Archive for the ‘autonomy’ Category

From PBS: Next Health Care Mandate: Flu Shots for Medical Workers?

Brandon Hostler’s arm is usually among the first extended for the annual flu shot at Ruby Memorial Hospital in Morgantown, W.Va. He is, after all, a registered nurse — he knows it can do some good.

But if that shot ever becomes mandatory, he will balk.

“I wouldn’t quit or switch jobs,” he said. “But we are health care professionals. We know the risks and the benefits, and to force us to do something like that and not have a say in it, I think it would be offensive and unwanted.”

This story nicely points out two different facets of one of the most important values in the world of healthcare, namely autonomy.

Why is autonomy important? On one hand, it is important for its own sake. We simply value the ability to choose for ourselves. On the other hand, we value autonomy because we generally believe that when people choose for themselves, they will choose better than when others choose for them. Both of those facets of autonomy appear in the story above. Some nurses are hesitant about the flu shot because they’re uncertain about whether the risks are worth the benefits; others think the benefits are there, but still want the freedom, for its own sake, to say “no thanks.”

But there are also limits on autonomy. And in particular, membership in a profession brings a whole bunch of such limits. The benefits of professionalism involve a kind of quid pro quo — society asks things in return. The hard question, of course, is whether any particular limit on autonomy — such as mandatory flu shots — is or should be part of that bargain.

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In most stories about conscience clauses and nurses, the nurse involved is the one appealing to conscience-clause legislation to justify non-participation in some medical procedure.

But that’s not always the case.

See this story, from CNBC: Idaho board: No action in Walgreens complaint

The Idaho Board of Pharmacy says it has no basis to start proceedings against Walgreen Co. in a complaint that alleged one of the drug store chain’s pharmacists in Nampa improperly refused to fill a prescription.

A nurse practitioner from Planned Parenthood of the Great Northwest contended the pharmacist abused the state’s 2010 conscience law in November after balking at filling a prescription for a drug that helps control bleeding after childbirth or abortions….

This I think is a little-discussed aspect of “conscience clauses” or “conscience laws”: they can be a focal point for disagreement between members of different professions. Also, while conscience clauses may sometimes help nurses avoid participation in procedures that go against deeply-held values, in other cases such clauses are going to frustrate nurses’ attempts to help patients obtain the services of other health professionals.

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