Friday, December 19, 2008

Conscientious Objections?

H/T to Geoffrey for keeping me up on the news. The Bush Administration today issued an expansion of what are called "right of conscience" laws, which allows individuals to refuse treatment on the basis of religious or moral grounds.

From the article in The Washington Post:

"Doctors and other health-care providers should not be forced to choose between good professional standing and violating their conscience," said Mike Leavitt, secretary of the Department Health and Human Services, which issued the regulation.

Some Thoughts:

This is a sticky wicket. It is the opinion of most, that this action is to protect those pharmacies that wish to not have the "morning after" pill on their shelves; that they may do so without fear of retribution. Individual right of conscience legislation regarding abortion has been around and sufficient for many years. The current wording is simply god-awful for a few reasons:

1. Way too broad- it's a sledgehammer, when a scalpel is needed. It encompasses too large a group of providers.

2. It does not differentiate between the individual vs. the corporation. A mom and pop pharmacy does not have to stock the shelves with everything. But denial of treatment is not denial of access there, as it would be if a clinic group was the only one available within a certain radius. If there are sufficient available alternatives, then this could be viable in small numbers.

3. There are insufficient parameters regarding the specifics of the religious beliefs and types of procedures. I see nothing that prevents me from becoming a Christian Scientist or (gasp) Scientologist, and refusing to give care that I am being paid to give. A company that fires me for that would potentially face loss of federal funding. I hope that all hospitals will be prepared to have husbands or unmarriageable male relatives on staff in case their female Muslim physicians are required to treat a male.

4. It is unethical to knowingly deny information to a patient. Refusal to directly treat on the basis of ethical grounds has been fairly well protected, but refusal to provide known information and referral is a violation of allowing access, and against medical ethics and duty to treat. From Laura Katz, in a Physicians News Digest article on ethics of termination and refusal of care:

"If a physician decides not to provide services to a patient on religious, ethical or moral grounds, the physician should discuss the reasons for the refusal with the patient, inform the patient of other resources or providers that can competently respond to the patient’s needs, and document the discussion with the patient in the patient’s medical record."

5. It conflicts with other legislation, such as the Americans with Disabilities Act (ADA). In several cases, the courts have addressed the application of the ADA to a physician’s decision to refuse to treat a patient. For example, in the case of Bragdon v. Abbott, decided by the Supreme Court in 1998, the court found that asymptotic HIV infection is a disability under the ADA. Bragdon involved a dentist’s refusal to fill a cavity of an asymptotic HIV patient in his office, although the dentist was willing to treat the patient in a hospital at a higher cost to the patient. The patient sued Bragdon for violation of the ADA. The court ruled that asymptotic HIV constitutes a disability. The court’s decision speaks to health care providers’ legal obligation to treat HIV infected patients along with patients with other disabilities. Similar diseases or conditions could easily constitute a disability.

It is likely that this regulation will be short-lived. Although the issue will continue. We are seeing a greater number of physicians from different religious backgrounds. We continue to answer questions old (physician assisted suicide) and new (cloning, gene therapy). Defining the balance of a physicians individual beliefs vs. duty to provide treatment will spark debate for generations to come.

Tuesday, December 16, 2008

Rudy's Little Secret?

Source: Multiple websites- orig. unknown- (feel free to provide citation)

Got a better caption? Do share.

Friday, December 12, 2008

The Skinny on Zoloft

Dr. Ajit, in his quest to educate the general public about medications, one drug at a time, has given an excellent review of Zoloft.


A recent conversation regarding altruism has been playing in the back of my head this past week, as the actions of various canines have made their way to prominent (and perhaps not so prominent) news stories. The coincidence of similarly themed news articles could be an interesting topic in and of itself (anyone remember the shark bite stories of early 2001?), but whether coincidental or not, the following have got me wondering about the altruism of man's best friend (the dates given are when I saw the reports on TV or the internet):

Dec. 5th: The most popular story involved a stray dog crossing a busy highway in an attempt to rescue an injured dog. The homeless dog is seen on camera dragging the injured dog across the highway to the safety of a median.

Dec. 8th: A local story here in Virginia about a three year old toddler that wandered off into the woods from the babysitters house. The child would have likely died from exposure overnight, if not for the two 12 week old puppies following him and cuddling up with him to keep him warm overnight.

Dec. 9th: Oklahoma. A dog takes three bullets to the head in chasing off a home intruder.

Dec. 10th: A research team in Austria have determined that dogs have a sense of fairness. The test involved getting dogs to shake hands for a reward. When one dog got a reward and the other didn't, the unrewarded animal stopped playing.

In the discussion I recently had, my friend and I were contemplating if there is a "true" altruism, or if altruism is only a very high defense mechanism borne out of selfishness, insecurity, or both. The actions of our four legged friends may have provided me with a bit of an answer.

Perhaps we humans can learn a bit from them:

Dec. 11th: Chicago: Jogger, dog owner jump in lake to rescue dog.