Monday, August 25, 2008

Religion and Discrimination in Healthcare

(Note: This is my fifth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

A San Diego fertility clinic that refused to provide artificial insemination to a lesbian woman based on her sexual orientation has tasted defeat at the hands of the California Supreme Court.

Guadalupe Benitez was denied insemination by two doctors at the North Coast Women's Care in Vista, California, after being told by the doctors in question that their Christian values would not allow them to artificially inseminate a lesbian. In later testimony, the doctors stated that they simply would not perform the procedure for any woman who was unmarried, despite her sexual orientation.

While a state appeals court did indeed rule in favor of the doctors' rights to refuse to treat based on sexual orientation or marital status, the California Supreme Court overturned that ruling by citing The Unruh Civil Rights Act, which prohibits discrimination by any business---including medical facilities---based on gender, sexual orientation, religion, and many other protected categories.

An editorial in the Los Angeles Times praises the decision, while also citing disturbing statistics that many states actually have legislation in place protecting doctors' rights to deny patients treatments or services that they find "religiously objectionable". The LA Times also shares the results of recent studies revealing that 14% of doctors polled stated that they would deny certain treatments to certain individuals while refusing to provide viable alternatives or referrals for such care, if confronted with a situation at odds with their religious convictions.

In reaction to the ruling, the Los Angeles Times editorial states:

"The tradition of religious freedom in the United States is one of the founding ideals of this country. But as our framers envisioned it, religious freedom referred to a right to practice one's own religion free of interference from others. It did not refer to religiously based interference with the rights of others, who may have their own and different religious traditions. Even in the relatively religiously homogeneous era of the framers, such interference was not acceptable. It is even less so in 21st century America. With religious heterogeneity growing, the devotional demands of one group may be increasingly at odds with those of others.

"Yet too often, our deference to religion in contemporary American society has allowed us to subordinate all other values. It has allowed us to routinely accept religiously motivated behaviors that we otherwise would have no reluctance to sanction and that, indeed, would be impermissible with any other justification.

"So it's time to say 'enough.' In the United States, we all are free to practice our religion as we see fit, as long as we do not interfere with the well-being of others by imposing our religious views on them. If physicians or other healthcare providers who have religious objections to legal medical treatments will not at a minimum inform their patients about those treatments and refer them to others who will deliver them, they should act in a way that is consistent with their convictions and the well-being of their patients and find other professions.
"Freedom of religion is a cherished value in American society. So is the right to be free of religious domination by others."

I could not agree more with the statements by the LA Times editorial team. While I wholeheartedly respect the beliefs and values that guide any individuals' life, doctors and medical personnel hold an oath to first "do no harm", and I believe that "harm" includes refusal to provide care to another human being based upon discrimination, potentially leaving that individual without recourse or alternative affordable options for such care. Even though in vitro fertilization is indeed an elective procedure which does not have life-and-death implications per se, it is the principal of the matter that lies at this heart of this case.

As the LA Times stated in yet another editorial: "A clothing store may choose not to sell polo shirts. But once it sells polo shirts, it cannot withhold them from customers based on their race, religion, sexual orientation and so forth." Taking into consideration that medicine is also a business, following the letter of the law, a business must abide by anti-discrimination laws when serving consumers of any class, group, or minority, regardless of the feelings or values of the business owner or operator.

Now, doctors can still indeed refuse to perform abortions, in vitro fertilizations, or any other manner of procedure that does not fall within the bounds of their personal moral compass (just as the aforementioned clothing store can choose to not sell polo shirts). However, following non-discrimination laws, if they choose to offer a procedure to their patients, then it must be offered equally to all, not solely to select groups who meet the doctors' criteria for moral righteousness.

While some may argue that the refusing doctors did, after all, refer the plaintiff to another provider who eventually performed the procedure (and apparently incurred the costs that the patient would have paid in higher fees to the other provider), it is easy to imagine other less fortunate patients being sent on a wild goose chase, seeking medical care that was consistently denied to them based on some aspect of their beliefs or lifestyle.

The California Supreme Court obviously felt that this case had much broader implications beyond fertility and in vitro insemination. With this decision, the court decided to send a clear message that protection against discrimination based on sexual orientation and marital status is just as crucial as protection against discrimination based upon race or gender. If this case had been decided differently, perhaps we would then begin to see further erosions of the rights of gays and lesbians in all manner of areas of legal, medical and commercial transactions.

I am certain that this issue is not going away, and that proposals and ballot initiatives striving to ban gay marriage entirely will surely gain moral steam in reaction to this decision. However, the California Supreme Court has taken a stand, and I personally feel that their choice to rule in the plaintiff's favor, however controversial, will stand the test of time and further appeal.
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