By DAN K. THOMASSON
So when is a physician not a physician?
Is it when the doctor refuses to offer treatment because of disapproval of the medicine available or the way the patient's disease occurred? How much leeway is there in the Hippocratic oath to allow a doctor to spurn those in medical need because of religious conviction or concept of morality?
And what about pharmacists who refuse to honor legitimate prescriptions or even to stock certain authorized medicines because the drugs run counter to their religious beliefs? Is there a case to be made for the primacy of conscience in those cases, even though a pharmacist's responsibilities are not dissimilar to a doctor's? Is refusing to fill a prescription tantamount to breaking the law and to making a pharmacist's judgment more important than the doctor's?
These and other questions surrounding the dispensing of modern medicine are being asked by state legislatures, ethics boards and public forums throughout the nation in the wake of controversial new research and compounds and treatments that run counter to fundamental religious convictions on such issues as stem-cell development, abortion, AIDS, the right to die. Chances are excellent that before the debate is over, it will change the way health care is dispensed in this country.
According to recent reports, legislation to permit medical providers to refuse care when it clashes with their beliefs is under consideration in a growing number of states. The legislation is just the tip of an iceberg of controversy that is expected to end up in front of Congress, if not the Supreme Court, before it is settled. If ever.
At the center is the age-old battle between conscience and duty, the requirements of the license granted by legal authorities vs. those ideals and standards imposed by religious teachings. It has intensified in a burgeoning atmosphere of evangelicalism that already has dramatically changed the political landscape and brought about major confrontations on a host of social issues between the right and left, in courts and in legislatures.
Many of the bills introduced at the state level would undermine patients' rights by permitting pharmacists to refuse to dispense "before" and "after" birth-control pills, which they believe cause abortions. The furor has increased over the availability of the "morning after" pill and whether it dissolves something that God already has begun. When does life begin? No one seems to know for certain. Legal authorities have been arguing this question forever and some standards have been established for judging criminal cases. The first breath taken by a baby out of the mother's womb is the standard in some cases for legal purposes.
When one enters medical school or decides to undergo training to be a pharmacist, it is doubtful that it is done with a provision that certain patients, treatments or drugs are off-limits, that while it is possible to save a life by performing certain procedures that are legal, the right to deny treatment or healing drugs supersedes any other obligation. Should doctors or drug dispensers or others in the health-care business who impose these limitations be identified with an asterisk by their names in the phone books or medical registries? It might be a good idea.
This is not to challenge the moral imperatives that govern us all. The decision of some doctors not to perform abortions is understandable when there is no emergency medical need. Cloning raises huge issues. But when there is a possibility of death, it is unthinkable that any physician would refuse to administer whatever lifesaving remedy is available. The same would be true for anyone with the state-granted authority to dispense a legal drug authorized by a licensed doctor.
The sound of struggle between religion and science, between bioethics and dogma, and the need to advance life and civilization through science is likely to intensify in the next decades. The doctors and those who depend on them for treatment uncolored by the disapproval of religion are right in the middle. Making it legal to deny recognized treatments is a very bad idea. Those who argue that Americans have a basic right to follow their conscience above all else seem to ignore that one has the right to try to control one's own destiny even in health matters, and not to have to worry about a healer's faith.
Doctors and pharmacists who form associations based on religious convictions seem beholden to standards other than science and the care of all patients required by their oath.
(Dan K. Thomasson is former editor of the Scripps Howard News Service.)
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