Health care workers hamstrung by law denying care to some
Florida Senate Bill 1580, now signed into law and in effect as of July 1, brings back disturbing memories.
In 1981, the medical community was beginning to learn how to recognize HIV/AIDS, but its cause continued to elude us. At the time, I was a junior resident in internal medicine at Cook County Hospital in Chicago, a large public hospital. Under normal circumstances, we cared for anyone that came through our doors, but something began to change. My faculty, the senior physicians — not all, but enough — were afraid. They began to stay away from patients who “looked gay,” who might be Haitian, who were potentially drug users. “You take care of them,” they said. “I will not be involved.” Some said it was against their moral beliefs. Most were just afraid.
Adherence to ethical codes in medicine has been greatly strengthened since then, but backward legislation threatens this advancement. Over 40 years later, behaviors that physicians would consider unacceptable are now permissible under Florida law.
Florida Senate Bill 1580 provides for what it refers to as “the right of medical conscience” for health care providers pursuant to their “moral, ethical, and religious convictions.” The law never defines what constitutes such convictions, meaning that, in theory, any bias can be invoked to deny care. Put simply, the law intends that providers be free from consequences as they discriminate against the people they are meant to serve.
Under this new law, anyone who is a health care provider can decide they do not want to care for a patient. Maybe she looks gay, or maybe he looks like a drug user. Maybe she has come in for birth-control medication but looks “too young” or “too unmarried.” Maybe he is an accident victim who smells of alcohol, and the EMT on the scene decides she does not wish to care for someone who drinks excessively. There are literally millions of possible examples of how individual health care workers could abuse this law to deny lifesaving care for arbitrary reasons.
By enacting this law, the Republican-led Legislature and the governor have given free rein to people’s prejudices. While the law states that it does not give the right to discriminate on the basis of protected categories like race, sex, or religion, anyone who wishes to do so can construct a rationale — a “conscience-based objection” — that achieves this goal by proxy. While organized medicine recognizes that there will be times when a physician cannot, for many reasons, provide optimal care for a patient, ethical codes hold that the physician is obligated to assist the patient in finding another clinician who will care for them. Bill 1580 demands no such thing. If a practitioner decides that you offend them in some way, they are free to deny you care and to leave you without any alternatives. Imagine how this plays out in a situation where you or a family member are severely ill or in pain. Where will you go?
What will you do?
Dr. A Joseph Layon is professor of anesthesiology at the UCF College of Medicine, as well as Medical Director of the Medical Surgical ICU at HCA Florida Lake City Hospital. He is a member of Physicians for a National Health Program (PNHP).