Arilynn

There is a problem with doctors not respecting DNR orders. Here is just one article that discusses it - if you use Google you can find many more:

"...the issue of not having some sort of such rule is that people feel doctors or hospitals could be forced to provide abortions..." Again, this is a non-issue. If the Bush rule is rescinded, there is still legal protection for health care workers who refuse to do something because of religious beliefs. Taking away the Bush rule doesn't take this away.

Trout Recreant

You don't happen to need a job, do you? We could use an intern. Willing to relocate? Good pay, horrid hours, but it's very nice in the NW. There's a couple law schools nearby - I could get you into the really good one, or you could try the UW if your standards are low. ( ).

This answer is perfect.

Jahar Aabye

Just to chime in on the DNR issue, one of the toughest weeks of my life was when I was responsible for researching our organization's existing policies on the use of AEDs by nurses in the absence of a clear DNR in terminal elderly patients. This is, in and of itself, not necessarily a religious issue, it actually tends to become a very complicated ethical issue in the absence of DNRs. But even with DNRs, they're often ignored, either intentionally or unintentionally.

As I understand it, this "conscience" regulation was aimed primarily at individuals, not organizations as a whole. It's not necessarily about the right of a facility to choose which services to offer (obviously not all facilities offer all available services), with the exception of emergency cases where facilities that accept Part A payments do have requirements for treating emergency cases.

As I understand it, this "conscience" regulation that was repealed was about "protecting" (and I use that term very loosely) the "rights" (again, I don't believe this is a right) of individual healthcare workers to refuse to provide treatment or services that their facilities or employer requires them to perform.

In these situations, the individual worker was interfering with the medical treatment of a patient, and in those situations the facility should have a right to fire the worker, both because it compromises patients' care and because it could otherwise leave the facility open to legal action as a result of an employee's willful inaction.

Furthermore, I don't believe that this was a major problem for physicians, and I noted that the AMA was strongly in favor of repealing the "conscience" rule. Most physicians already understand their ethical obligations. Where this rule stemmed from was more the issue of pharmacists refusing to fill prescriptions for birth control or (before it was made available on a non-prescription status) Plan B contraceptives.

In these situations, the problem with an individual pharmacist refusing to fill the prescription (which is also separate from the pharmacy not stocking the drug) is that the pharmacist is then choosing to override the medical treatment decision made by the physician. This is outside of the pharmacist's scope of practice, pharmacists are not qualified or licensed to diagnose or prescribe treatment for a medical condition. Their training involves checking for drug-drug interactions and other contraindications, as well as interpreting physician's orders, verifying information in the case of discrepancies or possible mistakes, and safeguarding controlled substance medications.

So those are situations in which the pharmacist is acting far beyond their scope of practice, actively interfering with the physician's treatment decisions for the patient, and in the process failing to do their job. It would be one thing for a pharmacist to ask a woman over 30 who was taking contraceptives whether she smoked tobacco and advising her on the risk factors that this entailed, or double-checking with her physician if she was taking oral contraceptives concomittantly with certain antibiotics that are known to interfere with the action of contraceptives. However, refusing to dispense contraceptives is not an acceptable option for a pharmacist. It is not a grey area and it is not an issue where the pharmacist should have recourse. A pharmacy may make an attempt to staff an extra pharmacist to assist and dispense the medication instead, but if this is not possible, then the pharmacist must do so.

This was especially important before Plan B was given non-prescription status, where a refusal to dispense the drug in a timely fashion would make a life-altering difference....and ironically, refusing to dispense that medication in a timely fashion might very well lead to an abortion being performed later.

And the thing is, this rule was definitely ripe for abuse. Can you imagine that problems that a Scientologist pharmacist would cause? And under this rule, the pharmacy would not be able to fire them.

But even leaving aside the potential abuse issues, or the rather unlikely potential for a Scientologist Pharmacist or Jehovah's Witness working at a blood bank, this rule was a clear example of people with very little medical training or experience enacting a regulation that was opposed by the medical community. It is understandable that there are medical practices that those outside the medical community find discomforting. DNR requests are one of them, as are things like abortion and contraception (but for some reason, no one has a problem with Viagra, sexism much?), and I can see how someone outside the medical community might look at some practices and think "I could never do that," or "this would clearly go against my beliefs." However, and I cannot stress this enough, medicine cannot ever be an issue of "belief" or religious conviction. There is no room in medicine for one's personal beliefs to enter into decisions regarding medical care. Just as an attorney cannot divulge priveledged information when he finds a client's actions repulsive (onging-crime and other exceptions notwithstanding), a medical professional cannot compromise patient care simply because they find something repulsive either.

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He pulled a Captain Ahab and Jaharpwn'ed her. - Trout

Chip Midnight

I believe the Bush rule had little to do with protecting the rights of workers and everything to do with providing a loophole that activists could use to obstruct women's access to contraception and abortions.

Cocoanut Koala

Hmmm. Well, that was in the year 2000. Since then, I found a NYT piece written by Jane Brody, in 2008, I believe, that you might prefer to use.

In general, though, from doing some very brief Googling, I got the impression that while it's not unheard of for some doctor to refuse a family or patient's request, by far the more common problem is a lack of proper legal documents.

This is made more difficult by the fact that the law varies from state to state, but I think the laws have been considerably tightened since 2000.

Several of the pieces I found gave specific advice on how to make sure your legal documents are well in order, and make sure they will be properly recognized in any state or locale.

Another problem seems to be paramedics (or at least was at one point), who aren't equipped to make these sorts of determinations in the ambulance, and whose companies didn't want to get sued.

coco

Cocoanut Koala

Well, I don't think you can successfully fight for more access to abortion through the mechanism of forcing doctors or hospitals to provide it against their beliefs.

I think you would just succeed in getting rid of those doctors and hospitals.

coco

Trout Recreant

W/ re: the paramedics. I just found out recently about something called a POLS - pronounced approx, "pulse". I think it stands for "Physicians Order on Life Support". If someone has a chronic or terminal condition, you can get one. It's a very brightly colored paper that you can post on your fridge or somewhere that the paramedics are supposed to look for if they find you in a satate where you can't make your desires known to them. It spells out whether they should resuscitate you or not, and what measures you want taken (or not taken) to prolong your life.

I don't know how I feel about this. I hate putting more of a burden on paramedics than they already have. But I'd like someone to know what my wishes are if I'm terminal.

Jahar Aabye

Again, I think that the issue with the "conscience" rule had more to do with pharmacists than physicians, since the AMA was adamantly opposed to it. Also, the "conscience" rule was more an application of policy restricting the ability of a facility, pharmacy, or hospital from firing a physician, pharmacist, or technician who refused to perform a procedure or provide treatment.

I think that you're getting hung up on the issue of hospitals providing abortions, which really wasn't the main issue related to the "conscience" clause, and ignoring the much more common issue of pharmacists refusing to fill prescriptions for birth control and (back when it was prescription-only) Plan B contraceptives.

The main issue that the "conscience" regulation was issued to deal with, if I remember correctly, were several high-profile cases of pharmacists being fired by their pharmacies for refusing to fill prescriptions for birth control pills and Plan B oral contraceptives.

Brenda Archer

Many many thanks. This is useful knowledge.

Gigs

DNR orders would be a lot less relevant if assisted suicide were legal.

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"It is the paramount duty of governments and of politicians to secure the wellbeing of the community under the case in the present, and not to run risks overmuch for the future" - JM Keynes

Jahar Aabye

Actually no, Gigs. There's a definite difference between "I want to die" and "I want to live out my days, but if the end comes, so be it."

A DNR doesn't mean that you're suicidal. It means that you know what full-on resuscitation looks like and don't want to have that happen to you. It means that you'd rather not spend the last hours or days of your life hooked up to half a dozen tubes with another half dozen needles in you, and more computers monitoring you than the tech room in The Matrix.

And then there are related issues like advanced directives, where you say that you would rather have someone pull the plug than live trapped on a bed hooked up to a ventolator for the rest of your life in a semi-conscious state.

It's not at all the same as physician-assisted suicide. It actually has very little to do with suicide at all.

Colette Meiji

The problem with a conscience law is that an employer could easily coerce their employees to "develop" said conscience.

Making a situation where an entire clinic or hospital doesn't offer a service. Not a big problem in Chicago or LA, just go somewhere else.

But in Frostbite Falls, Minnesota with only one clinic, it is a real issue.

It would have to be a lot better written than it was to be useful.

Chip Midnight

Doctors weren't forced to provide abortions against their will to begin with. I really don't think this was about that. However there are many religious activists that go out of their way to obstruct access to contraception and abortion, to the point of opening "abortion clinics" with deceptive names (Crisis Pregnancy Center, Pregnancy Aid, Birth Right, Open Door, Pregnancy Counseling Center, etc) sometimes located in the same buildings as real clinics, that deceive women into entering believing it's an abortion clinic and find themselves being proselytized to instead. Those are the kinds of people this law was intended to serve. It wasn't about protecting religious people from discrimination, rather it was intended to help them discriminate against others with impunity.

Cocoanut Koala

Well, I'm saying the fear is apparently that they WILL be forced to provide abortions, or forced to stop practicing medicine.

In fact, however, the problem seems to be around being forced to mention abortion in counseling, from what I read around on the web last night.

So I'm not sure how realistic that fear of being forced to actually provide abortions is.

***

Now - the Crisis Pregnancy Center you mention - hey.

My kids are from Catholic Social Services, and I believe they have a name for that arm that is called something like "Crisis Pregnancy Center."

In point of fact, an unwanted pregnancy is often a crisis (and often, a crisis of conscience), and I don't see these names as deceptive.

The only way one CAN see these names as "deceptive" is to come from a position where the default is abortion, and any other plan for a crisis pregnancy is some kind of usurper.

Indeed, one could claim by that same argumentation that "Planned Parenthood" is a deceptive name (and I believe some have claimed just that).

I believe the Catholics should not be prevented from having a Crisis Pregnancy Center and from having it wherever the heck they want to. Wherever the heck they want to.

Right next door to an abortion clinic seems a pretty good place to me (if indeed, they have any in such places), unless a person feels that "choice" actually means no choice, but rather, "abortion without anyone else telling you any different."

The types of people being served by all these organizations are those who are in the midst of an unplanned pregnancy. The solutions to that aren't limited to abortion, nor should they be.

***

I don't consider Catholic Social Services to be a bad organization, or to be performing a bad service by helping women to make adoption plans rather than helping them get abortions.

I don't believe they discriminate against anybody, unless one believes that their very existence is discriminatory, and they should not exist.

I can't even possibly see how the existence of Catholic Social Services is discriminating against other people in any way.

Needless to say, I'm a firm believer in adoption. VERY firm, I can't tell you how firm! hehe

I dislike adoption agencies such as Catholic Social Services being painted as the bad guys, out to fool and take advantage of others - which is the gist I gathered in your post here, although you may not have intended that.

coco

Chip Midnight

I'm not against religious counseling services. I'm sure some of them do wonderful work for women who want it. I am against using deceit to trick unsuspecting women into visiting thinking it's an actual clinic. In those cases they're not there to help the women but to browbeat them with their own agenda. It's not at all an uncommon practice.

Richie Waves

hmm.. could call it the Abortion Center for Eugenics of America or ACEA!

or am I listening to Eboni too much?

Cocoanut Koala

Catholic Social Services and the adoption arm thereof, are a religious organization that provides a crisis pregnancy service, which doesn't include abortion, but offers alternatives to abortions. The pregnancy crisis service is not different from their other services; for instance, to immigrants.

The immigrant services are also a service offered by a religious organization which helps immigrants.

In other words, the emphasis is not at all on proselytizing, just to be clear.

Here is a list of their services:

# After School Tutoring and Summer Camp
# Crisis Pregnancy Counseling
# Disaster Preparedness and Response
# Employment Assistance
# English as a Second Language Classes
# Financial Literacy
# Healthy Marriages
# Housing Counseling
# Immigrant Juvenile Program
# Immigration Detention Project
# Immigration Legal Services
# Marriage/Couples Counseling
# Outpatient Mental Health Counseling
# Path-to-Success
# Play Therapy for Children
# Refugee Parents Program
# Refugee Resettlement
# Thresholds
# Violence Against Women Act (VAWA)

In those services - if they are anything like our experience with the crisis pregnancy service - there is no attempt to convert people whatsoever; only to serve. These people are really quite invested in helping others in all kinds of ways - not trying to convert them. I know, because I met their foster parents and a whole slew of them when we were adopting our babies, and service is key; not proselytizing.

I'm sure, of course, that when they talk to pregnant women, they would try to guide them towards continuing their pregnancy; however, I doubt many people would come to Catholic Social Services expecting to get information on abortion in the first place.

Course, that is putting rather too fine a point on your description of them as "religious counseling services" - but, heh, I felt like it.

***

I understand there are less scrupulous people who apparently set up things that a person could mistake for an abortion clinic, and then try to talk them out of an abortion without actually offering any adoption services?

I seem to remember some such. I know there are very aggressive people trying to stop women from having abortions. But I'd have to look it up to be certain that there are such organizations, particularly any that don't actually offer adoption services.

In any case, most services with names such as you listed - including Catholic Social Services - are not like that, and I don't believe there is any reason for them to change their name.

Catholic Social Services does do wonderful work for pregnant women who (obviously) don't want abortion. This includes both services to help them keep their babies, and services to help them adopt.

Too many women think they will have no help with either of these options, and it looks daunting. Actually, there is a lot out there to help a woman either keep her baby or make an adoption plan for it, but you have to know about it.

CSS also does wonderful work for the babies. We who like to see abortions avoided, and good plans made for the babies where possible, are not a small or fringe group.

coco

Cocoanut Koala

Yeah, that's the problem! You'd have to call everything "Abortion Center" or "Adoption Center."

Which would at the very least be unfair, since both types of organizations offer more than just adoption or abortion.

coco

Chip Midnight

Here's a good article about them:

Ranma Tardis

What is going to happen is doctors and health care providers will avoid putting themselves in situations where they would be forced to provide health care choices repugnant to them.
The doctor will stop volunteering to work in the downtown clinic, positions in Emergency Rooms will be harder to fill and require a higher salary. Maybe there will be NO doctor on some shifts.

I do not think the government can force them to provide these services by force. They will take unemployment or transfers to positions where it is not a possibility to perform. Pro choice loudly proclaim the women s freedom to do what she wants with their bodies. The health care professionals demand the same.

Demanding doctors and health care professionals to perform abortions will not lead to more choice. In fact it will lead to less. I suspect these doctors will willing undergo unemployment and even jail before doing such. There are not enough medical facilities, doctors, nurses and other medical providers.

It is very easy to make your postings. This is a freedom issue but while they have the freedom not to participate they also have the duty not to interfere.

Cocoanut Koala

Dreadful behavior.

coco

P.S. But on the other hand, now that I think of it, Planned Parenthood has been caught on tape also engaging in some dreadful behavior. Specifically telling an underaged girl (who wasn't actually 13 or 14 or whatever it was, but was saying she was, and looked it) not to tell the name of the supposedly 30-something year-old guy who knocked her up, because then they would have to report it to the authorities.

And tapes showing them telling presumably underaged girls where they could go out of state for abortions, while saying, "I can't tell you this, so I'm not." And circling the place where they wanted her to go. "See." THEN circling the others.

Anyway, yes, there is bad behavior on both sides.

Cocoanut Koala

"This humiliating and frustrating experience seems, by all accounts, to await more American women in the near future. And the best part? It's funded by your tax dollars."

Oh, and while I'm on the subject, guess what - I don't like the idea of my tax dollars funding abortions! Either here or overseas.

I feel terribly guilty and sad about it, as a matter of fact. But I can't figure out how to get out of it. Somebody on another thread on the topic convinced me that Planned Parenthood doesn't actually offer abortions.

I felt a lot better about it. But then I started thinking, that can't be true.

coco

Harvey Swenson

I don't see this as bad behaviour. I think if an underage girl wants an abortion and they can't do it, giving her somewhere safe to have the procedure done is much more responsible than making a 13 year old have a baby.

Gigs

That doesn't sound like bad behavior, that sounds like them working around laws that violate patient confidentiality and laws that prevent people from making informed choices.

Cocoanut Koala

It's not only bad behavior, it's illegal behavior.

coco