Saturday, June 30, 2007

When religion and career collide.

I came across this story a few days ago about doctors who are unwilling to provide medical services for which they have a moral objection. This is similar to other cases in the news lately about pharmacists who are unwilling to provide RU486 or even less broadly controversial things like birth control pills, or Muslim cab drivers who refuse to carry passengers who are carrying alcohol, or checkout clerks at Target who refuse to handle pork.

The common thread, of course, is the imperative of one's religion vs. the needs of one's employer or one's customer. My view, however, is that if your religion and the duties of the job collide, you should take another job.

This position is easiest to defend in the case of employees serving customer demands. Let's use McDonald's as an analogy. You don't hear cases of kosher Jews seeking employment at McDonalds but demanding to be exempted from handling non-kosher food. And I suspect that if such a case were to arise and a lawsuit ensue, it would be laughed out of court. Employers are required to make reasonable accommodations for their employees, but changing the fundamental business that they're in cannot be considered "reasonable."

Similarly, employees who patronize McDonalds would be aghast to order a cheeseburger and be dissuaded from doing so by a kosher or vegetarian server. This is essentially no different from the Target, taxi, or even pharmacy examples above.

Of course, one might note that a vegetarian or Jew is obviously free to leave McDonalds and open a vegetarian or Kosher restaurant, but there are two key differences that differentiate this from the examples above: (a) doing so is no longer contradictory to the stated goals of their employer, and (b) customers can clearly see the focus of the new offering and make an informed judgment whether to eat at the new restaurant or elsewhere.

This is where things get a bit tricky for the MD example with which I started this post. A doctor takes an oath to do no harm, and if one's view is that abortion is murder, then this is a judgment about crossing a medical line (doing harm) and hence it seems to me perfectly appropriate for the doctor refuse treatment or to refuse to make a referral. However, just as I wouldn't want a vegetarian to lecture me when I patronize a McDonalds, I think that the decision by a doctor to exercise this conscientious objection imposes on them a responsibility to inform patients up front of this fact so that the patient can make a decision whether or not to see that doctor, in much the same way that the kosher person can discover and patronize kosher restaurants.

Heck, faith healers and witch doctors are free to offer their services to anybody that chooses to utilize them, but obviously would label their services as such (and in fact, legally must not put forth as being licensed physicians).

Here's the rub, though: fast food is a pretty efficient free-market system. Customers weigh choices according to a variety of factors and make a decision, and providers compete for their business. Medicine, however, often does not operate according to these principles - especially emergency medicine. Insurance takes cost out of the equation for many, and when one is dealing with one's health much of the normal tradeoffs go out the window: you want the best treatment you can have. In an emergency, of course, such as the rape example cited above, there's no time to make a decision, and the doctor therefore is in quite a powerful position to not only treat the patient, but to also inappropriately impose their particular world view upon them, whether wittingly or not. After all, you wouldn't want to go to an emergency room after a car crash and be refused a much needed transfusion by a physician on religious grounds if you did not in fact share that religion. As a result, I have a very hard time supporting emergency room physicians who are unwilling to provide legal services requested by their patients.

If you're not willing to make the cheeseburger, don't work at McDonalds. If you're not willing to treat your patients or fill valid prescriptions, then you should clear your moral conscience by not working in emergency situations or in a pharmacy.

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