Nancy Hicks’ article on the extended battle psychologists and other professionals have had in asserting our responsibility to retain nondiscriminatory language regarding sexual orientation and gender identity ("Boards, Ricketts at odds," March 11) provides an informative outline of this struggle and what is at stake. For nearly a decade the Nebraska Department of Health and Human Services and two successive governors have allowed a religious group to assert undue influence on the signing of updated licensing regulations. Here is some further discussion to clarify the importance of the issue and the motivations behind the impasse.
First, this issue is not just about referring people for “counseling” -- clinical psychologists diagnose and treat the full range of mental illnesses, including very serious ones. Our patients are often extremely vulnerable, at high risk for suicide and other calamities. The governor wants to allow psychologists to turn patients away without consideration of their stability or the public’s safety. This would be comparable to emergency room physicians ignoring accident victims who offend their deeply held convictions.
The new regulations that the governor is holding hostage reflect psychologists’ role in high-risk, high-stakes health care decision-making. They would update critically important diagnosis and assessment standards that affect how people are determined to be mentally ill, legally competent, eligible for disability benefits, not guilty by reason of insanity and subject to civil commitment. In addition, our outdated regulations are impairing our ability to recruit the best and brightest new psychologists. In some cases new university faculty who are licensed in other states are unable to juggle research and teaching demands of the tenure struggle while meeting Nebraska requirements. The new regulations would fix this.
These have nothing to do with the reasons the governor is holding up the regulations. The real reason remains somewhat obscure. The Nebraska Constitution requires that the purpose of health care licensing is to protect the public. Allowing psychologists to discriminate according to their deeply held convictions protects nobody, not even psychologists. No psychologist anywhere has ever been prosecuted, successfully sued or disciplined for refusing to treat anybody. In fact, we are trained to not treat people when our personal convictions may interfere with our effectiveness. But when we do decline to treat people we must also protect their safety and the public’s. This often requires more than handing them a phone book and showing them the door. Incredibly, this debate is about whether it’s OK for a psychologist to do no more than that, if patients offend our deeply held convictions, no matter how suicidal, distressed, agitated, angry, homicidal, psychotic, demented, confused or dangerous they may be.
It is also government overreach and regulatory micromanagement at its worst, to prescribe in licensing regulations a canned minimum response for such a huge range of situations. Sometimes a referral can be as simple as looking practitioners up in a directory. Sometimes it’s an extremely sensitive and risky situation with potentially catastrophic outcomes. The accepted way of regulating this complexity is to hold practitioners accountable for using their professional judgment to make a referral that ensures the patient will make it safely to the next caregiver. There has never been a need to change that.
There is a deeper, even more troubling side to this debate. For some, applying “conscience clause” logic to mental health creates opportunities to confront, berate, and bully those who offend one’s deeply held convictions. For some, simply informing patients that not all practitioners have the same deeply held beliefs is too much to ask. For health care professionals, this violates the very first of Hippocrates’ rules -- do no harm. This impasse is an extreme case of a mean-spirited solution looking for a defenseless problem. The only justification given by any state official is that the Catholic Conference demands it. It only makes sense as a politicization of health care regulation, to promote discrimination against vulnerable people on behalf of a special interest, with disregard for public safety or the public interest.