Grey Matters: Should a doctor be forced to choose between her faith and her profession?

Attachment-1-2ISSUE: This week in Grey Matters, we look at the First Amendment and the free exercise of religion, and how far should this be protected. In particular, should a doctor be forced to choose between following her faith and practicing medicine. Let’s examine this topic with a fictional story about Dr. Evelyn Wright, a pediatrician in Chamblee, Georgia, a northeast suburb of Atlanta.

BACKGROUND: Dr. Wright grabbed the chart from her nurse and reviewed the initial description of Levi’s symptoms. He had a temperature of 101F, and there were no other presenting symptoms.

Dr. Wright figured Levi was just suffering from a cold. She’d been treating him since he was just a few weeks old, and she knew that kids with asthma were more susceptible to viral infections.

She walked in to find Levi sitting in the lap of a woman she didn’t know. The woman was in her late thirties and wore a black and white print shift dress and more make-up than Dr. Wright would have worn out for an evening out.

She extended her hand to the woman. “I’m Dr. Wright.”

“Kristy Stevenson,” she said and shook Dr. Wright’s hand.

“Are you Sarah’s sister?” Dr. Wright asked. She had known Sarah Stevenson for six years, since she and her husband Tom, starting bringing Levi to see her.

“I’m her wife,” Kristy said.

Dr. Wright wrinkled her brow. “I’m sorry. I’m confused. Isn’t Sarah married to Tom Banning?”

“They divorced three years ago. She and I got married a few months ago.”

Dr. Wright didn’t say anything. She pretended to look at Levi’s chart but was trying to think of what to say next.

Kristy mistook the silence as Dr. Wright’s wanting to know more their relationship. “I used to be Sarah’s secretary at the law firm. We’d worked together for six or seven years. I’ve known Levi since he was born.”

Dr. Wright recovered and cleared her throat. “Let’s get little Levi onto the exam table here.” She put the tips of the stethoscope into her ears, drowning out any further explanation.

Kristy put Levi on the table. “It’s gonna be ok, sweetie,” she said and held his hand.

Dr. Wright put pressed the stethoscope’s drum onto Levi’s chest. “Just breathe normally.” She could hear the coarse whistling sound in Levi’s respiratory airways. She tapped on his chest and then pressed the drum to his stomach and back. She didn’t hear any of the rattle that would suggest bronchitis or any other infection.

Dr. Wright couldn’t stop thinking about what Kristy had told her. Sarah had never seemed like a lesbian. She was into fashion and always looked the part of the high-powered corporate attorney. She and Tom had seemed to be very much in love, but when she thought about it, she realized that she hadn’t seen Tom for several years. She’d just assumed that he was like most fathers: too busy or just didn’t view his role as the one to take the kid to the doctor. Dr. Wright asked the customary questions, careful not to stare too much at Kristy. By the end of the examination, Dr. Wright was confident in her diagnosis.

“Of course, we’ll do a culture for strep, but I’m fairly certain it’s the common cold. His asthma makes it seem worse.” Dr. Wright made notes to Levi’s chart and then instructed Kristy. “Just watch his temperature and bring him back if it gets above 103F or continues for more than a couple days.”

Dr. Wright left the exam room and went immediately to her office. It was her lunch time, but instead of going to the Church’s chicken across the street for her normal meat and two combo, she got out her Bible and read a few passages. She attended a conservative Baptist church, and she did not believe that two women should be able to get married, and she definitely was opposed to children being raised without both a father and a mother. She prayed and then knew what she had to do.

At the end of the day, she took Levi’s medical file to her colleague, Dr. Jameson, and asked him if he wouldn’t mind taking over Levi as a patient. She knew that Dr. Jameson had a sister who was lesbian, and Dr. Wright figured that he would be much better at working with the Stevenson couple. Dr. Wright was primarily concerned about Levi’s health, and she worried that she might not be able to provide the couple the best services.

Over the next month, Dr. Wright thought about her decision more, and then decided that she could continue to see Levi but only if Sarah brought him without Kristy. She only wanted the best for Levi, and she didn’t want him to suffer even more, just because he didn’t have a father.

Several months later, when Kristy called to make a regular appointment with Dr. Wright for Levi’s regular check-up, the receptionist asked whether she or Sarah would be bringing Levi to the doctor.

Kristy asked why it mattered, and she was told that Dr. Wright did not think two women should be raising a child. The receptionist offered that Dr. Wright would see Levi if Sarah brought him in or suggested that Levi could be seen instead by Dr. Jameson. The receptionist explained that Dr. Wright was not comfortable dealing with Kristy because she didn’t approve of their relationship.

Kristy hung up the phone, cried for a little bit, and then called her wife. Sarah immediately called her roommate from law school who worked at the ACLU. Sarah was only partially surprised to find out that although the American Medical Association frowned on that sort of behavior, it was perfectly legal, and she recommended a different pediatrician.

COMMENTARY:  Since the Supreme Court made same-sex marriage legal in all 50 states, many professionals have determined that their faith is in conflict with the practice of their profession. And whether it’s baking a cake for a gay couple on their wedding day or providing medical services to the child of a lesbian couple, conservative Christians have argued that their faith should allow them to refuse to provide services to gay and lesbian couples.

In this example, Dr. Wright did not refuse to provide service to Levi. In her mind, she treated him like she would have any other patient. She even offered a compromise solution to the lesbian couple and said that she would continue to see Levi. But the proposal was not accepted to Levi’s parents.

Let’s look at the legal and ethical implications of Dr. Wright’s actions:

Was Dr. Wright within her legal rights to refuse to see Levi?

If Dr. Wright were inside the city limits of Atlanta, her decision would have been a violation of the municipality’s anti-discrimination ordinance; however, because her practice is in the suburbs, Dr. Wright’s actions were perfectly legal. Like most states, Georgia does not prohibit discrimination on the basis of sexual orientation.

Did Dr. Wright act within the accepted ethics for doctors?

The American Medical Association has a long-standing ethical policy opposing any refusal to care for patients based on race, gender, sexual orientation, gender identity or any other criteria that would constitute invidious discrimination,” according to Gregory Blaschke, chair of the AMA’s LGBT Advisory Committee. However, the AMA guidelines are not legally binding on doctors.

What do Democrats and Republicans think about this issue?

Not surprisingly, the Democratic and Republican Parties are split on this issue. The Republican Party has included in their platform an express plank called “Protecting Individual Conscience in Healthcare.” This plank states, “America’s healthcare professionals should not be forced to choose between following their faith and practicing their profession.” The Democratic Party platform includes a plank calling for a federal anti-discrimination law that would protect the LGBT community. Which side is right?

What should Dr. Wright have done? 

In my view, Dr. Wright did Kristy and Sarah a favor in letting them know her discomfort with their relationship, but she did not handle the situation appropriately. It’s obviously unworkable for Dr. Wright to insist that only Sarah bring in Levi for medical exams. And she shouldn’t have had her receptionist tell Kristy about this over the phone.

I’ve never experienced anything close to this, but I have had an insurance agent invalidate my relationship. It’s painful. In 1998, I tried to get a reduction in my auto insurance because I was in a committed long-term relationship. We couldn’t legally get married, and there was no domestic partnership registration at that time. I thought that I should get the marriage discount, but the agent said that I wasn’t married. I tried to explain to her that I wanted to get married, but that I couldn’t. And she said that my relationship “didn’t count.” That comment stung. And I would have switched companies, but there wasn’t a company who would offer me the discount so I had no alternative.

Here, Dr. Wright was going to have another doctor in her office take over Levi’s case, but that wasn’t her decision to make. She should have asked Sarah and Kristy to come to her office and talked to them. She could have asked them questions about their relationship, and at the end, either explained to them in person why she wasn’t comfortable continuing to treat Levi or realize that her obligation should be to the patient and not judge the patient based on whether he has two mothers or just one or none.

CONCLUSION: If a healthcare professional’s faith affects his or her ability to provide care to a patient, then that person should not be in the healthcare industry. Of course, in the case of abortion, we have to recognize that a person’s faith may affect whether the healthcare provider considers the unborn to have the same status as the mother’s life, and exceptions are made in such instance. But when balancing a patient’s health and well-being against exercise of religious principles, doctors should choose the patient’s health or they are in the wrong profession.

YOUR TURN: What’s your view about Dr. Wright’s decision? What’s your view of the Republican Party’s platform on “Protecting Individual Conscience in Healthcare?” Join the conversation.