Let's start off with a controversy. We YOU Docs have never shied away from letting you know how we feel. Today is no exception. The newest controversy is the "right of conscience rule," which The Washington Post summed up in this headline: "Rule Shields Health Workers Who Withhold Care Based on Beliefs."
Basically, the Bush Administration issued this rule to protect healthcare workers who won't perform services that don't fit their personal beliefs. It also cuts off federal funding to entities that don't allow their healthcare employees to refuse to provide care. The rule takes effect before the current administration ends.

To us, this rule is the antithesis of the "serving master" concept that medical care is based on. As docs, we are supposed to serve you. We have studied hard and hold ourselves as masters (although we are not all-knowing, so we bring in colleagues to help). If we feel we cannot do what you need for our own religious reasons, we have an obligation to find you another qualified doc who can.

Our job is not to tell you to get lost or say that you've come to the wrong docs or that we won't honor your beliefs because ours trump yours. In our minds and practices, we are subservient to you.

Here's an example: Suppose you are a Jehovah's Witness and need your heart's mitral valve repaired. Any blood transfusion is against your religious beliefs. We believe that we need to inform you of the following options and their risks (we're simplifying them here):
  • We can try to do it without transfusion. If we fail, let your God and you have peace, even if you die. (Let's make it a little less complicated and suppose no one is absolutely dependent on you for their survival.) We would describe when and where bleeding could occur during the operation and suggest medications and lifestyle changes to build your tolerance in advance of such blood loss.
  • We can persuade you to accept blood transfusion alternatives as long as the blood doesn't lose contact with your body.
  • If we feel these options are too risky, we can persuade you to bring in your religious elders and discuss accepting a transfusion this one time.
  • We can find you another excellent team that will do the surgery according to your wishes.
We feel passionately that our task is to inform you of your options (using images as well as words). Once you've been fully informed, we follow your choice. But this new rule seems to abrogate the healthcare code that asserts that doctors serve you.

There's another side to this issue: emergencies. That's when the rubber hits the road. Emergencies are always exceptions. We believe no healthcare provider (not doctors, nurses, pharmacists, no one) has the right to refuse to perform a vital service (or refuse to dispense a time-critical drug) when there's no time to provide an alternative. It's our duty to serve you, even if we incur personal risk or a disruption of our belief systems. After all, we treat infectious diseases at our own peril, but that's the bargain we make with society and with you for the privilege of doing what we do.

We hope you believe that your docs and health professionals and institutions are "serving masters" to you—honoring your wishes after you have been informed of the alternatives. We've occasionally been persuaded that we were wrong (1988 was the last time, we think), so let us know your thoughts.

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