28 December 2009

Who's afraid of the health care conscience clause?

Does anyone know the fate of the conscience clause that went into effect on 1/20/09 that allows physicians and other health care workers to refuse to care for/treat people seeking help, based on their own religious beliefs?

Under the rule, workers in health-care settings -- from doctors to janitors -- can refuse to provide services, information or advice to patients on subjects such as contraception, family planning, blood transfusions and even vaccine counseling if they are morally against it.

CNN ran a story on it last February (where I got the above quote), saying White House set to reverse health care conscience clause, but I haven't heard about the fate of the regulation.

I assume that no news is good news -- for the folks who hoped it would be repealed. That news would be not-so-good for the folks who looked to that regulation to protect their beliefs and desire to live their lives and pursue their professions consistent with their faith.

Like combining church and state, mixing faith with professional practice can be a tricky business. On December 16, 2009 a Medical group CEO quits (the) AMA in protest. I can understand why he would do so. The AMA stance was clearly not consistent with his own beliefs, and what choice did he have, really? If you don't agree with your governing body, and you can't change it to be more in line with your beliefs, then it seems the only really honest thing to do, is leave. Apparently a lot of people are doing that, according to the CEO "that AMA's membership has dropped since the 1960s from nearly three of four practicing doctors to closer to one in five."

Which is fine for doctors. But what about the rest of us? What about those of us who are not aware of our doctors' religious beliefs and -- not making any judgments about who's right and who's wrong -- we find out too late that our doctor does not believe in certain procedures that we believe may preserve our health and save our lives? What do we do? Seek out a second opinion, certainly, but how do we find out in advance if the next doctor holds beliefs that are consistent with our own? If we are in need of a procedure that one doctor would do, which might help us, but another doctor would not even remotely entertain (or possibly even discuss) due to their ideals, how do we find out what those ideals are before we enter into a relationship with them? How can we do our due diligence and make sure that we're engaging with a physician who actually can help us?

Now, I'm not here to call people right or wrong, or claim that one belief system is superior to another. I grew up in a very conservative part of the country, and I respect people's rights to believe what is in their hearts. You can't argue with a conversion experience, and people who think that conservative folks can be won over to another side through heady, intellectual reasoning alone, have a rude awakening ahead of them.

But objectively speaking, I prefer to go to a doctor who won't refuse to treat me based on their religious beliefs. I am queer, after all. I live with a woman, and I have been committed to her and our life together since 1992. We are legally married in Massachusetts (not that it makes any difference in Pennsylvania, where I was raised). Our finances and our daily schedules and our very lives are more closely entwined than conjoined twins. You literally cannot affect one of us without affecting the other.

Of course, outside my own circle of like-minded folks, in many parts of this country -- indeed, the world -- my relationship is one of sin and iniquity. It is an affront to God, and to the natural order of things. It is an abomination that some believe will condemn me to eternal hellfire and damnation. Some believe that I have deliberately chosen this life of sin, and that my choice condemns me to eternal separation from God -- unless I confess my sins, vow to change my ways, and take to a strictly straight-and-narrow path of righteousness that leads me to the rewards of eternal life.

And I know from personal experience that in some parts of this country -- and in the world -- there are people who believe that my soul is safer in heaven, after having confessed my sins and changed my ways, than continuing to life in illicit iniquity here on earth. I also know that in the church where I've heard it said out loud, "I would rather my child be dead, than be homosexual, because at least then I would know they were with God," there were doctors who attended that church, some of them quite devout.

Now, I'm not here to say who's right and who's wrong. I'm not here to criticize, but to observe. What people believe, and why, is one of the great mysteries in life, and it's not my place to judge others for their strongly held beliefs. But when I go to the doctor - whether I agree with them or not - it's my hope that I will have access to the type of care I am seeking. And it's my hope that they will do everything in their power to help keep me alive.

Now, I don't expect health care providers to utterly abandon their beliefs in the process of helping me. I would never ask someone to willingly violate their own principles. But I do want to know if my beliefs are consistent with theirs, and whether we have the same medical perspectives and priorities. People's beliefs can run very deep -- and very hot. And if you aren't aware that your doctor harbors grave misgivings about helping you continue to stay healthy and whole, because they don't believe that you are doing God's will in your life and you're better off in heaven than staying in sin on earth -- or they deny you access to a procedure you desire because they don't believe in it -- well, then it gets problematic.

As with many issues with me, this is a data issue. There are lots of doctors in the world, and there are lots of different ways of understanding why we're here and what we're supposed to do with ourselves. And for every person who doesn't agree with me or has grave misgivings about helping me, there is surely someone else who does agree with me, and who has no hesitations about providing me with certain types of care. The trick is finding them. Maybe there's a great database in existence, containing details on doctors' and other health care providers' religious beliefs, a list of what they will and will not do in the line of helping their patients. Maybe there's a vast info warehouse that holds details on the ideologies of everyone who's in the care-providing chain -- from doctors to janitors -- so folks on the margins of mainstream or with alternative religious beliefs, as well as smack-dab in the middle of the range of popular acceptability, can decide whether or not to seek care from a certain physician or a certain hospital. But I'm not sure there is.

I wish there were, though. I wish there were some data repository where I could locate docs who are "friendly" to me -- as well as the ones who are not sympathetic with me for religious reasons. I wish there were some place I go to could find out if the hospital I might be admitted at has nurses or janitors or lab techs who have the job of helping someone like me, might have some reason not to. I wish there were a database I could simply query to find a doctor who has no moral qualms about keeping me alive AND who is open to me being an ePatient -- using email and social networking and trusted online resources to better manage my own care.

I'm not trying to be discriminatory in a negative sense, but in a positive sense. Freedom requires responsibility, and what better way to foster responsibility, than by giving both caregivers and patients access to each others' ideological profiles? I am genuinely interested in ensuring that people of all faiths and outlooks have access to quality care that is consistent with their world view and values. I'm also genuinely interested in ensuring that doctors who walk a path of faith and who take that faith very seriously are able to practice medicine in a way that is consistent with their spiritual values. There are an awful lot of doctors in the world, with a variety of ideals and values. And there are many, many different patients with a wide range of beliefs. We just need to find each other more easily.

From where I'm sitting, the problem is not whether doctors and patients are properly regulated/protected or not... it's a matter of whether the right doctors are paired up with the right doctors. And vice versa.

Imagine if there were such a data store that was easily accessed, accurate, up-to-date, and easy to use -- then, at the 11th hour, when so much is on the line, well-paired doctors and patients alike would be able to provide and receive care that is consistent with both their needs and their consciences. They wouldn't have to have all sorts of extraneous (and possibly unnecessary) ideological dramas and crises over life-and-death issues (which are of course never easy to begin with). They could both know that they were dealing with another person who was on the same page as them, who both acknowledged, respected and understood their points of view. And being on the same page could clear away yet more of the anxiety that comes along with healthcare and relying on someone outside yourself for your continued well-being (or possibly death with dignity).

If a doctor or nurse or technician is not going to treat me because they firmly believe that the way I live my life is not in keeping with God's will for humanity, and they also believe that life in the hereafter is far more important than life on this earth, I have no argument with that. I understand many people feel that way, and I don't want to deny them their right to live consistent with their faith.

But at the very least, I want to know about it ahead of time, so I have a fighting chance to stay alive with the help of someone who won't deny me care, based on my "lifestyle choices."

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