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Hmmmmmmm…….

with 12 comments

I’ve been watching the comments on that last post with increasing fascination.  And the rather casual assumption that if people “need” something–or even need it without the quotation marks–they have the right to force their fellow citizens to provide it against their wills is staggering to me.

First, the US abolished slavery in the 19th century.  Each US citizen, at least, offers his services in the marketplace and accepts the terms he is willing to accept in exchange for those services.  If the terms he is being offered are not acceptable to him, then it is completely within his rights to refuse.

This is the case even if there is no other source of the services in question, and if the person seeking such services will have to do without.  It is the case even if the person seeking the services is in desperate need of them.

If I am the only hospital in town and I am unwilling to provide the morning after pill to rape victims or anybody else, then I don’t provide it–and if there’s no other place to get it, then rape victims have to go without. 

If you pass a law that says that I must provide it or not operate an emergency room, then short of taking Lee’s suggestion of continuing in operation while refusing to abide by the law, I close my emergency room and that is no longe available to the community.

And in that case, the person responsible for losing the services of the emergency room is not the operator who shuts down because he is not willing to operate under the new terms, but the government that insists on imposing the terms.  If that government wants that particular emergency room to remain in operation, then must accommodate the hospital’s terms.

And that’s the case whether the hospital refuses for religious OR OTHER reasons.  Several secular CT hospitals did not offer the morning after pill because of liability considerations.

Second, it’s interesting to me as well what people think of as the alternatives in this case.  There’s a Seventh Day Adventist hospital, it’s the only one in town–well, that means we have to make the SDAs give blood transfusions!

But the chances are good that the alternatives are not “SDA no transfusions” and “hospital required to give transfusions.”  The other option is “hospital closes down and provides no more services at all.”

The question is–which is better, to have a facility with partial services, or NO  facility? 

Third, if a service you wanted isn’t voluntarily offered in your area, then you go elsewhere to find it, or you go without.

You don’t have a right to force your fellow citizens to provide you with that service against their wills–see the point about slavery above.

I’ve lived in a lot of small towns and rural areas, too, and we do a lot of going without.  Fully 80% of the counties in the US have not a single available abortion provider.  Abortion is just as legal there as it is anywhere else, but none of the doctors in those areas are willing to provide the service.

Women from those areas who want the service must go elsewhere, into the city, into the next state, whatever it takes–or not terminate. 

Fourth, being willing to help your fellow man does not abrograte your right to personal autonomy.  Setting up a soup kitchen does not suddenly pull the rug of rights out from under you, so that you have no right to stop providing the service ever again unless you can somehow get somebody else to do it.

If the state relies on me to run a homeless shelter, and it knows in advance that I will not aid, say, in the involuntary commitment of my clients to mental institutions, then it should also know that if they pass a law that says all homeless shelters must allow state psychiatrists to test clients to determine if they should be so committed should expect that when the law goes into effect, I will cease operation.

If they don’t want me to cease operation, they shouldn’t pass the law. 

If they want a different kind of operation, they should start and fund their own. 

If they think the people in my area should have access to a pharmacy that provides birth control pills and no pharmacist in my area is willing to provide them–then the state has the option of opening a state clinic that will provide them.

We none of us have a “right” to services from our fellow citizens, because they are fellow citizens–not slaves.

Written by janeh

December 28th, 2009 at 5:47 pm

Posted in Uncategorized

12 Responses to 'Hmmmmmmm…….'

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  1. I agree with the “not slaves” thing.

    I was mostly asking questions. How DOES the Catholic hospital reconcile the need for a life-saving *emergency* abortion? Do they perform it or let the mother (and consequently the fetus) die? I don’t know the answer to that question and I’m interested.

    Next question…What if the economic presence of a limited facility prevents the opening of a full-service facility in that area? Who then is responsible when people die for lack of those full services? I don’t know about your area, but in most places I have lived in there are regional commissions who license hospital openings. If a certain number of beds are already available, they won’t allow a new hospital to open, for fear that the extra beds in the market will force both institutions to fail, economically. A hospital has to have a certain number of beds full to make it.

    So if Hospital A is limited-service, but has excess beds, and Hospital B is full-service, but isn’t allowed to open, what happens when someone needs those full services and can’t get to them elsewhere in time? It’s not that anyone is asking A to provide full services, but that they have actively, by their presence, prevented full services from coming into an area that needs them.

    In large cities, this limitation may mean that someone in emergency distress is in the cachement area of a limited-service hospital. In normal times for elective needs they could go elsewhere. In emergency, they could end up somewhere that *cannot* treat them properly, but they can’t get to a full-service hospital anyway, as it’s too far away (in time or miles).

    So I guess I do have a problem with medical facilities that deliberately limit (common, emergency) services while being in a position where others who might want to offer those services are shut out. Please note I do not desire to make anyone perform services they don’t want to. What I do want is to make sure that no one shows up at a hospital in mortal need and dies because “oh we don’t do that here.”

    If that means that ONLY full-service hospitals are allowed to open, or given preference, well okay. It doesn’t mean the Catholics (or Seventh-Day Adventists) have to do anything they don’t want to. It does mean they should be operating only where there is an alternative.

    Maybe the problem is with the regional committees who decide these things. If someone opened a hospital with a religion that forbade hand-washing or clean linens, I’d sure hope that wouldn’t stop a conventional hospital from opening in the same area. In the current situation, though, I suspect whoever got there first would rule.

    I don’t have a right to services from any specific person. I do have the right not to go to someplace called a “Hospital” and find I’m not going to get a standard of care I expect in such a place. Perhaps the limited-services places should call themselves something else.

    Lymaree

    28 Dec 09 at 6:31 pm

  2. I didn’t know the answer to the ‘mother’s life’ question, but I was sure there *was* one, because one of the things I admire about the RCs is that they think things out logically. I might not always agree with their premises, but I can usually find out how they got from their premises to their conclusions, which is far more to my taste than ‘It’s natural’ or ‘It’s obvious’ or ‘It’s, well, just RIGHT’ which I get from other sources (not here, nothing personal, but I do read and listen outside here!).

    OK,
    http://www.newadvent.org/cathen/01046b.htm

    This is a moderately old resource, but I don’t think things have changed. It says that abortion, even to save the mother, is not allowed because it is a case of doing evil that good might result. However, if treatment of the *mother’s* body that kills the child, and the intention is to cure the mother, not kill the child, the treatment is permissable.

    That’s perfectly logical if you start with the assumption that both the mother and the child are human beings deserving of equal treatment and with equal rights to treatment, but I think it must be harrowing in the application. Probably no more so than aborting a desperately wanted child in an ectopic pregnancy, though.

    We have organizations that run hospitals, too – actually, complaining about them, lobbying them and the government, and, in worst case scenarios, getting a public enquiry into their operation is something of a popular local sport.

    Yes, of course, they decide how many hospital beds are needed in an area in the various wards. They do it overall, though. There’s no real attempt to provide all services in all hospitals. Admittedly, I live in a small city, so we don’t need too many hospitals, but no one thinks twice about the fact that all the eye surgery (and all abortions, actually, unless that private clinic is still going) are at one hospital, all ENT at the other, and while both have ERs, all major trauma goes to one of them, not both. It’s planned that way. So, sure, the ER staff of one of the hospitals might think ‘we don’t do that here’ and stabilize the person to ship him or her off to the other hospital. That happens every day without any religious reasons being involved. It happens in much bigger centres like Toronto, although there I think they got carried away a bit at one point. Ambulance staff would radio in, and if an ER was particularly busy the staff would tell them to take the patient to the next nearest hospital. After someone died, there was an incredible scandal about that. Anyway, when my brother was alive he spent more time than most in Toronto hospitals, and generally had a choice. Well, of the ‘Do you want to go to the nearest (which he hated) or the one across town (which made life really difficult for visitors) type of choice.

    Cheryl

    28 Dec 09 at 8:02 pm

  3. Jane, I think we’re looking at this from 2 different directions. You’re looking at the legal aspect. I’m looking at the moral one (from my point of view, anyway) and the professional one.

    I was brought up to believe that if you started something, you did it to the best of your ability, and you finished the job. If the job is one which, by its nature, is never finished, then you have an obligation to make a good-faith effort to find someone to take it over, or some way so that it is no longer necessary. I don’t expect to find this enshrined in law–it’s just the right thing to do.

    Since my upbringing ended, I’ve been serving the public most of my professional life. And doing my job to the best of my ability includes, in my profession, finding information and books about things which I find morally repugnant. To take an easy example, I am a vegetarian, but frequently need to find or order for the library books on hunting, or on cooking meat. And I do it, without comment, as would any other public librarian. I find it practically impossible to imagine any organization which serves the public in which the interests of the organization or the individuals comprising it are considered (either by the organization or the individuals) more important than the interests of the community they are serving. In fact, you can strike the qualifier “practically”. I find it impossible. Such an organization seems to me the work of dilettantes, not professionals. If they are more committed to their religion than to their community, I would find it hard to take them seriously as a hospital, and to rely on them, or trust the quality of their work.

    Lee B

    28 Dec 09 at 9:01 pm

  4. As it happens, I do have personal experience with the nearest hospital not being the right one.

    Two years ago in May I had a heart attack. Okay, so I’m dying (and I was, just not immediately) and in agonizing pain and the paramedics are asking me which hospital to take me to. I say “Memorial” because that’s where we go. They say “Oh, how about Doctor’s that’s closer (about 2 miles) it’s just as good blah blah blah. Did I mention I was panicked? So we let them take me to Doctor’s.

    I get to Doctor’s hospital and they did take good care of me, but not very *much* care. They don’t do heart surgery there, so after determining I needed a bypass, I had to get BACK in an ambulance, and go to, yes, Memorial. Then through the whole admit, in & out of beds, oh let’s get another 20 doctors in here to bill her, all before surgery.

    If it had been imperative I was operated on immediately, I would have died in the first hospital. I blame the paramedics in this case, who had clearly been told to talk up Doctor’s to patients in crisis. Somebody got another ambulance ride ($1000) out of my insurance, many more doctors got a shot at billing my insurance, and my continuity of care would have been better had I been taken to Memorial first. Because I was dying slowly enough to get to the second hospital everything worked out…though I wonder all the time if my heart might have been damaged *less* without the delay and the folderol.

    So having limited-service places calling themselves “Hospitals” is actually misleading. I don’t mind that Doctor’s is there, offering their “Everything up to but not including” services, but it shouldn’t be recruiting heart attack patients to come in there in the first place. It’s like taking someone with a traumatic amputation to a place with no orthopedic surgeons. Yeah…you can save their life, but you’ll never save the limb. You do that only in the lack of all other choice.

    Lymaree

    28 Dec 09 at 10:06 pm

  5. I tend to agree with Jane about “slavery”. But the question of abortion puzzles me. How did we get to a point where aborting a healthy fetus in a healthy mother can be considered good medical practice?

    jd

    28 Dec 09 at 10:28 pm

  6. I also agree with Jane.

    I only wish we had librarians in the ACT with Lee’s sense of professional propriety. For example, the ACT library system is replete with left-wing historians and virtually devoid of any conservative counter-balance whatsoever. No doubt librarians would happily pursue inter-library loans from interstate if specifically requested, but not to have politically neutral, let alone right wing, authors on the shelves is sheer censorship and, I imagine, entirely unprofessional. The Australian National Library bookshop (not part of the library itself), stocks nothing but books deemed “politically correct” by very politically correct librarians. Don’t hold your breath trying to find, say, Theodore Dalrymple, Mark Steyn, or Keith Windschuttle. Yet the shelves positively groan under the likes of Noam Chomsky, John Pilger, Peter Singer and others of that bent.

    Mique

    29 Dec 09 at 12:12 am

  7. Lee, I think one’s duty to one’s moral code, or God, takes priority over completing a job, and believe me, I grew up with (and generally support) all that stuff about ‘If a job is worth doing it’s worth doing well’ and ‘Finish what you started’, too. In your case, your moral code evidently teaches that all information should be provided freely to all who ask, which is actually something I agree with. But an essential part of professionalism is the duty to do what the professional considers to be right *even if* the other person disagrees. No one should delegate to another the right to make core moral decisions, even if everyone needs to accommodate others on the more borderline issues. Mostly, vegetarians and teetotalers don’t mind much if others eat meat or drink alcohol – although even in those cases, you’ll find people who take those as core values.

    For example, some years ago I listened to a radio documentary on sex change surgery in which several doctors who provided surgery or drugs to patients wanted to change their sex (or gender? I forget the distinction) were interviewed. Most of them explained how they carefully interviewed and examined the patient before agreeing to treatment. One – a family doctor in a clinic, so not a specialist – stated that she gave drug treatments to anyone who asked because it made them feel better, and that was her job. Was it? Does it make a difference that one of her patients, who was also interviewed, was in either her late teens or very early twenties, and had a serious history of psychiatric problems since early childhood? There are surgeons who will perform any surgery on anyone who asks, and surgeons who won’t do certain orthopedic procedures on certain patients because their physical history (smokers, overweight, previous surgeries that failed) make it almost certain that the new surgery will fail. The second group sometimes get in the media as people who are prejudiced against smokers or fat people; but they think they have a moral obligation NOT to agree with what their patient wants if in their professional opinion it will cause unwanted suffering.

    Obviously, this sort of thing can degenerate into paternalistic control of a patients life, but I think the option for a professional to decide on his or her own actions must still remain. I should not be allowed to force a doctor to provide me with treatment if the doctor’s moral code won’t let him give it to me. I don’t think I should even expect him to refer me on, although I can certainly keep looking for a more complaisant physician myself.

    And if I went to your library and asked to check out the latest snuff video or bit of child porn, I think you’d turn me down. That’s not a good comparison, because I’d be asking for something illegal. Let’s say I asked for you to get me a copy of something in the more secure section of your reference section. Larger libraries often have material you can only view on request, under the eagle eyes of the librarian, and while wearing gloves and not using a pen. The library’s moral duty to preserve the material for posterity outweighs their duty to provide me with reading material or mine to take it home and scribble notes in the margins and spill juice on it.

    John, nice to see you back.

    I think the idea of the ‘right’ to an abortion came out of the campaign for free access to birth control. If you start with the premise that a fetus is not a human being; that being a human being requires certain characteristics in addition to DNA such as viability outside the mother and mental or physical abilities, removing an unwanted fetus is just one step on from preventing its implantation (like an IUD does) and that’s one step on from preventing its formation in the first place. Even when I more or less though ‘abortion must be ok in extreme circumstances, I always was a bit queasy about the ‘not a human’ bit, and the more I thought of it, the more uneasy I became.

    Lymaree, at least our lot don’t have a financial interest in shifting us from one hospital to another. I really should check if ambulance rides are covered by medicare in my province; I know they weren’t in another one because a student got the bill – or rather, her parents did, because she sure couldn’t afford it, and it was about half yours. Some ambulances here are run by private companies, so I suppose they’d get the fee, whoever pays it, while others are run by the hospitals.

    But do you really use ‘hospital’ to refer to places that offer everything? I don’t. A hospital is a place where they offer in-patient care for acute problems, and almost certainly various related things like outpatient clinics, blood labs, X-ray and other imaging technologies, etc. A nursing home provides in-patient care but no labs and no out-patient work. A clinic (meaning a standalone one) offers anything from GPs to various specialized care – we have a couple that take blood samples for tests (to try to reduce the pressure on the ones for outpatients in the general hospitals), one that does only mammograms and breast exams, two for psychiatric problems… There are different levels of care offered in different hospitals, ranging from a few beds and nurses and one doctor in a very small rural one to a tertiary care centre. And even at that, there’s stuff like transplants and care for really rare diseases that we have to go next level up for – to a hospital in a major out-of-province city. And, of course, if someone’s psychiatric problems are too severe to be dealt with by the short-term care unit or the crisis centre, there’s a hospital that doesn’t treat anyone but psychiatric inpatients. And the hospital strictly for children, but I tend to lump that with the major tertiary hospital centre, which it is attached to, although I shouldn’t.

    By your definition, we wouldn’t have a single hospital in the province – and most of the other provinces would have maybe one, if that, in the biggest city. All of our facilities are ‘limited service’ in one way or another.

    I do know someone who broke her ankle while visiting a very small town, and went to the nearest rural hospital which didn’t have an orthopedic surgeon. The doctor there did the diagnosis and sent her to the big hospital in town. The staff didn’t want to send her by ambulance because they might need theirs for someone who needed it more! She and her husband absolutely insisted, since she couldn’t face a couple hours stuck in a car sitting upright!

    She got her surgery and recovered well.

    Cheryl

    29 Dec 09 at 9:44 am

  8. “I also agree with Jane.

    I only wish we had librarians in the ACT with Lee’s sense of professional propriety.”

    I also agree with Jane and distinguish Lee’s situation quite simply: She is almost certainly on the public payroll her library almost certainly supported by taxpayer’s. As a service provided by the government the library should not, can not, engage in view point discrimination. Not in the United States, not without getting sued by someone.

    Most suits against libraries are by conservative nut jobs trying to get something off the shelves, but they always lose for the same reason that the library would lose if it (i.e. its librarians) tried to engage in discrimination.

    But a charitable hospital is still a private enterprise run by private citizens and owes no such duty. And if the only hospital in the area was a Catholic hospital that didn’t provide the services you wanted that would be inconvenient — but if the only hospital in the area is a Catholic charity, my intuition tells me that but for the Catholic (or some other) chairity there wouldn’t be any hospital AT ALL. So all any law requiring that all hospitals have to offer all services of nature ‘x’ if they offer any services of that nature would do is guarantee – as Jane illustrates partially in Ct. – that certain services simply disappear because no entity that has to support itself (with or without a profit) could survive, and the government in the area probably lacks the tax base to provide the service as a government service.

    Michael.Fisher

    29 Dec 09 at 3:36 pm

  9. I agree with Jane also. If the government wants a given service to be made available, it must provide it. When the government, or a private corporation for that matter, is hiring someone, they have the right to set requirements for that employee.

    So if a hospital says they offer abortions and you want to work there, they can ask if you object, and if you do, not hire you. You can’t go to work there and then cross your arms and say no. Or if you are a vegetarian and you want to work at a grocery store, they can ask if you would object to working in the butcher shop, and if you do, not hire you.

    I used to live in CT and I can’t imagine that there wouldn’t spring up a network of providers of morning after pills and a network of referral sources…probably overnight. I know I would have been passing out the business cards to ambulance drivers myself.

    Cathy

    CAFiorello

    29 Dec 09 at 4:18 pm

  10. Please note that the entire basis of a welfare state is that I can compel my fellow citizens to provide for my “needs.” Making them do it by tax money instead of a corvee is not a moral improvement.

    On Catholic hospitals and maternity, policy is–or was, at least–that if it came down to a choice the child was to be saved even at the cost of the mother’s life. That’s why I was NOT born in a Catholic hospital, even though it was closer. Mom and Dad were taking no chances–and they had a choice. Under Virginia law today, an ambulance MUST take the victim to the nearest hospital, even if the situation is not critical and the nearest hospital is notorious for gouging. (The legislature was, presumably, correcting some other problem. It’s called “unintended consequences” which is sometimes the case.)

    But if we’re discussing government and compulsory service, why stop there? The government is perfectly capable of lethal deprivation of service. Observe: Joe is a cancer victim, in remission ever since he began taking Medicine X. Under the “Pure Food and Drug Act” the FDA can and has taken Medicine X off the market–not because it is demonstrably harmful, but because the FDA does not believe it to be beneficial. No actual testing is required. Let’s assume the FDA is never wrong about efficacy. If I deprive someone of the placebo which keeps him alive, am I legally guilty of murder? I ask about the legality, because I don’t think morally there’s even a question.

    robert_piepenbrink

    29 Dec 09 at 5:07 pm

  11. If you’re hiring for a a gyne nurse or doctor, or for a butcher, the beliefs of your applicant re abortion or vegetarianism would be relevant to the hiring decision. If you were hiring for a neurosurgery nurse or doctor, or a deli clerk, not so much. And it would be nice – and in some places, under some employment contracts, required by law – if the required work changes significantly, your current employees are offered the chance to retrain for or move into another position rather than be outright fired because you’ve started requiring the nurses you hired to assist in deliveries to perform abortions, and some of them find it not only morally repugnant, but also not what they agreed to do when hired.

    Cheryl

    29 Dec 09 at 5:33 pm

  12. Like Lee, I am a librarian. I also have to help library users locate materials I find morally, ethically,or aesthetically offensive. But I do so without comment because libraries (responsible ones) adhere to intellectual freedom. I also purchase materials–books by scientologists, practitioners of wicca, white supremacists, Rush Limbaugh, or many in between that I find offensive.
    Materials (often archives)shelved in non-public areas are not allowed restricted use for moral reasons. Morals aren’t a consideration. For example, public records not available online and only found in government facilities aren’t given to citizens for unrestricted use either. The reason is that they are often one of a kind or are public documents that must be preserved according to law. Hospitals that receive any public funding and do not perform procedures (like blood transfusions) for ethical reasons can operate just like any other but tax advantages should be withdrawn. Abortion is such a divisive issue that all I can say is if the mother’s life depends on it and the hospital refuses then no tax advantages. Abortions are sometimes medically necessary. If abortion is a woman’s choice for other reasons then it is her responsibility to find a medical facility that will provide one.

    jem

    30 Dec 09 at 10:00 pm

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