A different kind of cross.
UPDATE: please view our full comment and argument against the regulation, here.
Good news bad news time. Mike Leavitt, of the Department of Health and Human Services, has a blog, and he’s responded to popular concerns about a proposed regulation restricting access to abortions and contraceptives. To catch up on the regulation, read my coverage here, a great analysis here, and coverage of Leavitt’s response here. In brief, the regulation would classify contraceptives as abortions, and permit doctors to decline to provide either to patients without fear of losing their jobs.
Good news: on his blog, Leavitt seems to assure us that he has no intention to limit access to contraceptives. That’s encouraging. But the context of the “promise” is not. Read on:
The issue I asked to be addressed in this regulation is not abortion or contraceptives, but the legal right medical practitioners have to practice according to their conscience.
Ah. There’s the bad news. For Leavitt, the issue is “conscience,” which to him is bigger than, and possibly encompasses, contraception. In short, Leavitt is attempting to reframe the issue and delay giving a real answer. That, along with his “no comment” reply when asked about the issue point blank, tells me all I need to know: redefining contraception as abortion, and curtailing both, is definitely on the table, but Leavitt doesn’t want us to know that in the run-up to the election.
And from there it gets worse. Leavitt reminds us that, legally, physicians can already refuse to provide abortions, and can’t be fired for the same: however, as I’ve pointed out, while the law says that, it’s never been enforced. The Alien & Sedition Acts are still on the books: that, however, wouldn’t excuse their enforcement today.
Attempting to frame the issue as one of protecting physicians’ right to conscience is also a red herring. Doctors exist, and are licensed by the government, to act in the public trust, and to the direct benefit of their patients. No law ought interfere in the sacred relationship between doctor and patient; to make it otherwise, or deputize the doctor as a spokesperson for the (apparently state-sponsored) pro-life movement, violates this trust.
Stepping away from the already-troublesome effects of this on a case-by-case basis, let’s think through the community and aggregate affects of such a regulation. This law could utterly wipe out responsible reproductive services in insular, small communities served by just a few doctors. This doesn’t trouble Secretary Mike.
Is the fear here that so many doctors will refuse that it will somehow make it difficult for a woman to get an abortion? That hasn’t happened, but what if it did? Wouldn’t that be an important and legitimate social statement?
The Hippocratic Oath does not read “first, make a social statement.” Clinical examination rooms are not a podium where doctors are privileged to, in the name of the state, shove ideology at women. Enough said.
Unfortunately, should this regulation eventually be promulgated, since its evils occur only on a case-by-case basis, it could likely only be attacked in individual lawsuits. Today’s Supreme Court increasingly refuse to strike down threatening laws & regulations (unless they’re lib’rul), preferring to confront them on an as-applied basis.
Let this be a reminder to us about what we get when we elect Republicans. They may act cute and cuddly now, and promise no litmus tests for judges, and pretend that they might choose pro-choice running mates, but that’s the general election. Once in office, from any Republican president, you can expect more stunts placing ideology over responsible medicine. Remember that on November 4th.
Thanks to Danio, guest blogger at Pharyngula, for pointing out the latest development on this important issue. We hope he continues to do so.
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I’m still very much troubled by the idea that med schools ought to put out “pro-lifers need not apply” signs, which is what I’m getting out of this. I think I may be missing something, so here are some questions:
In what way would whatever change is being considered “deputize the doctor as a spokesperson for the (apparently state-sponsored) pro-life movement”? Does this go farther than giving doctors the option of not providing or talking about abortions?
What is current practice, what would the effect of this change be, and what would your ideal policy be regarding doctors in private practice?
Finally, is there any place at all for pro-life MDs in public employment? What about in larger hospitals where one doctor being anti-abortion does not prevent patients from having access to the procedure?
Comment by Gotchaye August 21, 2008 @ 2:13 amI live just outside of a small city (80K) and there is no where within 30 miles for a woman to get an abortion. The town where I’m originally from is 60 miles from the nearest abortion provider. There is no public transportation to get there, from here (or there) which means a low-income woman living in my community would not be able to have the procedure. So, his assertion that it hasn’t happened yet is wrong.
Comment by Jennyjinx August 21, 2008 @ 9:37 amI’ve been following Leavitt’s propaganda as policy behavior for a long time (link at my name), and he is nothing if not a Bush loyalist who also manages to get his Mormon religious ideology into health policy. Leavitt’s blogging as a nice guy is simply a ruse to sell poisonous propaganda which undermines science and the legitimate practice autonomy and authority of licensed health professionals, such as physicians and nurses.
Comment by Annie August 21, 2008 @ 12:28 pm[...] it T… on …On a Cabinet Secretary…Ames on …On a Cabinet Secretary…HHS Followup: Aborti… on …On a Cabinet Secretary…Ames on …On the Perversity of …Steve on [...]
Pingback by …On Doing it Twice in a Row. « “That you may ruminate” August 21, 2008 @ 6:51 pmgotchaye … i think part of the confusion you have might be because there is an image that abortion providers are foaming at the mouth, knives and vacuums in hand, hardly able to wait to abort embryos and fetuses … what is the lowly pro-life medical student to do?
not true.
women seeking abortions are given access to information on all options. the difference between the approaches of planned parenthood and pregnancy counseling centers is the, er, brainwashing aspect of information delivery. planned parenthood provides information without the manipulation and the preaching.
i agree with ames … a doctor exists to provide the best care for his or her patient … the patient that stands before him or her. period. the doctor’s role is not that of moral arbitrator or … more to the point … moral manipulator.
his or her patient has decided, most assuredly after a great deal of reflection, that abortion is the best choice. therefore, the doctor is bound by the hippocratic oath to provide the best service possible to insure the patient’s health … the same way michael jackson’s plastic surgeon is bound by oath to provide the best care possible when he wants to have more of his nose shaved off … the same way doctors are bound by law (not just oath) to follow a patient’s living will.
the AMA admonishes doctors to avoid specialties that collide with their consciences. that does not bar pro-life doctors from practicing gynecology. there are many, many, many gynecologists who do not perform abortions … less, i suspect, for moral reasons than for the headache of protests and liability … and fear for personal safety.
worrying about what doctors are being forced to say to patients is a slightly less serious worry than the problem jennykinx presents. the pro-life movement is winning with death by attrition. good luck trying to find an abortion in missouri … or other places in the south.
and this attrition has occurred quite well without a script doctors must follow.
***
on a related note (and not directed toward ANYONE in particular) … i have often (like, for at least 20 years) wondered this, and i hesitated bringing it up in another comment thread regarding abortion … but, what the heck …
i wonder how the pro-life movement would change … in membership size and composition … and even in existence … if every single abortion performed in america was performed on a latina or a black woman. the pro-life movement likes to talk about the one-million babies that would be saved each year. what would happen if that one-million were all black?
Comment by didionsmommy August 22, 2008 @ 9:10 pmThanks for continuing to cover this, Ames. The “contraception = abortion” language is out of the final policy document, but that certainly doesn’t mean it’s no longer an issue. Threatening health care agencies with losing their funding if they take any action against an employee who serves his or her own moral interests before those of the pateint is federally mandated blackmail.
Your readers might also be interested in Michael Egnor’s nuclear stupidity re: this issue.
Thanks for the plug, and by the way, I’m a ‘she’.
Comment by Danio August 23, 2008 @ 12:19 pmHey Danio! Thanks for coming over :-). I did see that but the regulation is, still, crappy for All sorts of reasons. I’m drafting a comment; you should urge Pharyngulites to do the same!
And thanks for the gedner correction :-) oops….
Comment by Ames August 23, 2008 @ 1:29 pmDM, you’ve addressed some of my concerns, but I’m still confused by some of the language I’ve seen thrown around.
With abortion being a legal procedure, I have no problem with laws that protect the ability of women to get them, and I have no problem opposing laws that make it significantly harder for women to get them. My concern is that, mostly in other threads, I’ve read Ames and others as intimating that a pro-lifer simply has no business being a doctor. There was a thread a while back where someone compared a pro-life doctor to a scientologist psychiatrist. It doesn’t seem to present society with an undue burden to make sure that there remains a place for pro-life doctors, and abortion isn’t nearly as central to the practice of medicine as psychiatry is to, well, psychiatry. As you say, lots of doctors don’t perform abortions, and, for half of patients, one can very reliably predict in advance that they’ll never be interested in getting one, and so it doesn’t seem to me that a pro-lifer can’t be a valuable doctor.
It’s also worth noting that abortion is special in that it can’t be decided on “do no harm” grounds. As was discussed in another thread, the fact that deciding the moral issue at stake requires the determination of the number of persons involved means that there’s no obvious ‘libertarian’ position (everyone agrees that Jackson’s nose has no rights of its own). Unless the Hippocratic Oath can obligate doctors to murder a third party in order to further their patient’s interest, it cannot unambiguously require a doctor to perform an abortion, nor can it even unambiguously permit one. That the Supreme Court also doesn’t seem to understand that the determination of personhood is so central to the abortion issue is the main reason that I think political justice requires the repeal of Roe, even though I’m probably more thoroughly pro-choice than most here.
Your question is interesting. I don’t know what would happen. That would also hit the pro-choice movement pretty hard too, and for the same reason.
Comment by Gotchaye August 23, 2008 @ 3:07 pm[...] A number of us in the blogosphere have been outraged by Bush’s Department of Health and Human Services’ desire to put the arbitrary wants of doctors before the needs of patients. At first it was just a draft proposal, but now Mike Leavitt is pushing to implement the changes. Soon, it may be legally acceptable to deny you a needed health service because the health care provider thinks your decisions are immoral. [...]
Pingback by Mike Leavitt to patients: "F*** you" [denialism blog] August 24, 2008 @ 3:00 amLet me get this straight – you will fight to imprison someone because they refuse to provide a blood transfusion for their child but you fight to force a doctor to kill an unborn child? What kind of lunatic reasoning is that? You base everything on what “you” want, your comfort, you deserve what you want – even if it involves the taking of a human life! You are selfish and narcissistic! What right do you have to tell a doctor, who has sworn to do no harm, he has to kill your unborn child? If you want a “service” as you call it, find some lowlife doctor that doesn’t care whether he murders someone or not! Where is YOUR conscience? I for one taxpayer am tired of the federal government spending MY tax dollars on doing exactly the same things we condemn Hitler and Stalin for doing! Look at the path that Germany took, that Russia/Soviet Union took and compare the path that we as a country are taking. Freedom is not absolute freedom! You are not free to do ANYTHING you want. There is another side of the coin of freedom. It’s called RESPONSIBILITY.
The same path was taken with marriage and divorce – first it was the sanctity of marriage until it became the “quality” of marriage. Now it’s “What is marriage, really?” First it was the sanctity of life until it became the “quality” of life. Now it’s “Well, when does life REALLY begin?” and “We don’t have a right to tell a woman what to do with her body.” Now it’s “You don’t have a right to obey your conscience and refuse to provide me an ELECTIVE PROCEDURE!”
By the way, life begins at the moment of conception otherwise the woman’s body would discard/discharge the “dead” “blob of tissue” – just like it does the UNfertilized egg every 28 or so days.
Comment by Tim January 3, 2009 @ 9:48 amIf you’re still around, Tim, I’d be happy to discuss this with you, but if this is just a drive-by “You’re Hitler!”-ing, count me out :).
By the way, one quick point, as to this – “life begins at the moment of conception otherwise the woman’s body would discard/discharge the ‘dead’ ‘blob of tissue’ – just like it does the UNfertilized egg every 28 or so day” – the question is a moral one, not biological.
Comment by Ames January 3, 2009 @ 3:52 pm