Recently the executive branch of the United States government launched a strategy to create a Conscience and Religious Freedom Division as part of the Office for Civil Rights within the Department of Health and Human Services (HHS) to ease the way for doctors, nurses and other medical professionals to opt out of providing services that violate their “moral or religious beliefs.”
The new division will not only accept complaints from health-care professionals, but will be responsible for ensuring that hospitals, clinics and other institutions across the country are accommodating their beliefs. These provisions would apparently “protect” healthcare workers who refuse to take part in abortions and those who deem treating transgender patients, and presumably other groups or individuals, objectionable.
This approach to allow choice by health care givers regarding their patient encounters undermines the tenets of the Hippocratic Oath and all pledges dealing with the healing arts.
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I personally can appreciate that physicians, nurses and others who have strong anti-abortion beliefs should appropriately choose to work in institutions that support their anti-abortion beliefs so as not to have to make a moral decision. Other possibilities, however, emanating from this HHS edict create significant dilemmas.
Incredible challenges would arise, especially in the surgical and critical care fields, if healthcare personnel could decide on an individual basis, whether they must treat individuals with specific gender identification issues who are brought to our emergency departments with severe trauma or less acute surgical illnesses.
How far would this reach? Should we allow a selective application of surgical treatment to apply when the injured gunman who has just shot a policeman arrives at our ED door? Do we condone a moral imperative that would allow physicians or nurses to object when asked to treat a patient of a certain race or ethnicity? Do we pardon our colleagues who choose not to treat the drug addict or HIV-infected patient based on their moral or religious convictions?
For those with the responsibility of hiring physicians, nurses, medical house staff and others, is there now going to be an absolute necessity to ask potential caregivers about their unique religious and moral barriers to rendering care for certain patients? In the majority of our hospitals that care for diverse patient populations, do we allow credentialing and privileging of individuals who will make immediate decisions to treat or not based on their religious and moral beliefs?
Should we be able to count on all caregivers to render treatment in a professional and ethical manner to all those injured in mass casualties or acts of terrorism?
In lieu of the classical Hippocratic Oath, many medical schools throughout the world have used the Declaration of Geneva during graduation exercises. This Physician’s Oath was adopted by the World Medical Association General Assembly in 1948 and amended over many years with the most current revision in 2017. It is a declaration of a physician’s dedication to the humanitarian goals of medicine, a declaration that was especially important in view of the medical crimes that had been committed in Nazi-occupied Europe.
The Declaration of Geneva was intended as a revision of the ancient Hippocratic Oath that could be comprehended and acknowledged in a modern way. One of the main tenets of this oath is that physicians “will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient.”
It is my fervent hope that the current members of the executive branch of our government and especially the leadership of HHS and its Office of Civil Rights read and understand the nuances of this document before making a final proclamation.
Frederick L. Greene, MD FACS, is a Clinical Professor of Surgery at UNC School of Medicine, and Medical Director of Cancer Data Registry at the Levine Cancer Institute.