[Rhodes22-list] Politics - Camel Nose Logic

[DCLewis1 at aol.com]

Ed,
 
Thank you for your response.  To reply:
 
Regarding emergency rooms not providing all services: Two comments:
-  First, I think all emergency rooms provide a comprehensive, and pretty 
uniform,  set of emergency services.  I would be interested to know of an 
emergency  room that cannot handle wounds of all sorts, broken bones, head injuries,  
poisonings, heart attacks, etc.  They may not be able to handle all medical  
cases that are presented because many cases that enter the medical system  
through emergency room are not emergencies - but they can all provide first  
level medical treatment for nearly everything.  The common reasons for  moving 
people to another ER facility are: lack of suitable insurance, lack of  bed space 
(they are full), it’s not about the inability to deliver medical  service.  
There are cases, for example burn cases, where a hospital will  specialize in 
burn cases - in those cases the ER will render appropriate aid and  forward the 
patient to the specialized facility; or even direct the ambulance  directly 
to the special facility in the patients interest.  But any claim  that the ER 
of an accredited hospital cannot provide the full range of emergency  services 
is wrong - in my experience.  I believe there is a national  accreditation 
agency that makes sure that’s the case (the initials escape me  right now).
- Second, I am absolutely not claiming that a medical facility,  or any 
physician, should be required to provide any service for which they are  not 
completely competent.  Proof of competence for a physician is board  certification 
by the appropriate liscensure authority in the jurisdiction of  interest.  In 
fact I would recommend that if a physician is not board  certified  they should 
only render aid outside of there sphere of  competence in extreme and 
extraordinary circumstances (i.e. not your standard  commercial transaction) - this 
protects the doctor, and it protects the  patient.
 
Regarding your example that pharmacies would have to carry all drugs: If  you 
will re-read my post you will explicitly see that I said there are a zillion  
drugs and that I would NOT expect any pharmacy to carry them all, BUT that if 
 they did carry the drug, and it’s dispensation were legally authorized in 
the  jurisdiction the pharmacy resided, I would regard any decision by the 
pharmacist  not to sell the drug to someone because they didn’t like the person, or 
they  didn’t like what the drug might be used for, as discrimination.  So I  
explicitly said I didn’t expect every pharmacy to carry every drug in the 
world  - I don’t think anyone does.
 
It seems to me that the practical resolution of the pharmacy/pharmacist  
dilemma you’ve posed is: if the pharmacy doesn’t like the drug, don’t carry  it.  
And if the pharmacy carries the drug, but the pharmacist working there  doesn’
t like the drug, he should get another job with another pharmacy.   What you 
don’t want is the pharmacist that would be dispensing the drug denying  it to 
someone that needs it and giving his view of morality to the person.   I would 
add that this applies to AIDs drugs, emphysema drugs, and possibly other  
drugs.  The job of the pharmacist (the human being standing at the counter)  is 
to competently and  legally dispense drugs, on a commercial basis, not  impose 
his view of morality on the customer - he is explicitly licensed to  dispense 
drugs and the public should expect that he perform his agreed duties or  
forfeit his license.
 
Regarding Catholic hospitals: I really don’t know whether Catholic  hospitals 
do abortions, I suspect they might when the mother’s life is at risk,  but I’
ve never had an abortion and I’m not Catholic.  I also think policies  may 
vary across the country.  Also, I don’t think most abortions are done  at 
hospitals, I think they’re done at clinics - I could be wrong.  All of  that 
notwithstanding,  I think you’ve mixed-and-matched apples and  oranges.  We are 
talking about physicians (skilled people who have  pro-actively gone out and 
secured public approval, based on their training and  skill, to execute specific 
medical procedures - including abortions - on a  commercial basis) not hospitals 
(facilities that are basically managed real  estate and facilities).  What a 
hospital (real estate/facility) will or  won’t do is not the topic, the focus 
is the physicians (persons that have  represented they will provide a service 
on a commercial basis).  Physicians  are licensed and board certified to 
provide a service, they should be  willing  provide that service if they have sought 
and gained approval to  provide that service.

Regarding Indian restaurants: Restaurants  (real estate and owner) have a 
business license - they can do what they want  with it, it’s NOT a license only 
for Indian food, or any specific food or  menu.  IF IT WERE a license of a 
specific food menu - for example if the  license were for Indian and Mexican food, 
I would expect them to provide Indian  and Mexican food.  If they have a 
license for specific foods that  liscensure agreement is with the public (or it’s 
agents, the licensing  authority).  The fact that a specific food type is not 
spelled out on  restaurant licenses does not mean they have to provide every 
type of food and  menu, as you suggested, that’s simply not practical 
(remember, the law is  ultimately about practicability), instead it means the owner has 
complete  freedom in providing whatever menu he wants - and he can change 
what he offers  in an instant, it’s his decision.  A board approved Ob/Gyn doctor 
does not  have that flexibility.  A board approved Ob/Gyn doctor is on the 
hook to  provide Ob/Gyn services - if he unilaterally decides to branch out to 
dentistry  or podiatry, or open an Indian restaurant, on the basis of his 
Ob/Gyn  certification, he’s in big trouble.  The Ob/Gyn doctor has made a deal with 
 the public through it’s liscensure authorities (the certification board) 
that  he/she will provide Ob/Gyn services - and he or she should.  
 
There’s a simple solution to all this from the physician’s perspective, if  
you don’t want to provide the full range of services expected of you as an  
Ob/Gyn specialist, pick another specialty.  Many Ob/Gyn doctors have made  that 
choice for insurance reasons.  I imagine podiatrists, dermatologists,  
orthopedic specialists, and psychiatrists, to name just a few specialties, are  
rarely called on to perform abortions or prescribe drugs related to birth  control. 
 From my perspective, what this whole deal is about is people  (some 
physicians) trying to impose their standards of morality on the  public.  The reality 
is, the public authorizes the physicians commercial  endeavor, and the public 
can and should take its authorization away if the  physician, for whatever 
reason, stops serving the public’s interest.  This  does not dictate what the 
physician believes, but it does dictate how he must  act - he must serve the 
public good, as defined by the public.
 
If doctors did not require liscensure, or if the public could get medical  
support from anyone, none of the above would apply.  Each party could  behave 
however they wanted and it would be a free market.  My whole point  is that what 
makes this situation NOT a “free market” transaction is  liscensure.  The 
public has traded off it’s freedom of choice to ensure  competency - that’s 
what the licensing deal is all about.  It’s the  liscensure requirement that 
limits the public’s choice as to who will serve them  - that kills the free 
market, there may be 1 person in town that could help Ms  whoever, that requirement 
gives the Ob/Gyn physician the right to basically  print money, but the flip 
side is that he or she is on the hook to provide  service to the public. 
 
Again, JMO. 
 
Dave