Sunday, January 4, 2009

The Tyranny of an Undisclosed Conscience

Displacing professional standards by an undisclosed conscience can only result in tyranny – and other undesirable unintended consequences of a new Federal rule are also inevitable!

Beginning January 19, you can go to a hospital that says it provides family guidance services yet be denied legitimate healthcare information without your knowledge or consent simply because of the conscientious beliefs of the clinician serving you that day.  For example, “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.” (Los Angeles Times, 12/2/08)  

The BIG difference between the old and the new scenarios, as we will see below, is that when using a hospital that objects to certain services such as abortion, you used to know what to expect; but under this new rule you no longer know what to expect since what information you receive will depend on each clinician’s personal conscience. It really does NOT matter what the published literature of the hospital says anymore.  The conscience of the individual clinician prevails in every case.


Since this is a federal rule, it trumps local laws:

Many states currently have laws requiring that rape victims treated in hospital emergency rooms be offered the option of taking emergency contraceptive pills to prevent pregnancy. But she [president of Planned Parenthood] said that because providers who don’t believe in emergency contraception could now simply opt not to tell women about that option, “under this rule, we believe that in fact now women who are the victim of sexual assault either would not be guaranteed either information or health care access to emergency contraception.”(NPR, 1/3/09)


This rule has severe penalties:

The far-reaching regulation cuts off federal funding for any state or local government, hospital, health plan, clinic or other entity that does not accommodate doctors, nurses, pharmacists and other employees who refuse to participate in care they find ethically, morally or religiously objectionable. It was sought by conservative groups, abortion opponents and others to safeguard workers from being fired, disciplined or penalized in other way. (Washington Post, 12/19/08)


This rule extends to a wide network of healthcare workers:

The Bush administration announced its “conscience protection” rule for the healthcare industry Thursday, giving doctors, hospitals, and even receptionists and volunteers in medical experiments the right to refuse to participate in medical care they find morally objectionable.  (Los Angeles Times, 12/19/08)

The final rule, however, affects a far broader array of services, protecting [pharmacy] workers who do not wish to dispense birth control pills, Plan B emergency contraceptives and other forms of contraception they consider equivalent to abortion, or to inform patients where they might obtain such care….  While primarily aimed at doctors and nurses, it offers protection to anyone with a “reasonable” connection to objectionable care — including ultrasound technicians, nurses aides, secretaries and even janitors who might have to clean equipment used in procedures they deem objectionable. (Washington Post, 12/19/08)

No More Basis for Trust

When you go to a healthcare organization such as a Catholic hospital that clearly states its ethical position, you know what to expect, and you know you will be served professionally within the bioethical beliefs of that organization.  So, for example, they will not offer you abortion services, though they are required to offer alternative options.

Rules already are in place to protect any person, doctor or pharmacist from going against their conscience by providing abortion or contraception information or services to patients or clients. But current practice requires people to inform people that other options are available elsewhere. (Pittsburgh Post-Gazette, 1/3/09)

As we have noted above, however, this new rule does not allow you to know you are not being denied certain services, which means you will not know what to expect.  “The provider can deny information and services to their clients without their knowing it is being denied.”  (PittsburghPost-Gazette, 1/3/09)

You will be under the total control of each clinician’s conscience regardless of their ethnic or religious background, or even any misguided confusion of a partially developed or guilty conscience they may be experiencing at the moment.  Some warn that “As written, the rule also would protect health care providers opposed to vaccinations or other medical procedures.”  (Pittsburgh Post-Gazette, 1/3/09)  It will take a long time to sort out because no one will know when it is being employed because clinicians who take advantage of it are not legally accountable for their actions.  This rule does not require anything from them; rather, it permits them NOT to do what other laws, professional codes, and ethical codes DO require them to do.  It is truly antinomian.  

When I think how many healthcare organizations are turning over ever more of their clinical functions to nurses and much less educated providers; when I think how narrowly educated these specialized medical technicians are; and then when I think how the mass media has made almost all of us highly vulnerable to every wave of pop culture thinking and current fads, I wonder what kind of conscience we are turning our future medical care over to?  Whatever the current movies are promoting?  What kind of social strategizing does the Bush administration have in mind?  Certainly not the good of the unborn – that is plain to see, since there have been no commensurate increases in social services to support the increased birth rate this rule is intended to accomplish.

This rule seems bound to create moral chaos. There is no basis for trusting one’s clinician since they legally do not have to tell you anything that offends their conscience. They are not compelled to give you as much respect as God gave Adam and Eve. They may even deny you your own right to refuse treatment by denying you the right to even know about it. If there ever was a place where the “house of cards” imagery applied, this is it. You can’t just say conscience takes priority in one clinical area but not in another. If it applies to bioethical issues, why should the underlying principle not also apply to alternative medicine, mental heath, and controversial medical treatments? It makes no sense to view this rule as limited in scope: the legal basis for justifying this one area must surely apply to other areas as well.  But my bet is that the whole thing will collapse because it makes no practical sense. 

 

Unintended Consequences?

No one can fully predict the legal implications of this rule if it stays in place since it supersedes other related laws and seems to sanction a kind of libertarianism in medical ethics as far as denying medical treatment is concerned.  As noted above, some are concerned about medical procedures not mentioned in the rule being included as matters of conscience for some clinicians. There are all kinds of matters of conscience that this rule will undoubdedly bring to light.  This rule is not simply a regulation – if it continues it will create a new ethical  paradigm – the belief that personal ethics trump responsibility to clients in the professional relationship.

From all reports, the creators of this law seem to presume a traditionally Christian-based bioethical stance as either the legal heritage of the USA and/or the proper direction which the USA should take.  It appears that they have their own minds made up since they have not adapted the rule based on widespread public input. (Huffington Post, 12/19/08)  They seem unconcerned about the need for people of various viewpoints to live together amicably in a multicultural society, and in a society that does not reflect their common moral viewpoint.

And curiously and in contradiction to the Christian tradition which they seem to represent, this rule appears to be another example of the Bush administration’s nietzschean approach to create social change. In more genteel new age terms, this tactic could also be characterized as an attempt to create their own reality.  This from a president who said Jesus was the most influential political thinker in his life!  Jesus, the one who said “the truth will set you free” (John 8:32).  Yet President Bush wants to be known as a president who promoted a culture based on hiding the truth? 


 


Posted by Jim Johnson at 04:50:32 | Permalink | Comments (2)

Saturday, August 16, 2008

What’s Good about it?

HHS Moves to Define Contraception as Abortion

In what it must consider an act of Wilberforcian moral leadership, the Bush administration seems to want to force an increase in the American birth rate and remove freedoms Americans currently enjoy in the name of freedom of choice for health care providers.


They propose to do this with the kind of superficial logic that manipulates thoughts the way someone first learning a foreign language manipulates words in a dictionary. Government officials transferred the reasoning they deciphered from public polling data into legal arguments as if the public has a consistent and logically held medical and ethical position on fertilization and abortion issues. They translated generic polling data into precise legal arguments.


You will have to read the logic for yourself as documented in this source; only the barest outline can be afforded in this post.


Here are key excerpts from this source:


There are two commonly held views on the question of when a pregnancy begins. Some consider a pregnancy to begin at conception (that is, the fertilization of the egg by the sperm), while others consider it to begin with implantation (when the embryo implants in the lining of the uterus).


Up until now, the federal government followed the definition of pregnancy accepted by the American Medical Association and … the American College of Obstetricians and Gynecologists, which is: pregnancy begins at implantation.


So [now] HHS proposes that anyone can enforce his or her own definition of abortion “within the bounds of reason.”


The practical outcome of this logic led to the next step in the following headline:

Redefining abortion

Federal officials considering a rule allowing health care workers to refuse to provide contraceptives

Already “an existing regulation allows health care providers with objections to abortion to abstain from providing it to patients.”


By extending the definition of abortion to cover contraceptives, the new rule being promoted at HHS “would allow health care workers who object to abortion on moral or religious grounds to refuse to counsel women on their birth control options or supply contraceptives.”

Who’s “Good” does this new rule serve?

1. Obviously this rule is not for the good of unwanted babies who will be born, since many providers may opt out. Nor is it for the good of poor people who will be channeled into less than healthy options for dealing with the resulting consequences of unwanted pregnancies or alternative attempts to avoid them. Given the state of the economy, we can be fairly sure that there is no intent to ensure that other providers will be made available in every situation.


2. The rule that exempted health care providers with objections to abortion from providing it to patients was good because it allows them to avoid the direct act of what they perceive as killing. But indirect acts such as providing supplies cannot so simply and so arbitrarily be prescribed because this is a far more complicated issue. Do everyday store clerks have the right to refuse to sell condoms? One can at least imagine a host of legal controversies and more business for the legal profession as a result. One can even imagine a backlash against the original exemption.


3. According to the Houston Chronicle, this federal administrative rule would probably void a great many state laws. This rule is obviously not for the good of democracy, because it does not reflect a democratic decision-making process nor does it come close to reflecting decisions made by that process in the past.


4. Instead, this rule is widely viewed as payback to the Christian and religious right for its support of the Bush administration. Perhaps it is a cynical concession to the belief that the Democrats will win in November and immediately overturn it. But what if they don’t win? After all, John McCain has sided with the religious right on abortion. Real leaders do not play with fire like this. One has to wonder whether tainted hiring practices have also affected this area of the Bush administration.


Fanaticism takes what is good to an extreme. As we pointed out above, exempting conscientious objectors from providing abortions was good. But sneaking in exemptions for indirect contributions, however defined, without extensive debate and democratic decision-making is fanaticism.


Avoiding fanaticism involves a bit of relativistic thinking. A truly Christian approach to social change is not absolutist. Following the Apostle Paul’s example, one does not simply appeal to God’s revelation, but also recognizes the importance of social mores, because the objective of God’s law is love and peace. The goal of such social action is always to gain voluntary agreement.

What is Good about this Rule?

Absolutely nothing as far as I can see, for reasons already cited above.


Then why is it proposed?


The stated reason based on public opinion polls cited and refuted above is also invalid. A professional philosopher could provide a better explanation and the Bush administration would have done well to consult one. Even research specialists would be able to spot some of the errors in this approach since they would recognize the limitations of interpreting social surveys.


The underlying rationale for the rule is patent, however. The rule extends the likelihood of denial of abortions by giving high status to the definition of pregnancy as simply fertilization (apart from implantation) and by allowing providers such as pharmacists who contribute indirectly to opt out of providing.


In giving “equal” status to such a narrow ethical stance it allows that view to dominate the broader approach much like having a significant number of non-drinkers in a church tends to mean that alcohol may not be served on church property even though there are also a significant number of drinkers, who may actually be in the majority. The strong must accept the weak, but the weak do not have to accept the strong, because the weak think they are right. A teaching that was intended to express mutual concern becomes a tool for domination of others in express violation of Jesus’ commands to the contrary. Christians who deny Jesus’ paradigm as they contend for the “kingdom” in the civil arena are doing no better than those Jesus condemned for their practice of Corban.


Incidents like these help us begin to understand why Jesus predicted that both the sheep and the goats will be surprised about the verdicts on judgment day!


I’ve already expressed my view on the fertilization issue in a previous post. It boils down to the belief that human beings are called to be more than mere physical matter, including even the aspects of soul that the Bible always associates with the body (which is everything that fertilization represents). We must be “called” in some sense to become human. In a Christian theological sense, we are all are born spiritually dead. To have any spark of life and a chance of making it, individuals have to be wanted. My mother-in-law used to tell my children they used to be “a gleam in your father’s eye.” For communities to survive, older members need to reproduce and draw younger members into them. There are no stand-alone human beings.


Our responsibility is to draw individuals into human relationships and into relationship with God. It is not an isolatable responsibility to protect fertilized eggs. You can’t ethically fulfill the duty of protecting a fertilized egg without also fulfilling the duty to draw that being into the human family. A commitment of our country to a higher birth rate given our history and current economic conditions must be accompanied by a correspondingly huge investment in relevant social services supporting this commitment. It is the very fact that this rule is being introduced in such a backdoor manner that demonstrates that it does not reflect the high moral caliber that its backers would like to claim for it.


I do not believe that the “fertilized” ovum that do not implant are human beings that will some day be resurrected like everyone else. But that is what you as a Christian believe if you believe what the Bush administration is promoting to take precedent over other established laws.


Does that sound “good” to you?

 


Posted by Jim Johnson at 07:42:03 | Permalink | No Comments »