[SUBMITTED] Medical Provider Conscience Act

[Kenmoria]

"I would place the hashtag after the space, not before it."

[Gratissima]

"I would place the hashtag after the space, not before it."

"Noted.
I have decided to officially submit this draft as a proposal to the World Assembly, having received much useful (and some not so much) criticism to improve it. Thank you to all who assisted in the writing of this draft. To delegates wishing to support it: Thank you, please spread the word to regions your region has embassies with."

[Attempted Socialism]

https://www.nationstates.net/page=UN_view_proposal/id=gratissima_1523532002

Medical Provider Conscience Act

A resolution to increase democratic freedoms.

Category: Furtherment of Democracy

Strength: Mild

Proposed by: Gratissima

The World Assembly,

NOTING the number of varying procedures defined as medical procedures in today's world,

RECOGNIZING some of aforementioned procedures are a matter of controversy regarding their morality (e.g. abortion, euthanasia, vasectomy, etc.),

ALSO RECOGNIZING that some medical personnel bear strong personal convictions regarding the morality of aforementioned procedures,

HEREBY:

1. Defines medical facilities as a building or association that is dedicated to the provision of healthcare; medical personnel as any person or persons who by contract either provide or assist in the provision of healthcare within a medical facility; and public medical facilities as medical facilities owned and operated by the government of the nation or region they are located in.

2. Protects medical facilities that are privately run (e.g. by a religious institution) and medical personnel that are currently employed by public health facilities from being forced to perform or otherwise promote practices that are contrary to the moral principles either of the individual personnel member in question, person or persons that own/run the establishment or the institution that owns/runs the establishment.

a. If the government has fully privatized the healthcare system, and no facilities are willing to perform said procedures, the government must establish facilities in convenient locations that provide said procedures.

3. Also protects such personnel and facilities from any legal action taken against them for refusing to partake in a medical procedure, provided their reason is legitimate. Objections based on race, gender, enmity towards the individual, criminal history, or religion are not considered to be legitimate, and will not be accepted. The objection must be towards the morality of the practice in itself, not towards the person.

a. Objections to lifesaving procedures will not be accepted unless there are alternative forms of treatment that the provider does not object to using and the patient does not object to receiving.
b. The objection must not in any way object to the gender, race, or personality of the patient.
c. If another medical professional cannot be found in a timely manner to perform the said procedure (if it is deemed medically necessary but not immediately necessary for the preservation of life), the doctor in question must perform the procedure. An exception is in the case of abortion, where as provided by GAR #128, "...no physician may be compelled to perform abortion against their moral stance."

4. Requires that from this point, medical personnel applying or seeking to work in a medical facility are to have their full contract explained to them in order to make them aware of all medical services they are expected to provide, and if they disagree with the morality of a certain service in said contract, negotiations are to be made to see if they can be accommodated in some way that does not violate their principles.

5. If a compromise cannot be reached, then the medical personnel applying will either have to accept the contract as it is, or will have to be turned away.

Two illegalities:
- This is not Furtherment of Democracy, so the category is wrong.
- Clause 3c is in violation of the HoC rule, building on a resolution that, if repealed, would change this resolution.

Cross-post from the Illegal GA Proposals thread per Wrappers admonishment.

[Gratissima]

https://www.nationstates.net/page=UN_view_proposal/id=gratissima_1523532002


Two illegalities:
- This is not Furtherment of Democracy, so the category is wrong.
- Clause 3c is in violation of the HoC rule, building on a resolution that, if repealed, would change this resolution.

Cross-post from the Illegal GA Proposals thread per Wrappers admonishment.

Well, it would have been nice had someone told me this before, but OK then. I will fix that.

[Wrapper]

Well, it would have been nice had someone told me this before

OOC: The HoC one might be debatable, but as far as category, you don't have any attached to your draft in the OP (which would be common practice), nor did you definitively choose one at any time in this thread. Can't blame anyone for not mentioning it before.

[Gratissima]

Well, it would have been nice had someone told me this before

OOC: The HoC one might be debatable, but as far as category, you don't have any attached to your draft in the OP (which would be common practice), nor did you definitively choose one at any time in this thread. Can't blame anyone for not mentioning it before.

OOC: Good point.

[Attempted Socialism]

Cross-post from the Illegal GA Proposals thread per Wrappers admonishment.

Well, it would have been nice had someone told me this before, but OK then. I will fix that.

OOC: It would also have been nice if someone had spent more than a few days of drafting; had posted information like category and area or strength from the start; and had made a more collected effort in the various drafts, rather than shotgunning new versions all the time without any comments, so people lost track of the changes.
In other words, I'm not in charge of making your draft legal, and trying to blame me for not spotting it really ought to be below you.

[Gratissima]

Well, it would have been nice had someone told me this before, but OK then. I will fix that.

OOC: It would also have been nice if someone had spent more than a few days of drafting; had posted information like category and area or strength from the start; and had made a more collected effort in the various drafts, rather than shotgunning new versions all the time without any comments, so people lost track of the changes.
In other words, I'm not in charge of making your draft legal, and trying to blame me for not spotting it really ought to be below you.

OOC: Not blaming you.

[Sierra Lyricalia]

OOC: It's a marathon, not a sprint. Most successful first-time authors let their drafts simmer and percolate for weeks or even months before submitting, precisely because there's always something else that fell through the cracks.

[Kenmoria]

(OOC: I would do "human rights" as the category, and "significant" as the strength.)

[Masurbia]

OOC: It's a marathon, not a sprint. Most successful first-time authors let their drafts simmer and percolate for weeks or even months before submitting, precisely because there's always something else that fell through the cracks.

Auralia's proposal that's at vote right now was first posted 8 months ago and it only has two clauses. Shows that short length doesn't equal fast drafting.

[Attempted Socialism]

(OOC: I would do "human rights" as the category, and "significant" as the strength.)

OOC: I can see HR (As, strictly speaking, this decreases what governments can require of their citizens), but how do you figure 'significant' strength? I can't see how that's right.
For what it's worth, I agree with health: healthcare, and would probably challenge any other category as worse fitting.

[Kenmoria]

(OOC: I would do "human rights" as the category, and "significant" as the strength.)

OOC: I can see HR (As, strictly speaking, this decreases what governments can require of their citizens), but how do you figure 'significant' strength? I can't see how that's right.
For what it's worth, I agree with health: healthcare, and would probably challenge any other category as worse fitting.

(OOC: I see it as significant strength because the proposal clearly isn't strong but mild seems to... mild for a proposal that would have such an impact on access to controversial procedures which could mean basically all procedures given how many things are controversial is NS. That said, it could be mild, and that might be a better fit. I'm not really sure at the moment.)

[Christian Democrats]

I'm curious. How do infringements on freedom of conscience improve physicians' health or happiness?

"Since that doesn't happen, this is a red herring, Ambassador. This draft, however, would allow a physician to infringe on a patient's right to good care and honest counsel, would enable physicians to claim freedom from conscience, and would remove legal recourse from both the mistreated patient and public actors to punish or remove said physician. All this in the name of a fantasy we know does not correspond to reality. My delegation is of the view that this draft would legalise the obscene and grant it immunity; we are not and will never be for."

So people who believe their patients are inhuman are more qualified to provide medical care?

OOC: Not what I said. People who think a child (Rather than, say, a foetus) can be killed in the womb would fail first year of medicine. People who think human children are inhuman might fail their ethics or philosophy of science courses (While someone who thinks that foetii have personhood could benefit from such courses). And people who clearly ought to know that words have meanings but still use them incorrectly to make a poor point generally seem deceitful in debates.

OOC: So how many medical school courses have you taken?

How would forcing physicians to perform operations to which they're morally opposed increase the quality of medical services? How would forcing certain individuals out of the medical profession due to their moral beliefs increase the quality of medical services?

Should a member state or a hospital, in your view, have the power to force physicians to perform lethal injections on criminals?

If at all it is their own moral conviction that forces them to not take a job that entails actions they object to. Noone is forced by the state. Especially not out. They try to take a job they are not willing to perform in the first place. Giving the job to someone who is actually willing to do it therefore increases quality of medical services. The explanation how any of this equates to slavery is still absent from your reply.

Performing executions is a standard medical procedure in your country? We will make sure to issue a travel warning for Christian Democrats to our populace.

The Most Holy and Grand Empire has abolished capital punishment, Ambassador.

Also, your argument is unclear. Are you saying that physicians should be forced to perform all procedures that they are capable of performing even if they do not want to perform them, and what counts as a "standard medical procedure"?

How would forcing physicians to perform operations to which they're morally opposed increase the quality of medical services?

OOC: Because the state is required to provide said care (at least if staying in NSWA world) at high enough quality regardless, so they'd have to find qualified people actually willing to do their job.

I agree. They should find people willing to do the procedure; they shouldn't coerce anyone.

How would forcing certain individuals out of the medical profession due to their moral beliefs increase the quality of medical services?

How would requiring said individuals to do their damn jobs regardless of their moral beliefs be bad? If they were hired to do the job of a doctor, they shouldn't be allowed to pick and choose when they want to do it and when not.

I wasn't aware that there's such a thing as "the job of a doctor." I was under the impression that there are different kinds of medical professionals. Furthermore, I don't believe physicians should be deprived of the freedom to choose when and where they work.

Should a member state or a hospital, in your view, have the power to force physicians to perform lethal injections on criminals?

If death penalty is allowed and the injection needs to be given by a doctor, then naturally, if there are no willing volunteers. Like with certain aspects of healthcare, the state just has to get it done, simple as that.

I disagree. The best solution for the state would be to raise pay until somebody agrees to perform the procedure.

I ask you: why the hell would you become an actor if you weren't willing to do pornos?

...to flip that back to healthcare you'd be asking why a general practitioner wouldn't do dental work? I hope the answer's obvious.

The answer is obvious, and it should also be obvious why physicians should have the freedom to choose what procedures they offer.

So people who believe their patients are inhuman are more qualified to provide medical care?

At least as qualified as people who think that a thousands of years old book knows better than modern medicine just who should or should not be allowed to decide what happens to their own bodies...

Your response here is patently absurd. You're saying: "People should be allowed to decide what happens to their own bodies. Therefore, we should punish people who refuse to use their skills to perform labor contrary to their moral convictions." Certainly, such punishment would be a violation of the physician's supposed right to decide how he uses -- and what happens to -- his own body.

When the gynecologist is hired and their contract says they need to be qualified and able to do all procedures that go under the specialization of gynecology, then if they refused to, say, insert a IUD into the womb of an unmarried woman, they damn well should get fired.

Because reducing the number of physicians will totally improve medical care . . .

[Auralia]

As previously stated, Auralia is strongly supportive of the idea of providing conscience protections to medical personnel in World Assembly law. However, I would encourage the delegation from Gratissima to withdraw your proposal from consideration for the time being, as I don't think it's ready for submission as it is. It's not going to make it to quorum without a campaign anyways, which I'll be glad to help you with eventually.

Regarding the category debate: in my opinion, this is a Human Rights proposal with a strength of Mild or Significant, probably Significant. None of the Healthcare category's areas of effect really deal with the issue of conscience rights.

Let's take a look at the proposal itself:

NOTING the number of varying procedures defined as medical procedures in today's world,

RECOGNIZING some of aforementioned procedures are a matter of controversy regarding their morality (e.g. abortion, euthanasia, vasectomy, etc.),

ALSO RECOGNIZING that some medical personnel bear strong personal convictions regarding the morality of aforementioned procedures,

I think this preamble needs a stronger emphasis on precisely why it is good to respect conscience rights in a healthcare setting. For example, I'd like to see it point out that government coercion on matters of principle rarely works and that it benefits nobody to drive skilled doctors and nurses from the medical profession.

1. Defines medical facilities as a building or association that is dedicated to the provision of healthcare; medical personnel as any person or persons who by contract either provide or assist in the provision of healthcare within a medical facility; and public medical facilities as medical facilities owned and operated by the government of the nation or region they are located in.

I think the terms "healthcare practitioner" and "healthcare facility" would be preferable to "medical personnel" and "medical facility". This would provide more consistent terminology and address the fact that it is difficult to singularize "personnel". The title should also be changed to match, perhaps to "Conscience Rights in Healthcare".

I don't think a medical facility should be defined as a "building", which is not a legal person with rights; the term should refer only to institutions or organizations. I also don't think that "medical personnel" should be limited to those working in a medical facility, or that it's necessary to define what "public" means.

2. Protects medical facilities that are privately run (e.g. by a religious institution) and medical personnel that are currently employed by public health facilities from being forced to perform or otherwise promote practices that are contrary to the moral principles either of the individual personnel member in question, person or persons that own/run the establishment or the institution that owns/runs the establishment.

I don't think it's necessary to speak of "persons that own/run the establishment"; just assume that the establishment is a legal person. I would also use better terminology than "moral principles". It should made clear that this is about a belief that certain care is unethical, harmful, or otherwise contrary to good medical practice.

a. If the government has fully privatized the healthcare system, and no facilities are willing to perform said procedures, the government must establish facilities in convenient locations that provide said procedures.

I don't think it's necessary to explicitly require this; it's enough simply to note that this resolution doesn't eliminate any existing obligations under World Assembly law. It's up to the member state to decide how they intend to meet those obligations.

3. Also protects such personnel and facilities from any legal action taken against them for refusing to partake in a medical procedure, provided their reason is legitimate. Objections based on race, gender, enmity towards the individual, criminal history, or religion are not considered to be legitimate, and will not be accepted. The objection must be towards the morality of the practice in itself, not towards the person.

I'm not clear on why (2) uses a "moral principles" standard, while (3) uses a "legitimate" standard. These should be harmonized.

a. Objections to lifesaving procedures will not be accepted unless there are alternative forms of treatment that the provider does not object to using and the patient does not object to receiving.
b. The objection must not in any way object to the gender, race, or personality of the patient.
c. If another medical professional cannot be found in a timely manner to perform the said procedure (if it is deemed medically necessary but not immediately necessary for the preservation of life), the doctor in question must perform the procedure, except in cases defined by international law.

I don't see any reason to single out lifesaving procedures for special treatment. Certain abortion procedures may be construed as "lifesaving" even though the intentional killing of the unborn child is obviously not necessary to preserve the mother's life. So long as the employer receives adequate notice, it's on them to ensure someone is available in these circumstances to provide such procedures.

4. Requires that from this point, medical personnel applying or seeking to work in a medical facility are to have their full contract explained to them in order to make them aware of all medical services they are expected to provide, and if they disagree with the morality of a certain service in said contract, negotiations are to be made to see if they can be accommodated in some way that does not violate their principles.

I think that perhaps this is too much micromanagement. I think simply requiring notice from the medical personnel about objections to certain duties is sufficient.

5. If a compromise cannot be reached, then the medical personnel applying will either have to accept the contract as it is, or will have to be turned away.

Why? Why doesn't the employer have a duty to accomodate? Perhaps this makes sense if a particular job consists primarily of duties that the practitioner finds unacceptable, but short of that...

One further general comment: I think your proposal should protect pharmacists, who should not be forced to dispense harmful drugs.

Martin Russell
Chief Ambassador, Auralian Mission to the World Assembly

[Auralia]

I have redrafted your proposal in accordance with the comments I made in my previous post. Feel free to take what you want from it.

Conscience Rights in Healthcare
Category: Human Rights | Strength: Significant

Recognizing that certain healthcare practitioners and facilities object to certain forms of health care that they believe to be unethical, harmful, or otherwise contrary to good medical practice,

Believing that it benefits nobody to drive skilled doctors and nurses from the medical profession by coercing them to act contrary to their well-formed medical judgement,

Seeking to provide adequate protection for the conscience rights of healthcare practitioners and facilities in member states,

The General Assembly,

1. Defines, for the purposes of this resolution, the following terms:
   
   1. "health care practitioner" as any individual who is employed or contracted to provide or assist in the provision of health care, such a physician, nurse, or pharmacist, and
   2. "health care facility" as any business, non-profit institution, or other organization established for the purpose of providing health care, such as a hospital or pharmacy;
2. Prohibits member states from:
   
   1. requiring any health care practitioner, or private health care facility, to provide or assist in the provision of specific forms of health care in cases where:
      
      1. the professional or facility would otherwise have a duty to provide or assist in the provision of such care pursuant to government regulation, an employment agreement, or a contract, and
      2. the practitioner or facility sincerely objects to the provision of such care as unethical, harmful, or otherwise contrary to good medical practice,
   2. punishing or otherwise discriminating against a practitioner or facility for refusing to provide or assist in the provision of such care in such circumstances;
3. Exempts from the protections of this resolution health care practitioners and facilities who:
   
   1. fail to provide reasonable notice of their objections to appropriate parties, as required by law, in advance of refusing to carry out their duties,
   2. object to performing their duties insincerely or on grounds other than those relating to good medical practice, such as laziness or malice, or
   3. object to performing the majority of the duties for which they are employed or contracted;
4. Reminds member states that the provisions of this resolution are without prejudice to any duty to provide or make available certain forms of health care under World Assembly law, but that member states may not contravene the provisions of this resolution in order to fulfill such duty.

Martin Russell
Chief Ambassador, Auralian Mission to the World Assembly

[Imperium Anglorum]

Always a big fan of lists.

[Attempted Socialism]

OOC: Not what I said. People who think a child (Rather than, say, a foetus) can be killed in the womb would fail first year of medicine. People who think human children are inhuman might fail their ethics or philosophy of science courses (While someone who thinks that foetii have personhood could benefit from such courses). And people who clearly ought to know that words have meanings but still use them incorrectly to make a poor point generally seem deceitful in debates.

OOC: So how many medical school courses have you taken?

OOC: Would my answer change anything in your mind? No, of course not. It's another red herring from you.

I shall give you a straight answer, though:
None. Through my time at university, however, I have worked with and been romantically involved with enough medical students to know they have both ethics in medicine and philosophy of science courses during their first years here, as well as a first-year test made to weed out the patently unqualified. Someone doing the very basic mistake that you did at an exam would seriously have a hard time passing.
I could link you to my university's Department of Medicine English webpages, but I know by now that there's no actual way of convincing you on this subject.

Edit: Fixed quote tags.

[Arotania]

If at all it is their own moral conviction that forces them to not take a job that entails actions they object to. Noone is forced by the state. Especially not out. They try to take a job they are not willing to perform in the first place. Giving the job to someone who is actually willing to do it therefore increases quality of medical services. The explanation how any of this equates to slavery is still absent from your reply.

Performing executions is a standard medical procedure in your country? We will make sure to issue a travel warning for Christian Democrats to our populace.

The Most Holy and Grand Empire has abolished capital punishment, Ambassador.

Also, your argument is unclear. Are you saying that physicians should be forced to perform all procedures that they are capable of performing even if they do not want to perform them, and what counts as a "standard medical procedure"?

We are glad to hear your stance on capital punishment, Ambassador.

Executions neither involve the consent of the 'patient'/victim nor are they conducive to health and well-being. Since they fail even this simple minimal yet not exhaustive test (a standard we can imagine you can broadly agree to) they can not reasonably classified as medical procedures in our eyes but at best procedures under medical supervision. Therefore we took your initial question as unproductive hyperbole and answered in kind.

Please allow us to answer your broadly overgeneralized question with a very specific example: Should a talented doctor that objects to blood transfusions be employed as an emergency room doctor or trauma surgeon? Should they be excempt from all legal liabilities that might arise from complications that arise based on their objection to blood transfusions?
Since moral convictions can change, should a doctor employed as an ER doctor or trauma surgeon that begins to voice strong objections towards blood transfusions and refuses to partake in any case involving them be kept in employment in this position? Or should they be fired and replaced by another doctor that does not jeopardize the health of their patients?
Please be reminded that 'blood transfusions' can be replaced by an innumerable amount of possible medical procedures. ER doctor and trauma surgeon would then be replaced with a specific job position that, according to best medical practices, is equipped and should be required to perform said specific medical practice.

No part of this constitutes forcing a doctor to perform a specific procedure. We merely insist that a patient's health and life take priority over objections to general medical best practices by doctors or institution. There is an inherent imbalance of power between doctors and patients. Patients have to be able to rely on their doctors administering the best possible care or be referred to a suitable medical professional in cases where the doctor cannot be reasonably expected to be equipped or trained for said care.

We ask again: What part of this reasoning is comparable to advocacy of slavery?

[Attempted Socialism]

OOC: This has been submitted as Human Rights. Why, when a more appropriate category exists?

[Auralia]

OOC: Not what I said. People who think a child (Rather than, say, a foetus) can be killed in the womb would fail first year of medicine. People who think human children are inhuman might fail their ethics or philosophy of science courses (While someone who thinks that foetii have personhood could benefit from such courses). And people who clearly ought to know that words have meanings but still use them incorrectly to make a poor point generally seem deceitful in debates.

((OOC: The existence of intelligent and thoughtful pro-life philosophers and physicians would seem to disprove this remarkably arrogant claim.))

OOC: This has been submitted as Human Rights. Why, when a more appropriate category exists?

((OOC: Healthcare is not a more appropriate category. Human Rights is the correct category.))

Please allow us to answer your broadly overgeneralized question with a very specific example: Should a talented doctor that objects to blood transfusions be employed as an emergency room doctor or trauma surgeon? Should they be excempt from all legal liabilities that might arise from complications that arise based on their objection to blood transfusions?

Why not, so long as their employer is made aware of their objections and an alternate physician is available to provide the transfusion in such circumstances?

Since moral convictions can change, should a doctor employed as an ER doctor or trauma surgeon that begins to voice strong objections towards blood transfusions and refuses to partake in any case involving them be kept in employment in this position?

Why not, so long as their employer is made aware of their objections and an alternate physician is available to provide the transfusion in such circumstances?

No part of this constitutes forcing a doctor to perform a specific procedure. We merely insist that a patient's health and life take priority...

Then you should support medical conscience rights, since talented doctors compelled to act against their conscience will simply leave the profession. I fail to see how access to fewer doctors benefits patients.

Martin Russell
Chief Ambassador, Auralian Mission to the World Assembly

[Attempted Socialism]

OOC:

OOC: Not what I said. People who think a child (Rather than, say, a foetus) can be killed in the womb would fail first year of medicine. People who think human children are inhuman might fail their ethics or philosophy of science courses (While someone who thinks that foetii have personhood could benefit from such courses). And people who clearly ought to know that words have meanings but still use them incorrectly to make a poor point generally seem deceitful in debates.

((OOC: The existence of intelligent and thoughtful pro-life philosophers and physicians would seem to disprove this remarkably arrogant claim.))

Not sure how it's an arrogant claim. So far the only anti-choice advocates I've seen have been the products of diploma mills or without even fake credentials, and the medical science is quite settled: 'Child' is not synonymous with 'foetus'.
I'm sure there are some arm-chair anti-choice philosophers out there. They would gain a lot from attending accredited universities.

OOC: This has been submitted as Human Rights. Why, when a more appropriate category exists?

((OOC: Healthcare is not a more appropriate category. Human Rights is the correct category.))

I thought you might claim something like that. Funny how you said this about another proposal that, in much the same fashion, could be construed as HR, but has a more specific category:

((OOC: Prior to the introduction of the Health -- Bioethics category and area of effect, it probably would be Human Rights. However, this category and area of effect specifically covers ethical regulation of medical research, which is precisely what you're doing with this proposal. In general you should use a more specific category if one is available.))

So where's the difference in terms of categorisation between these two proposals, if you'll be so kind?

[Auralia]

Not sure how it's an arrogant claim. So far the only anti-choice advocates I've seen have been the products of diploma mills or without even fake credentials, and the medical science is quite settled: 'Child' is not synonymous with 'foetus'.
I'm sure there are some arm-chair anti-choice philosophers out there. They would gain a lot from attending accredited universities.

((OOC: ... seriously? You really believe there are no contemporary pro-life philosophers with a degree from an accredited university?))

So where's the difference in terms of categorisation between these two proposals, if you'll be so kind?

((OOC: There is no area of effect in the Health category that corresponds to conscience rights for healthcare practitioners. This proposal does not promote access to healthcare (Healthcare) or provide international aid (International Aid) or promote medical research (Research) or place ethical restrictions on such research (Bioethics).))

[Burninati0n]

This proposal does not...place ethical restrictions on such research (Bioethics).))

Actually, it would do this under limited circumstances.

Tf medical research takes place at a medical facility and uses medical personnel (defined in this proposal), then those personnel could use it to refuse to participate.

So it does leave the door open to some research restrictions.

[Auralia]

This proposal does not...place ethical restrictions on such research (Bioethics).))

Actually, it would do this under limited circumstances.

Tf medical research takes place at a medical facility and uses medical personnel (defined in this proposal), then those personnel could use it to refuse to participate.

So it does leave the door open to some research restrictions.

((OOC: This is true, but this is a secondary effect of the right of conscience itself, which has other, more common applications.))