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Personal, and Professional, Rights

I tend to surf through the friends of friends' journal entries; it's related to that bit about having a monkey on my back (see the entry immediately preceeding this one in my LJ). I run across all kinds of interesting things this way, and I've also made new acquaintences and refreshed old ones. I should also state that while I'm not apolitical (politics is nothing more, nor less, than people interacting on a large scale), I eschew political naming, whether it be via a party name, or a position. I flex; my positions may change, though know there's a strong foundation upon which they are built. Bamboo flexes before the wind, ans so survives the storm. So there's not been much written in my little corner of the world of a political nature.

I do partake in the process. Along with the right of casting my ballot in an election, I've been priviledged to travel to my nation's capitol and meet, in company with many of my professional nursing colleagues, with my specific legislators and with the legislators from other states. Even there, I am well aware that greasing those wheels requires getting along. Getting along means you find those places, those topics, upon which you may flex, and the ones near and dear to your soul which embody that foundation. Like, individual rights. Call them moral rights, if you will. And so this comes along un response to a couple of postings I've encountered recently in Betnoir's LJ, as well as a thread on Community Zoe, and another posting more recently in fgwriter's LJ :

OK, I hear a trend here which greatly disturbs me: that health care professionals are not allowed to act on their own moral beliefs. All health care professionals, because restricting members of a single profession from being able to act on their moral beliefs carries across the continuum.
Deny any health care professional the right to refuse delivery of care, then you deny the rights of all health care professionals to do so. This denies them their humanity.

The error committed in the first instance is the refusal to immediately defer the specific care request to another health care practitioner. The error is not the exercise of their moral choices. Deny them that, and you become no better than those who you see as denying you your moral choices. The problem cited in the second instance is, again, not the exercise of moral choices, but the provision of a legal means to avoid a professional responsibility, to whit that if the professional is morally prohibited from providing that care then they should refer to a practitioner who is capable of provideing that care.

Rhetorical Example: As a Registered Nurse, I have the moral right to say, "I will not care for substance abuse patients because I believe their addiction is due to their lack of faith and moral strength." I do not have the right to say, "This individual does not deserve substance abuse treatment. It will be with-held."

You are entitled to your position. I'm entitled to mine, and since I'm a practicing health care provider, I feel pretty strongly about this. Since I'm a Registered Nurse, I also hold the position that I'm a patient advocate. So while I do support my right to refuse treatment, I also hold my professional colleagues to the second aspect of my rant; you can refuse to do it, but you can't refuse them getting it.

So: Don't tell me that a pharmacist can't refuse to dispense medication to you. Don't tell me that a physician can't refuse to prescribe contraception to you. So alright, get out your sticks and get ready to beat me: Because They Can.

And when you're done beating me, remember, I believe you've got a right to those medications, to contraception, to abortion whether or not I am willing and able to deliver it, and because I'm a patient advocate, this went along to my Representative and Senators:

I am writing to express some concerns regarding H.R.5006, the House version of the Labor, Health and Human Services Appropriations Bill. (NOTE: and to the senators, this sentence included "which is coming before the Senate for consideration."

While I strongly support the right of health care practitioners in any field to exercise their moral standards in decisions about their provision of care, I can not say the same in terms of supporting a legal right for any health care practitioner to refuse to refer a recipient of health care to another practitioner who may not hold the same moral standards. This is to me a violation of a basic tenet of a professional code, that all people are entitled to receive the health care they believe they need.

I am speaking to the Federal Refusal Clause ammendment to H.R.5006. I myself, as a Registered Nurse, have exercised my moral right to refuse care to a woman who elected an abortion; I can not support a position which would allow me to interfere in any way with that same person finding a practitioner to meet the needs she felt she required.

Consequently I can not support legislation which would provide a legal means for any practitioner to so refuse to provide the information as to where such care could be legally obtained. While the appropriations addressed in this legislation are vital, I believe this particular ammendment needs to be addressed and removed from this appropriations bill.

Thank you for your consideration in this matter

Rant Mode OFF. YMMV


( 5 comments — Leave a comment )
Nov. 18th, 2004 09:15 pm (UTC)
I see your point. I can even agree with your point. But I have at least one concern.

Many people are limited in their choice of health care providers -- they live in small towns or have restrictive insurance policies or a Catholic hospital bought the secular hospital in their county. Even if the health care professional were willing to refer the person to another provider, another provider might not be available. I'm not sure how to address this.
Nov. 19th, 2004 03:22 am (UTC)
I understand the point you're making, and I partially agree with it. I can accept a particular doctor or hospital refusing to perform abortions on the basis of "moral objections", given your caveat that they must then be REQUIRED to provide a referral to someone else who will.

I cannot accept a pharmacist refusing to dispense a legally-prescribed medication on such a basis, because at that point the pharmacist is setting himself up as the arbiter in the doctor-patient relationship. The pharmacist does not necessarily know for what purpose the medication was prescribed; while birth control pills are primarily used as contraceptives, a significant fraction of women who use them do so for other reasons. I had a prescription for the Pill years before I was sexually active, because it was the only thing short of opiates which would control my menstrual cramps.

It is also worth noting that the Pill DOES NOT OPERATE in the way that these loons are claiming it does -- which makes me even less inclined to sympathy for their position. Abortion is abortion, but to falsely claim that the Pill is an "abortifacent" and then refuse to prescribe it on that basis goes well beyond the bounds of "moral concern" and straight into "delusions of ownership". And make no mistake, that is what this entire mess is about: who, in the end, owns a woman's body and her right to healthcare.

And, as Janet notes above, the real issue here isn't for me, safe in a large city where I can almost certainly find a sane provider. It's the women who are trapped 150 miles from the nearest outpost of civilization, with only a single option for local care. If that option is taken away, where do they go? We're looking at the opening salvo for The Handmaid's Tale here, and I for one will not submit while I am alive.
Nov. 19th, 2004 09:58 pm (UTC)
I cannot accept a pharmacist refusing to dispense a legally-prescribed medication on such a basis, because at that point the pharmacist is setting himself up as the arbiter in the doctor-patient relationship.

This may be a point on which we will mutually disagree, which is acceptible. However, I don't see the pharmecist as an arbiter in the doctor-patient relationship. Why? Because each profession brings it's strengths to the table of health care, and the same information overload found in Life In General is very much in evidence in health care. Physicians and Registered Nurses both rely on pharmacists and their specialty knowledge regarding pharmacopaea.

Furthermore, if a pharmacist tells you they don't want to issue a prescription because (in this instance) it is a contraceptive, it is within your rights to refer them to the physician to clarify the intent behind any prescription, and report them to their licensing body if they refuse to do so or to return your prescription. In that instance, I would be surprised if the physician did not re-issue the prescription itself, either in hard-copy or via telephone.

I still stand with my statement, all health care practitioners have the right to exercise their moral values; we also all have a professional obligation to refer someone elsewhere if morally we can not provide the particular sevice. The error commited in the actions cited is not the exercise of their moral values, it is the failure to meet professional obligations.
Nov. 19th, 2004 10:25 pm (UTC)
Do not misinterpret me here: I am not commenting on the appropriateness of their morals, only on their rights to those morals.

I cited an example where I refused nursing care; I also made sure there was another nurse available. That was and is my professional responsibility, my duty. And I will hold all health care professionals to the same standard.

Part of what I'm saying... There's a prinicple I was taught, that Nurses treat our patients holistically. We are the profession that considers all of the patient's needs, across their continuum. Not just illness, nor medications; all of it.

And we can not consider our patients holistically if we do not also consider ourselves in the same light. We can not deliver a professional service with integrity if we attempt to dissociate our profession from our being, if we are denied our moral and ethical values.

I may not agree with their choices, and I often don't. Read what I wrote: there's nothing in it says I agree with them. But to deny them their rights, even while they attempt to deny you yours, reduces you to their moral and ethical level. Holding them to their professional responsibilities maintains your moral and ethical ground, and lets them know they're being assholes. I've said it before, I don't have time for assholes.
Nov. 24th, 2004 03:06 am (UTC)
a bit late perhaps, but
Each individual must be true to themself and their beliefs first and foremost. You remained true to what you believed, and true to what you felt responsible for, ensuring that the individual received care.

It is similar in every facet of life, and business. How many times have you seen a sign in a business stating *We Reserve the right to refuse service, etc etc etc.*

And while I said it is similar, your profession has a much more demanding personal association with those you provide service for than most other professions.

Sometimes a persons integrity makes them appear to be an asshole, we all take that risk in our lives as we make the choices necessary to maintain our own personal integrity.
( 5 comments — Leave a comment )

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