Thursday, April 29, 2004

first, do no harm

As if I needed more proof that Michigan is becoming ever more terrifying, a few nights ago I learned of four pieces of legislation that have passed the State House. Taken together, they would form the Conscientious Objector Act, and they could literally be deadly.

Here's a link to the Michigan Legislature and HB 5006, with fiscal analysis and all that good stuff. And here's a simplified version of what the bills would do, from the Detroit Free Press.

Now, the Conscientious Objectors these bills would empower aren't trying to avoid serving in the military--they're medical personnel, and the definition of such is very, very broad--who for one reason or another do not wish to perform a procedure, administer a drug or test, or perform medically-related research. The reasons given as acceptable under the bill's language are ethical, moral, or religious objections. A health worker also cannot deny lifesaving service, under this act, but there's a loophole involving the presence of an attending physician. And if an employee of a healthcare organization objects to something that comprises 25% or more of their work obligation (counted as hours), they can be fired--but they must be given at least two months' notice. There are other protections and caveats, but these are the bare bones.

What is not so clear is what protections are available to patients. Although these "conscientious objectors" cannot refuse to treat patients on the basis of race, gender, religion, or national origin, that's only because these are protected classes established by the Eliot Larson Act.

Eliot Larson has no clauses regarding gay folk. Or the indigent. Or the incarcerated. Or the mentally unhinged. So conceivably, a pharmacist could refuse to fill a prescription for Acyclovir if she did not approve of her customer's homosexuality--or perceived homosexuality. A prison doctor could choose not to treat a man convicted of murder, which is doubly wrong considering the too-high rate of false convictions. And what of the homeless, particularly the mentally ill among them?

And the related question is this: How could a court prove that a CO wasn't really operating from bias based on race, color, gender? A clever enough defendant could claim some other reason for choosing to withhold treatment. This slope is far too slippery, even for those classes of people it supposedly won't affect.

I can see only one bright thing about all this, which is that people who oppose animal testing could not be forced to participate as part of their employment. But then again, jobs that involve animal testing are usually pretty upfront about that aspect. It's not like you sign on to be a nurse in the maternity ward, and suddenly you're injecting red-eyed little mice with botulism. The point holds across the spectrum of medical practice. Job hunter, beware! If you're opposed to doing certain procedures (abortions being an obvious example), well, don't go looking for a job at Planned Parenthood, for cryin' out loud.

Where and when did the Hippocratic Oath get misplaced? My father's old high school buddy, who flew in from California with his wife to see us last weekend, was standing behind me reading a printed-out email about this legislation. He's a neurologist, and by the time we got done reading, he was nearly jumping up and down and waving his fists. This sort of "pick and choose who you want to treat" idea ran completely counter to his understanding of his responsibility as a doctor.

Welcome to Michigan was, sadly, all I could offer in the way of explanation.