Moral and ethical boundaries in healthcare

Over the last year that I've been writing about science and medicine, I have argued for protections for those who object to performing procedures or dispensing medications that they find morally reprehensible. The more I read and see about the issue, my feelings lie towards the "find another line of work" slant. I found this editorial in the WaPo the other day, and I've only just now gotten around to reading it.

Pharmacists refusing to dispense Plan B. Doctors refusing to prescribe Viagra to unmarried men. Fertility specialists refusing to artificially inseminate a gay woman.

These occurrences represent a provider, who is in a position of power, forcing their moral beliefs onto their patients. It isn't right. But at the same time, I have a hard time condemning these people for refusing to go against their moral grain. I don't think this dichotomy exists in any other field *but* medicine. Over time, medicine has evolved from a purely "healing" profession into something that deals with everything related to the human body and basic biology. As our knowledge and understanding of many different fields of science and social science blend with our knowledge of what has been traditionally labeled medicine (physiology, pathophysiology, microbiology, etc.), these responsibilities have changed.

The issue is driven by the rise in religious expression and its political prominence in the United States, and by medicine's push into controversial new areas. And it is likely to intensify as doctors start using embryonic stem cells to treat disease, as more states legalize physician-assisted suicide and as other wrenching issues emerge.

"What constitutes an ethical right of conscience in medicine, and what are the limits?" asked Nancy Berlinger of the Hastings Center, a bioethics think tank. "This keeps getting harder and harder for us."

I wish I had easy answers, but I don't. I can see and understand both sides of the debate, but seeing and understanding isn't the same as creating policies to protect both sides of those who are affected: the patient and the provider. My opinions on religion aside, I think that in reasonable circumstances, both parties must be accommodated as much as possible — but what about places where the population density is much lower, and there may not be another provider within a reasonable radius? Should the patient be made to suffer? Should the provider be forced to compromise their moral principles?

Again, I lean towards the provider compromising — people should not be allowed to force their beliefs on another. That's the side of "religious freedom" that many seem to forget when they talk about people's religious rights. It certainly cuts both ways.

While I was happy to see that Godwin's Law did not apply to this article, slavery — the next best thing to Nazis — was invoked. And I don't think the analogy was necessarily appropriate. Morality is a fundamentally gray area during the times in which a specific controversy exists. It is only with the passage of time that things become black-and-white — the controversy becomes "solved." Slavery, for instance, has the benefit of that passage of time, so attaching something like medical ethics to it is a case of tying a very gray issue to one that is black and white. It's breaking one of the rules of debate — though I can't remember the fancy Latin name.

Some argue that health workers should not even be required to refer patients elsewhere for care they find objectionable.

"Think about slavery," said physician William Toffler of the Oregon Health and Science University in Portland. "I am a blacksmith and a slave owner asks me to repair the shackles of a slave. Should I have to say, 'I can't do it but there's a blacksmith down the road who will?' "

In this case, if a provider is unwilling to participate in something they disagree with, I think they should be required to refer the person elsewhere, for the simple reason that they should not be allowed to force their beliefs on another, which they are tacitly doing through their inaction. Referrals protect the provider from directly violating their beliefs, and they protect the patient by allowing them to receive the care they need or desire. It's as close to a win-win situation as one can get in this ethical morass.

As an aside, there are many who would say "to hell with morals, these providers should be doing their jobs!" as though "doing their jobs" is some absolute written in stone somewhere. It's not. As with any other job, there are people from all walks of life in the medical profession, and regardless of what you might think of their religious beliefs, they must be protected. Because like it or not, what you think of another person's set of morals is entirely irrelevant. That's one of the things that makes this country great — and introduces these seemingly impossible ethical questions…

[tags]Medicine, pharmacy, ethics, morals, malpractice[/tags]