Hollowing out medicine (or, Leavitt is a bastard)

19 12 2008

Those fuckers have done it. Everybody knew it was coming, but it’s so egregiously bad that, somehow, I thought it might disappear into the trailing vapors of the soon-to-be-ex Bush administration.

From a story by David Stout, of the New York Times:

“Doctors and other health care providers should not be forced to choose between good professional standing and violating their conscience,” Michael O. Leavitt, the secretary of Health and Human Services, said in a statement on his department’s Web site.

The rule prohibits recipients of federal money from discriminating against doctors, nurses and health care aides who refuse to take part in procedures because of their convictions, and it bars hospitals, clinics, doctors’ office and pharmacies from forcing their employees to assist in programs and activities financed by the department.

Excellent. Never mind professional standards, fiduciary responsibility, and, oh, patient health and well-being. Nope, if you’re too wobbly, er, conscience-stricken to deal with birth control or IVF or emergency contraception or even letting a woman know that there’s this procedure known as (shhh!) abortion, and that the doctor down the hall might just be willing to provide you with one, you now have an executive-branch rule to NOT DO YOUR JOB. And still get paid, presumably.

I was never much of a fan of the so-called conscience rule (dating back to the 1970s Church amendments and to a 1996 directive), believing that if you choose to enter a particular discipline, then you agree to adhere to the standards of that discipline. This is particularly important in medicine, insofar as your primary duty is to your patient, i.e., not a theoretical construct but an actual, mortal, human being.

If you want to practice medicine, then you ought to think about what that entails. I briefly considered trying to earn a spot at the US Air Force Academy, but as my pop (who put in his own stint as an Air Force enlistee) pointed out, once you’re in, you do what you’re told. I don’t particularly like to be told to do anything, and the thought of carrying out the policies of the then-Reagan administration really didn’t work for me. My efforts ended with those stray thoughts. (For the record, I doubt I would have passed the psych tests.)

I’m not saying that all doctors have to perform abortions. However common a procedure, it’s a fairly narrow one, unlike, say, drawing blood or inserting a catheter. In other words, it’s pretty damned easy to avoid doing abortions. Not all doctors want to cut someone open, or examine children or work with old people; the appropriate response to these disinclinations, then, is to avoid surgery, pediatrics, and gerontology. That said, there may be times, however rare, when surgery, children, or old people are unavoidable: you then have a duty to care for that patient until you are able responsibly to hand that care over to another doctor. Along those same lines, then, it seems to me that knowledge of how safely to perform abortions should be a basic part of medical education—not even that every resident must induce abortion, but that each should know the process for doing so.

Still, mine is a minority opinion: the conscience clause for abortion seems pretty well set in American medical ethics. And I guess that as long as those who decline to do abortions are willing to refer a patient to a willing doctor, it is a reasonable compromise.

It is not clear to me (I’ll try to find this out) that the old conscience clause require such willingness to refer; what is clear is that new regs not only do not require this, they protect a wide variety of ‘health care providers’ from their refusal to assist in any way with procedures they find morally objectionable—including not only abortion, but also sterilization and the provision of contraception (including emergency contraception), and undefined research activities. (cf. p. 15 of the pdf doc in the above link).

I’ve only skimmed the document, so my rant is based more on impressions than a good, critical read. Key sections appear to be II. Comments on the Proposed Rule (pp. 13-  ; esp. 14-25 , 34-60, 68-77). Let’s just say that even this preliminary once-over is. . . GAH! I can’t even detail how fucking awful it is! Mealy-mouthed in its refusal fully to define or limit terms! Blandly dismissive of counter-conscience claims (and yes, Mr. Secretary, health care providers who perform abortions, prescribe contraceptives, and fill those prescriptions also have consciences!)! Condescending in its approach to patient concerns! Stupidly ignorant of how actual human beings make use of actual medical services! Derisive in its approach to informed consent and standards of medical care! And on and on and on. . . !

One more perverse invocation from an administration far more in love with its own mirrored image than the people it purports to serve.