This week, The Des Moines Register published an op-ed written by Lauris Kaldjian, who is a medical ethics professor at University of Iowa Carver College of Medicine, supporting Senate File 2286. The bill allows health care providers to refuse care on the basis of “religious beliefs and moral convictions.”
Though the article appears reasonable at first glance, it is written from a perspective of malicious intent. SF 2286 is not about complex ethical issues such as brain death and organ transplants. This bill aims to protect health care providers and institutions who refuse care to gender-diverse and LGBTQ+ patients seeking gender-affirming care.
It is akin to the 2018 Supreme Court case in which a bakery refused service to same-sex couples. This bill, however, would protect discrimination on matters of life and death for patients seeking care in Iowa.
SF 2286, which has progressed to the Iowa Senate floor, would allow health care providers, along with insurance companies and administrative bodies, to refuse services to patients based on personally held or institutional beliefs without fear of retaliation.
Providers could share misinformation that is not evidence-based clinical practice or deny procedures they deem violate their religious values, and insurance companies could deny claims post-service on this same basis. This creates an avenue for physicians to mistreat patients of already vulnerable populations with no examination of their personal biases.
While the physician’s role in health care has historically been one of paternalism, contemporary models emphasize information sharing and shared decision-making without biased appraisement of our patients’ lives. Patients should be free to make decisions about their own care solely based on their goals and the objective medical advice given by their physician. It is not our job as current or future medical professionals to act as a moral authority on behalf of patients.
There are laws in place to prevent medical providers from being grossly negligent and knowingly harming patients when doing so, which is what this proposed Senate bill is taking away. Iowa already has a conscientious objection exception for civil lawsuits when it comes to refusing abortion.
The tort reform bill signed into law last year created a cap amount a jury can award in medical malpractice lawsuits, making it more difficult for injured patients to seek compensation. Moreover, current Iowa Code already has language to protect providers.
The Iowa Legislature is constantly chipping away at people’s legal protections and rights to be compensated if the medical system harms them.
The dangers of this bill have severe consequences on the lives and safety of patients. What would happen if a patient who was suffering an ectopic pregnancy had the misfortune of encountering an emergency medicine physician whose religion did not support abortion?
Denying the patient the treatment critical to their survival would result in treatment delays and subclasses in care in direct opposition of the Hippocratic Oath to do no harm. Should the same provider be allowed to refuse treatment to an LGBTQ+ patient seeking evidence-based, gender-affirming care? Or if the physician refused to provide a life-saving blood transfusion on the basis of Leviticus 17:12?
What if the provider withheld CPR from an elderly patient based on the futility of that life-saving intervention? There is a recent frightening trend in our country’s courtrooms and legislatures to deny protections/services on the basis of religious bigotry masquerading as conscience.
Moreover, Iowa is a rural state. Often, rural medical providers are the first and only health care provider to which a patient can turn to. The notion that it is appropriate and justified to refuse care and hand off a patient to another provider is an elitist one, as many do not have the time, money, or access to shop around for physicians who would be covered by their insurance.
This does not even begin to address the physician shortage we have in rural areas in our country, as well as in our state — Iowa has the least number of OB/GYNs per capita. Only about one quarter of psychiatric inpatient beds in the state since 2007 are still available. We are not in the position or line of business to deny patients care.
The statement that “different healthcare professionals have competing perspectives about what is good for patients, about what is harmful, and even about what health is,” does not support the foundation on which health professionals practice — evidence-based medicine. Statistics show that abortion denial is associated with higher rates of eclampsia, postpartum hemorrhage, gestational hypertension, chronic pain, intimate partner violence, and death vs. patients who received abortions.
Additionally, transgender youth disproportionately experience poor mental health outcomes, including depression and suicidal ideation and attempts, likely due to a lack of family support as well as social rejection and bullying. But gender-affirming interventions are associated with 60 percent lower odds of moderate to severe depressive symptoms and 73 percent lower odds of self-harm or suicidal thoughts during the first year of multidisciplinary gender care.
We can wax philosophical about “moral injury,” but for patients this comes with the risk of serious harm. Iowa needs clinicians dedicated to improving patients’ health and well-being, not clinicians who look toward state-sanctioned discrimination to enforce their religious “beliefs.”
Aastha Chandra
With support from Sophie Banegas
Over 130 Carver College of Medicine students have signed on to this essay.
Columns reflect the opinions of the authors and are not necessarily those of the Editorial Board, The Daily Iowan, or other organizations in which the author may be involved.
