(edit: someone beat me to the punch - Avenging Angel posted a similar diary just before I did. Go read it. Also, this is too long for a comment, and has some additional information, so I don't plan on deleting. Sorry.)
You keep hearing about it. Pharmacists refusing to fill morning-after pills, hospitals refusing to perform emergent abortions. Well, since Bush is on a rampage to push as many of his bad policies into effect before he leaves office, it should come as no surprise that he's trying to enact a broader policy of "Conscientious Medical Refusal", one that would effect more than just doctors and nurses.
Follow me below the fold...
Let me preface my diary by disclosing who I am. I'm a fourth year medical student who has done the vast majority of my clerkships in some of Southern California's biggest county hospitals. Those of you who work in the medical field have an understanding of what "county" means. To those who do not, "county" means "where all the poor, uninsured people go to get care." I'm blessed that I've had the opportunity to work where I have - you see some of the most interesting cases in a county hospital, but at the expense of your patient, who's been sick for so long that they present to the emergency department in a disaster state.
I've also been fortunate that the medical staff I have worked with - from surgeons to the housekeeping staff - have always put the patient first and foremost. I've never seen anyone's access to medical care blocked due to someone's "personal beliefs". I would like to think that the vast majority of obstetricians and gynecologists go into their field with open eyes and a clear understanding of the scope of their practice. I would hope the same from their nurses, medical assistants, and so on. Often, I'm confused when I read that there are pharmacists that refuse to fill prescriptions for birth control, or morning after pills. I often think, "You KNOW that is a part of YOUR JOB. You FILL the prescriptions that THE DOCTOR PRESCRIBES!" But I keep reading about this, again and again.
Needless to say, my hackles when up this morning when I read in today's LA Times:
The outgoing Bush administration is planning to announce a broad new "right of conscience" rule permitting medical facilities, doctors, nurses, pharmacists and other healthcare workers to refuse to participate in any procedure they find morally objectionable, including abortion and possibly even artificial insemination and birth control.
For more than 30 years, federal law has dictated that doctors and nurses may refuse to perform abortions. The new rule would go further by making clear that healthcare workers also may refuse to provide information or advice to patients who might want an abortion.
(emphasis mine)
Excuse me?
Up to this point, they could refuse to do the procedure. Now, one does not have to even PROVIDE INFORMATION for obtaining one. In other words, Bush is allowing these so-called "conscientious objectors" to ABANDON patients - yes, it is patient ABANDONMENT - by not providing referrals.
Among those behind this push to restrict access to care are the Christian Medical Assn. and the U.S. Conference of Catholic Bishops. And they aren't stopping at abortion - among their targets are birth control and artificial insemination.
Now, hormones aren't just used as birth control. The uses for estrogen and progesterone range from ovarian failure to dysfunctional bleeding, and while I'd like to think that the anti-hormone crowd (yep, that's going to be my new technical term for them) wouldn't obstruct a woman's access to this therapy, I have a sneaking suspicion that there will be women who will not receive hormones because they just might prevent her from being pregnant.
To make matters worse, HHS secretary Mike Levitt plans on ramming his policy through as quickly as possible.
Despite the controversy, HHS Secretary Mike Leavitt said he intends to issue the rule as a final regulation before the Obama administration takes office, to protect the moral conscience of persons in the healthcare industry....
If the regulation is issued before Dec. 20, it will be final when the new administration takes office, HHS officials say. Overturning it would require publishing a proposed new rule for public comment and then waiting months to accept comments before drafting a final rule.
Yep. Ram that baby through there, Mike! We have to protect the anti-abortion and anti-hormone crowd! God forbid they do anything that makes them uncomfortable! Who cares about the patients, anyway?
Luckily, there are some big groups who do.
First, and foremost, Planned parenthood is on the case:
This new rule could allow almost 600,000 health care entities that receive federal funding to redefine abortion to include the most common forms of birth control — and then refuse to provide these basic services. For any health provider to intentionally withhold information about widely embraced treatment options from a patient — for any health condition — is absolutely unconscionable under any circumstances. It’s outrageous that President Bush is using his last days in office to implement a rule that would limit the rights of patients to receive complete and accurate reproductive health information.
A woman's ability to manage her own health care is at risk of being compromised by politics and ideology if this regulation goes into effect.
Even better, the American College of Obstetricians and Gynecologists is mad, and is calling for limits for conscientious refusals of care. They state that if someone is going to have an objection to performing a procedure or prescribing a medication, they should either refer (give information) or live in an area of like-minded individuals. Furthermore, if it is an emergency, an objector has an obligation to provide care.
In addition, the American Medical Association (yes, those guys) are not pleased. Overall, they believe that this sort of policy is bad for patients:
From a 2006 OpEd regarding conscientious objection:
Legislation, typified by a law enacted in Mississippi in 2004, protects a wide range of health care and health-related professionals and institutions against criminal law and civil (ie, non-criminal law) liability for withholding their services on grounds of “the religious, moral or ethical principles held by a health care provider, the health care institution or health care payer”. This law grants immunity to a physician for refusing to undertake a life-saving procedure on a patient and to refer her to a nonobjecting colleague; to a nurse for refusing to undertake hygienic care of an abortion patient; to a hospital staff member for refusing to prepare or serve meals for such a patient; and, for example, to an ambulance driver or paraprofessional for refusing to carry a patient believed to be suffering incomplete induced abortion. Paradoxically, a physician’s or pharmacist’s refusal to supply emergency contraception to a rape victim could lead to her resorting to abortion.
In short, such legislation, enacted or proposed in several states, entitles physicians and many other health care professionals to violate the most basic ethic of medicine by disregarding patient care. It also allows hospitals and other health facilities to neglect the medical needs of their patients, prospective patients, and dependent communities. Religiously affiliated hospitals, the first established facilities for administering health needs, are now absorbing nondenominational hospitals, thereby reducing lawful health service levels in those communities. The American Medical Association, American Bar Association, and many other professional associations have condemned the violations of professional standards and ethics exemplified by such legislation. Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with societ
the Mississippi case sounds extreme, but if a broad-scope policy goes into effect, this sort of blatant disregard for patient care could become more commonplace.
From the LA Times:
Since the 1970s, Congress has said no person may be compelled to perform or assist in performing an abortion or sterilization. One law says no person may be required to assist in a "health service program or research activity" that is "contrary to his religious beliefs or moral convictions." The HHS rule says that law should be enforced "broadly" to cover any "activity related in any way to providing medicine, healthcare or any other service related to health or welfare." (emphasis mine)
So, if a woman has an abortion and is hospitalized, she is not guaranteed anything - from nursing care to meals to housekeeping. And, frankly, that pisses me off. Again, from my experience in large county hospitals, I can say the vast majority of the patients I have seen go there because they cannot afford to go anywhere else. Since they receive federal funds, this scenario could play out and affect those who cannot otherwise obtain care.
This, my friends, is unacceptable. We need to contact our elected officials and get them on board to protect patients, and women, now.