Thursday, August 22, 2013

Morning-after pill conscientious objection ends in job loss

From Freedom2Care blog by CMA VP for Govt. Relations Jonathan Imbody, Aug. 8, 2013:

Tolerance. Diversity. Broad-mindedness. Those are the words.

Bullying. Discriminating. Compelling. Those are the deeds.

The contradictory words and deeds often come from one and the same individuals--and in a case I learned about today, companies. Turns out the words of tolerance, diversity and broad-mindedness only apply to those who comply with the dogma and submit to the will of the speakers.

Here’s an email I received this morning from a pharmacist member of the Christian Medical Association:
"Subject: Forced to resign over mandate to sell the morning after pill.

"Just to let you know that Rite-Aid corporation came out with a stricter policy on July 5, 2013 that requires all employees to accommodate the sale of the morning-after pill to all comers, of either gender and of any age. I tendered my resignation within the hour, it was accepted, and my last work day is July 20th. I realize that I am an 'at will' employee and I do not expect any recourse. Just for your information to add me to the list of those quitting pharmacy solely because of the policy change. Keep up the good work. The battle rages. The Lord is able to supply our needs."
Remember that even the Obama administration health department opposed the unlimited sale of the morning-after pill, citing health concerns. So presumably, even the radically pro-abortion Secretary of Health and Human Services, Kathleen Sebelius, is not radical enough to work at Rite Aid.

Unfortunately, Secretary Sebelius and President Obama trashed the only federal regulation protecting healthcare professionals from discrimination and firings for reasons of conscience. They and other abortion advocates also can't seem to muster enough liberality to support the tolerant, diversity-respecting and broad-minded principles of the Healthcare Conscience Rights Act (S 1204 and HR 940).

While the regulation and the law apply specifically to government-funded programs, each can help establish an environment of true respect for conscience, tolerance and diversity that will protect health care professionals nationwide. Until then, pharmacists, obstetricians and family docs who still adhere to the Hippocratic oath and faith tenets remain subject to job loss, discrimination and ostracism for their life-affirming views.

Lawsuits challenge contraceptives mandate

Excerpted from "Critics of contraception mandate vow Supreme Court appeal," The Hill, Aug. 14, 2013 - Critics of the contraception mandate in President Obama’s healthcare law said they will appeal to the Supreme Court after a federal appeals court declined to re-hear their case Wednesday.
Alliance for Defending Freedom, one of the organizations challenging the contraception mandate in the courts, said it will ask the Supreme Court to consider whether the mandate is unconstitutional.

“Every American, including family business owners, should be free to live and do business according to their faith," Alliance for Defending Freedom said in a statement vowing to appeal to the Supreme Court.


Visit the CMDA Freedom2Care website for news, resources, legal analysis and commentary.

Take Action:
Before taking action in professional situations involving conscientious objection, contact one of the conscience rights specialist attorneys we work with. They typically provide their services on a pro bono basis, working for non-profit organizations dedicated to preserving religious liberty and advancing respect for life. Visit our Freedom2Care webpage on discrimination to learn more.

Urge your senators to support conscience rights - S.1204

Urge your Rep. to protect conscience rights - HR 940

Tax reform drive threatens deductions and charity

Excerpted from "Taming the tax code beast," Washington Post column by George F. Will, August 09, 2013 - “Colleagues,” said the June 27 letter to 98 U.S. senators, “now it is your turn.” The letter’s authors are Max Baucus (D-Mont.) and Orrin Hatch (R-Utah), the chairman and ranking Republican, respectively, on the tax-writing Finance Committee. From their combined 71 years on Capitol Hill they know that their colleagues will tiptoe gingerly, if at all, onto the hazardous terrain of tax reform.

Together with Chairman Dave Camp (R-Mich.) of the House Ways and Means Committee, Baucus and Hatch propose a “blank slate” approach, erasing all deductions and credits — currently worth more than $1 trillion a year — and requiring legislators to justify reviving them. Hence the Baucus-Hatch letter, in response to which almost 70 senators sent more than 1,000 pages of suggestions. Although some often were short on specificity, the submissions were given encrypted identification numbers and locked in a safe, as befits dangerous documents.

Baucus still hopes to bring Congress to an “all join hands and jump together” moment, “a tipping point where there is a sense of inevitability.”


Jonathan ImbodyCMA VP for Govt. Relations Jonathan Imbody: In his column, George Will neglects to note that when Committee leaders put every tax deduction on the table, they opened the door to misdirected assaults on charity. I have been meeting on the Hill this month with U.S. senators (Thune, Hatch and Wyden) and staff on the Senate Finance Committee and the powerful House Ways and Means Committee to convince them not to tax money that people give away to charities. Doing so only transfers money from the hands of citizens and cost-effective charities to the government--and we know how well that works.

Faith-based organizations would get hit hardest under any of the current schemes secretly floated by Members of Congress. Cutting the charitable gift tax deduction would decrease giving and cut an estimated $140 billion in charitable services to needy Americans. Since the government would have to take up the cost for lost social services, any tax revenue gained from cutting deductions would be more than lost to new program costs. The result would be a deeper deficit, bigger government and less efficient and effective care.

Yet the prospect of targeting the charitable gift tax deduction has become alarmingly clear in my meetings with senators and staff. One of the most insidious cuts under consideration would eliminate deductions for gifts to charities such as universities, the arts and churches, which in the opinion of some do not provide sufficient tangible services to be deemed a "public benefit."

The 100-year-old tax deduction for gifts given "exclusively for religious, charitable, scientific or educational purposes" enforces the First Amendment's proscription against government infringement of the free exercise of religion. Imagine the IRS determining which churches and faith-based charities merit approval for tax deductions. Congress should take aim at real tax reform while protecting charity and those who depend on it. Charity is not a loophole; it's a lifeline.

Take Action:

Visit the Freedom2Care website now to learn more and take action on this issue that impacts your charitable tax deductions, charities and, most importantly, the millions of individuals served at home and abroad through American charities.

Use this easy form now to tell your legislators to protect your gift tax deduction, charities and, most importantly, those they serve!

To keep up with public policy:

Thursday, August 8, 2013

Ethics of Placebo Treatments

Excerpted from “Patients’ attitudes about the use of placebo treatments: telephone survey,” British Medical Journal. July 2, 2013 -- Several recent surveys of physicians have documented their use of placebo treatments in clinical practice. In a recent U.S. survey of internists and rheumatologists, half reported that they have prescribed placebo treatments, defined as treatments “whose benefits derive from positive patient expectations rather than from the physiologic or pharmacologic mechanism of the treatment itself.” These placebo treatments included active agents such as vitamins or analgesics that a physician prescribed to promote positive placebo effects rather than specific pharmacologic or physiologic effects.
The prescription of placebo treatments as part of medical care is ethically controversial. Their use has been criticized because the practice is thought to involve deception, thereby violating patient autonomy, because of concerns about the compatibility of placebo treatments with evidence-based medicine, and because the risks introduced by some placebo treatments outweigh the possible benefits of their use, as in the case of prescribing antibiotics for viral infection. U.S. clinical practice guidelines prohibit the use of placebo treatments without a patient’s knowledge, citing concerns about undermining trust and compromising the patient-physician relationship. Despite these concerns, some have argued that use of placebo treatments can be justified when they are effective, at least in certain cases.

The perspectives of U.S. patients have been missing in the debate over the use of placebo treatments in clinical practice. To probe the attitudes of U.S. patients regarding placebo treatments, a survey was conducted of adult members of a large Northern California health plan. The survey utilized a carefully constructed definition of “placebo treatments,” used a combination of general questions and detailed scenarios, and included a large and demographically diverse sample of patients. The data shows that patients are open to the idea of placebo treatments. Most (50 to 84 percent) judged it acceptable for doctors to recommend placebo treatments under conditions that varied according to the doctor’s level of certainty about the benefits of the treatment, the purpose of the treatment (for example, to address a patient’s need to receive a treatment) and the transparency with which the treatment was described to patients. Fewer than a quarter stated that it was never acceptable for doctors to recommend placebo treatments. In addition, many respondents indicated a willingness to try placebo treatments in different scenarios. This is generally compatible with trends reported in previous patient surveys in other countries regarding willingness to try placebo treatments.


Dr. Dónal P. O’MathúnaCMDA Member and Ethics Lecturer at Dublin City University, Ireland Dónal P. O’Mathúna, PhD: “The placebo effect is often viewed negatively, as something to be eliminated in medical research or as a way to explain how ‘inert’ interventions have effects. More recently, placebos have been declared unethical, a deceptive violation of patient autonomy. The American Medical Association holds that placebos should be prescribed only if patients agree to their use.
“The BMJ study defined the placebo effect as patients getting better after a treatment because they expected improvement, not because of the treatment itself. It found that most patients are open to placebos, but concerned about the deceptive element. The findings highlight the importance of honesty and trust in medical practice.

Many believe placebos only work if patients do not know they are taking them. In the BMJ survey, two-thirds would try a placebo for moderate stomach pain or chronic abdominal pain, if told they were given a placebo. A recent randomized controlled trial found that irritable bowel syndrome patients, fully informed about being given an inert placebo, had significantly better outcomes than those given no treatment (Kaptchuk et al. PLoS ONE 2010;5(12):e15591). The placebo included a supportive interaction with patients given a clear rationale for how placebos might be beneficial.

Research into the placebo effect provides evidence that ethics matter, and that patients want open and honest interactions with their physicians. These studies support the non-deceptive use of placebos. Our mind, body and spirit are intricately interwoven. How we relate to others makes a difference.

Alternative Medicine: The Christian Handbook by Dónal O’Mathúna, PhD and Walt Larimore, MD
CMDA Ethics Statement on Human Research Ethics
Bioethics Ireland

Doctors Badmouthing Doctors

Excerpted from “Doctors Badmouthing Other Doctors,” The New York Times. July 11, 2013 -- A physician friend recently disclosed that she was named in a malpractice lawsuit. Her revelation was rattling not only because there were no discernible errors in the care she provided, but also because another doctor had provoked the patient to hire a lawyer. “I’m shocked that nothing was done sooner,” the other doctor had said when the patient went for a second opinion. “You could have died.”
Surely, the doctor who had trashed his colleague was out of line. Throughout training and regularly at work, we are reminded of the importance of professionalism and respect. Shifting blame demoralizes other clinicians, undermines patient trust and compromises patient outcomes.

But it didn’t take long for me to recall instances when friends and I had been equally critical about other doctors’ work. Are we all capable of talking like that in front of patients? The answer, according to a recent study in The Journal of General Internal Medicine, is an unqualified and disturbing, “Yes.” “Doctors will throw each other under the bus,” said Susan H. McDaniel, lead author of the study and a professor of psychiatry and family medicine at the University of Rochester Medical Center. “I don’t think they even realize the extent to which they do that or how it can affect patients.”

“There is probably something reassuring in saying, ‘Boy, your doctor didn’t do a good job and now I’m going to take care of you,’” Dr. McDaniel noted. “But those kinds of comments are bad for the patient.” To help remedy this problem, Dr. McDaniel began a physician coaching program at the University of Rochester Medical Center a year and a half ago. “There’s a lot of attention focused on the patient experience, but I think we need to work on improving the clinician experience as well,” Dr. McDaniel said.


Dr. J. Scott RiesCMDA Vice President and National Director of Campus & Community Ministries J. Scott Ries, MD -- “When I first read the title of this article, my initial reaction was, ‘I don’t do that.’ Then the rubber met the road. Just last week, a 7-year-old girl accompanied by her grandmother came to my clinic with the same abdominal pain that had been plaguing her for four days. Initially evaluated by her grandmother’s family physician, she had been diagnosed with a urinary tract infection and treated with antibiotics. Three days later, when the pain had not improved, she returned to that doctor. A repeat urinalysis was normal and they were sent home with instructions on how to treat constipation. “Later that day, they came to me. I had the advantage of both urinalysis results (neither remarkable) as I evaluated the healthy appearing child in front of me. But something didn’t seem quite right. A couple hours later, I whisked her off to meet the surgeon at the OR to intervene for her ruptured appendix. But before they left the clinic, the question came: ‘Should the other doctor have diagnosed this on Monday?’ Two things hit at me at once, freezing any potential response. The first was the reaction, ‘I’m just glad you brought her to me. She could have died.’ The second was the article adducing that very phrase.

“How should we respond when we encounter and disagree with the work of a colleague? Try answering these three questions before responding:

  1. Will my response benefit my patient?
  2. Will my response attempt to inflate trust in me, by diminishing that in another?
  3. Am I representing well with my words the Physician I desire to emulate?

“If we are honest, our pejorative off-the-cuff responses are often (if not subconsciously) geared at building our own ego. Confident in our abilities, we want to make sure our patient shares our confidence in our prowess. But is this how the Great Physician treated His colleagues? Is this the grace with which the Great Physician has treated me? Ephesians 4:29 offers the answer that we need at this precise moment, ‘Do not let any unwholesome talk come out of your mouths, but only what is helpful for building others up according to their needs, that it may benefit those who listen’ (NIV 2011).”

Christian Physician's Oath
Christian Dentist's Oath
The Cry of the Patient--Are We Listening?