"Moral refusal" to provide care provisions

[crash_cart]

We have all heard about pharmacists who have refused to fill contraception medication for patients, based on the idea that doing so violates personal moral principles. You can read about such fights here. Interestingly enough, such "moral refusal" clauses have expanded to EMTs as can be read about in this article. One big concern about these clauses is the possibility that human life will be sacrificed due to the moral inclinations of a licensed provider. Perhaps it's a far-fetched idea, but would a "moral" EMT be legally able to allow a pregnant woman to die simply because she's a single mother?

So here are my questions-what experience have you been involved in or know of concerning "moral refusal" provisions? Should such provisions outweigh our "duty to act" in a given situation? I'm rather curious as to what responses here will be.

 

[daedalus]

Once the white coat goes on, personal beliefs and arrogant conservatism go out the door. When you are a health care provider, you do not judge, you do not discriminate, you preform medical care to your ability all the time, and you listen compassionately.

Forcing your will over someone else is elitism and arrogance. Even things like medical assisted abortion, if we apply the approach that we cannot decide what is best for others ourselves, we see that it is wrong to refuse care so we can sleep better at night. Who gives you the right to intervene against a patient's wishes because you believe you are a higher moral authority? The very basis of western society is that people get to chose what is right for themselves, not others. As a medical provider it is your job to ignore your personal feelings and provide care to the patient based on their wishes. Even you think God almighty has banned abortions, if you are a OB/GYN you do what is best for your patient, based on what the patient believes is best for herself (excluding cases of danger to self).

 

[Shishkabob]

What type of situations are we talking about?


Withholding contraceptives won't (usually) kill someone. What in our field can we choose not to do that won't have a lasting impact?


Are you speaking perhaps of refusing transport for a chipped tooth or the like?

 

[daedalus]

Withholding contraceptives won't (usually) kill someone. What in our field can we choose not to do that won't have a lasting impact?

With holding contraceptives could have grave consequences as bad as death itself.

 

[crash_cart]

What type of situations are we talking about?


Withholding contraceptives won't (usually) kill someone. What in our field can we choose not to do that won't have a lasting impact?


Are you speaking perhaps of refusing transport for a chipped tooth or the like?

How about transporting a patient to undergo an abortion?

The ACLJ filed suit today in U.S. District Court in Chicago on behalf of Stephanie Adamson, who was employed by the Superior Ambulance Service, located in Elmhurst, Illinois, a suburb of Chicago.

Adamson was hired as an Emergency Medical Technician in 2003 and was responding to a non-emergency call in August 2003 to transport a patient from Mt. Sinai Hospital in Chicago to an abortion clinic near Cook County Hospital. According to the complaint, once Adamson confirmed that her assignment was to transport the patient for an elective abortion, she told her employer that transporting the patient to an abortion clinic violated her religious beliefs. After a second crew was sent to transport the patient, Adamson's supervisor immediately fired her following a brief telephone call on August 21, 2003.

Source.

Here is my problem with that. Where does the buck stop? What will happen to EMS if people start objecting to treating alcoholics because a given EMT believes that the person desecrated their body? Will EMS personnel refuse to treat drug addicts? What if your *moral beliefs* dictate that mental illness isn't really an illness? Will you object to delivering a baby if the mother is single or was artificially insiminated and you find that offensive? Seriously, are we going to imperil the health and well being of people due to their personal circumstances that we find disagreeable?

 

[daedalus]

Here is my problem with that. Where does the buck stop? What will happen to EMS if people start objecting to treating alcoholics because a given EMT believes that the person desecrated their body? Will EMS personnel refuse to treat drug addicts? What if your *moral beliefs* dictate that mental illness isn't really an illness? Will you object to delivering a baby if the mother is single or was artificially insiminated and you find that offensive? Seriously, are we going to imperil the health and well being of people due to their personal circumstances that we find disagreeable?

We should not have to worry about where it will stop, because the ethics of our profession prohibit us from judging patients in the first place. This is not Burger King and we do not reserve the right to refuse service.

I think if governments are going to adopt these stupid protections than our professional bodies should blacklist and refuse to certify providers that behave like this. Sure, a potential doctor cannot be denied a license for refusing an abortion, but lets see that doc match into a residency that protects its residents from having to do procedures they do not feel like. They will fail out and have to go back to flipping burgers.

 

[Shishkabob]

With holding contraceptives could have grave consequences as bad as death itself.

Hence the "usually" part.

 

[EMERG2011]

Absolutely rediculous. The provider in question was not performing the abortion herself, all she was doing was transporting a patient. I agree with the above poster - once the white coat/star of life goes on, your duty is clear. Provide the patient with the care that they need and dont you DARE try to foist your beliefs on another individual. I have to wonder, would the provider refuse to transport an HIV+ gay male to an AIDS clinic because she believes that being gay is an abomination? Religion is an individual right, and nowhere does the constitution say that you can force another person to go along with your beliefs, especially when it compromises their own rights.

 

[Veneficus]

This may be an elitist opinion, but I think part of the purpose of religion is to instill behaviors. In the Christian and Muslim faiths, religion hinges around doing what somebody placed above you commands. Alternatively Eastern religions take an approach similar to creating harmony. Other uses for religion are to give meaning to death and explain that which is not understood by man.

Hopefully care providers of all levels have evolved to the point where they can recognize the difference between individual spirituality and “moral” reasoning in a multicultural society.

I stipulate any provider at any level who refuses care based on moral objection has not placed the art of medicine above their personal desires and should be banned. At least until they can reconcile that they chose to accept a position of nonjudgement in the spirit of using the knowledge they have to help others.

But considering a large part of the US is undereducated and ethnocentric, it doesn’t surprise me that this stuff comes up. After 8 years of unchallenged right wing conservative rule how is this shocking to anyone?

If you want to object on moral grounds, become a priest, witchdoctor, shaman, CS practitioner, or snake oil salesman, or whatever. They are all the same thing.

 

[seanm028]

I think it's very important to understand the difference between morals and ethics in this particular issue.

Morals are what you personally believe to be right and just. Ethics are what the society around you says is right and just.

For example, I'll use your scenario of the EMT who refused to transport to an abortion clinic. Personally, I am morally opposed to abortion. However, in that case, I am simply providing a ride that she probably would have acquired anyway, even if I refused. So refusing to transport her is simply delaying the inevitable. Therefore, it is ethically required that I transport her.

In a job such as EMS, you shouldn't allow your morals to conflict with your ethics. To be honest, most of the time, I feel that they play into each other very nicely when I'm on the job. As of yet, I have never had to do something that I felt was ethically acceptable but morally wrong.

 

[emtech419]

Here is my problem with that. Where does the buck stop? What will happen to EMS if people start objecting to treating alcoholics because a given EMT believes that the person desecrated their body? Will EMS personnel refuse to treat drug addicts? What if your *moral beliefs* dictate that mental illness isn't really an illness? Will you object to delivering a baby if the mother is single or was artificially insiminated and you find that offensive? Seriously, are we going to imperil the health and well being of people due to their personal circumstances that we find disagreeable?

I have worked with EMTs and Medics who have advocated not having to treat drug addicts on the grounds that if the person really wanted help they wouldn't be addicted to such harmful substances. These opinions are, unfortunately, not unheard of.

I agree with above: your uniform goes on, judgement goes away.

 

[TomB]

There is a difference between an EMS system and a private ambulance company. Refusing to transport a woman to an abortion clinic to have an elective abortion is not the same as refusing to transport a pregnant woman with an acute abdomen to the emergency department because she might require an abortion to save her life. Trying to make them the same in the name of bashing conservatism is ridiculous.

 

[TomB]

If you want to object on moral grounds, become a priest, witchdoctor, shaman, CS practitioner, or snake oil salesman, or whatever. They are all the same thing.

That's a shocking comment. You can't conceive of circumstances within which you would object to something on moral (or ethical) grounds? What if a nurse refused to turn off a life support system for a terminally ill patient? Should she be fired? Or should another nurse, or the physician, or a family member do it? Maybe she should become a priest or a snake oil salesman (same thing).

 

[vquintessence]

I stand with most of whats been. You're right that it is the job of medical personnel to leave their beliefs at the door and treat the pt appropriately while respecting their wishes. If you can't do that, get out.

However there are two sides to any coin. There is great irony in the people who point fingers at the devoutly religious and label them as self-proclaimed sacrosancts. I've seen those same "freedom fighters" mock Jehovas witness for refusing transfusions. Read stories of them ignoring the Christians Scientists refusal of medications during transport. And I'm from Massachusetts... there aren't many encounters of those faiths up here. I can't imagine the sheer numbers of similar instances out in the rust belt and down south.

So can we really pretend that the devoutly religious are the only ones out to do malicious harm? Are the medical professionals and non-religious exempt from causing "harm" (in a spiritual sense) against the religious?

 

[triemal04]

There is a difference between an EMS system and a private ambulance company. Refusing to transport a woman to an abortion clinic to have an elective abortion is not the same as refusing to transport a pregnant woman with an acute abdomen to the emergency department because she might require an abortion to save her life. Trying to make them the same in the name of bashing conservatism is ridiculous.

Actually, it is the same. Trying to make them different is ridiculous. In health care, no matter what section, you will very likely but put into a situation where you completely disagree with what is being done to/by the pt. But you know what? 1, it's the pt's choice, and 2, agree or disagree on a moral basis, it doesn't matter, it is still your obligation as a healthcare provider to perform your job is accordance with the pt's wishes and the standard treatements.

For those people who provide a medical taxi for people on a non-emergent basis, it doesn't matter where the pt want's to go...if your company agrees to take them there, it is now your job to get them there, whether or not you have a moral objection. Now, if you really don't like it, then please, feel free to quit your job and go somewhere else. Ethics are one thing, but morals are another, and allowing them to get in the way of pt care and your job is pathetic and inexscusable. Find another line of work.

How about this for an example: You work for a 911 agency that, instead of taking drunk bums to the ER, takes them to one of several homeless shelters. You happen to believe that the bums are at fault for being homeless and drunk and deserve no pity from anyone, and the fact that a shelter is available to them disgusts you. So you refuse to transport them anywhere. Is that ok since you are refusing on moral grounds?

That's a shocking comment. You can't conceive of circumstances within which you would object to something on moral (or ethical) grounds? What if a nurse refused to turn off a life support system for a terminally ill patient? Should she be fired? Or should another nurse, or the physician, or a family member do it? Maybe she should become a priest or a snake oil salesman (same thing).

Sure I can. But, my morals don't mean squat while working for the most part. I may completely disagree with what is being done, but, if the treatements are called for and are medically appropriate...guess what...they get done. Oh, and if a RN refused to turn off life support because it violated her conscoius or morals...then she needs a new job, and preferrable should lose her license.

 

[Ridryder911]

B.S.! Another half arse poor Internet reporting. Again, we see poor credibility and again left sided slant of reporting. Thank God for the Internet, because nobody else would consider this as real journalism.

I probably would had refused her as well. Sorry, why would you need an ambulance for an elective procedure? This was for birth control not a medical procedure. Sorry, being pregnant is not a warrant for EMS. Apparently, the patient was well enough to have such procedure.

Apparently none of you have worked at a Catholic hospital. They will not perform abortions nor give employees pharmaceutical rights for birth control. Wrong? Not really, its their hospital and their right to do as they see fit. Don't like it work somewhere else or go to another hospital. Period.

What people and especially patients are not aware, patients can be refused by physicians if it is not a life threatening condition.

Guess what? Life is NOT like a Burger King, you don't always get what you want.

Here is a good hypothetical scenario for left wingers (p.s. right wings usually have advanced degrees, so they are not uneducated).

A MVA involves a female patient which pregnant, she was struck by a drunk driver. A horrible situation that kills her and the baby. In the real world the driver would be charged with double manslaughter....

Now, lets say that the woman was en-route to an abortion clinic, should the double charge be dropped to a single charge?

Again, lefties love to use their "rights" and what the "definition of conception and life is"; when its convenient and to their point ... which ever is their opinion at the time.

There are certain procedures and care I will not participate in. I will not participate in abortions sometimes disguised as a D & C; just for elective procedures. As I will not euthanize or purposely overdose a patient to cease respiration's for delaying death, as I have seen. Not is against my religious beliefs but my personal ethics as well. Just because I am an employ does not release me from my moral ground or religious beliefs. As an educated and licensed health care provider, I realize what is "elective" and what is necessary to save a life, cure an illness, which is my main focus of my job.

R/r 911

 

[firecoins]

I am pro choice.

That being said, when do ambulances transport for abortions? A woman of child bearing years does not need an ambulance to go get an abortion. I object on the use of the vehicle for a non-emergency. I got better things to do.

 

[Dobo]

I'm with daedalus here, once you put on your hat you are required to fulfil your duty to the people. Regardless of race, religion, gender, politics, or moral values. Like say you are a member of the Ku Klux Klan, does that give you the right to refuse treatment on peoples of different races? I know it is an outlandish thing but that is the door you are opening here.

 

[Veneficus]

I stand with most of whats been. You're right that it is the job of medical personnel to leave their beliefs at the door and treat the pt appropriately while respecting their wishes. If you can't do that, get out.

However there are two sides to any coin. There is great irony in the people who point fingers at the devoutly religious and label them as self-proclaimed sacrosancts. I've seen those same "freedom fighters" mock Jehovas witness for refusing transfusions. Read stories of them ignoring the Christians Scientists refusal of medications during transport. And I'm from Massachusetts... there aren't many encounters of those faiths up here. I can't imagine the sheer numbers of similar instances out in the rust belt and down south.

So can we really pretend that the devoutly religious are the only ones out to do malicious harm? Are the medical professionals and non-religious exempt from causing "harm" (in a spiritual sense) against the religious?

I have encountered both situations you speak of here. If the patient has a legal right to refuse (no altered LOC, etc), I would honor their wishes. The same as I would turn off life support, perform an abortion, or any other medically accepted proceedure I can think of which the patient or their appointed rep. decides upon.

It is not within my authority or knowledge to judge them or the morality of their decision.

People who want to be conservative is cool with me, but it is not cool with me when they start making laws promoting their beliefs. There are conservative countries where they stone females pregnant out of wedlock.(killing both the mother and fetus, not exactly pro life) The practice of that culture is even making its way to the US and other multicultural centers. if you make a law protecting your morals, then why can't they have a law protecting theirs too? Because you disagree with them?

Shamans, etc. etc. all fall under the category of "spiritually based healers." If people want to go to them, that is their decision and fine with me. That should not be prevented by law either. But when you start deciding what treatments a person will receive based on your morals, then at the very least you should put them in contact with somebody else. Not simply say "too bad for you, I'm not doing it."

If an agency decides that they will/not allow moral objections then that needs to be discussed preemployment. If you want to work at a catholic hospital then do so. If there is no facility that shares your beliefs then you need to move or you are out of luck.

I do not trust any "true believers."

 

[Veneficus]

Here is a good hypothetical scenario for left wingers (p.s. right wings usually have advanced degrees, so they are not uneducated).

A MVA involves a female patient which pregnant, she was struck by a drunk driver. A horrible situation that kills her and the baby. In the real world the driver would be charged with double manslaughter....

Now, lets say that the woman was en-route to an abortion clinic, should the double charge be dropped to a single charge?

Again, lefties love to use their "rights" and what the "definition of conception and life is"; when its convenient and to their point ... which ever is their opinion at the time.

There are certain procedures and care I will not participate in. I will not participate in abortions sometimes disguised as a D & C; just for elective procedures. As I will not euthanize or purposely overdose a patient to cease respiration's for delaying death, as I have seen. Not is against my religious beliefs but my personal ethics as well. Just because I am an employ does not release me from my moral ground or religious beliefs. As an educated and licensed health care provider, I realize what is "elective" and what is necessary to save a life, cure an illness, which is my main focus of my job.

R/r 911

Wanted to reply specifically to this as it was well thought.

You cannot honestly tell me that a majority of people who run around conservative population centers have advanced degrees. I spent some time in conservative rural america, and even finishing high school is an achievement for many of them.

What is the difference if a drunk driver kills 1 person, 2 people, or 10? Why does it matter if they were pregnant, a little old guy, a mom or dad or whatever? It seems to me that the drunk driver's remorse, (if they are capable) rehabilitation, etc is not influenced by numbers or positions people may have occupied. Is the life of a pregnant female worth more than that of a young adult male? Why? Says who?