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diggA new oath for doctors: the customer is always right
Conscientious objection is becoming harder and harder for doctors in the United States, Canada and Britain.
A storm erupted not long ago when a Columbia University psychiatrist wrote that "My profession has been hijacked. I cannot do my job, my patients are suffering, and I am fed up." She was upset with the stringent political correctness in her profession, which dictated that she avoid being judgmental of her patients’ sexual practices. When they experienced problems due to their promiscuous behavior, she could only repeat, "Make sure you’re protected." Today, medical professions on both sides of the Atlantic are hardening this political correctness into an official code of conduct.
Canadian doctors are starting to feel the heat in the nation’s largest province, where the College of Physicians and Surgeons of Ontario (CPSO) has introduced a draft policy advising doctors that "there will be times when it may be necessary for physicians to set aside their personal beliefs" in providing services, and that decisions to restrict their practice "based on moral or religious belief may… constitute professional misconduct". In other words, there may be times when doctors are called upon to violate their conscience for the good of the patient.
| What's happening here is a wholesale overhaul of the physician's role in society. |
A strange concept, but it gets stranger still: the CPSO policy also states that doctors "should not express personal judgments about the beliefs, lifestyle, identity, or characteristics" of their patients. Not express "personal judgments" even about a patient’s lifestyle?
It may have always been part of the doctor’s role, but now it’s no longer acceptable for doctors to make us uncomfortable about our actions. We don’t want to hear about the dangers of promiscuous sexual behavior or the benefits of teen abstinence; still less do we want doctors to "preach" about the negative effects women often experience from abortion (or, gasp, about the humanity of the fetus). And least of all do we want doctors discouraging lesbians from artificial insemination, or young people from sex change operations.
Ontario is not alone. The General Medical Council in Britain introduced a similar policy in March. The GMC also says it expects doctors "to be prepared to set aside their personal beliefs where this is necessary in order to provide care".
And while British doctors are not being silenced altogether, they had better speak very carefully: "You must not express to your patients your personal beliefs, including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress", and "You should not normally discuss your beliefs with patients unless those beliefs are directly relevant to the patient’s care. You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views."
The GMC’s possible interpretation of terminology like "inappropriate" and "insensitive" should be enough to place any doctor in fear of losing his license if he doesn’t leave his tongue at the door.
What’s happening here is a wholesale overhaul of the physician’s role in society, for familiar reasons: to eliminate any possible criticism of the ideological agenda that has cloaked sexual relationships and settled over the central institutions of marriage and the family.
In the United States, doctors may not be afforded even the dubious "protection" of official codes of conduct like those in Ontario and Britain; they may simply be required to close their eyes and do the deed. This is what the California Supreme Court unanimously ruled this month in a shocking decision, where it found that a California doctor couldn’t refuse to artificially inseminate a lesbian on the basis of religious objections, even though other doctors were available to perform the procedure. The Court said: "Do the rights of religious freedom and free speech, as guaranteed in both the federal and the California Constitutions, exempt a medical clinic’s physicians from complying with the California Unruh Civil Rights Act’s prohibition against discrimination based on a person’s sexual orientation? Our answer is no."
The California Court repeatedly relied in its decision on a 2004 case where it had ordered Catholic Charities to provide their employees with insurance coverage for prescription contraceptives, although this violated their religious beliefs. Catholics are often in the firing line in these debates, because their hierarchy has tenaciously held to its disapproval of artificial contraception and abortion. Although many Catholic doctors and pharmacists do not agree with their Church and many others are willing to compromise Catholic teaching, a growing number in the United States have been "conscientious objectors".
Is this just dogmatic obstinacy? No, it is that the Catholic Church has developed, over the centuries, a coherent view of professional morals and a humane understanding of a physician's role, much like the ancient Hippocratic tradition.
Pope John Paul II viewed medicine "more as a mission than as ordinary work," and even called it "a commitment which, in its nobility, usefulness and ideality, is very close to the priest's vocation". He compared the doctor to a priest!
The Catholic understanding of the physician’s role is a holistic one. Since the body and soul are not viewed as independent but as joined, the doctor is not healing only the body, but also has a certain responsibility to help in the spiritual healing of the patient. Moreover, it is also recognised that actions done by individuals don’t occur in a vacuum but affect society; as a result, the doctor has a responsibility beyond the individual patient, to society and its common good – and beyond that still, like every Christian, to the ultimate Truth that is God himself. It would thus be inconceivable for a doctor to divorce his ethics from his practice of medicine. Here’s how the Pope described the doctor’s calling in 2000:
"You have firsthand experience that in your profession medical care and technical services are not enough, even if provided with exemplary professionalism… The sick must be helped to regain not only their physical health, but also psychological and moral well being. This presupposes that the doctor, in addition to his professional skill, also has an attitude of loving concern inspired by the Gospel image of the Good Samaritan. With every suffering person, the Catholic doctor is called to bear witness to those higher values which have their firmest foundation in faith."
It’s no surprise that the revamped face of the medical profession will be challenging for doctors who want to be consistent with pro-life convictions. But it should ring alarm bells for all doctors whose faith and morals inform their daily working lives. Physicians are now expected to carry out their patients’ wishes without being handicapped by moral hand-wringing. Medical associations seem to believe the time has come to toss the Hippocratic Oath and its "never do harm" into the dustbin of history. In an era of tolerance and individual autonomy, the emerging creed is "the customer is always right."
Lea Singh graduated from Harvard Law School in 2003. She works for a nonprofit organization in Ottawa, Canada.
Mal said: “David, I agree with much of what you say but I have heard of some bureaucrats in the US behaving like their Canadian counterparts.”
No doubt, and it must always be resisted; from the right as well as the left.
David, I agree with much of what you say but I have heard of some bureaucrats in the US behaving like their Canadian counterparts.
Mal, you’re raising the hackles of my Libertarian streak. Canada, for instance, is a country far more liberal than my own. But it is a liberalism with a strong totalitarian bent, bordering on Utopianism. They are close to considering some thoughts to be crimes. The problem with allowing that much government control is that it only works for you if you happen to agree with the government. Sometimes Christianity has that same totalitarian bent. The problem with a fundamentalist christian view, as with all fundamentalist views, is that the adherents are absolutely certain they are right. This gives them license to set about controlling the lives of others. There are secular fundamentalist, like the communists, who were certain of the rightness of there world view. The Nazis also fall into this category, with the caveat that Hitler said in ‘Mein Kampf’ that he was an instrument of God’s will. The result is always repression and, eventually, catastrophe. All people can’t be forced into the same mold.
I have to say here that Catholics are more consistent than there fundamentalist protestant counterparts. They oppose abortion but do not forget about those children after they’re born, at least officially. Catholic charities are some of the best in the world. But in the time when the Catholic Church ruled the western world, they didn’t do that great a job. Power always corrupts, regardless of the beliefs of those who wield it. I can’t think of a time when it didn’t. I will always favor limitations to the power of government.
David, each case is different. What is appropriate in one might not be so in another. Dr. Phil has been known to tell some ‘sick’ people that he would only help them if they were prepared to commit themselves to the healing process.
Regarding the nanny state I would say that every state has some nanniness about it. Of course, the character of the nanny does differ from state to state. In some cases the nanny is a strict disciplinarian ensuring that those in her care behave according to certain standards. There are people who consider states of this nature to be too controlling and limiting. Other nannies give into all the whims and demands of those in their care. So, we may have some self-serving desires turned into rights by politicians and protected by so-called human rights commissions. Invariable these commissions ignore an individual’s fundamental right to life in favour of a newly acquired right such as abortion. In this state a doctor could be punished for upholding a person’s fundamental right to life or for believing that the best place for a child is a home having a father and a mother. I am in favour of a nanny state that is slightly right of centre.
Mal, I’m confused by your response. You must realize that if you allow one case of a doctor refusing to treat a patient, then you must allow all cases with similar arguments. You also put yourself at the mercy of the prejudices of the doctor. I’m sure my doctor would tell me to stop smoking my pipe and to only drink white wine. I have a private pilots license. Any self respecting doctor would order me to stop flying immediately. Ask any insurance actuary. I ran with the bulls (actually away from them) some years ago in Spain. If I was hurt should the doctors refuse to treat me until I promised never to do it again? If I did it again and was hurt again, should they let me die? Freedom is important too. By the way, are you for or against the nanny state?
David, if smoking is the cause of this person’s cancer - early stages - then why should the doctor be compelled to continue treating this patient if the prescribed method is not followed? Perhaps, the patient should go to another doctor who employs other methods such as using Chinese herbs or whatever.
Mal, are you saying that a diabetic patient who doesn’t lose weight shouldn’t be given insulin? By the way, if you have lung cancer, it’s too late to quit smoking.
David, some of our illnesses ( diseases and disbilities ) are due to bad lifestyle choices, many are not. However, I feel that a doctor should not be compelled to treat a patient who chooses to reject the treatment - or part of it.
Mal, if doctors refused to treat patients who continue to make bad lifestyle choices, we would all be in trouble.
David Page said: “I also think a doctor has the right and responsibility to tell a patient that they are making bad lifestyle choices.”
I agree. In this case the problem or cause was the lifestyle itself. The lung cancer was the product or symptom. Should the doctor be compelled to continue treatment if the patient refuses to make the change required? The change is, after all, part of the treatment.
Mal said: “A doctor asked his patient who was in the early stages of lung cancer to stop smoking. The patient told the doctor: “my lifestyle is not your business. You just cure me.” I side with the doctor.”
Me too. I also think a doctor has the right and responsibility to tell a patient that they are making bad lifestyle choices. Having said that, I don’t think the doctor has the right to push their religion during patient visits.
A doctor asked his patient who was in the early stages of lung cancer to stop smoking. The patient told the doctor: “my lifestyle is not your business. You just cure me.” I side with the doctor.
Tim, the doctor in question was denying services to a lesbian that he was routinely providing for other patients. Of course he can’t do that. I dion’t think that was the main thrust of the argument.
David,why does the decision of the Supreme Court of California not count as a concrete example?
Moves are afoot here in Australia too but many doctors would at present be uncomfortable with the end point.
Autonomy is being wielded against doctors when it is patient’s autonomy. But few have thought enough about the doctor’s autonomy. Most doctors at present would have some residual valuing of this, especially when conceptualized as part of their professional ethics.
If this is refused, then doctors will have less capacity to act on professional judgement than hairdressers and plumbers.
ANother interesting set of fault lines in these current attacks revolve around the meaning of conscience, personal beliefs, professional judgments and medical decision-making.
Say a doctor, applies his knowledge about the state of the research on risk factors for serious psychological illness to a woman seeking an abortion, and finds that there is strong indicators that she is ambivalent, possibly heavily pressured and has some history of depression. Say that doctor says fine, here is the referral off you go. What is going on here between the doctor’s conscience and his knowledge of professional medical ethics. What if the doctor says, I would like to discuss with you the state of the research and your risk factors and perhaps urge her to seek some counselling or at least go away and think about it for a few days. Is that personal beliefs or medico-legal, ethical judgement and practice? What if the doctor refuses to refer for an abortion arguing that her patient is likely to be harmed by that course of action and instead urges an alternative strategy for the problem pregnancy. Is that good medical practice or personal belief. What if a doctor is personally opposed to all abortion but specifically in relation to individual patients assesses likely harms and alternative options. etc. These fault lines will appear across many other scenarios from vasectomies to the prescription of powerful anti acne medications, sleeping tablets, cosmetic procedures, heart procedures etc.
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