George W. Bush and the Jesus FactorHow Alarmed Should We Be?

On the day that George W. Bush was sworn into his second term as governor of Texas, friend and adviser Dr. Richard Land  recalls Bush making an unexpected pronouncement.

"The day he was inaugurated there were several of us who met with him at the governor's mansion," says Land, president of the Southern Baptist Convention's Ethics & Religious Liberty Commission. "And among the things he said to us was, 'I believe that God wants me to be president.'"

So begins the Introduction to the PBS Frontline special, The Jesus Factor.  (Also see news/reviews 1 2 3 4 5

I did not see the show, because it wasn't on the PBS broadcast that I get.  I did hear the interviews  on the NPR show, Fresh Air.  The key point during the Fresh Air interview has to do with what we can infer from Mr. Bush's frequent references to his evangelical ethos. 

This is controversial, unavoidably, since people can infer almost anything they want.  For example, the above quote: "I believe that God wants me to be president.", could be interpreted in a variety of ways.  One of the persons interviewed on Fresh Air, Dr. Land, stated that the comment is perfectly natural in an evangelical mindset.  Often, persons of such faith feel that they have gotten a calling to perform some particular duty.  Taken in context, Land argues, the statement is merely a reflection of Bush's perfectly understandable feeling that he has such a calling.  Dr. Land implied that Bush's statement is not at all pathological.  He did not find it to be alarming at all.  Since he was there, we must consider his interpretation seriously.  On the other hand, he was not an objective observer.

An article on www.news-journalonline.com phrases the question of interpretation:

Some viewers of this thought-provoking "Frontline" documentary might find that pronouncement startlingly off-putting while others doubtless will take extreme comfort in it. And then there are those who may see it as a savvy political move, given the choir Bush was preaching to.

Could it be a savvy political move?  Not all Christians would agree.  On the Interfaith Alliance website, we see a copy of a quote from their president, the Rev. Dr. C. Welton Gaddy.  The quote also appears on the PBS news release  about the show:

"If we turn religion into a tool for advancing political strategy, we treat it as anything other than a sacred part of life from which we draw values and strength," says Rev. Dr. C. Welton Gaddy, president of The Interfaith Alliance. "Any time that religion has identified itself with a particular political movement or a particular government, religion has been harmed by that."

Are there some who might take comfort in Bush's pronouncement?  I actually could not find mush in the Blogosphere about it, although 1) the show is just now on the air, and 2) I have learned that the weblog search engines tend to run a day or more behind.  (editorial note: That is because people don't ping after posting.  Use Ping-O-Matic  please!)  Many of the posts in the 'sphere are neutral, simply mentioning the show, sometimes urging people to watch it.  (1  2  3  4  5 6)

I will assume that some people are comforted by Bush's religious stance.  This is supported by a survey  done by the PEW Research Center:

Relatively few Americans express concern about the use of religious rhetoric by political leaders. In fact, nearly twice as many say there has been too little reference to religious faith and prayer by politicians (41%) than say there has been too much (21%). President Bush receives particularly positive ratings in this regard. Most (62%) say the president mentions his religious faith the right amount ­ with only a minority saying he does this too much (14%) or too little (11%).

This same sentiment carries over to religion's influence on the president's policymaking as well. Overall, six-in-ten Americans say the president relies a great deal (20%) or a fair amount (40%) on his own religious beliefs in making policy decisions. Roughly three-quarters of those who believe this say the influence of religion on the president's policy decisions is appropriate. Just 22% of those who see Bush influenced a great deal by his religion say it is inappropriate.

Are there people who find Bush's statement to be startlingly off-putting?  Some.  Blogleft author Raymond McInnis has amassed a great deal of information  regarding the influence of religion on Bush's policies.  The writing is obviously anti-Bush, but he makes some good points.  The Longbow Papers author, Joseph Bosco, states:

[The Jesus Factor] ...examines the extraordinary, and really quite frightening, influence that the far-right Christian fundamentalist movement has on the man who is the president of the United States of America, the most ethnically, culturally, religiously diverse nation on Earth...Below is the Title and Credits page, which in one glance should scare the bejesus out of you if you believe it is imperative that the separation of church and state remain one of the primary pillars of our beloved republic, as did the Founding Fathers, who enshrined its importance by making it the first words of the first clause of the first sentence that is the First Amendment of the Bill of Rights.

Loren Franklin writes  on the Portland Independent Media Center that Bush is a "Socialized Psychopath."  Linda McQuaig writes with some conviction that Bush's religiosity may not be genuine:

But the notion that Bush is motivated by deep religious convictions is being pushed with such vigour these days by his supporters that one senses an orchestrated campaign — perhaps to prevent worldwide skepticism about the motives for the Iraq invasion from spreading to the U.S.

Some Americans may worry about an evangelical crusader controlling the world's biggest nuclear arsenal, but religion — even the fundamentalist variety — is generally considered a good thing in the U.S. Certainly, focusing on religion helps keep attention away from other more contentious motives for invading Iraq, such as oil or world domination.

So the media have been hyping Bush's alleged spirituality (including a Newsweek cover story on "Bush and God"), even as the president snubbed pleas for peace from world religious leaders and last week tested a 21,000-pound bomb in preparation for unloading it on people in Iraq. (Blessed are the bombed children.)

Of course, it's possible that Bush is deeply religious, whatever than means.

More likely, Bush is simply an empty vessel, a hollow shell, a person of weak character and limited life experience who is therefore highly susceptible to the control of a small, determined group of ideological hard-liners bent on asserting U.S. power more forcefully in the world.

While I would no go that far, the points these authors establish lead to an interesting idea.  While I do not agree that Bush has Antisocial Personality Disorder  (the format term for a sociopath), I do suspect that he has some significant Narcissistic traits.  The statement, "I believe that God wants me to be president" would be interpreted in another context as being indicative of either mania or Narcissism.  It would be difficult to assemble a case arguing that Bush has Bipolar Disorder.  But making a case for Narcissism is not difficult. 

Why should we case what his personality style is?  After all, we don't care about his sexual orientation, or whether or not he likes to eat barbecued ribs.  The reason we care is that certain personality styles can be dangerous.  One of the core features of narcissism is a strong sense of entitlement.  A narcissistic person, by definition, believes that he (75% are male) is special  in some way.  This is not necessarily pathological.  One would argue that everyone  is special is some way.  The pathology comes from a particular cognitive linkage between the notion that one is special, and that one deserves special treatment or has special privileges.  This takes many forms.  Some are obvious; others are subtle. 

We all have seen persons of deep religious faith, who are in fact special because of their faith.  The thing is, a psychologically healthy religious person is not boastful about it.  He or she does not think that being religious entitles them to some kind of special status:

Proverbs 25:6-7  Do not put yourself forward in the king’s presence or stand in the place of the great; for it is better to be told, “Come up here,”
than to be put lower in the presence of a noble.

Colossians 2:16-19 Therefore do not let anyone judge you by what you eat or drink, or with regard to a religious festival, a New Moon celebration or a Sabbath day. These are a shadow of the things that were to come; the reality, however, is found in Christ.  Do not let anyone who delights in false humility and the worship of angels disqualify you for the prize. Such a person goes into great detail about what he has seen, and his unspiritual mind puffs him up with idle notions.  He has lost connection with the Head, from whom the whole body, supported and held together by its ligaments and sinews, grows as God causes it to grow.

Distinguishing between false humility and true humility is difficult.  I am hopeful that The Jesus Factor might enlighten us.  There will be a webcast available from pbs.org in a few days. 

Exciting Developments in Biomedical TechnologyHow Exciting Is It?

From Nature:

Could nanomachines be tomorrow's doctors?

DNA computer diagnoses disease and dispenses drug.
29 April 2004

HELEN R. PILCHER

Scientists have built a tiny biological computer that might be able to diagnose and treat certain types of cancer. The device, which only works in a test-tube, is years from clinical application. But researchers hope it will be the precursor of future 'smart drugs' that roam the body, fixing disease on the spot.

Instead of silicon chips and electrical circuits, the minuscule machine is made of DNA. And rather than being controlled by electrical signals, it senses changes in its environment and responds by releasing biological molecules.

Instead of silicon chips and electrical circuits, the minuscule machine is made of DNA. And rather than being controlled by electrical signals, it senses changes in its environment and responds by releasing biological molecules.

The biocomputer senses messenger RNA, the DNA-like molecule that helps create proteins from the information in genes. In particular, it can detect the abnormal messenger RNAs produced by genes involved in certain types of lung and prostate cancer.

When the computer senses one of these RNAs it releases an anticancer drug, also made of DNA, which damps expression of the tumour-related gene, researchers report in Nature¹.

From Science Daily:

Source: Oak Ridge National Laboratory
Date: 2004-04-28

Nanobiosensor Technology Gives New Access To Living Cell's Molecular Processes

OAK RIDGE, April 27, 2004 -- Researchers at the Department of Energy's Oak Ridge National Laboratory have developed a nanoscale technology for investigating biomolecular processes in single living cells. The new technology enables researchers to monitor and study cellular signaling networks, including the first observation of programmed cell death in a single live cell.

The "nanobiosensor" allows scientists to physically probe inside a living cell without destroying it. As scientists adopt a systems approach to studying biomolecular processes, the nanobiosensor provides a valuable tool for intracellular studies that have applications ranging from medicine to national security to energy production. [...]

Analysis:  I remember a lecture on psychopharmacology, probably 15 years ago, during which the professor talked in great detail about the process of the synthesis and release of neurotransmitters, followed by a discussion of how the transmitter crosses the synapse and interacts with the receptor.  The next slide said, simply: "Then Something Happens".

At that time, we really did not have much idea about what happened on a molecular level after the transmitter interacted with the receptor.  We all knew, though, that the "something" that "happens" would be crucial to the next step in our ability to diagnose and treat mental illness.  It has been noted here, and elsewhere in the 'sphere, that, current antidepressant medication, while useful, has serious limitations.  The majority of our medications act by modulating transmitters and receptors in various ways.  On 4/22/04, CC noted that there has been an advance in using a drug to affect G-protein-coupled receptor complexes to attenuate cocaine addiction in rats.  This is the first example I have seen of a successful effort to alter the something that happens inside  the cell, after the transmitter binds to the receptor.  (The transmitter binds to the receptor on the outside of the cell membrane.)   It might be another 20 years before anything truly useful comes of this, but with the development of nanobiosensor technology, and nanocomputers that sense cell conditions and release medications, we are sure to come up with something.

Last Sunday, my wife and I went to a farm north of Grand Rapids, Michigan, to pick up our mare, April.  She had been bred to a stallion, and had been gone for about a week.  It was the first time she had been separated from her colt.    When we let her go into the pasture with the colt and two other horses, they had a joyous reunion.  The four galloped, together, in circles around the pasture several times.  I mention this because it was one of the finest displays of unbridled happiness that I have seen in a long time.  This is the kind of emotion that a neuroscientist feels, when learning of the discovery of a whole new line of treatment that is under development. 

October, after having been fed some hay.  October had his first birthday this week.  April got back just in time for his birthday.

Latest Information on Safety of Antidepressant Use in Children

Here is an editorial from Lancet, possibly the world's most prestigious medical journal.  The editorial accompanies an article (free registration required for abstract; subscription for full access) about the safety of SSRIs in children with depression.  While it is not the entire story, it is a topic of interest and it comes from an authoritative source.  It points out some of the problems that can arise from industry-funded research.  

The authors of the editorial suggest that "Changes are required at every level of the global health-care infrastructure."  I would suggest that there ought to be a fundamental change in the way the pharmaceutical companies are run.  Specifically, at the board-of-director level, there should be mandatory input from scientists.  A board composed entirely of businesspersons will make decisions like businesspersons do.  There should be a requirement that all boards have at least 51% of their members holding advanced degrees in the biomedical sciences. 

Of course, incentive programs such as stock options and profit-sharing need to be re-evaluated.  Given the effect that a news release can have on stock prices, there is a strong incentive for squelching negative news.  This is true even if the news only sounds  negative.  Even the if scientific significance of the news is minor, people will dump their stock at the slightest hint of a problem.   For example, negative drug trials are common in all areas of medicine.  This is true especially when the drug is in the early stages of development, when clinicians do not yet know the best way to use the drug, have not determined the optimal dose, or have not yet defined the disease states for which the drug is most effective. 

If Ford Motor Company came out with a new Mustang, and the first prototype got flat tires more often that other cars, you probably would not go out and dump all your Ford stock.  You expect glitches like that.  But a negative drug trial tends to get people all worried. 

The Lancet recommends that "Governmental institutions such as NICE require legal powers to ensure that biomedical research is used to improve health even if this does not equate with improved profits."  It is difficult to imagine that this could happen in the USA, where profit is king.  Perhaps we will have to rely upon our EU brethren to look out for our safety on the biomedical front.  This could work: we will keep the terrorists from killing them; they will keep large corporations from killing us. 

One aspect of this story that I have not seen anyone else comment about, is the different approach taken to drug approval in the USA compared to Europe.  European countries seem to be quicker to release drugs for sale, but they also are quicker to pull them from the market.  I'm sure there is a sociological lesson in there somewhere, but I don’t know what the lesson is.

Note that I am not advocating that the USA ban use of antidepressants in children.  However, I agree with most people that we need to be exceptionally cautious about such uses.  There has not been nearly enough testing of any kind of pharmaceutical product in the pediatric population.  The reasons for this are complex.  There is an interesting history of the FDA's policies on testing of drugs in children and adolescents.  It is a long, strange, politically-charged story that I am still piecing together.  I will post that sometime soon.

Editorial from The Lancet

Volume 363, Number 9418; 24 April 2004

Depressing research (registration required)

It is hard to imagine the anguish experienced by the parents, relatives, and friends of a child who has taken his or her own life. That such an event could be precipitated by a supposedly beneficial drug is a catastrophe. The idea of that drug's use being based on the selective reporting of favourable research should be unimaginable. In this week's issue of The Lancet (p 1341), however, a meta-analysis by Craig Whittington and colleagues suggests that this is what has been happening for research into the use of antidepressants in childhood. Their results illustrate an abuse of the trust patients place in their physicians. They also represent an abuse of the trust placed by trial volunteers in the medical and pharmaceutical establishments.

The story of research into selective serotonin reuptake inhibitor (SSRI) use in childhood depression is one of confusion, manipulation, and institutional failure. Although published evidence was inconsistent at best, use of SSRIs to treat childhood depression has been encouraged by pharmaceutical companies and clinicians worldwide. Last month, the Canadian Medical Association Journal  (link here; see also 1 2 3 -- links added by CC) revealed excerpts from an internal GlaxoSmithKline memorandum demonstrating how the company sought to manipulate the results of published research. Concerning a study of paroxetine use in children, the memorandum states "It would be unacceptable to include a statement that efficacy had not been demonstrated, as this would undermine the profile of paroxetine". Last year the UK Committee on Safety of Medicines prohibited the treatment of childhood depression with any SSRI except fluoxetine. Despite this, the Food and Drug Administration in the USA appears last week to have failed to act appropriately on information provided to them that these drugs were both ineffective and harmful in children.

In a global medical culture where evidence-based practice is seen as the gold standard for care, these failings are a disaster. Meta-analysis of published data supports an increasing number of clinical decisions and guidelines, which in turn dictate the use of vast levels of health-care resources. This process is made entirely redundant if its results are so easily manipulated by those with potentially massive financial gains. The global sales of the GlaxoSmithKline SSRI paroxetine, for example, amounted to US$4·97 billion last year alone. Moreover, the utility of organisations such as the National Institute for Clinical Excellence (NICE) is significantly undermined in circumstances where they are only able to access data on health-care products that are seen as advantageous to the products' manufacturers.

How confident is society that similar failings will not occur on a larger scale in the future? UK Biobank intends to recruit and follow a cohort of around 500 000 volunteers. The data collected will be used in part to develop new pharmaceutical products and diagnostic tests. Much time and effort has already been invested into ensuring appropriate regulatory and ethical principles are in place for all stages of the project. However, the links of UK Biobank with the pharmaceutical industry are already clear. John Bell, chair of the UK Biobank science committee is also a director at Roche. In addition, at least part of the estimated £70-500 million required to complete the project is envisaged as coming from industry sources. With this level of involvement, will a pharmaceutical company really feel obliged to publish information derived from these volunteers that one of its products does not work?

Changes are required at every level of the global health-care infrastructure. Governments need to collaborate effectively over issues of patients' safety rather than duplicating efforts. Governmental institutions such as NICE require legal powers to ensure that biomedical research is used to improve health even if this does not equate with improved profits. On an individual level, doctors and pharmaceutical company employees must remember that without the trust of trial volunteers and patients medical research and practice will become impossible. People around the world understand the desire to achieve success and to work in a profitable environment. They will not, however, tolerate the notion that in biomedical research this could be at the expense of their children's lives.

The Lancet

Compassion and Hate at Townhall.com

One of my favorite sources for material to poke fun at (1  2) is Townhall.com.  The thing is, they do have some good columns.  They also have some really offensive ones.  This is not so much of a left brain - right brain comparison as a ego - id comparison.

Tourette Syndrome
George Will

April 25, 2004
COPPELL, Texas -- Even in what passes for repose, your basic 11-year-old boy resembles the former Yugoslavia -- a unity of sorts, but with fidgeting and jostling elements. Andrew Nesbitt is like that, only more so, because he has Tourette syndrome.

He also has something to teach us about the power of a little information and a lot of determination. And about how life can illuminate philosophy, which is supposed to do the illuminating. [...]

 The mind-body dichotomy is a perennial puzzlement for philosophers. Most people say, "I have a body."  Perhaps we should say, "I am a body." People who say the latter mean that the mind, the soul -- whatever we call the basis of individual identity -- is a "ghost in the machine," a mysterious emanation of our physicality. They may be right. But were Andrew given to paddling around in deep philosophic water -- if he were, he would not be your basic boy -- he might reply:

"No way. Wisdom is encoded in our common language. We all have, to some extent, a complex, sometimes adversarial, relationship with our physical selves. And I more than most people know that it is correct to say 'I have a body.' There is my body, and then there is me, trying to make it behave."


Day Dreamin' Anti-Dude Dames
Doug Giles

April 24, 2004

What do the anti-dude dames daydream about?  Well … I can think of 10 fantasies right off the top of my unapologetic, heterosexual, white, Anglo-Saxon, protestant, testosterone-fog-loving head.  Ready?

1.   Ellen DeGeneres and Anne Heche would get back together and adopt a cat.  Lovely!

2.   Rush Limbaugh would choke to death on a plate of Hooter’s hot wings.

3.   Newt Gingrich would actually turn into a newt, relocate to a Madagascar rain forest and be relentlessly chased by the Crocodile Hunter.

4.   Hillary Clinton would run for President in 2004 with Melissa Etheridge as her running mate. Yummy!

5.   Thelma and Louise would experience a cinematic resurrection, which would yield up the theatrical release of “Thelma and Louise Part 2: Revenge of the Bra Burners”.

6.   K.D. Lang would do another album with Tony Bennett, only this time they’ll sing her lesbian ballads. Oh, behave!

7.   Janeane Garafalo would permanently replace Brian Kilmeade on “Fox and Friends”.

8.   The script of “Boys On The Side” would be written into the U.S. Constitution.

9.   George Washington’s face would be removed from the dollar bill to be replaced by a glamour shot of Gloria Alred.

10. The line in the pledge of allegiance would be changed from “One Nation, under God”… to “One Nation, run by Broads.”

This is what the feminists daydream about while they’re shopping for golf shirts, stretch pants and at-home-hair-cut kits.

[...]  My ClashPoint is this: Just because when the white, conservative, Christian man talks, the feminists begin to squawk, does not mean we keep our mouths shut.  We had better talk, and not just talk, work -- to protect the state of our nation against these liberal “ladies” pushing hard to the left for a “She-ocracy,” and to support the giant majority of women out there who aren't buying their hashish.

I'm talking about the women who like being a wife, like having kids, enjoy being treated like a lady, are delighted not  to fight in a war, thrive on being feminine and not butch.  They’re the women who, if they choose a career outside the home, are not shamed into it by some uni-brow, chucka-boot wearing she-male with a bad hairdo and camel's breath.

But what do I know?  I'm gender challenged.

I actually edited out the more offensive stuff that Mr. Giles wrote.  Mr. Will deserves credit for writing about Tourette Syndrome, which, as an orphan disease, is often made the subject of crass curiosity.  It is a serious illness, but it is not necessarily debilitating.  Mr. Wills illustrates how a little compassion can go a long way toward helping humanity make the most of its resources: other humans. 

Giles, on the other hand, illustrates how intolerance just screws everything up.  He's not just gender-challenged, he's logic-challenged.  His kind of hate speech makes it difficult for people to cooperate with each other, which lowers the GDP.  Some Republican.

Updates Regarding the Conscientious Objector Policy ActWisconsin Tries the Same Stunt

As noted  on CC recently, the Michigan House recently passed a package of bills that would allow health care professionals, hospitals, and insurance companies to refuse to participate in any health care practice that they found to be morally objectionable.  I noted that there were few comments in the blogosphere or the news media that were supportive of this legislation.  My last post got a couple of comments, both expressing opposition to the legislation.  Today, I went out trying to find somebody  who actually thinks it is a good idea. 

I found that the Wisconsin State Congress recently sent a similar bill to their Governor, who promptly vetoed it.  A Catholic law blog then retracted its support for the bill. 

OK, first about the Michigan legislation: On Catholic World News, there is an article about the legislation.  While there is no overt editorial commentary, positive or negative, the selection of quotes in the article indicates that the author generally supports the legislation:

The sponsor of the primary bill, Republican Rep. Randy Richardville, in response to criticism from Democrat representatives that the bill would restrict patients' rights, said: "Nothing in this bill, not a thing, denies a patient from receiving medical care. This simply means a medical professional cannot violate their religious obligations."

Paul A. Long, vice president for public policy for the Michigan Catholic Conference, applauded the move. "Individual and institutional health-care providers can and should maintain their mission and their services without compromising faith-based teaching," his written statement said.

A medical blog that I missed the first time around, Gross Anatomy, makes no bones  about their opposition  to the legislation:

It's a frightening precedent they're trying to set--that you should be able to pick your patients, that it's okay to pass judgment on them when they walk in the door. The consequences could be dire for rural residents, since many times there are no other doctors available.

The Lansing State Journal has an editorial  on the subject (and a follow-up, which is here):

Published March 28, 2004
Health morality: 'Objector' bills deserve defeat

If you walk into a doctor's office or a hospital, do you want the people there focused on your physical condition, or your moral worthiness as a patient?

Under a package of bills backed by a group of legislative Republicans, a citizen's morality could become a legal reason to refuse medical care.

This "Conscientious Objector Policy Act" would allow health workers to shun you in non-lifethreatening situations, if your care conflicted with their "sincerely held religious or moral beliefs." [...]

The state, for secular reasons, issues medical licenses. No citizen or hospital or insurer has an absolute constitutional right to such licenses. If we did, anyone could claim to be a doctor and be so licensed.

People do have an absolute constitutional right to their religious views. Government cannot deny them. Neither, though, can government enforce those views on others.

Yet that is just what this legislation would do. Medical professionals would use their morality as a test for your care. A doctor or pharmacist could put up a sign saying "Sinners not accepted."

If protecting the health of others somehow conflicts with a person's morals, we suggest a simple solution: Don't practice medicine in Michigan.

Published April 23, 2004
'Objector' bills: Dangerous legislation inflicts moral judgments on patients

[...] The state Senate should reject the bills. If it doesn't, Gov. Jennifer Granholm should veto them. If she won't, the law should be challenged in court.

[...]  A law that broadly allows these professionals an escape clause because of moral misgivings is bad law. House Bills 5006 and 5276-5278 would be bad law.

The blog Kevindonahue.com, written by a person who describes himself as "a straight, married, 30-something, Texas Republican from the middle class," expresses  disapproval as follows:

Now, Some overzealous Republicans and Catholic priests decided this would be a good way for doctors to refuse to treat gay patients. That's crap. If you're a doctor (or an EMT, ER nurse, surgeon, etc) then you signed on to treat people in need. Race shouldn't matter, economics shouldn't matter, homosexuality shouldn't matter. Period.

What's with this "conscientious objector" nonsense? If a doctor things it's morally wrong to sell crack, then they don't have to treat drug dealers? If an EMT things it's wrong to be gay, then they don't have to answer ambulance calls to a gay person's home? If a nurse is atheist, can he refuse to take a blood test from a Christian?

A moral decision is definitely needed - but treating a patient cannot be the question. Doctors, nurses, and the like must ask themselves: Am I able to be a medical professional, or do I bear too much hatred to help someone in need?

Interestingly, I found that similar legislation in Wisconsin, Assembly Bill 67, was just vetoed  by their Governor:

Wednesday, April 21, 2004
Jessica Erickson, Governor's Office, 608-261-2156

Governor Doyle Vetoes Assembly Bill 67
Legislation Would Have Allowed Medical Professionals to Deny Care to a Patient Based on the Medical Professional's Own Ideological Beliefs

At the State Capitol today, Governor Jim Doyle vetoed a bill that would have allowed medical professionals to deny care to patients based on the medical professional's own ideological beliefs.

"One of the most sacred principles of our medical care system is that a doctor should always do what's in the best interests of a patient's health," Governor Doyle said. "Medical decisions should be made by patients and their doctors based on the best information and treatments that medical science has to offer. And physicians should provide complete and clear information in order for a patient to make the best possible health care decisions." [...]

"This legislation should be called the ‘Unconscionable Clause’ bill, because it would be unconscionable to deny our citizens the full range of needed medical treatment in order to satisfy the ideological views of some health care professionals," Governor Doyle said. "It is a disservice to patients and to our health care system, and today, I am pleased to stand with doctors, medical professionals, patients, and legislators, and veto this bill." 

 
For some reason, the Michigan legislation was reported and commented upon widely; Bloglines and Dogpile find few references to the Wisconsin legislation.  A group blog I had not known about previously, Mirror of Justice (tagline: A blog dedicated to the development of Catholic legal theory.), posted  the following:

April 25, 2004
Physicians in Wisconsin: a moral power play?

In response to my post on the Wisconsin governor's promised veto of the new state "conscience clause" (see "An amoral vision of physicians," below), a Mirror of Justice reader emailed me to point out that the statute seems not simply to excuse physicians from actively participating in certain procedures, but also from providing information on certain procedures.

[...]  it appears that my blanket endorsement of the statute may have been premature. One relevant section of the bill provides that "a hospital or employee of a hospital is immune from liability for any damage caused by a refusal to participate in [a range of activities, including abortion, sterilization, embryo research, fetal tissue transplants, withholding of nutrition/hydration, and euthanasia] if the refusal is based on religious or moral precepts." Significantly, "participate in" is defined very broadly: "to perform, assist in, recommend, counsel in favor of, make referrals for, prescribe, dispense, or administer drugs for, or otherwise promote, encourage, or aid."

[...] At a minimum, the statute does not appear to set forth (or preserve) any obligation to inform, as opposed to promote. If a woman's life is threatened by the continuation of her pregnancy, it should at least (in my view) be brought to her attention that abortion is an alternative, even if, for the physician, it is not an alternative in which he or she could participate in good conscience. Other parts of the statute state that a physician's moral or religious objection must be made in writing, which presumably gives the patient notice that the physician, as a general proposition, will not perform the procedure in question. But it is unlikely that a blanket notice will tell the patient much about abortion's potential relevance to the circumstances of her particular case.

Perhaps I'm misreading the statute. (If so, I'd welcome some enlightenment from a reader or co-blogger.) As I've indicated several times on this weblog, I am an unflagging supporter of allowing professionals to integrate their own moral and religious values with their provision of public goods. But I still believe that consumers must be empowered to make the ultimate decision about their own health care (or legal services, education, etc.) -- they just shouldn't be empowered to force a particular professional to facilitate it, especially when it embodies a morally objectionable vision of the good. But if Wisconsin means to allow physicians to avoid even making information about morally contested (but medically prudent) procedures available to the patient, the statute gives me pause. It's one thing to reinject a robust concept of moral agency into the physician's role; it's quite another to give the physician a statutory trump over the patient's own moral agency.

Posted by Rob Vischer on April 25, 2004 at 07:09 PM

The Mirror of Justice post includes a detailed comment by a reader, which is what prompted the author, Rob Vischer, to issue his partial retraction of support.  In my last post on the Conscientious Objector Policy Act, I pointed out that I disagreed with a statement on another blog: "Catholics hate all sorts of people."  Persons who agree with the comment are encouraged to read Mirror of Justice.  I found only thoughtful social commentary; no hate speech.  For example:

Earth Day

The recent observance of Earth Day prompts me to ask my fellow bloggers and any readers to recommend sources (legal or otherwise) engaging questions of stewardship of our environmental resources from a Catholic perspective.

Posted by Michael Scaperlanda on April 23, 2004 at 05:10 AM

A Burkean Function for CST in the Face of Ethical Pluralism

[...]  Catholic social teaching thus serves as one of the repositories of tradition by which we can evaluate value disagreements grounded on human reason. Individual reason in today's moral climate too often leads to mere values, which are purely matters of personal preference, lacking the moral force to bind others. In contrast, tradition emphasizes standards grounded on preferences that have been widely accepted over a very long period.

If I'm right about all this, it has important implications for those of us who bring to bear our own reason on the teachings of the Church. The function of human reason within a moral tradition is not a critical one, seeking to expose the tradition's faults, but rather a respectful one, seeking to learn what the tradition offers. [...]

Posted by Steve Bainbridge on April 25, 2004 at 03:14 PM

Perhaps the supporters of the Michigan Conscientious Objector Policy Act should read Mirror of Justice too.

Climate Change...yes, againJung, Emmerlich, Mastrandrea, and Biodiesel

Carl Jung coined the term, synchronicity, and defined it as "The coincidence in time of two or more causally unrelated events which have the same meaning."  I don't have a lot to say about Jung, since I could never understand what he wrote.  I also don't believe that there is a particular significance to it, when two things happen at the same time, even if they do have the same meaning.  But, every once in a while, there is a coincidence that is too remarkable to ignore.  This example has to do with the coincidental publication of an article about the new Roland Emmerich movie, and one about a new analysis that shows climate change is only 45% likely to cause any actual danger to the USA. 

Found via a Bloglines search, on BottleOfBlog, is a mention  of a NYT article.  Excerpts from the actual article  are posted here:

April 25, 2004
NASA Curbs Comments on Ice Age Disaster Movie
By ANDREW C. REVKIN

"Urgent: HQ Direction," began a message e-mailed on April 1 to dozens of scientists and officials at NASA's Goddard Space Flight Center in Greenbelt, Md.

It was not an alert about an incoming asteroid, a problem with the space station or a solar storm. It was a warning about a movie.

In "The Day After Tomorrow," a $125 million disaster film set to open on May 28, global warming from accumulating smokestack and tailpipe gases disrupts warm ocean currents and sets off an instant ice age.

Few climate experts think such a prospect is likely, especially in the near future. But the prospect that moviegoers will be alarmed enough to blame the Bush administration for inattention to climate change has stirred alarm at the space agency, scientists there say.

"No one from NASA is to do interviews or otherwise comment on anything having to do with" the film, said the April 1 message, which was sent by Goddard's top press officer. "Any news media wanting to discuss science fiction vs. science fact about climate change will need to seek comment from individuals or organizations not associated with NASA."

Copies of the message, and the one from NASA headquarters to which it referred, were provided to The New York Times by a senior NASA scientist who said he resented attempts to muzzle climate researchers. [...]

The initial efforts by NASA headquarters to limit comments angered some government researchers.

"It's just another attempt to play down anything that might lead to the conclusion that something must be done" about global warming, one federal climate scientist said. He, like half a dozen government employees interviewed on this subject, said he could speak only on condition of anonymity because of standing orders not to talk to the news media.

Along with its direct criticisms of a Bush-like administration, the movie also could draw attention to a proposed Bush budget cut. [...]

So the executive branch of our government wants to muzzle scientists.  That is not exactly news.  Just two days before the NYT article was published, the journal Science  published an article about climate change.  A subscription (or a trip to the library) is required to see the full article; free registration gets you to the abstract:

Probabilistic Integrated Assessment of "Dangerous" Climate Change
Michael D. Mastrandrea¹* and Stephen H. Schneider²

Climate policy decisions are being made despite layers of uncertainty. Such decisions directly influence the potential for "dangerous anthropogenic interference with the climate system." We mapped a metric for this concept, based on Intergovernmental Panel on Climate Change assessment of climate impacts, onto probability distributions of future climate change produced from uncertainty in key parameters of the coupled social-natural system—climate sensitivity, climate damages, and discount rate. Analyses with a simple integrated assessment model found that, under midrange assumptions, endogenously calculated, optimal climate policy controls can reduce the probability of dangerous anthropogenic interference from 45% under minimal controls to near zero.

¹ Interdisciplinary Graduate Program in Environment and Resources, Stanford University, Stanford, CA 94305, USA.
² Department of Biological Sciences and Center for Environmental Science and Policy, Stanford University, Stanford, CA 94305, USA.

Just as the USA is split between the Republican candidate and the Democratic candidate for president, the probability for "dangerous" climate change is close to 50:50.  Actually, according to Mastrandrea and Schneider, it is slightly more likely that there will not  be dangerous climate change.  The question is, what does this mean?  I have already commented  on the flippedy-do-floppedy-da-floop that our Dear Leader has performed on this subject.  In fact, it was the first post of mine that generated any significant traffic.  But today I am not going to heap any more criticism on politicians.  This is about science, since there is a light green background.

I would say that a 45% risk is pretty significant.  The risk posed by Iraq was much less than that, and we went ahead and spent $100 billion dollars to try to squelch the risk.  So what keeps us from spending the same amount to forestall climate change?  Is it the economy?  Consider these economic facts:

• Money spent on warmaking does not produce salable goods.  All the helicopters, bullets, etc. that are expended, are things that never will be sold.  This means that there is more money in the economy, but fewer goods that the money can be spent on.  This increases inflationary pressure.
• War takes some of our most productive citizens and sends them abroad, where they produce nothing that can be sold.  This decreases economic productivity.
  
• War kills people.  Dead people can't make anything. 
  
• War does help the unemployment figures, since someone has to replace all those soldiers who used to be working here at home.  But when they all come back, you get a sudden tightening of the job market. 
  
• War increases energy demand, and reduces supply, thus increasing energy costs.  This drives up prices.  It also makes it harder for poor people to afford to get to work. 
  

If you spend the same amount to develop technology to combat climate change:

• New industries could be developed, increasing the number of desirable jobs in the USA.
• Energy prices come down, as industry becomes more efficient.
• No one is killed; in fact, the overall health of the population is improved, since there is less pollution.
• The USA demonstrates leadership, and is in a position of power, relative to other countries.  Power is derived when you have something that someone else wants.  Other countries, as they become more industrialized, will want the technology that we develop to control pollution and increase efficiency.

Am I talking about castle-in-the-sky technology?  If so, my whole argument is bo-o-o-gus.  Consider these examples:

• Biodiesel fuel:  Instead of burning fossil fuels, which release carbon into the atmosphere, we could use carbon derived from plant sources.  Then, every molecule of carbon dioxide produced contains one carbon atom that was removed from the atmosphere by photosynthesis.  There is no net increase in carbon dioxide.  My liberal friends might crucify me for saying this, but we could genetically modify corn to produce a large amount of high-grade corn oil.  The corn oil would be used to make biodiesel.  The frankencorn also would produce sugar, which would be fermented into alcohol, for gasohol; and the cellulose could be diverted to use in engineered wood products.  This would be extremely efficient and have a small ecological footprint.   Almost every molecule in the entire plant would be used for some purpose.  We would not have to pay farm subsidies, since the farmers would all be busy growing the stuff.  And the trend toward urban sprawl would be reduced, since the need for farmland would be increased.
• Organic LEDs(1 2).  LEDs are already extremely efficient, but they are too expensive to use to light up a house.  Recent research has found ways that could lead to an efficiency close to 100%. (S Coe et al. 2002 Nature, 420:800).  The editorial in that issue of Nature  indicated that it seems feasible to mass-produce LEDs that could produce bright white light at a very low energy cost.  Although they would cost more that light bulbs, the energy savings would be enormous.  This is true especially when air conditioning is being used, because the LEDs would not produce any significant amount of heat. 
  
• Improved automotive technology.  Ford and GM are working on a six-speed automatic transmission.  The next step would be a continuously-variable transmission.  Coupled with hybrid technology and biodiesel, automobile efficiency would be increased greatly.

There are many more examples, but this is getting long and it is late and you are getting bored.  The point is, there is a much better cost-benefit ratio spending money on technology to combat climate change, than spending it on war.  And it is better for the economy.  And it is not just science fiction, like a Roland Emmerich movie.

Another Internet Quiz

Neocon quiz results
Based on your answers, you are most likely a liberal. Read below to learn more about each foreign policy perspective.

Liberals…

• Are wary of American arrogance and hypocrisy
• Trace much of today's anti-American hatred to previous US foreign policies.
• Believe political solutions are inherently superior to military solutions
• Believe the US is morally bound to intervene in humanitarian crises
• Oppose American imperialism
• Support international law, alliances, and agreements
• Encourage US participation in the UN
• Believe US economic policies must help lift up the world's poor

Historical liberal: President Woodrow Wilson

Modern liberal: President Jimmy Carter

Ok, no big  surprise here.  I have voted for only one Republican president in my life.  There are some little  surprises, though.  I don't beleive that the USA is morally bound to intervene in humanitarian crises, and I don't believe that much of today's anti-American hatred is due to previous US foreign policies. 

From The National Council of the Churches of Christ

Earth Day 2004

100 U.S. Church Leaders Write Bush on Clean Air;
NCC Offers April 25 'Earth Day Sunday' Resources

In an Earth Day 2004 focus on clean air, nearly 100 U.S. national and state Christian leaders today sent a letter to President Bush expressing their grave moral concern and dismay over the President's stewardship of America's environment, charging him with weakening critical health standards including those in the Clean Air Act. Their concerns also are reflected in a national ad set to run soon in The New York Times.  Thousands of congregations across the United States will continue the focus on air in their celebrations of Earth Day Sunday, using resources prepared by the National Council of Churches' Eco-Justice Working Group, "Life-giving Breath of God: Protecting the Sacred Gift of Air." Click here to download those resources. See also:

• The letter to President Bush and a related news release.
• An NCC news story about Earth Day Sunday 2004.

(link via Truthout)

"Conscientious Objector Policy Act"Serious Flaws With Bizarre Michigan Legislation

It is not common for legislation in Michigan to attract much attention.  However, the recent action on Michigan Senate Bill 972, and associated legislation, have generated several news items and blog posts around the country.  Because this is something that affects me personally, and because the Legislation is so obviously flawed -- in addition to having a bizarre twist at the end, I have surveyed the various points made by the denizens of the Blogosphere.  Here is the preamble for the bill:

Michigan Senate Bill 972

A bill to provide standards for personnel policies to protect the right of conscience of health care providers who conscientiously object to providing or participating in certain health care services under certain circumstances; to provide for protection from certain liability; and to provide for penalties and remedies. 

The legal website Yclipse  provides a guide to the four related bills:

HB 5006 protects any individual health care provider, such as a pharmacist, nurse, or doctor, from being fired or disciplined over refusal to perform acts, such as participating in an abortion or filling a prescription for an abortion drug.

Two other bills, HB 5277 and HB 5278, "would allow insurance companies to likewise exempt themselves from medical practices they find morally objectionable." HB 5277 covers "health care corporations", and HB 5278 covers insurers and HMOs. The operative language in each is:

Notwithstanding any other provision of law, [an entity] may refuse to offer or provide a health care benefit that violates an ethical, moral, or religious principle reflected in its articles of incorporation, bylaws, or an adopted mission statement.

For the duration of this article, I will refer to the entire package of bills as "the Legislation."  The current status and text of the Senate bill can be found here; the House bill status is here. 

Notice that the State of Michigan website also provides a link to a Legislative Analysis:

HFA - Legislative Analysis

Summary (3-222-04) This document analyzes: HB5006, HB5276, HB5277, HB5278

The date, 3-222-04, indicates that it was one very long  congressional session.  I'm glad I didn't have to sit through the entire thing.  I thought the Chicago White Sox & Milwaukee Brewers baseball game at Comiskey Park, 05-09-1984, was long.  That game went for 25 innings.  Having to add 191 days to the month, just to finish a piece of legislation,  must have been awful. 

Loose tangents aside, this is a serious matter; not only because of what the Legislation itself does, but also because it indicates how susceptible the Michigan Congress is to ideological influence. 

An AP news article explaining the Legislation is here:
   

Michigan House backs conscience rights for health-care workers
By The Associated Press
04.22.04

LANSING, Mich. — The state House has voted to protect health-care workers and insurers from being fired or sued for refusing to perform a procedure, fill a prescription or cover treatment for something they object to for moral, ethical or religious reasons.

The measures would apply to doctors or nurses who decline to perform or assist with abortions and to pharmacists who refuse to fill prescriptions for morning-after pills.

The Republican-controlled House overwhelmingly approved the four-bill package as dozens of Catholics looked on from the balcony.

The Michigan Catholic Conference, which pushed for the bills, hosted a legislative day for Catholics yesterday at the state Capitol. The Catholic Church opposes abortion and birth control. [...]

Gaywired.com, a website with gay-oriented articles, reprinted the AP story, using the headline, Michigan Preparing To Let Doctors Refuse To Treat Gays.  365Gay.com  added editorial content to their reporting on the Legislation:

Opposition Mounting Michigan Bill That Could Deny Gays Health Care
by 365Gay.com Newscenter Staff

Posted: April 23, 2004 5:32 p.m. ET

(Lansing, Michigan)  Some Michigan legislators are calling for amendments to a bill passed in the state House this week that could allow doctors and nurses who object to homosexuality to deny gays treatment or prescription drugs.

As reported first by 365Gay.com, the Conscientious Objector Policy Act would allow health care providers to assert their objection within 24 hours of when they receive notice of a patient or procedure with which they don't agree. However, it would prohibit emergency treatment to be refused. (story)

The bill was aimed at allowing doctors opposed to abortion or stem cell research to refuse the procedures, but opponents of the legislation say it is so loosely worded it could be used to refuse treatment to gays.  

During debate in the legislature Rep. Chris Kolb (D-Ann Arbor) the first openly gay legislator in Michigan, pointed out that while the legislation prohibits racial discrimination by health care providers, it doesn't ban discrimination based on a person's sexual orientation. [...]

I doubt that the bill was intended, originally, to have anything to do with the civil rights of homosexuals.  But since Rep. Kolb raised the issue during debate, and it was not addressed, it does give the appearance that the Michigan Congress is not concerned about this aspect.  Either that, or they are concerned, but only insofar as it affects their re-election prospects. 

Not all reporting was critical of the Legislation.  LifeSite.com, which presumably is a pro-life/anti-abortion site, has the following report:

LifeSite Daily News
Thursday April 22, 2004

Michigan House Votes in Favor of Conscience Clause
Law would also protect pharmacists from reprisals

LANSING, April 22, 2004 (LifeSiteNews.com) - The state House has voted to introduce conscience legislation to protect medical professionals from being fired or sued for failing to participate in procedures they are morally opposed to. The Conscientious Objector Policy Act allows for a period of 24 hours from the time a worker receives notice of a request to perform a procedure in which to object.

The law not only applies to health-care workers such as doctors and nurses, but also to pharmacists who will now be protected from reprisals for not filling prescriptions that conflict with their moral and religious beliefs. Pharmacists will not be exempted from filling prescriptions for the birth control pill, however. [...]

The sponsor of the primary bill, Republican Rep. Randy Richardville, in response to criticism from Democratic representatives that the bill would restrict patients' rights, said "Nothing in this bill, not a thing, denies a patient from receiving medical care. This simply means a medical professional cannot violate their religious obligations."

Rep. Richardville uses unfortunate wording here, "Nothing in this bill, not a thing, denies a patient from receiving medical care. This simply means a medical professional cannot violate their religious obligations."  The Legislation does not say that a professional cannot violate her or his religious obligations; rather, it says that a professional may choose to follow his or her religious conviction without fear of certain kinds of reprisal.  The other part of what he said simply is not accurate.  It leads me to wonder if he thought through the implications of the Legislation.  There are some areas where there are either very few physicians, or they all have the same religious convictions.  In such an area, a patient could very well be in the position of having care denied.   This is a serious problem with the legislation.  Many insurance plans provide a limitation on what doctors a person can see, or limit the geographic area in which care can be sought.  (There are exceptions for emergency care out of area.)  It is likely that there will be situations in which a patient does not have a realistic option available, because of these kinds of limitations. 

What about blogger commentary, which always is more interesting?  The popular medical blog, Medpundit, has a slightly positive take  on the Legislation: 

A gay person isn't a procedure or a service, he's a patient. That doesn't mean the doctor can refuse to treat a homosexual for heart disease, or an infection. It does mean that the doctor could refuse to, say, sign off on an adoption physical for a homosexual patient, or refuse to perform artificial insemination for a lesbian or a single mother. Is that discrimination? Maybe. But it's not nearly the blanket rejection of homosexuals that the first story made it seem.

To place this excerpt in context, Dr. Sydney Smith was comparing the text of two news articles on the subject.  To place it in a larger context, note that the American Medical Association Code of Medical Ethics  (section E 2.05) contains this statement: 

In the case of single women or women who are part of a homosexual couple, it is not unethical to provide artificial insemination as a reproductive option.

The AMA did not state explicitly that it would be unethical  to refuse to provide this service to homosexuals.  I don't know what their silence means.  Perhaps they assume that they do not need to specify that such a refusal would be unethical.  My guess is that their committee did not want to go so far. 

(note: you can download the entire AMA Policy, including the Code of Medical Ethics, from the AMA website.  This is the link; it is over 8Mb.  You have to agree to their disclaimer before you can download it.)

Andrew Sullivan comes out with a criticism  of the Legislation:

COMPASSIONATE CONSERVATISM: A Catholic and Republican initiative in Michigan will allow doctors to refuse treatment to any person of whom they morally disapprove. I can see why some doctors should be allowed to refuse to perform abortions on moral grounds (except I doubt that any doctors are routinely put in that position). But the sweeping nature of this bill is clearly aimed at allowing doctors to refuse care to homosexuals (there is an exception barring refusal of care on racial grounds). [...]

I have yet to read a conservative denunciation of this. Just as I have yet to see this president do anything to distance himself from the hatred coming from some parts of his own party. Why should it always be up to gay people to point this out? Are there no straight people prepared to stand up against this kind of thing in the G.O.P.?  

I can't agree that it "is clearly aimed at allowing doctors to refuse care to homosexuals".  However, I have no doubt that this will be the effect in some situations.  Yclipse casts a shadow  on Mr. Sullivan's point. 

This proposed law protects a person who objects to providing a health care service that is objectionable. It mentions nothing about a patient who is objectionable to the provider.

This is true, but in practical terms, it is irrelevant.  If a physician refuses to do artificial insemination for a lesbian, citing a moral objection, is it clear that the law not apply?  If a physician does refuse, will the patient have the legal resources to go to court and fight it out?  The point is that the Legislation imposes a barrier to health care.  Even if the the patient would eventually win a challenge in court, there still is a barrier.

Atrios at Eschaton  chimes in, adding a rather brazen title: The Taliban in America.  After quoting the news article, he concludes:

If this law passes, I will personally help compile the wall of shame so we can frequently and loudly object to anyone who thinks they have the moral right to do this.

Lean Left has the following inclination:

This is not about religious freedom. This is about bigotry, pure and simple. This is the modern equivalent of the laws that prevent people form selling their homes to Jews in the first half of the twentieth century. This is vile and disgusting, and it is supported by the Michigan Republican Party -- the party of hate once again, it appears. And the Catholics who supported this disgusting measure of hate should be ashamed of themselves. Denying care to the sick and the dying is the least Catholic thing I can think of.

 
One of the comments on Lean Left, by Len Cleavelin,  amplifies this:

The Michigan Catholic Conference pushed for this?  If the Pope doesn't immediately put Michigan under an interdict until they shitcan this measure, there's no justice on Earth.  Damn, I'm so proud I left the Church. This is disgusting.

The Dutch weblog, SILT, adds a bit more vitriol:

Anathema.

Prodded by the Catholic Church, the Michigan House has passed a law that would permit health-care providers to refuse to provide services to homosexuals.

And so Christo-Fascism marches inexorably on.

Lara, at The Diary of Elle Wiz, has a strongly worded entry:

This is insane. This cannot possibly be constitutional. Someone please appeal this!

Chad's Weblog offers a more moderate, but still negative, view  of the Legislation: 

The real disturbing part is where the bill states that health care workers can refuse service to anyone on moral, ethical or religious grounds. In short - they don't have to service anyone they don't like. Wouldn't that be weird if other jobs out there allowed you to do the same - such as McDonalds - where you only served the people you liked at the drive through window...

Doug, at George W. Bush, Will You Please Go Now?!, dismisses  the entire State because of the Legislation:

Congratulations, Michigan: You've just made me proud that I live in Alabama. On the other hand, I'm not especially proud to be Catholic right now:

James, at jameswagner.com, does not come down so hard on Michigan as he does on the Catholic Church.  Excerpt from his post:

But it's 2004! Why do we still have to deal with this accursed thing? I've absolutely had it with the abominations of the Catholic Church, and don't get me started on all the other monstrously evil cults which compete with it in advancing fear and superstition in this benighted land and around the world.

[...] If these idiots want religious war, I think we should let them have it. I'm in.

Sam, at mad LIFE, seems rather upset  by the whole thing:

So tired of all the bullshit. It's exhausting. I don't have the will to even talk about much of it anymore - you may have noticed my lack of blog entries with any substantial information, esp. anything about politics. The truth of the matter is that I am quickly losing hope. One day, I began to entertain the idea that I might hate America, just a little, little bit. And every day, I think I start to hate it just a little bit more (by "America," I mean a lot of stupid people)

[...]  God bless the USA, where freedom rings so loud that the majority & the rich can do whatever they want.

On the blog King of Zembla, Simbaud proclaims:

In Other News, Jesus Wept
Via Atrios. I haven't seen the actual language of the bill, but if the description below is accurate, wouldn't it allow a doctor to withhold treatment from Catholics?

[...]  Our esteemed colleagues at Musing's Musings report that Colorado is just as bad. Is there a national movement afoot to deny medical care to minorities that happen to be out of favor with the Republican party? And what was the last country to adopt a national eugenics policy?

Was it by any chance the one my old man went to war against?

A thoughtful and moderate opinion is snarled  by Robin at Giant Grizzly Twists And Shouts.  This resonates with my concern about the Michigan Congress being susceptible to ideological influence: 

As part of a special "you ask for it we'll give it to you" legislative day for Catholics, the state of Michigan has just passed legislation that will allow any Doctor or health care worked the right to refuse to treat anyone on the grounds of moral, ethical or religious grounds. They cannot be sued. They cannot be disciplined. You cannot complain, but you can die.

There something deeply offensive about a religious organization controlling a state's legislative program in such a country as America where people are allowed to have religious freedom.

I am truly shocked that such a Bill can be passed in America.

At A Man with a Ph.D. - Richard Gayle's Weblog,  we find the following thesis:

So, how is someone supposed to 'know' someone is gay, or a Catholic, or living with someone. Those are all questions that are not allowed to be asked before providing health. Will your ability to get healthcare depend on gossip and innuendo, then? It is scary to believe that my ability to receive medical care will be solely determined by the moral, ethical and religious views of the health care workers, not on my need. It must be nice to be allowed to enter an industry where you can opt out of a procedure simply by saying doing so would violate my sincere belief that disease is a curse from God, who will be the one to cure it. Insane.

A sarcastic but pointed version was floated on Push Fluids, a blog by three medical students.  I post the entire thing, partly for comic relief.  Medical students tend to have a strange sense of humor.

does manual disimpaction count as morally repugnant?

Dr. Quinn and I were apparently working in fits of righteous anger at the same time...

Here's a link to the bill passed the Republican-controlled house yesterday that she was talking about. The "Conscientious Objector Policy Act," would provide legal cover for a healthcare provider to refuse to treat a person, or perform a procedure, or prescribe a goddamn drug if it ran counter to their religious, ethical, or moral beliefs.

Awesome. So now all I have to do is graduate from medical school, do a quick residency, and then get a job at Planned Parenthood in Flint, MI. Then I can bust out with some newly found Catholic religious fervor and refuse to ever show up to work because it's an abomination before god. Those godless bastards won't have a legal leg to stand on when they try and can me! Yep. I'll be having fun in the legal protection of the Son (of man). (Sorry, I couldn't resist that last one. Yes, I know it's not even funny.)

In related news, California is working on passing a bill that protects clergy from being fired for refusing to preach the word of God or provide their congregations with those little Jesus crisps.

On a more serious note, also on Push Fluids, but by a different blogger, the following words flow:

some would argue that allowing physicians to refuse treatment of people who they would feel uncomfortable treating is better for the patients. but these people are wrong.

first, in a state like michigan, where there is a bible belt that is quite rural, there is a great possibility that gay people would have to travel long distances to find a physician willing to treat them. in addition, there is a greater risk to homosexuals who are in emergency situations. it is quite possible that this law could allow ER docs, and EMTs to refuse to treat someone who is homosexual in an emergency situation.

this is not an unheard of phenomenon. a woman named tyra hunter died in washington dc after a car accident. as she lay on the street, an EMT stopped treating her when he found that she had male genitals. robert eads was a female to male transsexual who died of ovarian cancer in georgia because he could not find an ob/gyn willing to take care of a transgender patient (there was an excellent HBO documentary about him). there are countless others (brandon teena, matthew shepard, etc.) who have died because people refused to help or protect them and allowed hatred and prejudice rule their lives.

i just don't know what to say about this. i'm tired. i'm just beside myself that there are people in this world so hateful.

Paul, at A Fortiori, adds even more anti-Michigan sniping:

Nice. Michigan is now officially off the list of "States I Might End Up Living In".

A Livejournal site, Feminist Rage, contains emotional -- but considered and nuanced -- commentary.  Here is a piece by Wiilowbean and a comment by ggdsbuckeye:

So doctors and nurses can refuse to give out or even talk about EC or birth control even if you ask for it. Pharmacists can refuse to fill birth control prescriptions. And my personal favorite, any health care provider can refuse to treat you if they believe you're gay. Because god forbid those horrid homos have access to medical care.

I can't even begin to process how outraged this makes me. Lesbians already have lower rates of seeking health care especially for things that can make a huge difference in health like annual paps. There's already enough bigotry and just plain old ignorance in the medical community about queers that creates barriers to care and now they want to go and make that not only legal (because since there's no anti-discrimination laws it already is) but legislatively encouraged.

[...] Furthermore, this bill does not contain any provision for referring the patient for requested services.

Feminist Rage is referring to emergency contraception with the acronym EC.  She is not quite right about the birth control.  The Legislation includes the following language:

Health care service does not include the provision of a contraceptive medication.

At first glance, this would appear to mean that neither birth control nor EC would be affected by the Legislation.  However, there is a peculiar specification:

"Contraceptive medication" means a medication approved for the prevention of pregnancy that is taken or used in advance of sexual intercourse. 

This specifically excludes EC, since EC is given after  intercourse.  Those that wish to argue that the Legislation is not ideologically influenced will have to explain the existence of this specific wording.  Most health care providers, and probably most randomly selected citizens, would not define "contraceptive medication" in this way. 

The last quoted line from Feminist Rage has to do with referral for services.  It is, presumably, a reference to the section that defines "participation" in a health care service:

"Participate" or "participating" means, at a minimum, to counsel, refer, perform, administer, prescribe, dispense, treat, withhold, withdraw, diagnose, test, evaluate, train, research, prepare, or provide material or physical assistance in a health care services.   . 

This means that a health care provider (or other person, such as a representative of a hospital or insurance company) could refuse to tell someone whether or not the requested service is available elsewhere, or even refuse to discuss it at all.  Personally, I find that highly offensive.  This would mean that a person could call her or his insurance company and ask about the coverage for a particular service, and the company person could refuse to discuss it. 

From The Republic of T., Terrence is teed off, as we see from these comments:

[...]  Here's my question for the Michigan Catholics who supported this bill. Was there anyone that Jesus refused to heal? Whom did he turn away?

For once, I am completely, and utterly speechless. This is just another example of how compassionate conservatism is a crock of shit.

Update: Apparently, the law bars health care providers from refusing service to those who belong to protected classes under Michigan law. Gays, however, are not protected from discrimination under Michigan law. So under this law, gays can be denied services by health care providers who morally object to homosexuality.

I cannot say whether Michigan law contains no provision for protection of civil rights of gay or lesbian persons.  I can, however, say that the Legislation does not:

A health care provider shall not assert an objection to providing or participating in a health care service based on the classification of a patient or group of patients protected under the Elliot-Larsen civil rights act, 1976 PA 453, MCL 37.2101 to 37.2804, or based on a disease or other medical condition.

The text that defines groups covered by the Elliot-Larsen civil rights act can be found here.  It does not offer any protection to homosexuals.

Kriston at Grammar.police writes a ticket for the Legislation:

The Hippocritical Oath

[...]  The site from which Atrios clipped focuses on the effect on the gay community, but remember that Catholics hate all sorts of people. I'd like to believe that anyone who's taken the Hippocratic Oath couldn't be so foolish or insincere to pay attention to this political pandering, but then only recently those Dallas pharmacists refused to fill prescriptions for contraceptives because of "personal beliefs." What's with the medical activism?

I disagree with the blanket statement that  "Catholics hate all sorts of people".  The point about the Hippocratic Oath requires some clarification.  It is widely believed that all doctors take The Hippocratic Oath.  That is not the case.  Also, there are many different versions of the Oath.  Some, for example, delete the reference to abortion.   Implicit in his statement is an important point, though.  Physicians have their own code of ethics, and most would -- narcissistically or otherwise -- place their own ethical principles above any legislation.  It sounds as though Kriston has this expectation. 

Henry Lewis at Just Left of Center adds the following:

In Michigan, it will soon be okay to refuse health care and coverage to gays, if you don’t like them.  Well, at least it’s still illegal to drag us out of our houses and shoot us. For now.

Lisa at Fuzzy Puppy snarls at the Michigan Congress thus:

OUTRAGE METER EXPLODES, SENDING TINY SHARDS INTO MINE EYES, BLINDING ME FOREVER, FOR WHICH I AM GLAD

As Atrios notes, it is indeed the Taliban in America. Of course, I've been saying that for years. There is no real difference between the god-fearing Christians here and the Islamic fundamentalists Over There. Not really. They should all get together over a nice hot book-burning fire sometime. 

Lachlan (who has what she calls a wee bio) posts on her site, my so-called blog,  a wee objection to the Legislation:

I cannot imagine, for the life of me, why this bill was sponsored. Marriage rights being denied- ok, that’s not going to kill anyone. But denying medical care to a segment of the population??

This comment, towards the bottom, ticks me off especially:

Paul A. Long, vice president for public policy for the Michigan Catholic Conference, said the bills promote the constitutional right to religious freedom.

“Individual and institutional health care providers can and should maintain their mission and their services without compromising faith-based teaching,” he said in a written statement.

So, placing one’s faith above another’s life is acceptable.

When are religious people of all stripes going to realize that beneath economics, faith, politics, sexuality, and gender we are all HUMAN? That that shared humanity links us, inextricably, and should not be dismissed in favor of societal trappings?

Those trappings, while part of our identities, should not be the basis for denying medical care. Each person is loved by someone, has feelings and dignity.

Unless, of course, you’re a gay MI resident and this law passes.

On Alex: tipping the balance, Alex weighs in:

Ostensibly, this legislation was written to provide an out for medical care professionals who are morally offended by treating gay patients (and probably abortion procedures as well). But let’s think about the statement, “This bill allows health care workers to refuse service to anyone on moral, ethical or religious grounds.” What could be any less ethical than for a medical professional to deny health care to any patient for any reason?

If medical professionals are going to start this kind of crap, then they do not belong in the medical field. I would suggest that this brings the word sanctimony to a stunning new level.

There are other comments by other bloggers, but I think the ones cited here cover most of the points raised in the Blogosphere.  Of note, I included all of the comments I found that were favorable to the Legislation, and that is a small number.  The overwhelming majority of those who wrote posts, and whose posts could be found using Waypath and Bloglines, are negative.  Many are strongly negative.  

There is one point that I did not see in any of the entries I surveyed.  From the Legislation:

A health care provider shall not make an objection known to or in the presence of a patient who is or may be the subject of the health care service to which the health care provider is objecting.                                  

This is bizarre, truly.  Especially when you consider that violations of the Legislation can be costly:

A person who violates this act is responsible for a state civil infraction and may be ordered to pay a fine of not more than $1,000.00 for each day the violation continues or a fine of not more than $1,000.00 for each occurrence.

I am not an attorney, but this would appear to mean that if a health care provider refuses to perform a service, and tells you to your face that he or she is refusing as a conscientious objection, then that provider could be fined $1000.  So, not only can the provider refuse to do something on moral grounds, the provider is not allowed to tell you why.  The Senate bill was passed by a vote of 69 to 35.  So 104 of our State's most distinguished citizens sat around and passed legislation making it illegal to tell someone why you are being obstinate.  I can understand why the 35 voted against it, I guess; but frankly, it is hard to image that anyone would even take this seriously, much less vote for it.