Doctors Are Not Judges

I was browsing my Twitter feed this afternoon, looking over messages being posted from conferences occurring around the world I am interested in for the medical knowledge, advice for health care providers and trainees, and general uplifting ideas being shared. Suddenly, I saw a headline from The Atlantic on my feed I could not believe.

When Doctors Refuse to Treat LGBT Patients

Now, even without reading into the details of this news story, I can assure you that as a physician, there are very few situations when it is ethically or legally acceptable for a physician, nurse, nurse practitioner, physician assistant, or other health care provider to refuse to provide medical care to a patient.

As an Emergency Medicine resident myself, if a patient is threatening physical violence toward myself and my staff, if they are brandishing weapons, or endangering other patients, colleagues, or me, legal justification may support my decision to not treat them until the situation can be deescalated.

I have spent the past 13 years of my life training toward becoming a physician. At every step of the way, I learned that by becoming a physician, I make sacrifices. Many already are aware of the monetary and time sacrifices that many health care providers make in order to gain the expertise and training necessary to provide quality medical care.

Delivering medical care is a privilege, not a right.

Receiving medical care is a right, not a privilege.

According to The Atlantic article linked above, in Mississippi and Tennessee, laws have now been passed by legislature which makes it “legal for doctors, psychologists, and counselors to opt out of any procedure or choose not to take on any patient if doing so would compromise their conscience.”

There are numerous ethical dilemmas and consequences that arise from such laws.

First, physicians, who I can speak for as a physician myself, are trained and ethically taught to provide quality medical care regardless of our own beliefs, values, or ideals. For example, no one would allow physicians to decide not to provide care to a potential patient on grounds of race, gender, or age. Furthermore, as an Emergency Physician, I am bound by the Emergency Medical Treatment and Labor Act, a federal law which expressly prohibits a hospital, or the physicians providing care in them, to refuse medical treatment to anyone on the basis of financial ability to pay or not pay.

The laws in Mississippi and Tennessee are now permitting physicians, as well as psychologists and counselors, to refuse to provide medical care to individuals based on anything which goes against their conscience. That is in direct contradiction on moral and ethical grounds to what it means to be a physician.

Second, the problem with such laws is that they are extremely vaguely written. Picture the scenario below.

I am a physician in Mississippi. A patient presents to my facility who expresses to me views which I do not personally believe in. He tells me he thinks all Hindus should be sentenced to death. As a Hindu myself, this patient offends me, and goes against my own beliefs. Under the new law, I am now legally permitted to tell this patient I cannot provide them medical care. They will have to look elsewhere for treatment.

Imagine what you would feel like if your medical provider decided to refuse treatment to you based not on any scientific reason, but simply because they did not agree with your particular beliefs. Imagine how you would feel if you took your wife or your daughter to an OB/GYN because she was pregnant and needed prenatal care, only to find that your loved one cannot be treated because of their sexual orientation, their religious beliefs, or literally anything at all that might go against the physician’s “conscience.”

Furthermore, if Mississippi enforces these laws and allows physicians, psychologists, and counselors to decide when and why they may not want to deliver medical care, it will become increasingly difficult for citizens to receive medical care. It’s possible that if the patient holds a belief, religion, or other ideal that caregivers in the area do not agree with, they will certainly have decreased access to medical care.

This situation is in direct opposition to efforts such as the Affordable Care Act, which are attempting to make access to medical care easier. As a nation of Americans, we must take a step back from the situation and decide what kind of country we want to be. It has become popular, as Donald Trump has exemplified, to be bigoted, hateful, and discriminatory.

It has become acceptable, apparently, to pass laws to limit access to vital and crucial medical care like what happened with Planned Parenthood affecting millions of women this year. It has become acceptable, apparently, to pick and choose which Americans individuals, organizations, and now, medical providers can discriminate against. It has become acceptable, apparently, to base an entire political campaign on the grounds of discrimination, bigotry, and open hostility toward particular citizens of our nation.

America, we have to take a hard look at ourselves right now. This cannot wait. Who are we, as a society? The rest of the world is laughing at us. A nation founded on the noble concepts of the rights to life, liberty, and the pursuit of happiness is now segregating using conflicting value systems and discrimination. Our founding fathers established the United States of America not with the intention that one day, specific populations of people within our borders, who live alongside us, who deliver our medical care, who sell us our groceries, would be declared unworthy of the same rights and freedoms we all share. The men and women in our armed forces, and their families, do not sacrifice their lives for us to defend hatred, discrimination, or bigotry.

I implore you, if you believe in America, if you love your country and your countrymen and women, speak out against laws, organizations, and political parties which threaten the values that define who we are. I beg you, as a citizen of the United States born and raised within the confines of this nation, as a contributing member of society with love for all individuals around me regardless of what they believe in or look like, do not allow America to become a country defined by hatred or discrimination.

Save America. Save her, for your families, for your children, and for our future.