Many pregnant undocumented immigrants are ineligible for public insurance covering prenatal care. National and state policies can either help or hinder patients’ access to health care that is universally recommended by professional guidelines.
AMA J Ethics. 2019;21(1):E93-99. doi:
10.1001/amajethics.2019.93.
The social institutions of medicine and the state have a complex history of interaction in which doctors have been the originators of political ideals, goals, and social change but equally often have found themselves to be instruments of political authority.
In the iconic painting Broken Column, Kahlo represents her spine as a Greek column that is fractured and disintegrating. In this beautiful and tragic interpretation, the fractured column bespeaks Kahlo’s physical weakness and emotional instability.
In the past, forced sterilizations violated the autonomy of vulnerable women. Today, measures intended to protect such women from the abuses of the past may in fact hamper their autonomy in a different way.
Restrictions on employer-based health insurance coverage of medical services or treatments, whether motivated by religious prohibitions, political objections, or concerns about cost, degrade quality of care and undermine the patient-clinician relationship.
Herman Melville's account of Bartleby the scrivener has something to teach us about the interactive nature of refusal and the empathy necessary for an exchange of values in the setting of conscientious refusal.
Qualifying conscience protections for institutions with requirements that they minimize hardship caused to the patient would prevent religious institutions from acting as a choke point on the path to services.