Science and Conscience

Around the middle of February, something quite significant happened, and almost nobody noticed. The Obama administration quietly moved to rescind most of the provisions of the Bush-era “conscience laws” that allowed health care workers to opt out of providing services with which they disagreed on moral or religious grounds.

“Without the rescission of this regulation, we would see tremendous discrimination against patients based on their behavior and based just on who they are,” said Susan Berke Fogel of the National Health Law Program, an advocacy group based in Washington, DC. “We would see real people suffer, and more women could die.”

The new rule is much narrower than the law enacted under the George W. Bush administration and leaves intact only two major provisions of the “conscience laws”:

  1. legal protections for medical personnel doctors and nurses who do not want to perform abortions or sterilizations
  2. a process for allowing health workers whose rights are violated to file complaints

According to the Washington Post:

The decision guts one of President George W. Bush’s most controversial legacies: a rule that was widely interpreted as shielding workers who refuse to participate in a range of medical services, such as providing birth control pills, caring for gay men with AIDS and performing in-vitro fertilization for lesbians or single women.

This is one of those areas in which there are no easy answers, and both nuance and context are important, to say nothing of abstract concepts like compassion, conviction and empathy. For instance, if someone truly believes abortion is murder, I don’t think that person should be required to assist with such a procedure, any more than a doctor who is morally opposed to state-sanctioned killing should lose his licence for refusing to administer a lethal injection to a convicted murderer, or a sincere pacifist should be forced to bear arms during wartime.

But in the case—and there have been many in the past two years—where a small town has only one pharmacist, and that person refuses to fill a prescription for emergency contraception or birth control brought to him by a struggling, exhausted young mother who has neither the means nor the ability to drive to the next town…then I think that pharmacist is probably in the wrong profession, and I don’t believe such people should have the protection of the law when they refuse to provide a necessary service. Nor should a doctor be able to legally turn a male patient with AIDS away, simply because he thinks homosexual behavior is a sin. A nurse who is a Jehovah’s Witness should not be legally protected if she is the only skilled person on duty but refuses to assist with a blood transfusion when a patient is bleeding to death on the operating room table.

In my opinion, the right decision in these cases is sort of like Justice Potter Stewart’s famous description of what constitutes pornography: it’s hard to define, but most of us know it when we see it. And it seems to me that with this new, narrower set of legal specifics and protections, the administration has got it just about right.

About filistro

Filistro is a Canadian writer and prairie dog who maintains burrows on both sides of the 49th parallel. Like all prairie dogs, she is keenly interested in politics and language. (Prairie dogs have been known to build organized towns the size of Maryland, and are the only furry mammal with a documented language.)
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30 Responses to Science and Conscience

  1. mclever says:

    Thank goodness.

    I think I shared my story on an earlier thread about driving 20 miles out of our way to get medication because the local pharmacists wouldn’t fill the prescription and the closest one that would wasn’t part of our medical plan, so we had to pay full price. Furthermore, along with the privilege of paying full price came a loud, lengthy, presumptuous, irrelevant, moralistic lecture every time we needed refills. I just wanted to tell all of those idiot pharmacists who refused to provide prescribed medication that those pills probably saved a life, and if they’d actually stopped their moralizing enough to ask, they might have learned something.

    It shouldn’t have mattered. If I present a pharmacist with a valid prescription issued by a licensed medical professional, the prescription should be filled. Period. No questions asked, except for the mandatory precautions about possible drug interactions with anything else I might be taking and, “Would you prefer generic?”

  2. filistro says:

    @mac… cognitive dissonance is an amazing phenomenon, isn’t it? The party that accuses the First Lady of running a “nanny state” because she suggests it would be good for kids to eat healthier foods…. that same party thinks it’s just dandy to deny people necessary prescription medication because of the purveyor’s “religious convictions.”

    On the bigger picture, it appears the GOP is going to jettison all its “small-government, deficit-cutting” blather… and campaign on abortion, birtherism and union busting in the upcoming elections. Good luck with that.

  3. mclever says:

    @filistro

    Cognitive dissonance–we’re all guilty of it from time to time. :-)

    If the GOP really does give up all pretenses of being budget hawks, at least they’ll be campaigning more honestly!

    Nothing forces someone to choose a career in medicine or a medical-related field. If you have religious objections to administering certain treatments, then perhaps you should consider a career change. (Nurses who don’t like dealing with certain obstetric issues should perhaps transfer to hospice care, for example.) I can understand the moral objections in the cases of elective abortions or administering lethal drugs for an execution, but pretty much anything else should be understood as part of the standard treatment that any medical professional should be willing and able to provide.

  4. “it appears the GOP is going to jettison all its “small-government, deficit-cutting” blather… and campaign on abortion, birtherism and union busting in the upcoming elections. ”

    What else can they run on? They ran on fiscal responsibility and jobs and have done nothing to show any fiscal responsibility besides cut programs used by the poor and cut taxes for the rich which has created or saved exactly zero jobs.

  5. filistro,

    The party that accuses the First Lady of running a “nanny state” because she suggests it would be good for kids to eat healthier foods

    The “party” did no such thing, unless the party to which you refer is the Tea Party. Mainstream Republicans were much more supportive of her campaign.

    On the bigger picture, it appears the GOP is going to jettison all its “small-government, deficit-cutting” blather… and campaign on abortion, birtherism and union busting in the upcoming elections.

    You’re sounding shrill here. Birtherism is a side show at best, and abortion is hardly front and center either. Union busting, though, may be a part of the central campaign. I get the impression that a majority of Americans fall on the ambivalent-to-hostile end of the union spectrum, which could work in the GOP’s favor.

  6. filistro says:

    @Michael… You’re sounding shrill here. Birtherism is a side show at best, and abortion is hardly front and center either.

    I beg to differ. Just wait till GOP primary season is in full swing, and see what is galvanizing the faithful primary voters nowadays… and the earnest suitors who are courting them.

    (Hint… it’s not “fiscal issues”.)

  7. electrovibe11,

    They ran on fiscal responsibility and jobs and have done nothing to show any fiscal responsibility besides cut programs used by the poor and cut taxes for the rich which has created or saved exactly zero jobs.

    Fiscal responsibility ≠ jobs. While I disagree with a lower tax, lower spending model before a recovering economy stabilizes, that hardly means that the term “fiscal responsibility” cannot apply to a lower tax, lower spending model. Their votes on fiscal issues have, thus far, matched their campaign rhetoric.

  8. Gator says:

    MW

    There you are being all reasonable again. What is up with that? You better fall in line, buster! LMAO!

    Are you trying to combat the self selection dilemna single handedly? Never fear, I’ll pop in and be a smarta** on a semi-regular basis. Still, you’re gonna need more help. :)

  9. filistro,
    It’s still a sideshow. The candidates want funding, and they’ll say whatever they need to in order to get it, but I highly doubt that birtherism will get much play in general election season. Or even late in the primary season.

    If I prove to be wrong this time next year, feel free to dance around and point fingers.

  10. mclever says:

    I’m more curious to see if this issue makes its way into the primary campaigns. Will we hear conservatives decrying that “Obama is taking away our right to practice our faith!” or similar?

    I doubt claims of “fiscal responsibility” are going anywhere, because the general public still accepts the false meme that conservatives are more fiscally responsible than liberals. (I think they’re both pretty irresponsible, and the data is inconclusive.) But it would be good (for the Democrats) if the Republicans were focused on other themes.

  11. Mainer says:

    Michael show me a Repubican that has supported the first lady on any thing. The witch patrol takes swipes at her and the rest of the republicans stand around looking at the floor and shuffle their feet. I don’t call being scared to death of offending the shrill du jour much support or even much respect.

    As for Americans being ambilavent about the unions maybe, maybe not. I thinkyou would find the support for crushing unions at about the same % of the public as makes up the hard core right. I know there are some polls out there which seem to demonstrate that and just as soon as I can dig them out will so post so until then you all can just ignore what I think.

  12. Gator says:

    Mainer here ya’ go:

    Michelle Obama’s healthy food fight has some bipartisan support

    New Jersey Gov. Chris Christie, who has struggled with weight, supports her campaign. “I think it’s a really good goal to encourage kids to eat better,” he said. If a kid can avoid that in his adult years or her adult years, more power to them, and I think the first lady’s speaking out well.”

    Mike Huckabee, who famously lost a ton of weight while in office, says that while he doesn’t think the government should tell us what to eat, “I think Mrs. Obama being out there. encouraging people in a positive way to eat well and to exercise and to be healthy, I don’t have a problem with that.”

    http://shortformblog.com/chatter/michelle-obama-bipartisan-support/
    *********************************************************************************
    Shocking News? Bipartisan Support for Child Health

    Last week, I found a pleasant surprise in the free Examiner newspaper they hand to commuters hurrying down Metro escalators here in Washington. The paper has a conservative slant, but the editorial on page 2 made the case for common political ground. The headline’s bold letters cried out, “Child nutrition: A true bipartisan issue.”

    Yes! That was my personal reaction because I’m a mother and I’m a nutritionist. I know how critical proper nutrition is for childhood development and health. And here was the Examiner saying Michelle Obama’s child nutrition effort both “enjoys and deserves bipartisan support.”

    http://savethechildren.typepad.com/blog/2011/02/shocking-news-bipartisan-support-for-child-health.html

  13. Mainer says:

    I had seen the Huckabee piece and simply had it fall out of one of the holes in my head. I had not seen the Christie piece but this is one of the times when it is good to be at least a little wrong………now care to talk about the sisters shrill?

    A dietician friend says that over weight young will most likely get worse with the economic conditions. The cheapest food apparently is stuff like pasta and such and if that is what one gets well……….only one piece of the puzzle. No worry in the future with WIC gone, cuts to food stamps and other austerity measures they will all look like Biafrans before they get to their adolesence.

    I used to hate teaching right before lunch. There were too many of the kids watching the clock to get to their one real meal a day to get much accomplished and having a study hall in the cafeteria was almost cruel as they smelled the food cooking (no snide school food comments as we had one great bunch of ladies out back and they could turn out a meal fit for a Grange supper) right after lunch wasn’t the best either as they would be full and wanting the sleep they didn’t get the night before from being hungry…….did I mention I live in a really poor area?

  14. Gator says:

    Mainer I would say that child hunger is an abomination and an embarassment to the nation. I am not a fan of entitlements but we are soul-less if we allow our own children to go hungry in this land of plenty. We MUST ALWAYS try to care for the children. That has nothing to do with politics, that has to do with humanity.

  15. mclever says:

    @Gator

    I am not a fan of entitlements but we are soul-less if we allow our own children to go hungry in this land of plenty. We MUST ALWAYS try to care for the children. That has nothing to do with politics, that has to do with humanity.

    I agree.

    It’s a shame that funding for school lunches is being cut across the nation. At my school, they also offered breakfast for kids who met certain financial need criteria. Personally, the most frustrating and difficult part was the paperwork and rigamarole required to prove that one qualified for the meals. And heaven forbid if your Dad made $1 too much for you to qualify! I’d almost prefer it if the schools were able to provide breakfast and lunch to any child who wanted it regardless of need, and parents had the option provide their own if they chose. That would eliminate both the stigma and the paperwork hassle, but it would cost a lot more to provide lunches to every student rather than just the 10% who qualify currently.

    It’s one of those “If we lived in an ideal world…” things.

  16. Gator says:

    mclever

    I have for the last two years, given money to the elementary and middle schools that my children attended years ago, for the sole purpose of buying lunches for those “just outside the bubble” students. I would encourage everyone who can to do this. I have found that the schools generally have someone who knows who these kids are and can see that they benefit. $50-100 dollars a month can feed 3-6 kids. Also, you can take canned food to the schools for distribution to needy families. The schools and particularly teachers know who is in trouble, which families need help.

    K, down off my soapbox.

  17. mclever says:

    Great message, Gator. And given the current economic climate, a timely reminder of a simple thing we can do to really help those around us. Thanks.

  18. Mainer says:

    Gator I will butt heads with you on many issues but if you wish to stay up on that soap box you and Mac go right ahead and I’ll do all the appropriate amens.

    Mac you must live in a rich area. When I left our local school we were at 52% of the student body on free or reduced and climbing. And keep in mind most of those kids had parrents that were working and in some cases both were working. When all that is available is minimum wage jobs the money does not go far and that is one of the reasons I get so wound up at those that would do away with that too.

    Gator I can’t name an over paid teacher that does not daily take money out of their own pockets for some thing for the classroom or one of their kids. Our govenor would like to play Wisconsin with public workers too. When I started there was no union and I made 5K a year. 30 years later with a Masters and being a 1/2 time assistant principal and 3/4 time teacher (yes I know what that adds up to) I was making 42,000. We are one of those states where teachers lose 1/2 their SS off the top to prevent them getting a windfall……..yup 1284.00 a month is a windfall. Teachers start around here for about 24K. Damn they are over paid and they already contribute to both their health care and and retirement. I could not even think about retirement or semi retirement with out my miltary retirement and TriCare health benefits.

    But I’ll get off my soap box as yours is more important and have you seen what old soap boxes sell for these days for decorator items, better that I sell it than stand on it.

    Hungry kids cranks me up some thing whicked.

  19. mclever says:

    @Mainer

    Some states have really poor participation rates in the National School Lunch Program relative to the actual poverty levels in the state. Oklahoma, for example, has the lowest participation rate of any state. Do you really think Oklahoma is the richest state? 30% of kids in OK would qualify if participation were 100%, compared to Maine where statewide it’s about 25% who qualify. Some of the lack of participation is due to stigma and some is due to parents simply not being aware that they are eligible for such programs, plus various other pressures. Schools also are not required to participate in the program, so kids at those schools must get help from the community or not at all. My heart really breaks for those kids.

    You said I live in a “rich” area. It’s true that “only” about 21% of families in Iowa would qualify for reduced cost or free lunches, and the actual participation rate is about 46% of those eligible, resulting in a little over 9.5% actual participation. I don’t think Iowa is that rich of a state, but I’ll readily admit that we’re doing better than you in Maine (or those poor sods in Oklahoma)!

    (Numbers taken from the US Census Bureau FactFinder.)

  20. Maine is the state that proves that simply being very white doesn’t make you very rich. Oh…Idaho is there, too.

  21. Mainer says:

    Actually Michael Maine is the whitest state in the union. And yes poverty does not respect skin color. After the earlier discussion today I ran down to our one grocery store to pick up a couple of things and while there grabbed the local weekly newspaper. In that paper is prominent article about the hunger issue here locally. Our local superintendent stated that our % of students qualifying for free lunch is now at 70%…..not free or reduced just free, I shudder what the numbers are for both free and reduced. The hunger issue has gotten so bad that a consortium of the school district, local agencies, food cupboards and LL Bean have gotten together to provide back packs full of food and various other necessities to a large number of children ever Friday afternoon so they can survive until they get back to school on Monday. When I say we are a poor area I am trying to not over state our situation. I applaud these efforts and will do that which I can to assist as will many of my neighbors as we are all sick about it but it is just not right on so many levels.

    Yet here is an area drowning in poverty that when for Republicans strongly this last election. The same Republicans that at the state and national level are now hell bent on pulling away what little rug exists under these people. I blame the local fundamentalist churches, lieing politicians and a media that has stopped doing its job. I get very fired up because I see good people that are trapped, hurting and about to hurt even worse because of nothing short of greed and ideology that sees them as expendable to larger games they never will be allowed to benefit from. A pox on any one that sees this whole Republican enrich the corporations and we will tax cut our way to economic nirvana as any kind of an answer.

    Oh and Bart welcome back ass hole. One post and yet again you prove why I think you are the poster child of what is wrong with this once great nation.

  22. Mainer,

    Actually Michael Maine is the whitest state in the union.

    Exactly why I mentioned that. And Idaho is #2.

    BTW, please stay away from the name calling.

  23. JC2 says:

    @Mainer

    You speak in objective terms that paint a picture from the student/educator perspective. I will attempt to bring add another perspective.

    Judging from a response to one of my comments a few threads back; I’ll guess you live in one of the coastal communities which used to be (marginally) middle class by a combination of tourism and the fishing industry.

    Most tourists, either passing through or briefly staying in the locale aren’t aware of the industrial fishing industry as it is so well tucked away and out of sight from the popular tourist sites.

    I have seen how, with the decline in tourism and fishing stocks, fishermen and those who depend in them manage to eke out a meager living. Not just talking about fishermen spending long days on halibut boats or weeks of potentially dangerous sea time going after scallops.

    There are less glorious but equally dangerous endeavors like the sardine industry, supported by myriad poor women working in a local cannery. Those unfortunates who frequently earn minimum wage and work horrible hours in conditions under which I or many others wouldn’t last 15 minutes.

    I have observed teenage girls in a sardine factory, sitting elbow-to-elbow wielding scissors over tables stacked with empty tins and delineated mainly by water filled troughs carrying sardines past their stations. Girls with bloody bandages on three fingers of both hands, snipping fish heads and tails, fitting sardines into tins to be cooked and sealed. Those with multiple bandages are the young ones, working with expressions containing mixtures of pain, determination and hope. Hope that they can master the job, stay employed and maybe earn a tiny bit more the next season.

    The ones who do not wear so many bloody bandages are exempt mainly because they long ago sacrificed the fleshy tips of their fingers and have little to get in the way of their scissors as they snip away at tough slippery little fish.

    Difficult way to earn a minimum wage or maybe a but more. But lucky for those who can land and keep jobs where the overall employment rate is very low.

    Whether in Main or any where else in the world; This situation sucks. Period.

  24. Bart DePalma says:

    Fili:

    But in the case—and there have been many in the past two years—where a small town has only one pharmacist, and that person refuses to fill a prescription for emergency contraception or birth control brought to him by a struggling, exhausted young mother who has neither the means nor the ability to drive to the next town…then I think that pharmacist is probably in the wrong profession, and I don’t believe such people should have the protection of the law when they refuse to provide a necessary service.

    And if the alternative is no service at all because the government has driven the conscientious objector out of his or her profession?

  25. filistro says:

    @Bart… And if the alternative is no service at all because the government has driven the conscientious objector out of his or her profession?

    C’mon Bart… that’s pretty weak. Pick up your game a bit, eh? I expect better from you. ;-)

  26. Bart DePalma says:

    Fili:

    So you assume that a conscientious objector medical professional will simply bow to the dictates of the the government, their moral principles be damned?

    The cost of practicing medicine has already hollowed out the medical profession in rural America as your hypo took into account. Why wouldn’t your hypothetical last town doctor simple leave if mandated to perform acts that she considered to be wrong and a violation of her moral principles?

  27. filistro says:

    Bart.. since you’re apparently in the mood for hypotheticals today, here’s one for you…

    What if your “conscientious objector” is a soldier? Should he be on the front lines in a battle, carrying a weapon that he refuses to fire on moral grounds?

  28. Bart DePalma says:

    Fili:

    The military is well practiced in dealing with COs.

    If the soldier volunteered for service in an infantry unit, it is rather difficult for him to later claim that he had a conscientious objection to killing.

    If there is a draft, COs can be placed in non-combat roles, although not necessarily off the front lines. Medics are a popular place to put them.

    The problem of COs is why I believe a draft should be a last resort to man the military – just as we should avoid any other government affirmative requirements on the citizenry if at all possible.

  29. filistro says:

    @Bart… If the soldier volunteered for service in an infantry unit, it is rather difficult for him to later claim that he had a conscientious objection to killing.

    Precisely!

    And if a pharmacist volunteers to sets up shop in a small town where she will be the only means of filling prescriptions, it is rather difficult for her to later claim she has a conscientious objection to filling prescriptions.

  30. Mainer says:

    Michael you are of course correct. Bart that was uncalled for on my part. That I find your positions distasteful should have no more bearing than that. I stand appropriately corrected. Aye Aye Michael.

    JC, no I grew up in the area of which you speak. Even in high school I stop seined along the coast with friends supplying those plants which lined the coast. They no longer do. The last one closed this last year. The area you speak of is the only area of the state that may be worse off than the inland remote area I now call home.

    No Bart a doctor took an oath. There was no part of it that said unless it goes against my other feelings. We have seen pharmacy chains pretty much take over that end of the business here and some of the “well I don’t really want to” has ended. One case where bigger has helped. Never thought I might say that. We had one individual in a nearby town that thought they should get preachy with folks. They were apparently warned twice and the third time it happened the store manager happened to hear the whole thing………gone. You want to be preachy then become a minister.

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