Womens Health: Doctors' beliefs can hinder patient care

[ignutzz]

From a recent MSNBC article: (http://www.msnbc.msn.com/id/19190916/)
Lori Boyer couldn't stop trembling as she sat on the examining table, hugging her hospital gown around her. Her mind was reeling. She'd been raped hours earlier by a man she knew � a man who had assured Boyer, 35, that he only wanted to hang out at his place and talk. Instead, he had thrown her onto his bed and assaulted her. "I'm done with you," he'd tonelessly told her afterward. Boyer had grabbed her clothes and dashed for her car in the freezing predawn darkness. Yet she'd had the clarity to drive straight to the nearest emergency room � Good Samaritan Hospital in Lebanon, Pennsylvania � to ask for a rape kit and talk to a sexual assault counselor. Bruised and in pain, she grimaced through the pelvic exam. Now, as Boyer watched Martin Gish, M.D., jot some final notes into her chart, she thought of something the rape counselor had mentioned earlier.

"I'll need the morning-after pill," she told him.

Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. "No," Boyer says he replied abruptly. "I can't do that." He turned back to his writing.

[edit]

If he wasn't willing to write an EC prescription, she'd be glad to see a different doctor. Dr. Gish simply shook his head. "It's against my religion," he said, according to Boyer.
In a survey published this year in The New England Journal of Medicine, 63 percent of doctors said it is acceptable to tell patients they have moral objections to treatments, and 18 percent felt no obligation to refer patients elsewhere. And in a recent SELF.com poll, nearly 1 in 20 respondents said their doctors had refused to treat them for moral, ethical or religious reasons. "It's obscene," says Jamie D. Brooks, a former staff attorney for the National Health Law Program who continues to work on projects with the Los Angeles advocacy group. "Doctors swear an oath to serve their patients. But instead, they are allowing their religious beliefs to compromise patient care. And too often, the victims of this practice are women."

The American Medical Association in Chicago, the nation's largest physician group, effectively agrees with her; its policy allows a doctor to decline a procedure if it conflicts with her moral ideology. The law also favors medical professionals. In 1973, following Roe v. Wade, Congress passed the so-called Church Amendment, allowing federally funded health care providers to refuse to do abortions. In the years since, 46 states have adopted their own abortion refusal clauses � or, as proponents call them, conscience clauses � allowing doctors to opt out. Now many states have gone further. Sixteen legislatures have given doctors the right to refuse to perform sterilizations; eight states say doctors don't have to prescribe contraception.
Reproductive health is seen as something other than regular health care" � not a straightforward matter of treating and healing, but something laden with morality � "and if you treat it that way, it becomes something providers can say yes or no to." Men, for the most part, escape such scrutiny: It's pretty hard to imagine someone being made to feel he's going straight to hell for choosing to take Viagra or get a vasectomy. And if women come to fear their doctors' judgments, a new set of problems can develop. "Then you have women who don't communicate with their doctors or avoid getting care," Morrison warns. "Any way you look at it, it's dangerous for women."

Every Catholic hospital is bound by the ethical directives of the U.S. Conference of Catholic Bishops, which forbid abortion and sterilization (unless they are lifesaving), in vitro fertilization, surrogate motherhood, some prenatal genetic testing, all artificial forms of birth control and the use of condoms for HIV prevention.[:eek:] Baptist and Seventh Day Adventist hospitals may also restrict abortions. Which means that if your local hospital has been taken over — or if you're ever rushed to the nearest hospital in an emergency — you could be in for a surprise at the services you can't get.

Edited to follow CR rules.

----------------------------------

I've always been aware of this issue, more so now than ever, but reading this article just twists my gut into knots. My visceral reaction of course is "who the **** are these health care providers to deny me appropriate care that I've specifically requested?" I realize however that this is a MUCH much more complicated issue. :o

I like that there are certain states that make it mandatory to provide EC to rape victims and I hope that the federal effort is successful. Perhaps another idea is to encourage individual hospitals to restrict those HCPs with objections from attending those cases that would conflict with their ability to provide complete care.

And, while this may or may not be the actual case, I just feel like women are constantly being treated as if we're children who can't take care of our own health properly. (I know this is not universally true (if at all), but I'm upset and feeling a bit angry about this situation.)

[LyLMyssChaos]

This is terrible. I fully support a doctor's choice to not perform certain treatments, but they should be upfront with the patient and tell them that they will not do such treatments and offer a list of alternative doctors who will.

[ajb524]

I read this article today and it made me so angry. I just cannot fathom going to a doctor after being raped and basically told that he cares more about a potential pregnancy that my care at that moment.

The women who was 14w PG and her water broke was terrible. There was no way that pregnancy was viable, yet the hospital wouldn't allow the doctor to terminate. Instead she needed to wait to get an infection which would have put her health at risk. Absolutely ridiculous!!!!!

I understand they may object based on religious beliefs, but part of me feels like they knew what they were getting into when they chose this profession. And regardless they should provide information on someone who will provide the service.

[MLA]

And, while this may or may not be the actual case, I just feel like women are constantly being treated as if we're children who can't take care of our own health properly. (I know this is not universally true (if at all), but I'm upset and feeling a bit angry about this situation.)


I feel the same way. You don't hear about this sort of stuff when it comes to men's health care. No one's refusing to do prostate surgery on a man because it could harm his reproductive abililities. No one's refusing to remove a man's testicles if its necessary to treat cancer. It's just so frustrating.

[BTB]

No one's refusing to do prostate surgery on a man because it could harm his reproductive abililities. No one's refusing to remove a man's testicles if its necessary to treat cancer.

Do you think that's an even comparison? For example, are you reading about doctors refusing to do hysteroscopies? Or refusing to remove cancerous ovaries?

[ignutzz]

LMC In the broad scope, I agree with you. BUT, there MUST be provisions in place to protect patients from this kind of prejudiced health care. I feel it is supremely unethical and discriminatory to not discuss EVERY legal option with a patient, and if the HCP is not going to provide the service they MUST provide immediate access to a provider who will.

ajb524 I completely understand your outrage. The stillbirth story was particularly awful.

As much as these decisions may be dictated by religion, they are affecting people who are NOT religious, or who are of different religions and that is NOT ok. I find it absolutely reprehensible that a conservative religious group is allowed to curtail health services to the general public. Churches don't belong in the healthcare business any more than they do in government.

MLA Those damn hormones, they just make us all hysterical and stupid. :rolleyes: On a more level headed note: so much of medicine used a male baseline that really leaves women, and their unique physiology, out in the cold. I recently learned that the indicators for heart attacks in women are entirely different than for men, yet all I hear about is the standard male symptoms! Which is particularly appalling considering that heart disease is the most common cause of death for women.

[lawyerlee]

The big problem I have with the situation as described above is that it is flat out bad care. If you have a personal issue that interferes with your ability to do your job, then you should plan ahead to address that issue. For instance, if the doctor had said he does not prescribe it, but gave her the names of three doctors he trusts and recommends who do, I would be okay with that.

I don't expect people to do things they find morally reprehensible, but I do expect them to realize these situations aren't all about them. They are fundamentally about the patients and making sure their needs are taken care of.

[BTB]

I feel it is supremely unethical and discriminatory to not discuss EVERY legal option with a patient, and if the HCP is not going to provide the service they MUST provide immediate access to a provider who will.

I agree with you on the first point - discussion should be separate from provision - but on your second point, do you have sources which show this is either the legal standard or the accepted moral standard? This reads as if you're putting this forward as the proscribed norm; perhaps you meant this as an opinion but I'm not sure.

Those damn hormones, they just make us all hysterical and stupid.

I'm pretty hormonal myself right now, but am perfectly willing to have (again) an intellectual discussion on this topic that's been done to death in other threads - assuming, of course, we can truly discuss it, and not rely on "visceral reactions" and fist-pounding that this is "wrong, wrong, wrong" as has happened in the past. ;)

[ysolde]

I would like to know on what medical grounds waiting is appropriate in this case. Is allowing a dead fetus to rot inside a woman so that her life is in danger in order to appease theologians really the standard of care these days?

If there's one thing both sides can agree on, it's this: In an emergency, doctors need to put aside personal beliefs to do what's best for the patient. But in a world guided by religious directives, even this can be a slippery proposition.

Ob/gyn Wayne Goldner, M.D., learned this lesson a few years back when a patient named Kathleen Hutchins came to his office in Manchester, New Hampshire. She was only 14 weeks pregnant, but her water had broken. Dr. Goldner delivered the bad news: Because there wasn't enough amniotic fluid left and it was too early for the fetus to survive on its own, the pregnancy was hopeless. Hutchins would likely miscarry in a matter of weeks. But in the meanwhile, she stood at risk for serious infection, which could lead to infertility or death. Dr. Goldner says his devastated patient chose to get an abortion at local Elliot Hospital. But there was a problem. Elliot had recently merged with nearby Catholic Medical Center — and as a result, the hospital forbade abortions.

"I was told I could not admit her unless there was a risk to her life," Dr. Goldner remembers. "They said, 'Why don't you wait until she has an infection or she gets a fever?' They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy." He tried admitting Hutchins elsewhere, only to discover that the nearest abortion provider was nearly 80 miles away in Lebanon, New Hampshire — and that she had no car. Ultimately, Dr. Goldner paid a taxi to drive her the hour and a half to the procedure. (The hospital merger has since dissolved, and Elliot is secular once again.)

[BTB]

Is allowing a dead fetus to rot inside a woman so that her life is in danger in order to appease theologians really the standard of care these days?

I neither agree with nor condone the way that case was handled, but if we're going to discuss it, we should be clear on the facts: the fetus involved was not dead. Further, it does not automatically follow that even early rupture kills the fetus, as some CC moms can attest.

[ignutzz]

Lawyerlee I agree with you completely.

BTB The first part of my statement that you quote was entirely opinion (as indicated by "I feel...") and my opinion on what I think should happen if an HCP is using a "conscience clause" to refuse treatment.

As for the second quote, if you read the end of my very first comment, as well as the remainder of the comment you quoted, it's very obvious that I understand and acknowledge that this is a big issue and that gut reactions are not going to get us anywhere. That doesn't mean that I don't get to express those feelings too though.

Re the early PPROM, I think you're right that there is not enough info presented to really understand what happened. But if it did happen as presented, and the hospital did want to allow the woman to become ill before they treated her, I just can't wrap my head around how that is responsible medicine. It just goes to solidify my opinion that churches have no place in providing healthcare.

[am_81]

I read this article in a friend's LJ yesterday. It wasnt all that surprising, but still mind-boggling all the same. Makes me quite depressed at the state of women's healthcare in the US.

[tlew12778]

I feel it is supremely unethical and discriminatory to not discuss EVERY legal option with a patient, and if the HCP is not going to provide the service they MUST provide immediate access to a provider who will.I agree with you on the first point - discussion should be separate from provision - but on your second point, do you have sources which show this is either the legal standard or the accepted moral standard? This reads as if you're putting this forward as the proscribed norm; perhaps you meant this as an opinion but I'm not sure. Obviously this article is about the US, but here in Italy it is law that if a medical practitioner refuses care based on religious or moral beliefs, they must provide access to a medical provider who will provide treatment. This also goes for pharmacies here who will not distribute ECP.

[jennylou]

I think if someone goes to a Catholic hospital, or a hospital affiliated with any religion, they have to expect that they are going to have to deal with whatever ideologies that that religion sets forth.

Now, if a person goes to a county hospital or a hospital unnaffiliated with a religion, they should not be told no due to religios feelings of the Dr. If that Dr has issues with contraception, etc, perhaps that Dr needs to find a new job at the Catholic/religious hospital. Sort of a seperation of church and state?

[j*east]

Just to post an alternate experience: I was raped (10 years ago) and went to the hospital. I was given a private waiting room with my two friends, both of whom (male, 20s, loud and kind of obnoxious on my behalf) were also allowed in the examining room with me. I was given emergency birth control as a matter of course. I received outstanding care; I know this in part because I later trained as a rape counselor and I know I received every recommended option.

So, this is not to say that the article does not portray horrific situations. Of course they are. However, there ARE plenty of hospitals/doctors out there who will give excellent care, and many do have special programs in place to educate health care professionals and law enforcement about what to do in cases of rape and assault.

OTOH, I had a terrible time with the police department, but that's another thread. :)

[Leilynne]

I think this is a tough subject. I don't think it's right to force doctors to perform procedures or administer drugs that violate their beliefs, however I think those doctors should take the initiative to recuse themselves from cases where they could face that issue. It is definatly unfortunate when no secular healthcare provider is available to a community. I just found out that my hospital is being absorbed by a Catholic healthcare organization and I am pissed because that means there is now no other alternative within a 40 min drive of my city. I personnaly believe that abortion is wrong, and I wouldn't use EC myself, but it's not my place to try to force others to live by my beliefs. I'm thinking about quitting actually, I don't think I'll feel comfortable working for a cathlic organization and I know I'm not the only staff member who feels that way. If this is happening in your community speak out! At the end of the day a hospital is just another business and if enough community members make it known that they will take their business elsewhere they will have no choice but to stay secular. I just hope it's not to late for my hospital.

[Niobe]

Now, if a person goes to a county hospital or a hospital unnaffiliated with a religion, they should not be told no due to religios feelings of the Dr. If that Dr has issues with contraception, etc, perhaps that Dr needs to find a new job at the Catholic/religious hospital. Sort of a seperation of church and state?

I really agree with this. I have a real problem with the idea that a licensed medical professional can refuse to give a patient proper, legal treatment for ANY reason, even religious. I can see respecting the patient's religious beliefs, but I just don't feel a doctor should place their personal beliefs over the patient's needs.

[mimieliza]

I think if someone goes to a Catholic hospital, or a hospital affiliated with any religion, they have to expect that they are going to have to deal with whatever ideologies that that religion sets forth.


Well, that works when you live in an area with many hospitals to choose from, but in vast swaths of the country, people have only one local hospital. So I guess you're just screwed if that hospital happens to have an ideologic disagreement with the treatment you require. If I want religion, I'll go to a church, not a hospital.

Our local hospital is Catholic. If someone were denied some vital service there (and I consider emergency contraception pretty damn vital) the nearest non-religiously affiliated hospital is 70 miles away. I know that a very large proportion of women who come to our local hospital as a result of sexual assault would not have any transportation to get to another hospital 70 miles away. That's the other thing about rural areas - no public transportation.


This is not the exception. This is the reality for most of the country. Luckily, our local OB-GYN provides ethical and fair treatment without imposing her religious beliefs (or the religious beliefs of the Catholic hospital) on her patients. But it's a total crapshoot in rural areas like this. Getting the wrong doctor could have devastating consequences. I think becoming pregnant with your rapist's baby or developing a uterine infection due to PROM that causes future sterility is pretty heavy burden for a woman to pay.

[ignutzz]

tlew12778 There are some states that DO require that EC be prescribed in cases like Boyer's and the article states that there is federal action under consideration. Unfortunately, the way the article tells it, the laws strongly favor the HCP and don't seem to take action to protect the patient (require an alternate HCP like you have in Italy).

JennyLou See mimieliza's post about the religious hospitals. Additionally, not all hospitals that are religiously affiliated make it obvious. The article states that even if a merger happens, there may be no outward indication (such as a name change) that such a big policy change is in effect.

On your second point, yeah, that would be nice. But wouldn't it also be employment discrimination??? (Honest question, I just don't know how something like that would work.)

j*east Thanks for posting your experience with the care you received. I certainly don't think this article describes every hospital or HCP but this has been an issue for a long time and doesn't seem to be getting any better.

Leilynne Sorry to hear your in that situation. I know some of these mergers have fallen through but I don't know if that was due to community pressure or just bad business situations. I think you're right about a community having some pull in an issue like this though.

Niobe I feel the way you do too. I think it's a really fine line right now trying to respect both sides of the relationship, and right now it's all favoring the HCP.

mimieliza Thanks for illustrating those issues.

[jennylou]

JennyLou See mimieliza's post about the religious hospitals. Additionally, not all hospitals that are religiously affiliated make it obvious. The article states that even if a merger happens, there may be no outward indication (such as a name change) that such a big policy change is in effect.

On your second point, yeah, that would be nice. But wouldn't it also be employment discrimination??? (Honest question, I just don't know how something like that would work.)


Hmm, I can see your point to an extent. I know we have a Catholic hospital that no where in the name does it say Catholic hospital - it does however display it as "a division of Catholic blah, blah, blah". If one didn't take the time to look at the small print (even on signs) or if one was in an area that there wasn't another hospital close by, I could see the problem. However, in that case, perhaps the Catholic hospital should stabilize if necessary and then send to another hospital?

As for the second point, I guess it could be. But, how about saying these are your duties, if you can't perform these duties, we need to know so that you won't be put in the position (or there can be another Dr there). I'd think that if you had huge issues with it as a Dr, you, as the Dr should seek out a place of employment that is likeminded, kwim?

[jennylou]

Well, that works when you live in an area with many hospitals to choose from, but in vast swaths of the country, people have only one local hospital. So I guess you're just screwed if that hospital happens to have an ideologic disagreement with the treatment you require. If I want religion, I'll go to a church, not a hospital.

Our local hospital is Catholic. If someone were denied some vital service there (and I consider emergency contraception pretty damn vital) the nearest non-religiously affiliated hospital is 70 miles away. I know that a very large proportion of women who come to our local hospital as a result of sexual assault would not have any transportation to get to another hospital 70 miles away. That's the other thing about rural areas - no public transportation.


This is not the exception. This is the reality for most of the country. Luckily, our local OB-GYN provides ethical and fair treatment without imposing her religious beliefs (or the religious beliefs of the Catholic hospital) on her patients. But it's a total crapshoot in rural areas like this. Getting the wrong doctor could have devastating consequences. I think becoming pregnant with your rapist's baby or developing a uterine infection due to PROM that causes future sterility is pretty heavy burden for a woman to pay.


Is it necessary to get the morning after pill right then and there? Couldn't the woman go to a Dr during regular business hours and get the RX?

We must have an abundance of hospitals in our area - I can't imagine one hospital serving a population without another hospital in 70 miles. :eek:

[ignutzz]

JennyLou I completely understand what you're saying about the hospitals and HCPs and I agree with your thoughts on that.

To play devil's advocate regarding your EC scenario: She finds an alternate Dr and then can't the the scrip filled because the local pharmacists refuses to dispense any kind of contraception....

No matter how you spin it, and who the people are, it's just ok for personal religious beliefs to hinder legal (and I would say proper but that's debatable) health care.

[katmg]

Is it necessary to get the morning after pill right then and there? Couldn't the woman go to a Dr during regular business hours and get the RX?

Yes, but if she is poor, she is unlikely to A)have a regular Dr. B) Have enough money to pay for an add'l visit to the dr. and the Rx. C) Be able to take add'l time off from work to see the dr.

Why should she have to pay more money b/c of her dr.'s religious beliefs? She was already getting treatment, she shouldn't have to seek additional services to fulfill part of her treatment.

[mimieliza]

Is it necessary to get the morning after pill right then and there? Couldn't the woman go to a Dr during regular business hours and get the RX?

The sooner it's taken after sex, the more effective it is. The efficacy drops rapidly, so 8 or 12 hours could make a huge difference. And so many people do not have a regular doctor - you can't just call a doctor who has never seen you and expect to get a same-day appointment (especially when you have no health insurance).

I can't imagine one hospital serving a population without another hospital in 70 miles.

There is one about 55 miles away, but it is Catholic, too. OT, but I'm a bit disgruntled because our local hospital doesn't do VBACs, and I had a c-sec. I'll probably end up with a repeat c because I'm not willing to drive 70 miles while in labor.

[Annette]

But Catholic directives specify that even in an ectopic pregnancy, doctors cannot perform "a direct abortion" — which, the on-call ob/gyn reasoned, would nix the drug option. (Surgery, on the other hand, could be considered a lifesaving measure that indirectly kills the embryo, and may be permitted.)

OMG!! That is awful! The whole article was very upsetting especially when these women were denied care even though their baby would not survive. And in this case of the ectopic, this woman had to lose a tube???

Isn't EC available OTC now?

[ajb524]

Isn't EC available OTC now?

Yes, for women over the age of 18. You also have to get it from the pharmacist (but no RX required).

[msnicolea]

re: EC: It's still not available at every pharmacy, though.

If your religious views prevent you from doing your job and treating EVERY patient fairly, then find a new profession.

[jennylou]

The sooner it's taken after sex, the more effective it is. The efficacy drops rapidly, so 8 or 12 hours could make a huge difference. And so many people do not have a regular doctor - you can't just call a doctor who has never seen you and expect to get a same-day appointment (especially when you have no health insurance).



There is one about 55 miles away, but it is Catholic, too. OT, but I'm a bit disgruntled because our local hospital doesn't do VBACs, and I had a c-sec. I'll probably end up with a repeat c because I'm not willing to drive 70 miles while in labor.

OT - the Catholic hospital won't do vbacs? Wow, the Catholic hospital here seemed more vbac friendly than the other hospital. I thought it (vbac) tended to fall into more of their beliefs.

*********************

I honestly don't know what the magic solution is. I just understand how if you go to a religious hospital, the chances of having to follow hospital policy will fall in line with that religious affiliations views on things. It's like if you want your child to go to Catholic school because the curiculum is the best in town and the public school system stinks, chances are high that they're going to be taught from a Catholic perspective.

[am_81]

You also have to get it from the pharmacist (but no RX required).


*But* you have to find a pharmacy that will have it stocked. I needed to take it once (back when I lived in Dallas) and I had to call around to several different places before I could anyone who would even fill the prescription. It was Target that I ended up getting it from IIRC.

[ysolde]

If your religious views prevent you from doing your job and treating EVERY patient fairly, then find a new profession.

My feelings exactly. Look, I used to be a tobacco defense attorney. Had I not been able to provide my client with the best possible defense, I needed to reconsider being an attorney. Some people defend people accused of horrible crimes. If they cannot provide the best possible defense to their clients, they need to find another profession. We don't get to pick and choose how we provide our services based on our personal morality. That would get us disbarred. I may not like a client who I know has committed a heinous crime, but if I know the evidence against him was obtained illegally, it is my duty to get that evidence excluded. End of discussion.

My doctor may not like what EC may (or may not) do. But if I have been raped, I am his one and only patient, and if his morality gets in the way of providing me the best possible medical care, then perhaps he should go into dermatology, or not practice medicine at all.

[ysolde]

OT - the Catholic hospital won't do vbacs? Wow, the Catholic hospital here seemed more vbac friendly than the other hospital. I thought it (vbac) tended to fall into more of their beliefs.

*********************

I honestly don't know what the magic solution is. I just understand how if you go to a religious hospital, the chances of having to follow hospital policy will fall in line with that religious affiliations views on things. It's like if you want your child to go to Catholic school because the curiculum is the best in town and the public school system stinks, chances are high that they're going to be taught from a Catholic perspective.

Are you going to be that comfortable when Christian Scientists buy your local hospital? Jehovahs Witnesses?

[jennylou]

Are you going to be that comfortable when Christian Scientists buy your local hospital? Jehovahs Witnesses?

Yes - I'd find another hospital or healthcare facility if they were not writing a prescription for something that I need.

[ysolde]

Yes - I'd find another hospital or healthcare facility if they were not writing a prescription for something that I need.


A Christian Science hospital would not dispense medication, no matter how ill you were. If the nearest hospital were 70 miles away, and you might die in transit, too bad.

A JW hospital would not provide blood products. If the nearest hospital were 70 miles away, and you might die in transit, too bad.

[jennylou]

A Christian Science hospital would not dispense medication, no matter how ill you were. If the nearest hospital were 70 miles away, and you might die in transit, too bad.

A JW hospital would not provide blood products. If the nearest hospital were 70 miles away, and you might die in transit, too bad.

But we're not talking about a life and death situation from the first post. The woman can go to another Dr for a prescription for the morning after pill. It's like comparing apples to oranges.

[ajb524]

*But* you have to find a pharmacy that will have it stocked. I needed to take it once (back when I lived in Dallas) and I had to call around to several different places before I could anyone who would even fill the prescription. It was Target that I ended up getting it from IIRC.

Yep, I had the same problem. I was finally able to get it from Kroger (this was before it available OTC though). When I first called Walgreens they claimed to have it and then when the RX was called in they called me to tell me they were "out of stock". I suspect the pharmacist did not want to fill it, but I needed to get it ASAP so I just went with Kroger once I found out they had it and would fill it for me.

[ignutzz]

But we're not talking about a life and death situation from the first post. The woman can go to another Dr for a prescription for the morning after pill. It's like comparing apples to oranges.

No, it's really not. It doesn't matter what the situation is, or if the service is available elsewhere. If it's a legal course of treatment, then it should be available at EVERY hospital/healthcare facility.

[ysolde]

Again, from the original article, life and death issues are involved:

If there's one thing both sides can agree on, it's this: In an emergency, doctors need to put aside personal beliefs to do what's best for the patient. But in a world guided by religious directives, even this can be a slippery proposition.

Ob/gyn Wayne Goldner, M.D., learned this lesson a few years back when a patient named Kathleen Hutchins came to his office in Manchester, New Hampshire. She was only 14 weeks pregnant, but her water had broken. Dr. Goldner delivered the bad news: Because there wasn't enough amniotic fluid left and it was too early for the fetus to survive on its own, the pregnancy was hopeless. Hutchins would likely miscarry in a matter of weeks. But in the meanwhile, she stood at risk for serious infection, which could lead to infertility or death. Dr. Goldner says his devastated patient chose to get an abortion at local Elliot Hospital. But there was a problem. Elliot had recently merged with nearby Catholic Medical Center — and as a result, the hospital forbade abortions.

"I was told I could not admit her unless there was a risk to her life," Dr. Goldner remembers. "They said, 'Why don't you wait until she has an infection or she gets a fever?' They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy." He tried admitting Hutchins elsewhere, only to discover that the nearest abortion provider was nearly 80 miles away in Lebanon, New Hampshire — and that she had no car. Ultimately, Dr. Goldner paid a taxi to drive her the hour and a half to the procedure. (The hospital merger has since dissolved, and Elliot is secular once again.)

[jennylou]

There are women here on CC who had their amniotic sack rupture months and months before they delivered their healthy, full term, babies. That's not a life or death situation. If it leads to infection it's a different situation.

[msnicolea]

But that's a slippery slope, Jenny. What if those same doctors who are refusing to provide EC decided that they were against a procedure that would save someone's life? Would that be ok? Because I don't think you (general you) can have it both ways--doctors shouldn't get to pick and choose what they will and won't do--they either need to provide the standard of care, or find another job.

What if a man contracted HIV from another man, and the doctor thought homosexuality was a sin--should he be allowed to deny the patient treatment? What's the difference between this scenario and the EC one? I can think of 57 examples that people would find unacceptable--yet they'll allow doctors the right to refuse EC all day long. I think it's hypocritical.

[mimieliza]

OT - the Catholic hospital won't do vbacs? Wow, the Catholic hospital here seemed more vbac friendly than the other hospital. I thought it (vbac) tended to fall into more of their beliefs.


Oh, no, I was unclear. They won't do VBACs because they have a policy against it, not because they are Catholic. It's just an example of some of the problems that arise when a particular hospital is the only game in town.

[mimieliza]

Yes - I'd find another hospital or healthcare facility if they were not writing a prescription for something that I need.

But we're back to the point that it's a very privileged position to be able to just go elsewhere. I would wager that many, if not most, of the people in the country don't have such choices.

I'll state it again: I go to hospitals for medical care, not religion. It is a hospital, not a church. If they want to impose their religious beliefs, they shouldn't be eligible to receive any public funding, including state and federal Medicare and Medicaid payments.

My husband is a criminal defense attorney (public defender). He has serious, moral issues with things his clients have done. But in accepting his job, in being admitted to the state bar, he made a commitment to protect his clients' interests. He doesn't get to opt out. Nor does he want to. I feel that doctors should be held to the same standard. They are to provide a medically sound standard of care to all of their patients. If they work in a hospital, they do not get to pick and choose their patients based on who they feel is morally fit.

[BTB]

If it's a legal course of treatment, then it should be available at EVERY hospital/healthcare facility.

If they work in a hospital, they do not get to pick and choose their patients based on who they feel is morally fit.

We're talking about two very different things when we discuss physicians' treatments and hospitals' offerings.

Physicians in this country work under a variety of business models. Some do work for a 'healthcare system' in that they are employed by a multispecialty group which is part of a larger corporate parent. However, the majority of physicians, even in hospital-based specialties like radiology, pathology, and anesthesiology work for physician-owned partnerships or small groups. These are private businesses that serve as independent contractors for the hospital; they are not hospital employees.

Should we extend this expectation of provision of all possible services to other businesses? For example, a customer decides they want to purchase only organic milk, but the grocer near them - say they're the only one for 70 miles - does not stock it. Does the customer have a right to demand their local provider deal in whatever goods they wish to purchase? Organic milk is, after all, a legal grocery option.

To keep the context closer to the discussion, for several reasons, most notably liability costs, more ob-gyns are presently chosing to practice only gynecology, and not to deliver babies. It's certainly in their job description to do so, but they take their privately-owned business and make their own business plan which no longer includes obstetrics. Should we as consumers have the right to force them to deliver a baby, since it's a legal healthcare service they're qualified to provide?

I understand the notion that healthcare is somehow - or at least ought to be - more than a business. But the fact is, that's not how it's presently treated in the US. If we want medicine to be more than a business, lots has to change, and this issue wouldn't be the place to start, IMO.

[ysolde]

BTB --

If I can't get organic milk, I can still get milk. If I can't get EC, and you are the only HCP in a 70 mile radius, I may have to spend weeks in agony, wondering whether my rapist has made me pregnant, and then try to get an abortion. If you refuse to provide an abortion, I am going to have to obtain an illegal abortion, putting my life at risk, all the while knowing that the man who tore me apart physically and emotionally continues to torment me, and that the people who are supposed to be helping me are now his accomplices.

[ysolde]

And, BTB, the Canons of Ethics governing attorneys make it clear that, once I have agreed to take on the representatino of a client, I must do it to the best of my abilities, whether or not I agree with what my client has done. Moreover, if I cannot continue to represent my client, I cannot just leave hm in the lurch. I must continue to represent him zealously until such time as he has found new representation. My personal feelings and morals have NOTHING to do with it.

One would think that the Medical Associations would require nothing less from the caregivers in whose hands we put our health and our very lives.

[Sarah]

Look, I used to be a tobacco defense attorney. Had I not been able to provide my client with the best possible defense, I needed to reconsider being an attorney.
Hm. I don't know anything about the legality of what you're saying, or what your professional ethics dictates, but I completely disagree. I would be perfectly fine with a lawyer refusing to defend certain people or certain acts, if they felt confident their client did what s/he was accused of.


Should we extend this expectation of provision of all possible services to other businesses? For example, a customer decides they want to purchase only organic milk, but the grocer near them - say they're the only one for 70 miles - does not stock it. Does the customer have a right to demand their local provider deal in whatever goods they wish to purchase? Organic milk is, after all, a legal grocery option.I think this is an excellent analogy, especially since many people feel that non-organic milk is dangerous and not fit for consumption.

I have some friends who only practice homeopathic medicine, and feel strongly that allopathic (what most of us would consider "regular" medicine) to be wrong. So if the local hospital/drugstore doesn't carry their homeopathic remedies, can they be outraged? After all, it's legal, and there might not be another homeopathy-providing store or hospital for miles and miles.

I have no problem with Dr's choosing which procedures to perform and not perform, especially since many doctors don't only base those practices on what their religious beliefs are, but also on what they feel is best for women's health. Of course I would be upset were I brought to a JW hospital and were harmed by lack of transfusion, but I wouldn't expect them to violate their beliefs. I think it demonstrates a huge feeling of entitlement that most people feel towards doctors.

A question- would those of you who feel very strongly about animal rights, or who are vegan, ever sell someone medicine which was tested on animals? Would you ever sell makeup which was tested on animals, or work in a grocery store which sold animal products?

I go to a midwife for my obstetrical and gynocological needs. She doesn't give epidurals, ever. Is this wrong? Should she be forced to?

And the OB whom I used to see didn't and doesn't do homebirths, which are legal in my state. Should he be forced to?

[Sarah]

If you refuse to provide an abortion, I am going to have to obtain an illegal abortion, putting my life at risk,But you took that risk (hypothetically), not the doctor. He's not responsible for what people do once he's refused you. You do have options, as repulsive and traumatic as they admittedly are.

Saying this as a rape survivor.

[BTB]

If I can't get organic milk, I can still get milk.

Okay then, say the grocer won't stock milk at all. Or bread. Or whatever product it is you want, that they don't carry. The point is simply that this is a business, and we don't place the burden on other businesses in our lives to have what we want, when we want it. If the business does a poor job of providing for customers' wants, it's not in business long, which serves it right - but we don't see governmental interference with the business' provision of goods.

If I can't get EC, and you are the only HCP in a 70 mile radius, I may have to spend weeks in agony, wondering whether my rapist has made me pregnant, and then try to get an abortion.

Doctors aren't very useful without hospitals, and hospitals are useless with just one doctor. Thus even tiny towns often fall into multiple catchment areas - two primary care doctors and a surgeon, for example. Regardless, the desire of the consumer remains what drives the market, but not what drives law. The same woman who would have to drive to the next town over for EC might also have to drive to the next town over for a bank, or to buy new shoes. Should Walmart be forced by law to open a store in that customer's area, so that everyone has convenient access to goods? Or, on a more pressing matter, should a healthcare system be forced to build a hospital in that customer's town, so that she needn't have a 70 mile drive to the nearest emergency room when she cuts her finger/has chest pain/needs IV rehydration?

If you refuse to provide an abortion, I am going to have to obtain an illegal abortion, putting my life at risk,

That's one leap too far IMO - if "I" (though this really isn't a conversation about me) refuse to provide "you" an abortion, "you" are going to have to seek one elsewhere, and one option facing "you" would be to obtain one illegally.

The realities of rural life include less convenient access, and sometimes the absence of access, to all kinds of products and services. Doctors are horribly geographically distributed as it is; not permitting physician entrepreneurs who enter these areas to write their own business plans won't solve the problem of access, instead, IMO, it will only hinder access further by redirecting some of the doctor supply to areas where they can be in charge of their own business.

[pocket]

this is very clear to me when it comes to pharmacists. a pharmacists job is to fill prescriptions. not to moralise about what sorts of medications have been legally prescribed to a client. if you can't fill prescription, you can't do your job and you should find something else that suits you better. But when it comes to doctors, i am less certain. i get that a doctor might have some moral issues with performing certain tasks. I actually think it's the hospital's fault for assigning this person to the ER. If you have limitations because of your religious beliefs and your employer is willing to work with you, that's great. But it shouldn't be at the expense of patient care. I don't go to doctors who don't do abortions - it's one of the first questions I ask. i think that a doctor who feels that they can't prescribe EC or contraception of any kind, shouldn't be working in an ER where they might reasonably have to perform this duty.

[BTB]

And, BTB, the Canons of Ethics governing attorneys make it clear that, once I have agreed to take on the representatino of a client, I must do it to the best of my abilities, whether or not I agree with what my client has done. Moreover, if I cannot continue to represent my client, I cannot just leave hm in the lurch. I must continue to represent him zealously until such time as he has found new representation. My personal feelings and morals have NOTHING to do with it.

One would think that the Medical Associations would require nothing less from the caregivers in whose hands we put our health and our very lives.

You can rest assured there are moral guidelines - and laws - against patient abandonment. But abandonment has a specific definition, and does not carry an obligation of the physician to treat anyone with anything at any time.

I don't think it's reasonable to expect the "Canons of Ethics" of one profession to apply verbatim to a different profession. They're different in many ways. Attorneys, for example, can bill clients for time spent on the phone with clients, time spent reviewing paperwork, even time spent thinking about and researching a case, if I understand correctly. OTOH, physicians can spend a quarter of their workday on the phone and filling out paperwork, and don't make a penny for any of that time.

[thyme]

And frankly, I don't see how the legal ethics hold up as a comparison anyway, unless you're employed by the government as a public defender. You are required to represent your client to the best of your ability -- once you've agreed to do so. You, in private defense practice, have a choice to take a given case or not.

[LittleFredPunkinHead]

I don't think it's reasonable to expect the "Canons of Ethics" of one profession to apply verbatim to a different profession. They're different in many ways.
In which case, isn't it reasonable to think that a grocer doesn't need to meet the canon of ethics of an attorney, or of a doctor?

[Leilynne]

Of course I would be upset were I brought to a JW hospital and were harmed by lack of transfusion, but I wouldn't expect them to violate their beliefs. I think it demonstrates a huge feeling of entitlement that most people feel towards doctors.

A question- would those of you who feel very strongly about animal rights, or who are vegan, ever sell someone medicine which was tested on animals? Would you ever sell makeup which was tested on animals, or work in a grocery store which sold animal products?

I go to a midwife for my obstetrical and gynocological needs. She doesn't give epidurals, ever. Is this wrong? Should she be forced to?

And the OB whom I used to see didn't and doesn't do homebirths, which are legal in my state. Should he be forced to?

Because it's been brought up a few times I thought I would mention that there are several Jehovah's Witnesses that work at my hospital and they are just as upset about the move to Catholic provided healthcare as everyone else. It's their churches offical position that they put their resources towards their preaching work not building hospitals etc, so there is no such thing as JW hospital. Also while they don't believe in abortion (birth control is a personnal choice for them) or blood transfusions they don't believe it's their right or business to oppose others for having one. Two of the nurses are JW and they explain it as they wouldn't be directly involved in an abortion but they wouldn't refuse to care for a patient after, like they wouldn't judge her and refuse to give her meds etc., also they wouldn't want to hang a blood transfusion but if someone got an infection after a transfusion they wouldn't say "well that's what you get" and not help them. I think that's a pretty acceptable balance, doing everything you can for someone without compramising your own beliefs.

Good point Sarah about the feeling of entitlement that people seem to have about medicine. So often I see that in the ER people feel entitled to be seen immediatly or get the treatment/medicine they feel they deserve. What does everyone think about doctors refusig to administer a drug or treatment for other reasons? What if there is a drug you want to try that is legal but your doctor feels that it hasn't had enough testing? What if there is a procedure you want that your doctor feels you don't need? One of our local doctors will not prescribe anti-biotics for things like ear aches etc., he is from Europe where it is not as common to do so. He feels very strongly that anti-biotics are over prescrived in America and that this is dangerous? Should he be forced to give my child anti-biotics just because I want them?

[Sarah]

explain it as they wouldn't be directly involved in an abortion but they wouldn't refuse to care for a patient after, like they wouldn't judge her and refuse to give her meds etc., also they wouldn't want to hang a blood transfusion but if someone got an infection after a transfusion they wouldn't say "well that's what you get" and not help them. I think that's a pretty acceptable balance, doing everything you can for someone without compramising your own beliefs.
well, of course. Is this an issue? I mean that seriously- are there people in this thread who have said "oh that's what she gets" about a woman who suffers complications from abortion or EC or any controversial procedure or medication?

I wouldn't be involved in an abortion in any way, but were I in a position to do so, I would do everything in my power to support a woman who had had an abortion- there's no use in not giving her after care, once the abortion is done. Likewise for EC- I wouldn't give it out or help someone find it, but if a friend had a complication (I don't think there are the same types of complications, but still) I would support her and do whatever was in my power to help. I think it's a stereotype that those who disagree with some of these procedures or medications are necessarily hateful, vengeful, or think that women "deserve what they get" if they suffer complications. I know a number of women who've had abortions in the past, and I have nothing but respect for them, as friends and acquantainces.

[msnicolea]

I don't understand why this conversation is constantly framed by an abortion debate. Sarah, would you think it was ok for a doctor to refuse to treat a homosexual with HIV if that doctor thought being gay was morally wrong? Would THAT be an acceptable exercise of the doctors's "moral perogative"?

As for the argumnent re: pharmacies not carrying homeopathic medications, for example--we talking about the standard of care, NOT having every possible alternative available to every possible patient.

I sincerely hope that those of you opposed to ECin every circumstance never have to face an unwanted pregnancy as a result of sexual assault.

[ysolde]

Or would it be OK for a doctor to refuse to treat a victim of a gay bashing if the doctor believed being homosexual is morally wrong? A few bruises never hurt anyone, after all . . .

[msnicolea]

Exactly, ysolde. I mean, it's not life-threatening, after all.

No, it is evident to me that, as always, it comes down to the abortion issue--people wouldn't tolerate this kind of blatant discrimination and "selective" medicine if other "moral" issues were involved. But because the issue involves Choice, well then, it's fair game for a doctor to disregard his/her oath and duty.

[ysolde]

As to why so many of us find the callousness of refusing basic medical care to a traumatized rape victim abhorrent, I don't even know what to say . . .

[Sarah]

I don't understand why this conversation is constantly framed by an abortion debate. Sarah, would you think it was ok for a doctor to refuse to treat a homosexual with HIV if that doctor thought being gay was morally wrong? Would THAT be an acceptable exercise of the doctors's "moral perogative"?

As for the argumnent re: pharmacies not carrying homeopathic medications, for example--we talking about the standard of care, NOT having every possible alternative available to every possible patient.

Well, I think the gay bashing thing is totally different, because no matter what your feelings about homosexuality, you are not being asked to do something you find immoral, or be a party to someone else doing it. Treating a gay man or woman for AIDS (or any other disease) is in no way asking the doctor to do anything wrong, whereas asking a doctor to provide an abortion or an abortifacient drug may be asking them to violate their morals.
Or would it be OK for a doctor to refuse to treat a victim of a gay bashing if the doctor believed being homosexual is morally wrong? A few bruises never hurt anyone, after all . . .I don't think sarcasm will get us anywhere. You're making a logical leap which doesn't make sense. Surely you can see the fundamental differences between the two situations. The doctor treating the gay man is not being asked to have sex with him, but to treat him. Nothing immoral about treating someone. A doctor being asked to provide EC is being asked to perform what he feels may be an abortion, and which he feels is wrong.

I don't think it necessarily needs to be framed around abortion at all- it's a larger issue about people being asked to violate their rights. That's why people brought up JWs and blood transfusions. However, abortion does figure into the discussion a lot, since the vast majority of these cases are about reproductive health and medicines or procedures which doctors believe cause abortions, which they disagree with.

No, it is evident to me that, as always, it comes down to the abortion issue--people wouldn't tolerate this kind of blatant discrimination and "selective" medicine if other "moral" issues were involved. But because the issue involves Choice, well then, it's fair game for a doctor to disregard his/her oath and duty. I don't think that's true- as I said, although it would make me angry, I don't have a problem with doctors refusing to give tubal ligations or any other controversial treatments or medications.

[phoenics]

I understand they may object based on religious beliefs, but part of me feels like they knew what they were getting into when they chose this profession. And regardless they should provide information on someone who will provide the service.

The gray-haired man knew that EC and legal abortion would be issues when they entered med school at age 22?

I'm not sure that's fair. We've made so many medical advancements that it's almost impossible to know at 22 what might be available when you're 70.

[msnicolea]

Again, if you don't believe in a woman's right to choose, then be a doctor of SOMETHING ELSE. Work with feet or noses--or hey, be a vet! But to enter the OB/GYN "field" means you have an obligation to provide the care your patient wants and needs, without judgment or prejudice.

[mimieliza]

Look, I don't even have a problem with people who oppose abortion or valid means of birth control (and I do not believe EC or hormornal BC cause abortions) being OB-GYNs. But, they have a duty to inform their patients that they will not provide certain services, and they need to refer their patients who need these services to someone who can and will provide the needed services in an accessible and timely manner.

And really, it's best if these doctors stay out of emergency rooms and clinics. They should have private practices so they can pick and choose which patients they will accept.

[phoenics]

I don't understand why this conversation is constantly framed by an abortion debate. Sarah, would you think it was ok for a doctor to refuse to treat a homosexual with HIV if that doctor thought being gay was morally wrong? Would THAT be an acceptable exercise of the doctors's "moral perogative"?



Okay - I feel uncomfortable with the way you've phrased the question. From a Christian perspective, it seems like many times people think that Christians hate homosexuals or something and that we live to persecute them or something... or that we'd stand by and willingly watch a person suffer - saying 'oh that's what they get'.

It makes the discussion of these issues hard. IF someone said they would not treat someone with HIV (who happened to be homosexual) because homosexuality is wrong, I would say that their 'belief' isn't Christian at all and that they are twisting the word of God to foster bigotry and hatred. If one follows the tenet of hating the sin but not the sinner, why would treatment that could save a life be refused?

There is a huge difference - but it seems like the tone of the thread is suggesting that people are doing the latter when they refuse treatment?

I think the reason it gets sticky in the case of EC is that refusing treatment there doesn't actually threaten life. That's why it's hard. I don't think you can force anyone to give someone something they believe ends human life (basically, in their minds, making them an accessory to murder). And then I think it gets into situations where everyone starts debating whether a doctor should have become a doctor.

It's definitely a tough issue.

[phoenics]

And really, it's best if these doctors stay out of emergency rooms and clinics. They should have private practices so they can pick and choose which patients they will accept.

Do they have that choice when they do residences?

[ysolde]

The gray-haired man knew that EC and legal abortion would be issues when they entered med school at age 22?

I'm not sure that's fair. We've made so many medical advancements that it's almost impossible to know at 22 what might be available when you're 70.


Ya know, Rita Moreno tells her story quite candidly. Back in the day, she was having an admittedly destructive but all-consuming love affair with the greatest living actor of his generation (think Method). He was married, as he was wont to be, and she was madly in love. She ended up pregnant. In those days (and, let's face it, things have not changed that much), Puerto Ricans were seen as dirty, oversexed people. So, Ms. Moreno's agent suggested what any good agent of that generation would suggest: have an abortion to save your career. Ms. Moreno had an expensive (but illegal) abortion. The doctor failed to remove all of the uterine contents, and, within days, Ms. Moreno had a severe infection. When she went tp see her doctor, he kicked her out of his office; after all, she was nothing more than a dirty, oversexed S___, and she was getting exactly what she deserved. Nor was he, a reputable ob/gyn, gonig to get involved in illegal activity after the fact. Her life was eventually saved by an ER nurse.

So, do I think that a grey-haired doctor knew that aortion would be legal? It's been legal nationwide since the early seventies, and in most states since before that, so, yes. Moreover, doctors have been dealing with abortion for decades, legal or not.

Finally, I remember my mother telling me about EC, back in the 70s. It was just a large dose of the BCP. It seemed to be quite common, back then. So I certainly think a grey-haired doctor now would have known about EC back then.

[msnicolea]

First of all, you GO, ysolde!

Secondly, my question had nothing to do with "Christians hating homosexuals." It's about the slippery slope that goes on when "morality" is used to justify discrimination or lack of treatment.

Doctors, particularly those in the ER, don't get to pick and choose who they treat--and whether the health issue is life-threatening or not is completely irrelevant.

What else can doctors refuse to do, under the umbrella of moral objection?

[mimieliza]

Do they have that choice when they do residences?

Hmmm... good question. I guess when they interview or apply for residencies, they need to make their limitations clear even if it bars them from certain residencies.


Really think about what we're talking about here: VALID and NECESSARY medical procedures such as emergency contraception after a rape and termination of a pregnancy which is very unlikely to be viable and very likely to threaten the mother's health. I can't believe this is even an issue - that plenty of folks are perfectly fine with doctors barring access to these procedures. It's sickening to think of a woman who has been raped or who is suffering a serious pregnancy complication being victimized again by her doctor who has so much power over her.

No one's saying that all doctors should be willing to provide elective abortions. But all doctors should provide these basic and valid medical options when they are in that position.

[Sarah]

Doctors, particularly those in the ER, don't get to pick and choose who they treat--and whether the health issue is life-threatening or not is completely irrelevant.But they aren't at all choosing who they treat- I agree with you on that. For a doctor to refuse to treat somone for being gay, of another race, of another creed, etc, is unacceptable morally and ethically. But these doctors are not asking not to treat certain people- they are saying there are some procedures and some medications they will not perform or prescribe.
Sarah, would you think it was ok for a doctor to refuse to treat a homosexual with HIV if that doctor thought being gay was morally wrong? Would THAT be an acceptable exercise of the doctors's "moral perogative"?
As I said in my other post, you must understand the problem with your analogy. It's a bad comparison.
VALID and NECESSARY medical procedures such as emergency contraception after a rapeValid and necessary are opinions here.

[Sarah]

Again, if you don't believe in a woman's right to choose, then be a doctor of SOMETHING ELSE. Work with feet or noses--or hey, be a vet! But to enter the OB/GYN "field" means you have an obligation to provide the care your patient wants and needs, without judgment or prejudice.I think you have a point to some extent- but OTOH, there are niche markets for doctors who dont/perform certain procedures, and niche markets for those who will. I know many women who won't see a doctor who does abortions, and then I know a few women who won't even go to doctors who give out contraception, at all (Catholic women), or who won't do ART. I don't agree with those latter two women's morals on those subjects, but I support their right to support the doctors whose morals they agree with. I think this is a situation where we should let demand decide what kind of doctors we have. Yes, it's very unfortunate if people who live in rural areas don't have access to certain services or medical procedures they may need or want, but as BTB stated, that comes with living out there. I know that some babies have died in rural areas (or remote ones) where there are no level 3 NICUs around, does that mean all hospitals should be forced to have level 3 NICUs, no matter the cost?

[msnicolea]

If I am a woman in need of EC and you refuse to give it to me, then you are choosing who to treat. You are saying "I refuse to privide you with the treatment you want/need becasue I don't agree with your choices." And that's unacceptable.

As for my analogy--well, I am quite comfortable with it, thanks! Your comparison of refusing to give medical care and the presence or non-presence of a NICU, however, is way off, as is the discussion re: women refusing to see doctors who perform certain procedures or give out certain medications. In this case, it is the PATIENT'S CHOICE--not the doctor's!

Many, many women have no choice re: who their care provider is--and they deserve comprehensive treatment without judgment.

[Sarah]

If I am a woman in need of EC and you refuse to give it to me, then you are choosing who to treat. You are saying "I refuse to privide you with the treatment you want/need becasue I don't agree with your choices." And that's unacceptable.It absolutely is not choosing who to treat. It is saying what procedure you won't do, or what prescription you won't write. And again, it is not about agreeing or disagreeing with your choices. It's about not wanting to be party to them.

[msnicolea]

It absolutely is not choosing who to treat. It is saying what procedure you won't do, or what prescription you won't write. And again, it is not about agreeing or disagreeing with your choices. It's about not wanting to be party to them.

Really? So if I say to my doctor--"I want and need procedure X" and she says "I won't do procedure X", she isn't refusing to treat me? You are playing semantic games and it's unproductive.

[Sarah]

As for my analogy--well, I am quite comfortable with it, thanks!Must you be so hostile?

It's a bad comparison. Treating a gay man is not having sex with him. Giving you an abortion or EC is (clearly, IMO) the taking of a life. This isn't just "I disagree with your choices", it's you asking me (the Dr.) to give you the tools with which to take that life.

Doing my best to use non-loaded language here, for the sake of discussion and respect.

[Sarah]

Really? So if I say to my doctor--"I need procedure X" and she says "I won't do X", she isn't refusing to treat me? You are playing semantic games and it's unproductive.It's not a game. If you, Msnicole, came to my office, and I was a doctor, and you say "I want some flu meds" but I see in your chart you had an abortion, and you are pg and are going to have another next week, then my refusing you the meds would be refusing you because I don't agree with your morals or politics. Or if I, as you said, refused to give a gay guy AIDS meds, because I disagree with the person's sexuality. But in this case the morals have a direct bearing on the treatment.

[msnicolea]

Sarah, I think it's safe to say that we all understand that having sex with someone isn't the same as killing him (although I have almost died of boredom, but that's another issue)--what I am saying is that this morality excuse is a slippery slope that leaves the door open for doctors to refuse to perform any treatment/prescribe any medication they don't approve of, and that is WRONG.

You are acting as though this allowance will only apply to abortion or other reproductive health services--and that's ridiculous.

Of COURSE morals have a "direct bearing" on treatment when a doctor refuses to give the treatment--how can you possibly not acknowledge that?

[Sarah]

Oh no, I don't think it will only apply to those things, I know it will apply to all kinds of medicine, but I think there's a clear difference and standard here. I have no problem, as I said, with doctors refusing other services based on their morals, as long as there is consistency and the decisions are based on asking the doctor to be involved in something he personally disagrees with.

I support this even in cases which are to my detriment.

For example, a close relative of mine was taken to a hospital several years ago, and this person needed (in most doctors' opinions) medication, since they were schizophrenic. Well, this hospital was Catholic, and the Dr. there had a real problem with psych meds, and wouldn't prescribe them. He felt therapy and prayer was best. I thought this was the dumbest thing I ever heard, and I transferred the relative, but I couldn't argue much with the choice, although I could argue with the belief.

[ignutzz]

...what I am saying is that this morality excuse is a slippery slope that leaves the door open for doctors to refuse to perform any treatment/prescribe any medication they don't approve of, and that is WRONG....
Some states are in fact trying to broaden the clauses to allow any HCP (nurse, Dr etc) to refuse to participate in course of action they find objectionable.
Since 2005, 27 states introduced bills to widen refusal clauses. Four states are considering granting carte blanche refusal rights — much like the law adopted by Mississippi in 2004, which allows any health care provider to refuse practically anything on moral grounds. "It's written so broadly, there's virtually no protection for patients," says Adam Sonfield, senior public policy associate for the Washington, D.C., office of the Guttmacher Institute, a reproductive-health research group. Sonfield notes that many refusal clauses do not require providers to warn women about restrictions on services or to refer them elsewhere.

[phoenics]

Again, if you don't believe in a woman's right to choose, then be a doctor of SOMETHING ELSE. Work with feet or noses--or hey, be a vet! But to enter the OB/GYN "field" means you have an obligation to provide the care your patient wants and needs, without judgment or prejudice.

That's probably a legit argument for new doctors - but not doctors who've been doctors long before abortion became legal.

[Sarah]

Of COURSE morals have a "direct bearing" on treatment when a doctor refuses to give the treatment--how can you possibly not acknowledge that?
??? What I mean is the difference, which you refuse to acknowledge, between asking a physician to do something (blood transfusion, EC, whatever) which he personally finds immoral, and asking him to treat someone whom he thinks is morally reprehensible. Big difference, I think.

[Sarah]

What about care for women who refuse to see a doctor who performs abortions, or gives EC, or gives any contraception at all, or performs tubal ligations? Don't they get to have doctors? Or is it too bad for them, they should see the doctor who does those things anyway?
Isn't there such a thing as integrity?

[thedoorchick]

I agree with what Sarah is saying here. Refusing to treat a particular condition or perform a particular procedure (regardless of the patient) is not the same as refusing to treat a person (regardless of the medical problem).

One is focused on the procedure or illness, the other on the patient. I don't think this is an argument of semantics at all, it's quite a discernable difference.

I can't decide if I agree or not with doctors refusing particular treatments, such as prescribing the morning after pill, but from a practical standpoint, I can't imagine I would want to be in a profession where it was likely I'd be asked to compromise my beliefs in order to get the job done.

[msnicolea]

Making a choice for YOURSELF is different than making a choice for someone else. If you choose to patronize only physicians that refuse to dispense EC, then knock yourself out. But doctors are making choices for other people, their patients, and that is entirely different.

Very disturbing excerpt, ignuttz.

[Sarah]

Making a choice for YOURSELF is different than making a choice for someone else. If you choose to patronize only physicians that refuse to dispense EC, then knock yourself out. But doctors are making choices for other people, their patients, and that is entirely different.

Very disturbing excerpt, ignuttz.
I agree, but you don't think doctors like the above shoudl exist, right? They should all be forced to dispense whatever? So where would those women go, if all doctors were forced to provide all services?

[phoenics]

Ya know, Rita Moreno tells her story quite candidly. Back in the day, she was having an admittedly destructive but all-consuming love affair with the greatest living actor of his generation (think Method). He was married, as he was wont to be, and she was madly in love. She ended up pregnant. In those days (and, let's face it, things have not changed that much), Puerto Ricans were seen as dirty, oversexed people. So, Ms. Moreno's agent suggested what any good agent of that generation would suggest: have an abortion to save your career. Ms. Moreno had an expensive (but illegal) abortion. The doctor failed to remove all of the uterine contents, and, within days, Ms. Moreno had a severe infection. When she went tp see her doctor, he kicked her out of his office; after all, she was nothing more than a dirty, oversexed S___, and she was getting exactly what she deserved. Nor was he, a reputable ob/gyn, gonig to get involved in illegal activity after the fact. Her life was eventually saved by an ER nurse.

So, do I think that a grey-haired doctor knew that aortion would be legal? It's been legal nationwide since the early seventies, and in most states since before that, so, yes. Moreover, doctors have been dealing with abortion for decades, legal or not.

Finally, I remember my mother telling me about EC, back in the 70s. It was just a large dose of the BCP. It seemed to be quite common, back then. So I certainly think a grey-haired doctor now would have known about EC back then.

There is a large difference between 30 and 50 years ago. Hell - technology I had 5 years ago is obsolete now.

What I am saying is that 40-50 years ago - when that doctor may have been in medical school, making choices about which branch of medicine a doctor may or may not have gone into - many people at that stage wouldn't have had all of the information to know what could happen. They couldn't know the laws that would be passed or the situations that they might face in the future. When I began my computer science courses, I had no idea how fast things would move and change - stuff I studied in college (which wasn't horribly long ago) has become near obsolete now. We also have issues now with privacy - issues that never really occurred to many in the field because even we didn't expect things to grow and move so quickly - so quickly now w.r.t. memory that Moore's Law is almost useless in terms of sw memory costs.

I wasn't really sure about what you meant to imply about Rita Moreno? Was that in response to me? Because I wasn't talking about illegal abortion.

[msnicolea]

I can't imagine I would want to be in a profession where it was likely I'd be asked to compromise my beliefs in order to get the job done.

Really? So you can't imagine choosing NOT to work for Planned Parenthood? Or, if you were anti-smoking, NOT working for a tobacco company? How about choosing to not be a cattle rancher if you were a vegetarian?

If you can't do the job fairly and completely, maybe it's not the job for you.

[Sarah]

Really? So you can't imagine choosing NOT to work for Planned Parenthood? Or, if you were anti-smoking, NOT working for a tobacco company? How about choosing to not be a cattle rancher if you were a vegetarian?

If you can't do the job fairly and completely, maybe it's not the job for you.

I think that's what she said- she doesn't think she's want to work in a place where her beliefs would be called into quesiton daily. ;)

[thedoorchick]

Really? So you can't imagine choosing NOT to work for Planned Parenthood? Or, if you were anti-smoking, NOT working for a tobacco company? How about choosing to not be a cattle rancher if you were a vegetarian?

If you can't do the job fairly and completely, maybe it's not the job for you.

I'm confused, and either I'm misunderstanding you, or you're misunderstanding me. I would never work for PP, for example. That's precisely what I was saying, but you seem to be saying the opposite. Or am I missing something?

[ignutzz]

That's probably a legit argument for new doctors - but not doctors who've been doctors long before abortion became legal.

Abortion is a practically negligible part of a woman's general reproductive health needs. The MUCH more practical application of this situation is access to birth control and that has been around for quite a long time, legally. And I do wonder how many men are being refused vasectomies by their urologists (on moral grounds, not the stupid age stuff)???

[msnicolea]

No--that's my point. If a doctor-to-be doesn't believe in providing comprehensive care to her patients, then she shouldn't be a doctor. Moral dilemma avoided!

[Sarah]

Right, that's what TDC said, Msnicole.


Abortion is a practically negligible part of a woman's general reproductive health needs. The MUCH more practical application of this situation is access to birth control and that has been around for quite a long time, legally. And I do wonder how many men are being refused vasectomies by their urologists (on moral grounds, not the stupid age stuff)??? I agree- abortion is probably a relatively small issue here, WRT to ER doctors, especially. EC is a bigger issue, especially with our rape, molestation, and poor teen contraception use rates.

I do know that the local Catholic hospitals of course won't do vasectomies or TLs, or provide any BC. They're pretty consistent, IMO.

[phoenics]

Secondly, my question had nothing to do with "Christians hating homosexuals." It's about the slippery slope that goes on when "morality" is used to justify discrimination or lack of treatment.

My point was in trying to get you to clarify which situation you were talking about. If you're talking about 'morality' - meaning people USING the issue of morality as a cover for being bigoted - then we do agree. But I'm talking more about the issue when someone is honestly being forced to do something that violates their moral code.

I get it that it can be a slippery slope - which is sort of the argument against certain medical procedures that are in question, according to what I've read.

What I was hoping to see in the discussion was at least an honest attempt to understand the predicament a person is in when they are honestly trying to lead a moral life and the 'secular' world then tries to marginalize them or punish them for that. I get it that you would hope that people who don't hold those beliefs would not be punished by the others' belief - but the way I see it, there has to be room for both. I just don't know how yet.


Doctors, particularly those in the ER, don't get to pick and choose who they treat--and whether the health issue is life-threatening or not is completely irrelevant.

I think it is relevant. I thought Sarah's point about 'entitlement' was interesting.


What else can doctors refuse to do, under the umbrella of moral objection?

This is what I was talking about... I think that the position that's being applied here is that anything the government or our legal courts pass into law is 'right' when that may not be true according to someone's moral beliefs. It's hard though. I'm not against someone refusing to do something that violates their moral code. What I am against is someone refusing to do something because of hatred or a desire to punish - while masquerading as though it falls under some moral umbrella. I do believe there is a difference and I think that is being overlooked here - worse, that it isn't even being considered by some on the 'don't refuse treatment' side.

[msnicolea]

I apologize, E--I did misread what you wrote.

[mimieliza]

I'm still really aghast that anyone thinks it is acceptable to deny EC to a woman who has been sexually assaulted. How do you defend this position?

[phoenics]

I'm still really aghast that anyone thinks it is acceptable to deny EC to a woman who has been sexually assaulted. How do you defend this (to me) indefensible position?

Keeping my own opinions out of it, why would anyone even try, as you've already labeled it 'indefensible'?

[msnicolea]

Well, the defense usually goes something like this:

"It's not the babies fault re: how it was conceived."
or
"EC=abortion=murder--regardless of the circumstances.

[phoenics]

Like I said - why would anyone even try to discuss it.

I'm so done with this 'discussion'.

[msnicolea]

Those are actual arguments that have been used multiple times--do you have a different one?

Seriously--multiple posters on this very board have sadid that EC = abortion and as such, should not be given out, regardless of cicumstances. How is it inflammatory for me to point that out?

If you have a different argument, then make it.

[mimieliza]

I'm still really aghast that anyone thinks it is acceptable to deny EC to a woman who has been sexually assaulted. How do you defend this position?

Edited my post to remove unnecessarily inflammatory language. But to me this is the heart of the issue.

[ysolde]

There is a large difference between 30 and 50 years ago. Hell - technology I had 5 years ago is obsolete now.

What I am saying is that 40-50 years ago - when that doctor may have been in medical school, making choices about which branch of medicine a doctor may or may not have gone into - many people at that stage wouldn't have had all of the information to know what could happen. They couldn't know the laws that would be passed or the situations that they might face in the future. When I began my computer science courses, I had no idea how fast things would move and change - stuff I studied in college (which wasn't horribly long ago) has become near obsolete now. We also have issues now with privacy - issues that never really occurred to many in the field because even we didn't expect things to grow and move so quickly - so quickly now w.r.t. memory that Moore's Law is almost useless in terms of sw memory costs.

I wasn't really sure about what you meant to imply about Rita Moreno? Was that in response to me? Because I wasn't talking about illegal abortion.

Someone who was in med school 40-50 years ago is (or is pretty close to) reitred by now, and I find it hard to believe that they would still be working in the ER. Quite frankly, though, the people who are at the forefront of this new-fangled "I am going to study medicine, go into ob-gyn, and not learn abortion procedures (although D&C is often used when a woman has had a miscarriage, so watch out for me, ladies, because I have refused to learn a life-saving procedure!), refuse to dispense birth control (and if I am the only ob-gyn in the neighborhood on your medical plan, I guess I'll be seeing you as you give birth EVERY YEAR -- hope you don't mind dying young, dearie), will not dispense EC if you have been raped (what's a lifetime of ongoing rape to you, anyway, you're just a woman?) etc." is a fairly new phenomenon, which began when the religious right realized they could not win the war against women in the legislature, and so decided to do it in the medical schools, pharmacies, and in the medical offices.

[msnicolea]

ysolde is exactly right-there are actually people entering medicine with an anti-choice, anti-woman AGENDA--and this is frightening.

[phoenics]

Where have they been used? I usually stay out of these discussions because of how nasty the threads tend to turn and because I typically feel that anyone who is against abortion or EC ends up vilified. It's not pretty to watch - and believe it or not, I can tell that you're just waiting to rip me apart no matter what I say about it.

I don't think that the question is as mimieliza posed it: at least not to me. Her question was basically a strawman. I'd rather not debate over straw.

For me, I was more concerned that the doctor would not refer the rape victim to another doctor. I believe that if a doctor believes that a procedure harms human life - that of an unborn baby - then forcing that doctor to prescribe EC would be in violation of the hippocratic (sp?) oath. BUT a doctor who then refuses to even refer said patient to someone else? I disagree with that vehemenently.

I used to be pro-choice. Now, I'm not so sure what I am. Part of the time I feel that women should have the right to choose. Other times, I wonder if it's murder. It gets harder to think about when the mother's life is at risk or when a woman was raped. But, if the number of times a doctor has to make an EC choice is really as small as some said on this thread - was that ysolde or you, misnicolea? - then hopefully if said situations come up, there are other doctors who can then give out the prescription.

What bothered me the most about this situation was that the doctor wouldn't even refer the patient. That's not right, imo.

[phoenics]

Someone who was in med school 40-50 years ago is (or is pretty close to) reitred by now, and I find it hard to believe that they would still be working in the ER. Quite frankly, though, the people who are at the forefront of this new-fangled "I am going to study medicine, go into ob-gyn, and not learn abortion procedures (although D&C is often used when a woman has had a miscarriage, so watch out for me, ladies, because I have refused to learn a life-saving procedure!), refuse to dispense birth control (and if I am the only ob-gyn in the neighborhood on your medical plan, I guess I'll be seeing you as you give birth EVERY YEAR -- hope you don't mind dying young, dearie), will not dispense EC if you have been raped (what's a lifetime of ongoing rape to you, anyway, you're just a woman?) etc." is a fairly new phenomenon, which began when the religious right realized they could not win the war against women in the legislature, and so decided to do it in the medical schools, pharmacies, and in the medical offices.

Okay. I'm not familiar with this campaign against women - though I have heard the debate framed that way before. I think it's a much tougher issue than it appears to be on the surface... and just as you can come up with the 'war against women' terminology, I'd imagine that the religious right (as you call them) would probably turn that back around and say that the other side was waging war on innocent unborn children.

My point is that the language 'war on...' really isn't helpful to the discussion and only puts people on the defensive.

[phoenics]

ysolde is exactly right-there are actually people entering medicine with an anti-choice, anti-woman AGENDA--and this is frightening.

That is frightening - but are you sure it's 'anti-woman' and that it's an 'agenda'? Do you see how terms like this actually marginalize people who honestly want to practice medicine, but who have strong moral beliefs about abortion and EC? It's like you're painting them all with this 'brush'.

[msnicolea]

If you go into the field of medicine with an express desire to prevent access to LEGAL health services, then yes, it is an "agenda."

[ysolde]

phoenics --

I first found out this was going on when a close friend went to Med School, and one of her classmates, who was somehow totally underwritten by some extreme right wing Roman Catholic foundation (as opposed to my friend, who had graduated from Harvard with debt, and was incurring major med school debt), refused to learn the D & C procedure, because he was "opposed to abortion in all cases." When one of the women in the class pointed out that the D & C had been used on her after a recent miscarriage, and the prof told him that it was, in fact, a multi-use procedure, he told the woman that there was "no reason for a single woman to have a miscarriage." While the rest of the class had no idea what they were going to do with their degrees, this nasty whackjob knew from day 1 he was going into OB-GYN, would never perform abortions, or do anything contrary to the teachings of the RC church. He lobbied the med school (in the midwest) to stop teaching abortion procedures, and, as it turned out, he had a whole organization behind him. This was back in the 1990s.

[katmg]

Argh! So what's a married gal to do when she has a miscarriage necessitating a D&C? Die from infection b/c it's just too bad that her OB/GYN didn't learn that dirty procedure?!

Banging head against the wall at the stupidity of it all...

[ysolde]

Well, according to some doctors, it is simply market forces -- doctors should be allowed to practice medicine however they darn well please, and if it goes against their moral principles to learn to perform a basic, lifesaving procedure, and you live in an area where this is the only doc around, well, you know, dying from infection is akin to not being able to buy organic milk at your local grocer. Just remember, people go to med school to inflict their personal morality on their patients, not to be healers.

[Sarah]

I'm still really aghast that anyone thinks it is acceptable to deny EC to a woman who has been sexually assaulted. How do you defend this position?Not sure how to answer this- I think as an educated woman you know why people feel this way, it's just incomprehensible to you, right? I am sure you know that arguments for and against abortion, and the argument that EC (hormonal BC) is abortifacient, or can be, yes?

And as I said, I have been raped, so I have some idea of what I am saying, however I have not become pregnant as a result, so I don't fully empathize with the position at all.
Argh! So what's a married gal to do when she has a miscarriage necessitating a D&C? Die from infection b/c it's just too bad that her OB/GYN didn't learn that dirty procedure?! I have no problem with physicians learning the D&C procedure. Did anyone say they had a problem with this? It's a red herring.

Again, calling people's opinions stupid or anti woman is inflammatory. I wouldn't call your positions stupid or anti child, or anti life.

It seems clear to me that few people here want to have an exchange of ideas. It's clear that you want to rant about the stupidity of people who disagree with you, and it's just masturbatory. If you want to rant and have people post "Yeah! Screw those horrible conservatives!" then do so, but why post in a thread for conversation and debate if you just want to roll your eyes and get furious when people disagree? Aren't you capable of having a debate without rudeness?

[jesvet]

I'm torn on this, I really am.

On the one hand- I am appalled the same way others are at women who are being denied access to what I and many others perceive as necessary care.

OTOH, I can understand a doctor's need from their own perspective to be able to uphold their own sense of ethics. Although I don't work in human medicine, it isn't uncommon for someone to request that I do something I'm not comfortable with. It usually involves euthanizing a pet for a reason I don't think is valid. And although I understand their right to do so and will tell them where they can go to have it done, and don't usually get into it with the client about how I think they are wrong, I PERSONALLY cannot do something i don't think is the right thing to do. It has less to do with the client or patient and more with myself and my need to be able to sleep at night.

So although I disagree with someone refusing to provide EC or the like, I can empathize with the quandry of being expected to do something that, in your heart of hearts, you think is the wrong thing to do. And although I wouldnt want someone to do something that they feel goes against their oath to do no harm or the like, by the same token I guess if there is a reasonable expectation that this is something they are going to be asked to do on a regular basis, they should be equipped to provide accomodations for people to access those services rather than try to withhold it entirely as part of an agenda. And that is kind of the key point to me.

[katmg]

Sarah - I was responding to ysolde's post re: physicians going to med school and refusing to learn the D&C procedure at all. I do think that doctors have the right to refuse to do certain procedures, etc BUT I think that they must provide referrals to providers who do not have moral objections.

[wendalah]

this nasty whackjob knew from day 1 he was going into OB-GYN, would never perform abortions, or do anything contrary to the teachings of the RC church.

Awright! Catholic bashing! I was waiting for it. ;)

[BTB]

I have no problem with physicians learning the D&C procedure. Did anyone say they had a problem with this? It's a red herring.

I was warming up to say the same thing - though, in typical fashion, probably not as concisely - but then into the thread comes a colorful, incendiary, and frightening anecdote, secondhand of course, of precisely one known instance of just that, which happens to also be one known instance of someone going to med school to further an agenda. My post would've said "no one in their right mind would ever go through so much to become a doctor out of political motivation" and, well, I think that'd still be right. I find it unfathomable that anyone would tolerate years of sacrifice completely useless for any political end just to further, in some tiny way, an agenda which only affects a portion of reproductive-age, fertile women who happen to live in remote areas and also have no reliable access to transportation. There are far easier, far cheaper, and far more effective ways to be politically active.

Well, according to some doctors, it is simply market forces -- doctors should be allowed to practice medicine however they darn well please, and if it goes against their moral principles to learn to perform a basic, lifesaving procedure, and you live in an area where this is the only doc around, well, you know, dying from infection is akin to not being able to buy organic milk at your local grocer.

Ysolde, that's not what I said. I did state market forces would punish or reward the physician, and that this was just - but I never said market forces were what led the physician to the decision to provide or not to provide certain procedures. Usually, even for doctors physically working inside - which is not the same as working FOR - a hospital, a doctor's practice is a private business. There is no constitutional right to walk into any given business anywhere and demand a specific product or service. There is, however, a constitutional guarantee that Congress shall not make any law prohibiting the free exercise of religion, which is why there isn't and should never be a prohibition against religious doctors. What type of discrimination should we employ to that end? Ban certain religions from medical school altogether? Or would it be better to force applicants to sign an agreement to violate their religious beliefs when asked?

If I am a woman in need of EC and you refuse to give it to me, then you are choosing who to treat. You are saying "I refuse to privide you with the treatment you want/need because I don't agree with your choices." And that's unacceptable.

It isn't out of judgment or spite that certain physicians don't provide certain services. It is out of moral conviction that to do so would be direct participation in an act of which they can't be part. I'm not a huge fan of becoming a specific example in any of these types of threads, but this time it is a clarifying point:

I do not have an issue with providing an EC prescription. I would not take EC myself, because I think the few times it fails to prevent ovulation and instead prevents implantation of a fertilized egg, that would be tantamount to me killing my child. However, I don't feel it is murder to hand a paper to someone else, have them walk down the street and trade that paper for pills, and then go home and take them. I don't have to swallow the pills, I only have to write on the paper, and that is not direct participation in something I can't do. However, others do feel this is an amount of participation they reap condemnation on their own heads for having.

On the other hand, I do not and will not perform abortions. I would quit medicine in a heartbeat before ever participating in another. When the mother is sleeping, it's me that would have to put the instruments in my hand, me that would use them to remove a pregnancy, and me that would put that pregnancy into a plastic bag labeled "products of conception" for the path lab. I can't do that. I never could've predicted I can't do that, either. I started on this path as a 17-year-old pre-med and at that time in my life was pro-choice. It was learning embryology and seeing "POCs" firsthand that led to a conscience saying no, this was not okay. Years of my life and $270,000 of medical school debt later I'm not about to say, well, gosh, you know what? I think I'd better not be a doctor after all. My saying "no" doesn't mean patients can't have abortions. I'm not out trying to pass laws to make abortion illegal again. I'm simply saying "I won't be the one to do it." And that is not just a moral conviction or just a business decision or even "just" both - I feel, and apparently at least a few in the legislative branch agree, that it is a constitutional right.

There's so many examples in this thread of life-saving obstetrics and gynecology. You know what'd really be interesting? To merge this thread with the recent thread vilifying hospital-model ob-gyn. In here, women are suffering left and right from infections, DIC, and hemorrhages because doctors don't step in and DO something. In that thread, obs are rampaging around, causing morbidity in natural processes that used to happen just fine, and would again if they'd only keep out of the way. Meanwhile, I've been at this a long time, with a couple years of training yet ahead of me, in debt up to my eyeballs, with my husband and daughter - who I miss terribly - also sacrificing daily, apparently just so I can punish patients and make them miserable. It's only a question of whether I'm making them miserable by doing too much, or doing too little. (these judgments on my performance, of course, will be made by people with little to no actual medical knowledge who nevertheless are experts.) And people wonder how doctors end up jaded?

[ignutzz]

Actually, BTB, I was thinking about the other thread as I read through some of these posts. I think you're right that asking for absolutes creates a hypocrisy amongst certain situations (did that sentence make sense??). I do think it's OK for an HCP to refuse to do a certain procedure AS LONG AS they provide a referral or access to an HCP who will. At the same token, for those people who don't want a particular model of care (such as allopathic OB/GYN) the alternative MUST be kept available (this works for Sarah's Catholic/religious woman who doesn't want to patronize a HCP who practices "against" her religious views).

But please, can we leave the "I'm know better because I'm a Dr." lines out of it.

[LittleFredPunkinHead]

Jesvet, thanks for posting that. Your perspective makes it easier (for me at least) to understand the grey area.

[phoenics]

But please, can we leave the "I'm know better because I'm a Dr." lines out of it.

I don't think she was saying she knows better than [you] - general you - because she's a doctor. She was saying she knows better for herself now that she's a doctor.

[LyLMyssChaos]

I am curious as to how those that think that a doctor shouldn't have a right to deny certain treatments would feel if a doctor refused to continue seeing you because you didn't agree with their suggested line of treatment?

For example, when I found out I was pregnant with my youngest son, I had an OB that suggested I terminate the pregnancy because it would be too difficult on my body. His thinking was that I could terminate this pregnancy and "just try to conceive again when my body was in a healthier state." I told him that I was not interested in terminating, so he refused to treat me after that. I had to find another OB that was happy to treat me throughout that pregnancy and was okay with me getting surgery to prevent any future pregnancies since it would put my life along with any future fetus' in jeopardy.

I think that if a doctor has a right to refuse to treat a patient for disagreeing, then a doctor should also have the right to refuse to perform any treatment.

[LyLMyssChaos]

*posted twice*

[ignutzz]

I was referring to this Phoenics.
(these judgments on my performance, of course, will be made by people with little to no actual medical knowledge who nevertheless are experts.)
I understand the point of her post that refers to the issue at hand, and have no issue with it. The above was a direct comment about posters from another thread (of which BTB has little to no knowledge of their educational background or personal interests) regarding another topic. Additionally, no one was critiquing HER. That's why I objected.

[BTB]

The above was a direct comment about posters from another thread (of which BTB has little to no knowledge of their educational background or personal interests) regarding another topic.

No, it wasn't a direct comment on that thread - it was about this thread and that thread equally, and about doctor-bashing in general, and I stand by it.

Additionally, no one was critiquing HER. That's why I objected.

Really?

Well, according to some doctors, it is simply market forces -- doctors should be allowed to practice medicine however they darn well please, and if it goes against their moral principles to learn to perform a basic, lifesaving procedure, and you live in an area where this is the only doc around, well, you know, dying from infection is akin to not being able to buy organic milk at your local grocer.

Someone commented in an altogether unrelated thread a few weeks ago they wish there were more MDs around the boards. They're here, but don't comment in threads like these. I can't imagine why... call me a masochist, but I actually like these threads, for the most part. It's too easy to forget doctors aren't nameless, faceless, evil cogs in a corporate machine. They're just plain people.

[msnicolea]

BTB--do you really believe that there aren't organizations that are trying to further their political agendas by having like-minded people become physicians? Why would the medical field be immune from that kind of effort? It happens in other professions, why not medicine?

In Wisconsin, an anti-choice group ha been VERY vocal about recruiting followers to become pharmacists--why do you suppose that is?

[Sarah]

do you really believe that there aren't organizations that are trying to further their political agendas by having like-minded people become physicians? Why would the medical field be immune from that kind of effort? It happens in other professions, why not medicine?Maybe, but I doubt you can think that makes a big difference. Because it's not like for every non EC prescribing person who becomes a doctor, another who would prescribe it isn't becoming a doctor, KWIM? It's not a zero sum game. Having more pharms who won't give out EC doesn't effect the numbers of pharms who will. I'm not being very clear- am I making any sense?

[msnicolea]

I understand what you're saying, Sarah, but I don't agree.

There are a limited # of pharmacy-school openings each year. If more anti-choice subscribers are choosing to become pharmacists--people who otherwise would NOT have made this choice, perhaps--then yes, the balance will shift.

[Sarah]

I understand what you're saying, Sarah, but I don't agree.

There are a limited # of pharmacy-school openings each year. If more anti-choice subscribers are choosing to become pharmacists--people who otherwise would NOT have made this choice, perhaps--then yes, the balance will shift.

That's a good point, but what I know of economics (which admittedly isn't a huge amount) it seems that with larger numbers of qualified pharm applicants, more schools will open, as has been the case with regular colleges.

Plus, while it may be performing a disservice to the women who want these controversial procedures or medications, there is a huge advantage in more people wanting to become OBs or pharms. OBs especially, since we have diminishing numbers of OBs, even in major metropolitcan cities. It's hard to say which is better- having fewer OBs, all of whom are willing to provide all services, or having more OBs, some of which are selective, and some of whom aren't. I think the negative (IYO) effect of having some physicians who are selective is outweighed by having so many more doctors who are available do do births, m/c care, gynocological care, birth control, etc.

[pocket]

I don't think it's much of an advantage for there to be more OB's and pharmacists, especially pharmacists, with this particular paradigm. I don't think a pharmacist who doesn't want to fill a BC scrip should be a pharmacist at all.

I also don't really think that the Pill falls into the category of a controversial medication. EC is just BC pills taken in a different quantity. My Gyn instructed me on how to use my own pills for EC a long time ago, and I kept an extra pack at home. JIC.