."

Heh. It doesn't *matter* that you don't have socialized medicine -- the profession is clearly based upon Marxist principles. From each doctor, according to his ability, to each patient according to his need.

dios:

"Doctors are people like you and me. They enter a profession.... a PROFESSION... they don't dedicate their lives to the state."

Civil servants in the USA clearly operate under very different regimes to the rest of the world. I was never aware that all those US mailmen, FBI agents, teachers, social workers, etc. were living under the lash of an oppressive state.

Here in the UK though, where we *do* have socialized medicine, doctors aren't obliged to treat all patients, come what may, either. A General Practitioner can say that his list is full and he isn't taking any new patients. A hospital consultant can have his registrar see the patient, or refer to another consultant. In practice, socialized medicine is a way to ensure that everyone who needs treatment gets it free at the point of delivery. The legal duty of care lies with the organizational unit -- the hospital or local health authority, not with the individual doctor -- though he or she may have professional ethics that govern their actions in this regard.

Yes, we ration our health care the same as you do, but we try to ration on the basis of need rather than ability to pay.

But I've never heard a British doctor object to working for the state. Until very recently, the state would have paid for their training, and would be paying their salary -- and if that arrangement doesn't suit them, they have always been free to try and make it in private practice.

Until quite recently, a very high proportion of UK lawyers also got the bulk of their income from the state as well, in the form of legal aid work. Ever spiralling legal costs have put paid to that for most things these days. Exceptions include medical negligence, criminal cases and family work -- though this has always been means tested, unlike health care provision.
posted by PeterMcDermott at 3:36 PM on March 30, 2005


Catholics make up a significant portion of the world. They don't all share the same voice, but the one that condemns birth control has a profound affect in the world. I would have said perhaps not in the US before reading this post, but it seems the Catholic lobby is making a stand.

Five Fresh Fish, when I say "respect and consideration", I meant taking part in active ethical debate among ourselves AND with members of the group with this particular opinion. Comparing them to child abusers is exactly the sort of arbitrary insinuation that will get the situation going nowhere.
posted by Mister Fyodor at 3:42 PM on March 30, 2005


Dios: In point of fact - the Hippocratic oath, in both classical and modern versions (of which there are several) doesn't even say 'do no harm." That's a line (in some translations) from Hippocrates Epidemics Bk. I, Sect. XI. "As to diseases, make a habit of two things—to help, or at least to do no harm."

On the other hand - in one version of the Hippocratic Oath approved by the AMA the words "That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power," occur.

'The sick', not 'some of the sick', I notice.
posted by Sparx at 5:09 PM on March 30, 2005


What are you talking about, Fyodor? If it is obviously wrong for a religious man to use the rod on his child, then it is obviously wrong for a religious man to deny health or safety to someone else.

The parallel is exact: it is illegal to cause physical harm to unconsenting others. Doctors that refuse service to those who have no other recourse are obviously causing harm to an unconsenting other, insofar as lack of treatment will result in further damage to the person.

Being a good doctor means looking after a person's health long before worrying about whether he's an enemy combatant, your worst enemy, a white supremecist, a protestant, a black man, a woman.
posted by five fresh fish at 6:06 PM on March 30, 2005


We don't live in a socialized country in America. . . Medicine is still private practice.

Interesting point here. Doctors are licensed by the state, and it is illegal to practice medicine without a license. If by not socialized you mean the market still sets the price for goods and services, then sure. Though we certainly have chosen as a society to have our government control the quality of health care.
posted by betaray at 6:22 PM on March 30, 2005


crap, I didn't read all the comments. Props to aeschenkarnos.
posted by betaray at 6:26 PM on March 30, 2005


Five Fresh Fish, I suggested earlier that the Catholics behind this bill are concerned more about the specific practice of prescribing birth control to everyone than of denying general treatment to a group of people.

I can tolerate a bill that allows doctors to avoid actively participate in a medical action with which they disagree, as I suggested may be the case here. This may entail turning away a patient.

Doctors that refuse service to those who have no other recourse are obviously causing harm

Provisions exist within the bill that gives patients at least 24 hours to find "other recourse", and in the case of an emergency the law would not apply.

Regarding your well poisoning metaphor:
Intentially causing A which is harmful
and
Refusing to cause B which will remedy a harm
are not the same. They do not "parallel exactly", and this is reflected in our laws. To use your example for simplicity:

If I beat a child, I will be arrested. If I choose to not report my neighbor for beating his child, I will not be arrested. Case in point.
posted by Mister Fyodor at 7:06 PM on March 30, 2005


on the surface, of course, this bill seems pretty harmless, but the basic idea behind it is horrible and it would inevitably lead to worse legislation.

and i'm all about banning partial-birth abortion. though it might strengthen challenges to roe vs wade, the basic idea behind that ban is sound. not so in this case.
not even close.

and, with a potential draft looming over my head, I REALLY resent the use of the term conscientious objector here....
posted by es_de_bah at 7:11 PM on March 30, 2005


Dios:

This issue is simply: should doctors be forced to treat every patient that presents to them in non-emergent circumstances.

But the right to refuse to perform treatment is a right that doctors already have (I'm still not sure why Michigan felt it had to pass this law). I don't see why people assume that doctors have a burden to provide medical treatment.

These two positions are incompatible; either you think that doctors don't already have that right or that they do. The bill, incidently, says nothing about compelling anyone to treat a patient, as you'd know if you bothered to read it:

Sec. 9. Except as provided in section 11, a health care provider's objection to providing or participating in a health care service as described in section 5 shall not be the basis for 1 or more of the following:
23 (a) Civil liability to another person.
24 (b) Criminal action.
25 (c) Administrative or licensure action.
26 (d) Termination of employment or refusal of staff privileges at a health facility.


You (probably) correctly note that health care professionals may already be able to refuse treatment, and that's not what this bill is about. It's intent is to protect people who refuse treatment from legal liability; as such, it's really an issue of what constitutes liability. This bill would shift people from the category of those hurt by foreseeable harm to a category which is not entitled to seek relief through tort. It has nothing to do with patients compelling doctors to treat them, despite your bizarre assertions to the contrary, but with excusing health care professionals from the legal consequences to which they are now, rightly, subject.
posted by clockzero at 9:00 PM on March 30, 2005


I believe you are wrong, Fyodor. If you choose to not report your neighbour for beating his child, you can be prosecuted for child endangerment or some similar thing. I refer you to this.

Provisions exist within the bill that gives patients at least 24 hours to find "other recourse"

I love how framing is used to make this sound like a good thing. It doesn't give patients a damn thing: it gives the doctors a minimum 24-hour respite from having to do something they don't wish to do. How nice for them.

Sucks to be a lesbian black muslim in the middle of Ohio when you break your leg and have to put up with 24 hours of pain because some asswipe local doctor can't be arsed put his prejudices aside and assist this despicable scum that's responsible for the collapse of civilization as he knows it.
posted by five fresh fish at 9:24 PM on March 30, 2005


gov jennifer granholm won't sign it, anyway ... it's just another attempt at grandstanding by those dickheads in lansing
posted by pyramid termite at 9:52 PM on March 30, 2005


Sucks to be a lesbian black muslim in the middle of Ohio when you break your leg and have to put up with 24 hours of pain because some asswipe local doctor can't be arsed put his prejudices aside and assist this despicable scum that's responsible for the collapse of civilization as he knows it.
Well, to be picky, this law would apply to Michigan, so this hypothetical woman would probably have no more trouble than normal in Ohio.
posted by Sangermaine at 11:39 PM on March 30, 2005


If Doctor's are to be able to refuse treatment based on their religious/moral beliefs perhaps licensing of the medical profession can be amended so that say, a secular agent could deny a medical license to any prospective doctors who would refuse to practice medicine on say, Taosists (or any other group.) After all, what are qualifications when measured against beliefs...

This is insanity.
posted by juiceCake at 12:55 PM on April 1, 2005


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