In Part 2 of the miniseries which we began yesterday, we discuss how "moral refusal" clauses are increasingly going far beyond just doctors and pharmacists, and are now extending to the most basic thing we associate with healthcare--the trip in the ambulance to have emergency surgery.
Yes, you're reading this right--dominionist ambulance drivers are now refusing to take people to women's clinics just because the woman needs a medically necessary abortion.
And at the end of the post--because I never like to just bring bad news without discussing ways to fix what's broken--I present some possible solutions to the problem of "moral refusal".
Firstly, a note to the EMT community
Firstly (because there has been some confusion on this), I should note that we are not talking about all EMTs--but rather the problem of dominionists who have infiltrated the ranks of EMTs and who have been using broad "moral refusal" laws to their favour.
The vast majority of EMTs are good folk who work damned hard at an unrewarding, potentially dangerous job to try to save lives. You folks have my respect.
The purpose here is to warn that broad "moral refusal" laws are essentially opening up the EMT ranks to the same problems that occur with women trying to obtain reproductive health services through OB/GYNs and women who are prescribed contraceptives--namely, dominionists have been "stealthing", purposely training themselves in those professions and targeting members of those professions for conversion, and then setting themselves up as essentially "human roadblocks" to prevent women from obtaining reproductive health care (among other things). Typically these laws also give near total immunity to persons refusing to treat or transport due to "moral refusal"; in particular, Mississippi's very broad "moral refusal" law (the most expansive in the country, covering everyone from neurosurgeons to candy stripers) explicitly prohibits the state licensure board from removing licenses of medical personnel who refuse treatment due to "moral refusal".
The expansion of "moral refusal" laws to EMTs and other non-doctor personnel--and the simultaneous targeting of the nursing, pharmacist, and EMT specialties by dominionists promoting "roadblocking"--has particularly serious consequences. Most of the laws including EMTs in "moral refusal" in particular are extremely broad and increasingly do not include "must transport in event of threat to life or health" provisions--in large part because of the use of Mississippi's extremely broad "moral refusal" law as a sort of "model statute" nowadays. (Even with the case noted below, it is iffy whether the person will ultimately be permanently fired or regain their job; Illinois does have an "immediate safety" provision, but the main court argument is whether the refused transport would have fallen under the "moral refusal" law or the one exception in aforementioned law.)
My goal is not to slag off EMTs--far from it. My goal, rather, is to try to prevent the same problems that women have now in finding an OB/GYN willing to prescribe "the pill", a pharmacist willing to fill the prescription, and a hospital willing to perform a vasectomy on her husband or a tubal ligation on her (did we mention she was taking "the pill" due to PCOS?). We do not want this to expand to having to find an EMT willing to take her daughter to a hospital or a women's clinic to perform an emergency abortion.
Dominionist "moral refusals" that can kill women
I've already noted in past in a series on the dominionist "parallel economy" in medicine--which includes a section on dominionist OB/GYN services--how Mississippi in fact has such a broad "moral refusal" law that even EMTs and ambulance drivers can claim "moral refusal" in regards to rendering emergency treatment and transport to hospital. I predicted, two years ago, that this would end up with people being refused to be taken for needed lifesaving healthcare as a result.
Unfortunately--and in a sad confirmation--the Washington Post article has noted that there are now cases of women being refused transport for medically necessary abortions:
The pharmacies are emerging at a time when a variety of health-care workers are refusing to perform medical procedures they find objectionable. Fertility doctors have refused to inseminate gay women. Ambulance drivers have refused to transport patients for abortions. Anesthesiologists have refused to assist in sterilizations.
I've been able to find some further info on the case:
Manion works for the American Center for Law & Justice, a Washington-based public interest law firm that specializes in constitutional challenges.
In the last eight years, he's handled at least 30 cases involving health care professionals who claim to have been discriminated against for refusing services on religious grounds. He has litigated six such cases, including a case he settled last May involving a county health department employee in Illinois who was denied a promotion because she refused to translate into Spanish information on abortion options. Faith Moncivaiz v. DeKalb County Health Dept., No. 03-CV 50226 (N.D. Ill.).
Currently, Manion is representing an Illinois emergency medical technician who was fired for refusing to drive a woman to an abortion clinic.
According to Manion, the technician, Stephanie Adamson, said her Christian beliefs prevented her from transporting the woman, who had abdominal pain, for an elective abortion. She is suing the ambulance company, Superior Ambulance Co. of Elmhurst, Ill., claiming religious discrimination. Adamson v. Superior Ambulance Service, No. 04 C 3247 (N.D. Ill.).
Manion argues that the elective abortion was not an emergency situation.
"Why did she need to go by ambulance to an abortion clinic? If she was truly in a medical emergency, why wasn't she taken care of downstairs [in the hospital emergency room]? Manion said.
(Of note, the American Center for Law and Justice (an Orwellian name if there ever was one!) is a dominionist "parallel economy" legal group that rather explicitly promotes itself as the dominionist alternative to the legitimate ACLU.)
This is bad. Really, Really Bad.
Generally, a woman won't be taking an ambulance to have an abortion unless there is a bona fide medical reason she may need one, and because abortion services may not otherwise be available (it's, again, not uncommon for public hospitals not to perform the procedure but to refer to women's clinics). There are indications this was exactly the case for the poor woman in Illinois; other reports on the issue indicate the woman in question was having severe pain--a sign of either an ectopic pregnancy possibly rupturing or a possible miscarriage in progress, both of which are major obstetrical emergencies.
In addition, there are a plethora of reasons why a woman, even one normally "pro-life", would be required to make the choice to terminate her pregnancy.
Ectopic pregnancy is when a pregnancy develops in the fallopian tubes--if an emergency surgical abortion is not performed, the fallopian tubes usually burst (which is a lifethreatening emergency). There is quite literally no way for a tubal pregnancy to make it to term, or often even to viability.
One wonders if the "every zygote is sacred" crowd would be happy to let women die in attempts to carry tubal pregnancies--or rather, one would wonder if they would, if one wasn't aware that this is in fact the case in El Salvador, which not only has banned abortion (even in medically necessary cases) but considers it a felony--and has several women die a year of ruptured tubal pregnancies.
For that matter, what about hyatidiform moles, or what is normally referred to as "molar pregnancy"?
Molar pregnancy is a way in which pregnancy can go horribly, horribly wrong--it is, quite literally, a type of cancer that originates in either placental tissue or in embryos with certain severe chromosomal defects. In other words--unlike practically all other cancers--it is a type of cancer that develops from a fertilised zygote whose development goes tragically wrong, and partial moles in particular can literally be described as embryo-based cancers.
Molar pregnancy not only can kill (from being a pregnancy related cancer) but in fact the massive hormonal disruptions (completely aside from the "if untreated it will invade your uterus, your other tissues, and kill you" aspect) can themselves be life-threatening.
The cure is a common abortion technique--a D&C--followed up with a course or two of chemo. In the rare cases where there have been "twinned" pregnancies where one embryo develops normally and the other becomes a molar pregnancy, these have a much higher risk of metastasis and a bad outcome; in fact, the risk of death from cancer is so high that in these cases abortion (of both the healthy embryo and the molar pregnancy) is recommended as a lifesaving measure for the mother because there is just too much risk in trying to carry the healthy embryo to term (in fact, molar pregnancies can metastasize to their "twin", too).
Again, just like ectopic pregnancies, there is no way a molar pregnancy--even though it developed from a fertilised egg--will ever develop normally, and if one attempted to "carry it to term" it'd likely kill the mother in the process.
And there are still other reasons why an abortion may be medically necessary to save the mother's life. One common reason is a fetus dying in utero and becoming septic; another reason is a hormone-sensitive cancer that develops in pregnancy (especially in the uterus, ovaries or breasts); other reasons still are preeclampsia and HELLP Syndrome--both of which can only be cured by delivery or abortion, and both of which kill (and preeclampsia has historically been one of the biggest killers of pregnant women). Another reason still is a fetus that will never survive outside the womb (including those with major organs missing--anencephalic fetuses, fetuses that developed without hearts or kidneys, and so on). Another reason is maternal renal failure. Another reason is the discovery of a catastrophic chromosomal disorder. Sometimes the mother's water breaks or she has a partial miscarriage. There are many reasons, almost all of them in the "heartwrenching" category, that a woman may have to terminate a pregnancy that she was very much hoping would result in a healthy son or daughter being brought into the world.
In fact, there is an entire website entitled "A Heartbreaking Choice" for people who had to end up terminating pregnancies--very much wanted pregnancies--for medical reasons. It's a horrible thing to go through--but it happens.
And extending "moral refusal" to refusing to take an ill woman to the women's clinic or one of the few hospitals allowed to perform an abortion can end up in losing both the fetus and the mother. :(
Still too much room for "refusal"--and a potential way of narrowing the loopholes
And there's another aspect that has been little mentioned, but has been touched upon in the Washington Post article--even in states that have "must dispense or refer" laws, the laws become rather useless if most of the pharmacies refuse to carry or have pharmacists that "refuse"--or if the person lives in an area that has only one or two pharmacies, with one of those being Wal-Mart (which has had a history of refusing to carry birth control and Plan B).
Especially if the only non-Wal-Mart pharmacy in town is one of those innocent-sounding "independent pharmacies" that just happens to be a big player in the dominionist "parallel economy"--women, even with a "must dispense or refer" law in their home state, can be left with no options. This is far from an idle concern:
But others worry about what will happen if such pharmacies proliferate, especially in rural areas.
"We may find ourselves with whole regions of the country where virtually every pharmacy follows these limiting, discriminatory policies and women are unable to access legal, physician-prescribed medications," said R. Alta Charo, a University of Wisconsin lawyer and bioethicist. "We're talking about creating a separate universe of pharmacies that puts women at a disadvantage."
In fact, a recent article in the University of Detroit-Mercy's Law Review makes the very important point that the proliferation of "moral refusal" clauses interferes substantially with patients' rights--including the right to treatment.
A much better solution, IMHO, is multi-fold:
a) Require licensed pharmacists to dispense all medication if there are less than two licensed pharmacists on staff. If there are two or more licensed pharmacists on staff, one must be willing to dispense medication in the event of one giving moral objections. (Yes, make this part of the formal licensing, too, and start yanking accreditation and licenses of pharmacists who try to make "moral refusal" cases.)
b) Formulate a state list of essential medications and require at least one pharmacy per incorporated town (or better yet, one pharmacy per "x amount of people in an area" to cover major metro areas) to be a "state formulary pharmacy". State formulary pharmacies would be required to carry all medications on the formulary (birth control pills and Plan B, and other reproductive health medications, will be included). Revoke licenses of pharmacies who are listed as "primary formulary providers" in their area.
c) (This could potentially be used in lieu of b) above) Require all pharmacies carrying pregnancy category D or pregnancy category X drugs to also carry all contraceptives, including "the pill", Plan B, condoms, etc. This would be especially effective--and would drive the point home. (The one bad thing is that it does have a loophole--namely, drugstores could opt out of carrying category D or X drugs--but combined with a "formulary pharmacy" law, that could eliminate the issue.)
(Note that I do not mention mifepristone, aka "RU-486". Due to federal regulations, this can only be given in a doctor's office.)
d) Require formal accreditation at a legitimate, mainstream pharmacists' association as a condition of hire (such as APhA) and do not let dominionist "parallel economy" groups in as alternate accreditation bodies. One possible way of doing this is requiring continuing medical education (CME) as a condition of pharmacist licensure and only accepting CME credit from legit groups like APhA.
e) No person is allowed to conduct a "moral refusal" if there is an effect of harming the life or health of the person who is being refused. (Yes, this is the "life or health" exemption. People can be involuntarily committed in cases where their life or health is at risk due to mental illness; the laws which largely prohibit abortion past the 24th week of pregnancy have life and health exemptions (for now); if we're going to allow "moral refusal" at all, put a "life and health" exemption there, too. :D)
E), I think, will be the biggie here--"if it could cause someone to die or be ill, you don't get to refuse it if you're the only one who can provide it".