My Care. Your Rights

I have, it seems, been laboring under a misconception.  All these years I liked to believe that the healthcare system was about the patient.  Sure, lots of people made money in the process, but that was OK with me, as long as how they made it was still about the patient.

That was naive.  I knew that a few people in healthcare were too focused on the money part of things, but what I was not paying enough attention to was that, for some healthcare professionals, what they do is about their beliefs, not my care. 

iStockPhoto-Cimmerian

The case in point was the recent situation in Peoria, Arizona, where a young woman was denied service by her pharmacist.  Nicole Arteaga was nine weeks pregnant when her doctor told her the baby's development had ceased.  The doctor gave her an option for a surgical procedure or for a prescription drug that was likely to cause her to miscarry, and she choose the latter. 

The pharmacist understood what the drug did, questioned why she was taking it, and refused to refill it due to "ethical reasons" -- which is permissible under Arizona law (and in several other states).  As she detailed in a Facebook post:

I stood at the mercy of this pharmacist explaining my situation in front of my 7 year old, and five customers standing behind only to be denied because of his ethical beliefs. I get it we all have our beliefs. But what he failed to understand is this isn’t the situation I had hoped for, this isn’t something I wanted. This is something I have zero control over. He has no idea what its like to want nothing more than to carry a child to full term and be unable to do so. If you have gone thru a miscarriage you know the pain and emotional roller it can be. I left Walgreens in tears, ashamed and feeling humiliated by a man who knows nothing of my struggles but feels it is his right to deny medication prescribed to me by my doctor.

Ms. Arteaga ultimately was able to fill her prescription at another pharmacy -- across town -- and both Walgreens and the Arizona State Board of Pharmacy claim they will "investigate" what happened, although a Walgreens spokesperson admitted to Buzzfeed that company policy "allows pharmacists to step away from filling a prescription for which they have a moral objection." 

What if there hadn't been another pharmacy in town, or another pharmacist who didn't have a "moral objection" to filling her prescription?  What if, for medical reasons, there hadn't been time to investigate other options? 

Photo: Reuters

Example number two: the Supreme Court just overturned a California law that required "crisis pregnancy centers" to tell pregnant women about the availability of abortion services.  These centers typically oppose abortion on religious grounds.  The law did not require the centers to provide such services, mind you, just to alert women that they may have options other than the ones those centers choose to inform them about. 

 Justice Kennedy concurred with the majority, claiming: "Governments must not be allowed to force persons to express a message contrary to their deepest convictions."  

Governments have, of course, for years had no qualms about requiring abortion providers provide a number of messages that are contrary to their deepest convictions -- some states require that they require pregnant women to get medically unnecessary ultrasounds before obtaining an abortion! -- but apparently it matters whether you agree with the message or not.

None of this should, in 21st century America, be a surprise.  We now have a "Conscience and Religious Freedom Center" within HHS, aimed at protecting "health care providers who refuse to perform, accommodate, or assist with certain health care services on religious or moral grounds."  The website lists a string of federal laws that have helped bring about such "conscience protections," most of which revolve around abortions and related procedures. 

But it is not just federal law and it is not just about abortions.  In Texas, for example, pharmacists have "exclusive authority" about whether to dispense a drug.  They can choose when they do not wish to, and they don't have to explain why then they opt not to. 

As Sonia Suter, a bioethics and law professor at George Washington University, told The Verge, recent interpretations of the "conscience clause" are troubling:

It defines actors pretty broadly, so it’s not just employees, but anyone involved: volunteers, trainees, contractors, health care entities. And they’re also broadening it beyond religious objection to moral objection, and that has implications for other kinds of health care like vaccinations and gender reassignment surgery, too.

Where does the line get drawn?  What about a healthcare professional refusing to treat gay patients?  What about one refusing to treat minority patients?  What about male healthcare professional refusing to treat a female patient?  Somewhere there are healthcare professionals in America who have religious or "moral" beliefs that might dictate each of such actions, and we should be very concerned.

PHOTO ILLUSTRATION BY THE DAILY BEAST

We've had a lot of debate about a baker refusing to make a custom wedding cake for a gay couple, even taking it to the Supreme Court.   When that baker is a doctor, that couple is someone in dire need of medical care, and instead of no cake it was that care which wasn't delivered, well, then we'll see what kind of country we are. 

You see, it's not supposed to be about their religious or moral beliefs.  They have every right to have them, and to express them.  But when someone becomes a healthcare professional, it's not supposed to be about them or their beliefs.  It is supposed to be about what is best for the patient.  It is about using their medical knowledge and training to help the patient as best they can, to the utmost of their abilities. 

If doing that conflicts with their beliefs, then they are in the wrong line of work.  They have the right to their beliefs, but not the right to have those beliefs interfere in doing what is best for the patient.

Our healthcare professionals don't have to be like us.  They don't even have to like us, and they certainly don't have to agree with us.  But when we can't depend on them doing what is best for us, then we've got a real problem.