In her proposal, Lynch mandates that each state medical licensing board maintain a record of physicians able to provide certain services but refusing to do so based on yet-to-be -determined criteria for conscientious objectors. Assuming there should be convenient "...access to services that have been deemed an essential component of basic health care" (152), and since she believes that "...access to precoital contraceptives, and potentially to the morning-after pill and abortion services, is in many ways essential to a woman's dignity and freedom from the control of others . . ."
Vol. 26:2 summer 2010 booK reVieWs Conflicts of Conscience in Health Care: An Institutional Compromise Holly Fernandez Lynch. Cambridge, MA: The MIT Press, 2008. I S B N 9 7 8 - 0 - 2 6 2 - 1 2 3 0 5 - 1 ; 3 7 6 PA G E S , H A R D C O V E R , $ 3 4 . 0 0 Issues of conscience in health care are most often discussed in light of current reproductive technologies. By definition, reproduction includes pre-born human; how one views that life informs one’s conscience. In 1973, Roe v Wade altered the landscape of medicine as well as American society, polarizing both into camps supportive or objective of legalizing the abortion of zygotic and embryonic babies. It is, then, with a sense of admiration that one picks up Holly Lynch’s Conflicts of Conscience in Health Care. She begins with uncompromising support for conscientious objectors, seeking to find a “middle ground.” Unfortunately, she then undermines her goal by proposing a tedious system of oversight that is neither value neutral nor even-handed to “refusers,” morphing what began as a “liberty right” in 1973 into something more akin to an “entitlement right.” In her proposal, Lynch mandates that each state medical licensing board maintain a record of physicians able to provide certain services but refusing to do so based on yet-to-be-determined criteria for conscientious objectors. She also recommends that this board develop and maintain a database of the availability and convenience of specific services in each geographic area. Lynch then suggests that the board selectively issue licenses to “. . . facilitate the recruitment and long-term maintenance of . . .” (179) those willing to practice in areas where services are considered to be in short supply. If an area does not have a willing provider, she argues that the “last doctor in town . . . [has the] heightened obligation of providing access to the service the patient desires . . .” (199, emphasis added), despite potential issues of conscience. By determining supply based on patient desire rather than need, she co-modifies the physician; the service provided is merely based on a patient’s desire or request. A physician becomes no different from any retailer with a sack of wares. Additionally, “health care” is transformed into something other than a quest to return patients to their optimal health (maximal physical functionality with minimal pain). Using the same logic, any specialty in medicine could be regulated: Why should reproductive technologies be any different than urological or plastic surgical technologies? Or further, what protects any service industry? What makes this book most pernicious, however, is the sleight-of-hand by which the liberty (so-called “negative”) right of Roe v Wade is transformed into an entitlement (“positive”) right. Assuming there should be convenient “…access to services that ha
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