Bush's new health regulations

[Gaspar]

I'm looking to buy a Kosher ham for Christmas.  Any ideas?

[Red Arrow]

quote:Originally posted by Gaspar

I'm looking to buy a Kosher ham for Christmas.  Any ideas?

On your grocer's shelf, right next to the Kosher bacon.

[guido911]

quote:Originally posted by cannon_fodder

quote:Originally posted by pmcalk

Next, are you going to start singing every sperm is sacred???

I've been committing genocide for decades. [xx(]

Guido:

Seriously, if a physician verbally and in writing gave a disclaimer that he may not mention life saving medicine or other procedures, pills, or treatments to a patient because he may morally object to some... then I'd be OK with the law.

quote:Sir or Madam, by seeing me as your physician you agree to accept the fact that I might not even mention treatments which very well may save your life or otherwise have positive life altering influences.  It is my prerogative to mention whatever treatments for you I feel my God or Gods would approve of.  Treatments not approved by my God or Gods, no matter what advantage they may have for you, will not be disclosed.  Federal law protects me from any consequences from my action/inaction based on what my God(s) have told me. Will you accept treatment under these guidelines?

That is what you are arguing in favor of, then fine.  If a patient is dumb enough to agree to those terms I'm OK with it.  Anything short of that is allowing a physician to steer the decision making of a patient based on whatever their God(s) tell them to do, without having to inform the patient (that pesky informed consent thing, where a Doctor is supposed to KNOW and reveal treatment options).

As a licensed position of trust (professionals having the highest duty to the public, by definition) a medical doctor has a higher duty than Joe the Plumber.  If he tells a woman there is no choice, she will believe him.  If he answers "there is no choice my God(s) will allow" she will rightly question his medical judgment and go elsewhere.

This law would allow an Doctor to abstain from recommending vaccinations because they morally object to it.  AIDS programs.  Birth Control. Cancer trials.  Whatever the hell they want to do, they can and I can't fire them and a patient might not know the difference.

YOUR moral convictions are YOUR problem.  If YOUR convictions prevent YOU from being employed, so be it.  I fail to see why something YOUR God(s) tells YOU should interfere with MY health care or my right to tell an employee what to do.

You're argument is that anyone should be able to believe anything they want to and act upon that belief in any manner that it may effect their job performance and not suffer any consequences.  Unfortunately, that is not how it works.  

Next up:  Pork slaughter houses that can't discriminate against Muslim or Jewish employees.  Got bacon?

Since apparently no one has actually looked at the regulation, I thought I would post the HHS press release regarding this rule. There is a link in this press release to the actual rule and its history.

http://www.hhs.gov/news/press/2008pres/12/20081218a.html

I found it interesting that the liberal 1970s Congress passed laws protecting health care providers that were discriminated against because they refused to perform abortions. This regulation was promulgated pursuant to those statutes.

The arguments in this thread, not just from you CF, (perform/recommend abortion or get the hell out of the medical profession) appear to have been a reason for the enactment of the statutes.

[cannon_fodder]

quote:In the preamble to the final regulation, the Department also encourages providers to engage their patients early on in "full, open, and honest conversations" to disclose what services they do and do not provide.

What a joke.

By law, my doctor is free to tell me he has no treatment to recommend and that I should go home and die - because he morally objects to the treatment.  He doesn't have to tell me there is a treatment and he morally objects to it.  He doesn't even have to tell me that there are some things he won't tell me because of his moral beliefs.

He can hold himself out as an expert and give me inferior care if he chooses to.

But it would be nice if he had a conversation with me about it first.  Doesn't have to.  But the Feds would appreciate it if he did.

It's a BS law basically designed to allow doctors to refuse abortions if they want to.  It pretends to worry about a "doctor shortage" (which the government is a huge contributor to), but this law does NOTHING to help that shortage.  Ultimately, it further limits the number of available physicians until you find someone who has the same moral philosophy that you do (lest you receive treatment in line with their moral philosophy instead of your own).

quote:Patients need full access to their health care provider's best judgment
as informed by practice, knowledge, and experience.

2008 Federal Register, Document E8-30134, at page 78073.

Full access... unless their God(s) doesn't think it's a good idea then you don't need full access to it.

quote:The ability of patients to access health care services, including
abortion and reproductive health services, is long-established and is
not changed in this rule.

Id. at 78074.

You still have access to them.  They might not treat you or they might tell you there is no treatment... but the access to health care is not changed.  It goes on to give MORE lip service to the open conversation and full disclosure, but FAILS to make it a requirement.  If an MD doesn't want to perform a vasectomy on an unmarried man, won't perform abortions, or won't treat AIDS patients because he thinks it is a punishment from his God(s), then so be it... advise the patient of such and suggest another MD.

Disclose to me that you will not offer me a full slate of treatment and professional advice - and I will go else where.   As an attorney I am required to give my client the best legal advice I am capable of, if the client wishes to pursue a course that I am not comfortable with I pass that client to another attorney.  It's pathetic that my medical treatment is given less consideration to "client' choice.

The full rule, proposed and final, along with comments is available as a txt file below:
http://edocket.access.gpo.gov/2008/E8-30134.htm

Guido, do you think requiring a level of disclosure similar to that of an attorney is too extreme?  Do you see what my real concern is here or am I being unclear?

[guido911]

CF, I completely understand your point. I guess Congress got it wrong by protecting physicians from discrimination because they dare to morally oppose abortion.
I am coming at this issue as an attorney, former military medic, emergency room tech, and someone intimately related to a physician. To me, requiring a physician to act contrary to their moral beliefs is both intrusive and oppresive. To you, it appears you have no problem with that. Seriously, you would want a doctor that is willing to dump on their own integrity taking care of you?

Since you oppose this regulation, to be consistent I would assume you would want to do away with that pesky hippocratic oath thing as well. That whole, "first do no harm", and "respect for every human life from fertilization to natural death" and "reject abortion that deliberately takes a unique human life" is BS anyway, right?

Here's the oath:

The Hippocratic Oath

I SWEAR in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

TO RECKON all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is not compromised thereby, and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient.

WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.

[swake]

There's more than one version of the oath,

Here's the original:

I SWEAR by Apollo the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others. I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot!

http://classics.mit.edu/Hippocrates/hippooath.html

And a more modern version in use by many medical schools:

   
I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.


http://www.pbs.org/wgbh/nova/doctors/oath_modern.html

[cannon_fodder]

Guido, you are other entirely misconstruing my point or being very obtuse.  

1) A doctor is a professional, their highest duty is to the public by definition.  Their moral objection to a procedure is not in service of the public and may admittedly cause medical harm to a patient.  

2) The oath you cite "rejecting" abortion is one of several version a physician may take.  Not all physicians are required to swear they will not perform abortions.  If I wanted to take the confrontational " [your position] is BS anyway" approach I'd mock the "DO NO HARM" by adding "unless your God(s) say it is OK."

In fact, the version you cited is strongly in the minority to the Classic or Modern versions, or even "alternative oaths" used by most schools (Declaration of Geneva, Oath of Lasagna).  Like most ancient codes, if you are attempting to adhere to it pick your version, translation, and message from it and move on.

3) My position on abortion is very well known, I have delineated it as clearly as anyone else.  I am not an abortionist, I think the practice is most often ill advised.  This issue is not about abortion to me, it is not about stopping a physician from having a moral objection, and it is not about being "oppressive" to a physicians beliefs.  

If this is a collateral attack on abortion then we can discuss that in a different thread (honestly, if you have strong convictions about abortion I doubt you would take a position at a job that might put you in the position of performing one).   If a physician has a moral object to a task inform the patient that you morally can not perform a procedure.  And I don't think requiring full disclosure is oppressing a physician.

It is about patient care, plain and simple.

4) THE ROOT OF THE PROBLEM, and the point I am interested in seeing addressed:

Under the rule a physician does not have to mention that they are failing to recommend a treatment or give advice based on their moral convictions.

Given that criteria, how is a patient supposed to make an informed decision?  When a patient goes to an MD for advice, they are seeking a professional opinion and in most cases THE professional opinion.  But refusing to give advice based on whatever your God(s) have told you - you are subjecting your patient to the constraints of your beliefs.

Can a Scientology Gynecologist simply not mention to a woman giving birth that medication or procedures are available that can help ease pain, because his God(s) tell him that pain during child birth is good for the child?

Certain sects of Christianity belief blood transfusions are forbidden by the bible, can an ER physician fail to perform a life saving transfusion and not even mention to the victim/family that they should seek another doctor who might save this persons life?

A Muslim cardiac surgeon that doesn't suggest heart valve replacement because they are derived from pigs?  You wouldn't be pissed if they didn't even mention it because of their moral convictions?

Refusing psychiatric drugs because the person is just possessed?   Seriously, there are some odd religious beliefs that could come into play here.  In most cases this crap won't be an issue.  But in some cases, it will be.

My primary objection is that a Doctor is not even required to advise a patient of their options nor inform them that the information they are giving is not complete in order to conform with their religious beliefs.  I damn sure want to make my health care choices myself.  99% of the time that means going with what the doctor recommended because I trust that the physician knows more than I do.

If I have to wonder if he knows more, and chooses not to tell me because of his beliefs, that decision becomes a lot more complicated.

SO... without hyperbole about how related you are to a doctor, or how I hate all moral and just people, or that I only want to associate with people who have no integrity...

What would be wrong about requiring full disclosure?  And if you don't think it should be required, would you then be comfortable being treated by someone who you know to have a different set of religious beliefs than yourself?  And when or if a loved one dies because the MD on call to the ER doesn't believe in blood transfusions, you're going to be OK with that?

[guido911]

We are getting nowhere here CF. I am not being "obtuse" (a word I have heard you use before whenever I do not agree with you). I just think you are missing my point by miring yourself in the slippery slope.  

I have no problem with full disclosure by a medical provider to a patient (whom the physician owes the legal duty) of his moral objections. If that is your position, then we agree. In reading your prior posts, in particular that disclaimer quote, I thought you were mocking that approach. I thought you called a patient "dumb" or something for sticking with a physician that disclosed their moral beliefs.

I am through with this thread. Plainly you believe a physician should be forced to pocket their moral beliefs because of their duty to the public and I do not.

[rwarn17588]

quote:Originally posted by guido911

We are getting nowhere here CF.

Translation: I'm getting my butt beat by cannonfodder's usual well-thought-out, lucid arguments and am going to change the subject.

[cannon_fodder]

Then we agree on the main premise.  Professionals should be free to restrict their practice to conform with their moral beliefs.  But any professional who restricts their advice/treatment of a client on moral grounds should inform that person of their actions in order to enable them to make an informed decision.

quote:Guido Wrote
Plainly you believe a physician should be forced to pocket their moral beliefs because of their duty to the public and I do not.

Again, for the 5th time:  I believe any professional should be able to act on moral conviction.  My caveat is that they should tell the person to whom they owe a duty of that conviction.   I have been very clear on this point.

And personally, yes, I do believe it would be crazy to stick with a physician who may or may not offer you the best course of treatment based on what they think a God or Goddess tells them to do.  I want to make that choice myself and allow my God or Goddess to tell me to do it or not.  

Extrapolating from that main point - if after being informed that you will not receive the best possible care on account of the MDs moral beliefs - you get treated by them anyway, then come what may.  Seems silly to me UNLESS you share their moral beliefs.  Which adds a new element to finding a good doctor (graduated from...  years practicing, number of malpractice suits, surgeries performed, religious conviction?).

And for the record, I only use the word obtuse when I believe a poster is being intentionally daft.  I believe you knew what I was trying to say long ago, yet insisted on attempting to get in jabs:

"I guess Congress got it wrong by protecting physicians from discrimination because they dare to morally oppose abortion"

"requiring a physician to act contrary to their moral beliefs is both intrusive and oppresive. To you, it appears you have no problem with that"

"you would want a doctor that is willing to dump on their own integrity taking care of you"

"I would assume you would want to do away with that pesky hippocratic oath thing as well"

"That whole, "first do no harm", and "respect for every human life from fertilization to natural death" and "reject abortion that deliberately takes a unique human life" is BS anyway, right?"


Essentially, most of that reply, which I called obtuse, was a snide insult directed at me.  Again, it implies (if not directly says) I hate the morals of others, I like abortions, I want to oppress MDs, I would only want an MD with a lack of integrity, and that I don't think an MD should "do no harm."  

I do not believe you actually distilled that meaning from my posts.  While my hypotheticals are hopefully rare events, your reply was purely emotional and directed at me - not the issue.  Hence, I suggested that you were being obtuse.  It lacked incite and discernment, intentionally so in an attempt to mock my stance.  The alternative was that you really did misconstrue my posts - an option which I readily admitted and attempted to correct by clarify my position in detail.  

At this juncture it appears your position is religiously based. If your position is mostly religiously based on the abortion issue (this law helps stops abortion, God hates abortion, this law is good) then the topic is essentially dead.  Logic and rationality have no place in "faith" issues.   As Martin Luther said "Reason is the greatest enemy that faith has . . . Reason should be destroyed in all Christian."  If my belief and your faith disagree on an issue we end up discussing Russell's teapot and all sorts of ancillary issues.   And I bet no one wants that.  

Thus, if you really disagree with the notion that a physician intending to limit their care based on their beliefs should be required to inform a patient of such - then I would be interested to hear your position.  It appears we actually are in agreement in spite of your conflicting statements.  I'm sure we can disagree about the ramification of ones convictions in the workplace (workplace does NOT have to accommodate in my world), so if you would like to disagree on something you can run wild with that one.

Otherwise, I shall digress to other issues but am interested to see what becomes of this new edict.

[guido911]

quote:Originally posted by rwarn17588

quote:Originally posted by guido911

We are getting nowhere here CF.

Translation: I'm getting my butt beat by cannonfodder's usual well-thought-out, lucid arguments and am going to change the subject.

[}:)]

Arguing with CF on this issue is getting nowhere. I am fervently against any physician being forced to perform medical procedures that are against their moral beliefs and he is not. I am curious as to which well-thought-argument you are impressed with? Was it that a physician owes a "highest" duty to the public? If so, show me where I can find authority for that. A physician owes a duty to his/her patient and that is all. If a physician owes a duty to the public, then under no circumstance could a physician refuse to provide services to someone they do want to. In other words, every person under CF's well-thought-out argument would be every physician's patient. The issue in this thread is what a physician should disclose to their patient and not to the public.

Next well-thought-out argument? Is it CF's refusal to accept that Congress in the 1970s found that certain physicians were being discriminated against by other physicians or health care facilities because they did not want to perform/provide abortion-related services and that Congress passed laws to protect those physicians? Remember, this recent regulation was promulgated pursuant to those statutes enacted by a very LIBERAL Congress.

Maybe it was CF's astute observation that the version of the hippocratic oath I quoted was "strongly" in the minority to the "classic" hippocratic oath despite the fact that this "classic" version was quoted by Swake in a previous post and plainly contains similar language.

I think CF & I agree that physicians should disclose their beliefs to their patient so the patient can decide whether to continue utilizing that physician.  

When you argue with someone who has their heels dug in on an issue, like CF & I, it comes to a point where you have to stop arguing--your little douchy post notwithstanding.

[guido911]

CF:  My position is not religiously based and it is troubling that you would go there given what I have stated in this thread. Indeed, I could just as easily minimize your argument by saying your position is meaningless because you neither have experience in the health care field nor have you made a legitimate life or death decision. My view on the subject is based on my personal/professional experience in the health care field only.  

As for a patient being "dumb" for going to a physician that limits the care they provide based on moral belief, call me dumb then because I will more likely go to a physician that is true to their integrity.

[cannon_fodder]

Agree with you Guido... except:

[/quote]
I am fervently against any physician being forced to perform medical procedures that are against their moral beliefs and [cannon_fodder] is not.[/quote]

I have said repeatedly:
"I believe any professional should be able to act on moral conviction."

I repeated:

I think any professional can abstain from providing services if it is against their moral conviction so long as they disclose that to their patient/client.  

No doctor should be forced to perform an abortion.  No lawyer a divorce.  No actuary assign a value to human life.

A doctor shouldn't have to perform a procedure they morally object to.

An MD doesn't have to abort babies.

Not sure how else to say it?

And no, the MD doesn't have to post a billboard telling everyone their beliefs.  Only the people that they wish to treat.  If I went to an MD for an opinion I have a right to be fully informed.  If your religious convictions are inhibiting my treatment, I have a right to know about it.  

No billboards, no disclaimer in their ads.  But if a patient comes in and asks your advice anything less than full disclosure is imposing your beliefs on them.
- - -

And the finding of Congress are as arbitrary as they need them to be to propagate whatever laws they want.  You know that very well. They could find evidence to support the sky is green if it helps THAT Congress pass whatever agenda they have or that agency promulgate whatever rule they want.

And furthermore, I am not even arguing with that contention.  I fully believe MDs are discriminated against as everyone else is that is employed.  My question would be to what extent is it discrimination against their beliefs and discrimination against the actions that are precipitated by those beliefs.  If I choose not to hire a Jehovah's witness for my ER because we only have one attending at a time and they MUST perform blood transfusions - then it is the ACTION precipitated by the belief which I can not employ.

Same would apply to an abortion clinic not hiring a fundamentalist Christian.  Or a heart clinic that does pig valves not hiring a Muslim.

I think you are confusing belief with action.  Actions precipitated by beliefs are not protected to the absolute degree the belief itself is.  I can not refuse to hire you because you are Jewish, but as a private employer I don't have to accommodate your belief's (Kosher meal plan in the cafeteria, special non-transfusion schedule, 5 times a day prayer breaks... whatever).
- - - -

I trust you are not offended by my discussion Guido.  If I thought you to be an idiot I wouldn't bother responding to you.  The fact that you have a different opinion and are capable of supporting it makes the discussion interesting and worthwhile.

[Nik]

Seven states have sued to prevent this from becoming law.

http://www.washingtonpost.com/wp-dyn/content/article/2009/01/15/AR2009011502059.html?hpid=sec-health