24 September 2008

Blackmail And The Catholic Church


YAAAAAAAAAAAAH! Oh, this makes me sick.

The catholic church, possibly drunk on power after World Youth Day, have signalled that they will close their obstetrics wards if the abortion bill passes through state parliament.

Not content with this, they have effectively told their doctors to consider breaking the law if it is passed.

I sent this complaint to Catholic Health Australia, and have crossposted it to the complaints blog:

Dear sir/madam,

I write to you with more than just a small degree of disgust over the blackmail stunt that you pulled today. I wish to complain about this as it is clear that you are behaving with an infantile level of dignity, decency and decorum.

Your board member Bishop Joseph Oudeman's threat to close your obstetrics wards in your Victorian member hospitals if the abortion bill successfully proceeds through state parliament is a national disgrace. Possibly even an international one. I cannot believe that you, in good conscience, would even consider resorting to blackmail to try to get this law stopped.

I can't even comprehend how you would even find blackmail to be appropriate.

All the bill requires is for doctors with a conscientious objection to abortion to refer women to doctors who do not. And yet, this isn't good enough for you: You have to enforce your concept of "life" on to the rest of us. Whether we're religious, specifically Roman catholic christians, or not.

How could you possibly do this?

All over the state, there are women who are going to need to give birth. According to stats on The Age's website, your hospitals deliver one third of them. Are you going to deny them assistance in a hissy fit over the laws, if they even become that? Law, that is?

And I read that your CEO, Martin Laverty, has stated that you will not require your doctors to comply with the law on this. This is a disgrace, and is completely irresponsible.

I can only conclude that you have the mental capacity of an eight year old who is threatening to take the bat and ball and go home if by chance he is given out. Please confirm when Mr Laverty and your board will be resigning over this matter.

Should you carry out your threat, I wish to advise that my wife and will have no alternative but to use condoms and birth control pills.


Yours sincerely,

Dikkii.

Catholic Health Australia may be contacted here: secretariat@cha.org.au

47 comments:

Plonka said...

as it is clear that you are behaving with an infantile level of dignity, decency and decorum.

That seems to have become the christin way...

Obviously you've dug a little deeper. So it's not even a fine eh? How extremely christian then...

Indefensible said...

Dikkii,

I think you've gone off half-cocked on this one. I support the bill, and I believe that abortion should be safe, legal, and above all, rare. However Catholics do not. It is fully within their rights to do whatever they see fit, to fight this bill.

You must remember that Catholic hospitals pre-exist most of the laws of this country. They were built out of the goodness of the church's heart, because of what certain orders believe. Are you seriously going to tell The Order of St Vincent De Paul (the order behind St Vincent's in Melbourne) that they must give people advice on abortion? The very idea is preposterous.

The real issue is that we have let ourselves be in this position. We should not be in the position that faith-based anything has a chance to interact with public policy. However we live in a polity that uses the public purse to fund religious and quasi religious organisations. This sort of argument is simply the blowback from that.

In the end, however this is a non-issue. All that needs to happen is that people need to have about an IQ of 60 and realise that at a CATHOLIC hospital, they shouldn't even bother asking for advice on terminations.

The government forced the Catholics' hand. Don't be surprised by what their cards are.

Dikkii said...

G’day Indefensible

However Catholics do not [support abortion].

This is not in dispute.

It is fully within their rights to do whatever they see fit, to fight this bill.

It is also within my rights to point out that blackmail is a new low, even for this organisation.

You must remember that Catholic hospitals pre-exist most of the laws of this country. They were built out of the goodness of the church's heart, because of what certain orders believe.

Would you support a Jehovah’s Witness hospital enforcing a “no blood transfusions” rule?

Are you seriously going to tell The Order of St Vincent De Paul (the order behind St Vincent's in Melbourne) that they must give people advice on abortion?

Indefensible, it’s not like you to strike out at straw men. Where they don’t wish to advise on abortion, the bill clearly allows for them to refer to a specialist who will. Your question has no answer as it is built on a premise that isn’t there.

In the end, however this is a non-issue. All that needs to happen is that people need to have about an IQ of 60 and realise that at a CATHOLIC hospital, they shouldn't even bother asking for advice on terminations.

I agreed with this for a bit, but then I realised that people also use these hospitals because they’re good. Not because they’re catholic.

Indeed, my doctor referred me to a surgeon for something once and he only worked out of St Vincent’s Private. I wouldn’t have known this until I saw the surgeon first, as his consulting rooms were not on campus. I’m neither catholic, nor do I come from a catholic family.

The government forced the Catholics' hand. Don't be surprised by what their cards are.

I suppose I’m not really surprised, but at the same time, shouldn’t this lot be asked to pull their heads in? Or even, “Render unto Caesar what is Caesar’s?”

Dikkii said...

Plonka: Not really surprised at all.

Indefensible said...

Would you support a Jehovah’s Witness hospital enforcing a “no blood transfusions” rule?

Yes. If they're up front about it. Would I support them getting government funding? No.

Indefensible, it’s not like you to strike out at straw men. Where they don’t wish to advise on abortion, the bill clearly allows for them to refer to a specialist who will. Your question has no answer as it is built on a premise that isn’t there.

Hardly a straw man, Dikkii. If you refer to a person that you know will give advice on abortion, then you have given advice by proxy.

I agreed with this for a bit, but then I realised that people also use these hospitals because they’re good. Not because they’re catholic.

Indeed, my doctor referred me to a surgeon for something once and he only worked out of St Vincent’s Private. I wouldn’t have known this until I saw the surgeon first, as his consulting rooms were not on campus. I’m neither catholic, nor do I come from a catholic family.


Again, you are over a barrel not because of what catholics believe (which they telegraph very clearly all the time) but because the government has abrogated its responsibility to provide hospitals and does it through faith-based organisations.

I suppose I’m not really surprised, but at the same time, shouldn’t this lot be asked to pull their heads in? Or even, “Render unto Caesar what is Caesar’s?”

Hmmmm. Should a group that provides services to the community, and represents a significant viewpoint in society be told to pull their heads in? Sure, tell them what you want, but I'm not sure what you intend to achieve. They're Catholics. They find abortion intolerable. They will not come around to your point of view, because it sickens them.

You might as well ask an Imam to show porn in a Mosque.

And don't try to use phrases from the bible to make your point. Render unto Caesar means a particular thing, and being forced to provide advice on who to terminate a pregnancy does not even remotely fit the bill. Plus, you're an atheist. You don't get to swap logic for doctrine ;)

Plonka said...

Or even, “Render unto Caesar what is Caesar’s?”

Hear, hear! Obey the laws of the land is also biblical - New Testament biblical - so there's really no excuse for this behaviour...

Dikkii said...

Indefensible:

Yes. If they're [Jehovah’s Witnesses and blood transfusions] up front about it.

The problem with this is that now, our aforementioned JW hospital cannot do heavy surgery at all. It will need to refer patients requiring this sort of thing to other hospitals. Patients dying on operating tables due to lack of blood does not for good PR make, whether they’re actual Witnesses or not.

If you refer to a person that you know will give advice on abortion, then you have given advice by proxy.

(Your emphasis)

The other day, I was asked where someplace nice to go on Lygon Street for dinner was. I told them, gave them directions and, because I had a couple of minutes to kill, looked up their number on whitepages.com.au .

Are you seriously trying to tell me that I cooked pasta for two and veal ossobucco followed by skinny lattes by proxy?

Do you know how unlikely it is that I would taint a caffe latte with skinny milk? Or knowingly serve veal?

Let’s take this one step further: How about if they cop some salmonella or listeria or something? Are you now suggesting that I should be made personally responsible for referring them in the first place?

I’m sure that you can see how I regard this scenario as silly.

Again, you are over a barrel not because of what catholics believe (which they telegraph very clearly all the time) but because the government has abrogated its responsibility to provide hospitals and does it through faith-based organisations.

It’s fortunate for us that private hospitals don’t get nearly the level of funding cf public hospitals that private schools do cf public schools. Then I’d be even madder.

Should a group that provides services to the community, and represents a significant viewpoint in society be told to pull their heads in?

Yes. Next question.

They're Catholics. They find abortion intolerable.

This is irrelevant. They can still refer to other people who will do this work with a clear conscience. Plus it would be hypocritical: Since when has the Roman Catholic Church demonstrated a consistent and/or logical horizon as to when life actually starts?

You might as well ask an Imam to show porn in a Mosque.

I could, but the questions remain: Who is being offended by the Imam not showing the porn? Whose rights are being trampled on? Who is being inconvenienced?

Render unto Caesar means a particular thing, and being forced to provide advice on who to terminate a pregnancy does not even remotely fit the bill.

The bill requires certain actions to be taken where specific services are requested. Asking staff to not take these actions kinda goes against the “Render unto Caesar” thing, don’t you think?

Plus, you're an atheist. You don't get to swap logic for doctrine ;)

Point taken, however I’ll quibble on one point: You’ve just joined a vast crowd of people who insist that I’m atheist. I keep insisting that I’m agnostic, but no one seems to listen.

Dikkii said...

Plonka:

Hear, hear! Obey the laws of the land is also biblical - New Testament biblical - so there's really no excuse for this behaviour...

While I always thought this and "Render unto Caesar" were the same thing, I defer to your superior knowledge of this text, Plonka.

Indefensible said...

I keep insisting that I’m agnostic, but no one seems to listen.

I thought you were an atheist based on your postings and your atheist blogroll listing.

Are you seriously trying to tell me that I cooked pasta for two and veal ossobucco followed by skinny lattes by proxy? Your response to this is glib at best Dikkii.

If someone asked you to murder someone (I'm not saying abortion is murder BUT CATHOLICS DO) and you said you wouldn't do it, but you knew a phone number of a guy that WOULD do it, you're an accessory before the fact, and potentially a conspirator too. This isn't a latte Dikkii. These are literally life and death issues.

I could, but the questions remain: Who is being offended by the Imam not showing the porn? Whose rights are being trampled on? Who is being inconvenienced? And exactly who is being inconvenienced and whose rights are being trampled if Catholics are forced to give advice on abortion?

There are plenty of hospitals that perform abortions. There are so many that abortion is a commonplace medical procedure - The Royal Women's Hospital performs untold thousands a year. Forcing Catholic hospitals to refer patients on to those hospitals is creating a crisis where none exists. You don't go to a Jewish deli and force them to tell you where to get a ham sandwich.

They're Catholics. They find abortion intolerable.

This is irrelevant.


How can it be irrelevant? It's the core argument against yours. You're suggesting that Catholics are out of line by threatening to close their maternity wards because the state is going to force them to make abortion referrals. Catholics are so forthright about this issue that they are prepared to take drastic action because they find abortion to be abhorrent. You're asking them to simply tolerate what they consider intolerable.

Again, asking Catholics to do this is stupid, unless the point is to start a fight. How fortunate that it was the Catholic Church, so often used as a punching bag.


FULL DISCLOSURE: I am an atheist but am a volunteer at a catholic hospital.

Greg said...

Interestingly, I've been debating this issue for some time with a good friend who happens to be a Catholic doctor, working at a "Catholic" hospital. (I use the quotes because it is funded by, staffed by and treats taxpayers, not Catholics, an important distinction.)

I fully support the right of Catholics to run their own hospitals as they see fit. Much like Jehovah's Witnesses (mentioned above, and also in my own debates), they are welcome to offer a subset of the full range of services.

The key point is that they should be doing so out of their own pocket. As an interim measure, the rest of us should allow [insert religious group] tax deductibility status, but that's it. No public money.

It is an historical accident that eg St Vincent's Hospital is owned and operated by an order of nuns. If someone proposed that another major tertiary public teaching hospital (say, The Alfred) be taken over by [insert religious group] they'd be told to get stuffed. It's a rort. In effect, public money goes in and Catholic-filtered services flow out. They are soaking up public money that would otherwise go to funding a hospital that could do the full range of services (abortions, IVF, meat on Fridays etc) allowed by Parliament. I doubt that many people would support The Austin hospital being converted into a vegan-only institution, with no treatments based on animal research allowed yet continuing to suckle on the public teat. That's our money, gathered from everyone and distributed by Parliament, which we all vote for.

The old Scottish adage comes to mind: "he who pays the piper calls the tune".

Is it too much to ask particular religious groups to pay for their own (slightly crippled) hospitals?

Like many visitors to the Vatican, I'm struck by the hoarded wealth. I'm sure one painting a year could be sold to fund the Catholic health system and no one would even notice the loss in artwork. If that's unappealing, we should call Archbishop Hart on his bluff and just boot the nuns out.

Would that result in diminished quality?

I have had quite a bit to do with St Vincents through various family members being sick there plus friends and family working there. It's a great hospital. But not because it's Catholic. However, at least one Catholic has argued to me that its very Catholicness is what makes it great, compared with eg the Royal Melbourne. I regard this as smug arrogance "our values are better than the other mob - we're special and we care more". There is no evidence for it, no reason to back it up and it's typical of the religionists' grating desire to attribute all human virtue to their particular faith.

So I say: bring it on.

On a more abstract point, it has been advanced to me that I should not support the Bill because it diminishes liberty.

How so? Well, the argument is that the government is taking away an option from doctors, thereby reducing liberty. Specifically, the option is to withhold options from patients. Taken further, the government is taking away from patients the option to not hear about other options. If the government bars you from remaining ignorant of alternatives, have you lost or gained freedom?

In a nutshell, this is the "human rights and religious freedom" argument that the Catholic hierarchy is presently advancing.

I find this idea both absurd yet intriguing. Is forcing someone to give options to someone else going to result in a net decrease in liberty? Certainly, the patient has more options, but the doctor has less. Presumably, some doctors would face this situation daily, whereas most patients just a few times in their lives. Like many utilitarianist arguments, it depends how you do the accounting.

The logic of it reminds me of the dilemma "to what extent should we tolerate intolerance?".

I'd like to see what the readership hear makes of that argument.

Plonka said...

Hmmm... Are we missing something? The ol' "separation" issue perhaps? I can't speak for Dikkii, but this is what's stuck in my craw.

What we really have here is a catholic minister (the arch mage) using blackmail to threaten the state into compliance with a catholic ideal.

Indefensible:

I have to agree with Dikkii that the fact that catholics find abortion intollerable really is quite irrelevent. All a catholic doctor has to say is "I'm sorry, you'll have to go somewhere else." It isn't much of a referal, but it should be good enough to escape any legal retribution.

Besides, the law wouldn't be asking "catholics" to do it, it'd simply be asking "doctors" to do it. If the doctor is catholic, then that's the doctor's problem and the doctor has the choice and the right to say "no, go away". There is no murder (or even ossobucco for that matter) by proxy.

And I also have to agree with both Indefensible and Greg. I'm quite happy for catholics (or JW's or whatever) to own and run their own hospitals by their own ideals for their own faithful.

If however, one of these hospitals wants to provide care to the great unwashed at large, and take government grants to do so, then those services should be provided within the scope of the state's laws, not god's.

Dunc said...

There's a basic question of medical ethics here - a doctor is duty-bound to give care as required by the patient, or refer the patient to another caregiver. If your religion conflicts with the ethical requirements of your chosen profession, that's your own problem. Any doctor who cannot abide by the basic principles of medical ethics, or who feels that their own religious convictions are more important than the needs of their patients (or give them the right to determine the needs of their patients in the absence of fully informed consent, for example by withholding information about certain treatment options) deserves to be struck off.

If Catholic doctors cannot give advice on the full range of medical options, then their patients cannot give fully informed consent to treatment. Withholding relevant information from a patient is deeply unethical.

Dikkii said...

Indefensible, I don't suppose that we'll get any agreement on this, but I did note the following:

In your haste to label my response as “glib” you raised a few points that should be addressed:

Firstly, your murder example requires deeper attention as well as some context. Let's put some around that.

As you would no doubt know, the bill as it is currently asks for referrals to be made to someone willing to carry out the abortion if the person in question is unwilling to perform the operation. Digging deeper, let's assume that in some parallel universe somewhere, a bill has passed through the lower house of state parliament which we'll call the “murder bill”. We'll also assume that in this parallel universe there are trained and licensed specialists who have the expertise and the authority to carry this task out. We'll also assume that, just like abortion, specialists may only kill those who fall into certain categories.

Lastly, we'll also assume that these specialists perform a variety of other vital services.

For the sake of my example, we'll also assume that I happen to be one of these specialists. Previous to this bill being written, I've refused to provide this service. Let's say that I get a client/patient asking me to murder someone. These specialists no doubt have their own codes of ethics and only these specialists may carry out the aforementioned task.

It goes without say that before commencing a career as one of these specialists, I would have a clue that my job might involve administering this unsavoury task. It also goes without say that if the bill is legislated I must comply.

I would not be an accessory to murder in referring my client/patient to someone else, because those drafting this legislation would be certifiably insane if they didn't include sections specifically exempting me. Likewise, if I didn't want to be doing this sort of thing in the first place, I would have to ask if I still wanted to be in this career. People have choices.

(It lastly goes without say that anyone drafting this kind of legislation would never get this out of white paper stage, let alone before a lower house of state parliament. Your murder example is, at risk of pointing out the obvious, neither a good analogy nor remotely plausible.)

Let's now put your example into play. The bill is before the upper house.

1.A specialist agency announces that they will no longer operate these kinds of specialists if the bill is passed. Blackmail or not?
2.The same specialist agency then announces that their specialists will be asked to break the law and not refer any clients/patients requesting murder as a service. Given the comprehensive conscience vote in the lower house, and almightily high approval in the opinion polls, is this not both going against the will of the people together with antisocial promotion of civil disobedience?

These are the questions. Not murder, abortion, lattes, ossobucco, abortion intolerance or anything else. Just these two questions. And I put it to you that this makes my example somewhat less “glib” now, don't you think?

(For the record, I wouldn't live anywhere that put a murder bill in front of parliament and had this much popular support, but that's me.)

Secondly, the Catholic Church has never been consistent on when life is said to begin. If they were, they would have shifted Christmas Day to 25 March decades ago. When catholics themselves cannot make up their minds on this, it's difficult to take their equation of foetal cells with a human life seriously.

Thirdly, a line has to be drawn on when life begins. The bill does this, and a lower house of state parliament democratically elected has deemed this bill by the majority to be OK.

(Comments as to whether the election process for the lower house is really democratic or not are hereby considered off-topic)

Fourthly, while the catholic hospitals system consider themselves “catholic”, not all their staff actually are. Non-catholic staff are being asked potentially to break a law which they themselves may actually agree with. Furthermore, at risk of having Godwin's Law invoked, we all know that “just following orders” is not considered a good enough defence for breaking the law.

Fifthly, services provided by obstetricians are not limited to abortions. It is simply blackmail to threaten to withhold all obstetric services just because one is being legislated for.

Sixthly, no one is asking catholics to give up a belief that abortion is murder. However, no one allows PETA activists who play the “meat is murder” line to get away with breaking the law. Why should the catholic health system be exempt?

Just a couple of other things:

And exactly who is being inconvenienced and whose rights are being trampled if Catholics are forced to give advice on abortion?

Sigh. “Catholics” are not forced to do anything other than a referral. This is not advice. There are no rights being trampled here: Just a new set of legislated standards around performing certain tasks. It might inconvenience a few obstetricians, but if they don't want to perform this particular duty, then they probably need to ask why they're in the industry in the first place.

On the other hand, who is being inconvenienced and whose rights are being trampled if someone seeing a catholic obstetrician cannot get advice on abortion? We all know the answer to this one.

Let's put this in perspective here. An obstetrician's moral anguish is no match for a confused and panicking potential single mother. No matter how you look at it.

You don't go to a Jewish deli and force them to tell you where to get a ham sandwich.

What? If I'm in Carlisle Street and I want a ham sandwich, BLT or pork bun, I will be asking the nearest shopkeeper where I can get one in the neighbourhood. And while no law forces them to tell me, social etiquette suggests that if the guy doesn't tell me, he either doesn't know, or is being a prick.

Either way, no Jewish deli owner is going to refuse to tell me on the grounds of religious moral outrage.

How can it be irrelevant? It's the core argument against yours. You're suggesting that Catholics are out of line by threatening to close their maternity wards because the state is going to force them to make abortion referrals.

See my numbered questions one and two, above.

I thought you were an atheist based on your postings and your atheist blogroll listing.

The Athiest Blogroll caters to agnostic bloggers as well. And you're not the first – people seem to assume that I'm atheist even without reading my blog.

Dikkii said...

Greg:

Up until this point in time, I didn't realise that Catholic Health Australia's threat extended to St Vincent's Public or Mercy Public. Now I'm even more pissed off.

Your question regarding liberties is intriguing. Do we consider the rights of the patient, to the rights of the doctor?

I'm siding with the patient myself, but while I'll happily resort to Hippocrates and Nightingale to back me up on this, I wouldn't mind hearing other opinions.

Dikkii said...

Plonka:

I contend that leaving catholics, JWs, homeopaths, Alive & Well AIDS Alternatives etc in charge of even private hospitals is kinda like leaving the wolf in charge of the henhouse.

I suspect that the majority, possibly even the vast majority of people who attend private hospitals attend for good healthcare. Not providing advice on all options is not good healthcare.

Just for comparison purposes, have a think about Mercy Ministries.

Dikkii said...

Dunc:

If Catholic doctors cannot give advice on the full range of medical options, then their patients cannot give fully informed consent to treatment. Withholding relevant information from a patient is deeply unethical.

Pretty much agree with that. I'm sure that I don't need to add "Hippocratic Oath" or "Declaration of Geneva". Or maybe I did.

Plonka said...

...hospitals attend for good healthcare

This is not in dispute Dikkii. The problem is that the vast majority of those hospitals also draw funds from the public purse, which is where I drew my line. In that case, it's mans laws, not god's and that includes both abortions and transfusions...

And sorry, that should have read someone else not somewhere. It does require that you are referred to a person, not a place...

But now I'm curious. What does a catholic hospital do now, in the rare case that the mother (or both mother and baby) will die if the baby isn't aborted?

Indefensible said...

This has become the type of discussion best done in person now because of the myriad points that need to be addressed.

I think we all seem to be in agreement that this issue arises only because of the public funding of faith-based services. As I mentioned, despite the fact that I am a strong atheist, I volunteer as a Catholic hospital.

The reason that I do this despite my lack of agreement with the basis for their funding is pretty simple - I operate in the real world. No matter how much we bluster, we're not going back to first principles here and building a society where religious orders have their hands off all the levers. I want to contribute to my community and this was an appropriate way for me to do so.

My opinion is that, as I said, abortion should be safe legal and rare. At the moment it is safe, quasi-legal and rare. This is because the ambiguity in the laws as they stand allow for some wiggle room. What do Catholic institutions do in these situations now? They give a nudge and a wink and make a quiet referral. The patient's needs are served, and the broader Catholic community is none the wiser. On a strictly utilitarian basis, this is an optimum outcome.

The problem now becomes that under law the Catholic institutions will no longer be able to say to the Catholic base 'we oppose all abortion' because the legislation demands of them that they make these referrals. So it takes the issue from the shadows and the arena of 'wiggle room' into the public arena.

You and I may not (and obviously do not) agree with the official Catholic stance on abortion, nor their hypocrisy on the issue of terminations. But they are operating under a pretty obvious internal logic. Their hand has been forced in this issue, and unnecessarily so.

One final thing to add. There IS a difference in the model of care provided at Catholic hospitals as compared to others, but the reason that you don't know what it is is that you're not at a life stage to notice it - we're all too young to have seen it really. The Catholic model takes into account not just the prolonging of life, but also the quality and dignity of life. I have been involved in quite protracted debates behind closed doors, and I can tell you that this concept of dignity and respect, especially in terminal cases, pervades the model of care in a way that is really quite different from other hospitals.

I'm not making a value judgement there at all, just noting that there IS a difference.

We should really continue this over a few beers...

Dikkii said...

Agree that this is best done in person, Indefensible.

I suppose that my position was best summed up by Plonka in a comment on Sean's blog:

If an obstetrician is asked to provide an abortion and is a conscientious objector, he/she must make a referral.

Apparently this may be done just by saying, "You have to see someone else."

Given this, the referral issue is a bit of a McGuffin and there is clearly only one desired outcome that Catholic Health Australia is after: The total defeat of the legislation in the upper house.

And, in order to achieve this end result, they're clearly not above blackmail.

I appreciate the work you do in the catholic health system. They might do things really cool ways compared to other hospitals.

But the government did not force their hand - on the contrary, they're trying to force parliament's hand. This is not cool.

Incidentally, it wasn't until yours and Greg's comments that I was aware that their threat extended to St Vincent's Public and Mercy Public. This snippet of information turns a disgrace into a fiasco.

I'm not making a value judgement there at all, just noting that there IS a difference.

I get you but I query whether this difference should be funded out of the public purse, in the case of public versions of St Vincent's and Mercy.

We should really continue this over a few beers...

They are long overdue.

Dikkii said...

Plonka:

What does a catholic hospital do now, in the rare case that the mother (or both mother and baby) will die if the baby isn't aborted?

If they carry out their threat, there won't be any expectant mothers in catholic hospitals. Remember, the threat is to close down all obstetric wards.

The Hulk said...

After reading all of the comments about this issue, which are all valid points, the issue really does become black and white.
The hospital accepts funding from the government/public. If they wish to take this course of action and have a certain set of standards and ethics, cease accepting funds and then they can do what they want. Until that day, maybe they should just accept the lesser of two evils and make the referrals. Simple.

Indefensible said...

Problem is, Hulk, that they ARE threatening to stop taking public money for the provision of maternity and obstetrics beds.

They're not threatening to close the hospital, just the parts that they feel they can no longer provide with good (to them) conscience. This will mean they won't get funded for those beds.

Not that big a deal, except for the fact that the state is struggling through a baby boom at the moment and we NEED those beds.

The Hulk said...

That is correct. Agreeing with your point about needing those beds, if they do this they are putting undue stress on the public health system and expectant mothers. It would seem while they are trying to make a point about what they deem to be right or wrong, what about the consequences of their actions on others? Their moral, ethical and religious codes may be intact but at what expense? We have seen what this kind of narrowminded belief system and iron fist ruling has done for religion in the past. Wars have begun that way. A little drastic I know, but you get my point.

Greg said...

What do Catholic institutions do in these situations now? They give a nudge and a wink and make a quiet referral.

I've heard about this "practical Catholicism" before and I reckon it's a crock.

Apparently, you can get the contraceptive pill whilst an in-patient in a Catholic hospital. It won't show up on your drug charts and the nurses aren't allowed to give it to you - but they give you your own form to tick off as you self-administer.

Ditto for the "nudge and wink" referral to abortionists. This may be acceptable from non-Catholic staff in a Catholic hospital, as a form of subversion. But not from practising Catholics.

Illustration: I'm dead against female genital mutilation (or male, for that matter). If I worked in a hospital and someone asked for a referral to a practitioner prepared to do that I'd give them a referral alright - straight to the police!

But if the laws of the land changed so that I had to provide that referral, I'd like to think I'd quit or move. (In reality, I'd probably just suck it up.)

But making such a referral on the sly without the compulsion of the law? Forget it. People need to hold to ethical standards, even if they are just imported wholesale from some old guy.

Dikkii said...

Greg, Hulk, Indefensible, et al:

There is one thing about this that is for me, the elephant in the room.

Suppose that amendments were made to this bill in the upper house to fully exempt staff in catholic hospitals from the provisions of the bill.

Does anyone really think for a moment that this would be enough for the catholic church?

Perhaps I'm being overly cynical, but the catholic church does not want this bill to pass through parliament in any way, shape or form. We've already seen that they're not above using blackmail in order to stop it.

I say complain, kids. Complain with all your fucking might.

Indefensible said...

Of course the Catholic Church wants to kill the bill! Of course it will use any and all leverage at its disposal in an attempt to defeat it.

Isn't that just a given? A known known, to use a Rumsfeldian turn of phrase?

So I guess you're right, complain as hard as you can, but be prepared for your complaints to fall on deaf ears.

Dikkii said...

Indefensible, the church and Catholic Health Australia could at least be honest about this, rather than all this bullshit about the referring provisions.

Yes, I know. I expect that Christian organisations acting with integrity is way too much to ask. Dunno why I brought it up, now.

Dunc said...

I think we all seem to be in agreement that this issue arises only because of the public funding of faith-based services.

No, we're not. If you want to call yourself a doctor, you have to abide by the principles of medical ethics set down by the appropriate professional governing bodies. You don't get to violate those principles simply because you're privately funded.

Greg said...

If you want to call yourself a doctor, you have to abide by the principles of medical ethics set down by the appropriate professional governing bodies.

True, but I think that medical ethics should be able to accommodate individual differences. For example, if a doctor is squeamish about, say, wart removal, then they shouldn't be compelled to perform those procedures.

I think their only obligation to their patients is to be upfront about that and say "Look, if you were with any other doctor, they'd be talking about your wart removal options right now. I don't do that, but if you're happy to proceed that's cool. Otherwise, here's the card of a colleague."

I find that ethical. Now, if you're talking about working as a doctor in a public hospital then it's not acceptable. You must do all the services required in the job, which is set by the government. Squeamish about warts? Refuse to use treatments based on animal experiments? Then get a job in the private system[*].

These issues should be teased out during interviews.

[*] As a practical note, I believe all doctors trained in Australia must work in the public hospital system for quite a while. So, as a consequence, there are no vegan or lesbian separatist doctors trained here. The Catholics have a slightly easier ride, whereby if you get into Melbourne Uni you can do your residency at St Vincent's and not put your eternal soul at risk by doing a vasectomy.

Dikkii said...

Dunc, I think what Indefensible meant is that we all agree that publicly funded religious health care is bad, even if we have different opinions on whether this it should be allowed in privately funded institutions.

I fully agree with you on this: hospitals where religious beliefs trump ethics is one step short of legalised woo.

Dikkii said...

Greg (and Dunc), assuming that the bill gets passed by state parliament, this will then cease to be an ethical issue, and one involving a legislated standard.

We use legislated standards all the time, and no one bangs on about "forced ethics" or "loss of rights".

A very good example is a pint of beer. If I go into a pub, I expect that pint to contain 570 mL.

There may be some publicans out there who might prefer the right to serve up a 565 mL pint, but they simply are not allowed do it, and can expect fines or other disciplinary action if they are caught.

Likewise, if this bill becomes law, anyone who goes in for advice on abortions to a doctor - any doctor - can expect this legislated standard to be upheld. No matter where they go.

This should be upheld in all public hospitals.

I cannot understand why we're engaging in special pleading with respect to private ones: Why should a private hospital (or private health provider, full stop) be allowed to get away with effectively serving pints in 565 mL glasses? Why penalise patients 5 mL for visiting a private health provider?

(For comparison purposes, if we're talking about legislasted standards, imagine if aforementioned patient went into a homeopath's and asked for our metaphorical pint. They wouldn't even get an empty glass, let alone a 570 mL one full of beer. Now should these be able to operate under their own belief structure?)

Greg said...

Hang on - are we talking about how things should work or how they do work?

I thought it was the former.

I, for one, am happy to buy beer in any quantity as long as it is clearly labelled as such. I haven't checked the regs, but I know from experience that one can purchase beer in at least 200mL, 285mL, 330mL, 375mL, 570mL and 1140mL. Possibly others. That is as it should be. People should be free to strike whatever beer-buying bargains both parties are willing to engage in.

In private hospitals, people should be able to do what they like - as long as it's a subset of the law.

The whole problem goes away if we just accept that Catholic hospitals shouldn't be getting public money.

As it happens, for historico-political reasons that egg is hard to unscramble. (Wait until Hamas and Hizbollah have to start dismantling their hospitals in the Gaza strip and southern Lebanon, respectively!)

So we end up with these crazy half-arsed worst-of-both-worlds systems.

That said, forcing doctors in public-funded/Catholic-moralled hospitals to provide referrals is probably the least worst of the practical options.

Dikkii said...

That is as it should be. People should be free to strike whatever beer-buying bargains both parties are willing to engage in.

There's no real need to be cute. You know what a pint is.

Pints are regulated under existing weights and measures standards. You must get 570 mL if you ask for a "pint", 425 mL if you ask for a "schooner" or 285 if you ask for a "pot".

People happily enjoy freedom from choice on this front, I'm afraid.

The whole problem goes away if we just accept that Catholic hospitals shouldn't be getting public money.

I'm not sure that it does. As it is at the moment, it's an ethical issue.

Let's look at a little private hospital in an outer suburb. Staffed by two. We'll call it "Doctor Bloggs medical clinic".

We'll assume that Bloggs receives no government funding. He makes his patients apply for their Medicare the hard way. And we'll assume that he and his wife, who mans the reception desk, are proud practising catholics with 8 kids, most of whom are now grown up.

Bloggs and his wife fully own the practice, and have the odd crucifix hung on the wall of the waiting room, together with a little shrine to Luke the Evangelist at the end of the front reception desk.

Shazza, who's just been knocked up by Bazza, goes in to see Bloggs about an abortion. Bloggs tells her that he neither does this sort of thing, nor is he willing to extend her the courtesy of referring her to someone who will. He doesn't mention that it's because he's catholic.

Shazza makes a complaint.

Has Bloggs acted unethically by refusing to even take his fingers out of his ears when the word "abortion" was mentioned? You bet your sweet booty.

Would it be worse if he worked in the consultation rooms of a public hospital?

The only reason it would be worse would be because he would be getting public funding for it. Apart from this, Bloggs conduct is just as bad.

Shazza would have grounds for a complaint in either instance to the RACGP or the AMA. (NB: They'd probably only slap him on the wrist in either instance)

It's special pleading to suggest that private hospitals can get away with lower ethical standards than public ones. It's also bad customer service.

Greg said...

Has Bloggs acted unethically by refusing to even take his fingers out of his ears when the word "abortion" was mentioned? You bet your sweet booty.

Not in my book. Maybe in yours.

Shazza would have grounds for a complaint in either instance to the RACGP or the AMA.

No, she wouldn't. [NB: medical complaints go to the state medical registration board, not the doctors' union or training body.]

There's only two plausible ways the board would get involved in something like this.

If a doctor (hospital or clinic, public or private):

1) jeopardised Shazza's life by, for example, refusing an emergency treatment that involved abortion (perhaps an ectopic pregnancy that went horribly wrong).

2) misinformed Shazza about her options, by, for example telling her that she was too far gone for an abortion, or that an abortion would endanger her life.

There may be other cases more extreme in nature, but these two cover over the most likely scenarios.

Dikkii said...

Greg:

Not in my book. Maybe in yours.

You must be reading Dan Brown or something, then, because if I was Bloggs, I think that I'd have let "creed" intervene. (Geneva)

No, she wouldn't. [NB: medical complaints go to the state medical registration board, not the doctors' union or training body.]

Yeah my bad, I meant to write that. Although the professional associations DO have complaints processes.

She would certainly have a complaint, though...

misinformed Shazza about her options, by, for example telling her that she was too far gone for an abortion, or that an abortion would endanger her life.

... or by not advising or referring her in the first place. Withholding information in this instance is misinforming.

The Hulk said...

Guys, settle down. Are we not getting off topic here just a little? We are not talking about the ethics of doctors on an individual basis. We are talking about an entire organisation setting a precedent for this type of activity, justifyable or not. The term "God complex" comes to mind.
The greater issue is that if this is allowed to happen, what type of changes to healthcare are going to occur in the future at the hands of the catholic church?
The whole thing is hypocritical in the sense of religion. How can a good, honest christian turn someone away from basic healthcare? because in this day and age, that is what it is.
The catholic church needs to remind itself that we are in 2008 and the common place, simple minded B.C. mentality needs to change or risk further alienation from the general public with their ridiculous values and judgments.

Dikkii said...

Hulk you’re probably righto a limited extent. When I wrote my original complaint, I was under the impression that the planned blackmail only extended to private catholic hospitals, which I think about half the comments here seem to think is OK anyway.

Dunc and I maintain that misinforming patients even in a private context is presently unethical, and my example of Doctor Bloggs was an attempt to show the absurdity of imposing one’s religious beliefs on a potential abortion case in a very small private yet catholic setting.

I certainly agree that this is more serious in a publicly funded hospital – the implication that St Vincent’s and Mercy would also be involved in such a ban is completely wrong – but whether misinforming such patients is under the authority of Catholic Health Australia or an individual catholic doctor, it effectively amounts to the same thing.

How can a good, honest christian turn someone away from basic healthcare? because in this day and age, that is what it is.

It’s a good question, because it raises the other question of whether “basic healthcare” should be subject to the religious biases of the practitioner.

The Declaration of Geneva suggests no (it uses the word “creed”).

As Indefensible rightly contends, a catholic might see advice on abortion to be akin to advising on murder. Their concept of good, basic healthcare would involve concealing all information regarding abortion or who might perform it.

The greater issue is that if this is allowed to happen, what type of changes to healthcare are going to occur in the future at the hands of the catholic church?

I both love and hate “slippery slope” arguments. So what indeed?

One of the reasons I don't fully buy the "doctors in private practice/hospitals can get away with murder if they like" angle is a similar argument: If you let doctors (in private practice/hospitals) get away with not advising or referring patients, what else do you let them get away with?

The Hulk said...

"As Indefensible rightly contends, a catholic might see advice on abortion to be akin to advising on murder. Their concept of good, basic healthcare would involve concealing all information regarding abortion or who might perform it."

This raises an interesting point. If they did intentionally conceal it, is that not a violation of some sort? Do they think they have the right to do that? I would certainly hope not. I could see myself arguing this with a devout catholic and them coming back at me preaching about the right to life.
However, they have surprised me on this one and headed straight for blackmail.I would suggest that if The Catholic church and the healthcare system can't play nicely they should not play at all but the Catholic church is going to do what they always do, which is whatever they want regardless of whether we agree with it or not. Once again religion is the issue. What a shock!

Dikkii said...

A thought did cross my mind, Hulk: Suppose that the bill was defeated in the upper house and not re-introduced to parliament.

What then? Can we introduce another slippery slope where:

Imagine that it's 2015 and Catholic Health Australia announces in a masterful display of spindoctoring that a policy of not referring or advising abortion patients has resulted in [insert meaningless and disputable statistic here].

In the background, they've begun lobbying for an anti-abortion bill that specifically bans advising on abortions, referring to abortionists and performing all abortions.

Introduce the right amount of spindoctoring, dodgy preference deals at the next state election resulting in a DLP candicate being elected as an MLC, a clueless population and a populist state government pandering to the lowest common denominator and such an anti-abortion bill could get up.

While it's tempting to say that this is the type of thing that the Catholic Church is always doing, allowing their staff to not provide these services legitimises the practise, which I don't think is a good idea.

Dunc said...

...I think that medical ethics should be able to accommodate individual differences.

I completely disagree. The essential core of all our current ideas about medical ethics is that the wishes and beliefs of the practitioner are completely irrelevant. Their purpose is to serve the patient. The only person who gets to make medical decisions based on their personal beliefs is the patient.

Take away that foundation, and the entire edifice crumbles into dust. It is to medical ethics what habeas corpus is to criminal law - the essential principle without which all else is meaningless.

For example, if a doctor is squeamish about, say, wart removal, then they shouldn't be compelled to perform those procedures.

They're not. If a doctor is squeamish about wart removal, then they shouldn't go into general practice - they should chose another specialism where the issue doesn't arise (of which there are plenty). Similarly, if a Catholic doctor is unhappy giving advice or referrals about abortion, they should chose a specialism where that issue doesn't arise.

All the hypotheticals and analogies are irrelevant. There are many fascinating and difficult questions in the realm of medical ethics, but this isn't one of them.

Anyone having trouble with this concept should read the AMA's Position Statement on Medical Ethics, particularly section 1.1 points A, H, J, K, and P through S.

Greg said...

Dunc, the citations you provided entirely back up my case. If a GP wishes to decline wart removal, she is under no ethical, professional or legal requirement to carry out the procedure:

q. Recognise that you may decline to enter into a therapeutic relationship where an alternative health care provider is available, and the situation is not an emergency one.

What could be more consistent with my position than that? (Cf my ectopic pregnancy and wart removal examples.)

You state that:

The only person who gets to make medical decisions based on their personal beliefs is the patient.

This is demonstrably not true. The doctor is also a partner to the decision and has "opt out" rights.

Dikkii said...

Greg, I think that your wart removal example is a good one. Unfortunately, in all discussion about this example, you don't consider the option that this doctor has to refer the patient to someone less squeamish about doing the procedure.

This is important, because at no point in the pending legislation is any doctor compelled to undertake the procedure. It's also important, because I don't think that Dunc is suggesting that a doctor has to perform the operation - I agree with you that to force doctors to undertake certain procedures is fascism. But you can support mandatory referrals in that instance, and here's why:

The doctor is also a partner to the decision and has "opt out" rights.

It strikes me that refusing to either perform the procedure or provide a referral for this would be a far more conscious activity. The question thus becomes, "Should the doctor continue to be provided with the options to not advise or to not refer?"

The answer is "Yes" and is what is discussed in the legislation. Doctors can continue to choose to not perform the procedure, or to not provide a referral.

Just not both at once.

Dikkii said...

Dunc, I think that a partnership thing exists between doctor and patient where a doctor is necessarily provided with some level of authority. That said, I think I agree more with your interpretation of the AMA code of ethics than Greg's. The point that he quotes doesn't explicitly enforce a referral to an "alternate provider" but only because the line in question appears to make such a referral implicit.

Greg said...

Re: My wart example. I always maintained that disclosure of the limitation and offer of referral was ethical. Here's what I originally wrote:

I think their only obligation to their patients is to be upfront about that and say "Look, if you were with any other doctor, they'd be talking about your wart removal options right now. I don't do that, but if you're happy to proceed that's cool. Otherwise, here's the card of a colleague."

This exactly maps to 1p in the AMA code.

Dunc, it is quite clear, does not think this disclose/refer approach is acceptable:

If a doctor is squeamish about wart removal, then they shouldn't go into general practice - they should chose another specialism where the issue doesn't arise

Doctors are able to "squeamish", provided they meet the AMA's code of ethics, both de facto and de jure.

Dunc is entitled to his views, but he is plainly wrong in claiming that the AMA code backs them up. His argument that doctors' views are completely irrelevant and that this principle is the agreed basis of all medical ethics cannot be sustained.

I don't think this is a case of different interpretations: that code is quite clear and unambiguous.

Dikkii said...

Greg:

I think their only obligation to their patients is to be upfront about that and say "Look, if you were with any other doctor, they'd be talking about your wart removal options right now. I don't do that, but if you're happy to proceed that's cool. Otherwise, here's the card of a colleague."

It's been so many comments back that you wrote that, that I forgot that you had. My apologies.

I was confused by your endorsement of Bloggs' conduct which included refusals to provide either advice or a referral.

Nonetheless, while it's probably over the top to insist that the doctor's personal views are irrelevant, 1.1p pretty much sets the standard that the patient needs to be informed properly. Bloggs failed to do this in my example. Doctors in catholic hospitals who are doing the same thing as Bloggs are effectively violating this as well.

(It might be implied that as an employee of a catholic hospital, this goes without say. I dunno. I'd like to hear what a discliplinary board makes of that defence, 'cause the way I read 1.1p, such a statement about beliefs must be expressed not implied)

Dunc said...

I have been unclear and hyperbolic, for which I apologise. Offering a referral is a perfectly acceptable solution. What is not acceptable is refusing to provide either treatment or a referral to another treatment provider. If you patient says "I want treatment x", you can't say "I'm not doing it, and I'm not telling you where you can get it. I'm not even prepared to talk about it," which seems to be the position the Catholic Church is trying to take here.

Dikkii said...

No need to apologise, Dunc. I think I might have made the same mistake.

But you're right:

I'm not even prepared to talk about it," which seems to be the position the Catholic Church is trying to take here.

This is exactly the position that the catholic church is taking. The bit about referring is just a smokescreen, though. They simply do not want the legislation to go through.