Research Proposal on "Discrimination Based on Religious Belief"

Research Proposal 10 pages (2985 words) Sources: 10 Style: APA

[EXCERPT] . . . .

Discrimination Based on Religion

Within the medical community many individuals have the right to refuse to provide care which transgresses from religious beliefs. Doctors have the right to refuse to prescribe medications such as birth control, morning after pills, abortificants, large doses of medication or procedures that will end or prolong life. Pharmacists have the right to refuse to provide such prescriptions, nurses the right to ask others to provide certain types of care if they are against their own religious standards. Yet, it must also be made clear that such provision of care or refusal to provide such care is rarely if ever done in urgency or in cases of emergent physical status of the patient. In an emergency the expectation of all is that such care will be provided as a standard that will save the life of the patient, regardless of the individual employees belief. In some cases even regardless of the beliefs of a patient such procedures are performed to save life.

The difference from a moral/ethical standpoint between a physician, nurse, anesthetist or pharmacist from refusing care in non-emergent situations and that which occurred as a result of the refusal of Mr. Max Comodo to assist in the case of triage on an emergent accident victim who needed blood transfusions is the fact that the case was emergent and Comodo was available to provide care, where as seeking an alternative care provider put the emergent patient's life at grave risk. The actions of the hospital to dismiss Comodo for insubordination for refusal to provide care in an emergency is therefore justified, and is further justified by the fact that his dismissal was a result not only of his refusal to provide care but his insubordinate attitude with regard to care. "Last year the Hospital had to request that Mr. Comodo assist other personnel in an emergency where a person had a car accident and a blood transfusion was necessary. Mr. Comodo refused, alleging that this was not his job or his responsibility. He also stated that people die when God wills it and that no one on earth had a right to interfere with that." (case study) Additionally, though Comodo had previously stated his beliefs and made other arrangements in situations where blood transfusions were indicated, he never made legal arrangements with the organization that detailed his intentions to remove himself from such cases, and it is therefore not a clear case of direct religious discrimination. (Ghanea, 2003, p. 73) as an aside providing any kind of intervening care, according to his stated beliefs, mentioned above including but not limited to surgical assist even where transfusions were not provided to the patient would seem contrary to his chosen profession. The hospital also has an obligation to provide such emergent care, regardless of the situation, and not doing so or delaying care is a clear demonstration of unsafe practice, a liability directly resulting from Comodo's refusal to provide care. The dismissal of Comodo was therefore not arbitrary or discriminatory, as seeking employees who are willing and able to provide emergent care and excluding those who refuse to do so is in the best interest of safe running of the hospital. (Dicesare, 1995, p. 49) There are also institutions in the U.S. And elsewhere who have provisional services which provide care without the performance of transfusions and patients are made aware of this before they arrive and employees are also aware of this prior to employment and sign employment agreements that reflect it. In the case of the Misericordioso Hospital in Puerto Rico there was no such employment agreement and Comodo's employment would be assumed to be contingent on his ability to provide all the care that is needed of him in his position, including but not limited to assisting on cases where transfusion was provided.

Jurisprudence on the issue of blood transfusion and other non-native treatment to individuals surrounds mostly the allowance of the refusal of the individual to receive care, but does not necessarily apply to employment issues associated with employee religious belief and refusal to provide services. (Cawthon, 2004, p. 246)

In the case of Comodo the development of the situation was likely limited in scope as emergent care was often shuffled away from Comodo in transfusion cases, by him without regard for his duties, and yet his superiors never took formal action against him, likely for fear of being deemed discriminatory. The only sticking point as a labor relations advisor is that Comodo's 20 years of service and employment reviews did not reflect his superiors desires or actions prior to his dismissal in this case. In other words the hospital should have taken action in the form of either releasing him formally from the obligation to assist on such cases or given him due documented warning that such refusal might result in his termination. This could have been done through employment agreements that reflected a full listing of Comodo's responsibilities, including but not limited to inclusion of emergent triage cases that might require transfusions or conversely by including an allowance for his refusal to do so on religious grounds. The bioethics committee of the hospital and the legal department of the hospital should have been briefed and allowed to give input on this situation prior to the development of an emergent case where insubordination could be utilized as grounds for dismissal of Comodo. Additionally, Comodo, with 20 years of service should have been made aware that his employment might someday be contingent on such a refusal of care. The case for insubordination is made more clear when inclusion of Comodo's explicit statement of his own religious beliefs, in the presence of other staff, as well as possibly the patient and/or family of the patient when he refused to provide life saving care. In this situation the actions of the hospital could have been better served had the situation been more clearly defined and Comodo been given the opportunity to protest such care in a non-emergent situation.

Prior to this situation Comodo did not seem to have been the victim of unfair discrimination, at the hands of other staff or supervisors, as can be seen by his previous ability to refuse to provide such care without stigma or threat of or dismissal from employment.

Individuals are stigmatized (i.e., bear stigmas or marks) to the extent that there is a negative (discrediting) discrepancy between their virtual social identity and their actual social identity (Goffman, 1963; Jones et al., 1984). A virtual social identity is a perceiver's conception (e.g., prototype, stereotype) of what a target should be like in terms of a host of factors, including race, physical appearance, moral character, religious beliefs, sexual orientation, nationality, and personality. It generally reflects what the perceiver considers to be acceptable, normal, or desirable. In contrast to a virtual social identity, an actual social identity is a perceiver's views about a target's actual characteristics, which may be real (i.e., verifiable) or assumed (i.e., inferred by the perceiver). (Stone-Romero, 2005, p. 257)

Though religious organizations have been frequently upheld in their right to discriminate against potential or real employees based on religious tenets there is also a clear sense that the right soft h individuals post employment are limited unless the individual signs a statement prior to employment as a contingency to employment or voluntarily does so upon hire. In the case of Comodo, neither the institution nor Comodo signed any declaration of beliefs that would preclude him from employment if he refused to provide care that was divergent from his belief system. (Carter, 1997, p. 1627) Therefore it can be assumed that a court would see in favor of Comodo, unless such a declaration can be produced that either excludes him from such care or makes his employment contingent on it. Yet, in this case it is not necessarily the fact that he refused to provide care but as the employer's dismissal letter indicates had more to do with Comodo's attitude upon refusal to provide such care and the position it placed the hospital in. "The day after the incident, Mr. Comodo received a dismissal letter as a result of insubordination; the letter also stated that his attitude was a threat to the institution's proper functioning." As the institution is clearly a provider of emergent care Comodo's attitude, if sufficiently inappropriate could very well be seen as a cause for dismissal, or at the very least a strong warning as well as the development of an employment agreement that reflected either his inability to retain employment if he continued to openly refuse to provide such care or again proved insubordinate in his refusal to do so. Again in many cases it is the refusal of care on the part of the individual receiving care that is reflective of the jurisprudence or in most cases by proxy, for say minor children or as a result of emergent care of individuals where treatment denial is made by the family of the… READ MORE

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