religion and profession

[cellio]

osewalrus posted an excellent essay on conflicts between religion and one's profession. He and I agree: you are completely free to practice your religion, but if doing so causes complications in your life, you -- not the rest of society -- need to deal with that.

Comments

Re: How do you avoid...

[cellio]

I think there's a difference between refusing to provide care and insisting on providing it. Physicians (and others) have a professional code of ethics that, as I understand it, you have to agree to in order to be allowed to practice. That code clearly prohibits refusing to administer care to a patient who requests it (explicitly or implicitly). The MCP who told you not to treat the newborn was giving the medical equivalent of an illegal order.

I don't see how that analogy can be extended to an employer requiring a pharmacist to give the morning-after pill to the rape victim and the pharmacist refusing. If the professional code of ethics barred morning-after pills and the employer said "I don't care", that would be analogous -- but that's not the case.

I don't know what happened in the wake of Katrina -- if those doctors intended to relieve pain (a norm of their profession) or to kill the patients (obviously shaky territory). I suppose that's what the court is going to try to find out.

If you have voluntarily undertaken employment that comes with certain rules, you are bound to those rules. If you don't like them, you should seek other employment. Things are different if either party later changes the rules, or if the association isn't voluntary (e.g. conscription into the military).

I don't see a difference

[cellio]

To some, Plan B is murder. As I've blogged many times, this is an incorrect analysis of the data.

Still, for the pharmacists who hold this incorrect opinion, they are being asked to give a drug which they believe will kill a living human being. (It's worth noting that my objection to the objection to Plan B is exactly because of this: Plan B does not cause abortions. It prevents conception. By not permitting the drug, the possibility of having to destroy a living being for soeone else's crime would arise. I'd rather avoid the decision.)

If that same pharmacist was given a prescription by a parent for an obviously lethal dose of a sedative for a mildly retarded child, should the pharmacist refuse it? It's a valid prescription from a valid doctor: can the pharmacist say "no?"

Also, you interpret the medical code of ethics incorrectly. If someone calls and requests treatment with morphine for addiction, we as paramedics are not obligated to "treat" them with morphine. Had the infant been clearly non-viable, the order to not treat would have been the correct one, although I would have still argued for basic comfort measures (drying, warming). If a person is clearly dead, we are not required to start CPR, even though the next of kin demands everything be done.

Deciding when medical care is and isn't appropriate is difficult.

While riding on a Notartzwagen in West Germany in the late 1980s, the physician decided to not treat a patient for chest pain. The patient called, asking to be taken to the hospital. The physician turned the patient down and left. His reasoning was that the patient had lived long enough. I specifically asked if it was a question of the patient being terminal and a DNR -- it wasn't. I questioned other W.G. doctors, and in their medical system, physicians were permitted to make unilateral decisions. I tried to argue, but they couldn't conceive of my reasoning. I do not believe what happened in Katrina would have been a problem in West Germany. No one would have complained. I couldn't help think what ethical geniuses the Germans had been 50 years earlier.

The situation is exactly analogous to the pharmicist conundrum.

I believe the reason you do not wish to permit these people an "exception of conscience" is because you disagree with them. Were the conscience objection about something you felt strongly, you would side with them.

I wonder what a study would show comparing the number of "nothing can be done" calls compared to "CPR initiated" calls for the half hour before a shift change compared to a half hour anywhere else in the shift. Whether an attempt to save someone's life is initiated or the crew gets to go home on time depends on the ethical mindset of the responding crew.

Actually, that's disingenuous. I know full well what the study would show. Not only did I have to fight it in co-workers, there were days I had to fight it in myself. I view ethics as a court of last resort, a court that forced me to behave in ways I can look back on and live with.

THAT is the real problem wea re facing. THAT is why there are no easy answers to this question.

If you remove the people with consciences, the medical profession is turned over to sociopaths. Trust me, there's already enough sociopaths in medicine without working to artificially increase the number.

Crap. It won't let me register under my livejournal name.

Rob of UnSpace.

Clarification

[rob_of_unspace]

I worked with people that, when it came to patient care, did what they were supposed to do. But these were people with ethical approaches to their work.

Without such an approach, I believe the rate of resuscitations started would, in fact, vary with time to shift change. This was a hypothetical statement that I thought obvious in intent, but was pointed out to me wasn't.

I do need a proofreader, don't I?

part 1 of 2

[cellio]

If that same pharmacist was given a prescription by a parent
for an obviously lethal dose of a sedative for a mildly retarded
child, should the pharmacist refuse it? It's a valid prescription
from a valid doctor: can the pharmacist say "no?"

Surely there is a middle position -- how else do pharmacists currently
deal with possibly-forged prescriptions and ambiguous cases? It doesn't
come up in my field, but if I were told to do something that I thought
would be lethal, I'd sure as heck push that issue up my management
chain instead of just saying "yah, sure, whatever". I mean, what does
a pharmacist do if someone comes in with a prescription and says "I'm
also taking $drug and I'm concerned about interactions", and the
pharmacist
doesn't know whether that's a problem?

Also, you interpret the medical code of ethics incorrectly. If
someone
calls and requests treatment with morphine for addiction, we as
paramedics
are not obligated to "treat" them with morphine.

I would have assumed that paramedics aren't allowed to dispense morphine
no matter who's asking. Besides, when do patients get to make these
kinds
of calls?

Deciding when medical care is and isn't appropriate is
difficult.

Certainly true.

The [German] situation is exactly analogous to the pharmicist
conundrum.

If you're syaing that pharmacists refusing to fill prescriptions is
exactly analogous to physicians refusing to treat elderly patients,
well, that's a little extreme, but I'll agree. If you're trying to
say that the pharmacists are analogous to you in that
situation,
rather than to the negligent doctor, I don't see how.

part 2 of 2

[cellio]

I believe the reason you do not wish to permit these people an
"exception of conscience" is because you disagree with them. Were the
conscience objection about something you felt strongly, you would side
with them.

I don't think that's the case. I invite you to propose a scenario.

I feel very strongly that (1) I have an obligation to live a moral and
ethical life in accordance with the principles I have come to
understand,
(2) that has costs, and (3) that's my problem, not yours. If my ethics
compel me to intervene in a situation, I must do it in a way that is
consistent with those principles. For example, suppose I think the
proposed nuclear plant in town will poison the atmosphere and kill
my family -- that's clearly something I care about. (It's also a
ficticious
example.) I will try like hell to block their access through legal
channels -- zoning hearings, lobbying my representatives, publicizing
the threat to rally the neighbors, applying whatever market forces are
relevant, and so on. I will not simply turn tail and move (I was there
first and that would be a PITA), though if I lose I might conclude that
I have to to protect myself. But I don't get to lace the building site
with land mines (that miraculously destroy equipment but not people), or
hack their financial systems to prevent payment to their contractors
and employees (in hopes that they'll quit).

Here's one a little closer to home. Suppose I work for a government
contractor (true), and suppose we are told to work on a domestic-spying
program (false, just to be absolutely clear about this).
I won't work on the project, at the risk of my company not having enough
unobjectionable work to go around. I know people who would work on the
project but deliberately introduce bugs; I would not. My choices are
to do the work honestly, be excused from the work, or seek out a
more-agreeable employer. I think this is analogous to the pharmacist
who has a personal (as opposed to objective) objection to a legal
prescription.

I wonder what a study would show comparing the number of "nothing
can be done" calls compared to "CPR initiated" calls for the half hour
before a shift change compared to a half hour anywhere else in the
shift.

I don't wonder. I may be a cynic sometimes, but I'm pretty sure I know
the answer to that one. :-(

If you remove the people with consciences

Who said anything about removing the people with consciences? Heavens
no!
But do not make the mistake of assuming that there is one universal idea
about what acts are conscientious and what ones are not. That
is the problem: the employer's and customer's consciences permit an act
that the employee's conscience does not permit, and the employee
attempts
to make a unilateral decision.

Are you ok with the idea of, say, the guy at the all-night emergency vet
clinic saying "sorry, I don't think people should own birds so I won't
treat yours -- go see your vet in the morning"? How is that different
from the pharmacist and the rape victim who wants to prevent conception?

Again, in this particular thread we've been talking about emergency
situations (mostly), but I think the real issue isn't about emergencies
-- it's about taking a job where, as a matter of course, you
will run into duties that you find objectionable. Everyone's stressed
in an emergency and we make the best calls we can, but if you know
that you're going to run into a problem and you take the job anyway,
without making arrangements with your employer, then you have erred.