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Bush's Right of Conscience Rule

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The "right of conscience" rule designed to protect health-care workers that refuse to participate in procedures they deem "morally objectionable" was passed in the waning hours of the Bush administration. It was really aimed at protecting pharmacists who choose not to dispense medications that may cause abortion or help with birth control. I couldn't help, as a physician, think of the times I have been confronted by morally objectionable medical situations but have been obligated to overcome my qualms.

All physicians and pharmacists encounter patients they would, if they had a choice, prefer not to treat for reasons that range from moral, ethical to personal. But we have all taken an oath: to treat everyone, no matter what we feel about their actions, no matter how despicable. We drown our objections and do our best for them. All professions have standards and certain requirements; we may find some of them disagreeable. Those of us with insurmountable objections should seek other employment.

I have had my own disagreeable moments with patients whose behavior and beliefs I've found morally reprehensible. The most egregious was a young man with swastikas tattooed across his chest and upper limbs -- red flags to my mind. He epitomized all that is repugnant in the small, remaining fringe of bigoted America. He spat on me; I fulfilled my obligation -- I took care of him.

Worthy of note is, for thirty years federal law has dictated that doctors and nurses may refuse to perform abortions; Catholic institutions don't perform them or other human fertility terminating procedures. Bush's rule specifically stated that healthcare workers may refuse to provide information or advice to patients who might want an abortion, covering surgeons, nurses and "employees whose task it is to clean the instruments."

The main thrust of the regulation was to protect pharmacists who refuse dispensing the morning after birth control pill and therapies they think might cause an abortion, from disciplinary action or from lawsuits. The danger in the rule is that in rural communities with only one pharmacy, rape victims or women forced into unwanted sex may not get the morning after birth control pill. In fact pharmacists don't even have to provide any information to them.

This is the worst injection of the politics of abortion into the deep, binding and sacrosanct professional relationship which has been in existence for centuries, but is fraught with difficulties. Any attempt to breach it should be viewed with repugnance and vigorously opposed by all in a democratic society.

We all have different convictions -- religious or otherwise, and would like to abolish some things or resurrect others. But in a secular society, we can't cater to all: Muslim, Hindu, various strands of the Christian faith. We must separate our religious beliefs from our politics. In that spirit, no matter my belief, I view the doctor/patient relationship as a sacrosanct space; unique and separate from all others. When I step into that space I leave my beliefs, my faith and prejudices behind, becoming neutral, to serve my patients' needs; to help cure their maladies. Similarly pharmacists are bound by their oath and code of ethics.

In medical care, the most important entity is the patient and their illness. The regulations proposed by the Bush administration place the care provider -- the pharmacist -- at the center of their relationship which is the opposite of the intent and letter of all medical practice.

The Bush administration's rule placed the issue of a practitioner's faith in the middle of the very difficult issues that already confront healthcare providers. This is a slippery slope down which we're led by some non-medical bureaucrat who spent very little analytic time on it. This unfortunately happens often when certain faiths, religious convictions, moral imperatives are used as part of legislative agendas.

My hope is that the new, more enlightened administration will rescind Bush's rule and herald a day when the doctor/patient relationship can be one of respect and true care without religion reaching its invasive hand into it.