the eye of Nova&#39;s mind

As abhorrent as the denial of right-to-refuse is, it is a right that some feel should be denied to pharmacists and doctors as well as prostitutes.

From:

I'm not sure I understand what you mean. From what I understand, the "right-to-refuse" issue for doctors involves doctors being able to turn away patients that aren't of the same religious affiliation or something similar. That I adamantly don't agree with--that's quite opposed to the Hippocratic oath, IMO.

From:

Indeed, if that's what guttaperk is getting at, I ditto the opinion that doctors and pharmacists do not have the right to withhold medication or treatment due to their "moral stance".

If that's the way they feel, they should not be doctors and pharmacists.

From:

Right to refuse simply refers to the right to refuse services for (almost) any reason. It is staunchly defended by most who deal with the public.

Most modern governments rightly note that refusal on the basis of the racial/religious classification of the potential client- that is, on the basis of bigotry- is of such pressing danger to our societies that it is not to be tolerated. Non-bigoted reasons, even idiosyncratic ones, however, are usually tolerated, e.g. dress codes.

The Hippocratic Oath was an important early step in the development of medical ethics. However, I don't think that it remains the definitive reference for modern practise. For instance, it specifically forbids the practise of abortion and euthanasia, if I recall correctly, and both remain common practises in one form or another.

The important part of the Hippocratic Oath that you are likely referring to, the still-pertinent part, is "Do No Harm"; and I agree that where it can be shown that refusal of service poses immediate danger to the patient, it should fall under illegal-endangerment as well as unprofessional-conduct statutes.

But that is a specific minority of cases. Most cases of refusal of service, medical or not, do not constitute immediate danger, and so are (to me) legally tolerable. I should not be forced to perform routine infant circumcision or extreme breast enlargement (or other body modification procedures) at the whim of the patient; neither should pharmacists be forced to engage in prescription practises which they deem to be inappropriate.

Pharmacists and pharmacies which subject their patients to troublesome idiosyncratic refusals should, however, be subject to the usual marketplace punishments, just as are bars with unusually inconvenient dress codes.

From:

Here we go.

Hippocratic Oath -- Classical Version

I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else.

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.

What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

There is much here with which we will both likely agree, but there are also significant components which fly against common current morality, including the waiving medical school fees and entry requirements for children of physicians, the forbiddance of military action for physicians, and including the forbidding of abortions.

From:

As abhorrent as the denial of right-to-refuse is, it is a right that some feel should be denied to pharmacists and doctors as well as prostitutes.
I'm not sure I understand what you mean. From what I understand, the "right-to-refuse" issue for doctors involves doctors being able to turn away patients that aren't of the same religious affiliation or something similar. That I adamantly don't agree with--that's quite opposed to the Hippocratic oath, IMO.

I actually don't know of any cases where doctors wished to deny service on the basis of the patient having a different religion. We agree that such denial would be reprehensible- though still within the doctor's rights, if the patient is not endangered by it.

I believe that we all should be allowed to chart our own destiny unless we are directly putting others in harm's way by doing so. That is the basis for declaring blackmail to be morally wrong, after all.

State insistence that an individual dispense services against their wishes is essentially forced labour; such insistence should only be considered allowable in cases where life and safety would be directly in harm's way in the absence of such insistence.

I don't believe in double standards for doctors versus pharmacists versus prostitutes versus bricklayers. All deserve to chart their own courses, and forced labour should be extracted from no-one, except in cases of critical emergency need.

Conscientious refusal is not against the Hioppocratic Oath. Abortions, euthanasia, and medical school tuition, however, are specifically repudiated within the classical Hippocratic Oath, though they are predictably often omitted from modern reformulations.

Prominent cases of medical right to refuse service have generally revolved around abortion, but have occasionally revolved around other procedures such as routine circumcision of the newborn, as well as other body-modification procedures, and even non-medically-indicated Caesarian Section. (That last not recently, as sections are safe enough nowadays that fewer doctors object.)

It certainly seems arguable that medical professionals be forced to participate procedures they consider objectionable, where reasonable alternatives to safeguard the life and wellbeing of the patient are not available; but it does not seem arguable that such forced labour be condoned in the name of patient convenience.

From:

Oops!

For some reason this turned up in my mailbox as being a new comment, and I replied to it.

Sorry!

adrian

From:

If what you are getting at, I ditto novapsyche's opinion that doctors and pharmacists do not have the right to withhold medication or treatment due to their "moral stance".

If that's the way they feel, they should not be doctors and pharmacists.

From:

We all should have recognised the right to conscientious withdrawal from a process to which we have moral objection, unless that withdrawal can be shown to cause immediate danger to another (e.g. in case of emergencies.)

Note that this position does not depend on agreement with a particular conscientious objection or objector; I feel that conscientious objection, is an important safety valve at all levels of our societies, and not one that should be so casually discarded.

Can you show me any basis for your removing the right of health care workers to conscientious refusal? Should doctors, for example, be forced to perform infant genital mutilation at the whim of the parent?

From:

I see no problem with a doctor advertising the fact that they don't perform, say for instance, cosmetic procedures.

I see a big problem with a doctor withholding generally accepted treatment because they are in some way personally opposed to it.

I am even more strongly offended by the thought of some middleman or middlewoman, such as a pharmacist, in the position of fulfilling a prescribed treatment, using their position to impose their own beliefs on the people they are expected to serve.

From:

Exactly. The right-to-deny issues I've seen in the news recently deal with pharmacists who are against birth control refusing to fill the prescriptions of their clients. (Of course, if birth control were available over the counter, this wouldn't be a problem....)

From:

I agree. The whole situation seems to me to be a result of excessive governmental regulation of contraceptive use. They've been around for decades and we know how safe they are- far safer than cigarettes and arguably safer and more beneficial than aspirin.

Oral contraceptive pills should be available over the counter.

From:

I don't understand your position. Routine infant circumcision is still a standard procedure in America. Are you saying that a doctor would only have the right to refuse to perform such a procedure if they had previously advertised such reluctance?

What about a situation where a pharmacist had previously made his discomforts clear? Does that justify his refusal?

How about a situation where a doctor is acting as "middleman"- for instance, where an anaesthetist is asked by a generalist to perform a procedure, but refuses to perform the service? Does his middleman status mitigate against his choice, or only against choices made by pharmacists?

I don't really have a problem with people using whatever kooky moral codes they have to determine their own behavior, as long as the resultant behavior is not plainly dangerous. If the pharmacist were to attempt to control the behavior of the patient, say, by spreading lies about her, or by intercepting her mail, the pharmacst in question should go to jail, plain and simple.

But I do not equate "I refuse to participate in X, because I think it is wrong" with "I am trying to control your behavior and impose my moral code on you". The two seem quite plainly different to me.

From:

First, let's be clear about the point you are apparently trying to make. It sounds very much to me that you are trying to justify the well-publicised cases of pharmicists refusing to dispence certain birth-control treatments because they personnally object to them. Is this your position?

Then, we can address the examples you use to support your arguments:

- There is no issue if a doctor chooses not to perform elective surgeries or other procedures. There are usually plenty of other doctors around who can do them.

- It is extremely unlikely that an anaesthetist would find him or herself on a given surgical team if he or she was unwilling to comply with the wishes of the surgeon.

- A pharmacist is expected by the customer, the coustomer's doctor, and the pharmacy he/she works for to fulfill the duties of his/her job by providing the indicated product without being reluctant or judgmental. If they can't, then they are not doing their job.

From:

I support conscientious objection, including but not limited to the above pharmacists, where such objection does not place patients in danger, and where it is not due to bigotry.

I do agree that there is a stronger argument for forcing pharmacists to dispense where there is no alternative for the patient. I find, though, that this is really not usually the case.

Even given the politics of team formation, it does occur that doctors refer a patient to a subspecialist only to have the case refused. Does such refusal, when given on ethical grounds, constitute immoral behavior because it runs counter to generalist and patient expectation?

Are you really saying that customer expectation should universally overwhelm the ethical qualms of the vendor? Judgemental behavior, while certainly obnoxious and counterproductive, is not usually considered to be the sort of behavior that the law should notice. And can you not draw a distinction between moralising endlessly over someone else's behavior on the one hand, and refusing to participate in it on the other? Is all nonparticipation judgementalism by default? If so, we have lost a useful distinction.

I do agree that a pharmacist has an obligation to make any large areas of objection known to his potential employer. But if the employer chooses to employ a pharmacist who only provides a subset of the services that the public wants, why should the government feel the need to intervene? What next, a requirement that pharmacists must open a particular number of hours per week? Requirements that pharmacies open on Sundays? Why all the enthusiasm for these excesses of governmental regulation? Why shouldn't we let the marketplace exert its usual punishment on those who choose to irritate their customers, or provide sub-optimal but nondangerous service?

I feel that there are important steps to be taken in making health care in general and reproductive health/contraceptive guidance in particular more available to all; but I see this focus as being a counterproductive one. Plans to make health care services more available need to be formed to be considerate of the ethical qualms of both healthcare employee and potential client, instead of riding roughshod over either.

In the end, what I think is that we all should be allowed maximal autonomy over our own behavior. I think that it is a travesty when shopkeepers and pharmacists and doctors and prostitutes are forced to ply their wares because a majority with a moral code says they must. The only reasonable justification in my eyes for such coercion is the avoidance of clear danger, e.g. the dangerous bigotry that was fracturing our societies with regard to racism, or the more short term dangers constituted by medical emergencies.

I understand that my points are considered (1) somewhat off-topic and (2) somewhat controversial here; but the topic, is the general one, for me, of individual self-determination. Kidnapping and rape are wrong even where physical danger does not exist (as in this case with the pseudo-policeman), because they violate the self-determination of the victim; and this stricture against pharmacists violates the same principle.

Apologies to any I've offended, and thanks to those who have discussed the issue with me.

Cheers!

From:

kali-ma.livejournal.com

So.... the right to not be raped is somehow the same as the right to deny medication to a patient becaue you don't like them?

From:

Thank you for boiling this down.

From:

With respect to the specific situation of prostitutes, yes, there are some similarities- though the correspondence is obviously far from an exact one.

Some people argue that because prostitutes offer sex as a public, commercial service, that they by doing so give up the normal rights of refusal that accrue to one when sex is considered a private, personal, noncommercial activity.

I am pointing out that from my perspective, even if we take the shaky, questionable step of regarding all sexual activity of prostitutes as being necessarily commercial, that the right to idiosyncratic refusal should still apply, and that obtaining those sexual services fraudulently or via coercion remains heinous and criminal.

The tone of your question implies that the comparison somehow trivialises rape. Such an implication would be unfortunate, as it would suggest that analysis-by-analogy could never be used in cases of heinous crime.

From:

m0n90053.livejournal.com

Yeah, it's strange. For what other profession would it be considered that it's even remotely okay for someone to come along and force the practitioner to give their goods/services away, at the threat of or during the commission of physical violence to their person?

From:

Well, several, actually; but the forcers are wrong there, too.

I think that the stance she describes is predicated not on the acceptance of the violence so much as on negation of the personhood of the prostitute, always an essential step when atrocity is to be committed.

From:

m0n90053.livejournal.com

????

"...but the forcers are wrong there, too."

Neither I nor (at least I think) novapsyche are talking about just the people who commit the crime, but the general societal "consensual" attitude that raping a prostitute isn't a criminal offense because the prostitute already sells her sexual favors, flaunts her wares in the attempt to attract customers (and so has "asked for it" when she is raped), and (willingly?) exposes herself to danger in the process of doing so and in commission of her services, whereas the truth of the matter is that the prostitute has as much of a right as anyone else to refuse nonconsensual sex, even in the case of a would-be paying customer whom she does not care to service (just as 'more legitimate' businesses have the right to refuse service at will).

As far as "...predicated not on the acceptance of the violence so much as on negation of the personhood...", I don't see how you can separate the two; violence other than self-defense is predicated on negation of the personhood of the victim. One doesn't attack others whom one sees as equals.

From:

Naah, I don't agree.

I think that even those who don't see it as a criminal offense still disapprove- in the same way that they might disapprove of the neighbor kicking their dog. Not a criminal offense, but still not the sort of thing they want to see their brother doing. People don't kick dogs because kicking is OK; they do it because dogs don't matter to them in the slightest.

Which brings me to the next point: you overgeneralise. "One doesn't attack others whom one sees as equals" may be true for you, but it is not true for all others- though it becomes more and more likely to be true as the perceived level of violence, the perceived severity of the attack, increases. People easily attack equals where the attack is seen as routine, trivial or justifiable- including but not limited to your example of self defense.

So there are at least two ways, easily separable, in which a violent act may become more acceptable to the perpetrator; trivialisation of the act, and trivialisation of the victim. The two usually occur simultaneously, 'tis true, but they remain distinct processes.

I think that the legalisation of prostitutution would alleviate the problem of the dehumanisation of prostitutes to some degree, though not completely.

From:

Decriminalization would be better. Prostitution is legal in several parts of Nevada, and that system really needs to be revised. In a BIG way. (Firstly, working girls need to be able to form unions.)

From:

Remind me of the difference, I've forgotten. :-)

From:

Legalization means that the women have to register with the state. Decriminalization means that they would actually be able to be independent contractors (as they're called now) and work perhaps out of their own home without fear of being arrested.

And if you think "registering with the state" is benign, let me say that no process that involves fingerprinting in triplicate is benign, especially when one set of those is whisked off to the offices of the FBI.

From:

I live in a country where all who offer food for sale to the public have to be registered with the state. The system generally works well, and I think that in theory a parallel, similar system would be suitable for prostitutes.

In practise, in a country which is trying to emerge from an era in which prostitutes are often stigmatized victims of cop and client alike, I agree that such registration offers yet another opportunity for abuse.

Given my preoccupation with consistency, I'm still trying to wrap my head around the concept of registration with stringent public-health criteria for food vendors, but no registration or public health criteria for prostitutes. It's hard.

Perhaps a voluntary registration process with certification? The erection of a union of sorts overseeing the governmental registration process? There would need to be some protection against current and possible future abuses; but there would still have to be some sort of mechanism in place to weed out those prostitutes who constitute a public danger.

From:

All the fingerprinting sounds awfully draconian.

Do food handlers have to jump similar hoops?

From:

techno-shaman.livejournal.com

I agree with you adamantly.
Ive known several street-girls in my life.
My friend Missia was raped by a "customer" and a couple of his friends once (Apparently this was after she stole some money out of his wallet). The reaction from other people I found horrifying- responses like "well, she got what was coming to her" and "shes a whore, Im sure she is used to it"
*shakes his head*
Sick.
~Zeph would have taken Magdalene in too~

From:

Some folks seem to think that's one of the "perks" of the trade. Regardless that it's usually not a chosen trade to begin with.

A similar argument from such folks might go "You should expect to be homeless and hungry. After all you're jobless and poor."

From:

Well, they would be right. If you are jobless and poor, you should expect to be homeless and hungry, barring another source of support.

However, that should have nothing to do with justifying theft and assault.

The fact that I should expect to have my house burgled if I leave the windows open and go on vacation does not mean that larceny should cease to be a criminal offense.

From:

We should never expect anyone to be homeless and hungry, regardless of their financial situation.

You seem to have a very cynical and self-righteous attitude.

---

"that should have nothing to do with justifying theft and assault"

I'm in agreement there, and wasn't trying to justify anything illegal.

If you leave your window open expecting to be burglarized, maybe you are just stupid. If you forgot to close your window, maybe you are just forgetful. Either way, the burglary is still a burglary.

From:

Well, if you think I sound self-righteous, and I think you sound the same, perhaps we could both call it evens and drop those kinds of accusations?

What I am saying, that you are perhaps missing, is that pragmatically speaking certain things are unsurprising, and we should not allow our best-case hopes to interfere with our most-likely assessments.

Thus, if I am jobless and poor, with no support, I may think that the best-case hope would involve community recruitment of resources for my assistance. Realistic assesment of the current situation, however, should remind me that I can depend on no such occurrence, and in fact should not expect it.

And really, again, please drop the self-righteous accusations. Please.

From:

Deal. No more name calling.

I'm still not sure what point you are trying to make, but this discussion is getting tedious.
So, I'll say peace be with you and leave it at that.

From:

You have been saying that we should "expect" what should happen.

I have been saying that we should "expect" what is likely to happen.

I do think that such a position places me somewhere on a scale between "realistic" and "cynical", though I'm not sure how that became self-righteous etc.

I hope that is more clear. Thank you for helping me clarify my thoughts. Cheers!

From:

kali-ma.livejournal.com

I wish I could say I would be amazed. The number of people who believe sex is just something done for one's own personal pleasure and shouldn't involve the enjoyment or even explicit consent of the other person is very troubling. I've seen people excuse all manners of rape and sexual abuse of both adults and children on the flimsiest of excuses. It makes me want to hide in my house and never emerge unless I am wearing a titanium chastity belt to prtect myself from all the freaks.

From: