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Author Topic: The right to free speech on healthcare
Adam Masterman
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quote:
Originally posted by G2:
He says he'd treat him to the best of his ability.

He also posted a sign that saying the opposite. So he's lying, one way or the other. Raise your hand if you are willing to risk your nether-regions on correctly ascertaining which statement is true.

Adam

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G2
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quote:
Originally posted by Adam Masterman:
quote:
Originally posted by G2:
He says he'd treat him to the best of his ability.

He also posted a sign that saying the opposite. So he's lying, one way or the other.
No he didn't. He posted a sign that says " "If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years." That sign does not say anyone seeking treatment will be denied. You may infer that but he has confirmed on national TV that he does not ask his patients who they voted for and that he treats and will continue to treat anyone that comes in his office.
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Wayward Son
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quote:
That sign does not say anyone seeking treatment will be denied. You may infer that...
As any reasonable person would. [Smile]

So why make a sign that any reasonable person would understand to mean he won't treat them when he will?

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G2
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It's called freedom of speech.
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Adam Masterman
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quote:
Originally posted by G2:
quote:
Originally posted by Adam Masterman:
quote:
Originally posted by G2:
He says he'd treat him to the best of his ability.

He also posted a sign that saying the opposite. So he's lying, one way or the other.
No he didn't. He posted a sign that says " "If you voted for Obama … seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years." That sign does not say anyone seeking treatment will be denied. You may infer that but he has confirmed on national TV that he does not ask his patients who they voted for and that he treats and will continue to treat anyone that comes in his office.
Telling someone to "seek healthcare elsewhere" *is* denying them treatment. What other form do you expect it to take? And armed escort off the property? Denial of treatment means, when its requested, you say no. This guy says no in advance to a whole class of people (a strong majority of voters, to be precise), but then claims that, if they as verbally, he will give them a different answer. That means he's denying treatment to anyone who reads his sign and takes him at his word.

The thing is, "the G2" knows perfectly well that this guy is trying to get rid of as many Obama voters as he can without being so blatant as to lose his license. Its convictions without the courage, and its the only plausible reason that he would hang a sign that he claims is not true. By parroting his legalistic defense, you are being intellectually dishonest.

Adam

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G2
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quote:
Originally posted by Adam Masterman:
Telling someone to "seek healthcare elsewhere" *is* denying them treatment. What other form do you expect it to take? And armed escort off the property? Denial of treatment means, when its requested, you say no. This guy says no in advance to a whole class of people (a strong majority of voters, to be precise), but then claims that, if they as verbally, he will give them a different answer. That means he's denying treatment to anyone who reads his sign and takes him at his word.

No, it doesn't. When someone goes in there and is refuse treatment, then he's denying treatment.

quote:
Originally posted by Adam Masterman:
The thing is, "the G2" knows perfectly well that this guy is trying to get rid of as many Obama voters as he can without being so blatant as to lose his license. Its convictions without the courage, and its the only plausible reason that he would hang a sign that he claims is not true. By parroting his legalistic defense, you are being intellectually dishonest.

Adam

You're the guy saying that someone exercising free speech rights is proof of insanity, you have no basis for questioning the intellectual honesty of anyone.
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Adam Masterman
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quote:
Originally posted by G2:
You're the guy saying that someone exercising free speech rights is proof of insanity, you have no basis for questioning the intellectual honesty of anyone.

Wow. You respond to my charge of intellectual dishonest by repeating a lie about something I said, even after you were called on the lie the first time. If I called you a thief, would you rebut by stealing my car?
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G2
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quote:
Originally posted by Adam Masterman:
quote:
Originally posted by G2:
You're the guy saying that someone exercising free speech rights is proof of insanity, you have no basis for questioning the intellectual honesty of anyone.

Wow. You respond to my charge of intellectual dishonest by repeating a lie about something I said, even after you were called on the lie the first time. If I called you a thief, would you rebut by stealing my car?
Hmmm, let's revisit it shall we?

quote:
Originally posted by Adam Masterman:

I think the sign ends up providing an unintended benefit, in that most people, regardless of politics, will see it as a strong indicator of an unbalanced personality, and seek a more reliable provider. Were I on a licensing board, however, I would find it difficult to renew someone who lets petty politics trump one of the most basic principles of medicine. Maybe let him practice as an "unlicensed urologist"? He can make his case to patients about why he lost his license, and let them choose.

Adam

edit: just re-read the first post, and realized that the sign was directed at Obama voters (not merely health care reform supporters). Maybe I should change the third paragraph phrase "strong indicator" to read "definitive proof".

Wow indeed. [Wink]

[ April 07, 2010, 09:10 PM: Message edited by: G2 ]

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Michelle
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Forty years ago we would be shrugging this off.

"So? It's a free country." If he doesn't want to treat Obama supporters, big deal. He seemed fairly harmless in an interview I saw. He's just frustrated with the outcome of the health care reform.

He's not really hurting anybody. There could be a doctor out there who isn't honest about how he really feels, and you could be putting your care in his hands. Would you want a doctor treating you, who secretly hated your guts for your political views? Now, that to me would be scary.

Better he get it off his chest and out in the open, and better we respect the openness of his character.

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TomDavidson
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I don't think we need to respect anything in particular about his character. But I certainly wouldn't force him to see the penises of anyone he doesn't want to.
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scifibum
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Oh, god, I just heard "typical liberal penis" in Sean Hannity's voice.
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Greg Davidson
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Hopefully, this is a serious set of questions. Let me see if there is a generalized principle that those who favor this doctor can agree on:

Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Is this right limited to private individuals? Do individuals who work for a federal, state, or local governmental organization have this right?

Is it only in regard to voluntary transactions (urology can be urgent and life threatening, but it is voluntary)?

Do there have to be alternative providers? And if so, how much access is required to those alternative providers? (if there are only two specialists in the country who can handle a certain condition, is that adequate, but not if there is only one?)

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PSRT
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quote:
Better he get it off his chest and out in the open, and better we respect the openness of his character.
Sure. Respect the openness of his character. While disrespecting his inability to be professional, in a profession that demands maturity and professionalism.

quote:
Forty years ago we would be shrugging this off.
It was illegal to make service contingent upon proper voting behavior then, too.
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Wayward Son
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Wayward Son said:
quote:
So why make a sign that any reasonable person would understand to mean he won't treat them when he will?
To which G2 replied:
quote:
It's called freedom of speech.
[LOL] [LOL]

That is probably the worst non-answer I've ever seen on this board. An answer almost pefectly perpendicular to the question, which sounds like it may address the question but actually says nothing.

Freedom of speech means he can do it, G2. No one is questioning that. He can put up a poster saying "If you are from the destroyed planet Vulcan, look elsewhere for help" if he wanted. He has the right to do so.

What I asked is why he would do so. Why would he make it sound, to anyone with a head on his shoulders, that he would not treat an Obama supporter, when actually he would. Why say something he did not really mean.

I can think of a number of obvious answers, but I was hoping you could come up with one, G2. One that you could intellectually and morally defend. Instead, you just avoid the question entirely with a non-answer that would make a politician proud.

Then again, maybe I'm just expecting too much from you, G2... [Frown]

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JWatts
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quote:
Originally posted by Greg Davidson:
Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Numerous musical groups have refused to let their music be played at Republican conventions.

Granted those were just songs, not medical care, but if your asking the question in a general sense:

"Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?"

The historical answer has been yes, you can deny someone the use of your services if you don't like their politics.

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noel
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JW,

quote:
Let me clarify, what I was attempting to say is that "rationing" is not a prerequisite of a static model.

The US has a growth model in health care on both the supply and demand side, i.e. it's Not a static model. If the growth rate were equal to or greater on the supply side, there would be no need for increased rationing (assuming an even distribution of resources across the entire health care sector.) However, for decades the demand side has grown faster than the supply.

So, since there are fewer resources available than demand, choices must be made. This is a normal economic model, but it does result in "rationing". Rationing in the sense that an individual can't have any medical care he desires, but must choose (or have chosen for him) an affordable solution.

I think you meant to say that a static model is not a pre-requisite for rationing, and I agree with you. I just find the progressive mentality to be unidimensional, and that static models of resource availablity are more often, than not, assumed in formulating liberal policy. The psychology of scarcity is an effective motivational tool in expanding a paternalistic bureaucracy.

I believe that the two of us genuinely disagree on the idea that demand is outstripping supply in the field of medicine. It is true that costs, in both relative, and absolute, terms are increasing, however; the purpose in linking the service delivery results in Neonatology was to demonstrate that care, by both quantitative, and qualitative measures has increased steadily over the past 60 years.

Demand follows ever increasing capability to treat more effectively.

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noel
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That said, as you can tell by my response to Pyrtolin, it is not possible for all medical services which can be performed to be performed.

This is different than saying demand is out-pacing supply, because the implication is that the demand is being placed for the same services over time.

What we are seeing is technology that is a victim of it's own success.

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DonaldD
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quote:
Originally posted by JWatts
Numerous musical groups have refused to let their music be played at Republican conventions.

Playing music in a public venue requires that they pay royalties. Practically speaking, I don't think the 'artists' in question could have enforced their wish, but the artists were mostly calling out that their music could not be played for free and especially not when they disagreed with the position of the parties not paying their royalties. Which is not good if you are a political party trying to leverage a catchy tune and the 'owner' of the tune comes out and says you are wrong.

At any rate, this has nothing to do with refusing service, unless you can show that the artists in question are able to force the political party/candidate to stop using the song (as opposed to making it impractical/unbeneficial to use the song)

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JWatts
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quote:
Originally posted by noel:
That said, as you can tell by my response to Pyrtolin, it is not possible for all medical services which can be performed to be performed.

This is different than saying demand is out-pacing supply, because the implication is that the demand is being placed for the same services over time.

What we are seeing is technology that is a victim of it's own success.

Your absolutely correct in saying that the level of care is growing. Indeed, the medical technology available today far exceeds in complexity and capability anything from a historical perspective.

This growth in capability is the chief culprit behind the US very expensive medical system. But to some degree that's beside the point. We could afford to give everyone in the country 1960's medical coverage for free, but it would never be tolerated.

See the TennCare example, where the state was forced to provide an ever expanding scope of medical care until the system was bankrupt. Granted it will be far harder for various groups to sue the Federal Government for increased care, but it will surely happen.

The only solution is to limit access of care to an affordable subset of all the possible care.

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JWatts
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quote:
Originally posted by DonaldD:
Playing music in a public venue requires that they pay royalties. Practically speaking, I don't think the 'artists' in question could have enforced their wish, but the artists were mostly calling out that their music could not be played for free and especially not when they disagreed with the position of the parties not paying their royalties.

Wiki entry:
quote:
"Barracuda" was played at the 2008 Republican National Convention in reference to John McCain's running mate, Sarah Palin, who was known as "Sarah Barracuda" as a high school basketball star (and as "Sarracuda" after the convention, a play on her name). The Wilson sisters disapproved, as they disagreed with Palin's politics, and sent a cease-and-desist letter to John McCain's campaign, despite the fact that they had no legal standing from which to do so, due to the McCain campaign's lawful purchase of rights to use the song.

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noel
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JW,

quote:
See the TennCare example, where the state was forced to provide an ever expanding scope of medical care until the system was bankrupt. Granted it will be far harder for various groups to sue the Federal Government for increased care, but it will surely happen.

The only solution is to limit access of care to an affordable subset of all the possible care.

I am assuming that the limited access which you are talking about presupposes the BFD will not be repealed. If that was the case, then I am in complete agreement with you.

A the politically incorrect terminology for this is "rationing". Since anything rationed involves value judgements in allocation, I do not understand where the objection to "death panel" terminology, by the progressive participants in this thread, comes from.

The sad part is that the high-end technology, currently beyond reach to those of moderate means, would eventually become commonplace if the market was trusted enough to function naturally. It is the "poor" who will be ultimately cheated out of the long term advancements which "wealthy" consumers fund.

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OpsanusTau
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Donald said:
quote:
Practically speaking, I don't think the 'artists' in question could have enforced their wish,
JWatts quoted Wiki without comment:
quote:
The Wilson sisters disapproved, as they disagreed with Palin's politics, and sent a cease-and-desist letter to John McCain's campaign, despite the fact that they had no legal standing from which to do so, due to the McCain campaign's lawful purchase of rights to use the song.
That's you guys saying the same thing, right?
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TCB
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Heart requesting that Palin not play their song would be more similar to this Florida doctor refusing to treat Obama than to him refusing to treat (or suggesting that he refuses to treat) all Democrats.

The analogy would have been better if Heart requested that Republicans no longer attend their concerts. Hopefully, had they done that, they would have been regarded as petty and immature by both Republicans and Democrats. But it's tragically easy to overestimate America's appetite for maturity and civility these days.

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DonaldD
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OT - Yep. Which brings us to my second sentence,
quote:
At any rate, this has nothing to do with refusing service, unless you can show that the artists in question are able to force the political party/candidate to stop using the song
where I suggest that such practices are not in any way equivalent, and don't amount to
quote:
deny[ing] someone the use of your services if you don't like their politics
as JWatts suggested.
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noel
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Greg,

quote:

Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Yes, a private citizen, or organization, can "legally" discriminate in this way under current law, which is an issue separate, and distinct, from the "right" to discriminate.

The Constitution itself permits greater discrimination, but is at the mercy of the SCOTUS judicial composition. I believe that the "right" of free association is among the natural rights protected by the Constitution itself.

quote:
Is this right limited to private individuals? Do individuals who work for a federal, state, or local governmental organization have this right?
Yes, this right is limited to individuals functioning outside of government at all levels.

quote:
Is it only in regard to voluntary transactions (urology can be urgent and life threatening, but it is voluntary)?
I believe there should be a legal obligation to aid anyone, in a life threatening situation, by all citizens to the degree that they can help. Unfortunately, this moral duty is not a legal obligation. The Constitution confers powers, and limitations, on the federal government only.

As harsh as it may sound, a physician is bound only by his conscience. Even law enforcement personnel are not legally bound to save the life of a citizen.

quote:
Do there have to be alternative providers? And if so, how much access is required to those alternative providers? (if there are only two specialists in the country who can handle a certain condition, is that adequate, but not if there is only one?)
No, none, and irrelevant.
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TomDavidson
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quote:
As harsh as it may sound, a physician is bound only by his conscience.
This is not true. He may also be bound by state and federal laws, as well as the terms of his licensing/certifying organizations (many of which might be very arbitrary).

I hold several technical certifications and a handful of professional ones. While none of these certifications are required of me by law in order for me to practice my profession in the way that doctors are now required to maintain theirs, a couple of mine do require that I abide by certain ethical guidelines and maintain stated professional standards.

In this way, most medical professionals are bound by a great deal of things.

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stayne
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quote:
Originally posted by Greg Davidson:
Hopefully, this is a serious set of questions. Let me see if there is a generalized principle that those who favor this doctor can agree on:

Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Not merely threaten, but to actually deny if their conscience so dictates.

quote:

Is this right limited to private individuals? Do individuals who work for a federal, state, or local governmental organization have this right?

They have the right, but the government might choose to terminate their employment, as would any employer in a similar situation. The government might be required to, in some cases, where a private employer would have more leeway. The government should not be permitted to take the further step of making certain they cannot be employed elsewhere by making laws preventing them from doing so, however. For example, a government teacher might be dismissed for expressing his views on religion in the classroom. However, his license should not be at stake, and he should be free to teach at a private school.

quote:

Is it only in regard to voluntary transactions (urology can be urgent and life threatening, but it is voluntary)?

The necessity of the service is not relevant in my opinion. Everyone requires food, but farmers should not be compelled to grow more than they choose.

quote:

Do there have to be alternative providers?

No, though typically there will be.

quote:

And if so, how much access is required to those alternative providers? (if there are only two specialists in the country who can handle a certain condition, is that adequate, but not if there is only one?)

It is not relevant. We would be in the same situation if the only provider died, or if he simply retired. The proper place for government intervention in such a situation is to provide opportunity and incentive for an adequate number of providers to exist, not to force the few to labor against their will.

[ April 08, 2010, 09:55 PM: Message edited by: stayne ]

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noel
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Tom,

quote:
I hold several technical certifications and a handful of professional ones. While none of these certifications are required of me by law in order for me to practice my profession in the way that doctors are now required to maintain theirs, a couple of mine do require that I abide by certain ethical guidelines and maintain stated professional standards.
I do also, and none of them require me to accept a client which I do not wish to serve... only to perform, within specified minimum standards, my task for those that I do.

quote:
In this way, most medical professionals are bound by a great deal of things.
Yes, within the terms of licensure, and no more. To the the extent that any professional organization attempted to go beyond this, they would raise some interesting constitutional issues.

A number of Trade Unions actually have crossed this line, and legislation was passed to remedy the problem.

[ April 08, 2010, 10:23 PM: Message edited by: noel ]

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Pyrtolin
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quote:
Originally posted by Greg Davidson:
Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Public political actions? Absolutely.

The far better question is if they have the right to do that based on the contents of a officially protected secret ballot vote in and election. To that I say absolutely not. The contents of your vote are between you and your voting machine and no one else.

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stayne
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quote:
Originally posted by Pyrtolin:
quote:
Originally posted by Greg Davidson:
Do you believe that any private person or organization has a right to threaten to deny service to any American based on prior political choices?

Public political actions? Absolutely.

The far better question is if they have the right to do that based on the contents of a officially protected secret ballot vote in and election. To that I say absolutely not. The contents of your vote are between you and your voting machine and no one else.

But given that the vote IS a secret, it would be impossible to ascertain unless the voter announced it, making it a public statement. He might be telling the truth or not. That's the entire point of having a secret ballot.
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OpsanusTau
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quote:
Yes, within the terms of licensure, and no more. To the the extent that any professional organization attempted to go beyond this, they would raise some interesting constitutional issues.
What is the antecedent of "this" in your second sentence?

Regardless of your opinion on constitutionality, it is quite clear that the practice of medical professionals is bound by criteria other than their personal consciences.

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TomDavidson
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quote:
To the the extent that any professional organization attempted to go beyond this, they would raise some interesting constitutional issues.

A number of Trade Unions actually have crossed this line, and legislation was passed to remedy the problem.

I don't think they'd raise constitutional issues at all. That's actually why legislation needed to be passed as a remedy; it is entirely constitutional for a trade organization to impose stark restrictions on its members.
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Greg Davidson
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noel and stayne, I am pretty close to agreeing with your clarifications. But I do worry about the following case:

What if a private firm (say, Waste Management) is operating under a contract with the government, and a sanitation worker's union is working under a contract to Waste Management. Under those circumstances, should the union workers be allowed to threaten to withhold services from customers based on their past voting? They are not government employees and they are working for a private company.

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Funean
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quote:
As harsh as it may sound, a physician is bound only by his conscience.
Well, no, not really, so long as he'd like to be a legally practicing physician (of course you are a doctor forever regardless of whether you can practice; defrocked priests are still priests too). For example, in most states I believe physicians, EMTs and other presumably medically useful people are required to render assistance if they are present at the site of a medical emergency, e.g. person choking at the next table, accident on the road as one passes, etc. It's part of the responsibility you assume upon accepting the license.

That said, provided a physician meets the requirements of his state for discontinuing care or refusing care in an ethical manner (ie he does not abandon patients; he either provides appropriate referrals or sufficient time for the patient to find an appropriate replacement), he is under absolutely no requirement that I'm aware of to defend or explain his reason for discontinuing care. He could decide he doesn't want to treat people of a different race, for example, and as long as he didn't abandon his patients I believe he would be within the boundaries of his responsibilities as laid out in his licensing agreements. It would be a public relations nightmare once the pattern were noticed, of course, but not, I don't believe, a technical violation of his license (probably a moral one, but that's beside the point we're talking about here).

A sign on the door that tells patients of a certain persuasion that they aren't welcome anymore is a different matter. It's not the content of the sign that's at issue, it's the flatness of the rejection. The idea that anyone would go past the sign and find out "Aw, we're not really turning anyone away" is a bit silly. I'd like to see the reaction to a dentist who put a sign on his door saying "NO N*****S" but tried to claim it was really just a statement of principle; he doesn't REALLY have an issue with his black patients, and OF COURSE he'll continue to provide care for those members of his practice (or OF COURSE he has referrals for everyone one of them and/or they have a year to find a new dentist, etc.).

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stayne
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Fun, I don't feel it is equivalent to compare racism and discrimination against race with discrimination based on political behavior. There is a vast difference between posting a sign saying "No n*****s" and posting one saying, "No KKK members."

Greg, I don't really see the conundrum in your example. Perhaps I am missing something, or misunderstanding. In my opinion, anyone, government employee or not, has the right to withhold service. That may have the consequence of others choosing to no longer do business with you (i.e. you get fired). I merely note that the government should not additionally prevent such a person from finding another job in the same field by rescinding their license. It seems irrelevant here. Sanitation workers do not generally have professional licenses, do they?

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noel
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Tom,

http://caselaw.lp.findlaw.com/scripts/getcase.pl?navby=case&court=us&vol=487&page=735

The fact that legislation is employed to remedy a situation does not mean that it is not also a constitutional issue. In this case, the first amendment right of "free speech" was determined to have been infringed, in that the union refused to provide fair representation.

OT,

The "this", is the terms of State licensure.

http://www.rules.utah.gov/publicat/code/r156/r156-67.htm#T10

In Utah there is no requirement to accept a patient that I am aware of.

As in the earlier example of the Communication Workers Union, it is possible for a State licensing agency to over-reach, but the State Medical Boards seem to be smarter that.

Greg,

Just as the non-union communication workers (cited above) were obligated, by the employer's union contract, to abide by the same agreement conditions as the union, so would a privately contracted waste management company assume the obligations of the governing agency which they are under contract to. Accountability is to the people, and the remedy for failing to collect garbage should be a breach of contract damages suit to recover expenses incurred by by the municipality in meeting their responsibility to the citizenry.

Funean,

quote:
It's not the content of the sign that's at issue, it's the flatness of the rejection.
quote:
I'd like to see the reaction to a dentist who put a sign on his door saying "NO N*****S" but tried to claim it was really just a statement of principle; he doesn't REALLY have an issue with his black patients,
We have areas of agreement, but these comments appear self-contradictory.

Federal legislation has dictated that a business can not discriminate based upon the race of a patron. It is the content of the sign that is at issue.

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OpsanusTau
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Noel, you appear to be missing the point.

The question currently under discussion is not whether a physician has an obligation to accept a patient, but whether a physician may capriciously terminate a doctor/patient relationship.

The Utah code, which you reference, states that physicians must abide by the AMA Code of Ethics in order to maintain licensure.

The AMA Code of Ethics states,
quote:
Physicians have an obligation to support continuity of care for their patients. While physicians have the option of withdrawing from a case, they cannot do so without giving notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured.
That is what Funean is talking about. The doctor-patient relationship is a special one, and we're not talking about a restaurant refusing to serve someone who's behaving in a way the management doesn't like. We're talking about a physician abruptly terminating (or at least saying that he's abruptly terminating) his relationship with patients he previously saw.
It's possible that he's doing this in a way that doesn't violate medical ethics, but it's this that is cause for concern.

*****

Although, of course, on the other topic you might be wrong as well. The AMA Code of Ethics also says
quote:
(2) The following instances identify the limits on physicians’ prerogative [to choose to enter into a physician-patient relationship]:

(a) Physicians should respond to the best of their ability in cases of medical emergency.

(b) Physicians cannot refuse to care for patients based on race, gender, sexual orientation, or any other criteria that would constitute invidious discrimination , nor can they discriminate against patients with infectious diseases.

[...snipped irrelevant portion...]

(3) In situations not covered above, it may be ethically permissible for physicians to decline a potential patient when:

(a) The treatment request is beyond the physician’s current competence.

(b) The treatment request is known to be scientifically invalid, has no medical indication, and offers no possible benefit to the patient.

(c) A specific treatment sought by an individual is incompatible with the physician’s personal, religious, or moral beliefs.

The statement goes on that physicians have an obligation to provide charity care, but only to an extent that would not compromise care received by existing patients.

This is stated elsewhere in the Code a little bit more succinctly:
quote:
The creation of the patient-physician relationship is contractual in nature. Generally, both the physician and the patient are free to enter into or decline the relationship. A physician may decline to undertake the care of a patient whose medical condition is not within the physician's current competence. However, physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, gender identity, or any other basis that would constitute invidious discrimination. Furthermore, physicians who are obligated under pre-existing contractual arrangements may not decline to accept patients as provided by those arrangements.
(emphasis mine)

And most specifically of all, the Code clearly states that while physicians should most definitely stay abreast of political developments, stay informed and active,

quote:
Under no circumstances should physicians allow their differences with patients or their families about political matters to interfere with the delivery of high-quality professional care.
I'm not agitating for this guy to lose his license; that is, as I have said before, not mine to determine, and I'm sure the appropriate authorities will figure out whether his violation of professional ethics so warrants. (Regardless, it's not a question of Constitutional right to free speech in my opinion - if he were to lose his license because he chose to abuse his position of Aesculapian authority and inappropriately terminated physician/patient relationship, that is not at all the same as going to jail or being fined for criticizing the government.)

I'm just saying that his behavior is definitely childish and unprofessional on all accounts.

[ April 09, 2010, 02:01 PM: Message edited by: OpsanusTau ]

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Funean
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I wrote a whole thing this morning that I now see did not post--grr. But Ops has done a much better job with the gist of it, what with substantiating it with the actual Code and all.

The only thing I will add (mostly for stayne's benefit, because I would prefer to stay on his good side since there are not so many people with whom I often disagree yet always have civil and friendly discussions) is that my example of the racist dentist was not meant to equivocate between the two situations but to demonstrate the disingenuousness of the claim that the sign doesn't ***really*** exclude patients, with an example of a form of discrimination that is both ethically and legally disallowed.

I'm not sure anyone has said this yet, but freedom of speech doesn't mean freedom from consequences of that speech--while the government had better not come down on this doctor for his opinion, the state medical board may well do so for the *method* he used to express his opinion, insofar as it violates any of the terms to which he voluntarily agreed when accepting their licensure. And I might also argue that this might be something close to the doctor's right to swing his fist ending with his patients' noses, if his free speech denies them the health care their relationship otherwise has given them to expect.

Finally, in my first version of this post I had written that a sign on the counter which read "Please ask us for a referral if you are a supporter of the recent health care bill. We will no longer be able serve you" would have had the same effect he ostensibly wants--removing those supporters from his practice--in a manner much more likely to be permissible than the sign on the door. At that time I didn't realize that at least one Code prohibits denial of care based on politics, so I will amend this idea to note that he can plaster his office with any political posters or signage he'd like (excluding, I suppose, those which advocate or appear to present any kind of threat to patients in his practice). He just can't make care conditional on agreeing with him.

All that aside, I believe allowances are made for referring patients you simply despise, for whatever reason, on the grounds that you will not be able to provide them with the quality of care someone who doesn't despise them could provide. But recent partisanery aside I would hope that the number of people who categorically despise all people who have certain opinions would be a comparatively small one.

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noel
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OT,

quote:
Noel, you appear to be missing the point.

The question currently under discussion is not whether a physician has an obligation to accept a patient, but whether a physician may capriciously terminate a doctor/patient relationship.

As you might anticipate, the point was not lost on me at all. Medicine is not the only profession in which "continuity" of services is obligatory upon a professional who is terminating a relationship with his client... and it can be very "abrupt", trust me.

quote:
It's possible that he's doing this in a way that doesn't violate medical ethics, but it's this that is cause for concern.
It is precisely this kind of ambiguity that places Dr. Cassell on safe ground.

quote:
And most specifically of all, the Code clearly states that while physicians should most definitely stay abreast of political developments, stay informed and active,


quote:
--------------------------------------------------------------------------------
Under no circumstances should physicians allow their differences with patients or their families about political matters to interfere with the delivery of high-quality professional care.

A timely refferral to another physician satisfies this condition entirely. I would dare any Medical Board to dispute this, under threat of one healthy lawsuit in the event that a license is unconstitutionally withdrawn.

quote:
I'm just saying that his behavior is definitely childish and unprofessional on all accounts.
I am sure this was the precise reaction of King George III to those colonists who just didn't know their place. I personally prefer people who speak their mind, especially when they put themselves in the line of fire by doing so.

Funean,

quote:
I'm not sure anyone has said this yet, but freedom of speech doesn't mean freedom from consequences of that speech...
On this we agree, and this doctor seems fully prepared to loose patients who support the BFD. It is the flip side of your comment that could be expected to send these BFD patients packing to a new care provider... as their choices have consequences also.

quote:
the state medical board may well do so for the *method* he used to express his opinion, insofar as it violates any of the terms to which he voluntarily agreed when accepting their licensure.
I anxiously await a chance to see the Florida Board of Medicine walk that plank, but they will not. [Wink]

quote:
All that aside, I believe allowances are made for referring patients you simply despise, for whatever reason, on the grounds that you will not be able to provide them with the quality of care someone who doesn't despise them could provide.
This is reasonable.
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noel
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OT,

quote:
Furthermore, physicians who are obligated under pre-existing contractual arrangements may not decline to accept patients as provided by those arrangements.
You do realize that implicit, in this provision, is the right to terminate under all non-contracted arrangements, correct?
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