Tuesday, February 17, 2009

The "Provider Conscience" Rule: Time for Obama's--and the Media's--Move

Earlier today on the NPR show Here and Now (WBUR) there was a piece on the "Provider Conscience" Rule, one of the final Presidential acts of the Bush administration. It's a gem. According to the piece, "[the rule] says a doctor or a pharmacist can legally refuse to provide not just abortions, but any services or advice they find morally objectionable, even birth control." Laura Meckler, the Wall Street Journal reporter who has written on the issue and interviewed for Here and Now, noted that the rule is written so broadly as to include much more than just physicians and pharmacists. She states,

"let's say a receptionist opposes abortion on moral grounds, and she does not want to make appointments for abortion, or she does not want to make referrals for abortion. Well, she can decline to do so--that's the kind of breadth we're talking with this rule."

As Doctor Rubin was hearing this he was ruminating over the Bush administration policies, returning to a well-worn thought that his brain has utilized these past eight years (to the effect of you gotta love these guys) but then a curious transition took place. The show's host, Robin Young, abruptly transitioned into a prolonged discussion (5 full minutes of a 9-minute segment) with a family physician in San Antonio named Michelle Phillips, a woman who resigned from a hospital because she felt uncomfortable prescribing contraceptive pills for unmarried women--not all cases of contraception, mind you, just specific cases in which she felt that her patients had no business asking for or receiving contraception according to her moral conscience, which she unapologetically noted was rooted in her interpretation of biblical scripture.

What followed was a somewhat tedious discussion about the sticky ethics of Dr. Phillips's position--tedious because the ever-polite Ms. Young, of whom Doc Rubin is something of a fan, absolutely refused to shred the frail logic of Dr. Phillips, which is so bald that hardly anything more need be said. (I recommend the listen; WBUR's website has no direct link so the piece, entitled "Overturn for Bush's Provider Conscience Rule?" will only stay "live" with a link for a few days.)

However, what does need further exploration is how Here and Now handled, or rather failed to handle, the overall story. Two immediate problems leap to mind: first, who the hell is Michelle Phillips and how did WBUR track her down? My own brief time devoted to internet sleuthing revealed nothing other than her practice's address (feel free to send obnoxious letters), so I am at a loss to explain how a radio station in Boston manages to track down a fairly anonymous physician in Texas. The second, more grave problem is that Here and Now devoted the entire back half of the piece to give Dr. Phillips a platform. What's troublesome about this is that Dr. Phillips, at least from this doctor's point of view, is so clearly violating all sorts of firmly-established medical ethical precepts and Here and Now never appeared to go to the trouble to point this out.

I don't mean to imply that they were obligated to have a second guest to argue with her, and thus set up the false dichotomy of pro-con that journalists love because it allows them to be intellectually lazy. But Dr. Phillips isn't just someone who could benefit from the Provider Conscience Rule because she has a controversial though consistent stand; she's a physician who has obviously unethical principles; she applies her biblical worldview to her patients willy-nilly, choosing which personal questions to ask of which patients and then deciding whether she wants to provide certain treatments. For instance, she indicates that, as a rule, she would probably provide married women with contraception, but fails to indicate if she would ask if they were having extramarital affairs and possibly deny contraception if her patients shared this with her. And Ms. Young never even touched on the very thorny subject of what she would do if approached by a closeted gay male--or female, for that matter--who required any form of help from Dr. Phillips.

All that needs some context--just a quick check-in from, say, the chairperson of the Disciplinary/Ethics Committee of the Texas Medical Board as to whether or not her views or actions could lead to disciplinary action. Or someone from any number of national groups: the AMA or the American Academy of Medical Ethics would be decent starting points. And in attempting to provide some much-needed context for the views of this fringe doctor, Here and Now failed, and did so badly.

Let us hope that other media outlets are not as sloppy should President Obama overturn this reprehensible policy.

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