New Federal Rule Protects "Conscience" Rights Could Also Support Futile Care Theory
The Department of Health and Human Services will publish its Final Rule tomorrow protecting the rights of conscience for health care workers who refuse to perform medical acts with which they morally disagree. The rule specifically applies to abortion and sterilization. But it also has a general clause that, as I read it, could apply to medical futility. From the Rule:
2) (d) Entities to whom this paragraph (d) applies shall not:(1) Require any individual to perform or assist in the performance of any part of a health service program or research activity funded by the Department if such service or activity would be contrary to his religious beliefs or moral convictions.I think this provision could easily be interpreted to protect doctors against who don't want to provide tube feeding for patients diagnosed as in PVS or who refuse wanted life-sustaining treatment based on their moral view that the quality of life of the patient isn't worth living and/or worth spending limited resources upon.
(2) Discriminate in the employment, promotion, termination, or the extension of staff or other privileges to any physician or other health care personnel because he performed,assisted in the performance, refused to perform, or refused to assist in the performance of any lawful health service or research activity on the grounds that his performance or assistance in performance of such service or activity would be contrary to his religious beliefs or moral convictions, or because of the religious beliefs or moral convictions concerning such activity themselves.
This is of some concern to me. However, the rules only apply if a physician, nurse, or other covered health care worker is discriminated against for their act of conscience. I don't expect medical futilitarians to ever face job discrimination since the care will be pulled with consent of hospital bioethics committees.
On the other hand, I think the rule could protect health care institutions from sanction for imposing futile care--so there may be a problem after all.
On the other, other hand, it will also protect doctors and health care facilities from having to participate in assisted suicide.
So overall, a good job. As a consequence, expect the new administration to work overtime to undo what has been done.
posted by Wesley J. Smith @ 10:10 AM
5 Comments
5 Comments:
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Meh. People will complain that giving a doctor the freedom to refuse to do something he thinks is wrong is stepping on the "rights" of others, but eventually that breaks down, because he can turn around and say the same thing about the person complaining.
So, yeah, this law is mostly common sense done up in a way that forces people to accept reality - you can't have turtles all the way down; likewise, you can't have everyone forced to bend to the thinking of everyone else.
At some point, there has to be some kind of "truth." Otherwise you get cases where people hear about tribes that eat pygmies (other *humans*) as a delicacy, and they're busy squirming while trying to be culturally relativistic.
I'm ethnocentristic and proud!
that is a scary thought-because people can interpret documents however they want, and if someone has a vested interest in futile care being applied to others, it is likely that he or she could impose it under this law, at least temporarily until it is clarified. It's too bad that our culture's values-on both the right and left-are so screwed up that we even have to worry about this.
Hello - just heard you on the president of Southern Baptist Theological Seminary's podcast, and I'm a chaplain who is a seminary graduate and who is interested in bioethics, so I thought maybe I'd comment a couple of times and see if anything comes of it.
Honestly this seems like a slippery slope. I mean, what if a doctor performs a "slow code" for someone on 'religious or moral' grounds? What if a doctor refuses to change a patient's status to DNR, at their request? What if a nurse won't turn a patient in the ICU to prevent bedsores because they have a moral/religious prohibition against touching the opposite sex? This seems tremendously broad, and while I'm not necessarily in favor of making doctors or other care workers violate their conscience, I can also see how this can be applied outside the narrow focus of euthanasia or another hot-button issue to trump medical standards in favor of whatever a doctor's personal biases or beliefs happen to be...
This seems like something you're happy with, but I wonder - what happens when someone whose moral/religious standards and assumptions are totally contrary to yours (or mine) acts on it? It sounds like you're assuming a worldview that isn't assumed in the policy. I mean, what if a proponent of euthanasia on moral/religious grounds refuses to resuscitate a patient who codes? Etc.
Doug: What is really going on is a stifling of people with certain views. The futile care issue is a real concern to me. Note that patient choice is overturned by the doctor's professional values, even though it means the patient will die.
We used to be a society that agreed on ends but disagreed on means, which allowed us to get along better. I now believe we have devolved into a society that disagrees on ends as well as means, making it much harder.
Some believe this means "choice" is all that matters. But that turns professionals into technocrats doesn't it? Moreover, as I noted, choice will be a one way street.
I think the right balance is for conscience rights to apply for elective procedures, and not non elective procedures. Thus, no doctor should be able to refuse to save a patient's life, but should be allowed not to participate in ending a life.
What we see happening are laws as in Australia that require all health care professionals to be complicit in things such as abortion, by requiring referrals if the doctor doesn't wish to be personally involved. But that makes the doctor complicit (to be distinguished from transferring files at the request of a new doctor the patient obtained themself). A couple of California assisted suicide bills had the same kind of approach.
See today's post. This isn't about choice, it is, in the end, about upturning the current moral order and imposing another on society. Once that is accomplished, we will find that choice has its limits.
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