Trump Administration to overall HHS to permit workers to deny service based on moral objections

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Catnip1024:

erttheking:
No, we cannot accept that there are legitimate issues on both sides.

R&P in a nutshell, these days.

There are legitimate issues on both sides here, but it all comes down to one simple thing:
- If you don't want to do the job, don't apply for it.

We've already had a midwife in Sweden who tried to get jobs but with the caveat that she wanted nothing to do with abortions due to her religion. She's been consistently turned down by employers, which eventually led her to suing all of them (that is, Swedish public hospitals) for discrimination. The ruling was that it is not discrimination, because you are hired to do a job and refusal to do some of the tasks involved means you can be rejected as an applicant.
There's literally not a single union or trade organisation in Swedish health care that supports her fight for moral objections, because the agreement among all of them is that our job is to provide for the patient, no matter how we feel about them. This is the very foundation of trust between the patient and the caregiver.

You are free to think whatever you want about abortion or trans sexuality, but the moment you put on your scrubs and set foot in a ward or clinic, that doesn't matter. What matters then is that you are caring for people's health and those people need to know that they can trust that they'll get the best care you can offer, no matter what you might think about them as people. If you can't put yourself aside to do that, you don't belong in health care.

Catnip1024:

erttheking:
No, we cannot accept that there are legitimate issues on both sides.

R&P in a nutshell, these days.

Maybe you should pick better positions to argue then if you feel that way. Not every argument has a golden mean.

This is a rather simple case
Patient: I have a right to receive life-saving medical care regardless of my physicians' individual beliefs

vs

Physician: I have a right to deny my patient life-saving medical care due to my individual beliefs

-----------------------------------------------------------------------------------------------------------------------

One of the above is not a legitimate right. I'll let you sort out which one.

There is a very simple compromise that solves both parties' issues though; it's the way where the patient still receives their life-saving medical care, the physician doesn't have to violate their individual beliefs, and this dilemma never occurs again. The physician simply stops practicing medicine in any field that might require a compromise of their beliefs to fulfill their duties. Voila, the patient is never denied care, the physician never has to compromise their beliefs, and the whole world keeps on spinning.

Catnip1024:

erttheking:
No, we cannot accept that there are legitimate issues on both sides.

R&P in a nutshell, these days.

Yeah I'm sorry, this is a very simple matter. If you don't want to do the things required of a doctor, get a new job. Don't put the patient at risk because of your selfish need to preen your own morality.

I'm not going to arbitrarily concede that the people who want this may have points in a vain attempt to appear more moderate, because one side is advocating that doctors get to pick and choose what they do, which, as I said, no job anywhere would allow, so why should one that saves lives get to do it?

I take it when they say religious objections they mean only those who identify as Christian.

Kwak:
I take it when they say religious objections they mean only those who identify as Christian.

But of course. Every other religion can't possibly be a real religion because it's too political.*

*This is an actual fundie talking point.

Catnip1024:

Right, to summarise my response:
- Regarding the "it's their job" argument, I don't know the exact wording of contracts. But I know for sure that mine doesn't specify all tasks that I am required to undertake.

This doesn't fly. "Reasonable expectation" easily covers these medical procedures; it would be blindingly obvious to somebody long before they finished medical school, or wrote their application, that they might be called to perform these.

It is not the same as failing to realise you might be called on to do some minor admin. These are major surgeries, requiring extensive training.

Catnip1024:
Last I checked, one isn't quizzed on every possible situation before one receives a job.

lol, you're acting like it's some big shock that people go see a doctor for an abortion, or to a pharmacist for plan B pills. Who could have possibly had the foresight going into these professions to know they might find themselves in such a situation!

"Perform acts against your will and beliefs" is basically equal to "Find a different doctor" in this argument it seems.

Either side appears to believe the duty is on the other side to resolve the issue.

The Lunatic:
"Perform acts against your will and beliefs" is basically equal to "Find a different doctor" in this argument it seems.

Either side appears to believe the duty is on the other side to resolve the issue.

Gee, why didn't anyone ever think about this before? I mean it's perfectly reasonable to expect people having a medical emergency to go doctor shopping.

I'm having a pregnancy complication and bleeding internally and externally? I better grab the phone book and start calling practices to see which individual doctors won't deny me the necessary procedures and if those doctors are in/on call at this moment in time. I sure hope that if I'm at one of these hospitals/practices for an amount of time that any specific operation doesn't become necessary while a doctor with beliefs more important than my life (and the medical code of ethics they've agreed to) is on duty.

Also, who cares if the next nearest hospital is in the next county over? It's the patient's fault they require an operation the local physician(s) refuses to provide for no valid medical or ethical reason. Guess the sick person better hop in their car, if they have one, and drive 50 miles; if they don't, they better hope there's a bus.

Your post honestly leaves me wondering if you simply don't care for the well being of people in potentially life threatening situations or if you just didn't take any time to think this over before writing something.

Has anyone mentioned the Hippocratic Oath yet? Anyone?

Avnger:
Gee, why didn't anyone ever think about this before? I mean it's perfectly reasonable to expect people having a medical emergency to go doctor shopping.

I'm having a pregnancy complication and bleeding internally and externally? I better grab the phone book and start calling practices to see which individual doctors won't deny me the necessary procedures and if those doctors are in/on call at this moment in time. I sure hope that if I'm at one of these hospitals/practices for an amount of time that any specific operation doesn't become necessary while a doctor with beliefs more important than my life (and the medical code of ethics they've agreed to) is on duty.

Seems extremely unlikely to come up.

Hypothetical tend to work better if your situation is vaguely realistic.

What reasons would there be for a significant portion of doctors to not operate in that situation?

Avnger:

Also, who cares if the next nearest hospital is in the next county over? It's the patient's fault they require an operation the local physician(s) refuses to provide for no valid medical or ethical reason. Guess the sick person better hop in their car, if they have one, and drive 50 miles; if they don't, they better hope there's a bus.

Your post honestly leaves me wondering if you simply don't care for the well being of people in potentially life threatening situations or if you just didn't take any time to think this over before writing something.

Likewise, you expect people doctors who agreed to an oath 20-30 years ago in a completely different cultural landscape to perform operations which they never agreed to. People who swore to protect life, you expect them to end, and if not, you expect them to leave their livelihoods.

Added to that, let's say overnight we decide that everyone who holds beliefs, is forbidden from being a doctor, who are you intending to solve the massive shortage of medical staff we now have?

NemotheElvenPanda:
Has anyone mentioned the Hippocratic Oath yet? Anyone?

You do know what the oath says, don't you?

"I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein."

The Lunatic:

You do know what the oath says, don't you?

"I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein."

Still stands to reason that the health of a patient takes precedence over the personal beliefs of the person hired to take care of them.

The Lunatic:
"Perform acts against your will and beliefs" is basically equal to "Find a different doctor" in this argument it seems.

Either side appears to believe the duty is on the other side to resolve the issue.

This has been tried in a few European countries where moral objection clauses exists for doctors. The results have been that in some areas a large part of ob/gyn doctors don't assist in abortions, which means that in some parts of Italy, for example, you literally can't get an abortion because none of the ob/gyns will perform one.

So this argument not only sucks, it has been proven to create problems for patients in need of healthcare. Which, you know, is one of the most basic things that we in healthcare try to ensure: that a patient in need of healthcare shall receive that healthcare without regards to who they are as a person or what their affliction is.

The Lunatic:

Likewise, you expect people doctors who agreed to an oath 20-30 years ago in a completely different cultural landscape to perform operations which they never agreed to. People who swore to protect life, you expect them to end, and if not, you expect them to leave their livelihoods.

It is good that the Hippocratic Oath hasn't changed in that time, nor that more contemporary ethical codes for doctors and nurses have either, then. It is also good that a fetus prior to week 20 or so doesn't qualify for actual signs of life if held against the international standard of what constitutes life in a human.

There's exactly one kind of doctor that helps with abortions, the obstetrics/gynecology specialist. Historically, these have been the doctors at the forefront of the abortion movement, because their broader specialization is women's reproductive health. They are not pediatricians, their job is not to care about the baby, but to ensure that women get the health care they need in relation to their reproduction. This has included help with avoiding unwanted pregnancy and terminating unwanted pregnancies since the early 20th century. This ob/gyn problem with not wanting to do abortions is not a long going issue, it has cropped up in the last 10-15 years under the advent of increased religious pressure on society in general. If you started your ob/gyn residency 30 years ago, it is quite likely that you'll do abortions without a second thought, because back then it was just a part of the job.

Becoming a doctor is a significant investment in time, money and energy, but it is ultimately still a job. If a doctor can't actually get behind the entirety of their job description, then they shouldn't be doing the job. This is no different from being a soldier but refusing to fight, being a firefighter but refusing to go near fires or being a priest who refuses to talk about the bible.

NemotheElvenPanda:
Still stands to reason that the health of a patient takes precedence over the personal beliefs of the person hired to take care of them.

If a doctor believes the fetus inside the person is also their patient, then, yeah, that's them doing that.

They're ignoring the personal beliefs of the mother in order to provide care for their patient, the child.

NemotheElvenPanda:
Has anyone mentioned the Hippocratic Oath yet? Anyone?

If the doctor believes that a fetus is a full valid human being, then the Hyppocratic oath forbids the procedure.

Which is basically the core of the whole problem. There is severe disagreements about if those procedures are actually to the good of the patient or something a doctor should do. And about that there is not even consesn in the society.

Sure, other countries have decided one or the other way long ago (rules about age and other requirements for sex change operations are really common as is forbidding assisted suicide) some eventually found strange copromises and everyone who becomes a docto in those countries knows beforehand what is coming.

But in the US there seems to be no agreement in the society yet. And this is the reason why in this particular case i support the desicion to allow doctors to follow their personal conviction/judgement about which procedures are appropriate and beneficial for the patient.

Gethsemani:

It is good that the Hippocratic Oath hasn't changed in that time, nor that more contemporary ethical codes for doctors and nurses have either, then.

The Hippocratic oath specifically states against acting in a way to cause abortion.

Contemporary ethics codes have, of course changed. As Roe vs Wade was only 40 years ago and legislation from it is still ongoing.

Until there's some form of unanimity, it seems the only reasonable course is to leave it down to the individual's ethics.

It is also good that a fetus prior to week 20 or so doesn't qualify for actual signs of life if held against the international standard of what constitutes life in a human.

Gethsemani:
Becoming a doctor is a significant investment in time, money and energy, but it is ultimately still a job. If a doctor can't actually get behind the entirety of their job description, then they shouldn't be doing the job. This is no different from being a soldier but refusing to fight, being a firefighter but refusing to go near fires or being a priest who refuses to talk about the bible.

Sure, so, why do you want doctors to abandon their investment, and stop performing life saving duties in other areas because they disagree with the current popular opinion of the left-wing on abortion?

And how do you intend to replace these doctors you're forcing out of the service?

Added to that, a lot of issues the patient's preferred treatment is statistically proven to either not make a huge amount of difference, or in cases worsen matters.

I mean, gender reassignment surgery, according to recent studies has shown to not make a significant difference in the rate of suicide of people who're transgendered. Are doctors to be forced to perform operations they know aren't helping just because it's politically agreeable?

Jux:
lol, you're acting like it's some big shock that people go see a doctor for an abortion, or to a pharmacist for plan B pills. Who could have possibly had the foresight going into these professions to know they might find themselves in such a situation!

Note that one of the mentioned items is assisted suicide. Why should one expect their job to involve helping another kill themself? Unless of course you work in certain Swiss clinics.

The Lunatic:
What reasons would there be for a significant portion of doctors to not operate in that situation?

Again, there is an alarmingly high number of hospitals in the United States that are owned by Catholic religious groups that hold the entire facility to Catholic Doctrine that prohibits a range of reproductive health care services even when a woman's life/health is in danger. In some states, more than 40% of all hospital beds are in a Catholic facility, which means entire chunks of these states are left without any option for some types of reproductive health care. Which means that yes, they will have to go to the next county over, 100 miles or more out of their way.

The procedures range from providing contraception, sterilization, many infertility treatments, and abortions, even if the woman's life or health is at risk from her pregnancy. This means that Catholic hospitals are also withholding emergency care from patients who are having a miscarriage or other pregnancy complications. They won't perform tubal ligations at the time of delivery, which is the safest time to undergo that procedure, which means they'll have to go through an additional surgery after recovering from childbirth. Women who are being told "You should not have another child, you risk dying" are being denied the means to prevent another pregnancy. These hospitals still receive billions in taxpayer money, yet still are allowed to deny health services to both men and women under the banner of religious doctrine.

At this point, it's not even a matter of "I hope my doctor isn't a religious whackjob that puts their personal religious beliefs ahead of doing their damn job and provide me with the care I need", it's "Gee, I hope I'm not unfortunate enough to need a doctor and the hospital is owned by a Catholic group which means that even if my doctor isn't a religious whackjob I still won't get the help I might need!"

As more and more hospitals are owned by religious groups, and, consequently, as more and more hospitals are being held to religious doctrine, certain health services become harder and harder to find. This is the alternative tactic that certain religious groups use to fight against reproductive health, control the facilities that people get these services from and prohibit anyone under their employ from performing these services. They may not succeed in outlawing things like abortion, but they'll prohibit it through the fact that no facility within reasonable distance will perform the procedures, especially in the wake of the rejuvenated witch hunt after Planned Parenthood, causing many of their clinics to shut down. Regardless of the cause, health care providers should not be able to use religious doctrine as an excuse to deny service to a patient.

The Lunatic:
The Hippocratic oath specifically states against acting in a way to cause abortion.

Contemporary ethics codes have, of course changed. As Roe vs Wade was only 40 years ago and legislation from it is still ongoing.

Until there's some form of unanimity, it seems the only reasonable course is to leave it down to the individual's ethics.

The Hippocratic Oath is also some 2000 years old. Very few doctors today follow it to the letter, especially since several parts actually clash with modern understandings of medicine. The part about not administering poison becomes hilarious when you consider that atropine is a poison and one of the most common medicines used to stabilize heart rate during surgery. The Hippocratic Oath today is more of an inspiration, the "do good, do no harm, be a good person"- thing, not some principled oath every doctor takes. Which is pretty obvious when you consider that medical doctors still felt the need to write another ethical code for themselves.

Also, I note with amusement that you didn't use the modernized Hippocratic Oath from the 60s, the one which omits the antiquated (see the pun?) part about abortion among other things as well as include parts much more relevant to modern medicine and health care:

The Lunatic:
Sure, so, why do you want doctors to abandon their investment, and stop performing life saving duties in other areas because they disagree with the current popular opinion of the left-wing on abortion?

And how do you intend to replace these doctors you're forcing out of the service?

Because this is about a broader issue then just abortion. It starts here but if us healthcare professionals can use moral objections to refuse treatment if we feel it violates our personal moral code, where does it stop? Should someone be allowed to refuse administering blood because they're with Jehova's Witnesses? Should someone be allowed to refuse performing surgery on lung cancer patiens who smoke, because it is self-inflicted?

The point here is that as a doctor, nurse, biomedicine analyst or someone else in healthcare you are supposed to put the patient first. If I refuse to do something that they are legally entitled to (ie. medical treatment) because it clashes with my personal morals, I am putting myself ahead of the patient. That's a big fucking no-no.

Just look at the modern Hippocratic Oath: "I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick." A line which specifically suggests that the doctor must look beyond "wants to do abortion" and look at the person wanting the abortion and what that means for the patient, the patients family and their social situation. The disease and the treatment is never about the doctor, it is about the patient in need of medical assistance.

That we are even discussing this, and that I have to re-iterate the point about putting the patient first, perplexes me, because it is literally medical ethics 101.

The Lunatic:
Added to that, a lot of issues the patient's preferred treatment is statistically proven to either not make a huge amount of difference, or in cases worsen matters.

That's a nice shift in goalpost. No one is talking about treatment options here, we are talking about providing medical care that patients are legally entitled too. There's a very marked difference between discussing treatment options for cancer (chemo, radiation, surgery etc.) and whether or not a doctor should be able to refuse to perform specific treatment options entirely for moral reasons. Don't try to conflate the two.

Catnip1024:

Right, to summarise my response:
- Regarding the "it's their job" argument, I don't know the exact wording of contracts. But I know for sure that mine doesn't specify all tasks that I am required to undertake.
- Regarding the ethical framework - sure, you have a broad framework. That's standard. But to apply it to individual situations requires a level of interpretation.
- There is no reason why you cannot make concessions for individual staff members on the condition that the practice-holder ensures a set range of procedures. You can have this whole thing be a win-win scenario, this is not a bipolar issue. Setting more stringent requirements on the company than the individual is only logical.

Abortion (for instance) is an accepted, established, standard and routine medical operation that patients have a clearly detailed legal and ethical right to demand in various circumstances. No, a doctor in the relevant field (obs/gyn) does not need a specific contractual clause telling him/her to carry abortions out any more than he/she requires one for any other specific medical treatment.

There is potentially wiggle room in one sense you state. A patient's demand for treatment is usually met by an organisation rather than a specific medical professional. An organisation might be prepared to excuse a doctor a duty due to his/her personal conviction and hand it to other staff if there is no significant disadvantage to the patient. But if it is negatively impacting patient treatment, there's no reason professionally negligent staff should have a right to keep their jobs.

P.S. We disagree. Okay, cool. I can see your arguments, and I respect them. I just weigh the balance differently. Can we please keep this a civil thread, accept that there are legitimate issues both sides, and then go on our ways?

You (and, say, Lunatic) are ultimately disagreeing with an over 2000 year old fundamental basis of medical ethics: whether or not you realise it, de facto arguing that the care of the patient is not the principal concern of healthcare professionals. That is one hell of a big deal.

Agema:
Abortion (for instance) is an accepted, established, standard and routine medical operation that patients have a clearly detailed legal and ethical right to demand in various circumstances. No, a doctor in the relevant field (obs/gyn) does not need a specific contractual clause telling him/her to carry abortions out any more than he/she requires one for any other specific medical treatment.

There is potentially wiggle room in one sense you state. A patient's demand for treatment is usually met by an organisation rather than a specific medical professional. An organisation might be prepared to excuse a doctor a duty due to his/her personal conviction and hand it to other staff if there is no significant disadvantage to the patient. But if it is negatively impacting patient treatment, there's no reason professionally negligent staff should have a right to keep their jobs.

This would be my interpretation of the intention of this overhaul. To give the individual the ability, with (in an ideal world) no impact to the customer. It'll almost certainly get fucked up by the political interpretations, but still.

You (and, say, Lunatic) are ultimately disagreeing with an over 2000 year old fundamental basis of medical ethics: whether or not you realise it, de facto arguing that the care of the patient is not the principal concern of healthcare professionals. That is one hell of a big deal.

The individual worker has a duty of care to the patient, yes. But the organisation also has a duty of care to its staff. And if there is a way to meet both, surely that's worth it? I'm not saying that the individual should place themselves over the needs of the patient, but that the organisation should where possible endeavour to make sure that that's not the dilemma.

Catnip1024:
The individual worker has a duty of care to the patient, yes. But the organisation also has a duty of care to its staff. And if there is a way to meet both, surely that's worth it? I'm not saying that the individual should place themselves over the needs of the patient, but that the organisation should where possible endeavour to make sure that that's not the dilemma.

"Duty of care to its staff" means that the workplace is safe and sufficiently provided for to allow the staff to perform the tasks they were hired to do. It does not mean that the company must take into consideration each staff members' moral compass or align with it. When you take on a job, it's under the assumption that you are willing to and capable of performing all tasks that will be required of you under that specific job title. You still wanna be a doctor but don't want to deal with reproductive health services? Pick one of the professions where you won't have to deal with the stuff you don't like. Be a children's doctor, become a specialist in a certain field of medicine, don't just say "My religious beliefs prevent me from doing X." and expect people to be accommodating of your beliefs.

Catnip1024:
The individual worker has a duty of care to the patient, yes. But the organisation also has a duty of care to its staff. And if there is a way to meet both, surely that's worth it? I'm not saying that the individual should place themselves over the needs of the patient, but that the organisation should where possible endeavour to make sure that that's not the dilemma.

And If "the organization" doesn't want to provide service for trans people on the basis of "they's got Satan in them" and they're the only hospital in town? Trans people get to, what, bleed out on the street until someone tries to start up an extremely expensive competing emergency room? If said "Organization" doesn't believe in medical abortions for dead fetuses because miracles are a thing, a miscarrying person gets to die from toxicity as God intended?

Theory is all good and well, but this shit's going to happen in the real world. Because this shit already happens in the real world, only now it'd legal.

I know that people are trying to tie this into the whole gay cakes debate but no. Just... no. It's not remotely the same. And this is coming from someone who's more radically anti-abortion than probably anyone else on the forum. I work in the law and it's a violation of my ethical duty to deny a person represenation that I would otherwise be able to provide on the basis of discrimination against some protected class. To wit, I could refuse to represent a person because their case was wrong or it's an area I'm not competent in, but I cannot refuse to represent someone because they're transexual or HIV positive. And I accept that as much as I may disprove of an individuals choices that doesn't give me grounds to deny them representation (No cab-rank rule like UK Solicitors in the USA but my state's bar has an anti-discrimination clause last I checked). And that's the legal field were talking about, which is significantly less life-or-death than your average hospital.

My advice: Compartmentalize your life. If you really hate transexuals and abortion so much, rant about them on /pol/. That's what I do. Or maybe go into a field that doesn't have as many things you morally object to.

Catnip1024:

Jux:
lol, you're acting like it's some big shock that people go see a doctor for an abortion, or to a pharmacist for plan B pills. Who could have possibly had the foresight going into these professions to know they might find themselves in such a situation!

Note that one of the mentioned items is assisted suicide. Why should one expect their job to involve helping another kill themself? Unless of course you work in certain Swiss clinics.

If it's legal in the state or country the person is seeking it, then people entering the medical profession should absolutely be prepared to face that potential scenario. If not, then 'moral objections' has fuck all to do with it, you just point to the law and say 'I'm not legally allowed to do this.'

CM156:
I know that people are trying to tie this into the whole gay cakes debate but no. Just... no. It's not remotely the same. And this is coming from someone who's more radically anti-abortion than probably anyone else on the forum. I work in the law and it's a violation of my ethical duty to deny a person represenation that I would otherwise be able to provide on the basis of discrimination against some protected class. To wit, I could refuse to represent a person because their case was wrong or it's an area I'm not competent in, but I cannot refuse to represent someone because they're transexual or HIV positive. And I accept that as much as I may disprove of an individuals choices that doesn't give me grounds to deny them representation (No cab-rank rule like UK Solicitors in the USA but my state's bar has an anti-discrimination clause last I checked). And that's the legal field were talking about, which is significantly less life-or-death than your average hospital.

My advice: Compartmentalize your life. If you really hate transexuals and abortion so much, rant about them on /pol/. That's what I do. Or maybe go into a field that doesn't have as many things you morally object to.

While I don't necessarily agree with your opinions, I respect your ability to recognize they have a time and place, and should not interfere with your work, and will always respect your right to hold those beliefs in the same way. *doffs hat*

Dr. Thrax:
"Duty of care to its staff" means that the workplace is safe and sufficiently provided for to allow the staff to perform the tasks they were hired to do. It does not mean that the company must take into consideration each staff members' moral compass or align with it. When you take on a job, it's under the assumption that you are willing to and capable of performing all tasks that will be required of you under that specific job title. You still wanna be a doctor but don't want to deal with reproductive health services? Pick one of the professions where you won't have to deal with the stuff you don't like. Be a children's doctor, become a specialist in a certain field of medicine, don't just say "My religious beliefs prevent me from doing X." and expect people to be accommodating of your beliefs.

Actually, duty of care does cover mental wellbeing as well as physical. I agree that staff shouldn't willingly enter a field in which there are requirements they disagree with, but I also think that there are likely to be jobs where things crop up. Possibly not as a doctor, but as a nurse or whoever assisting with operations, being asked to cover another department?

Catnip1024:
I agree that staff shouldn't willingly enter a field in which there are requirements they disagree with, but I also think that there are likely to be jobs where things crop up. Possibly not as a doctor, but as a nurse or whoever assisting with operations, being asked to cover another department?

And again, it's part of the job.
If you cannot do the entire job then don't apply for the damn job. Unless you are your own boss, you don't get to pick and choose what you will and won't do. That is still not an excuse for allowing people to claim moral objections to parts of their job they don't like, and does nothing to address the fact that there are already entire hospitals that operate in such a manner regardless of each individual employee's personal beliefs.

Catnip1024:
Actually, duty of care does cover mental wellbeing as well as physical. I agree that staff shouldn't willingly enter a field in which there are requirements they disagree with, but I also think that there are likely to be jobs where things crop up. Possibly not as a doctor, but as a nurse or whoever assisting with operations, being asked to cover another department?

Let's put this into perspective: Would you say it is alright for a soldier to refuse combat tours? Would you think it was ok for a police officer to not intervene against certain crimes because their personal morals says that crime shouldn't be a crime? Would you trust a lawyer that refused to represent someone because of their political beliefs?

"Things crop up", that's a thing in any job and employees are expected to handle them. Doesn't matter if it is a soldier who finds themselves ordered into combat, a police officer who has to arrest their friend or lawyers who have to represent people they actively dislike. In health care this is really obvious since we are expected to help our patient no matter what they are or what their medical need is. If Literally Josef Stalin came into my ward and needed treatment for his depression, I'd be expected to give him the same care I'd give to the traumatized teenager who saw all his friends executed by Literally Josef Stalin. Because as a Nurse or a Doctor you don't pick sides, you care for patients. No matter who they are or what their medical need is. If you can't stomach that idea, you're in the wrong line of work, and if you actively dislike abortions and pregnancy prevention you're in the wrong line of Medicine if you pick Ob/Gyn as your specialization.

Gethsemani:

Let's put this into perspective: Would you say it is alright for a soldier to refuse combat tours?

https://en.wikipedia.org/wiki/Desmond_Doss

Yes. In fact, I'd say it makes them pretty fucking brave for the most part.

Gethsemani:
Let's put this into perspective: Would you say it is alright for a soldier to refuse combat tours?

First, one can serve in the armed forces without being on the front lines. Second, there was, as Lunatic points out, and entire film addressing this, which does point to a supreme court or whatever ruling on the eligibility of pacifists to contribute. Third, if a non-combatant truck-driver / mechanic was suddenly asked to storm a bunker, that would be wrong and they would be entitled to complain. (The difference being that H&S at work applies differently to military operations, making this a somewhat misleading example in the first place)

Would you trust a lawyer that refused to represent someone because of their political beliefs?

I wouldn't want a lawyer representing me who thinks that I was in the moral wrong. The same as if the lawyer believed me to be guilty.

"Things crop up", that's a thing in any job and employees are expected to handle them. Doesn't matter if it is a soldier who finds themselves ordered into combat, a police officer who has to arrest their friend or lawyers who have to represent people they actively dislike. In health care this is really obvious since we are expected to help our patient no matter what they are or what their medical need is. If Literally Josef Stalin came into my ward and needed treatment for his depression, I'd be expected to give him the same care I'd give to the traumatized teenager who saw all his friends executed by Literally Josef Stalin. Because as a Nurse or a Doctor you don't pick sides, you care for patients. No matter who they are or what their medical need is. If you can't stomach that idea, you're in the wrong line of work, and if you actively dislike abortions and pregnancy prevention you're in the wrong line of Medicine if you pick Ob/Gyn as your specialization.

Yes, I've pointed out that the specialisation thing should avoid this. But if you're a nurse, and are suddenly asked to prep for an assisted suicide, that's very different. Throw another ball in there - what happens if the law changes? Suddenly your contract has implicitly changed.

And again - think about patient wellbeing too. If you treat someone you absolutely despised, are you not considerably more likely to give lesser quality of treatment? Even due to subconscious issues?

Catnip1024:
The individual worker has a duty of care to the patient, yes. But the organisation also has a duty of care to its staff. And if there is a way to meet both, surely that's worth it? I'm not saying that the individual should place themselves over the needs of the patient, but that the organisation should where possible endeavour to make sure that that's not the dilemma.

Actually, you're precisely arguing that practitioners can place themselves over the needs of the patient.

The whole point of professional ethics is that they are goal-orientated; considerations, reasoning and processes designed to carry out a task; the goal of medicine is self-evidently providing care for patients. Unwillingness of a worker to meet the requirements of the profession tells that person they are in the wrong profession. Professional organisations work under the same professional ethics - the ultimate requirement to do carry out a task. The duty to take care of their staff exists under the requirement to do the job. An army, for instance, should care for its soldiers in terms of stress and trauma. But that doesn't extend to letting frontline soldiers decide they never have to shoot at the enemy, because that would mean fundamentally failing to carry out required tasks.

There are easy ways to avoid certain potentially problematic duties: don't do the area that requires them. No-one's going to be calling the neurology, cardiology or orthopaedics departments to do abortions, for instance. Likewise people who want to serve in the military and (probably) not shoot people can be vehicle engineers and cargo plane pilots.

This would be my interpretation of the intention of this overhaul. To give the individual the ability, with (in an ideal world) no impact to the customer. It'll almost certainly get fucked up by the political interpretations, but still.

I think you're missing the point that this is a deliberate political move designed to make it harder to provide certain medical services - specifically, services that the US right wing do not approve of. That's been the whole tactic of the US right-wing since Roe v. Wade: unable to outright ban abortion, it has spent decades instead concocting inconveniences to make it as inaccessible as possible to as many people as possible. Make no mistake, this is just the latest.

The Lunatic:

Gethsemani:

Let's put this into perspective: Would you say it is alright for a soldier to refuse combat tours?

https://en.wikipedia.org/wiki/Desmond_Doss

Yes. In fact, I'd say it makes them pretty fucking brave for the most part.

Do note that Doss did not refuse combat service, only armed service. That's a significant difference.

Catnip1024:
First, one can serve in the armed forces without being on the front lines. Second, there was, as Lunatic points out, and entire film addressing this, which does point to a supreme court or whatever ruling on the eligibility of pacifists to contribute. Third, if a non-combatant truck-driver / mechanic was suddenly asked to storm a bunker, that would be wrong and they would be entitled to complain. (The difference being that H&S at work applies differently to military operations, making this a somewhat misleading example in the first place)

Never been in the armed forces I take it? I've had friends who did tours in Afghanistan as support personnel, which didn't stop command from putting them as riflemen in patrolling squads when gaps needed to be fulfilled. They could complain, but they had absolutely no recourse but to grab their rifle and get in the van or face court martial for disobeying a lawful order. The point is that if you sign up for the armed forces, in peacetime or not, you can reasonably expect to be placed in a combat zone, some times as an active combatant or right next to the combat (as in combat medics) as part of your job description. Everyone who joins the armed forces knows this.

Catnip1024:
I wouldn't want a lawyer representing me who thinks that I was in the moral wrong. The same as if the lawyer believed me to be guilty.

Which is exactly why lawyers are trained not to think in moral terms when dealing with client cases. Same as health care professionals are trained not to think in moral terms when dealing with patients. Man, there's almost like there's some kind of similarity here.

Catnip1024:
Yes, I've pointed out that the specialisation thing should avoid this. But if you're a nurse, and are suddenly asked to prep for an assisted suicide, that's very different. Throw another ball in there - what happens if the law changes? Suddenly your contract has implicitly changed.

Which is where the employer is doing this thing you've been advocating all along, and caring for their staff. If you don't do ob/gyn you won't suddenly be pulled from your psychiatric residency to help perform an abortion. If you don't work in a terminal care ward you won't get pulled from your orthopedic ward to go help inject lethal doses of opiates in an assisted suicide.

But as an aside, my mother has worked in an emergency medical ward for the last 15 years and both she and her co-workers have assisted in numerous controlled terminations of irrecoverable patients. Those patients that obviously won't survive and where next of kin agrees that it is more humane to stop the ventilator or administer large doses of anesthetics instead of waiting for what might be days for the patients body to give in. This is not uncommon and pretty much any nurse or doctor who works in somatic care for an extended period of time will have to perform the act or prescribe it. It is a part of the job and our ethical codes makes it an unproblematic (if stressful) work task.

Catnip1024:
And again - think about patient wellbeing too. If you treat someone you absolutely despised, are you not considerably more likely to give lesser quality of treatment? Even due to subconscious issues?

So who would you "pass off" Literally Josef Stalin to? Send him across the country to the one psychiatrist who things he did nothing wrong? That's unethical and unlawful in way too many ways to list. I mean, I've cared for mothers who have killed their infant babies. Do I think it is a despicable act? Yes. Did I, or any of my co-workers, allow that to get in the way of the fact that the patient was under our care? No, because we had a job to do and a professional obligation to do it.

Turns out, that we are trained to ignore our own moral values, feelings and ideas. This is the entire reason nurses and doctors are required to internalize their professional ethical codes to begin with, so that we can function in situations when our patients are people we find unpleasant. If half a dozen gang bangers show up with gunshot wounds after a gang fight the ER personnel can't just shake their heads and refuse to treat criminals, they have to help them irregardless of what they think about staging firefights in urban areas or pushing drugs. Because the option is that we say that health care is accessible as long as medical staff finds you an agreeable person.

Because what you are proposing, to have moral objections in health care, means that those teenage guys who just shot each other up could come into an ER bleeding from multiple gunshot wounds... and get turned in the door because the ER staff and on-call surgeon refuses to deal with criminals, for example. The very idea makes the professional nurse in me angry, because that's irreconcilable with the ethics I've been internalizing and practicing for a decade.

This is not about abortion or trans-gender surgery for me, it is about the broader perspective that every single person in need of health care should never have to worry about health care personnel refusing to help them because the staff has moral objections to something with the patient.

Gethsemani:
Never been in the armed forces I take it? I've had friends who did tours in Afghanistan as support personnel, which didn't stop command from putting them as riflemen in patrolling squads when gaps needed to be fulfilled. They could complain, but they had absolutely no recourse but to grab their rifle and get in the van or face court martial for disobeying a lawful order. The point is that if you sign up for the armed forces, in peacetime or not, you can reasonably expect to be placed in a combat zone, some times as an active combatant or right next to the combat (as in combat medics) as part of your job description. Everyone who joins the armed forces knows this.

And I did point out that the rules are different for military operations. Which made the whole comparison flawed from the get go. Comparisons generally are, to be fair. Medical work is very different from most other streams to begin with.

But as an aside, my mother has worked in an emergency medical ward for the last 15 years and both she and her co-workers have assisted in numerous controlled terminations of irrecoverable patients. Those patients that obviously won't survive and where next of kin agrees that it is more humane to stop the ventilator or administer large doses of anesthetics instead of waiting for what might be days for the patients body to give in. This is not uncommon and pretty much any nurse or doctor who works in somatic care for an extended period of time will have to perform the act or prescribe it. It is a part of the job and our ethical codes makes it an unproblematic (if stressful) work task.

There is a difference between a controlled termination and an assisted suicide. One is a person due to die imminently who you are purely saving further pain, with little time being taken from them. The other is generally someone with many years potentially left, who personally believes their quality of life to be insufficient to be worth it. Which may go against the recommendations of a doctor, and possibly even the wishes of their family.

So who would you "pass off" Literally Josef Stalin to? Send him across the country to the one psychiatrist who things he did nothing wrong? That's unethical and unlawful in way too many ways to list. I mean, I've cared for mothers who have killed their infant babies. Do I think it is a despicable act? Yes. Did I, or any of my co-workers, allow that to get in the way of the fact that the patient was under our care? No, because we had a job to do and a professional obligation to do it.

Thing is, the law as phrased doesn't mention totalitarian dictators. Or criminals. The wording clearly referred to particular procedures / services. Which yes, can single out groups based on the service, but is much easier to work around than long-dead dictators.

This is not about abortion or trans-gender surgery for me, it is about the broader perspective that every single person in need of health care should never have to worry about health care personnel refusing to help them because the staff has moral objections to something with the patient.

And it isn't about that for me either. It's about making a little leeway for workers at virtually no expense to the patient. It's not necessarily something I would have thought of as being a great idea, but the people rabidly against it are kind of overlooking the various nuances. It isn't purely about LGBT rights, it isn't purely screwing people over.

I mean, sure, the perfect outcome would be everybody being happy doing everything. But people are by nature more or less happy doing different things, and that does distort job performance.

Catnip1024:

Gethsemani:
Never been in the armed forces I take it? I've had friends who did tours in Afghanistan as support personnel, which didn't stop command from putting them as riflemen in patrolling squads when gaps needed to be fulfilled. They could complain, but they had absolutely no recourse but to grab their rifle and get in the van or face court martial for disobeying a lawful order. The point is that if you sign up for the armed forces, in peacetime or not, you can reasonably expect to be placed in a combat zone, some times as an active combatant or right next to the combat (as in combat medics) as part of your job description. Everyone who joins the armed forces knows this.

And I did point out that the rules are different for military operations. Which made the whole comparison flawed from the get go. Comparisons generally are, to be fair. Medical work is very different from most other streams to begin with.

But as an aside, my mother has worked in an emergency medical ward for the last 15 years and both she and her co-workers have assisted in numerous controlled terminations of irrecoverable patients. Those patients that obviously won't survive and where next of kin agrees that it is more humane to stop the ventilator or administer large doses of anesthetics instead of waiting for what might be days for the patients body to give in. This is not uncommon and pretty much any nurse or doctor who works in somatic care for an extended period of time will have to perform the act or prescribe it. It is a part of the job and our ethical codes makes it an unproblematic (if stressful) work task.

There is a difference between a controlled termination and an assisted suicide. One is a person due to die imminently who you are purely saving further pain, with little time being taken from them. The other is generally someone with many years potentially left, who personally believes their quality of life to be insufficient to be worth it. Which may go against the recommendations of a doctor, and possibly even the wishes of their family.

So who would you "pass off" Literally Josef Stalin to? Send him across the country to the one psychiatrist who things he did nothing wrong? That's unethical and unlawful in way too many ways to list. I mean, I've cared for mothers who have killed their infant babies. Do I think it is a despicable act? Yes. Did I, or any of my co-workers, allow that to get in the way of the fact that the patient was under our care? No, because we had a job to do and a professional obligation to do it.

Thing is, the law as phrased doesn't mention totalitarian dictators. Or criminals. The wording clearly referred to particular procedures / services. Which yes, can single out groups based on the service, but is much easier to work around than long-dead dictators.

This is not about abortion or trans-gender surgery for me, it is about the broader perspective that every single person in need of health care should never have to worry about health care personnel refusing to help them because the staff has moral objections to something with the patient.

And it isn't about that for me either. It's about making a little leeway for workers at virtually no expense to the patient. It's not necessarily something I would have thought of as being a great idea, but the people rabidly against it are kind of overlooking the various nuances. It isn't purely about LGBT rights, it isn't purely screwing people over.

I mean, sure, the perfect outcome would be everybody being happy doing everything. But people are by nature more or less happy doing different things, and that does distort job performance.

You don't get to place personal beliefs before your job when it involves someone's life. It's that simple. I don't understand how this needs to be spelled out to you multiple times.

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