Sunday, April 5, 2015

Do Physicians Need a Religious Freedom Restoration Act?

There’s nothing like discrimination – true or imagined – to keep our airwaves humming.  Earlier in the week, Indiana and then Arkansas were media fodder for laws that were proposed to protect religious freedom.   Yes, I know the other side of the argument, that these ‘religious freedom’ protections were veiled attempts to discriminate against the LGBT community.   Both states raced to revise their original laws, although the laws' backers deny any discriminatory intent or effect.

It was likely that these governors feared an economic riposte from large companies who have expressed concern and disapproval over the perceived discriminatory effects of religious freedom laws.  I wonder how many of these companies do business with or remain silent about countries that use child labor, discriminate against women, have no freedom of speech or make homosexuality a crime. 

Realize that the original RFRA proposals do not guarantee an outcome in any dispute, a point that I believe is widely misunderstood.  For example, the law would not make it legal for a florist to deny service to a gay wedding.  It would permit the florist to allege in court that such a service would constitute a significant burden on his religious beliefs.  If I were the sitting judge, I would likely rule against the florist as I do not accept that selling flowers assaults one’s religious tenets.  Just because a person claims his religion is being attacked, doesn’t make it so. 

Everyone deserves flowers.

Some acts of discrimination get a free pass.
  • Ivy League institutions discriminate against students with lower SAT scores
  • NBA teams discriminate against players who can't dribble
  • News executives discriminate against broadcasters with speech impediments
  • The Catholic priesthood will not ordain Muslims as priests.
Of course, I’m not entirely seriously here.  I do not think that anyone should face discrimination for who they are.  Indeed, I wish our society were closer to a meritocracy.  Sometimes, the reason that an individual does not get a job promotion, make the team, get the lead role in a play or get acquitted at trial is because the person doesn’t deserve it. I don’t deny the existence of prejudicial behavior and bigotry, but they should not be invoked by default when a person is denied a desired outcome. Sometimes folks are fired because they should be.

Should a tattoo artist be able to refuse to ink ‘I Hate Jews’ on someone’s chest?  What if an atheist wants body art with bold lettering of ‘I Hate Jesus’?  The Supreme Court decided in the Hobby Lobby case that a private business can deny services for religious reasons under certain circumstances. When can a private business lawfully refuse service to a customer? 

What about physicians?  Do we have to treat every person who makes an appointment to see us?  I don’t know the private beliefs of my patients, but I’m sure they are a cross section of society with all the prejudices that one would expect.  If I knew for certain that a patient was a homophobe or a racist or an anti-Semite, should I discharge this person from my practice?  Could a pro-life physician ethically discharge a pro-choice activist from his practice?  Could this doctor justify this decision by his belief that the patient advocates murder and that a healthful doctor-patient relationship would not be possible?  Or, should doctors see everyone as our mission to heal and comfort transcends personal beliefs and practices?


Anonymous said...

Is refusal of a heterosexual to have any sexual activity with a homosexual bad?
Should whites be made to marry only blacks.
Should mob rule be taxed.

dog gone said...

I would argue that what Anonymous wrote was just silly. No one is compelling heterosexuals to engage in homosexual sex, or for whites to be made to marry only blacks.

The question of taxing mob rule is an interesting one.

However back to your topic -- we have seen a version of your question raised before, not for doctors but for pharmacists. That legislative attempt would have given every pharmacist the right to refuse to refill prescriptions both for religious reason but also if they disagreed with the doctor prescribing the meds.

I don't want any pharmacist -- and I have a great respect for their training and education -- to impose EITHER their religious beliefs on me or to intrude their opinion so as to supersede the judgement of my doctors or other medical care providers.

Some states now permit a doctor to lie to a patient as regards medical care and status on religious grounds when it comes to abortion.

I also don't want any doctor to lie to me about whether or not I'm pregnant, or about the health issues of abortion, etc.

It was my impression, and it is I'm sure a broader one among most people, that doctors are supposed to adhere to certain principles as part of their profession. Not lying to patients should be one. Serving every patient they treat without passing judgement on them or requiring conformity from them to the doctor's belief should be another. Isn't this covered by either the Hypocratic Oath or Maimonedies prayer? If not it should be.

Michael Kirsch, M.D. said...

dog gone, delighted to see you back. If an obstetrician believes that abortion is murder, should he be compelled to perform one? If a hospital denied this physician privileges, would the doctor have a legitimate legal grievance?

Dr. Schlussel said...

Catholic hospitals don't allow their physicians to perform abortions. Even if a doctor is pro-choice, his privileges will be taken away if he counseled patients on birth control. What is ethical for doctors to do in such places?

Michael Kirsch, M.D. said...

A Catholic hospital is a private and religious-based institution. I would not expect them to violate central tenets of their faith. A physician who personally feels ethically and professionally obligated to offer women family planning services or pregnancy termination advice should practice elsewhere. Similarly, women in search of such services should seek care from other physicians or institutions.

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