Charo cites collision of rights - patient vs. provider

By LaKisha Ladson

Addressing attendees recently at the Daniel W. Foster, M.D., Visiting Lecture in Medical Ethics, bioethicist R. Alta Charo posed a number of questions:

  • What if the patient is a woman who wants an abortion or a referral to a doctor who will do the procedure?
  • What if the patient is a single woman who is seeking birth control?
  • What if a lesbian couple is seeking treatment for infertility?

R. Alta Charo

Moving past those gender-specific questions, Ms. Charo, a senior adviser to the Food and Drug Administration and the Warren P. Knowles Professor of Law and Bioethics at the University of Wisconsin at Madison, had more pointed queries:

  • Is it professional to refuse to perform a medical procedure?
  • Is it ethical, for moral reasons, to refuse to inform a patient about all medical options?
  • If a medical treatment could be performed and it’s not, should there be consequences?
  • Ms. Charo, who has had a number of papers published in The New England Journal of Medicine and was a member of the national bioethics advisory commission under President Clinton, laid out a history of the debate over women’s reproductive rights.

She also asked her audience to consider what might really be driving the debate.

The first procedures doctors felt they had the right to refuse, she said, were abortion and sterilization. Since the 1970s, the number of situations that patients — and especially women — have had to deal with has grown, creating “a kind of concrete distress for patients as they try to negotiate a system in which professionals are acting simultaneously as their own individual selves and as the purveyor of what is essentially a public service.”

Refusals have expanded in four ways, Ms. Charo said:

  • Laws now protect professionals such as nurses, pharmacists, orderlies, medical transcribers and ambulance drivers who refuse to provide assistance.
  • Health care workers have refused to provide emergency and ordinary contraceptives, infertility treatments, therapies that involve the use of embryonic stem cells at any point and end-of-life therapies.
  • In addition to refusing to provide specific treatments, some doctors have refused even to provide information about such treatments because they believe doing so makes them complicit in behavior that they consider immoral.
  • Health care workers now have freedom from any form of professional discipline for refusing to provide treatment, even if their behavior violates the code of ethics of their professional group. Further, they can’t be reassigned, fired, denied a promotion or sued for malpractice.

The medical profession, Ms. Charo said, hails from a noble professional code of self-sacrifice to put the patient first. That is why doctors in the past made house calls, got up at 3 a.m. to see patients and accepted chickens for payment.

Urging her listeners to consider who is affected by the current debate, she said she has yet to hear of a man being required to present a marriage certificate in order to fill a prescription for Viagra, or of a man being denied the drug even though it might make him more likely to engage in sex outside of marriage.

Both those arguments have been used to deny contraceptives to women.

“In the world of health care, these so-called ‘claims of conscience’ come exclusively in women’s and reproductive rights,” she said.

Ms. Charo said that providing health care should be viewed as a public service. For that reason, the rights of patients and the rights of the health care professionals should not necessarily come into conflict.