Monday, April 24, 2006

First Do No My Personal Values

This is one of those stories that really bugs the crap out of me. Like Carla, I have a relatively strong libertarian streak in me, and so when I heard last year about pharmacists refusing to dispense birth control pills or the "morning-after" version, I figured that on balance they probably should have that right. It concerns me that you might be able to opt out of duties that are specifically germane to the performance of your job--in this case, dispensing medication--but as long as the pharmacy in question has someone on staff who WILL dispense it, or at the very least will direct the customer to a pharmacy that will, I think we can tolerate conscientious objection on that score.

Key to that agreement is that while the medical professional is afforded his or her right to abstain on religious or moral grounds, the customer must also have his or her right to obtain legal medication protected. Which is why Friday's Trib article on OHSU professor/family doctor Bill Toffler pisses me off: not only does he refuse to help his patients with abortion, or birth control, or assisted suicide, he also refuses to direct them to doctors who will.

Bluntly put, who the fuck does he think he is? He may answer to God, but someone decidedly more tangible is signing his paychecks--us. OHSU is at least in part a state-funded institution, remember, one that serves quite a few patients who receive care there because their insurance options are sorely limited, and thus don't necessarily get their pick of doctors and pharmacists. Why on earth should OHSU let individual health care providers essentially pick and choose which professional duties hospital staff will perform?

Sanely, they don't. Institutional ethics committee chairman Gary Chiodo is pretty clear in the article that what Toffler is doing is verboten:
OHSU’s policy on conscientious objectors focuses on a couple of fundamental principles. OHSU employees will not be required to participate in procedures that come in conflict with their own beliefs.
But even conscientious objectors cannot refuse “indirect involvement” in procedures, according to the policy. Indirect involvement can include necessary care and comfort that patients may require, and also referring patients to other practitioners. And that just happens to be where Bill Toffler draws his line.
“Providers have a monopoly,” Chiodo said. “The patient can’t go to some other profession and get this. If a patient requests medical service, the policy says you don’t have to be directly involved in delivering it, but you do have to refer the patient to somebody else.” That, it appears, is where OHSU draws its line.
Whew! So this rogue doc will be put to heel right away, correct? It would be unconscionable to do anything other than immediately move to protect the rights of Toffler's patients, wouldn't it? Well, maybe:
[Toffler has] begun to hear of complaints made to his dean about his unwillingness to provide services.
He said he has had a visit from an OHSU administrator who brought up his unwillingness to refer a woman patient to another provider, as required by the conscientious objection policy. He also has been asked to post signs in his office about the procedures he won’t perform. He refused, and considers the request a form of discrimination.
But it is the conscientious objector policy on indirect care — a physician’s duty to refer patients — that has Toffler perplexed, and a little concerned about his job.
“I cannot believe the (ethics committee) believes it is ethical to refer someone for something that you believe is unethical,” he said.
Yet that’s how the conscientious objection policy reads. According to ethics committee chairman Chiodo, “It’s OHSU policy and it is adopted at the highest level.” Chiodo said he expects high level administrative discussions about any OHSU employee who disregards the policy.
Well, that's great! An administrator visited him about it once. Did anything happen? If it did, the Trib's Peter Korn makes no mention of it. Wait, they did ask him to put up signs explaining what he won't do. That could help...if Toffler agreed to do it, which he did not.

So where are we on this? We have a doctor working for a hospital that likes to think of itself as a public entity when issues like medical tort claims come up in conversation. That convenient status cuts both ways, and a doctor for a public entity shouldn't have the ability to let their personal beliefs block the accepted prescription of legal medicines. And private/public aside, the rule is right there in the ethics guidelines for employees. So what does OHSU plan to do with Dr. Toffler? Cancel his golf club membership? Revoke his parking pass? Tell him he can't use the tram? Because so far, I see a scofflaw who's made his abuse of the system quite public...and his bosses are doing squat to stop it.