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[Kraazy]

She could already be pregnant. Therefore, the massive dose of contraceptive would destroy that pregnancy.

Fair enough. I guess then you would have to check whether she has already ovulated and offer her EC if she hasn't.

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[mshheaddoc]

This would probably be better in the Topic in Healthcare forum since its not really about medical school. Moving ...

 

[McDoctor]

She could already be pregnant. Therefore, the massive dose of contraceptive would destroy that pregnancy.

From a recent review in the New England Journal of Medicine:

The mechanism of action of emergency contraception is incompletely understood. It does not interfere with an established, postimplantation pregnancy. The use of emergency contraception can delay ovulation and decrease the probability of fertilization after ovulation47; at least some of its effect appears to occur after ovulation.48

The author doesn't cite a source for the statement that Plan B does not interfere with postimplantation pregnancy, so take it for what its worth. The statement did survive the peer review process, if nothing else.

But your statement insinuating that Plan B is an abortion pill is completely unfounded. The consensus is that it does NOT work in this manner.

 

[McDoctor]

Plan B is going Over The Counter, if it hasn't already. So some of this discussion is a moot point.

I'm not sure how the thread got turned into an abortion debate. I think those who declare Plan B an abortion pill should provide some evidence to support the argument.

I couldn't care less what one's religious beliefs compel them to believe or how that influences their practice of medicine. But I don't understand why this clown in the article is working in a capacity which puts him in a position where his religious beliefs are going to conflict with his duties. If you don't want to prescribe Plan B, then don't do rape exams. Its pretty simple.

 

[Kraazy]

From a recent review in the New England Journal of Medicine:



The author doesn't cite a source for the statement that Plan B does not interfere with postimplantation pregnancy, so take it for what its worth. The statement did survive the peer review process, if nothing else.

But your statement insinuating that Plan B is an abortion pill is completely unfounded. The consensus is that it does NOT work in this manner.

Problem is that many people believe that pregnancy as well as conception begin at fertilization, so preventing implantation post-fertilization would constitute intentionally impeding the embryo's growth and thus make EC an "abortifacient" intervention. If you consider pregnancy to begin at implantation, then there are no such implications.

 

[FoughtFyr]

Out of curiousity, how would this change if the physician stated that they would not even see emergency cases unless payment was rendered first? I mean Jesus chased the moneychangers from the temple and several strict fundamentalist christians (among other faiths) forbid money lending. If a physician claimed that he or she couldn't meet EMTALA due to religious reasons, what should happen? (BTW - before you cry foul on the issue I chose, read the article again. A physician wouldn't do a physical exam for a woman trying to adopt. Show me the bible verse that prohibits single parenthood via adoption! The money lending is at least prohibits on strict reading...).

- H

 

[evade]

She could already be pregnant. Therefore, the massive dose of contraceptive would destroy that pregnancy.

Whoa! No, that's completely untrue. Contraceptives, including emergency contraceptives, do not harm implanted pregnancies. They can't. Contraceptives are nothing more than synthetic hormones. What do you think women's bodies release when they're pregnant? THOUSANDS of times what's in those pills. Contraceptives are designed to inhibit ovulation. Researchers postulate that they can prevent implantation, but if you'll look closely, there are no studies proving this one way or the other. It is well-known, however, that contraceptives can't touch implanted pregnancies.

From the FDA: "If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.

 

[evade]

Problem is that many people believe that pregnancy as well as conception begin at fertilization, so preventing implantation post-fertilization would constitute intentionally impeding the embryo's growth and thus make EC an "abortifacient" intervention. If you consider pregnancy to begin at implantation, then there are no such implications.

For those who believe that pregnancy begins at conception (which of course is not the medical definition), do you believe that test tubes are pregnant when holding human zygotes during IVF?

Before implantation, there's no real interplay between woman and zygote/blastula/morula/blastocyst. How can you claim it's a pregnancy? Even if you believe the splitting cell is a "life," they're floating around with no attachment for five days. That's not a pregnancy.

 

[8744]

...If a woman gets raped, give her the damn pill, send her to someone who will, or step away from the job and rethink your loyalties, for if they are to something beyond reason and and patients best interest, then the two letters after your name are no better than the lack care you would provide...

I'll tell you what, we don't live in a perfect world. If you agree to stop refering women for elective abortions I will give out the morning after pill.

There, I can't get more fair than that. Of course, the "Rape and Incest" mantra is just a red herring. The overwhelming majority of abortions are purely elective and have nothing to do with incest and rape. The fact is that "rape and incest" are used to muddy the waters.

Get you own letters after your name and you will see that medicine is not a cult, we do not have to do anything that we don't want to do, and nobody can make you. I certainly am loyal to my patients but I have a higher loyalty to Christ and, while I am not the best Christian in the world, this one is a no-brainer.

As an aside, there are a lot of things patients want that I won't give them. I won't refer them to an acupuncturist or a chiropractor, for example. I've been asked and I simply reply that I don't believe in these things and they are on their own.

 

[Psycho Doctor]

Look, doctors should have a strong sense of morality if they are to practice medicine. Practically every med school has a course on ethics just for this reason. Morals often conflict with one another, which is why discussions like these occur. That's a fact of life. If you feel that morality doesn't belong in medicine, then go into a research position instead.

I hope that wasn't directed at me, since I totally believe morality belongs in medicine which is why I would not allow my decisions and practices to conflict with my sense of morality and integrity.

 

[Psycho Doctor]

For those who believe that pregnancy begins at conception (which of course is not the medical definition), do you believe that test tubes are pregnant when holding human zygotes during IVF?

Before implantation, there's no real interplay between woman and zygote/blastula/morula/blastocyst. How can you claim it's a pregnancy? Even if you believe the splitting cell is a "life," they're floating around with no attachment for five days. That's not a pregnancy.

Whether it's a pregnancy or not, it's a life and that's the essence of the situation right there. "Thou shall do no harm..." I would never harm a life and to me that means I'd never take the life of an unborn child.

 

[Climberak]

I hope that wasn't directed at me, since I totally believe morality belongs in medicine which is why I would not allow my decisions and practices to conflict with my sense of morality and integrity.

It wasn't meant towards you. I try to criticize ideas, not individuals. I'm glad that you have a strong sense of morality when you practice. As I'm sure you are well are of, we will at some point have to make a moral decision that will influence what treatment a patient will receive. My comment was simply meant towards those with the notion that a doctor's morals shouldn't interefere with what they will or will not do with a patient.

 

[QuikClot]

There are three sets of values that come into this; the patient's, the physician's and the society's. None of them are absolutely determinate over the others. A compromise between them has to be struck, and that is true even when a physician has an absolute moral objection to a given course of treatment.

The rights of the patient include medical care consistent with their values, not the physician's values. The physician may believe, for example, that the human soul resides in a human being's right leg, and refuse to amputate on that account. (What does it profit a man to be rid of Clostridium perfringens if he lose his own soul?) In a situation where time is not critical, a referral is a good solution, one that 82% of physicians apparently support (if only 18% say they would not refer). But withholding treatment choices is not an option, because the contract between the physician and the patient requires the patient to rely on the physician's medical judgment. Hence, if they agree to treat the patient but refuse to inform the patient of treatments consistent with their (the patient's) values, they have substituted their values for the patients, and this is neither legal or moral (a cabdriver may refuse to take an army recruit to the airport, or, indeed, anybody anywhere, but a laywer may not withold legal options from his client because he thinks his client belongs in jail.)

In situations in which there isn't time to seek help elsewhere, or it isn't practical to do so, the physician must perform to the standard of care according to the patient's values, not their own values. Denying, say, EC in this context is similar to forcing blood on a competent, refusing Jehovah's Witness. Whether in action or in refusing to act, we serve the patients in respect for their autonomy, subject to constraints laid down, usually, in law.

It may be that a person feels they absolutely cannot be a part of some such act. That is honorable; we should respect people of conviction. They should not be physicians working in those roles, however. Their belief system disqualifies them, as often happens. You do not see Mennonites qualifying as navy SEALs; you find few Hasidim managing Red Lobster franchises. You have an absolute right to your beliefs, but not to your job, if you can't carry out your responsibilities.

 

[FoughtFyr]

There are three sets of values that come into this; the patient's, the physician's and the society's. None of them are absolutely determinate over the others. A compromise between them has to be struck, and that is true even when a physician has an absolute moral objection to a given course of treatment.

The rights of the patient include medical care consistent with their values, not the physician's values. The physician may believe, for example, that the human soul resides in a human being's right leg, and refuse to amputate on that account. (What does it profit a man to be rid of Clostridium perfringens if he lose his own soul?) In a situation where time is not critical, a referral is a good solution, one that 82% of physicians apparently support (if only 18% say they would not refer). But withholding treatment choices is not an option, because the contract between the physician and the patient requires the patient to rely on the physician's medical judgment. Hence, if they agree to treat the patient but refuse to inform the patient of treatments consistent with their (the patient's) values, they have substituted their values for the patients, and this is neither legal or moral (a cabdriver may refuse to take an army recruit to the airport, or, indeed, anybody anywhere, but a laywer may not withold legal options from his client because he thinks his client belongs in jail.)

In situations in which there isn't time to seek help elsewhere, or it isn't practical to do so, the physician must perform to the standard of care according to the patient's values, not their own values. Denying, say, EC in this context is similar to forcing blood on a competent, refusing Jehovah's Witness. Whether in action or in refusing to act, we serve the patients in respect for their autonomy, subject to constraints laid down, usually, in law.

It may be that a person feels they absolutely cannot be a part of some such act. That is honorable; we should respect people of conviction. They should not be physicians working in those roles, however. Their belief system disqualifies them, as often happens. You do not see Mennonites qualifying as navy SEALs; you find few Hasidim managing Red Lobster franchises. You have an absolute right to your beliefs, but not to your job, if you can't carry out your responsibilities.

I so rarely agree with you Clot, but in this, wow, well stated.

- H

 

[Miami_med]

In my opinion, you are far more morally guilty if you deny a rape victim emergency contraception that she desperately needs than if you prescribe it. Everyone is entitled to their own belief, but you cannot force your patients to believe the same things you do. By denying them care or a referral, you're grossly abusing your power as a physician to propagate your own belief system. thumbdown

Your patients are more than able to go to a different doctor on their own if you don't tie them down. You are denying nothing. Maybe the problem is in a law that requires someone to be an intermediary. The patient's desire shouldn't force anyone to act antithetically to his moral code.

 

[FoughtFyr]

Your patients are more than able to go to a different doctor on their own if you don't tie them down. You are denying nothing. Maybe the problem is in a law that requires someone to be an intermediary. The patient's desire shouldn't force anyone to act antithetically to his moral code.

It doesn't force anyone to act antithetically to their moral code. We all have choices. No one forces you to be a physician. But a society does have the right to create and enforce expectations that a particular profession act in a specific manner in a given situation.

For example, a public high school principal may not be allowed to lead lunchroom in a prayer prior to eating, despite this being their belief and practice at home.

For example, a judge may not sentence a thief to having their hand cut off, even though that is the teaching of the judge's faith.

For example, a firefighter may not refuse to work an assigned shift, even if that shift falls on the sabbath or another holiday where their religion prohibits work.

Now, if you want to have a private practice where you provide your patients with clear notice as to your beliefs and practices, that is fine, just like a principal choosing to work at a Catholic High School so that they may say grace before meals. But if you are a physician whose practice is open to all, then you must agree to the standards set forth by the community you serve. That goes double if your position is one where a patient may not have a choice but to use your services (e.g., emergency physician, trauma surgeon, intensiveist, etc.).

We all have choices in what career we pursue, not all patients have choices in the physicians they see.

- H

 

[Psycho Doctor]

It wasn't meant towards you. I try to criticize ideas, not individuals. I'm glad that you have a strong sense of morality when you practice. As I'm sure you are well are of, we will at some point have to make a moral decision that will influence what treatment a patient will receive. My comment was simply meant towards those with the notion that a doctor's morals shouldn't interefere with what they will or will not do with a patient.

well i certainly would hope it does or that doctor is pretty hypocritical in what he preaches but does not practice. What's the point of morality if you don't even practice it?

 

[Psycho Doctor]

For example, a firefighter may not refuse to work an assigned shift, even if that shift falls on the sabbath or another holiday where their religion prohibits work.

- H

actually i don't know if that's true. most places of employment allow you to follow the "rules" and beliefs of your religious affiliation and faith, as long as it's somethinh you always standby and not just use it out of convenience.

 

[FoughtFyr]

actually i don't know if that's true. most places of employment allow you to follow the "rules" and beliefs of your religious affiliation and faith, as long as it's somethinh you always standby and not just use it out of convenience.

Actually, I do know it is true. I was a firefighter. Deriliction of duty gets you fired. Period. You can try and trade shifts but if the shift is yours and uncovered - you work. There is a difference between critical services (such as firefighting, police, emergency medicine) and the usual "places of employment". Second, you miss the point. There are certain jobs that people of certain faiths can't / won't do as a matter of religious conviction. A devout muslim dog-walker? A hindu butcher? Should we mandate that a meat market hire and pay a hindu into the position of a butcher and continue to pay him/her despite the fact that they refuse to butcher the cows?

Look, the public has a right to legislate that certain services will be available in an emergency department, they have the right to mandate that a pharmacist dispense legally ordered drugs. That right is born of the same auhority that allows the public to license the physician or pharmacist in the first place. You do not have the right to prescribe medication as a physician. A government grants you the privledge when certain conditions are met. Just as that government can (and should) require that a physician complete specific training, it can mandate that physician's actions in specific situations. If your religious convictions prevent you from performing those actions, then don't become a physician (or become a physician that doesn't provide services open to the general public, i.e., a botique practice where all of your patients are informed ahead of time as to the restrictions in your practices).

- H

 

[Nasrudin]

For everybody here hiding behind the reputation of a man who died 2,000 years ago....


Is anybody reading the article?...the lady was raped...Jesus Christ!


Red Herring my butt. What if that was your wife or your daughter we were talking about. If you can maintain your high morality under that circumstance, well then, you deserve your sanctity.

 

[lisichka]

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[supercut]

No cardiologist would refuse to do a heart transplant otherwise he would not have become a cardiologist, no doctor would refuse women patients, and no doctor will refuse to do a abortion if the situation is life threatning. Otherwise they would not have become doctors. However, this case is different as its a emergency contraceptive.

First of all, cardiologists don't do heart transplants. Cardiac surgeons do heart transplants. Cardiologist are medical doctors, not surgeons. They do not do surgery.

Many doctors have biases that keep patients from receiving treatments. There was an article out very recently demonstrating that patients with early stage pancreatic cancer aren't being referred for surgery, because the medical docs have outdated ideas about pancreatic surgery. In fact, in surgery we frequently find that a patient has a problem for which they should have at least been offered surgery a long time ago, but they were never sent to a surgeon. Usually this is due to a bias against surgery on the part of the primary care doc.

I'm not saying that it's right for the ED doc to deny the woman the contraception. I'm sure that a mechanism could be put into play whereby patients can get the care they want without trying to force a doctor to go against his/her religious beliefs. Sounds like the rape councelor in this case did exactly the right thing.