No Connection - Hasting Center Essays Miss the Mark

The Hasting Center has published an online collection of essays called"The Values and Health Care Reform Connection" allowing the public to comment on health care and "American Values." You have to admire the awareness of the academics - not only have they noticed that the conservative, pro-life, religious “American” is concerned with values, but they are trying very, very hard to appeal to those of us with a Judeo-Christian background. I’ve only skimmed a couple of the essays so farm but I have found a glaring inability to stay on task or a basic lack of understanding of the world view of the intended target, uh, audience.

For example, in “Stewardship: What Kind of Society Do We Want?,” Len M. Nichols misses the mark in spite of peppering the essay with terms like “stewardship,” “abundant life” and “covenant” and appeals to the writings of John Locke and Thomas Jefferson.

 (Skip over the use of a faulty, biased 2009 Institute of Medicine report on the consequences of lack of universal health care insurance in the U.S., already thoroughly debunked by Steven Malloy’s “Junk Science” blog.)

In his appeal to “American Values,” Nichols attempts to define “stewardship” to include a “covenant” as a duty of property owners to ensure that the poor have food to eat. He refers to the book of Leviticus and Jewish Law that land owners leave “the corners” of their fields for the poor to glean, rather than going back to harvest all that is there.  While noting that the rule was propagated the “other books that Moses wrote,” Nichols explains that only adult males could own land "in ancient Palestine." He would have been better off referring to the “Torah” or “the Law,” which was given by G_d, not Moses, and to the Nation of Israel, since there was no “Palestine” at that time.

Nichols almost persuades me that he “gets it” in his discussion of the basis for rights: the belief that humans are created in the image of G_d. However, he asks what good is the right to life or the pursuit of happiness without access to essential health care and quotes Jefferson’s comparison of liberty with health. He does not seem to understand that both Locke and Jefferson described these as negative rights: the right not to be killed, and the right not to be enslaved or have ‘the fruit of one’s labor” forcibly taken. In other words, no one has the right to cause another to be sick, but there is no right to medicine or medical care.

Nichols does not resort to the usual call for Christians to remember the Good Samaritan. In fact, he turns to an argument that might be more appealing to Libertarians, whom he calls “a tiny group of argumentative people.” His discussion of rights and stewardship by is converted to support for the rationing of health care, noting that Leviticus does not require the landowner to bring the poor person home and cook him a meal. In this, too, he demonstrates his lack of understanding of the Judeo-Christian world view. The covenant to care for the sick and poor is between individual believers and G_d. Government hasn’t proven itself to be trustworthy enough for me to assign my duty to G_d over to its stewardship.

Rumor: Francis Collins to head NIH

The Scientist reports that the name being circulated as most likely to head the National Institutes of Health is Francis Collins.

Dr. Collins spearheaded the US government efforts to document the human genome. However, he's just as well known for being not only a believer, but a Christian. He has told the story of his conversion in the face of the beauty of nature, in his book,The Language of God; A Scientist Presents Evidence for Belief.

Dr. Collins believes that the evidence is strong that the Earth is more than 6000 or so years old and that it looks as though the Creator used evolution to do His work. (You can imagine the shock when he gave his talk outlining his evidence at the Center for Humanity and Bioethics a few years ago.) He's started an organization called "BioLogos.org," to explore the interface of science and religion.

Elections have consequences (abortion, contraceptives, committees)

ABC's This Week with George Stephanopolis ran an interview with Speaker of the House Nancy Pelosi on Sunday, January 25, 2009. The transcript is here.

Stephanopolis allowed the Speaker to gloss over her policy that does not allow debate or amendments from the House floor, or that no Republicans were allowed to see or vote in Committee on last week's SCHIP Bill ("H.R. 2 is rushed legislation by the Democrat Majority that did not hold a single committee hearing or allow amendments to be offered on the bill."), and were only given a summary at 5:30 AM on the day of the vote.

STEPHANOPOULOS: The president has made it pretty clear he wants this to be a real bipartisan effort. Yet House Republicans have said they have been shut out of this process. There were no Republican votes in the appropriations Committee, no Republican votes in the Ways and Means Committee.
PELOSI: Well, because the Republicans don't vote for it doesn't mean they didn't have an opportunity to.

While I believe that true contraception, as in prevention of the union of sperm and oocyte, is ethical, I had planned to move strait to the Speaker's comments about Family Planning funds. However, it appears that the President was listening to the voters, even if the Speaker hadn't.

Posted: Tuesday, January 27, 2009 11:41 AM by Domenico Montanaro
Filed Under: White House, Congress

From NBC’s Mike Viqueira
The provision within the stimulus that would allocate money for contraceptive programs through Medicaid will be pulled out of the package.

NBC News confirms that the president called Henry Waxman, the chairman of the committee that inserted the contraception provision into the stimulus during the mark up last week, to ask him to remove the measure from the bill, according to a Democratic leadership source.

In short, the idea has simply become too controversial. Speaker Nancy Pelosi's defense of the program over the weekend, where she indicated that it would be a money saver, was not well received.

So that provision is out.

Complicating matters, both Minority Leader John Boehner and No. 2 Eric Cantor have told House Republicans that "all Republicans should vote against the stimulus" if it remains "in its current form," according to a GOP leadership aide.

They spoke inside their weekly conference meeting, behind closed doors. Afterward, both men came to the on camera stake out. The House will begin debate on the stimulus package late today, with no votes expected until tomorrow. Debate is expected to begin somewhere close to 5 p.m. ET.

The way your U.S. House works is that anyone who wants to offer an amendment to be considered on the floor has to go to a committee, the Rules Committee, beforehand.

The Rules Committee is a complete and utter tool of the majority leadership. (Emphasis mine, BBN.) It decides which amendments will be allowed on the floor for consideration. The minority is habitually unhappy with the result, as their measures, especially the ones that have a chance of passage or contain some political mischief or "poison pill" language, are barred. The Rules committee meets this afternoon to make its decisions.

So, besides politics, what's all the fuss about?

Part of the problem is the $50 million for the National Endowment for the Arts, ACORN, $200 million for sod for Washington, DC parks, $20 Billion for electronic medical records, and the emphasis on global warming research (with its increased costs for housing, transportation, food production and all aspects of our daily life).

One day after the 36th Anniversary of Roe vs. Wade and as the number of electively aborted children in the United States alone (non-medically necessary, not associated with "rape, incest, or the life of the mother") approaches 50 Million, President Obama overturned the so-called "Mexico City Policy" or "global gag rule." US tax dollars will once again be allocated to organizations that advocate abortion as birth control, and even those that lobby to change the laws of other nations to allow abortion where it is not currently legal. Every news article I've seen conflates the gag rule with limiting non-abortifacient contraception. However, the only restriction is that on abortion.

Another Bill now in the House and Senate, would wipe out abstinence-based sex ed and mandate emergency contraception according to the Rochester, NY newspaper:

* House member Louise Slaughter submitted the Prevention First Act of 2009 (H.R. 463/S.21). In the Senate it was introduced by Democratic Senate Majority Leader Harry Reid.

The legislation focuses on reproductive and sexual health issues, and in some cases reverses Bush administration policies. It provides funding for comprehensive sex education programs, and none for abstinence-only sex ed. Other provisions include mandatory access to emergency contraception for rape survivors, and a requirement that hospital staff provide factual, science-based information on EC, including instructions that it doesn't cause abortions.

The bill would also force health insurers to offer equitable coverage for prescription contraceptives.

And then, finally (from the first link above), Speaker Pelosi on Federally funded contraception for the poor:

STEPHANOPOULOS: Hundreds of millions of dollars to expand family planning services. How is that stimulus?

PELOSI: Well, the family planning services reduce cost. They reduce cost. The states are in terrible fiscal budget crises now and part of what we do for children's health, education and some of those elements are to help the states meet their financial needs. One of those - one of the initiatives you mentioned, the contraception, will reduce costs to the states and to the federal government.

Renewed fuss over conscience in medicine

For some reason, the media has decided to focus on the proposed rule from the Health and Human Services Department on the right of conscience, even for doctors, and even for abortion. I guess they felt it was the right thing to do.

LifeEthics has been following the conscience issue as it unfolded over the last year and I wrote a review of the history of the rule in November. Here is the actual notice of the proposed rule, in pdf.

Kaisernet.org, the Kaiser Family Foundation's daily on line newsletter article recalls the report by the New York Times last month that 3 of 5 members of the Equal Employment Opportunity Commission (two Democrats and one man, the legal council appointed by President Bush) released a statement that the new regulation would "overturn" years of protection. In my opinion, that is ridiculous in light of the recent debate about the American College of Obstetricians and Gynecologist's Ethics Statement #385 requiring member physicians to provide abortion, practice in close proximity to an abortionist, and/or make prior arrangements with an abortionist. In practice, all physicians who provide health care to women, including Family Physicians, Internists and Pediatricians, are held to the ACOG standards.

For those physicians and other medical professionals who are employed, the regulation will merely underscore and clarify protections. For those of us who are self-employed but subject to Boards and ethics statements like that of ACOG, the new regulation will provide protection from new pressures to act against our consciences.

For the worst report that is not on a blatantly pro-abortion website, see the AHN ("AllheadlineNews") editor's incredibly biased contribution. Practice your skills at unravelling biased non-news statements on this excerpt:

The Equal Employment Opportunity Commission has advised the president that the rule would overturn four decades of civil rights laws in the nation. They also say that current law protects people who have religious objections from performing duties that conflict with their religion.

Many groups support the regulation, although about as many oppose it.

******

The new rules probably wouldn't stop people with money or those living in large cities, or metropolitan areas, from finding the care they needed.

However, critics worry that poor people, or those living in small towns, might not be able to afford to travel outside their area to find a medical facility or health care workers that would provide them with the medical care they needed.

Thus the new regulation would create a two-tier health care system for some in America, while being funded from taxpayer money.

Overthrow protections by protecting? And, "Many . . . about as many?"

Remember that ACOG would requirements doctors who do not perform abortions to only practice "in close proximity" to those who do.

I still say that the ethical solution would be to make sure that pro-abortion OB/Gyns spread out to cover any shortage areas, rather than force the rest of us to clump together or make some areas - and all the men, women, and children that will never need an abortion - do without a local doctor so that no one ever has to be exposed to a conscience.

Beyond Belief 3: Candles in the Dark, From early in October, 2008, video is on line. The program invites scientists to discuss ways in which science can enlighten society.

The first sessions I've watched so far are part of the Panel on "This Is Your Brain on Morality."

Jonathan Haidt, describes morality as,

"Moral systems are interlocking sets of values, practices, institutions, and evolved psychological mechanisms that work together to suppress or regulate selfishness and make social life possible."

He notes that human societies serve to to control the free riders who do not contribute, the selfish, or those who do not display altruism and/or who harm others. They do this by encouraging moral values such as:

1. Harm/care (Discussion in other segments identifies this as equaling empathy.)
2. fairness/reciprocity (This is later called fairness.)
3. In-Group loyalty (altruism or the cooperation in large unrelated groups)
4. Authority/respect (humans, unlike animals, don't depend on just fear, but involve feelings of love)
5. Purity (Proper use of the human body,not necessarily sex, but in terms of drug use, too. He notes that Liberals are likely to consider purity in food very important.)(I thought about the way that smoking has become unacceptable.)

Haidt says that "Any nation is a miracle in evolutionary terms," since large scale cooperation among unrelated groups is not seen among animals, as it is in humans. He believes that traditional societies tend to use all 5 foundations to control "free riders" or the selfish, while liberals tend to use the first two and discount the other three.

An example and a way to understand this concept described by Haidt is to note that "E pluribus unum" is the national motto of the United States. He believes that Liberals are easily painted by "the right" as obstacles in the unity or coherence of society by emphasizing their love for rebellion, autonomy, individuality. (Or "Change" vs. "Country First"? Well, so much for that.)

Haidt has some really clear ideas about good and bad and insight into politics that I'd never thought of, before. Watch the faces of the audience, especially during the last few minutes: I think they're having the same experience.

And then, Sam Harris ("Can We Ever Be Right on Right and Wrong?") proceeds to confront Jonathan Haidt while sucking all the joy out the audience when he starts talking about the failure of science to "demolish" the idea that science can't guide society on morality.

(Harris may have been angered by the teasing he took about how long he's been working on his Ph.D.)

Harris flatly states that there are moral truths, and believes that the study of "human brain science" can inform society on what "goodness is in the public domain." He focuses on religion and seems to imply that religion is a poison.

Harris embraces what he calls "bounded utilitarianism," without regard to Haidt's values as they could shed light on the morality of his examples, including empathy, fairness, and then, altruism. Just as most people are ignorant about "biology, history, chemistry, and everything else worth understanding," most of them are "ignorant about the basis for human well being." He claims that some day, it will be scientifically correct to say that some societies are better than others, because they produce "lives worth living" vs. "lives barely worth living." I believe that he fails in his argument - and chooses poor phrasing as above) and very weak examples that are easily proven immoral by such values as Haidt's.

Harris contrasts morality as "well being among conscious human beings" vs. "superstitious beliefs." He refutes the claim that people can know whether they are happy other than how they fit within their society and absolutely equates conservative religious Americans with the Taliban in Afghanistan -- with no recognition that he is calling on "empathy," "fairness," as his own values and discounting them in others. (And he displays his ignorance about fundamental evangelical Christianity by describing "The Rapture" incorrectly. That makes me wonder about those of his examples that I'm not familiar with.)

The videos can also be viewed (and turned into MP4's) on Google videos.

Another end of life dispute (Motl Brody)

Doctors at a hospital in the District of Columbia have determined that a 12 year old boy, Motl Brody, has no upper or lower brain activity. He was declared dead by legal criteria November 4. Here's the Washington Post article on the case.

By legal and medical criteria, the boy died last week.

The dilemma is that he was placed on a ventilator and receiving drugs to stimulate his heart beat before the determination that he met the criteria for legal death in the District. His parents are Hasidic, Orthodox Jews and have legally objected to turning off the ventilator or stopping the medications, saying that their religion does not recognize anything other than cessation of breathing as "death." The case is now in court.

Perhaps the parents would consider discontinuing the addition of new doses of medications when the current ones run out? In this way, there is no intentional act of stopping the heart, and there would be no intervention if the heart continued to beat.

One way to look at the case is that it's never ethical to force doctors to act against their medical judgment as to what is in the patient's best interest. However, this patient is now dead. What do we owe the parents of a dead child?

The child's doctors have said, '"Ethically, there is no appropriate treatment except removal of the ventilator and of the drugs."'

However, it is considered ethical to continue cardiopulmonary support in order to preserve organs for harvest and transport. So, the organ support itself is not unethical. Is support for the body ethical in order to meet the religious requirements of the deceased patient's family?

Finally, who is responsible for carrying out acts that the doctor believes is not in the medical best interest of the patient? And for how long?

Is conscience solely a religious matter?

I've commented on the surprising accusation that protection of the consciences of physicians is anti-gay as well as anti-abortion by the pro-abortion faction. Now, the atheists are chiming in, claiming over and over that it's just the Christians who might refuse to perform abortions and object to calling abortion standard reproductive care.

"Pharyngula," is the blog of PZ Myers, who teaches biology at the Morris campus of the University of Michigan. Dr. Myers is one of the sources of the mocking of the Catholic communion and a "Red Letter," evangelical, atheist. He's also notorius for being banned from the local free showing of "Expelled, the Movie."

His blog post, "I don't want to be healed by Jesus, I want real medicine," advocates the view that "the religious" are the only people who would advocate for regulations protecting the jobs and licensure for people who conscientiously do not perform or refer for abortion.

Skeptical view on Expelled, the Movie

Michael Shermer, the Skeptic, has seen the movie, Expelled, in advance of its release Friday, April 18th, and posted a review on his blog at Scientific American.

Shermer is a spin doctor who, while purporting to follow reason, is actually better understood by the title he often sports, "skeptic." His near-"single-issue" is atheism vs. religion, specifically Christianity and Christians. He says in one of his books that he joined the Church of Christ (the conservative, no instruments) to impress a girl and never felt the conversion that should have gone with his baptism, but that he tried to justify his choice. He even went so far as to attend Pepperdine University, which is owned and run by the Churches of Christ. Rather than throwing out the bad and keeping or developing a faith in Jesus as he understands the Bible, he set about to prove to the world that religion is just one of the "weird things" that people believe. He loves to debate questions like "Is Religion a Force for Good or Evil?"

Shermer doesn't tell us that the agency that investigated Richard Sternberg's case against the Smithsonian agreed that he had been the subject of discrimination and a behind-the-scenes coordinated move to get him out of the Smithsonian. The case was dropped because he didn't belong to a protected group and he simply had no standing to sue within that agency, since he was not an employee. He did, however lose his lab space - going from a private office to a shared space and the privileges of unlimited access and his own key that he had enjoyed up to that time.

Also, Shermer claims that Sternberg went against policy in the peer review of the article by acting as editor and choosing the reviewers himself. Sternberg tells his side of the story and answers the charges against him at his own website, here, and here.


There's more on the web, including this review from 2006 Dispatches from The Cultural Wars , which details - and is an example of - the political nature of academia, research and the theme of Expelled.

Both sides spin to make a point. But, Sternberg's case appears to be a classic example of academia's - or any closed group with limited power to make change in the open - whisper campaigns and peer pressure to "expel" any doubters, gad-flies on the edge of scientific "consensus." Ironically, I've read that the reason that people don't understand the mutation that brings about changes in the gametes of individuals and eventually species, is that we don't understand really large numbers. Ironically, Intelligent Design began with the discussion about the mathematics involved in the evolution of species.

"Expelled" Producers make silly, ironic mistake

The producers of the movie "Expelled" owe PZ Meyersa lifetime pass to the movie. And they really need to attend and pass a logic class.

Dr. Myers, a scientist who researches cephalopods, and one of the men interviewed for the movie, was escorted by security from a free event that included a preview of the movie. However, the producers allowed Myer's wife, daughter, and her fiance to enter and view the movie, accompanied by Richard Dawkins.

The producers should be ashamed of themselves. They advertised the event, inviting people to register to see the movie. They did not send out notices that "everyone except x, y, and pz, may see the movie."

And to skip over Red-A Atheist-wanna-be Myers for the original, Dawkins, is just plain dumb. Dawkins has posted his review of the movie, here. (I haven't read it yet.)

Here's the real-time "Pharyngula" blog post about the incident - from PZ Myer's blog (he ran over to the Apple computer store to post on his blog) and there's a follow up post, here.

The entire conversation about the movie has left the original topic of academic prejudice against believers or even doubters, the near topic of the truth about Creation and evolution. The little boys are throwing mud pies and calling each other "dummie." I can't help but believe that the move to expel Myers from the showing was just a power play on the part of some would-be producer intern.

The Producers had a chance to frame the publicity from a PJ Myers appearance (along with that other guy) at their movie. ("Look who's coming to see the movie" will now become "Expelled from Expelled" and "Evidence that "Expelled" is not too bright." and "Myers is a saint.")

Here's the LifeEthics blog conversation that's been going on since October, and which also has a notice about the incident with Myers, Dawkins and the Producers and bouncers. Here's the Christianity Today review, and here's the New York Times. I guess that if all the Producers wanted was publicity, their strategy worked.

"Expelled, The Movie" Conversation Continues

The many Anonymice are still discussing world views on a post from last October.

(In case you wondered where I've been:

We've had our primary, with one hotly contested local Republican race ending in a cliff-hanger. The same seat was decided by 54 votes out of about 20,000 in 2006. This time, it looks like the winner may be decided by about 38 votes out of 30,000, before the mail in ballots are counted. We're expecting a recount.

It turns out that the consequences of politics and policy became personal this last 2 months. We've spent the last year - over 14 months, now - working out a plan to remodel our 65 year old house only to find out that the city adopted the new provisional FEMA flood plain map, and we can't remodel - we have to fill in the basement, tear down the old house, and build 2-3 feet higher. I'll admit that I haven't reacted very well. But, still, the City's bureaucrat literally lost the plan for 6 weeks before telling us that the concrete-poured-in-place house and basement that's still plumb, smooth and level after more than 60 years might float up and turn on its side.)

Politics Bites

Chris Comer, Director of Science Curriculum for the Texas Education Agency (TEA) sent out an email from her State account that was blatantly political in nature and which she knew was a bad idea.

Surprise! So did her bosses.

She made the political move, and got fired for it. Really, advocating a lecture titled, "Inside Creationism's Trojan Horse," by Barbara Forrest, a well-known anti-Creationist. That's worse than "not neutral." The title of the lecture is blatantly political.

If you want to see a video of Forrest's lecture, this page hasa link to the video, "Barbara Forrest's Inside Creationism's Trojan Horse."

The Red-A blogger,Pharyngula, The Austin American Statesman, and Nature blogger, "The Great Beyond," among others are blaming the politics on the Texas Board of Education. "The Austringer" blogger has the text of the original memo that Ms. Comer sent out.

In my experience, Ms. Comer's boss has it right. In her memo to the Agency, she notes that Ms. Comer either violated what she knew is TEA policy against employees of the State advocating for a political cause or she does not have the understanding that she should. (There's a link to the memo from the boss on the Austin American Statesman link above, but theres some sort of glich in it - it tries to add Japanese script updates to my computer.)

(In the video, go to 1:01/1:09:52: "These people are fanatics. . . . They know they have to get hold of the kids." A little earlier, Forrest stated that the believers are guilty of projection. From this side, it looks like a case of "Pot, Kettle." The last thing Forrest speaks on is the need to watch out for which judges are appoint, the need to teach the teachers to tell students that belief in a Creator is bad science and that "We need to stop electing people who put up with this crap!")

CNN objects to conscience

This subject again.

CNN, that bastion of upstanding plants ethics, objects to doctors with morals - or at least the ones who act on them.

The CNN video (not a "news piece") shows interviews with a woman who was refused contraception by one doctor and a second interview with another doctor who is Catholic and who does not believe that contraception is moral and so he does not prescribe it.

The reporter is shocked that 60% of doctors feel that it's okay to tell patients our moral views.

The reporter asked the patient whether she felt "rejected." The woman said that she did and that she felt that the doctor was judging her and imposing his morals on her. She said that any doctor who would not do what his patients wanted should not be in practice.

The woman isn't judging or imposing her morals on every doctor, is it?

Doctors make "judgments" all the time. We are not simply dispensers of products that people want. We must "impose" our judgment on patients who smoke (a perfectly legal drug) and drink (ditto) or who have become overweight from eating legal food and choosing not to exercise enough to burn off calories faster than they take them in. We are responsible for determining whether a patient is becoming addicted to pain medications, asking for a note for missing work when they were never sick, or a handicapped parking sticker when they're not disabled.

Much more often, we make judgments about the cause of a patient's symptoms or disease and how best to treat it. Our job is not to make the patient feel good about themselves, although most doctors I've met prefer to do so. What we do is diagnose and treat in order to help the patient be as healthy as we are able.

While I don't object to non-abortifacient contraception, it is an elective service in most cases. It is very rarely necessary to maintain the health of the body of patients. It is truly a "choice."

As I've said before, it would be simpler for people who feel that contraception is important to arrange to pay doctors who will write and dispense those medications and devices to go around to the areas where they are needed.

The alternative is to find a way to trust a doctor who will act against his conscience - to do what he considers the wrong thing for your pet issue - to do the right thing every other time.


Hat Tip: Blog.bioethics.net

Laws, conscience, medicine and bloggers

In contrast to the hype that you might read on blogs and in the press, the Federal District Court judge in Washington has upheld the law of that State. The basic right to not be forced into action that one considers unethical or immoral - the right to liberty - was upheld first, by the Washington State Legislature and affirmed by the Court.

According to the Seattle Times article, there will be a trial next year and the "rules were meant as a compromise after long, contentious hearings and intervention by Gov. Christine Gregoire, who threatened to replace members of the Board of Pharmacy who didn't vote to protect women's rights." (Emphasis mine, BBN.)

The judge ruled in favor of State Law and overturned regulations passed by the Washington State Board of Pharmacy which were changed in July of this year to require that "pharmacies must maintain at all times a representative assortment of drugs in order to meet the pharmaceutical needs of its patients." The plaintiffs, two individual pharmacists and a corporate pharmacy were asking to be allowed to follow their previous practices "refuse and refer."

The Court's ruling is posted here at the Seattle Times website, which also has a fairly good review of the case to this point, here. (I've saved copies of each, so let me know if they disappear).

Judge Ronald B. Leighton issued an injunction that delays the force of the regulation, since it appears that the regulation violates laws passed by the Washington State legislature to protect the rights of individuals:

"As a part of the Health Care Access Act, the legislature expressed the recognition “that every individual possesses a fundamental right to exercise their religious beliefs and conscience.” RCW 70.47.160(1). The Legislature further acknowledged that “in developing public policy, conflicting religious and moral beliefs must be respected.” RCW 70.47.160(1). Accordingly, the Legislature provided that “no individual health care provider, religiously sponsored health carrier, or health care facility may be required by law or contract in any circumstances to participate in the provision of or payment for a specific service if they object to so doing for reason of conscience or religion.” RCW 70.47.160(2)(a). No person may be discriminated against in employment or professional privileges because of such objections. RCW 70.47.160(2)(a). The right of conscience, however, is not intended to result in a patient being denied timely access to any service included in the basic health plan. RCW 70.47.160(2)(b).

"An identical right of conscience was included within the Insurance Reform Act adopted by the Legislature in 1995. RCW 48.43.065."

(emphasis in italics are mine, BBN)


The regulation itself was poorly written.

The phrase "at all times" is a big problem. Would that mean that all pharmacies must change their hours so that they are open or on call 24/7? As to the phrase, "representative assortment," that might mean different things to different people. The wording open to the widest interpretation, however, is the phrase, "pharmaceutical needs of its patients." (Let's forget that pharmacies don't have patients, pharmacists do.)

The "pharmaceutical needs" of patients is wide open to interpretation, especially in the case of Plan B. I've covered the evidence (here) that indicates that Plan B only works to prevent ovulation and fertilization the 5 days or so of the month before and the day of ovulation and the lack of evidence that it acts in any way as an abortifacient. Unfortunately, this isn't acknowledged in the court's ruling or by any of the other parties in the case.

I depend on pharmacists to evaluate the prescriptions I write for my patients. They have often helped me by catching and refusing to fill scripts because they knew about drug interactions, allergies, and fraudulent prescriptions when I didn't. I would like for them to notify me if they refuse to fill my scripts, but their professional judgment is the very thing we physicians and patients are depending on, isn't it? If we force them to do what they believe to be wrong, the only pharmacists we'll be left with will be people who will do wrong because they were "only doing their job." (Where have we heard that before?)


There's an especially over-wrought emotional discussion over at the Women's Bioethics Project blog. No posts are published without the permission of the author, who evidently has some pretty strong feelings involved. I added to the intensity of the silliness and self-righteousness with my comments, I'm afraid. (So far, they haven't posted my remarks from 12 hours ago about cigarettes as a legitimate treatment for priapism [an old remedy - no longer advised - that was actually used as late as the '80's], prescribing of wine as a relaxant, and the fact that I make it a policy not to prescribe medications until they are on the market long enough to be proven by lots of other doctors' patients.)


As Mick Jagger sang, "You can't always get what you want. . . but you can try sometimes to get what you need."

(edit - typos fixed at 5:30 PM CST 11/14/07)

Catholic Bishops to Allow Plan B in Emergencies

Can anyone be forced to act against his conscience? Do religious convictions have any weight in the law? How far can the courts go to make a person do an act that he believes is unethical or immoral?

I hope these questions are not ignored due to the sensationalism that surrounds emergency contraception.

The Catholic Bishops of Connecticut have decided to allow the doctors in Emergency Rooms at the Catholic hospitals in their State to prescribe Plan B for rape victims. (More here.) The courts had ruled that the hospitals would be required to follow state law mandating that all emergency rooms prescribe the pills, even those belonging to religious organizations which object to contraception and abortion.

The law requiring all hospitals to prescribe Plan B to rape victims, which passed in June and takes effect Monday, does not allow for an ovulation test. Instead, it requires a pregnancy test.

Barry Feldman, a spokesman for the Connecticut Catholic Conference, said that since the bill passed, the bishops have questioned the feasibility of the original policy because of "further revelation by them about the state of existing science and the lack of definitive teaching by the church and the fact that there are many who are affiliated with the church that believe the ovulation test isn't necessary."

Feldman said the bishops' decision to allow Plan B to be used for all rape victims in the hospitals does not mean that the bishops' personal beliefs have changed. Also, they still believe the law is seriously flawed and should be changed to allow an ovulation test.

In June, Bridgeport Bishop William E. Lori said the new law violated religious liberties and suggested that politicians might force Catholic hospitals to perform abortions or euthanasia.

Sen. Jonathan Harris, D-West Hartford, who worked to negotiate a compromise bill with the church, said lawmakers have no interest in taking such steps.

"Our efforts had only one goal, to protect the victims of rape," he said. "There was no other agenda. It was started to just do that."

Rape crisis counselors in Connecticut said there have been unclear and inconsistent policies for supplying Plan B to victims who seek treatment in emergency rooms across the state, including some in nonreligious hospitals.

According to Connecticut Sexual Assault Crisis Services Inc., 40 percent of rape victims were not offered or did not receive the full dose of emergency contraception at the hospitals where they were treated during the first half of 2006.

Plan B, a package of pills containing levonorgestril, a progesterone, is also called "the morning after pill."

My review, "Plan B, How It Works and Doesn't Work," with links to reliable information and research papers, is here.

It appears that the bishops aren't just caving in to legal pressure, but were convinced that the pill works, when it works, by delaying ovulation or keeping the sperm from getting to the oocyte. There is quite a bit of evidence that this is true and none (from some pretty good studies in animals and ovulating women) that the Plan B formulation prevents implantation or causes an implanted embryo to be aborted.

The biggest problem now is that the courts in Connecticut dared to over-rule a religious principle and conscience issue in the first place. At what point can the state force men and women to act against their consciences?

An oldie but a goodie - new conversation

The November 2006 post, "Beyond Belief: the Institutional Delusion of Scientism" commenting on the Belief net symposium on science and religion has a new life - with comments.

Paul Booth has left a new comment on your post "Beyond Belief: the Institutional Delusion of Scien...":

"If you ask me (or read this far in the blog), a rational universe that is subject to measurements and study that yield consistant and ever sharper, more focused results in different labs and at different times does not preclude a Creator"

I dont think a single participant in the beyond belief conference would claim otherwise. Science does not claim disprove the existence of God. It does however demonstrate that 'God' as 'he / she / it' is conventionally conceived and depicted is incredibly unlikely. Science also is making inroads into understanding why we are likely to be susceptible to a belief in God.

Of course none of this affects me as a Jedi.

While "science" doesn't claim anything, the practitioners of science may, given a forum.

However, if they have no more proof - and don't expect to - if the who belief that there is nothing to believe in is a matter of faith, what's the difference between religion with a Creator and religion of science?

Doctors, faith and helping the poor

The Chicago Tribune published an article on a study concerning doctors who help the poor. I haven't read the actual article, yet, but I wonder how the "poor" are defined and question the definition of "religiosity" vs. spiritual.

For one thing, I'm not sure how, as a Family Physician, I would separate my patients into poor and not-so-poor. Currently, I work for other doctors, but their patients seem similar to the ones I cared for when I had my own practice, although the trend is away from Medicaid, which pays very little compared to Medicare and private insurance. (Medicaid pays less than the office overhead for the time it takes to see the patient.)

There seems to be a fair mix in the patients that come to our practices through the hospital call lists because they don't have a doctor. Also, I frequently hear that this patient or that has an agreement with the doc to pay what and when she or he can. I'm also reminded by the staff that the patient is "self-pay." These patients are "coded" or charged as little as we legally can without committing the felony offense of insurance or Medicare fraud. (The law says we can't charge less than we would charge a Medicare patient and we can't charge a "discounted" rate without risking charges of fraud. There is a little bit of lee-way, however, in calculating the risk, history necessary, etc.)

The study, based on a mail survey of more than 1,100 American physicians, found that 31 percent of doctors who described themselves as religious reported that they serve primarily poor or uninsured communities, compared with 35 percent of doctors who had no religious affiliation.

Those two figures were statistically equal, but other comparisons showed that doctors were more likely to treat underserved populations if they considered themselves highly spiritual, felt that their religious beliefs influenced their medical practice, or said they were raised in a family that encouraged service to the poor.

How do you determine "religious" if not by those who "considered themselves highly spiritual, felt that their religious beliefs influenced their medical practice?"

BTW, I've been away while studying for and taking my every-7-years American Board of Family Physicians National Boards. I won't know the results until mid-September, but at least there's no dead lines looming ahead of me for a while. Yeay!!!

Sam Harris at the Aspen Ideas Festival

Sam Harris, author of the books, The End of Faith: Religion, Terror, and the Future of Reason and Letter to a Christian Nation, was given a forum at the Aspen Ideas Festival. I'm not sure how I ended up finding the video, "Believing the Unbelievable: The Clash Between Faith and Reason in the Modern World," but I believe I was referred by one of the Science Blog forums. I can't remember which one, and, as far as I can tell, only one of these blogs is owned by a believer.

Which is probably how I got lost. There's a bit of a row, right now, concerning the derision of believers by "Pharyngula." (Which is surprising, since that seems to be his purpose in blogging.) I was once again struck by the idea that science and religion are incompatible, chased some links, and ended up watching a video from the Festival.

Mr. Harris spent his time at the Festival blurring the edges between “Christianity, Judaism, and Islam,” with a little Hinduism and Buddha thrown in to strengthen his point. There doesn’t seem to be any difference in his viewpoint, although he does grudgingly admit to a questioner that “moderate” Christians and Jews have been influenced by the belief in human rights and equality by secular, outside influences, while Muslims have remained isolated and so have not “evolved.”

Beyond the fallacy of treating all religions as one, Mr. Harris denies that atheism is a religion, using his second favorite technique, mockery and one liners designed to encourage his listeners to laugh with him. He mocks the Second Commandment: “Is this as good as it gets? . . . How about, ‘don’t deep fry all of your food?’” and mocks the idea that agnostics are a separate from believers and atheists by saying, “I haven’t met too many agnostics about Zeus.”

The biggest logical fallacy in which Harris engages is his statement that religions change from without, due to secular ideas about human rights. In fact, the Judeo-Christian tradition teaches that we are all created in the image of God.

While Christians have cited the fact that very young children naturally display concern for others and seem to understand the concepts of justice and beauty as proof of God, Mr. Harris believes that this actually disproves the “usefulness” of religion. While he admits that 70% of (I presume, U.S.) college graduates believe in the Biblical God, he strongly commends “peer review” in science.

His major point seems to be that “much of the Bible and Koran is life-destroying gibberish.” He dismisses the rest. While he insists that believers who promote their religions or teach their children to follow them are enabling religious fanatics who kill in the name of religion, shouldn’t Harris, who has been called an "Atheist Evangelist" take responsibility for enabling those who kill and enslave to suppress religion, as in China? Or the Western academic powers that be that harass, deny recommendations, employment and funding to those who fall out of favor, such as Richard Sternberg (see the review at Sternberg's site and at National Public Radio)?

Christian Docs' Ethics on The Moral Worth of Human Life

Yesterday, at the annual meeting of the House of Representatives of the Christian Medical and Dental Association, three statements on ethics were approved. I don't have all of the text or the final versions of any of them at this time and will report on them in more detail later, but I would like to brag on the our Ethics Commission and the work of the House. (I'm the Chair of the Family Medicine Section.) Watch for more here and - hopefully - in the Press. I'll post links as soon as they're published on line.

The Chair, Dr. Robert Scheidt also gave one of the workshops on Conscience issues, which I'll discuss after I get home. At the meeting, he introduced statements on "Abuse of Human Life," "Human Stem Cell Research and Use" and "Human Life: Its Moral Worth."

These are statements from an unabashedly Christian world view - with strong logic and historic background. And some of the most elegant language on "person," the image of God, and the moral worth of human life. Here's a bit of the wording - draft version:

Every being of human origin is a person. A person is not a Homo sapiens with the superadded quality of "personhood." Some, however would attempt to withhold moral worth from human beings unless they "qualify" as persons. The status of "personhood" cannot be conferred by society.

The beginning and continuity of the moral worth of human life are concurrent with human life itself. Human worth begins with the one-cell human embryo and lasts lifelong. A living human being is an integrated organism with the genetic endowment of the species Homo sapiens. . . . Thus a human being, despite the expression of different and more mature secondary characteristics, has genetic and ontological identity and continuity throughout all stages of development from formation of the human being until death.

There is beautiful language on the image of God, the sacred nature of human life, and the love of God. I will post these more fully as soon as I get home. Now, I have to go catch a 7 AM plane.

Racism, politics, and really big numbers

Last week's announcement that three different labs have managed to not only reproduce work showing that certain genes are responsible for embryonic-stem-cell-ness, but actually managed to turn adult cells into embryonic-like stem cells has been widely reported and comment upon.

Times Magazine displays blatant racism and not a little naivete in their report, "Japan gets ahead of the curve":

But it was March 2006, just months after the South Korean stem-cell scientist Hwang Woo Suk—who had become an international sensation after claiming to have cloned a human embryo, a first—had been exposed as a fraud. As another Asian stem-cell scientist announcing a surprise advance, Yamanaka knew his peers would put him under the microscope. (emphasis mine)

Yep, all them furinner's look alike to us.

Actually, the Times reporter mentioned the most important factor in any increased scrutiny and pressure from Yamanaka's peers: ". . . because Yamanaka did not use human embryos, his technique offered researchers everywhere a way to sidestep the ethical controversies that have dogged the field since its birth."

We've been treated to examples of politics in science each time non-destructive stem cells news breaks out. I reported on the comments at the American Society of Bioethics and Humanities meeting last October. David Stevens, MD, CEO of the Christian Medical and Dental Association describes the scenario:

. . . proponents rushed to the microphone to do damage control and claiming we must continue embryonic stem cell research since we can't predict which technique will provide cures. With 1,200 clinical studies underway using adult stem cells and none using embryonic ones as well as these two breakthrough studies in the last year, it is becoming a pretty sure thing on simple pragmatic grounds where we should be putting our tax money. It is like predicting whether the San Antonio Spurs are going to beat your local Saturday afternoon pick up basketball team.

The emperor has no clothes but continues to ride smiling through the public. Sooner or later the people notice."

(Go, Spurs, Go! Yeaaay Champs! Sorry, couldn't resist.)

We've read that the results we keep seeing from adult stem cells are simply a matter of the numbers - more US tax dollars are spent on adult stem cell research than on embryonic stem cell research, and embryonic stem cell research is much newer than adult. But let's look at the facts: Yamanaka did his work in Japan, and Nature is published in the United Kingdom. Nope, no influence from US tax payer funding or the lack there of. Perhaps it's just that non-destructive stem cell research actually produces reliable, frequent results?

But maybe, just maybe, if we get out our tin hats and/or risk assuming a duty to die, we might contemplate there's Something Else going on. A UK conspiracy? Or is Someone higher up messing with the United States Congress?

Dr. Stevens:

Ironically, the day this bill passed last fall, the news announced the breakthrough study that showed that amniotic stem cells could become endoderm, ectoderm and mesoderm. They have all the benefits of embryonic stem cells but none of the risks. They don't turn into cancers, they are readily available, genetically stable and easier to control. This year, the ground breaking study on dedifferentiating mouse skin cells into embryonic stem cells hit the front pages and TV screens the same day as the House vote and stole its thunder. Though this technique has a number of hurdles to cross before being applicable in humans, I'm beginning to wonder if God has a great sense of humor!

(Go, God, Go! Had to do it.)

And Dr. Stevens is not the only one to notice that there are just too many coincidences, what Yogi Berra called, "Deja vu, all over again."

A very funny Washington Post Op-Ed by Rick Weiss, entitled "Darn cells, Dividing Yet Again!" could be used to discuss humans' need to attribute natural phenomena with supernatural explanations with these guys, over at The Edge. Or at least a cosmic conspiracy.

Go read the whole thing, but here's a bit:

Is there a plot afoot?

Lots of lobbyists, members of Congress and even a few scientists are starting to think so.

"It is ironic that every time we vote on this legislation, all of a sudden there is a major scientific discovery that basically says, 'You don't have to do stem cell research,' " Democratic Caucus Chairman Rahm Emanuel (Ill.) sputtered on the House floor on Thursday. "I find it very interesting that every time we bring this bill up there is a new scientific breakthrough," echoed Rep. Diana DeGette (D-Colo.), lead sponsor of the embryo access bill. Her emphasis on the word "interesting" clearly implies something more than mere interest.

"Convenient timing for those who oppose embryonic stem cell research, isn't it?" added University of Pennsylvania bioethicist Arthur Caplan in an online column. (The bill passed easily, but not with a margin large enough to override Bush's promised veto.)

Even some scientists, those exemplars of rationality, couldn't help but wonder if somebody, somewhere, was -- if not out to get them -- at least taking some pleasure in irritating them.

"I don't think this is the most sensitive timing for Nature to release these papers," said Harvard stem cell scientist Kevin Eggan, the lead author of one of the articles that appeared in the London-based journal on Thursday.

Twice in six months. What are the odds?

Religion and zealotry of one sort or another

The National Review has published an editorial by Colleen Carroll Campbell on the resignation of St. Louis' Archbishop Raymond Burke from his position on the board of that city's Children's Hospital foundation. The Archbishop objected to the invitation to the outspoken (and vocal) proponent for abortion and embryonic stem cell research, Cheryl Crow.

Ms. Campbell states the problem well:

Today’s religious leaders increasingly face a double standard when it comes to their public pronouncements: They can say what they want as long as they express politically correct views or stay mum on hot-button social issues. Where secular pundits and celebrities are given free reign to plead their case to the public, religious leaders are derided as theocrats for injecting religiously derived moral principles into political debates. This stifling of religious voices is intended to prevent religious conflicts in the public square. But it also prevents the most fundamental form of deliberation necessary to the functioning of a pluralistic democracy: honest debates about right and wrong, good and evil, truth and falsehood.

However, I would add that the zealotry of some who complain about activism by any and all religious people in any public dispute is near-religious in itself.

A case in point:

The journal, Nature Neuroscience published an unsigned, unattributed essay in the April, 2007 issue, entitled "Shaky arguments against stem cells: Recent attempts to use scientific findings to discredit embryonic stem cell research are distorting the state of the field." (I'm not sure whether this requires registration to view.)

(Amazing, huh, that the editors could afford so much space for their title, but none for their own names?)

The editorial is nothing but a call for all embryonic stem cell research and nothing short of the same, without comment, without restrictions.

In order to illustrate their point, the authors (whoever they are), discuss an essay written to inform the readers of First Things. The authors (whoever they are) state that the content of the article is "correct," but feel it necessary to stress that the journal is a "conservative Roman Catholic magazine" and cite Maureen L. Condic, Ph.D. for "trying to spin science—both its problems and successes—to fit an anti-scientific purpose."

In fact, they seem most offended that Dr. Condic commented at all.

As I wrote the editors, the editorial reflects a deep bias and a "spin" of its own, discrediting their journal and "distorting the state of the field," indeed.

If we knew who these anonymous authors were, perhaps we could ask them why their own position is "right" and the Dr.s' is "wrong." I would also ask them why they insist on bringing religion and politics into the debate, when Dr. Condic so obviously - as they state - avoided both.