The Surgeon General, medicine, and morality

President Bush nominated Kentucky cardiologist Dr. James Holsinger to be the Surgeon General of the United States, but gay rights groups are unhappy with his nomination. Apparently Dr. Holsinger voted to expel a lesbian pastor from the United Methodist Church, has said that gay sex is unnatural and unhealthy, and helped found a congregation that believes being gay or lesbian is a choice and can be cured.

I’m all for gay rights groups coming down in opposition to any particular presidential nominee if that individual doesn’t match up with their interests, and from what little we’ve seen about Dr. Holsinger thus far (he seems to be letting his opponents define him by not granting any interviews), he certainly doesn’t seem to be a friend of homosexuals. However, as some of his supporters have pointed out, there’s a big difference between having moral convictions on an issue such homosexuality and permitting those convictions to interfere with one’s medical judgements.

“Jim is able, as most of us are in medicine, to separate feelings that we have from our responsibility in taking care of patients,” said Douglas Scutchfield, a professor of public health at the University of Kentucky. (quoted from the article above)

While I agree with Prof. Scutchfield in general, there comes a point where personal morality begins to interfere with your duties as a medical professional. It’s quite possible that Dr. Holsinger’s views on homosexuality as being a choice and curable qualifies as his theological beliefs interfering with his medical judgements, but without more information from Dr. Holsinger directly, we simply lack enough information to know for sure. Given that recent scientific research into the biological basis of homosexuality are pointing toward it being either entirely genetic in nature or partly genetic/partly prenatal environment (as discussed in this excellent Discovery Magazine article, The Real Story on Gay Genes), there’s certainly enough information available that we should be able to get a straight answer from Dr. Holsinger – eventually.

One of the more important cultural conflicts simmering away on the back burner of the United States is medical professionals refusing to provide medical services based on their moral convictions. In Great Falls, Montana, a pharmacy is phasing out their sales of birth control pills because they’re morally opposed to supposedly abortifacient drugs that prevent fertilized eggs from implanting (story here). Access to the morning-after pill, Plan-B, is limited due to FDA restrictions that permit pharmacists to refuse to dispense it, and Rebekah Gee, a Robert Wood Johnson clinical scholar at the University of Pennsylvania, found that most drugstores didn’t stock Plan-B and that of those who did, many wouldn’t dispense it (story here). And in Colorado, a bill to require all hospitals to provide information about emergency contraception (ie Plan-B) to rape and incest victims was watered down when the requirement to refer the victims to a provider was removed to mollify religious hospitals with moral objections to contraception (story here). And now we have a Surgeon General nominee who apparently believes that homosexuality can be cured.

It strikes me that the core issue in all these situations is whether someone’s personal morality is more important than their professional ethics. To put it another way, is the welfare of the community more important than the welfare of the individual? And as such, this particular cultural conflict straddles the fundamental divide between common good and individual freedom that has ebbed and flowed throughout U.S. history. And as such, I don’t expect that this debate will either go away or wrap up anytime soon.

Personally, I consider it unethical to force your morality on someone else who may not share it. And when professional ethics and personal morality conflict, it’s my personal belief that professional ethics always wins – if it doesn’t, it’s time to leave the profession, or at least the position where the conflict occurred.

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