PAs and Religion

[Guest JMPA]

A very ill elderly couple in my community committed suicide together. Married for 67 years, they wrote a letter describing their choice, dressed in their Sunday best, parked on hill watching the sunrise and died together. I did not see tragedy in their death, I saw love & compassion.

 

Physician assisted death is a very strict process. Palliative care and hospice care may be the more appropriate choice for many who must face such situations. But I do believe people should have the choice.

 

 

 

And I don't think that you should ever have to. Your beliefs should be protected and you will never have to write a script for someone wishing to end their own life. But should that choice be denied to others with different beliefs from you?

 

Even in the teachings of Judeo-Christian religion, "thou shalt not kill" is not an absolute. War, self-defense, and mercy killings are all prescribed exceptions in various historical and religious teachings.

 

I find it hard to support the taking of human life in some contexts such as for war or capital punishment while absolutely opposing it in others such as mercy/suicide.

You are wrong, the correct interpretation is "thou shalt not murder". 

[rev ronin]

There is nothing wrong with inserting your religious faith into your practice, but if a patient desires something that is a legal service and you won't provide it, you have an obligation to refer them to someone who will.

Actually, no.  If a provider legitimately believes that abortion ends a human life, then in case of an elective abortion, such a provider has an obligation to *not* make such a referral.

 

Referring is fine for things that are against the provider's belief system and medically neutral.  I might refer to another provider if asked to provide a prenuptial virginity certificate.

 

But when the process itself is, per one's own belief system, medically incompatible with the health and well being of all affected parties, referring for the process is complicity in the harm.  For example, if asked to perform a female genital mutilation, I would instead call our mandatory child abuse reporting hotline, and would never, ever assist the requester to find a medical provider willing to perform such an operation.

[rev ronin]

The same Greeks who developed the Hippocratic Oath also practiced abortion, infanticide, and mercy killings. Yes the physicians, not just random people.

Of course they did.  Every rule ever made has someone's name invisibly attached to it: someone did something wrong, so the rules had to be made to prevent future wrongs. The clause in the oath is significant because in a world that had no problems with slavery or many other things we find morally repugnant today, it was already recognized how important it was to keep the doctor's role separate from the executioner.

[PACdan]

You are wrong, the correct interpretation is "thou shalt not murder". 

 

Yes, as defined in Hebrew the word for murder means deliberate killing. So all the things I mentioned; from war and capital punishment to mercy and suicide.

 

We're leaving out the purely accidental killings like "I slipped and dropped the Ox cart on my neighbor". 

 

Thank you for your contribution though.

 

 

Of course they did.  Every rule ever made has someone's name invisibly attached to it: someone did something wrong, so the rules had to be made to prevent future wrongs. The clause in the oath is significant because in a world that had no problems with slavery or many other things we find morally repugnant today, it was already recognized how important it was to keep the doctor's role separate from the executioner.

 

I would be completely fine taking the role away from the physician. Create an independent role with enough knowledge to look at a person's medical records, prognosis, and evaluate their request objectively enough to say "Yes, let this person have access to a means to pass away peacefully if they choose so" or no.

 

It's simply a better choice than telling them "You must gasp for every agonizing last breath until you die, despite the best pain management, because that is what I believe". It's about giving them choice and control in their final moments of life. The bridges and the guns still exist, but that's truly horrifying. Drinking a glass of bitter liquid and going to sleep sounds much better.

 

I don't believe it will open up a world of Futurama-esque Suicide Booths. Most people don't want to die, they want to live as long as they can. But should we ignore those who are truly suffering and quite ready to die, because we don't understand it? Or because it does not fit in with our beliefs structures?

[LT_Oneal_PAC]

Actually, no. If a provider legitimately believes that abortion ends a human life, then in case of an elective abortion, such a provider has an obligation to *not* make such a referral.

 

Referring is fine for things that are against the provider's belief system and medically neutral. I might refer to another provider if asked to provide a prenuptial virginity certificate.

 

But when the process itself is, per one's own belief system, medically incompatible with the health and well being of all affected parties, referring for the process is complicity in the harm. For example, if asked to perform a female genital mutilation, I would instead call our mandatory child abuse reporting hotline, and would never, ever assist the requester to find a medical provider willing to perform such an operation.

Straw man argument fallacy. Genital mutilation is not a legal service and does not fall under my statement. Denying access to care is, in my opinion, infringing on another's rights. May not be to you. Agree to disagree. If you would like to debate it further, I recommend not using scare tactics and hyperbole to distort my meaning.

[LT_Oneal_PAC]

Also, I'm not debating abortion, euthanasia, or anything else. I have my opinions. They are mine and I've long given up debating them. The world will be what it will be and I will continue to be what I am.

[akdEM]

Agnostics/atheists forget that the foundation of western ethics and culture flows from Judeo-Christian religion.

 

I think most agnostics and atheists would argue that you are working from a false premise here by implying that ethics flow directly from religion. Sure, they influence one another, but they can exist totally separately as well.

 

What ethics are you referring to in this thread that are specifically western anyway? The belief in the sanctity of human life and the idea of "do no harm" are not unique. You don't have to accept Judeo-Christian religion to hold those beliefs.

[rev ronin]

Straw man argument fallacy. Genital mutilation is not a legal service and does not fall under my statement. Denying access to care is, in my opinion, infringing on another's rights. May not be to you. Agree to disagree. If you would like to debate it further, I recommend not using scare tactics and hyperbole to distort my meaning.

No, actually, it's not.  It's a culturally expected service in some cultures represented in America's immigrant population, not explicitly outlawed in most states.  It's real, and I picked it because I think it less divisive than abortion--I don't know anyone here who thinks removing a clitoris to deny a young girl sexual pleasure throughout her entire life is actually a good idea, hence using it as an example to build common ground and understanding.

 

You think FGM is not care, and denying access would not be at all inappropriate.  I agree.  What I urge you to consider is that to those who consider life beginning at conception, abortion services of any sort have that same level of inherent opposition.

 

Again, no scare tactics, no hyperbole, just a realistic thought experiment.  I don't expect anyone to change their minds, but I hope to build bridges and understanding about what really matters to some providers based on their personal belief systems.

[db_pavnp]

Slippery slope arguments are never fallacious arguments when it comes to societal discussions.

 

Very funny, dude.

[LT_Oneal_PAC]

No, actually, it's not. It's a culturally expected service in some cultures represented in America's immigrant population, not explicitly outlawed in most states. It's real, and I picked it because I think it less divisive than abortion--I don't know anyone here who thinks removing a clitoris to deny a young girl sexual pleasure throughout her entire life is actually a good idea, hence using it as an example to build common ground and understanding.

 

You think FGM is not care, and denying access would not be at all inappropriate. I agree. What I urge you to consider is that to those who consider life beginning at conception, abortion services of any sort have that same level of inherent opposition.

 

Again, no scare tactics, no hyperbole, just a realistic thought experiment. I don't expect anyone to change their minds, but I hope to build bridges and understanding about what really matters to some providers based on their personal belief systems.

Find a place that performs genital mutilation in America and I'll consider your argument valid. And it doesn't build common ground, it causes more divide. You are making a comparison of someone having an abortion to a male parental figure forcing their child, without consent, to a disgusting procedure that, while maybe not explicitly allowed, isn't legal. If you could call CPS on them, it isn't legal.

 

I started to write a lengthy response, but then I remembered: not my monkeys, not my circus.

[LT_Oneal_PAC]

And let me be clear that I'm taking about emergencies here. Elective procedures allow for plenty of time for them to find other care.

[cinntsp]

Medicine is one of the many places where religion doesn't, or rather shouldn't, have a place in my humble atheist opinion.

 

Sent from my Nexus 5 using Tapatalk

 

 

[rev ronin]

 If you could call CPS on them, it isn't legal.

Not true.  I've already decided that if I run across total anti-vaxx parents--you know, those who skip the vaccines prone to saving life and limb--my ethics compel me to report them to the state, because the reporting statute is based on SUSPECTED medical abuse or neglect.  I can call CPS, knowing full well that what is being reported will generate no investigation at all, because my belief system about what constitutes medical neglect is more strict than the current consensus.

[Belladinotte]

Medicine is one of the many places where religion doesn't, or rather shouldn't, have a place in my humble atheist opinion.

 

 

 

Sent from my Nexus 5 using Tapatalk

Thank you Chris! Agreed and happy to hear it from others in the field.

[rev ronin]

You are making a comparison of someone having an abortion to a male parental figure forcing their child, without consent, to a disgusting procedure that, while maybe not explicitly allowed, isn't legal.

Yes, I am, and on purpose. But we can drop that and go with something else if you prefer:

 

Patient: "I'd like you to help me kill someone"

Provider: "I'm sorry, that's not a service I provide"

Patient: "Then you need to refer me to someone who WILL help me kill someone"

Provider: "..."

 

To a provider who believes life starts at conception, anything that prevents a fertilized egg from implanting is morally equivalent to killing a living, breathing child.  You don't have to agree with that, and many of the people posting here don't and won't ever agree with it, but in order to have a realistic discussion of provider obligations to meet patient requests, it would be really helpful to have general acknowledgement that that is, in fact, how a fair number of people feel.  I haven't heard any such acknowledgement from you, and I'd be interested in hearing how you'd square the "must refer to another provider" stance with "folks really do believe that would be morally equivalent to taking a life".

 

But I think I've repeated this enough, if not more than enough, in these threads. Those of you who want to learn from others' perspectives will have already done so, and those of you who choose not to, will not.

 

[LT_Oneal_PAC]

Not my pig, not my farm.

[PACdan]

Rev ronin,

 

You'd shied away from the suffering, dying patient question. Abortion is a separate life that others are making choices for, used in your examples. But what of the terminally ill, greatly suffering patient who wants to end THEIR own life?

 

Would you not refer them, if they somehow came to you? (Assuming legality in your state practice) Would you offer them no help at all because of what they desire for themselves?

[Boatswain2PA]

Rev - You gave numerous analogies to prove your point. Unfortunately some people are so intransigent in their belief that THEIR belief system is the right one so all others must be wrong.

 

Again, it is funny how the left is now the intolerant side of the spectrum.

[Belladinotte]

I would argue that denying access to contraception is much more intolerant than the "left" who allow patients to make their own informed decisions regarding their own bodies.

[rev ronin]

Rev ronin,

 

You'd shied away from the suffering, dying patient question. Abortion is a separate life that others are making choices for, used in your examples. But what of the terminally ill, greatly suffering patient who wants to end THEIR own life?

 

Would you not refer them, if they somehow came to you? (Assuming legality in your state practice) Would you offer them no help at all because of what they desire for themselves?

Sorry, hadn't shied away from it on purpose, just had to deal with a lot of other things in between posting here (busy night at the fire station...)

 

Hospice providers routinely provide large enough amounts of narcotics to mask a patient's physical pain, that, if taken all at once, would lead to respiratory arrest.  As well they should, because the primary purpose and prescribing goal is amelioration of suffering.  At the point where, for example, my patient decides to take all of the meds I prescribed for them at once, that's their choice for their own life--the narcotics had a legitimate use, and a suicidal use, much like firearms do.  They chose the latter? That's their call.

 

But I'd never prescribe medications that had ONLY the purpose of ending a life, which is what my state's 'death with dignity' act specifies. Nor would I prescribe an amount of narcotics out of step with the physical pain.

 

So, if a cancer patient of mine wanted to accelerate their demise, I would be passively involved in that by virtue of appropriate narcotics prescribing, but if they were interested in dying before they got to the degenerative stage of a fatal disease without a major pain component (e.g. Huntington's), then they'd be hard pressed to get me to help them.

[rev ronin]

I would argue that denying access to contraception is much more intolerant than the "left" who allow patients to make their own informed decisions regarding their own bodies.

The problem with that statement is that no one is denying anything to anyone.  Patients can seek out providers willing to do what they want them to do--doctor shopping happens all the time.  If I decline to do something on behalf of a patient, then they can go find another provider if they choose.

[PACdan]

Again, it is funny how the left is now the intolerant side of the spectrum.

 

I never got the whole "left v. right" thing. It must be more relevant to the older generations.

 

Most of my peers, that I know personally, tend to form opinions based on individual issues, rather than subscribing to broader political or ideological platforms.

[Boatswain2PA]

I would argue that denying access to contraception is much more intolerant than the "left" who allow patients to make their own informed decisions regarding their own bodies.

 

 

Like Rev said, a single provider not writing a script (or performing an abortion, or performing FGM) is not personally denying that patient access.  The patient can go find someone else.

 

Kinda like the Christian baker who refused to put his artwork in a gay wedding.  He in no way denied that couple a cake.  He just chose not to be part of it.

 

Don't you think it is more intolerant to FORCE someone to do something they feel is morally wrong?    If you don't feel that way, then I suggest you look at areas of the world that are truly intolerant.  There ARE cultures in this world where young women are forced into FGM, where they are forced into arranged marriages, where they are not allowed to go to school, or drive, or leave the house without a male family member.  There are places in the world where Christians are marched to the seashore and beheaded simply because they are Christians.  There are places in the world where homosexuals are thrown from rooftops simply because they are homosexual. 

 

THAT is intolerance, and it is not found anywhere in America (except for some small enclaves of immigrant culture where these actions carry over).

 

INTOLERANCE would be a provider who doesn't just choose to not write the script, but instead pulls that patient into the public square and whips them. 

 

INTOLERANCE would be shutting down a business simply because the store owner did not agree with your political or social beliefs. 

 

The Christian store owner tolerated the homosexual couple, he just refused to do business with them.  The homosexual couple was INTOLERANT of the existence of a Christian store owner, so sought to shut them down. 

 

 

I never got the whole "left v. right" thing. It must be more relevant to the older generations.

 

Most of my peers, that I know personally, tend to form opinions based on individual issues, rather than subscribing to broader political or ideological platforms.

Please forgive me if this comes across as a personal attack, because I really don't mean for it to be one....but maybe that's because you (and many of your "generation") have not been exposed to anything other than liberal ideology.   Well, you probably have been "exposed" to conservative/right wing ideas, but only as a classroom example of what is "bad". 

[PACdan]

Please forgive me if this comes across as a personal attack, because I really don't mean for it to be one....but maybe that's because you (and many of your "generation") have not been exposed to anything other than liberal ideology.   Well, you probably have been "exposed" to conservative/right wing ideas, but only as a classroom example of what is "bad". 

 

Oh no, not at all, I've had plenty of exposure to both. I hold some beliefs that are considered traditionally "conservative" and some that are "liberal". My point being, I feel that my generation is less likely to toe a party line and subscribe to all the "traditional" values of that grouping just because, be it conservative or liberal as you say.

 

More emphasis on free thought, less on conformity.

[PACdan]

INTOLERANCE would be shutting down a business simply because the store owner did not agree with your political or social beliefs. 

The Christian store owner tolerated the homosexual couple, he just refused to do business with them.  The homosexual couple was INTOLERANT of the existence of a Christian store owner, so sought to shut them down.

 

The problem is not where the owner's objection stems from, but that fact that he is running a public business.

 

Under that logic, the owner of a public business should be allowed to tolerate a black or interracial couple, but also be able to refuse to do business with them. Regardless of where his beliefs stem from.