Rob Stein, a Washinton Post syndicated writer, had an article in The Lakeland Ledger on Sunday. In it, he describes one of the major issues in bioethics which confronts health care providers. I’ve blogged on this previously here. According to Gene Rudd, of the Christian Medical and Dental Association:
“This issue is the San Andreas Fault of our culture. How we decide this is going to have a long-lasting impact on our society.”
The issue concerns the rights of health care workers to not violate their conscience and the rights of patients to receive care they feel they are entitled to. Among the scenarios presented in the article include an ambulance driver who refused to transport a patient for an abortion, fertility specialists who rebuffed a gay woman seeking artificial insemination, and a pharmacist who turned away a rape victim seeking the morning-after pill.
Stein framed the argument as follows:
Proponents of a “right of conscience” for health workers argue that there is nothing more American than protecting citizens from being forced to violate their moral and religious values.
Patient advocates and others point to a deep tradition in medicine of healers having an ethical and professional responsibility to put patients first.
Among the quotes of the those opposed to health care workers rights of conscience, are these:
“I think it’s absolutely wrong to impose your religious beliefs on someone else.” - Paige Gerson, whose doctor refused to give here the morning-after pill.
“If your religious orientation is such that you can’t discharge your professional responsibilities, then you shouldn’t take on those responsibilities in the first place,” said Ken Kipnis, a philosophy professor at the University of Hawaii at Manoa. “You should find other work.”
“I grew up in a very religious family. But I don’t think that religion tells you you can judge other people.” - Guadalupe Benitez, a lesbian who was refused an insemination procedure.
Unpacking the arguments from the previous statements, we are left with these principles:
1. A physician has an obligation to give a medication to a patient even when she feels the administration of this medication will kill a human being.
2. It is the responsibility of physicans (or substitute other health care providers) to provide to patients whatever treatments they request, even if morally objectionable.
3. A physician should administer whatever treatment is requested by his patient, even if he feels it is inappropriate and immoral to do so.
I’m not sure what professional responsibilities Kipnis was referring to when he suggested physicians who refuse to give treatments they feel are immoral should find another profession. I wish he would have outlined those duties. The Hippocratic Oath, which all physicians take (in some form or another) outlines the duties of the physician:
I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.
To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my art.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.”
It would seem from the above, that the duty of a physician is to withhold treatment that would cause an abortion. The Hippocratic Oath imposes upon a physician the duty to act morally. A good physician will not simply give to a patient whatever he asks, he will do what is morally right. Following the moral logic of Kipnis and others, a physician would be wrong to refuse to assist someone in taking her life (of course many have already gone this far in their reasoning). It is interesting that the Hippocratic Oath prohibits both abortifacents and physician-assisted suicide. It seems the Oath has been turned on its head and the only responsibility the physician has is to cater to the whims of the patient, no matter what harm may come. The first duty of the physician is primum non nocere (First, do no harm). Health care workers must not be forced to violate their consciences by administering treatments which cause harm.