Bentancourt v. Trinitas, New Jersey

If you haven't been following the end-of-life rights case in New Jersey, you can catch up on the developments at Thaddeus Pope's Medical Futility Blog. He presented to the court and is posting related materials at his site. From Saturday's post, an online letter from the New Jersey Hospital Association:

A three-judge panel heard arguments this week in Betancourt v. Trinitas Regional Medical Center, which involves important end-of-life issues. In addition to legal counsel for Trinitas, arguments were heard from NJHA, the Catholic Healthcare Partnership of New Jersey and the Medical Society of New Jersey, which together submitted a friend-of-the court brief on behalf of Trinitas.

The case involves an appeal by Trinitas from a lower court order which effectively compelled healthcare professionals to provide life-sustaining medical treatment (in this instance, kidney dialysis) indefinitely to a dying patient in a permanent vegetative state, despite medical professionals having determined that the treatment was not medically justified and was against the standard of care.

The appellate court heard oral argument for approximately 90 minutes. John Zen Jackson, from the law firm of Kalison, McBride, Jackson and Robertson, presented the case for NJHA, CHPNJ and MSNJ. Questions from the judges reflected a disparity of views. The principle of patient self-determination and autonomy was emphasized by one, while another appeared to question whether that principle alone was sufficient to compel the hospital and its physicians to continue providing care beyond a point that they believed was appropriate. The court also asked questions about the process for making decisions regarding end-of-life treatment and the role of the family and non-medical persons. NJHA’s joint brief suggested a process for resolution of such disputes, including internal hospital reviews and a procedure for transfers to a different healthcare facility.

Another aspect of the case is whether it should be considered at all by the court in light of the death of the patient as the appeal was being filed, and the lack of interest on the part of his family in continuing to litigate the matter. Jackson, among others, noted that the issue could recur and needed to be addressed now, rather than at a later time.

Doctors' Dilemma: Denominational Hospitals.

Tom Rees writes at Epiphenom about the challenge faced by doctors who work at denominational hospitals -- about 1 in every 8 -- in the U.S. Rees highlights a recent study that polled doctors on how they handled religious restrictions to medical services delivery. About 1 in 5 doctors reported having some conflict with the laws of their employing institution. So much for the sanctity of the doctor-patient relationship, huh? Here's a clip:

So, for example, some religious hospitals stop their doctors from providing legal medical treatment, such as contraception, abortion, and certain end-of-life treatment options.

This poses a potential dilemma for healthcare providers. A recent survey, by Debra Stulberg, at the University of Chicago, and colleagues, set out to investigate.

They surveyed over 400 doctors, chosen at random [technical note: this wasn't a completely random sample. To make it statistically robust, they specifically set out to get more doctors with South Asian or Arabic surnames, and they adjusted the results to take this into account].

Just over 40% had worked at one time in a religious hospital. This was pretty evenly spread across age, religious affiliation (or none) and other demographics.

One in five of those who had worked in a religious hospital reported that their treatment decisions had at least sometimes come into conflict with hospital policy. In other words, 20% of doctors in religious hospitals have been prevented from prescribing what they believe to be the best treatment for their patients.

Women were twice as likely as men to have faced this problem (presumably because they are more likely to be dealing with female sexual health). And young doctors were more likely than older ones to have had conflicts with hospital policy.

Although you might expect non-religious doctors to be more likely to have problems with the ethics of religious hospitals, it turns out that they are not alone. As shown in the graph, Muslims and Hindus also had problems (contraception is allowed under Islamic law).

In fact, the differences between faiths were not statistically significant (although this may be because the survey was too small).

What did these doctors do when faced with a conflict? Well, almost without exception they complied with hospital policy and denied treatment to their patients.

New York State Gets Into the Provider Refusal Act.

From Thaddeus Pope at Medical Futility Blog: two NY bills would not only allow doctors or others to deny legal and prescribed treatments to patients, but to also refuse to refer them to a place where they can get those services:

I just noticed this language in N.Y. A.B. 2935 and S.B. 4898, bills aimed at several types of conscientious objection (from abortion, to contraception, to end-of-life):

WHEN PROVIDING A PERSON WITH ANY FORM OF ASSISTANCE OR INFORMATION RELATING TO LIFE-SUSTAINING MEDICAL TREATMENT IS CONTRARY TO THE CONSCIENCE OR RELIGIOUS BELIEFS OF ANY PERSON, HE OR SHEMAY REFUSE TO PROVIDE SUCH ASSISTANCE OR INFORMATION, OR REFUSE TO REFER A PERSON FOR SUCH ASSISTANCE OR INFORMATION, AND NO PUBLIC OR PRIVATE HUMAN SERVICES OR HEALTH CARE AGENCY, HOSPITAL, PERSON, FIRM, CORPORATION OR ASSOCIATION SHALL DISCRIMINATE AGAINST THE PERSON SO REFUSING TO ACT.

Britain's Pharmacists and the Conscience Clause.

From the BBC, Britain has decided to keep the same provider refusal laws that exist in the US. Pharmacists who morally object to contraception will be able to legally refuse those services. But discussion in Britain is now taking place that will require refusing pharmacists refer patients to other pharmacies or facilities where they can get the prescription their doctor has given them.

Here in the US, the same question looms over pharmacists. Obama rescinded the 11th hour conscience clause made law by Bush in his last month of the presidency. Obama has yet to take up the issue again, despite strong calls for it's inclusion in the health care bill. Here in the US, the argument continues to be framed as one of provider conscience; the rights of patients seldom make it into the discussion, unfortunately. I hope this conversation does take place in the US; patients' rights need to be considered, explained, and debated on a national scale.

From the article:

A revised code of conduct from the new industry regulator will allow staff to opt out of providing items such as the morning-after pill and contraception.

But they may in future have to give customers details of alternative shops.

The National Secular Society wanted the General Pharmaceutical Council to scrap the so-called conscience clause.

The General Pharmaceutical Council (GPhC) is to take over the regulation of pharmacists, pharmacy technicians and the registration of pharmacy premises from the Royal Pharmaceutical Society later this year.

Under its new code, pharmacists with strong religious principles will still be able to continue to refuse to sell or prescribe products if they feel that doing so would contradict their beliefs.

But the GPhC says pharmacists who refuse services could be obliged to tell patients where they can access them and it plans to consult more widely on the issue.

Terry Sanderson, president of the National Secular Society, said he was disappointed by the code.

"This was a perfect opportunity to severely restrict the exercise of this supposed conscience clause which has caused a great deal of embarrassment and inconvenience to people recently.

Repealing the Conscience Clause.

After more than a year of waiting for the Obama administration to address the hideous provider refusal laws that Bush passed in his last weeks of office, 365Gay reports that there may be movement to rescind - at least in part - some of the discriminatory restrictions:

(Washington) The Obama administration is expected this week to begin the process of repealing so-called “provider conscience” regulations that could have been used to discriminate against gays, people with HIV/AIDS, and women seeking abortions.

The regulations, instituted in the last days of the Bush administration, strengthened job protections for doctors and nurses who refuse to provide a medical service over religious beliefs.

Human rights groups say the regulations could impair LGBT patients’ access to care services if interpreted to permit providers to choose patients based upon sexual orientation, gender identity or family structure.

The regulations also threaten women’s access to comprehensive health care by permitting pharmacists to refuse to dispense contraception even when doing so significantly burdens the patient’s access, or to refuse to participate in an emergency abortion even when the woman’s health is at risk.

snip

The Bush administration rule was quickly challenged in federal court by several states and medical organizations. As a candidate, President Barack Obama criticized the regulation and campaign aides promised that if elected, he would review it.

Late last week the White House released a statement saying that Obama supports a “carefully crafted” conscience clause – not Bush’s version.

The administration early this week will publish notice of its intentions, opening a 30-day comment period for advocates on both sides, medical groups and the public.

The administration already held a comment period regarding the laws. I hope that the "carefully crafted" regulations will protect the conscience of all individuals, not just those of health care providers and denominational institutions hell-bent on discriminating agains gays, women, and elders.

More On the Coakley-Brown Emergency Contraception Issue.

A new post from Sargent at the Plum Line makes it sound like he's missed the entire hoopla over the "devout Catholic" comments Coakley made on radio recently. Sargent reports thatshe's got a flier out attacking Brown on the issue, below.

But just to be perfectly clear: Catholic hospitals have been fighting this law since it came down. Because they are governed by the USCCBs Ethical and Religious Directives, they say they should not be forced to provide rape victims with emergency contraception because they believe contraception causes an abortion. In many Catholic hospitals across the country, women will only be given the EC after a pregnancy test has proven the victim is not pregnant. In other words, Catholic hierarchy is demanding that its care facilities not be subject to state laws and in many cases are non-compliant. If a provider or institution refuses to administer EC, it should be required to inform victims of the pill and give them a meaningful referral.

And an aside: these hospitals are tax exempt, receive 50% of their funding from the federal government, and serve pluralistic societies. If that's not federally funded discrimination, I don't know what is.

This is absolutely brutal: Massachusetts Dems have dropped a mail piece accusing GOP Senate candidate Scott Brown of wanting hospitals to turn away “all” rape victims.

The mail piece — sent over by the Brown campaign — shows pictures of women who are supposed to have been raped, one of them in a wheelchair bent over with her head in her hands. It says: “1,736 WOMEN WERE RAPED IN MASSACHUSETTS IN 2008. SCOTT BROWN WANTS HOSPITALS TO TURN THEM ALL AWAY.”

Click to enlarge:

The mailer — paid for by the Massachusetts Democratic Party — says the claim is based on “a law to let emergency hospitals turn away rape victims in need of emergency contraception.” That appears to be a reference to a Brown-sponsored 2005 amendment that would have exempted hospital personnel, on religious grounds, to inform victims of the availability of the morning after pill.

As Coakley’s own Web site says, after Brown’s amendment was rejected, he voted in favor of the bill to require emergency rooms to provide rape victims with emergency contraceptives, and the whole debate seems to be more nuanced than the mailer suggests.

The mailer could be related to the fact that internal Dem polling reportedly shows Coakley under-performing with less-affluent women.

******************************************

Update: Scott Brown and Republicans attack the Coakley campaign over the mailer.

Is It Legal? Catholic Mandate for Patient Care.

Bob Egelko at the San Francisco Chronicle has an article today that gets most things right.

The article's title, "New Catholic Mandate on Comatose Patients," is misleading. The mandate, Directive #58, applies not just to comatose patients but to all patients who are deemed by the church in need of the introduction of artificial nutrition and hydration (ANH) or who wish to have ANH removed, whether they be victims of a terminal disease, a tragic accident or old age. The Directive qualifies ANH, applied by a surgical procedure, to be "obligatory" care, regardless of the "do not resuscitate," advance directive or living will desires of the patient.

Egelko asks, "A Legal Conflict?" As we've seen with other patients' rights at Catholic hospitals, particularly women's reproductive rights, the church is shielded by a webwork of laws (provider refusals or so-called "conscience clauses") that allow not only individuals but institutions (even those with tax-exempt status, serving diverse communities and 50% funded by the federal government) to deny patient's their rights by either not informing them of common procedures, not referring them for such procedures, or simply not performing those procedures.

The conscience clause enacted by Bush 13 months ago is up in the air as the Obama administration reviews it. Fierce lobbying by (unregistered, unreported) Christian lobbying groups, such as the USCCB, which has a staff of 350 in Washington, are working around the clock to ensure that their health care entities are not regulated by the federal government - and can subsequently shape health care as they see fit. Beyond segmented patients' advocacy groups for elder and terminal rights, gay rights, and women's rights, there are few powerful entities within society that can stand up to the entrenched, well-funded, and influential medical or Christian lobbies.

Religiously-inspired conscience clauses have been challenged unsuccessfully in the courts but only on privacy grounds, not on Establishment, Equal Protection, or separation of church and state grounds. The courts, including the Supreme Court, have famously shied away from engaging "separation of church and state" arguments with regard to health care. The patients' rights movement has struggled for decades against the powerful medical industry and fundamental Christian forces. As patients' rights stand now, medical institutions and the Catholic Church enjoy much more protection and many more rights than the patient.

The solution that Lori Dangberg of Alliance for Catholic Health Care disingenuously offers is that patients who encounter a conflict with the Catholic institution where they are being cared for can be transferred. But anyone who has experienced the wasting and death of a loved one knows that Coombs Lee is right when she states, "[Patients and families are] very vulnerable to the kind of duress and shame that a policy like this would inflict."

We've seen the church use this tactic before with abortion, sterilization and other "shameful" women's services. Over the past 30 years women have been shamed out of hospitals, become accustomed to traveling for the services they need, or required to comply with the dictates of the Church because they lack the resources to go elsewhere. A network of clinics and independent reproductive service centers has risen up to serve those neglected by the Catholic and other discriminating hospital networks.

The end of life is a trying period for both patient and family. Because few Catholic hospitals readily provide patients with informed consent - and because the general population doesn't understand that Catholic hospitals restrict their care services according to doctrine - many patients and families find themselves in a situation where the advance directive is ignored and death is prolonged or futile care is applied when the patient doesn't want it.

It is nearly impossible for patients and their families to be savvy when they are typically encountering the Catholic medical system - or any medical system - for the first time. Doctors and medical institutions operate from a position of authority and vulnerable and distraught patients and families are often cowed into complying with such authority, against their wishes. For many, this experience of death is their first and they go into it without understanding how we die, what medical procedures are standard or necessary, and what a patients' rights are. Going against hospital policy takes tremendous knowledge and effort when in such a traumatic situation.

I'm tickled to see Egelko's article now. I hope it is a sign that the media is beginning to recognize the current discrimination in health care delivery. And I hope that it raises pressure on the church, the state, and the medical industry to better serve citizens.

The nation's Catholic hospitals, including three in the Bay Area, face a new religious mandate in the new year: to provide life-sustaining food, water and medicine to comatose patients who have no hope of recovery

The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses. Invoking a 2004 speech by Pope John Paul II, the bishops said Catholics must provide nutritional assistance to patients with "presumably irreversible conditions ... who can reasonably be expected to live indefinitely if given such care."

A previous directive let Catholic hospitals and doctors decide whether the burdens on the patient outweighed the benefits of prolonging life. The bishops said the new policy was guided by "Catholic teaching against euthanasia" and by John Paul's observation that providing food and water "always represents a natural means of preserving life, not a medical act."

The directive plunges the bishops into another health care controversy, on the heels of their lobbying for tight restrictions on abortion coverage in health legislation pending in Congress.

Catholic hospital officials say the November decree isn't rigid and leaves room for accommodating patients' wishes. But the bishops' language appears to conflict with a hospital's legal duty to follow a patient's instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient's intentions.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient's wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

A legal conflict?

The bishops' order "fails to respect settled law that empowers patients with the right to refuse or direct the withdrawal of life-prolonging care," said Barbara Coombs Lee, president of Compassion & Choices, which advocates for the right of terminally ill patients to make life-or-death decisions.

"It will apply irrespective of your religious faith, your stated wishes in an advance directive, or the instructions of your family."

That's not how the bishops' decree will be carried out, Catholic hospital organizations insist.

The decree itself does not require life-sustaining care that would be "excessively burdensome for the patient" or would cause "significant physical discomfort." If those exemptions don't apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the organizations said.

"If it was unresolvable ... we would transfer them or find some other means to accommodate them," said Lori Dangberg, spokeswoman for the Alliance of Catholic Health Care, which represents California's 55 Catholic hospitals.

The hospitals include St. Francis and St. Mary's in San Francisco and Sequoia Hospital in Redwood City, all owned by the Catholic Healthcare West chain. Dangberg noted, however, that such situations usually arise in nursing homes and other long-term facilities, rather than in acute-care hospitals.

Ethics considerations

The Catholic Health Association of the United States, which represents both hospitals and nursing homes, said a facility's ethics committee would probably meet with the doctor and the patient's representative to "explore the alternatives" whenever a patient's decision to withdraw life support clashed with Catholic doctrine.

"In some instances, this might include the transfer of the patient to another facility," the association said.

That's not an adequate option, even when non-Catholic health facilities are nearby and available, said Lee, of Compassion & Choices.

"These decisions are hard on the family," she said. "They have to muster their will and their courage to do what they know Mom would want or what the advance directive says.

"They're very vulnerable to the kind of duress and shame that a policy like this would inflict."

Pharmacists and the Conscience Clause: If You Don't Want to Deal With Complex, Messy Human Life, Then Please Don't.

From Britain's Independent, an article on the damages that a provider refusals there would cause:

This goes against the idea of the pharmacy as a great democratic space, where we can ask a neutral guide questions about how our bodies do – or don't – work, without feeling embarrassed or bullied. If we are to be kind to ourselves, we need somewhere to buy Imodium and Tampax and corn plasters without feeling marginalised.

Levonelle 1500, the medicine currently used in the UK for the morning-after pill, needs to be taken 72 hours after sex. So the clock is ticking. Unsurprisingly, calls for the "conscience clause" to be scrapped have come from pharmacists themselves as well as groups such as the National Secular Society. In response, the Council for Healthcare Regulatory Excellence, a government quango that oversees the health professions, is asking whether the practice should continue. The consultation, which ends on 12 January, is part of plans to set up a new General Pharmaceutical Council to regulate the profession.

Predictably, conservative campaigners (who range from anti-abortionists to members of the Church of England) are up in arms about the potential scrapping of pharmacists' "right to say no". Some evangelical types even reject the idea of making an immediate referral to an appropriate alternative dispensing pharmacy – to help the customer – because they argue it's the same as forcing them to fill prescriptions that violate their beliefs.

Yet whatever your conscience, you should not have the right to refuse to dispense the morning-after pill, or any form of over-the-counter legal contraception. We have rights and expectations as health service users. Any doctor or pharmacist who refuses is not doing their duty. It is not up to the prescriber, or the dispenser: the matter rests with the patient. We already have the most teenage pregnancies in Western Europe. I don't want more young women feeling confused and desperate, or having unprotected sex because they are too embarrassed to ask about barrier contraception. A fragile group, who may have other problems in their lives, need better access to information. Not less.

In an age of Tesco-ification and mega chemists, I feel passionately about supporting independent and family-owned pharmacies. I don't want us buying online from dubious pharmaceutical wholesalers in America because we are too embarrassed to walk into a normal shop. Or getting prescription pads on the black market because it cuts out the moralistic middle man – or woman.

Private faith matters. I'm sure many are inspired to join caring professions because of their own compassionate beliefs. But we need help, too. If you don't want to deal with complex, messy human life, then please don't. If the way we love and work – and build alternative families – offends you, please don't become a key service worker. A job in a registry office that conducts same-sex civil partnerships may not be for you. Don't open a hotel or a B&B if you think you will want to turn away certain sections of the community. And most of all, please don't become a pharmacist. It's a job I value far too much.

The Conscience of Pharmacists in the UK.

I don't know much about the profession of pharmacy. I have only used a pharmacist for various reasons related to birth control and I can't say I have an affinity for any I've encountered at the many drug stores I've been to around the world. I have gone to a pharmacy for one reason: to get the drugs a doctor has prescribed for me.

In the US we are waiting in a grey area for the US government to rescind the discriminatory Bush "conscience clause" that grants nearly anyone working in the medical profession to exercise their religious ideology to refuse services to patients. It's a horror for any woman to encounter government sanctioned discrimination for her lifestyle or reproductive needs and I hope the pressure being exerted by women's and patients' rights advocates will sway the Obama administration to deny those in positions of medical authority from abusing their power to impose sanctions on any one.

As we wait for a decision to come down here in the US, Britain is having its own battle over the exercised consciences of pharmacists. The Mail Online has a story about the questions the Council for Health Care Regulatory Excellence is asking about the continued practice there that religious ideology may be used to deny a patient a prescription for medication. From the article:

To alarm, however, the Council for Healthcare Regulatory Excellence, a Government quango that oversees the health professions, is asking whether the practice should continue.

Calls for the conscience clause to be scrapped have come from pharmacists as well as groups such as the National Secular Society.

But anti-abortionists are warning the code of ethics is in danger of being ‘hijacked by an anti-life agenda’.

The consultation, which ends on January 12, is part of plans to set up a new General Pharmaceutical Council to regulate the profession.

The Department of Health denied that Ministers, who have been struggling to bring down teenage pregnancy rates, had any role in the questionnaire.

Some experts have questioned whether the clause is ‘in keeping with the rising rights and expectations of Health Service users’.

The Church of England, however, says many Christians would wish for their right to refuse emergency contraception to be preserved.

Get that? Choosing to take birth control means you're "anti life." So who should best decide when you have children? Your pharmacist.

On the one hand, I feel strongly that no one should be required to perform a service that violates their religion. Yet, this right of conscience can't impede one's performance of a task that so deeply and personally effects other's lives. If pharmacies continue to staff employees who oppose performing even the most basic duties of their job - like filling prescriptions for birth control in any form - the pharmacy should also ensure that patients have access to an employee who will do their job.

And giving entire health care organizations the right to a conscience - as here in the US has led to the second largest provider of health care services, the Catholic church, doing so with unchecked discrimination against women, gays, and the elderly - is an unconscionable denial of patients' rights.

Watching the battle over pharmacists' consciences in Britain may help us to understand what comes for us here in the US. I've used a clinic for my reproductive health care since I returned to New York. Beyond the nasty picketers outside who assume that all clinic attendees are there for abortion, I find clinics better meet and understand women's needs now that shaming and discrimination have invaded hospitals and expenses have driven many of us on the lower income brackets away from private doctors. And I've given up on chemical birth control. Thirty dollars a month was just out of the question now that I work for myself.

But I was fortunate enough to have a $500 nest egg I could put down for an IUD. (Sterilization is still completely out of the question for single, childless women who don't want to have children but also don't deem psychological evaluation - a requirement for such women to receive sterilization, as if choosing not to have children makes you crazy - as a suitable requirement for such a reproductive decision.)

In other words, like millions of women who know what it's like to manage the hassle of doctors and pharmacists when earning little income, I've found another path to reproductive services. But I recognize that I'm privileged. Such policies as the US should strike down and the UK is reconsidering do the most damage to those who don't have the same privilege and resources that I do. Not only is allowing pharmacists to decide who has effective birth control discriminatory against those who don't hold such religious values, it perpetuates the class divide in this country that has kept women without the freedoms or privacy to make their own health care decisions - most often the very women who are economically, socially, and educationally most discriminated against in the first place.

Such policies shouldn't be upheld; they should be deemed illegal.

Louisiana Passes Conscience Clause (Provider Refusal) Bill.

There go patients' rights. From Louisiana Medical News:

BATON ROUGE- The LA Healthcare Workers Conscience Act, HB-517, passed late Wednesday afternoon.

Despite efforts to dilute the inevitability of the bill by pro-abortion pols, pro-life legislators fought off the attack against rights of conscience for ALL health care workers.

The bill had been amended days ago so that it only applied to public employees, but Sen. Amedee was able to strip that line from the bill today.

The LA House had originally passed the bill by a 2 to 1 margin of 65 to 33. The Senate followed last week and the final Senate-House conference overwhelmingly passed the conference bill 31-2.

Gov. Bobby Jindal, who has a strong pro-life record, has promised to sign the bill.

Aid in Dying and Health Care Reform.

Dr. Joseph Kincaid contests that the health care bill, as being debated by the senate right now, lacks the usual "pro-life" suspects. In some ways he's right. His desire, I would gather, is to impose greater restrictions on legal health care services in excess of existing Hyde guidelines. He also worries that Christian or "pro-life" providers won't be able to refuse services to patients' based on their (unrestricted, religious) personal views.

He's got other beefs too. To be clear, Kincaid wants to prevent or limit the the utmost legal services, in effect further eroding patients' rights to legal, ethical, moral, scientific health care treatments and information because he personally believes these patients shouldn't have them.

Get that? He knows what's good for you; he and others will decide what your moral health care decisions should be.

But I want to mention the funding issue he has with aid in dying, or assisted suicide. He writes:

The last area of concern is end-of-life care. On page 364, section 1553, there is a conscience clause protecting medical professionals who do not participate in assisted suicide. Reading between the lines, this means that the Senate bill has no prohibition on promoting assisted suicide or having it paid for under the plan. Also, in section 1323, page 186, a community health insurance option is prohibited from limiting access to end-of-life care. However, in Oregon, Washington, and Montana, assisted suicide is legally considered a form of end-of-life care. So the Senate bill would cover assisted suicide in these three states. Why is the Senate bill involved in assisted suicide? What medical treatment for the seriously ill is cheaper than the $100 cost for the drug that can be used in assisted suicide?

The Death with Dignity laws already allow doctors to deny patients' requests for assisted suicide. And the Assisted Suicide Funding Restriction Act of 1997 not only prevents federal funds from being used for AS but it prevents federal funds from being used by advocates of AS. In other words, his problem is not with existing law and the proposals in the health care bill. He's proposes use of the bill to further restrict the rights of those who request aid in dying.

This is not about reforming health care, really. Without a doubt this is about "pro-life" groups holding health care hostage unless they get to further limit the health services they ideologically oppose.

The Conscience Clause and Patients' Rights: A Notre Dame Panel.

Notre Dame's Observer reports on last night's panel held at the university titled, "What Would a Good Conscience Clause Look Like?: A Catholic University's Perspective":

Notre Dame, especially in light of lasts May’s Commencement address by President Barack Obama and the pro-life rallying that came with it, has delved into the political debate on conscience clauses and continues to examine the issue of abortion through intellectual dialogue. On Thursday, a panel of University professors addressed the position of the Catholic Church on the topic.

“We do not regard the intentional killing of human beings as heath care,” Orlando Carter Snead, associate professor of law at Notre Dame, said.

Snead, along with Margaret F. Brinig, professor of law and associate dean at the Law School and Fr. Michael Place, chair of the International Federation of Catholic Health Institutions, spoke Thursday at the McCartan Courtroom in the Eck Hall of Law as part of a panel discussion titled “What Would a Good Conscience Clause Look Like? A Catholic University’s Perspective.” The panel was hosted by the Task Force on Supporting the Choice for Life and the Notre Dame Law School.

Brinig initiated the discussion by focusing on the personal perspective of the woman.

In her extensive research, Brinig found that the most common denominator in abortion cases is a lack of support for the mother.

Brinig believes, therefore, that certain steps that must be taken to assist pregnant women.

“Preventive conscience clause … also need to be our concern,” Brinig said. Support, she said, can be offered “through prayer, service and sometimes financial help.”

Place followed Brinig and discussed the Catholic view of moral order.

“There is an objective moral order … an affirmative response to do good and avoid evil,” Place said.

He explained how this view is upheld traditionally in the Constitution.

“There are certain inalienable rights [for all human life,]” Place said.

Place also discussed the role of religion in society, citing the post-Vatican II stance on the state-religion interaction.

“Government ought to provide space for the free exercise of religion and the personal conscience of society,” Place said.

There are, he said, three principle ways religion influences a state: forming of conscience, advancement of society through institutional works and a shared moral vision.

Some people today, however, advocate for a greater separation between religion and government. And yet, Place said, even without religion, abortion is still wrong.

“It is not a religious obligation first, but it is a human obligation,” Place said. “Without life there is no society.”

In addition, Place warned of those who use language as a tool, citing the examples of classifying patients as consumers and abortion as a basic health right.

Snead concluded the panel and reiterated the two foundational premises of the pro-life argument: that all human beings are created equal and that life begins at the moment of conception.

Snead described how, under the new administration, government policy toward living embryonic stem cells has shifted from a policy of “neutrality to destruction.”

He said he is glad to be part of an institution that shares his view on the dignity of human life.

“It is my position that public funding should not be used to provide or subsidize abortion funding directly or indirectly,” Snead said.

The bold above is mine. Place argues that the role of religion - specifically Catholic religion - in society is to form a moral conscience. The state, he says, is then to enforce that moral (Catholic) conscience with law, to allow the church to provide institutionalized services that reflect their moral teachings. How does this represents separation of church and state? I think that actually, this is a fair description of how our society operates at the moment, particularly regarding health care.

The argument is often made, even by me, that the concept of a fetus as a human is a religious supposition. The motive that opponents of abortion have is protection of God's right to create life. The motive of abortion advocates is to protect the rights of a woman, a family, to decide when life is created.

The church has one objective: to end abortion or any other medical treatment that allows a woman and her family to determine when reproduction occurs. Restrictions to access for reproductive services at Catholic hospitals, lobbying to change state and federal laws and funding for such services, and the USCCB's meddling in health care reform all impede the rights of families, for the sake of God, one God, the Catholic or evangelical right God.

It is the motive which betrays any notion that this opponent to women's and patients' rights can be compromised. Nothing less than full compliance with Catholic law will do. Where do the rights of those who form their moral beliefs outside of Catholic teaching come in? They don't.

Bishop: Church Speaks with "Moral Voice" on Health Care.

In an interview with Minnesota Public Radio Bishop John Nienstedt cleared up a couple of issues for those of us who were wondering who defines our morality and controls our health care needs:

St. Paul, Minn. — Archbishop John Nienstedt reiterated the Catholic Church's opposition to any health care reform bill that would allow abortion coverage, in an interview with MPR's All Things Considered on Thursday.

Nienstedt, the archbishop of St. Paul and Minneapolis, called health care "essential for the human life and dignity of every person," but said the Catholic Church will not support health care legislation unless it meets specific church demands.

"I believe that health care reform is necessary," said Nienstedt. "I'm all in favor of that. The question is, What kind of health care do we want as a nation? And any health care program that would include the killing of the unborn is unacceptable."

Nienstedt said that parishioners should oppose any bill that allows abortion or euthanasia coverage, rations care for the elderly, or lacks a "conscience clause" to allow medical providers to opt out of performing abortions or other procedures they consider immoral.

The Catholic Church has attracted controversy for its lobbying efforts in the health care debate, particularly for its efforts to ban abortion coverage in public option insurance plans.

The U.S. Conference of Catholic Bishops sent a letter to U.S. senators in November urging lawmakers to oppose abortion coverage, provide coverage for illegal immigrants and expand coverage for low-income Americans.

"I don't see that as political muscle," Nienstedt said. "I think that's the moral voice of the church speaking."

What About Separation of Church and State?

Carole Joffe has a great post up at RHRealityCheck about the assertion of Catholic and evangelical groups that they have a justified role in delivery of social services. Her piece gets to the heart of the issue I've been ranting about for days: that these groups wish to continue the imposition of their ideological values while maintaining tax exempt status and receiving federal funding. Their argument is that they do so much for the nation that they can't possibly be ordered to comply with patients' rights. Joffe writes:

Most fundamentally, however, the Church’s recent political activism on both gay marriage and abortion raises disturbing issues about the current state of play regarding church/state separation in the United States. The U.S. is neither a “Christian nation” as fundamentalists like Pat Robertson have long-declared it to be, nor one where its citizenry should be ruled by Catholic teachings, as the Bishops appear intent on achieving. But evangelical Protestants have long been tied to the Republican party. With Democrats in power, the Catholic Church is inevitably more influential at this moment, given its historical support of many of the issues favored by Democrats (with abortion being a glaring exception). As if the coming deliberations in the weeks and months ahead over health care reform were not complicated enough, these negotiations also challenge the Democratic Party to reaffirm a strong commitment to church/state separation.

It's a great little reminder of how the Catholic Church is working to assert the myth that theirs is the moral position; that they do more charity work and more for the poor than anyone else. There's no ground for this when you're talking social services, particularly hospital care. Allowing them the moral argument gives them more credibility than they deserve and only enforces their continued encroachment on patients' rights.

Center for Reproductive Rights on Conscience Protections in Health Care Reform.

There are three main reasons that the conscience clause contained in section 1303 of the Senate healthcare reform bill – and not the conscience clauses in the House of Representatives’ version of the bill – should be included in the final bill:

First, the Senate bill puts women’s right to healthcare first without compromising conscience rights, while the House bill puts anti-choice ideology ahead of health.

Second, the Senate bill respects, and treats fairly, all viewpoints on abortion, but the House bill version would allow people to be discriminated against based on their viewpoint.

Third, the Senate bill is better because it provides more comprehensive protection for conscience rights than the House bill.

For more explanation of each point, go here.

Use of Your Conscience or Battery?

From Kmareka comes this Albuquerque case of a nurse/AP who "accidentally" removed a woman's IUD because she found the form of birth control to be against her own conscience:

I’ve been watching this court case move slowly through the system. A nurse is being sued because she pulled out a patient’s intrauterine device without permission, and then lectured her. An IUD prevents fertilization and alters the uterine lining to make it less receptive to sperm and implantation. This is what some define as abortion. In fact, some believe that the birth control pill is abortion, and there are legal strategies in progress to separate contraception from other health care and remove it from insurance coverage.

snip

She could have told her employer at hire that she had a list of birth control methods she personally found unacceptable, and would not cooperate in providing care that violated her standards. She could have refused to see the patient with the IUD, and claimed conscience and let another nurse or doctor see her. She’ll have a chance now to say in court whether she was acting on principle, or was just clumsy. Here’s some testimony…

From Courthouse News:

A clinic nurse first removed her intrauterine birth-control device without permission, the patient claims in a federal action, then told her that "having the IUD come out was a good thing," because "I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them."
The patient sued Presbyterian Medical Services Rio Rancho Family Health Center and nurse practitioner Sylvia Olona in Federal Court.
The plaintiff says she went to Rio Rancho to have the strings on her IUD shortened.
The complaint states: "As soon as Defendant Olona began speaking to (the plaintiff), she questioned her about her choice of contraception.
"As Defendant Olona began the procedure, (the plaintiff) felt Olona pull on the strings of the IUD. (The plaintiff) felt a distinct pulling on the strings followed by a sharp pain in her uterus similar to a very strong menstrual cramp.
"As that happened, Defendant Olona stated, 'Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.' She then explained, 'I cut the string than went back and gently pulled and out it came. It must have not been in properly.'
"Olona then stated, 'having the IUD come out was a good thing.' She asked (the plaintiff) if she wanted to hear her 'take' on the situation. Without receiving a response, Defendant Olona stated, 'I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.'
"Defendant Olona stated, 'Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it's not true, they accidentally come out when I tug.'
"At this point, Defendant Olona advised that (the plaintiff) needed to take a pregnancy test. (The plaintiff) did, and the test was negative.
"Defendant Olona told (the plaintiff) that is was better that she did not have the IUD because she could now use a "non-abortion" form of contraception. Defendant Olona suggested the deprovera (depo) [sic] shot or the pill, and made clear that she would not insert a new IUD."
The plaintiff demands damages for battery, constitutional violations and negligence. She is represented by Ryan Villa with the Law Office of Robert Cooper.

Kmareka concludes:

The thing about conscience is that good people can disagree in important matters. I do think that medical people have a right and necessity to follow their conscience, but they have an obligation to be truthful to their patients. They do not have a right to impose their beliefs on people who are trusting them to provide care. If they need to opt out, they should make sure the patient has an alternative. Because she has a conscience too. And it’s her life and body on the line. Doctors and nurses have no right to sabotage medical procedures from some notion that they know better than the patient.

UPDATE: Apparently the case was settled out of court. Darn. I was wondering what Nurse Olona, (or Physician’s Assistant Olona in some news accounts) would have said with her hand on the Bible.