Prolife doctors should have choices, too.
AMERICAN HEALTH CARE IS IN THE MIDST OF A TERRIfying, though silently fought battle that may have grave implications for everyone seeking care in the future. Attempts are underway to force out health care providers who refuse involvement in either the direct or indirect termination of life. Though mainline sources of news tend to ignore the conflict--as they do most issues that would lend credence to a prolife orientation--the struggle is real.
A recent article in the Journal of Gender-Specific Medicine that addressed competing legal rights--of women to abortions and of health care providers to the right of conscientious objection--offered the chilling suggestion that "state licensing agencies could take disciplinary action against pharmacists who hinder ... arrangements to allow women to get abortifacient drugs." The central point of this legal argument is that medications like the "morning-after pill" must be made available to all women who seek them. Pharmacists who do not wish to fill a prescription for Previn or for other abortion-inducing drugs must refer the woman to an alternate pathway for securing their abortion drug of choice--or face disciplinary action, potentially depriving them of their right to practice their profession.
Many prolife pharmacists feel that referring a patient to another pharmacist to fill a prescription for an abortion drug is as morally culpable as filling the prescription themselves. Nonetheless, the article's author presents the prochoice argument that "pharmacists relinquish the right to unfettered autonomy when they enter this service profession."
Pharmacist Karen Brauer stuck with her religious and ethical beliefs and refused to fill a prescription for an abortion-causing medication. She was terminated by K-Mart even though both federal and state law make it illegal to fire a person because of his or her religion. Even the American Pharmaceutical Association acknowledged in 1998 "the individual pharmacist's right to exercise conscientious refusal" to dispense certain medications.
PHARMACISTS ARE FAR FROM ALONE IN SUFFERING DISCRIMInation, harassment, and termination of employment when they refuse to participate in medical activities that terminate life. Karen Kelly is a registered nurse who found out, upon taking a position with an Orange County, California health care agency, that her duties included teaching graphic sex and referring for abortions. Kelly, a Catholic, refused. She was harassed, threatened by coworkers and superiors, then fired.
Michelle Diaz was hired by another California county in early 1999. While still in her six-month probationary period, she and several other nurses were told their duties would now include dispensing the "morning-after pill." Four nurses, including Diaz, refused. Two resigned, one was transferred, and Diaz--after harassment in the form of an extremely excessive workload--was fired right before her probationary period was to end.
The only reason the Kelly and Diaz stories have come to light is that both are suing. But they represent the tip of the iceberg. Most health care workers, knowing that their salaries depend on not bringing attention to themselves as prolife "extremists," try to avoid taking any stand on life issues. A physician's assistant student at the University of Southern California School of Medicine, for example, objected to being assigned for his mandatory obstetrics and gynecology rotation to an abortion clinic. He had to threaten legal action before the rotation site was changed.
Physicians, of course, aren't exempt from this issue, either, and may become more at risk as managed care penetrates ever more deeply into our nation's system of health care. Under managed care, physicians must provide services to their identified patients and can be disenrolled from health maintenance organizations--brokers for patients--for cause. A recent law passed in California requires such organizations to provide reproductive care for women. Indeed, California is one of several places where legislation has been enacted or proposed to require all employers to provide contraceptive coverage through their health plans.
So a physician, for example, who does not wish to dispense birth control pills--because in some cases progesterone-only pills act as early abortifacients--might be deprived of his or her livelihood because the health care plan doesn't want on its roster any physician who won't meet all the patients' legal care needs (i.e., abortion). Obstetrician-gynecologists are at special risk because they are expected to put in IUDs, which can cause abortions, and to provide Depo-Provera birth control shots.
Perhaps I am more sensitive to the implications of medicine's silent war against its prolife members because of several personal experiences, the last of which compelled me to leave my most recent position at a university-affiliated family medicine practice rather than risk a malpractice suit for wrongful birth because of my refusal to complete an abortion initiated by another physician.
THE LOSS OF A PROLIFE PRESENCE IN ACADEMIA, OF COURSE, has implications that extend much farther than one individual physician's career. Young physicians, nurses, pharmacy students, physicians' assistants, and others are at a vulnerable time in their formation. Being exposed only to the expediency of a prochoice perspective can't help but influence future generations of physicians.
Academicians who are prolife, on the other hand, in an effort to retain their positions, often retreat into silence when they see more vocal advocates of the fight to life being swept from the academic landscape.
There also is a dearth of prolife physicians in the higher echelons of organized medicine--in organizations like the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology. Strongly prochoice positions are carved out by the leadership of such organizations even when polls show their rank-and-file membership to be more evenly divided. While its leadership has actively opposed parental-notification laws on abortion, for example, one AAP poll showed a full 49 percent of the membership in favor of parental notification laws.
Even so-called "conscience clauses" are not safe. These provisions, which allow health care providers to deny treatment on the basis of religious or moral beliefs, were established-usually through state laws--in response to the 1973 Supreme Court Roe v. Wade ruling, exempting individuals from performing abortions or sterilizations. But these, too, have come under attack. According to one legal case being brought against such clauses, these "generally deny patients access to health services," "exempt providers from offering the standard of care," and are a "tactic of the anti-choice community to limit access to reproductive health services and are a strategic effort to hinder such services."
ONE NOTABLE EXCEPTION IN AN OTHERWISE HOSTILE CLImate: The American Medical Association (AMA) recently rejected a resolution aimed at forcing Catholic hospitals to provide sterilization and contraception. The threat under which the AMA acted was the possible termination of all obstetrical services--or even complete closure--of Catholic hospitals, which disproportionately serve inner cities and the poor.
Does the silencing of prolife voices in medicine necessarily portend bad care for those whose medical problems have nothing to do with reproduction?
Perhaps minorities have seen the writing on the wall more clearly than the rest of us. I find that it's not uncommon now for people of color to refuse hospitalization--or to express concern about the possibility of being secretly euthanized while in the hospital. Many more people worry that signing standard end-of-life care documents means agreeing to cessation of treatment for possibly curable conditions. Physician-assisted suicide is already legal in Oregon.
Medicine is slowly becoming less a profession of healing and more a profession of social engineering, and woe to those who protest the means or goals of this new role.
Those of us who are prolife and in medicine need all the help we can get. Patients can help by selecting health care providers who do follow a life agenda. They can write letters to their hospitals, HMOs, and representatives supporting stronger conscience clauses and more legal protection for those who dare refuse the pro-death agenda that increasingly permeates our health care system.
For the day is rapidly approaching when health care providers who refuse to kill Grannie--or to give up on an imperfect child--will no longer exist in American medicine. And on that day, no clinic or hospital will ever again be a refuge against disease.
By KATHERINE DOWLING, M.D., a pseudonym for a family practitioner living in California.
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|Date:||Mar 1, 2001|
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