Horrible Proposed HHS Regulations Announced
By Kay Steiger - Aug 22nd, 2008 at 3:33 pmRemember those really horrible Department of Health and Human Services regulations that we heard were going to be proposed last month? Well, they’ve officially been announced. The regulations allow doctors and nurse practitioners to refuse to treat women for anything that might “conflict” with their religious beliefs. They also define “abortion” as ending a pregnancy even before implantation–which means they’d allow health care professionals to refuse to distribute birth control.
We’ve known about the potential for these kind of tactics for a while. HHS Secretary Michael Levitt raised a stink back in March over the American College of Obstetricians and Gynecologists’ new ethics guidelines (PDF), which said that a health care provider had an obligation to give a referral to a woman in a timely manner if he or she felt that the requested reproductive services would conflict with his or her conscience.
Additionally, such regulations directly conflict with state laws in California, Massachusetts, and Illinois that require hospitals and pharmacists to distribute birth control and emergency contraception if a patient requests it. In other words, this proposed rule could be very bad news for women and their reproductive health.
I’m with you on the way the regulations redefine abortion. However, just to make sure I’m clear, are you opposed to allowing medical professionals to refuse to treat an individual in a way that conflicts with their religious or ethical beliefs.
I’m all for reproductive health, but in the end isn’t really about having freedom of choice. A woman has the right to decide what to do with her body.
By the same token, shouldn’t a doctor or a nurse be free to choose whether or not to do something that conflicts with their own ethical views? It’s not that different from a soldier refusing to go into combat because he or she has ethical principles that disallow it - and it’s just a guess, but I’d assume you’re fine with that sort of conscientious objector.
How can one possibly support choice for one side of the reproductive health question and not the other?
August 22nd, 2008 at 4:11 pmWow, thanks again for proving that libertarians are in practice the same as Republicans.
August 22nd, 2008 at 4:41 pmI think that if you’re aware that your personal beliefs are going to make you loath to administer treatment to a segment of the population, or under a certain set of circumstances, you would be best advised to AVOID THAT PROFESSION. Who are these morons who think, “Gee, I hate the idea of abortions, so … I’ll be an OB-GYN!”? Waterman’s example of the soldier merely makes me question why such a theoretical person would join the military in the first place. If you have a problem with combat, maybe you shouldn’t go into a profession that pays you to shoot people? How about a firefighter with a deathly fear of fire, Waterman? If he’s drawing a paycheck from the government, I think the government thereby has a right to force him to a) fight fires or b) find a new job. No one is forcing doctors to be doctors, but once you are a doctor, you should be willing to act as your profession demands 100% of the time.
August 22nd, 2008 at 5:14 pmKay,
Yeah, that libertarian hatred of the Patriot Act, the Drug War, prostitution, anti-sodomy laws, and farm subsidies really lumps us right in there with the Republicans.
Nick,
The soldier analogy is rare if ever occurring in a non-draft scenario, perhaps not the best choice. So maybe I’m wrong, but I hardly think a doctor or a nurse necessarily has total control over what part of a hospital they are assigned to, and therefore could potentially end up in a scenario where they are faced with the situation even though they had hoped to avoid it.
It is fully possible to be a doctor and meet the demands of your profession 100% and still refuse to administer abortions or contraceptives. If you have an absolute belief that there are two lives involved in an abortion, than you are fully within your ethical bounds to refuse to do the abortion - the whole first do no harm thing.
And what of other health care industry figures? Should a pharmacist be obliged to fill a prescription for something they are ethically opposed to? Should an insurance agency be forced to provide contraceptives even if they market themselves to an elderly or to devoutly Christian market?
The fact is, as far as I know, there is no shortage of doctors, nurses, or anyone else in the healthcare industry without these moral qualms. And because of that I suspect that anyone who did refuse to act on such moral grounds would quickly lose their jobs. And Kay, as a libertarian, I’m perfectly fine with that, another point where I differ from the Republicans you attempt to lump me in with.
August 22nd, 2008 at 6:55 pmWaterman,
I hear your points and I can’t say I strongly disagree that in a perfect laissez-faire market system, simple market forces would cause doctors and nurses with qualms about offering abortions and morning-after pills, etc., to lose their jobs. Five thoughts, though:
1. I still have a difficult time envisioning a scenario in the private sector where a man goes in for a job interview and says he really wants the position, but is only willing to do 95% of the job description–that 5% just really goes against his personal beliefs–and actually getting hired for the job. This goes with what you’re saying about market forces causing moral holdouts to lose their jobs. It seems we’re arriving at the same end via different means.
2. The means by which this end is derived which I support–governmental regulation banning doctors from refusing to hand out condoms, etc.–prevents two things: unnecessary, market-induced job loss on behalf of doctors who would be forced out in favor of those who have no such qualms, and immediate relief for women who need abortions. I’m uncomfortable with a scenario wherein doctors can refuse to perform abortions or offer the morning-after pill in a time-sensitive scenario where a woman’s health or life (or even just her pregnancy status) may be on the line. Why subject people to those sorts of very real concerns during the time it takes for market forces to shuffle out the Christianist doctors? It seems much easier to pass regulations saying, “Hey, if you sign up for a job that involves seeing after the health and welfare of human beings, you have an obligation to fulfill those duties to the best of your ability.”
3. Even if we were to move to a free-market sort of system which would theoretically self-regulate Christianist doctors out of existence, what’s to say that that would actually take place? The problem with libertarianism in the real world is that it relies on conditions which cannot exist–primary among them the need for free, unfettered flow of information, capital and labor. As long as more information is vested in the control of those who also control the capital necessary to free that information, consumers will remain at an information deficit. Without perfect information, capitalism would face negative externalities (barriers to competition, the tendency toward monopoly, low consumer awareness of best choices and practices) that impede its ability to operate perfectly (see the libertarian economist Hayek and his followers on this point). I think a libertarian model would end up being geographically self-segregating: Californians would have a market allowing for relatively easy abortion access, but people in the Dakotas would probably have to drive quite a ways to find a place that actually performed them, given the prevailing sentiments in those areas.
4. I’m not a doctor myself, although I’m friends with a few, and outside of their residencies, rotations and internships, all of which take place during medical school, doctors are pretty free to choose where they seek employ. I think it’s highly unlikely for a doctor to suddenly find herself performing abortions against her will without some foreknowledge that she might very well end up there someday.
5. The principle of “do no harm,” in my mind, should really require evidence rather than simply gut feelings. By the standard you advance–that a doctor convinced of the concept of the soul conferred at conception can refuse to perform an abortion, or I guess even offer a condom or the morning-after pill–what’s to prevent a doctor from justifying their refusal to perform blood transfusions based on their Christian Science beliefs, or harvesting organs from someone on life support because it’s wrong to kill under any circumstance? We quickly run into problems when we allow people to make decisions that affect others with no regard for the actual facts at hand. Neither legislation nor market forces should make allowances for stupidity.
August 22nd, 2008 at 9:23 pmNick,
Thanks for the reasoned debate, it’s a much better reaction than some other times I’ve debated progressives (and it makes me hold out hope, since progressives and libertarians definitely have points we agree on and ought to work together on them).
1. No points of disagreement here.
2. I’m willing to concede that so long as a doctor is on the government payrolls compulsion is allowed. That would ensure that some venues, at least under current realities, like Planned Parenthood would always be there as an option. Additionally I’d question that the market is that undersaturated that the vast majority of persons could not find a doctor willing to treat them (of course that raises insurance issues, but we can save that for another discussion).
3-A. Obviously there would be some transitionary pains, but in the event of this becoming reality, I am sure a number of means of relaying information about what doctors wouldn’t perform abortions or offer birth control. After all, in this day and age there is more information out there than ever and its all easier to access. I fully expect a DoctorsWatch.org or the like would appear very soon and provide the sort of information service necessary.
3-B. I’ll admit I haven’t read as much of Hayek as I’d like to (it’s in the process of being corrected), but under my understanding of his ideas, the lack of perfect information is the very need for capitalism - only the market is able to access the full degree of knowledge and through price indicators make the necessary corrections for the lack of knowledge of any individual actor. If perfect knowledge could be had by one entity than a centrally planned system could work, but since such a thing is impossible we’re left with the free market as the best option.
3-C. I don’t disagree at all on the issue of geographic segregation. But is that terrible problematic. Bill Bishop in his new book The Big Sort has shown that there has been a growing trend towards ideological self-segregation on geographic terms; basically more and more people are choosing to live with people that think like they do. Of course there will always be some demand even in the most antithetical of places, and there will likely be some enterprising or philanthropically minded sorts that set up shop in these regions so that even there abortions and contraceptives will be available.
3-D. Another potential solution to the issue of regional self-segregation would be to loosen up the rules controlling access to drugs. If we allowed individuals to purchase say contraceptives online that would do a great to open up access, even in those locations where it is not easily available due to the issue of negative externalities. The ease (and privacy) of access would also likely increase usage, thus dropping the need for abortions. And morning after pills and other intermediaries between standard contraception and abortion could always be rush-delivered if need be.
4. I don’t know many doctors, nor am I one myself. I would agree it is improbable that outside of their early period (residency and the like) it is improbable that doctors will be forced into that sort of situation. However that doesn’t answer the question of nurses and pharmacists. I don’t know the answer when it comes to them.
5. I think we’re going to have to agree to disagree on this one. I think even the Christian Science believing doctor should be allowed to act according to his ethical principles.
Thanks for the real debate. In spite of what some say, it’s a complex issue that deserves serious discussion and analysis.
August 22nd, 2008 at 10:06 pm