Posts under ‘discrimination’

(Note: This is my fifth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)

A San Diego fertility clinic that refused to provide artificial insemination to a lesbian woman based on her sexual orientation has tasted defeat at the hands of the California Supreme Court.

Guadalupe Benitez was denied insemination by two doctors at the North Coast Women’s Care in Vista, California, after being told by the doctors in question that their Christian values would not allow them to artificially inseminate a lesbian. In later testimony, the doctors stated that they simply would not perform the procedure for any woman who was unmarried, despite her sexual orientation.

While a state appeals court did indeed rule in favor of the doctors’ rights to refuse to treat based on sexual orientation or marital status, the California Supreme Court overturned that ruling by citing The Unruh Civil Rights Act, which prohibits discrimination by any business—including medical facilities—based on gender, sexual orientation, religion, and many other protected categories.

An editorial in the Los Angeles Times praises the decision, while also citing disturbing statistics that many states actually have legislation in place protecting doctors’ rights to deny patients treatments or services that they find “religiously objectionable”. The LA Times also shares the results of recent studies revealing that 14% of doctors polled stated that they would deny certain treatments to certain individuals while refusing to provide viable alternatives or referrals for such care, if confronted with a situation at odds with their religious convictions.

In reaction to the ruling, the Los Angeles Times editorial states:

“The tradition of religious freedom in the United States is one of the founding ideals of this country. But as our framers envisioned it, religious freedom referred to a right to practice one’s own religion free of interference from others. It did not refer to religiously based interference with the rights of others, who may have their own and different religious traditions. Even in the relatively religiously homogeneous era of the framers, such interference was not acceptable. It is even less so in 21st century America. With religious heterogeneity growing, the devotional demands of one group may be increasingly at odds with those of others.

“Yet too often, our deference to religion in contemporary American society has allowed us to subordinate all other values. It has allowed us to routinely accept religiously motivated behaviors that we otherwise would have no reluctance to sanction and that, indeed, would be impermissible with any other justification.

“So it’s time to say ‘enough.’ In the United States, we all are free to practice our religion as we see fit, as long as we do not interfere with the well-being of others by imposing our religious views on them. If physicians or other healthcare providers who have religious objections to legal medical treatments will not at a minimum inform their patients about those treatments and refer them to others who will deliver them, they should act in a way that is consistent with their convictions and the well-being of their patients and find other professions. “Freedom of religion is a cherished value in American society. So is the right to be free of religious domination by others.”

I could not agree more with the statements by the LA Times editorial team. While I wholeheartedly respect the beliefs and values that guide any individuals’ life, doctors and medical personnel hold an oath to first “do no harm”, and I believe that “harm” includes refusal to provide care to another human being based upon discrimination, potentially leaving that individual without recourse or alternative affordable options for such care. Even though in vitro fertilization is indeed an elective procedure which does not have life-and-death implications per se, it is the principal of the matter that lies at this heart of this case.

As the LA Times stated in yet another editorial: “A clothing store may choose not to sell polo shirts. But once it sells polo shirts, it cannot withhold them from customers based on their race, religion, sexual orientation and so forth.” Taking into consideration that medicine is also a business, following the letter of the law, a business must abide by anti-discrimination laws when serving consumers of any class, group, or minority, regardless of the feelings or values of the business owner or operator.

Now, doctors can still indeed refuse to perform abortions, in vitro fertilizations, or any other manner of procedure that does not fall within the bounds of their personal moral compass (just as the aforementioned clothing store can choose to not sell polo shirts). However, following non-discrimination laws, if they choose to offer a procedure to their patients, then it must be offered equally to all, not solely to select groups who meet the doctors’ criteria for moral righteousness.

While some may argue that the refusing doctors did, after all, refer the plaintiff to another provider who eventually performed the procedure (and apparently incurred the costs that the patient would have paid in higher fees to the other provider), it is easy to imagine other less fortunate patients being sent on a wild goose chase, seeking medical care that was consistently denied to them based on some aspect of their beliefs or lifestyle.

The California Supreme Court obviously felt that this case had much broader implications beyond fertility and in vitro insemination. With this decision, the court decided to send a clear message that protection against discrimination based on sexual orientation and marital status is just as crucial as protection against discrimination based upon race or gender. If this case had been decided differently, perhaps we would then begin to see further erosions of the rights of gays and lesbians in all manner of areas of legal, medical and commercial transactions.

I am certain that this issue is not going away, and that proposals and ballot initiatives striving to ban gay marriage entirely will surely gain moral steam in reaction to this decision. However, the California Supreme Court has taken a stand, and I personally feel that their choice to rule in the plaintiff’s favor, however controversial, will stand the test of time and further appeal.

Twelve days. For twelve days, disabled elders in the community where we work were stranded in public housing without a working elevator. A group of eight-story high-rise buildings, originally built in 1961 for low-income families, now house poor, disabled elders. Constructed before the Americans with Disabilities Act (ADA), these decrepit buildings have only one elevator each. Nowadays, this would be unheard of, but in the 1960’s, I’m sure it wasn’t given another thought. And evacuation plans were probably just a pipe-dream, with occasional lip-service to assuage the bleeding hearts and housing advocates.

Public housing authorities do not exactly have stellar reputations, and in this city of ill repute, where cronyism and corruption are seemingly imprinted on the city’s official seal, stealing from the poor to benefit the undeserving rich has been de rigeur for decades.

A public meeting today in the local community room brought outrage, measured argument, cynicism, paternalism, the media, and politicking at its most tedious. The city councillors expressed their official outrage. The housing authority director pointed fingers and blamed the weather and the victims, claiming ignorance, poor communication, and any other excuse that seemed plausible. Those of us in the room who know the score are only hell-bent on making sure our seniors and disabled community members are provided for, heard, respected, and accomodated. It will be an uphill battle.

Whether we verbalize it or not, we all know that if this group of seniors had been white, with white families and connections in the community, this intolerable situation would never have mushroomed into the crisis it is today. Outrage certainly has its place, and enough outrage was expressed today to perhaps succeed in lighting some hot fires under a few choice buttocks.

Communication, cooperation, foresight, and meticulous planning are needed to overcome barriers which place the elderly, the poor, and the disabled at risk. Coupled with outdated architecture, bureaucratic stupidity, organizational chaos, and a lack of anyone willing to take enough responsibility for what went wrong, only a coalition of community leaders and key agencies can partner with the residents to effect change. Change may be organizationally painful, and there may be kicking and screaming along the way, but a snowball was pushed towards the top of a hill today, and one can only hope that it will continue to gather momentum and mass, crushing any bumbling bureaucrat who gets in its way.

Browsing through an eclectic used bookstore recently, I came upon a copy of Susan Sontag’s small but mighty “Illness as Metaphor“, published in 1978. Sontag uses her wisdom and literary talent to expose and debunk the myths which blamed the victims of tuberculosis (in the 19th century) and cancer (in the 20th century) for their own conditions, often exacerbating their suffering by propagating myths which have the power to discourage rational thinking and the pursuit of the best treatments for disease. Although I fully embrace the idea of the mind-body connection, certain writers, thinkers, public institutions and media sources have often used fear, ignorance, and outright bigotry to hold sufferers of certain diseases at arm’s length, rendered single-handedly responsible for their plight. Fear of death will turn humans away from their suffering brethren, and Sontag points out that TB and cancer were hallmark cases in such treatment and myth-making.

Making my way through the first few chapters, I immediately began to wonder how this idea has been treated by writers and thinkers vis-a-vis the AIDS epidemic. A quick Google search revealed that, lo and behold, Sontag had revisited the ideas of her original book in a follow-up treatise, “AIDS and its Metaphors“, published in 2001, which I am now very keen to read.

Although I have yet to finish the former work of Ms. Sontag and am as yet uncertain if I will agree with 100% of her thesis, I can immediately agree that language has been frequently used as a weapon against the sufferers of myriad diseases. I am sure Ms. Sontag will address in her second work the notion that AIDS began in the early 1980’s as a “gay” disease, with large numbers of gay men in urban centers falling prey to a strange “gay cancer” erupting on the skin like so many bruises. The long-esgtablished marginalization and social isolation of the gay community allowed mainstream America to ignore its importance, many claiming that AIDS was a punishment by God visited upon the “wicked” homosexuals and their “unnatural”ways. Photographs of early protests even show evangelicals holding signs using the word “gay” as an acronym for “Got AIDS Yet?” or “God Abhors You.”

Words are powerful, and even those of us with the best intentions may at times use them to the detriment of others. In my position, it is all too easy to fall into blaming those affected by substance abuse, eschewing the disease model and embracing the notion that these individuals are wholly responsible for their actions and should know better. Life experience alone will convince most thinking individuals that substance abuse and the suffering it engenders goes well beyond a simple “personality flaw” of the sufferer. Similarly, depression—experienced by millions of people around the world—responds quite poorly to admonitions that one should simply “get over it” and “cheer up”. Research bears out that substance abuse and mental illness have genetic, physiological, psychological, and chemical components over which we do not have complete control. Exasperation with a recalcitrant substance abuser is one thing—outright blame is another.

AIDS, cancer, substance abuse, disfigurement, disability—any and all of these conditions can cause the uninitiated or ignorant to turn their faces in disgust or denial, the common denominator being fear. Fear of death, fear of mortality, fear of the unknown, fear of the “other”—our fears will often prevent us from looking another in the eye and see their suffering as if it were our own.

Each day is an invitation to open ourselves to the suffering of others, and each time we embrace that opportunity, we further the causes of compassion and love. As Mother Teresa once said in one of my favorite quotes of all time, “I have found the paradox that if I love until it hurts, then there is no hurt, only more love.”

I watched the cockroaches crawl around the clean laundry in the basket next to the couch as I took my patient’s blood pressure. I noted the single-pane windows, wondering about the coming winter’s bitter cold. My patient complained to me that this apartment–to which she moved after we requested a first-floor apartment for her—has floors which are harshly askew, causing her to fall frequently.

I wandered around the apartment, noting clearly that the floors do indeed slant in one direction or another in each room, at times to a considerable degree. Her daughters, able-bodied and young, say that even they sometimes lose their footing from the missteps they take on the floors which are not unlike those in a carnival fun-house. My patient, who suffers from arthritis so severe that she receives intravenous chemotherapy every two months, has a difficult time negotiating the apartment, a cause of much frustration and anger on her part. This move to the first floor from the fourth is fraught with new challenges, and perhaps has been for the worse.

When I first met her, she lived in the building next door on a fourth-floor walk-up, the stairs becoming an increasing challenge as her disability worsened. I drafted a strongly worded letter to the landlord asking for urgent placement in a first-floor residence, or a building with reliable elevators. The landlord responded quickly but didn’t even give her a chance to see the apartment. Before she knew it, she was moving, and the askance floors were immediately apparent. Several falls later, I’m considering my next steps. This is housing “approved” for Section 8—hasn’t it been inspected? Are there structural problems with the underpinnings of the building which might endanger those on the upper floors? There is obviously something wrong. While I am not a social worker, these are battles I often choose to wage, and this one may cost me a great deal of time and effort. But if she breaks a hip, all hell will break loose and I want to head that disaster off at the pass.

Substandard housing for the poor is commonplace all over the world, and the United States is sadly no exception. Even low-ranking soldiers in the military live in government-issued housing that most of us would find unacceptable. When did viable housing become a priviledge in this society? Probably around 1492.

In my time as a nurse working in the community, I have seen some housing situations which were utterly appalling. An older gentleman with a unilateral leg amputation who I used to know lived in a hovel behind his nephew’s house, wheeling himself over floor-boards decrepit with age and rot, a large hole in the bathroom floor daily threatening to swallow his wheelchair. I’ve seen rats, cockroaches, holes in floors, broken windows, missing locks, lack of ventilation, stifling heat in summer, lack of proper heating in winter, the list goes on. Granted, some public housing is abused by some tenants, slums becoming such when they are neglected and trashed by uncaring residents. But one must look sociologically at the source of the rage that damages such properties. As I have said before, those who feel cast aside and uncared for by society will, by default, be uncaring for their environment, and perhaps for their own well-being. Our responsibility to house the needy is enormous, and we are, in my estimate, failing miserably on many fronts.

There are some examples in our area of excellent housing for the elderly and disabled. Nicely maintained, with common rooms, landscaping, excellent security and organized social gatherings, these residences could serve as models for others. On the contrary, one year after Hurricane Katrina, there are still squabbles about what type of viable housing—aside from FEMA trailers— to provide for those displaced by the storm. Luckily, some groups of service-oriented architects are creating models of cheap, durable housing which can be freely copied and altered—in a manner similar to open-source freeware on the Internet—a practice which may transform the idea of affordable housing for the future.

But that future seems far away as my patient slips and slides along her not-so-fun-house floors, and my rising ire against a corrupt system which provides such abominable living conditions for the most vulnerable among us slowly turns to rage. The housing authority in the city in which I work has lately been revealed to be rife with corruption of the most reprehensible kind. A prominent family bilked the authority of millions of dollars over many years, allowing said family’s members extravagant home improvements while the poor of the city languished in substandard dwellings. For those individuals who were sent to jail, good riddance, and their post-release community service should include five years of living in the worst of the public housing for which they were responsible creating and maintaining in its sorry state. If that type of corruption is not a source of rage, I don’t know what is.

So, it seems that for all of us out there fighting the good fight on behalf of those not able to fight on their own and win, there are others who will take advantage, corrupt the system, and provide shoddy work and horrible conditions in the interest of saving money and advancing their own wealth. If it didn’t make me so angry, it would bring me to tears.

Someone might ask, is this what a nurse does? Is this how a nurse thinks? Should a nurse even involve him- or herself in such societal issues? The easy answer is “of course”. Physical, emotional, and spiritual health has myriad aspects and properties, and the health of the home, the place where one rests one’s head, has an enormous impact on one’s sense of health, safety, and groundedness. A home which does not offer that which a person needs for their own protection and security and comfort is a home which lessens that individual’s ability to be whole, to be productive, to feel valued.

The frustration in the eyes and voice of my patient who is negotiating those off-kilter floors is filtering down into her sense of self, her sense of her relative health, her well-being, her groundedness. How can one feel grounded when the floor beneath one’s feet can fool the eye and the foot? Housing certainly is a right, not a priviledge, and those rights are generally worth a good fight. I think I’ll be taking off the gloves tomorrow.