The assisted suicide advocacy organization, Compassion and Choices, clearly opposes the right of medical professionals to refuse to participate–or be complicit in–the intentional taking of human life. This issue is going to be one of the biggest in bioethics in the coming decade, so it is worth looking at what the forced participation crowd are saying.
C & C’s head lawyer, Kathryn Tucker, recently published an article ludicrously entitled, “The Campaign to Deny Terminally Ill Patients Information and Choices at the End of Life,” in the Journal of Legal Medicine (30:495-514 , no link). Most of it is the same nonsense C & C usually shovels about the Catholic Church–which is perfectly able to defend itself–and other assorted diatribes against conservative opponents. Then, she warns about a new Boogie Man, the so-called “medical right:”
Medical Right organizations are delving ever more deeply into activism, policy promotion, and politics. They are expanding the range of issues they work on, forming new organizations, and consciously taking front and center roles in media and legal debates. The RCRC Report points out that the Medical Right has created a virtual “shadow medical establishment.” Unlike professional societies that represent physicians and other health care providers, medical schools, and teaching hospitals, most of the Medical Right groups are relatively unknown because they act outside of the normal channels of medical policy and practice.
I beg your pardon? The American Medical Association opposes legalizing assisted suicide. So does nearly every state medical association and most international medical groups. On this issues the Medical Establishment-establishment is against Tucker’s ideology, as well as any supposed shadow establishment, by which she presumably means great groups like Physicians for Compassionate Care.
She continues to perpetuate the Oregon Myth, which we won’t belabor here. But the heart of the matter is an attack on medical conscience:
The Medical Right introduces and supports legislation and other policy initiatives that would protect health care providers from liability for refusing to inform patients about, provide, or pay for services the facility or individual providers object to on religious, moral, or personal grounds…Such measures would establish a right for all health care institutions (hospitals, insurers, and pharmacies) and other providers to refuse to inform patients about, refer patients for, or provide or pay for any end-of-life care to which the providers have a religious, moral, or ethical objection. In the end-of-life care context, this might include refusing to inform a patient about the right to refuse or direct the withdrawal of life-prolonging interventions, such as a feeding tube or ventilator; voluntarily stop eating and drinking, and obtain comfort care in the interim until death arrives; have aggressive pain management, including palliative sedation if conventional pain management is not effective; and, in Oregon and Washington, to seek a prescription for medication that the patient could self-administer to bring about a peaceful death.
I don’t know any group that would seek to deny patients information about medical treatments such as aggressive pain control. But many would–and should–refuse to participate in any way in the intentional taking of human life–which until relatively recently, was the ethical requirement of all doctors under the Hippocratic Oath. What is also interesting is that conscience clauses were put in by assisted suicide advocates to induce the people to pass assisted suicide in Oregon and Washington. Of course, that was always an expedient political tactic, not a principled position.
So, the conscience battle is being joined. Tucker and her allies want doctors forced to commit assisted suicide or refer to a doctor they know will. They want pharmacists forced to dispense lethal prescriptions. I disagree profoundly. I have written extensively about how I think conscience clauses should work, so we won’t repeat that here. But this much is sure: At stake literally is the right of medical professionals who believe in Hippocratic values and the equality/sanctity of human life to remain in medicine.
January 22nd, 2010 | 4:52 pm
meanwhile the largest abortion trial of the new Millennium is underway, and completely ignored by Wesley.
Because a friend of his friends are on trial for a politically motivated murder. That is by defintion terrorism.
but we wont talk about that here…
January 22nd, 2010 | 5:06 pm
andrewj: I am not sure what you are addressing. If it is the murder trial involving Tiller, you merely show your ignorance, because I have repeatedly decried the killing of George Tiller and have covered trial developments. Try doing a search and you’ll find it.
January 22nd, 2010 | 6:31 pm
“Friend of his friends”? Which “friends” are those?
January 22nd, 2010 | 7:18 pm
Wesley: You mis-state the issue. Nobody has to force doctors “to commit assisted suicide or refer to a doctor they know will” unless the doctor chooses to work at a hospital whose policies include such policies and practices. You need to stop making it sound as if someone’s holding a gun to the doctor’s head and muttering “you do that abortion or else…” After all, doctors DO have rights, including the right to work at any hospital that doesn’t offend their moral sensibilities. The whole “conscience” business is a not-too-subtle attempt by the anti-choice crowd to force secular hospitals to adopt religious principles.
You also complain that “[t]hey want pharmacists forced to dispense lethal prescriptions.” I have some surprising news for you: pharmacists have been dispensing prescriptions that have lethal possibilities for more than a century. The entire family of barbiturates require only small overdoses to be lethal. It’s not up to pharmacists to second-guess the purpose of a doctor’s prescription, but if by some mischance a piece of legislation allows their morality to trump doctors’ judgments it’s a simple matter to get around it.
One need only complain to his doctor that he’s having great difficulty sleeping, obtain a legal prescription for a barbiturate and OD himself. The correct lethal dosages by body weight can be found on the Internet, or in any good Forensic Medicine & Toxicology text.
Wesley J. Smith Reply:
January 22nd, 2010 at 7:26 pm
History Writer: In WA, lethal prescriptions are legal and under the regulations ALL pharmacies must be willing to issue ANY legal prescription. Lethal prescription–not those that could have an unintended lethal consequence–are explicitly legal there. Hence, every pharmacist could be required to be complicit in the taking of human life or lose their jobs–if the Bush conscience clause is revoked.
January 22nd, 2010 | 8:33 pm
Wesley: I understand what you’re saying, but as a practical matter enacting a conscience clause for pharmacists in order to prevent assisted suicide is a wasted effort. There’s virtually nothing a Washington pharmacist can do to prevent an assisted suicide when all a physician has to do is: (1) Write out a normal dosage prescription for a barbiturate, and; (2) Privately advise the patient of the amount that constitutes a lethal overdose, in order to “warn” him — e.g., “Now don’t take more than fifteen of these at one time or you’ll be dead within minutes…”
Or the doctor might choose to stock the necessary drug himself, as he’s legally entitled to do, give it directly to the patient and circumvent the pharmacist altogether.
January 22nd, 2010 | 9:34 pm
Tucker’s valid point is this: medicine is a science-based practice. Patients’ are entitled to information regarding all legal and sound care options.
An institution’s right to “conscience” hurts doctors, nurses, and pharmacists by mandating their conscience (see Catholic Church’s ERDs, applied to 624 hospitals in the US) and it hurts patients because they are not receiving proper informed consent or referrals.
Hate women’s reproductive rights or elder’s rights all you want. But working to apply your religious ideology to a pluralistic society (via publicly-funded hospitals) is in violation of the Constitution.
Yes, the “conscience” laws are the new turf. And they should be. Daily, thousands of patients have their health care decisions made for them by institutions and providers who presume to know what a patients’ conscience should be.
All that care for “the least of these” is only given if the Catholic Church approves it. And for women, elders, and gays they don’t approve much.
Religious tolerance is not theocratic medicine, it is allowing each patient to consult their own faith.
Wesley J. Smith Reply:
January 23rd, 2010 at 1:17 am
Ann: No, medicine isn’t ONLY a science based practice. It is also ethically based. Hence, on the other side of the coin, some doctors want to refuse efficacious treatment based on patient quality of life. Futile care theory is not science based. It is philosophically based.
January 22nd, 2010 | 10:36 pm
Exactly, Wesley. And I foresee attempts to refuse to allow hospitals that accept Medicare or Medicaid patients (and if Obamacare had passed, it would have been any patients receiving federal affordability credits) to deny these so-called “treatments” on their premises. History Writer’s idea of independent hospitals that set their own rules is outdated and bogus. From what I have read, I believe that it is already required in some states that Catholic hospitals dispense “emergency contraception.” My point doesn’t concern the debate over “emergency contraception” itself. My point is simply that there is precedent for requiring all hospitals by law within a jurisdiction to provide controversial “treatments.”
January 22nd, 2010 | 10:38 pm
Moreover, Tucker is explicit about what she decries:
“Such measures would establish a right for all health care institutions (hospitals, insurers, and pharmacies) and other providers to refuse to inform patients about, refer patients for, or provide or pay for any end-of-life care to which the providers have a religious, moral, or ethical objection.”
It couldn’t get much clearer. Tucker believes that, inter alia, _hospitals and pharmacies_ should _not_ have a _right_ to refuse to dispense or refer for the things she favors, including prescriptions for purposes of suicide.
January 22nd, 2010 | 11:06 pm
Newsflash, HW: There are plenty of atheists who oppose abortion and assisted suicide.
What religious values are they trying to impose on secular society?
January 23rd, 2010 | 9:45 am
Clearly Historywriter is in favor of forcing medical personnel to assist in killing people. However, must he be a liar as well as a killer? The point being addressed by the article is that those in the medical profession DO work in hospitals whose policies may permit these objectionable procedures. I guess, like Martha Oakley, his solution is that doctors who object to killing shouldn’t work in those hospitals. Americans, even in blue Massachusetts, just repudiated that mentality.
We as a society need to loudly condemn this coercive mentality of death , no matter how these “compassionate” ghouls try to spin the issue.
January 23rd, 2010 | 9:59 am
holyterror: You don’t seem to be getting the point. NOBODY should be legislating his religious belief or disbelief regarding the treatment of patients or the practice of medicine.
January 23rd, 2010 | 11:13 am
Yes, Lydia, History Writer’s “just don’t work there” scenario is naive. If they could have their way, people like Tucker would subjugate any nonconformists. holyterror is also spot on.
HW: If someone is determined to find a way to kill himself, will he not find it even if he does encounter setbacks? I think it is fairly common knowledge that downing a bottle of sleeping pills can kill you soundly, and if it’s that easy to deceive a doctor then there is no need to force participation. (Thanks for doing half the work for me!)
In a way you miss the point still. Conscience clauses may have the effect of preventing some assisted suicides but the primary intent is to prevent coercion into “assisting.” The former is a good thing, but the latter is of stand-alone importance. A pharmacist who has filled what he believes is a legitimate prescription may be disturbed to find out how it was actually used, but he won’t be culpable.
January 23rd, 2010 | 1:09 pm
Wesley, your point regarding futile care theory is spot on and continuing that thread this entire discussion is philosophy. Several of the commentors would seem to believe that their position is the product of a clear eyed rationalism when it would appear that they are merely philosophically appositional, that is when they are not being merely hostile to religion.
When a piece of legislation finally passes into law it, by necessity, is secular. However in the process of becoming law all points of view have equal claim to participation though not outcome.It seems that some would not allow views of a different philosophical perspective to participate in this process.
The “establishment” clause in the Constitution seems to be their trump card forgetting that “free exercise” is part of the same and 1st amendment. That means that religion, that thing that some find so intrusive, was deemed by the founders to be of primary significance in both a restrictive and liberating sense.
At a more practical level those who would eliminate conscience clauses should take a cue from an old religious saying,” be careful what you pray for.”
January 23rd, 2010 | 1:31 pm
To HW: I am not sure what I am missing.
You and others like Ann Neuman, above, keep asserting that the demand for conscience clauses is about forcing religion on the public. But if the oppsition to certain practices is not always religious, then how does your assertion stand?
I also take issue with a more basic assumption: that there is no place for the expression of religious views in public life. We make allowances for religious belief in other ways, such as conscientious objectors in war and the allowing of observant religious to take certain days off from jobs to practice their faith.
Wesley’s principles forconscience clauses are very well-thought-out, and address and protests about helping peple who are in immediate dnger. If anyone here who disagees with the idea of c.c.’s has not done so, you should read them.
Finally, as a feminist, I believe that women’s organisations who are worried about getting information to people should be ready to fill in the gaps that will supposedly open, as the last line of defense against ignorance of your rights. (I do not think that, in this age of information, women will not know they have a right to an abortion, or that there are multiple methods of contraception out there, for example.)
Ignorance of medical options is actually a widespread problem and not limited to reproductive or end-of-life care, actually, and in itself the people of his country should be taking on more responsibility to end our own ignorance andto advocate for others who need it. Doctors can’t be blidly counted on in this respect, not matter what the medical issue is.
January 23rd, 2010 | 1:37 pm
Ann Neumann: “Hate women’s reproductive rights or elder’s rights all you want.”
Fans of euphemism, are we?
January 25th, 2010 | 2:37 am
Ann doesn’t believe in “elders rights” because she explicitly said that such people should be denied care they choose if the doctor doesn’t want to give it to them based on his or her judgment of the treatment’s “futility,” and that if “they want something extra, they can pay for it.” The only elder’s right she seems to support is the “right” to off themselves so that she can use the resources they would have used instead.
January 25th, 2010 | 2:39 am
As I remember it, Ann then drew a ridiculous correlation between the provision of that care and the availability of abortion services, which is ridiculous. Basically, she was totally willing to let people die to save the tax payer money as long as her “basic reproductive care” was covered by the taxpayer.
January 25th, 2010 | 3:07 am
Ah, yes, here’s Ann’s post from December in response to Wesley’s entry about ‘evidence based medicine’:
I don’t see the problem.
If you don’t support your tax dollars being spent for my reproductive services, I don’t support my tax dollars paying for your brand-name drugs and overpriced, futile treatments.
I thought you were all about “free-market” anyway. You want something extra, pay for it.
If it should work so well for women, the poor, minorities, elders and gays, it should certainly work as well for “gratuitous” treatment of patients.
Touche.
And all this continued rationing talk is silly. With 50 million Americans without health care, 45,000 dying every year from lack of coverage, we already ration by class.
All I hear in this argument is those with great plans – and particularly those in the fat medical industry – complaining that they have to give up their futile treatments brand-named money-makers so the underprivileged can have access.
Sounds like self-righteousness to me.
January 25th, 2010 | 6:22 pm
I guess since people are already rationed against because of their economic status, we should extend that to the elderly, eh, Ann?
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