Last week the overwhelmingly Republican Arkansas legislature passed The Medical Ethics and Diversity Act, which Republican Governor Asa Hutchinson subsequently signed into law.
Invoking “the right of conscience” and “the Hippocratic Oath” this new law permits doctors, pharmacists, hospitals and health insurance companies to refuse to provide or pay for non-emergency care if they feel their “religious, moral, or ethical principles” would be violated.
However, no definition is provided in the law as to what these “principles” can or cannot be.
Since throughout US history some Americans have asserted that their “religious, moral, or ethical principles” justify slavery, subjugation of women, white supremacy, or lynching, the lack of any definitions in the law make it absurdly vague.
Henceforth, in Arkansas, refusing to care for a patient because of one’s “principles” will not be punishable, by loss of hospital “staff privileges,” “refusal of board certification,” “refusal to award any grant,” or “refusal to provide residency training.”
I am a physician who has practiced cancer medicine for over 40 years and a medical school professor who teaches medical ethics and medical history. This law is a rare combination of ignorance of medical history, flagrant disregard of medical ethics, bigotry, and buffoonery.
Refusing Care Because of ‘Religious, Moral or Ethical Principles‘
While it is highly likely that the authors of this bill envisioned it as an anti-abortion measure, under the law a doctor can:
- Refuse to treat a patient with cancer of the oral cavity because the doctor’s “principles” view the patient’s past history of cigarette smoking and alcohol consumption, behaviors which typically cause this type of cancer, as “immoral”
- Refuse to treat a patient who has never been married with cancer of the cervix because the doctor’s “principles” view viral transmission during sexual intercourse, a behavior which typically causes this type of cancer, as a “breach of religious principles”
- Refuse to treat a homosexual or transgender patient with diabetes, high blood pressure, cancer, or any other non-emergency condition because they view the patient as “immoral”
- Refuse to treat an alcoholic because they view alcoholism as a “moral failing” rather than a disease
Under the law a hospital can assert that its “religious, moral, or ethical principles” allow it to:
- Refuse prenatal care to an unmarried woman “because pregnancy outside of marriage is immoral”
- Refuse routine pediatric preventive care to a child born out of wedlock because the child is “the product of sin”
Under the law a pharmacist can:
- Refuse to fill any prescription if they judge that it violates their self-determined “religious, moral or ethical principles.”
Additional examples of individuals who might be refused care because of this law is endless.
On top of the unethical audacity of the law, it is wrong about medical history. The law invokes the Hippocratic Oath but fails to recognize that the Oath requires doctors to “benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them…into whatsoever houses I enter, I will enter to help the sick, and I will abstain for all intentional wrongdoing and harm…”
Refusal to provide care to those in need of that care is an egregious breach of the Oath.
Regarding the law’s buffoonery: Arkansas does not have the power to determine who is or who is not board certified in a medical specialty. This authority resides in national medical specialty boards. The state does not have the power to tell the public and private agencies that control biomedical research grants how to judge the ethical conduct of physicians participating in research.
Were I to find myself on a committee judging applications for medical research funding for cancer, I would vote against funding any doctor or hospital who refused to care for cancer patients because the doctor or hospital decided they didn’t like the patient’s choice of who to love, who to marry, or the patient’s past choices about smoking or drinking.
Treating the Sick
Finally, it is obvious to anyone involved in graduate medical education that Arkansas does not have the power to decide what is and what is not an accredited medical residency program. The role of a doctor is to treat the sick, not judge the sick as being worthy or not worthy of treatment because of the doctor’s view of whether the patient and their disease falls within or outside the doctor’s undefined “religious, ethical and moral principles.”
I do not know why the authors of the Arkansas law included the word “diversity” in the title. It is, however, an apt choice. Diversity is a noun meaning the condition of having a great deal of variety. There is, indeed, a great deal of variety in this Arkansas law. It contains a variety of legally unenforceable immoral, unethical, and ahistorical points-of-view; all of which are antithetical to the practice of medicine.Disclaimer: The views and opinions expressed here are those of the author and do not necessarily reflect the editorial position of The Globe Post.