Closing Thoughts...

Excerpt from: USA Today Magazine: March 2009 Closing Thoughts Column:

Do you have the right to refuse to do a job you believe is morally wrong?

If you are self-employed, must you accept every customer? Must a plumber go on a midnight call to an unfamiliar neighborhood? Should your teenage daughter be forced to accept every babysitting job offered, even if the adult gives her the creeps?

If you wonder who would make your little princess take a job she wouldn’t want, and what would be the point of being self-employed if you don’t have more self-determination than you would on someone’s payroll, you understand the dilemma for many healthcare professionals.

The leaders in healthcare professional organizations want to deny their membership the rights afforded independent subcontractors and teenage babysitters. There have been many op-ed pieces claiming it is wrong and unethical for healthcare professionals to refuse to participate in activities they believe are immoral. State legislatures are grappling with this. At least one professor asserts that those unwilling to perform any legal procedure in their field should quit their practice entirely.

Often this is neatly wrapped in the feel-good phrase that while we have religious freedom, we do not have the right to “impose” our religion on others. Thus the Catholic obstetrician who believes abortion is murder “imposes” her beliefs on some hapless patient when she refuses to provide the abortion. I can only infer that university professors who write such things believe that patients are so stupid it wouldn’t occur to them to ask for another doctor.

Note to readers: many people in ivory towers think you are idiots.

This argument starts out facially invalid and deteriorates from there. Everyone knows there are many doctors, pharmacists and therapists. Shopping for the service you want is the American way. That’s why people go to CVS for some items and Walgreens for others.

Those who want to protect patients’ rights to obtain services, while denying professionals’ rights to determine what services they shall provide, are either deliberately, or out of ignorance, misunderstanding both religion and freedom.

Implied in the argument against practicing your profession in accordance with your religion is the assumption that religion is some sort of sideline activity. This renders Orthodoxy the equivalent of enjoying a rousing game of table tennis. The argument reveals much about the person who takes this position, perhaps more than he would have you know. Undoubtedly there are those who practice religion, if one can call it practice, as a matter of form. They have compartmentalized their religion, like holding your godchild at Baptism while your enemies are gunned down. But compartmentalization is not the nature of religion.

Faith provides a set of basic principles and an overarching purpose. If it does not, it does not meet the criteria to be a religion. Basic principles are just that: a base, the foundation upon which everything else rests. The precepts of faith provide a launch pad for the great questions of existence and guidelines for daily life. Religion affects your kitchen (no pork for some; no meat on Friday for me); it affects finances (tithing) and conservation (stewardship). Religion provides a framework for sexuality (not married = no, no! and married = woo-hoo!) and family life. Faith forms our attitudes towards the first things and last things of life.

I hesitate to trust a physician who would act in violation of her professed faith. If she won’t stand up for the Almighty, exactly how much energy do I imagine she’ll put forth for me? If something goes wrong on the operating table, will the surgeon just throw up gloved hands, shrug, say “what the hell?” and walk away?

There is also the question of freedom. Many insist that patients should have the freedom to get whatever care they want from whatever professional they want, but professionals should not have the freedom to decline to provide services they feel are immoral. Perhaps this is an outgrowth of policies that assert that patients who show up demanding care at certain venues must be provided care regardless of ability to pay. Most of our professional codes of ethics require us to provide free services in our community, but thus far we are allowed to determine when and how those services will be provided.

If professional groups’ leadership wins this round, professionals will lose the freedom to opt out of providing services they believe are evil.

The protest against living your values is very selective, e.g., the pharmacist who would rather not dole out the morning-after pill. Religious rationales are refused. I have heard pastoral advisors assert that, for pharmacists, only the morning-after pill warrants taking a position. Since oral contraceptives are prescribed for many reasons (i.e., perimenopausal symptoms) they do not meet the criteria for refusal. We are talking, then, about a very narrow scope for referring patients elsewhere.

Apparently, non-religious values merit the protection of professional organizations.

The American Psychological Association has scrambled to develop a statement that psychologists ought, and should be legally permitted, to refuse to participate in any questioning of enemies of the United States, that might inflict psychological distress on the detainee.

I have no quibble with this. I would like to know if it would it be okay for the psychologist-officer to refuse for religious reasons (The Pope says no?) or should the refusal be permissible only if a code of professional ethics is invoked? If the latter, we can infer that the APA, and other organizations, fancy their current Code of Ethics outweighs thousands of years of Judaic law and the concurrent two millennia of Christianity. They are not alone in this effort. If we give professionals who have sworn to uphold the Constitution the right to opt out we should extend that to those who have sworn to uphold those principles upon which the Constitution was based.

At least, consider giving us the same rights as 14-year-old Tabitha, who, at least for now, can turn down a babysitting gig for someone who gives her the skeeves.

(This piece appears in USA Today Magazine, March 2009)