Monday, December 22, 2008

On Bush's Conscience

George has kissed us ladies goodbye. From last Thursday's Washington Post:

The Bush administration yesterday granted sweeping new protections to health workers who refuse to provide care that violates their personal beliefs, setting off an intense battle over opponents' plans to try to repeal the measure.

Critics began consulting with the incoming Obama administration on strategies to reverse the regulation as quickly as possible while supporters started mobilizing to fight such efforts.

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 ways.

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Sen. Patty Murray (D-Wash.), who with Sen. Hillary Rodham Clinton (D-N.Y.) introduced a bill last month to repeal the rule, said: "We will not allow this rule to stand. It threatens the health and well-being of women and the rights of patients across the country." Similar legislation is pending in the House.

< snip >

Leavitt initially said the regulation was intended primarily to protect workers who object to abortion. The final rule, however, affects a far broader array of services, protecting 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. The rule could also protect workers who object to certain types of end-of-life care or to withdrawing care, or even perhaps providing care to unmarried people or gay men and lesbians.

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.

There ya go! Now not only your doctors and nurses might lie to you but even janitors and secretaries can refuse to help you out!

I have written on this topic fairly extensively before, but it might be good to point out one additional aspect, having to do with this statement by a proponent of the new conscience clause rules:

David Stevens of the Christian Medical Association said: "We will do all in our power to ensure that health-care professionals have the same civil rights enjoyed by all Americans. These regulations are needed, do not change the law but simply stop religious discrimination."

Note the odd definition of civil rights in that quote. "All Americans" don't have the right to refuse parts of their work which they consider ethically wrong. As I wrote earlier, I, as a vegetarian, can't work at a deli counter and just refuse to fill any orders for meat. If I try to do that I will be severely reprimanded or fired. So where are these civil rights that I am supposed to enjoy?

And more importantly, where are the civil rights of the patients these people refuse to serve? Are patients to sit there, waiting and wondering if they have been told the truth? How can they find out an alternative provider of care? What if giving that person's name is against someone's conscience, too? That is scary.

Dr. Stevens applies an odd definition of discrimination in that quote, too. Think about it. Labor market discrimination commonly means treating a worker unfairly (in hiring, pay, promotions and firing) just because of the group the worker belongs to (e.g. gender or race or ethnic group) when a neutral observer would agree that the group membership is irrelevant from the point of view of work performance.

In my deli example I'd be discriminated against if I filled all the orders with a permanent rictus of a smile on my face but was still let go because of those snake scales (assuming snakes were one of the protected groups, but you get my meaning). But to refuse to do the work is not irrelevant. This makes Dr. Stevens' view of discrimination a very tricky one indeed.

Imagine the Pandora's Box we might open here! Almost everybody has some profoundly held ethical beliefs and it's not too hard to cast them into a religious command. Then we can all take lots of time off at work.