ABORTION and the interview

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secretstang19

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Hey guys--

Knowing the penchant that most interviewers have for asking ethical questions (and being about to start my interviews), I was wondering what anyone thought about the best way to handle questions about abortion. Ultimately, I am pro-life, though of course I recognize the medical necessity in certain situations.

Does anyone have any experience with questions of this type, or have any ideas about how to handle these issues?
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I think the best way to handle this or any type of ethical question is with a well thought out, honest response. Generally with this kind of question, what you say is not as important as how you say it- adcoms want to see that you have thought out your positions and can think critically about complex issues that you may face in your career as a physician, including controversial issues such as abortion and physician-assisted suicide. Good luck in the interview process!
 
i've heard that cloning will be a big issue this year. better study up on that also.
 
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When I was interviewing, I was worried about the same sort of questions. Now that I "know the ropes" so to speak, I can honestly tell you that there IS NO RIGHT ANSWER to the ethical questions. They don't ask you ethical questions because they CARE what your views are...they ask them to see if you HAVE AN OPINION and will STICK TO IT. The whole point of the questioning is to see if you are wishy-washy, or if you can make a logical decision and stick to it.

If you're pro-life (or pro-choice, or whatever), that's fine...just stick to your guns with your reasoning, be it personal morals, religious or other. At the same time, concede to your interviewer that there ARE other views and opinions on the subject, but that this is YOUR opinion on the matter. They will often try to pose hypothetical situations to trip you up, but all you really have to say is that you would "give the patient all the options available to her, and if she still chose abortion, I would refer her to a reputable colleague who performs the procedure".
 
when thinking about ethical issues just make sure that patient autonomy is a top priority. yes, there is no wrong answer to a ethical scenario, but there are answers that may lead the interviewer to suspect that you put your own belief system on a higher pedestal than the patient's well being. This could be looked upon negatively. you can be very honest about your views on abortion (for there is one right answer for YOUR beliefs), but when getting your point across..be sure to emphasize that, as a physician, your top priority is to treat the needs of your patients, regardless of their beliefs or yours...and if you are uncomfortable doing so, then it is your duty to make sure that the patient can see someone who can treat them for their needs.
 
I had an abortion question come up in one of my interviews, and I handled it similarly to the reply above. I too happen to be strongly pro-life for personal and religious reasons, however, I also believe it's not the place of the physician to emphasize those beliefs on others in the professional and clinical setting. I simply responded that I would make sure the patient was completely informed about everything, risks, and otherwise to make the decision for herself. If she went further than that, then I would inform that patient that perhaps I wasn't the doctor she needs to be talking with about that due to my own beliefs, and I might be able to refer her to someone else.
 
I have heard that it will kill you application to be pro-choice at the Jesuit universities, such as Georgetown.
 
Originally posted by JBJ
I have heard that it will kill you application to be pro-choice at the Jesuit universities, such as Georgetown.
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I heard something to that effect too.
 
One of my interviewers loved:love: ethical questions. Since I said I was interested in PEDS he asked me what I would do if a 15 yr old patient of mine was pregnant and wanted an abortion. Now I find myself to be pro-life for ME and I had feared this question most of all when I was preparing for interviews. Anyway, I just stuck to the question and NEVER let my own personal beliefs enter into the conversation. I gave a good answer of what I would do as a Doctor (i.e. give her all the options, make sure she understands, make sure I have a strong rapport, take into consideration her family life and emotional/psych state, give her the option to see social workers, visit Planned parenthood, etc) The interviewer, I think, really liked how I stood my ground without throwing my own monkey wrench into it! I think it was key that I didn't tell him whether I was pro-life/choice because he got into a rant afterwards about how he is so pro-life and he is sick of politicians making abortion a political rather than personal choice.

I think not mixing my personal beliefs with this situation really saved my ass!!
 
I saw elsewhere that someone got asked a similar question at interview:
"What would you do if a young woman came to you requesting an abortion?"

Here's my permutation of it:

"What if you were an Ob/Gyn and a young woman came to you requesting an abortion?"

Here's what Roe v Wade says:
"(a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgment of the pregnant woman's attending physician. Pp. 163, 164.

(b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. Pp. 163, 164.

(c) For the stage subsequent to viability the State, in promoting its interest in the potentiality of human life, may, if it chooses, regulate, and even proscribe, abortion except where necessary, in appropriate medical judgment, for the preservation of the life or health of the mother. Pp. 163-164; 164-165."

If the woman is "requesting" an abortion, that implies that it is not a life-or-death situation. I guess I would perform an abortion in an early stage of pregnancy, but it appears to be illegal in some states to perform one in later stages under most circumstances, and I doubt I would feel comfortable doing one in the last few months. To me, the issue is whether the embryo/fetus feels pain or not. In early stages they don't really have a nervous system, so how could they feel pain? But in later stages...

What would your answer be?
 
Originally posted by souljah1
when thinking about ethical issues just make sure that patient autonomy is a top priority. yes, there is no wrong answer to a ethical scenario, but there are answers that may lead the interviewer to suspect that you put your own belief system on a higher pedestal than the patient's well being. This could be looked upon negatively. you can be very honest about your views on abortion (for there is one right answer for YOUR beliefs), but when getting your point across..be sure to emphasize that, as a physician, your top priority is to treat the needs of your patients, regardless of their beliefs or yours...and if you are uncomfortable doing so, then it is your duty to make sure that the patient can see someone who can treat them for their needs.
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Hum, this seems like slightly tendentious advice.

Some of us SDNers might actually consider that there are two patients in the situation. I know that is how I would treat an expecting mother who would be giving birth within a month or so.

In a situational question, of course I would give my 'first' patient all her options, but I would honestly let my opinion creep in, and have her consider adoption and probably give her some local parish contact numbers for advice. Let her know that there is something within her body, that left untouched, would eventually grow into a living and fully capable human being that an abortion would destroy.

Whether she chooses to have an abortion or not, hopefully it will be just one more factor pushing the woman to not have unprotected sex in the future.

Its that darn Hippocratic oath getting in the way of things again!
 
Originally posted by rjhtamu
I had an abortion question come up in one of my interviews, and I handled it similarly to the reply above. I too happen to be strongly pro-life for personal and religious reasons, however, I also believe it's not the place of the physician to emphasize those beliefs on others in the professional and clinical setting. I simply responded that I would make sure the patient was completely informed about everything, risks, and otherwise to make the decision for herself. If she went further than that, then I would inform that patient that perhaps I wasn't the doctor she needs to be talking with about that due to my own beliefs, and I might be able to refer her to someone else.
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Hey, in my State a physicians cannot be compelled to refer a woman for an abortion if he has ethical reasons for being against it. Likewise he can not be held liable for not referring the woman.

Also, in the public hospitals in my state, health care providers are forbidden to discuss elective abortion as a treatment option. This includes making referrels to private clinics which perform them.

It's the Law, you understand. My state is a little more civilized then many and understands that while physicians should go easy on imposing their morals on their patients, the patients for their part shouldn't try to impose thier morals on the physician.

I don't want to argue the whole pro-life, pro-choice thing because it has been beaten to death. I am very pro-life, however and I will not hesitate to tell a patient, if she asks for my advice, that abortion is wrong and she is making a grave mistake. I mean, if she asks, I'll tell her what I think.

There is no need to get all PC and wishy-washy just because you are a physician. I tell patients to stop smoking crack all the time and I don't qualify this advice with any allowance for their morality.

Remember, all you pro-life folks: Referring a woman for an elective abortion makes you just as complicit in the murder of an unborn baby as performing the procedure yourself.

I will not argue "pro-life" vs "pro-choice" with anybody on this board. This subject, like DO vs MD, Chiropractor vs Quack, Ivy League vs State School, has been beaten to death.

I just want to point out that the "neutral position" on the subject is not "I won't do it but I'll refer you to a butcher who will."
 
Originally posted by holler79
One of my interviewers loved:love: ethical questions. Since I said I was interested in PEDS he asked me what I would do if a 15 yr old patient of mine was pregnant and wanted an abortion. Now I find myself to be pro-life for ME and I had feared this question most of all when I was preparing for interviews. Anyway, I just stuck to the question and NEVER let my own personal beliefs enter into the conversation. I gave a good answer of what I would do as a Doctor (i.e. give her all the options, make sure she understands, make sure I have a strong rapport, take into consideration her family life and emotional/psych state, give her the option to see social workers, visit Planned parenthood, etc) The interviewer, I think, really liked how I stood my ground without throwing my own monkey wrench into it! I think it was key that I didn't tell him whether I was pro-life/choice because he got into a rant afterwards about how he is so pro-life and he is sick of politicians making abortion a political rather than personal choice.

I think not mixing my personal beliefs with this situation really saved my ass!!
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Har Har. You in no way "stood your ground." In fact, you caved in and gave the craven answer that is expected of you by the dominant liberal intellectual culture in this country.

"Stood your ground." Man, that's a hoot. All you did was regurgitate the force-fed orthodox opinion which is required of those who are ostensibly pro-life but are too chicken-**** to say anything that might offend anybody.

"Standing your ground" would have involved saying, "In no way will I ever perform, refer for, or advise a patient to have an elective abortion because I find the practice morally repugnant and I fear the Lord more then I fear you or any other person who is placed over me."

Now that would have been a courageous answer.

Ho Ho Ho. Man. Oh boy. You really told them. You really gave them a shockingly original answer which they did not expect. Har Har. I particularly liked the way you courageously NEVER let your own personal beliefs enter into the conversation. How brave! Move over, Rosa Parks, cause we got us another Lion.

I bet the interviewer patted you on the head and gave you a treat like the performing animal you are.
 
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I haven't read all of the above replies, but I would definitely realize that one of the most important things that interviewers are looking for in an interviewee is the interviewee's recognition of the priority of patient autonomy. Physicians have many different viewpoints on ethical issues so there is no one right answer, but what most physicians agree on (or should) is that they shouldn't push their own religious/political/ethical beliefs on their patients, but rather inform them of the benefits and risks in a way that shows empathy and professionalism. I tried to keep that in mind as I interviewed and 'patient autonomy' was an answer that I used to a couple of questions. If you are pro-choice, then it would be perfectly appropriate for you to say that you would feel very uncomfortable performing/assisting in abortions, but that you would also make sure that the patient was atleast provided with information/assistance if they still wished to undergo the procedure.
 
"Standing your ground" would have involved saying, "In no way will I ever perform, refer for, or advise a patient to have an elective abortion because I find the practice morally repugnant and I fear the Lord more then I fear you or any other person who is placed over me."
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And then you could launch into your spiel about how you'll never recommend birth control because the Catholic Church says it's bad and you're Catholic, or you'll tell all your patients they're going to hell for eating cow because you're Hindu.

The bottom line is simple: when I go to the doctor, his job is to give me all my options. Not all my options that the pope approves of, not all the options that he thinks Jesus wants me to have, but all the options that are legal and considered valid by the medical profession. Nobody would ever suggest you are obliged to perform an abortion, certainly, but I think it's wildly inappropriate to rule out telling patients about any commonly performed procedures on the grounds that they're against your beliefs. Unfortunately it's not that uncommon, because of the paternalistic idea that still persists whereby the doctor is somehow the one who should be telling the patient what to do with their own body. I don't really have as big a problem with giving the big pro-life spiel as much as with simply omitting abortion as an option because it's more clearly just the doctor's opinion, something most patients know is just that - an opinion someone else has.

You'd never catch me performing an abortion, but I'd consider myself a terrible doctor if I went around selectively omitting information given to patients based on my personal beliefs.
 
I was asked my opinion about abortions during an interview just recently. I was honest. I come from a well to do family; have been protected in many ways, but when I was 17, my then girl friend got pregnant by me. She was 18.

It was a painful choice. It was hard. We both off to college the following year. She was planning to attend Dartmouth. This would have changed our lives. I didn't feel comfortable with the idea, but she had an abortion. I felt depressed and sick for about 3 months.

So, when I was asked I said it's hard. It's a choice that no person wants to make. I've help another make that decision. I told them about my past. I said I don't feel proud of it. Sometimes, I live with regret. I still don't know if we made the right choice. Nevertheless, a choice was made, a baby died, and we went on with our lives. We have talked in 3 years.
 
the thing that really depresses me about this issue is the fact that there are literally thousands (at least in my area) of people desperately waiting to adopt. a long time family friend of mine and her husband had to go to ridiculous lengths and spend tens of thousands of dollars in fees (and from what i understand, bribes) to adopt a russian girl. I can say that the first thing out of my mouth in response to a patient who wanted an abortion would be "while this situation is bad, it could turn into something wonderful for a loving family who can't have a child on their own, and you could be a part of that."
 
Originally posted by R_C_Hutchinson
the thing that really depresses me about this issue is the fact that there are literally thousands (at least in my area) of people desperately waiting to adopt. a long time family friend of mine and her husband had to go to ridiculous lengths and spend tens of thousands of dollars in fees (and from what i understand, bribes) to adopt a russian girl. I can say that the first thing out of my mouth in response to a patient who wanted an abortion would be "while this situation is bad, it could turn into something wonderful for a loving family who can't have a child on their own, and you could be a part of that."
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I didn't realize that there was such a shortage of kids for adoption. So many kids are in foster care and homes, I would have thought that it would be easy to adopt around here.
 
Originally posted by rCubed
I didn't realize that there was such a shortage of kids for adoption. So many kids are in foster care and homes, I would have thought that it would be easy to adopt around here.
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Usually people want to adopt babies - and there's a huge demand for those. Russian babies are particularly appealing because they look like (caucasian) Americans. Very few people want to adopt grown up kids or maybe African orphans.
 
There are plenty of children to adopt in this country, if you don't restrict yourself to a healthy white newborn. The problem is, many of the couples wanting to adopt do just that, then cry for years about how badly they just want a child of their own to love; all the while waiting for a particular type of baby to be handed to them, like they're shopping for a purebred puppy or something.

I get so tired of the "adoption, not abortion" cry of the christian right, who tout this slogan on bumper stickers and t-shirts as if the two were equivalent options. This couldn't be further from the truth, and I find it incredibly disingenous for anyone to imply otherwise to push their agenda. The physical, mental, and emotional toll of carrying a pregnancy to term and then handing the child over is absolutely huge for most women, and that is why less than 2% of women facing an unplanned pregnancy go this route. Of course adoption can be a wonderful alternative, but it is simply not a viable option for most women in this situation, and to try to force it on them with no regard for their life and circumstances shows an incredibly narrow-minded and self-righteous attitude that I find disturbing in aspiring physicians. Your role as a healthcare provider is not to dictate morality to your patients, but rather to provide them with sound medical information so THEY can make THEIR OWN decisions about THEIR OWN BODIES. If you want to provide moral or spiritual guidance, you should be looking into a career with the clergy.
 
Originally posted by Mistress S
Your role as a healthcare provider is not to dictate morality to your patients, but rather to provide them with sound medical information so THEY can make THEIR OWN decisions about THEIR OWN BODIES. If you want to provide moral or spiritual guidance, you should be looking into a career with the clergy.
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This outlines the fundamental misunderstanding on this thread, pro-life doctors view the situation of a mother with an unplanned pregnancy as containing two patients, not one. So when you tell them that they have to keep their beliefs to themselves when acting as the physician, you speak self-righteously.

No one is at fault, but in order to have an informed debate, everyone needs to know exactly how everyone stands.

BTW, the p-town your from, is that Provincetown Massachusetts?
 
I am also sick to death of the "adoption, not abortion" routine. I am the adoptive mom of 2 children from Vietnam. I am also staunchly pro-choice. I realize that giving a woman a choice does not necessarily mean she will choose to have an abortion, but she should have that choice.

The problem in America is not that there is a shortage of children or even babies to adopt. The problem is *how* we manage those adoptions. There are more than a few agencies (and/or lawyers) around who will use the concept of open adoption as a way of easing the birthmother's anxiety about placing her child for adoption. "You don't *really* have to give up your baby. You can see her anytime you want!" For many families, that's a good option, but there are plenty of adoptive parents (or wanting-to-adopt couples) who do not want continued contact with a birthmother in any way.

Now, throw in the fact that our court's are so hesistant to cut off a birthfather's rights they will engage in lengthy court battles to decide the best interest of the child. It's even worse if you try to adopt a child or infant from the foster care system.

Most couples waiting to adopt are white couples. Most babies waiting to be adopted are not. Not everyone wants to adopt a bi-racial child. Most couples do not want to adopt a child who may have health problems or addictions.

Russia is attractive *only* because babies are caucasian, not because they are necessarily healthy. In fact, a large number of them are not. It costs a lot of go to another country to adopt...if you take out the travel money, it's about the same as a U.S. adoption and there are wonderful tax credits now as well. The money we spent almost certainly did not go for "bribes" though I think one or two "expedition" fees were just a way of paying off the folks that were doing the paperwork.

With all that said, my husband and I were discussing the recently-passed ban on late term abortions. As much as we would love to see babies find a loving home, we can't tolerate the idea that anyone other than a woman and her doctor would make such decisions. I've tried for years to get pregnant, but if I discovered late in the 2nd trimester that my baby was anencephalic, you better believe we'd be talking termination.

I once had a dr who would not prescribe birth control to unmarried women because we 'didn't need to have sex before marriage.' I told him then and I still believe--'if you want to preach, then be a preacher.' I go to a doctor for advice and treatment concerning my physical (and mental) health...if I wanted a lesson in morality, I would go to church.

Willow
 
Originally posted by dmoney41
And then you could launch into your spiel about how you'll never recommend birth control because the Catholic Church says it's bad and you're Catholic, or you'll tell all your patients they're going to hell for eating cow because you're Hindu.

The bottom line is simple: when I go to the doctor, his job is to give me all my options. Not all my options that the pope approves of, not all the options that he thinks Jesus wants me to have, but all the options that are legal and considered valid by the medical profession. Nobody would ever suggest you are obliged to perform an abortion, certainly, but I think it's wildly inappropriate to rule out telling patients about any commonly performed procedures on the grounds that they're against your beliefs. Unfortunately it's not that uncommon, because of the paternalistic idea that still persists whereby the doctor is somehow the one who should be telling the patient what to do with their own body. I don't really have as big a problem with giving the big pro-life spiel as much as with simply omitting abortion as an option because it's more clearly just the doctor's opinion, something most patients know is just that - an opinion someone else has.

You'd never catch me performing an abortion, but I'd consider myself a terrible doctor if I went around selectively omitting information given to patients based on my personal beliefs.
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Look, all sarcasm aside, the fundamental flaw in your arguement is that you assume that elective abortion is a health-care option and from this you conclude that it is only right to inform and support a woman of all her options.

In logic, this is called "begging the question." In other words, you assume your premise to be correct and then extrapolate your desired conclusion from that unproven assumption.

But pregnancy is not a disease. It is a natural function of the human species and requires no treatment. Can we say that a woman who has had an abortion is "cured" of her pregnancy?

It is not in our sphere of action as physicians to offer options for the treatment of a condition which is not a disease and, with the exception of relatively rare complications, poses no health risk for the mother.

Or to put it bluntly, a fetus is not a neoplasm which needs resection.

To reiterate, inconvenience for the mother (the primary reason for most abortions) should not be an indication for an elective abortion. Think of it this way: You would not give a prima-para woman with no contraindications to vaginal birth an elective c-section simply for convenience sake. Why on earth will you treat elective abortion as an option when it is a cure for nothing and is also just a convenience measure?

Notice I said "elective abortion." I'm sure without too much thought we can both come up with a handful of conditions which are exacerbated by pregnancy putting the mothers's life at grave risk. Not to mention tubal pregnancies. In these cases, elective abortion is a valid "health care option" and should be presented to the patient.

As to the question of religious morality and its place in the doctor-patient relationship, let me just say that your problem is that you are an extremist. Since you have an absolute and fanatical belief in the relativity of morality, you are absoutely unwilling to assert or even suggest any course of action to anyone at any time which may be in conflict with there own personal beliefs.

In this way, you are as as fanatical as the worst islamic fundamentallist and probably more dangerous in the long-run because your attitudes are accepted as normal.

I am a little more open-minded then you are and so I take a rather more nuanced approach to morality with my patients. Nothing better demonstrates this then the fact that I recognize the difference between eating meat on Fridays and murdering an unborn child and you apparently don't.

I imagine that even if I had the desire, it would be a lonely and ultimately fruitless task to try to impose the finer points of my religion's dogma on my patients. I believe Christ will forgive me if I don't fast during lent and I have great hope that he will forgive me for not prosyletizing my patients.

On the other hand, I have a conviction that the Lord strongly disapproves of abortion and will treat it as something other then a misdemeanor.

For this reason, I have absolutely no compunction in telling a woman not to commit this crime and, more importantly in our free and secular society, I resent the implication that I must be forced by by any entity to act in a manner contrary to my private morality. That is, for the sake of the patients irresponsibility I am to be made an accomplice to a crime.

Do you see my point. I'm taking the time to explain this because of your moral confusion. On one hand you assert that you will never perform an abortion (because you find the practice repugnant?) but on the other hand you will willingly send your patient to some butcher who will. Or did I not understand you correctly?

I have given you two arguements against elective abortion. One purely secular and one unashamedly religious. You can take your pick.

And, both of these would have been more interesting to an interviewer and would show the depth and subtlety of your mind. Not to mention your moral courage in not hiding behind the politically correct pablum which passes for "standing your ground" today.
 
Originally posted by Panda Bear
Look, all sarcasm aside, the fundamental flaw in your arguement is that you assume that elective abortion is a health-care option and from this you conclude that it is only right to inform and support a woman of all her options.
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Sorry, Panda Bear, but despite YOUR fanatical religious beliefs, elective abortion IS a legitimate health care option in this country! Your argument that physicians "only treat diseases" is impossibly simplistic--ever heard of plastic surgery? Just because you don't like the fact that elective abortion is a widely available, safe, and popular healthcare option doesn't change the fact that it is all of the above. Contrary to whatever world you inhabit, in the real world people choose elective medical procedures all the time, from c-sections (yep!), to nose jobs, to abortions. This is all legal and within the realm of medicine practiced by many, many physicians. So there goes your so-called secular argument against elective abortion, unless you want to outlaw all elective medical procedures.

As for your claims about the evils of moral relativism: damn right morality is relative! Point out to me the "sins" that at all times, in all cultures, have been considered wrong: there aren't any! At some point, every taboo in our society today has been accepted somewhere, be it incest or cannibalism, and certainly murder. Murder is itself a relative term, defined by the society in which one lives, as all cultures allow for and even glorify some types of murder (self-defense, killing of animals, murders in battle, execution of criminals, etc). Face it, there are no "absolute" wrongs in our world, as nice and neat as that would make everything.

It must be great to be so arrogant as to assume that what you think is right or wrong is the absolute standard by which the whole world should adhere, in the face of all rationality. Even if we all accepted biblical mandates as the gold standard of morality (which I surely do not), interpretation of these varies wildly. Why is your interpretation of god's word the true and correct one? Why should I accept it when you say god or christ or whoever is opposed to abortion, when plenty of other interpretations run contrary to this? You are entitled to your beliefs, but to try to force them on others, including your patients, is the epitome of narrow-mindedness. Isn't that exactly what the islamic fundamentalists that you condemn are doing? Why is it wrong for them to do that, but right for you? Oh, I forgot--you apparently know what god REALLY thinks, and they must just be confused.


Originally posted by Panda Bear
I am a little more open-minded then you are and so I take a rather more nuanced approach to morality with my patients. Nothing better demonstrates this then the fact that I recognize the difference between eating meat on Fridays and murdering an unborn child and you apparently don't.
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Good for you, Panda Bear! Too bad god isn't so fond of making such fine distinctions, as demonstrated by the following select examples, all taken directly from the bible:

Sins punishable by death-
1.) cursing your mother or father (Leviticus 20:9)
2.) adultery (Lev. 20:10)
3.) "playing the harlot after Molech" (Lev. 20:2)
4.) sleeping with a woman and her mother (Lev. 20:14)
5.) being a harlot and the daughter of a priest (Lev. 21:9)
6.) eating animals that have died of natural causes or been torn by beasts (Lev. 22:8-9)
7.) working on the sabbath (Lev. 23:28-30)
8.) blaspheming the name of the lord (Lev. 24:16)

And the list goes on (don't you just love Leviticus)! All of these "sins" are mentioned explicitly as punishable by death, often in colorful ways including stoning and burning. Oh, I know--no one takes all that stuff "literally" these days...except when it's convenient to your cause, right? So feel free to pick and choose which of these commandments god REALLY meant, since you've got the inside scoop on biblical exegesis and all. You've really showed all of us moral relativist cowards how to stand up for the real and absolute truths you've so clearly demonstrated!

Jesus Christ (oops! stone me!), if you want to live your own life according to a certain set of religious beliefs that you accept as truth, fine! More power to you! But when will people learn that the world is not black and white, not everyone thinks the same things you do, and you do not have the right to tell other people what to do based on your personal religious convictions? As a doctor, you are entrusted with a position of authority, and your patients will look to you for medical (not moral or spiritual) guidance. You are violating that trust, plain and simple, if you omit or discourage healthcare options that are legal, safe, and accepted by the medical community simply because you dislike them.

Originally posted by Panda Bear
I have given you two arguements against elective abortion. One purely secular and one unashamedly religious. You can take your pick.
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Done and done.
 
Originally posted by Mistress S
Sorry, Panda Bear, but despite YOUR fanatical religious beliefs, elective abortion IS a legitimate health care option in this country! Your argument that physicians "only treat diseases" is impossibly simplistic--ever heard of plastic surgery? Just because you don't like the fact that elective abortion is a widely available, safe, and popular healthcare option doesn't change the fact that it is all of the above. Contrary to whatever world you inhabit, in the real world people choose elective medical procedures all the time, from c-sections (yep!), to nose jobs, to abortions. This is all legal and within the realm of medicine practiced by many, many physicians. So there goes your so-called secular argument against elective abortion, unless you want to outlaw all elective medical procedures.

As for your claims about the evils of moral relativism: damn right morality is relative! Point out to me the "sins" that at all times, in all cultures, have been considered wrong: there aren't any! At some point, every taboo in our society today has been accepted somewhere, be it incest or cannibalism, and certainly murder. Murder is itself a relative term, defined by the society in which one lives, as all cultures allow for and even glorify some types of murder (self-defense, killing of animals, murders in battle, execution of criminals, etc). Face it, there are no "absolute" wrongs in our world, as nice and neat as that would make everything.

It must be great to be so arrogant as to assume that what you think is right or wrong is the absolute standard by which the whole world should adhere, in the face of all rationality. Even if we all accepted biblical mandates as the gold standard of morality (which I surely do not), interpretation of these varies wildly. Why is your interpretation of god's word the true and correct one? Why should I accept it when you say god or christ or whoever is opposed to abortion, when plenty of other interpretations run contrary to this? You are entitled to your beliefs, but to try to force them on others, including your patients, is the epitome of narrow-mindedness. Isn't that exactly what the islamic fundamentalists that you condemn are doing? Why is it wrong for them to do that, but right for you? Oh, I forgot--you apparently know what god REALLY thinks, and they must just be confused.




Good for you, Panda Bear! Too bad god isn't so fond of making such fine distinctions, as demonstrated by the following select examples, all taken directly from the bible:

Sins punishable by death-
1.) cursing your mother or father (Leviticus 20:9)
2.) adultery (Lev. 20:10)
3.) "playing the harlot after Molech" (Lev. 20:2)
4.) sleeping with a woman and her mother (Lev. 20:14)
5.) being a harlot and the daughter of a priest (Lev. 21:9)
6.) eating animals that have died of natural causes or been torn by beasts (Lev. 22:8-9)
7.) working on the sabbath (Lev. 23:28-30)
8.) blaspheming the name of the lord (Lev. 24:16)

And the list goes on (don't you just love Leviticus)! All of these "sins" are mentioned explicitly as punishable by death, often in colorful ways including stoning and burning. Oh, I know--no one takes all that stuff "literally" these days...except when it's convenient to your cause, right? So feel free to pick and choose which of these commandments god REALLY meant, since you've got the inside scoop on biblical exegesis and all. You've really showed all of us moral relativist cowards how to stand up for the real and absolute truths you've so clearly demonstrated!

Jesus Christ (oops! stone me!), if you want to live your own life according to a certain set of religious beliefs that you accept as truth, fine! More power to you! But when will people learn that the world is not black and white, not everyone thinks the same things you do, and you do not have the right to tell other people what to do based on your personal religious convictions? As a doctor, you are entrusted with a position of authority, and your patients will look to you for medical (not moral or spiritual) guidance. You are violating that trust, plain and simple, if you omit or discourage healthcare options that are legal, safe, and accepted by the medical community simply because you dislike them.



Done and done.
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I wont even get into this, except to say that most of the bashing and bullying, especially in the ivory tower of academia, is done not by those who are religious, but those who hate them. This thread has made me feel strongly for those who've been so ready to flame pro-life doctors, such anger must stem from some kind of negative experience with religion and for that, as a member of the Episcopalian church, I apologize. I will, however, reiterate my position that adoption, in my opinion, is a both psychologically and pragmatically better choice for both the mother and child. Given that as my opinion (backed up by statistics), it would be irresponsible for me to quickly reccomend an abortion when a better "treatment" (although it makes me shudder to consider pregnancy an "ailment") is available. Obviously every serious premed on this forum would tell the patient all of her options; the point is that a doctor is a doctor because he not only gives the options, but he gives his honest opinion as to what the best treatment option is and why. in the end, the decision is not his, but if he were to omit what his training as a doctor and experience in medicine had taught him, that would truly and inextricably be a crime.
 
Originally posted by R_C_Hutchinson
I wont even get into this, except to say that most of the bashing and bullying, especially in the ivory tower of academia, is done not by those who are religious, but those who hate them.
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Oh God i am going to barf!
 
"As for your claims about the evils of moral relativism: damn right morality is relative! Point out to me the "sins" that at all times, in all cultures, have been considered wrong: there aren't any! At some point, every taboo in our society today has been accepted somewhere, be it incest or cannibalism, and certainly murder. Murder is itself a relative term, defined by the society in which one lives, as all cultures allow for and even glorify some types of murder (self-defense, killing of animals, murders in battle, execution of criminals, etc). Face it, there are no "absolute" wrongs in our world, as nice and neat as that would make everything."

So you admit to being an extremist when it comes to the relativity of morality? Or, to put it another way, you seem to revel in your intolerance of other people's moral beliefs.

I suppose then that, given your unwillingness use your own moral compass as a guide, if you suspect a patient's father of sexually molesting him you would ignore the situation because, after all, who are you to judge? Or would you present the child with all his options and let him decide whether he wants to be removed from the home or whether his father should be prosecuted.

Or perhaps you actually do have a standard of morality which you are willing to apply to your patients? You probably do, accept you draw the "moral line in the sand" a little bit past mine.

Do you see the inherent danger of being unwilling to impose the slightest bit of "personal morality" on others.
 
Originally posted by Panda Bear
So you admit to being an extremist when it comes to the relativity of morality? Or, to put it another way, you seem to revel in your intolerance of other people's moral beliefs.
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No more than you admit to being an extremist in insisting on an absolute morality. How exactly am I intolerant of your beliefs? Because I do not share them? I said several times that you have every right to your own beliefs, and I do not require that you agree with my views. I don't expect to convert you to my way of thinking, any more than you should expect to convert me. You just do not have the right to abuse your authority as a physician by imposing your morality on others.

Originally posted by Panda Bear
I suppose then that, given your unwillingness use your own moral compass as a guide, if you suspect a patient's father of sexually molesting him you would ignore the situation because, after all, who are you to judge? Or would you present the child with all his options and let him decide whether he wants to be removed from the home or whether his father should be prosecuted..
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No, that would be unethical and illegal; I do not need to have an absolute moral compass to understand that, and to do what the law and my ethical principles would guide me to do to protect the child in question. It doesn't even matter if I thought the father in this hypothetical situation was right or wrong; I would have an ethical obligation to act in a certain way, just as you would have an ethical obligation as a physician to present a patient facing an unwanted pregnancy with all her options, whether or not you agreed with all of them morally. See how that works? Saying that morality is relative does not endorse anarchy; we live in a society, and as a society agree on laws and modes of conduct that are acceptable. These change periodically, reflecting the relative nature of morality; but if we are to live together, we are bound to follow them or work to change them as we see necessary. You are free to oppose abortion strongly in your personal life, to never ever have one, to advise your friends and family against it, and to work to change abortion laws. As a physician, however, you are ethically obligated to present it to patients as the safe and legitimate healthcare option that it is.

I am not so much angry as fed up with the arrogance and hypocrisy of some (not all) religious right-wingers. They hold the bible up and demand that we all should follow their interpretation of it, which selectively ignores the parts they don't care about and conveniently emphasizes the social and political causes they endorse. Many of these people are hateful and simply looking for an excuse to justify their feelings of superiority; the kind of people who show up at the funeral of a boy who was violently murdered for being homosexual with signs delaring, "God hates fags" and "He got what he deserved", say, or the type who would shoot up an abortion clinic. These are extreme examples, of course, but their type of thinking is unfortunately much more widely held in the christian community than some would like to acknowledge. If they are using the bible as their guide, as they insist, than why aren't there any rallies against blasphemy? Why aren't hate crimes committed against people going to work on Sunday? Why, instead, does all of this christian self-righteousness and vitriol focus on sexual/political issues such as abortion and homosexuality? The bible doesn't differentiate between these "crimes"; all are punishable by death (actually, there isn't even any specific biblical passage against abortion). I think people should be honest about what they are really doing: not spreading god's word, but selectively interpreting the bible to suit their own personal (and relative) moral beliefs.
 
Hey
One of the admissions officers of a medical school(I wont say which one) told me it was illegal for them to ask your opinion on abortion...
 
Originally posted by Mistress S
No more than you admit to being an extremist in insisting on an absolute morality. How exactly am I intolerant of your beliefs? Because I do not share them? I said several times that you have every right to your own beliefs, and I do not require that you agree with my views. I don't expect to convert you to my way of thinking, any more than you should expect to convert me. You just do not have the right to abuse your authority as a physician by imposing your morality on others.



No, that would be unethical and illegal; I do not need to have an absolute moral compass to understand that, and to do what the law and my ethical principles would guide me to do to protect the child in question. It doesn't even matter if I thought the father in this hypothetical situation was right or wrong; I would have an ethical obligation to act in a certain way, just as you would have an ethical obligation as a physician to present a patient facing an unwanted pregnancy with all her options, whether or not you agreed with all of them morally. See how that works? Saying that morality is relative does not endorse anarchy; we live in a society, and as a society agree on laws and modes of conduct that are acceptable. These change periodically, reflecting the relative nature of morality; but if we are to live together, we are bound to follow them or work to change them as we see necessary. You are free to oppose abortion strongly in your personal life, to never ever have one, to advise your friends and family against it, and to work to change abortion laws. As a physician, however, you are ethically obligated to present it to patients as the safe and legitimate healthcare option that it is.

I am not so much angry as fed up with the arrogance and hypocrisy of some (not all) religious right-wingers. They hold the bible up and demand that we all should follow their interpretation of it, which selectively ignores the parts they don't care about and conveniently emphasizes the social and political causes they endorse. Many of these people are hateful and simply looking for an excuse to justify their feelings of superiority; the kind of people who show up at the funeral of a boy who was violently murdered for being homosexual with signs delaring, "God hates fags" and "He got what he deserved", say, or the type who would shoot up an abortion clinic. These are extreme examples, of course, but their type of thinking is unfortunately much more widely held in the christian community than some would like to acknowledge. If they are using the bible as their guide, as they insist, than why aren't there any rallies against blasphemy? Why aren't hate crimes committed against people going to work on Sunday? Why, instead, does all of this christian self-righteousness and vitriol focus on sexual/political issues such as abortion and homosexuality? The bible doesn't differentiate between these "crimes"; all are punishable by death (actually, there isn't even any specific biblical passage against abortion). I think people should be honest about what they are really doing: not spreading god's word, but selectively interpreting the bible to suit their own personal (and relative) moral beliefs.
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So in fact you admit to having some moral principals which you will impose on others? With all due respect, what's the difference between my moral standards and yours?

As for extremism, look, your absolute belief in moral relativism is pretty extreme and you are completely inflexible in its application. I, on the other hand, (and I repeat) am a good deal more tolerant of people who do not share my moral beliefs. But since I am more flexible, I have a certain freedom of action which you lack. I can let some things (most things in fact) slide when it comes to our patients. You, on the other hand, are locked into a pattern where you must grit your teeth and accept everything your patients do no matter how horrendous or contrary to what you know to be right.

Get it?
 
Originally posted by JBJ
I have heard that it will kill you application to be pro-choice at the Jesuit universities, such as Georgetown.
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i highly highly doubt this. it is possible that some interviewers *might* look down on you for it, but i got the feeling that gtown was interested in students from varied backgrounds who had respect for all religions, ethnicities, etc... i don't think they expect their students to subscribe to a particular religion or philosophy other than respect for their patients.
hell, i said i was in favor of embryonic stem cell research, and they let me in! i will admit that when my interviewer asked about important ethical issues i steered clear from abortion, but i think she would have been fine with whatever i had to say as long as it was well thought out and respectful.
it's always best to be yourself!
 
Originally posted by Panda Bear
Look, all sarcasm aside, the fundamental flaw in your arguement is that .....
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...you completely neglect to consider the history of abortion in medical care. Abortion used to be illegal, and desperate women still had them performed. By hacks and quacks, and they died for their folly. Prohibition does not work, for anything. Take for example our countries "war on drugs". I wish the idea of abortion had never been dreamed up. But it would be foolish to try to impose my beliefs on another.
We live in a society with many different beliefs. We all need to be able to sit down and discuss our differences, without insulting one another. Hate and intollerance breed more of the same.
Want to make a difference; stop arguing.
 
Originally posted by rgporter
Prohibition does not work, for anything.
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Wow. I suppose that would simplify the penal code a tad. I'll miss all those laws against child labor, robbery, endangered-species-sport-hunting, pollution, and medical practice without a license.

I suppose it would level the playing field, though. That way the seventeen week old fetuses won't be the only ones without protection against being crushed by forceps.
 
Originally posted by lukealfredwhite
Wow. I suppose that would simplify the penal code a tad. I'll miss all those laws against child labor, robbery, endangered-species-sport-hunting, pollution, and medical practice without a license.

I suppose it would level the playing field, though. That way the seventeen week old fetuses won't be the only ones without protection against being crushed by forceps.
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I guess I should follow up by saying that generalizations are always false. :p
Quit nitpicking.
 
I do think that nitpicking is neglecting the general thrust of someone's argument by attacking a peripheral point. Your point, as best as I can tell, was that prohibition doesn't work for anything. If your argument is that abortion is evil, but that prohibition doesn't work for bad things, "anything" is pretty much the only word you can use for the argument to make sense, since there are are a great many very bad things we already prohibit with some degree of success.

Less a matter of nitpicking, then, than with following your argument through to its necessary extreme. If you'd care to refine it, though, I'd be of course interested to listen.

But to all:

Personally, I prefer people following their arguments through to their extremes. In the Allopathic forum we have a fascinating abortion thread in which at least one person has allowed for infanticide AFTER birth "in theory," and another one has made the brave claim that he "never argued against infanticide." See how well the adcoms like that. Of course, those are people already in med school, so they needn't worry about massaging their views to fit what they think the adcoms most want to hear.
 
Originally posted by rgporter
.....We live in a society with many different beliefs. We all need to be able to sit down and discuss our differences, without insulting one another. Hate and intollerance breed more of the same.
Want to make a difference; stop arguing.
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Actually the main point of my argument was that we live in a pluralistic society. We should learn to accept other people and that they may have different beliefs.
The argument about prohibition was refering to subjects where there is a sharp division of beliefs, i.e. abortion. Which although legal, is very distasteful; Not homicide, rape or anything else for which there is no division of beliefs.

P.S. Yes I used drug use as an example; yes it is illegal. Perhaps people continue to believe it isn't wrong. I don't know, prohibition doesn't seem to be working though.
 
A familiar argument: If beliefs on a matter are sharply divided, there should be no prohibition of it. One of the favorites of those in favor of unfettered abortion.

Of course, what it's really saying is: "If a large chunk of the population believes something is ok, then it should be allowed even if another large chunk believes it's wrong."

It's a fairly new argument, since there wasn't nearly so much pro-abortion sentiment back in '72, and it's going out of style again since pro-life sentiment is swelling. Those in favor of abortion tend to rely on supposed rights when they feel themselves a sharp minority on an issue, and when they feel a little safer in numbers on the argument that what's right doesn't matter so much as what society thinks.

We prohibit lots of things over which opinion is sharply divided with some success. To cite a slightly dated example, slavery was prohibited pretty effectively after 1865, despite the fact that a huge chunk of the population was all for it. Not personally, mind you. They would never THEMSELVES own a slave, but were willing to fight for the right for others to own a few.

Etc. etc. We're a republic, not a democracy. And one of the advantages of a republic is that rights can be protected irrespective of what a majority thinks.

As for the interview, this has direct application: The physician is responsible to act according to what he or she considers the best interest of the patient, whether or not the patient agrees. If the patient wants treatment that the physician considers not in their interest, not only is the physician permitted not to facilitate it, but is obligated not to. You wouldn't refer the high school football player to your friend Guido simply because you won't prescribe the steroids he wants. Nor would you even if steroids were legal--it would be bad medicine.

Those on the thread who would obligate physicians to "provide all the options," as they put it, would do well to seriously consider the logical consequences of the principles they're arguing beyond the one cause they've tried it out on.
 
Originally posted by Panda Bear
So in fact you admit to having some moral principals which you will impose on others? With all due respect, what's the difference between my moral standards and yours?

As for extremism, look, your absolute belief in moral relativism is pretty extreme and you are completely inflexible in its application. I, on the other hand, (and I repeat) am a good deal more tolerant of people who do not share my moral beliefs. But since I am more flexible, I have a certain freedom of action which you lack. I can let some things (most things in fact) slide when it comes to our patients. You, on the other hand, are locked into a pattern where you must grit your teeth and accept everything your patients do no matter how horrendous or contrary to what you know to be right.

Get it?
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No, I admit to having ethical principles which I will follow in my chosen profession. I have personal ideas about what is right and wrong in my own life that have little to do with my work: I do not need to waste energy worrying if the actions of others fit within my personal moral beliefs, as my beliefs do not require them to.

You keep making the bizarre claim that your stringent, black-and-white, absolute morality, which you have already declared obligates you to preach to your patients your views on the moral purity of their actions beyond the realm of medical advice, somehow makes you "more flexible" and "tolerant" than simply freeing yourself from the need to impose your morality on others by letting go of the idea that there is some kind of unassailable moral truth out there which only you and a select few really understand, but which all must follow regardless--and no, I do not "get that" at all.

I work in a reproductive health care clinic now, and my job would indeed be a grueling one if I wasted my time judging every patient that walked through the door and "gritting my teeth" in anger at their "horrendous" actions that I don't agree with. Instead, I accept them as people just like me in need of medical advice and attention, which I am in the privileged position to provide to them as respectfully as I can (regardless of whether I think whatever behaviors they are engaged in are moral or not) because that is the ethical duty of my profession. I do not need to tell anyone what to do or not do beyond the medical and legal impact of their actions. Thank god (there I go again!) that it is not my job to judge everyone else and decide how they should live their lives--it is enough for me to judge my own actions and make those decisions in my own life; why on earth would I want to do that for everyone else? But I guess that's one of the differences between you and I. If you feel that this outlook--that individuals should make their own decisions in their lives based on their personal moral belief systems, regardless of what I think is "right" or "wrong" (within the bounds of the law, of course)-- somehow makes me more intolerant than you of the moral beliefs of others, fine; whatever. That makes no sense to me, but we're obviously never going to see eye to eye on any of these issues (abortion, morality, religion, etc), and you're free to believe whatever you want. I won't try to tell you what to think. :p
 
Originally posted by lukealfredwhite
Etc. etc. We're a republic, not a democracy. And one of the advantages of a republic is that rights can be protected irrespective of what a majority thinks.
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From Webster's New World dictionary:
republic: a state or nation in which the supreme power rests in all the citizens entitled to vote (the electorate) and is exercised by representatives elected, directly or indirectly, by them and repsonsible to them

democracy: government in which the people hold the ruling power either directly or through elected representatives; rule by the ruled

So how exactly, at least in theory, do we not live in a democracy? And how does this entitle so-called "rights" to be protected against the will of the majority?

Originally posted by lukealfredwhite
As for the interview, this has direct application: The physician is responsible to act according to what he or she considers the best interest of the patient, whether or not the patient agrees. If the patient wants treatment that the physician considers not in their interest, not only is the physician permitted not to facilitate it, but is obligated not to.
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I don't know what kind of medicine you plan to practice, but unless you're going to work with coma patients I think what you're proposing is highly unethical. I plan to teach patients about their bodies and healthcare options, provide my best medical judgement as to what is the best treatment course or medical option for them, then let them decide what they want to do, since it is after all THEIR BODY and THEIR LIFE in question. Where did you get the idea that the physician's job is to make decisions for patients and do what you think is morally right for them, regardless of what they want? Try telling that to an adcom (please, share this view with them). I find that to be a disturbing show of arrogance and complete lack of respect for the patient.


Originally posted by lukealfredwhite
You wouldn't refer the high school football player to your friend Guido simply because you won't prescribe the steroids he wants. Nor would you even if steroids were legal--it would be bad medicine.

Those on the thread who would obligate physicians to "provide all the options," as they put it, would do well to seriously consider the logical consequences of the principles they're arguing beyond the one cause they've tried it out on.
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Steroids are legal, but I assume you are talking about using them to enhance athletic performance, for which they are illegal. But if they were legal for that purpose, sure I'd refer him to another doctor--why wouldn't I? Of course there can be very serious health issues associated with long-term abuse of steroids, and as a physician I'd be obligated to inform him of those and advise him of other, more heathful ways to better his abilities; but it's up to him, as an individual, what to do with his body.

This happens all the time today in medicine; I'll give you just one of many examples I could provide--human growth hormone. Some physicians prescribe this to children who are exceptionally short for their age; there's nothing medically wrong with them, but usually a parent demands this in order to better their child's quality of life (in their opinion). Some physicians feel this is wrong and, as it is unclear what all the dangers of a healthy person taking HGH just to add on a few inches might be, refuse to prescribe it; I probably wouldn't provide it myself for that reason, unless it were clearly established to be safe. But I wouldn't withold this option from patients, or discourage them from it with anything other than medical evidence that it may not be safe, even though I find it somewhat disturbing for parents to medicate their healthy children for appearance issues. That would be grossly overstepping my authority as a physician, to selectively omit options or refuse to provide information and referrals because of my beliefs apart from my medical judgement.

You see, I have thought through the implications of this argument, and I have no problem placing patient autonomy over my personal beliefs, ever. Outside of what the law and professional ethics dictate, I would not tell a patient what to do or not do; they get to decide what's best for them, and I'm there to help, not make decisions for them against their will. The best way I can help them is by respecting them as individuals and providing clear, comprehensive information so they can be fully informed to decide what is the best choice for their life. It's a lot simpler and more respectful than trying to judge and make decisions for everyone, as if you could possibly know what is right for everyone else; you should give it a try. ;)
 
Look, all sarcasm aside, the fundamental flaw in your arguement is that you assume that elective abortion is a health-care option and from this you conclude that it is only right to inform and support a woman of all her options.
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No, I assume that individual physicians do not have the right to selectively omit information based on their morals/religious beliefs. The job of the physician with regards to patient information is to follow the standard of the medical profession. Am I a good doctor if I tell my patients that prayer is the best treatment for cancer and I don't mention surgery? No, because I'm not in accord with the general, elucidated standards of the medical profession. When patients come to a licensed doctor with that MD or DO after their name, the implicit assumption is that the information and treatment they're getting is going to follow the general standards of the medical profession.

What are the general standards? The AMA says abortion is a legitimate medical procedure, and that no doctor should be forced to perform an act violative of personal principles. That means that, sure, you don't have to recommend abortion as an option - but if you can't, you're obliged to withdraw from the case, NOT only provide options you like. If you don't, you're violating AMA ethical standards, which I consider to be unacceptable in a doctor and a violation of public trust.

If you don't like the policy/abortion it's your duty to work within the legislative system (and the AMA too) to get policy changed, but letting doctors selectively choose which, if any, standard professional ethics codes they "agree" with just doesn't work for me.


http://www.ama-assn.org/apps/pf_online/pf_online?f_n=browse&doc=policyfiles/HOD/H-5.995.HTM
 
The physician is responsible to act according to what he or she considers the best interest of the patient, whether or not the patient agrees. If the patient wants treatment that the physician considers not in their interest, not only is the physician permitted not to facilitate it, but is obligated not to.
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Aside from the obvious (and, IMO, distasteful) paternalistic nature of this argument, I must say....*this* is what second opinions are for!

The patient decides what is in the patient's best interest. The doctor offers options and gives his/her opinion on which offer the most benefit. It is still up to the patient to decide how to proceed.

To take it out of the abortion scenario...if a patient had a small mass on a mammogram and you thought "wait & see" was in the best interest of the patient, does that mean the patient should just accept that and not seek out a second opinion? Do you fully understand how waiting will affect the patient mentally and emotionally? Nope...none of us do unless we are inside the patient's head.

I think Mistress S made some wonderful points. It doesn't matter what I would choose for myself. There will be plenty of times when I will encounter a patient whose choices are not what I would choose for myself--maybe would not think they were in the "best interest" of the patient. However, if you are blatantly judging patients for those choices, you end up with patients who simply don't tell you what they are doing.

You can deal with a patient's issues without bringing your own morality into the issue. Forget about referring the patient to someone else. Most women know that abortion is legal (mostly...for now). If a patient knew that you thought abortion was abhorrent, would she tell you she had one? Would you still see her as a patient if she'd had one? Would you go into the exam room thinking "oh, here's the patient that got pregnant at 13 and had an abortion.."?

Maybe I'm one of those "horrible" patients but I don't automatically assume that any doctor knows what is in *my* best interests.

Willow
 
First off, I have to say that everyone would be better off if people would stop throwing "paternalistic" around. It's tired, and betrays one's biases all too well. In many respects the doctor must indeed be paternal (why do we insist on that -istic anyhow?) and maternal to boot. Physicians are not technicians, and medicine hasn't advanced by democratic poll.

Now, for the various specific issues:

Mistress S argues that we live in a democracy, rather than a republic, and suggests that "so called rights" shouldn't be protected against the will of the majority.

I'd rather not get sidetracked into civics, but there are a variety of ways to determine whether or not a country is a republic. Since the US has "republic" in its name, that's at least a starting indicator. Moreover, many of the decisions are made by representatives who are not directly elected, or who are in fact appointed, thereby allowing them to protect the rights of the minority even when those rights may be unpopular. A certain group of nine black-robed folks in Washington, none of them elected, made just this attempt in Roe v. Wade.

As for what gives the republic a right to protect the rights of those not in the majority, let's skip the theoreticals and look at a hypothetical. Let's say that twenty years from now China and India, which both have hugely disproportionate male majorities due to the common habit of aborting females, decide to outlaw female schooling after a certain early age to encourage them to marry and thus close the gender gap a bit. This would obviously be immoral (at least to those who accept universal morality). In a democracy, there's no safeguard against this. Majority wins. In a republic, representatives have more freedom to act against the public interest when necessary.

So say what you will about abortion's rightness or wrongness (though again, I don't see how you can say much at all if you're a moral relativist), but arguing from some sort of notion of democracy is intellectually poor and will, more likely than not, come back to haunt you.

Mistress S also notes that if recreational steroids were legal, she'd have no problem referring the young kid to another doctor because, well, it's his body after all. Certainly consistent with the abortion position, and no less awful. That's not medicine; that's enabling. If you see a physician as the professional who simply provides people with the medical knowledge that will help them do whatever they choose, then you've created a new profession entirely. You'll certainly be in good company, as all too many people practice like that now. It's easy, requires no tough decisions about right or wrong, and tends to be more lucrative than the alternative. But it's not medicine.

No one is forced to go to this doctor or the next. Everyone has choices, limited though they sometimes are, and they're more than welcome to exercise their right to do things that aren't in their own best interest as long as that right doesn't infringe on the well-being of others. A physician, however, isn't obligated to play any part in their destructive behavior.
 
Let me recapitualte a few things.

First of all, appealing to the AMA as the arbritar of ethical issues is what is called in logic "reversion to authority." In other words, you ask us to accept the authority of the AMA on ethical issues when, while second to none as an intellectual body, they have no special wisdom when it comes to morality. If I cited the Pope as the foundation of my arguements you would probably rupture a blood vessal in your brain.

I also detect the unshakable belief in many of you that we must present every option even if it conflicts with our own ethical views. Clearly this is not the case as has been demonstrated.

Let's say a poor patient comes to you for treatment which he cannot afford. You know that in some areas of the world a person can get a good sum of money for one of his kidneys. Would you present this as an option to the patient? What if the practice were legal? Someone pointed out that many practices we once considered taboo are now accepted. Is everything that is legal neccessarily moral?

Or, does a vote by a majority of the citizenry confer morality on a practice? If you believe this, then you should have no problem with a physician refusing to perform or refer a woman for an abortion because in my state the legislature, which represents the will of the people, voted overwhelmingly to protect physicians (like me) who object to elective abortion on religious or moral grounds.

I think some of you want it both ways. On one hand you insist that the majority confers legitimacy on practices of which you approve but refuse to accept the majority opinion when it conflicts with your beliefs.

On another point, the accusation has been made that those of us who will not refer a woman for an abortion are "ramming our morals down the throats" of our hapless patients." This assertion is laughable.

If you ask me to help you rob a bank and I refuse, am I "ramming my morals down your throat?" The opposite is true. You are attempting to ram yours down mine by asking me to take part in an action which I consider immoral.

I think we can all agree that we shouldn't prosyletize our patients or try to convert them to our religion. I believe that religion has very little place in the doctor-patient relationship. On the other hand, I am not an extremist and I can confidently make exceptions to this general principle.

If a patient asks for help obtaining an abortion, it is well within your moral and legal rights to refuse. If she presses you, you can say, humbly, respectfully, but firmly: "Ma'am, I am a devout Christian (Moslem, Hindu, Jew, etc.) and for religious reasons I will not discuss abortion with you nor can I in good conscience refer you to someone who will." No "ramming" involved. The patient asked, you gave her your professional opinion.

I say "professional" opinion because as physicians we are not supposed to be just technicians, that is, black boxes into which are put symptoms and out of which come treatments.

Society expects physcians to be moral. And I don't mean they expect us to be "plaster saints." Just that they expect us to have convictions about the human condition.

I find it funny that many of you cannot reckognize your own extremism. It's ironic that me and most of my fellow Christian medical students are more willing to accept behavior which we consider immoral then many of you are to accept behavior which you consider immoral. In your case, your personal morality is defined by your belief in the absolute relativism of morality.

Apparently, the thought that somewhere, somehow, somebody is applying some personal non-relative morality in medicine has you figuratively foaming at the mouth in rage.

I also want to add that many of you have firmly held but none-the-less-wildly incorrect stereotypes about Christianity. If I clung to every out-dated and incorrect stereotype about blacks, Jews, or the Irish you would correctly label me as a racist. What's your excuse?

If all you know about Christianity is what you learn from Pat Robertson then I am sorry for you.


By the way. There are hundreds of Catholic hospitals in the United States which do not discuss elective abortion as a treatment option.
 
First of all, appealing to the AMA as the arbritar of ethical issues is what is called in logic "reversion to authority." In other words, you ask us to accept the authority of the AMA on ethical issues when, while second to none as an intellectual body, they have no special wisdom when it comes to morality.
Click to expand...

Yes, because the AMA is viewed by the public as the arbiter of the standards of the medical profession. Your argument carried to its logical conclusion is that every doctor should be allowed to make their own decisions without having to operate within the framework of "standard" medical practice. What I'm getting at is that AMA policies do not emerge from a vacuum - they emerge from the majority opinion of American physicians, and as such they ARE the standard by which the majority of doctors are operating.

Forget abortion for a moment - what I'm saying is that doctors need to be bound by one code of ethics for the sake of the public. Should I have to give every doctor I go to a quiz on ethics to make sure their beliefs are compatible with the standard? Should I have to ask him if he'd let me die because I'm gay and he thinks gay people should die? No, because there are general medical ethics, which for the sake of argument are defined by the AMA in its capacity as the majority of American doctors. I should be able to expect any doctor to follow the same general medical ethics policies, especially since they don't violate anybody's morality - they specifically say you don't have to do anything against your morals, but if your morals and professional ethics conflict, you must recuse yourself.

I'm aware that people want to change what's viewed as professional ethics, but the way to do that is not by disregarding them, but rather by working through accepted channels to get them changed. I just find it distasteful when people say they'd blithely limit patient information based on personal beliefs, no matter what the beliefs are - patients should be getting the same information from every doctor (opinions are a different matter, which is why I have no real problem with "abortion is an option, but I think it's a bad one").
 
I really have nothing to add to yet another tireless abortion debate between Mr. White and pandabear and everyone else on SDN. What it comes down to is that no one ever changes anyone else's opinions on these forums or anywhere else.

I just want to say that I fully support the intelligent, well thought out arguments of Mistress S and willow rose. Thank you guys for giving such an intelligent account of the pro-choice mentality. You make me proud to consider myself among you.
 
Originally posted by Panda Bear


...the patients for their part shouldn't try to impose thier morals on the physician.
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I totally disagree with your statement Panda. For the sake of argument, i will equivocate morals with religion (as both dictate values). You cannot tell a patient to turn their back against or exclude what they believe in, their values, beliefs, and opinions just because you think it isn't part of the patient doctor dynamic. It is very much so a part. And if you continue to hold such opinions, you will have a great time treating Jehova's witnesses, jew, muslims, Hmong, etc, (pretty much a good portion of the people that make up the social fabric of this society)



There is no need to get all PC and wishy-washy just because you are a physician. I tell patients to stop smoking crack all the time and I don't qualify this advice with any allowance for their morality. .
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Smoking crack and getting an abortion are two totally different ball parks. You cannot make such an anology without considering the social construct of both cases.




Remember, all you pro-life folks: Referring a woman for an elective abortion makes you just as complicit in the murder of an unborn baby as performing the procedure yourself.
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Again, I totally disagree. You are talking about guilt by association but all I am hearing is treachery via omittion. Just because you don't believe in something doesn't mean the option shouldn't be available to someone else. We no longer live in the day where the opinions of the physician was the pinnacle of the patient doctor relationship. There has been a trend of increased empowerment and decision making on behalf of the patient. I would never want a doctor that would withold treatment options from me just because he/she has a moral objection. That would be a true pitty.

[/B][/QUOTE]
 
Originally posted by dmoney41
Yes, because the AMA is viewed by the public as the arbiter of the standards of the medical profession. Your argument carried to its logical conclusion is that every doctor should be allowed to make their own decisions without having to operate within the framework of "standard" medical practice. What I'm getting at is that AMA policies do not emerge from a vacuum - they emerge from the majority opinion of American physicians, and as such they ARE the standard by which the majority of doctors are operating.

Forget abortion for a moment - what I'm saying is that doctors need to be bound by one code of ethics for the sake of the public. Should I have to give every doctor I go to a quiz on ethics to make sure their beliefs are compatible with the standard? Should I have to ask him if he'd let me die because I'm gay and he thinks gay people should die? No, because there are general medical ethics, which for the sake of argument are defined by the AMA in its capacity as the majority of American doctors. I should be able to expect any doctor to follow the same general medical ethics policies, especially since they don't violate anybody's morality - they specifically say you don't have to do anything against your morals, but if your morals and professional ethics conflict, you must recuse yourself.

I'm aware that people want to change what's viewed as professional ethics, but the way to do that is not by disregarding them, but rather by working through accepted channels to get them changed. I just find it distasteful when people say they'd blithely limit patient information based on personal beliefs, no matter what the beliefs are - patients should be getting the same information from every doctor (opinions are a different matter, which is why I have no real problem with "abortion is an option, but I think it's a bad one").
Click to expand...

I understand your point, and it is well presented.

But medicine is not a cult. As much as I respect the AMA I don't know of any law which binds us to obey every edict which they promulgate. I'm not even a member of the AMA so except that they lobby the legislative bodies of this country to enact their policy as law, I don't see how they have too much power over me. And I don't see why I should blindly surrender 1400 years of Orthodox Christian teaching to a body which is scarcely 100 years old and includes among its goverrning body many members who, while no doubt fine individuals, are probably devoid of religious belief. But that's just me. You of course, must let your own conscience be your guide.

Now, in the clinical realm I am more then happy to defer to the judgement of the AMA and I appreciate their practice guidelines as much as anybody. But let me reiterate: membership in the AMA is not a requirement for matriculation to medical school, graduation, or licensing. The leadership of the AMA is not even democraticly elected, so as a good American I am a little leary of surrendering my autonomy to some non-represntrative body.

By the way, the AMA does not issue "commands" on social issues. It issues "opinions" which are merely guidlines arrived at by a consensus of their members.

To confuse the issue even more, the only oath we take in medical school, the "Hippocratic Oath" in its original form prohibits physicians from performing abortions. In fact, since ancient times abortion has been anathema. It is only in the last thirty or so years that it come to be viewed as a "health care option."

I am not "reverting to authority" here. I'm just pointing out that elective abortion as a health care option has been the historical exception and not the rule.

the issue here is not whether abortion is right or wrong. The issue is whether in a free society people are allowed to live their lives governed by moral principles.

I'm with you when you say we should be careful about imposing our morality on others. But the AMA and a patient who wants me to provide her with an elective abortion are imposing their morality on me...big time.
 
Originally posted by smartreader
I totally disagree with your statement Panda. For the sake of argument, i will equivocate morals with religion (as both dictate values). You cannot tell a patient to turn their back against or exclude what they believe in, their values, beliefs, and opinions just because you think it isn't part of the patient doctor dynamic. It is very much so a part. And if you continue to hold such opinions, you will have a great time treating Jehova's witnesses, jew, muslims, Hmong, etc, (pretty much a good portion of the people that make up the social fabric of this society)



Smoking crack and getting an abortion are two totally different ball parks. You cannot make such an anology without considering the social construct of both cases.



Again, I totally disagree. You are talking about guilt by association but all I am hearing is treachery via omittion. Just because you don't believe in something doesn't mean the option shouldn't be available to someone else. We no longer live in the day where the opinions of the physician was the pinnacle of the patient doctor relationship. There has been a trend of increased empowerment and decision making on behalf of the patient. I would never want a doctor that would withold treatment options from me just because he/she has a moral objection. That would be a true pitty.
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[/B][/QUOTE]

I understand what you are saying, but you have it exactly backwards, my religious beliefs in no way hinder me in treating those of different faiths or those with no faith. The opposite is true. I have an absolute basis for compassion towards everyone and I would not be much of a Christian if I refused to treat an HIV positive patient because he was, like me, a sinner.

We are commanded to show mercy, love, and compassion. It is not merely a suggestion.

Besides, religion aside, I am a fairly decent guy. It is not hard for me to like everybody I meet despite their background.

Also, because you approve of abortion and don't believe it to be the murder of the unborn, you can rationalize it as just another medical procedure which we are obligated to provide.

Consequently you can't understand how someone who believes it to be murder would refuse to become an accomplice by helping a woman find a more willing murderer.

If you asks me to commit murder and I am too squemish to do it myself but help you find someone who will, then, in most legal codes I am considered an accomplice.

The Orthodox Christian Church, (of whom I am a dutiful son) the Catholic Church, and most protestant denominations are very clear on this.
 
Originally posted by lukealfredwhite
First off, I have to say that everyone would be better off if people would stop throwing "paternalistic" around. It's tired, and betrays one's biases all too well. In many respects the doctor must indeed be paternal (why do we insist on that -istic anyhow?) and maternal to boot.
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No, I think folks would be better off if they understood the idea behind saying someone (or some entity) is "paternalistic." We used it a lot in law school when discussing whether it is the job of the legislature or judiciary to decide what's "good for us." Because we live in a patriarchy, the word used is "paternalistic." Any way you look at it, the ideas expressed by the self-labelled "moderate Christian moralists" here are paternalistic--looking at the patient as a child who cannot be trusted to know what is good for himself/herself and must be led by the good doctor.

Edited to add the "official" Webster definitions:

Paternal=fatherly, of or relating to a father

Paternalism=a system under which an authority undertakes to supply needs or regulate conduct of those under its control in matters affecting them as individuals as well as in their relations to authority and to each other

That's why you need the "ism"--because there's a big difference between acting fatherly and being condescending.

Not everything we do as physicians is going to be a matter of health/disease. Sometimes the choices are not clear-cut. The problem with morals is that they are a black & white issue. Ethical questions allow for gray areas where most of life falls anyway.

I am not extreme, nor do I believe morals are relative. Personally, I believe morals have no meaning to anyone except the person who holds them. Ethics are a different story. I abide by the laws of the country and I hold personal standards for myself. I do not expect anyone else to share them. Yes, it frustrates me sometimes when they hold opposite views, but I can get over it. In the end, my goal as a physician will be to facilitate openness and honesty with my patients.

It's easy to say that patients have choices, but they don't always have a choice. Sometimes the only choice is take it or leave it. A bad experience with one physician does not always lead to the patient immediately finding a new one. By passing judgement on a patient, we run the risk of jeopardizing their health care. If a patient wants my non-medical opinion on a matter, she will ask for it. Otherwise, I won't be giving it.

Willow
 
Originally posted by Panda Bear
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The Orthodox Christian Church, (of whom I am a dutiful son) the Catholic Church, and most protestant denominations are very clear on this. [/B][/QUOTE]

By the way, if you look into the history of the Christian church, this has not always been "very clear."

Going back a bit to Aristotle (yes, before the Christian church, I know)...most Pagans followed an idea of "delayed ensoulment" that happened around 40 days post-conception for males and 90 days post-conception for females. Notice that's roughly the 1st trimester. Any abortion prior to that 90 day "cut-off" was not considered murder because no soul was destroyed.

Jewish faith was generally opposed to abortion except in cases where the health of the mother was compromised--in which case she was *required* to have an abortion.

In the 2nd-4th Century CE, the Pauline version of Christianity equated abortion with murder. By the 5th-17th Century CE, they were back to the "delayed ensoulment" idea, courtsey of St. Augustine. He wrote that a human soul cannot live in an "unformed body," thus, abortion prior to this point was not murder because no human soul was destroyed. When the penitentials were being written in the 7th C, there were harsher penances for coitus interruptus, oral sex, and anal sex than for abortion . Oral sex cost 7 yrs to a lifetime of penance. Abortion? 120 days

Early 13th Century, Pope Innocent decided that ensoulment occurs around the time of "quickening." If you destroy a "non-animated soul" (what Aristotle called a vegetable soul), then it wasnt murder. Abortion after that point was murder because it destroyed a life. Prior to that it was a lesser offense because the fetus was only a potential life.

From the 17th to 19th century, it's murder again. The Catholic church requires excommunication for anyone who obtains an abortion. Since 1886, it has been against Catholic decree to perform any operation that would result in the death of a fetus, even if necessary to save the mother's life. The Roman Catholic Church has occasionally held funerals for aborted fetuses, but mostly pre-viable fetuses are not considered worthy of a formal requiem mass or burial.

Today, the Catholic church holds that it is not acceptable to do anything to directly cause the death of a fetus. It isn't clear by any means what is included. For example, an ectopic pregnancy that could lead to rupture of the fallopian tube...it may or may not be acceptable to remove the tube, thus *indirectly* causing the death of the fetus.

"Moral" of this story is--even the Christian church, which claims to have the answers on morality doesn't always agree. If you read up further on modern church views on abortions, some of their "acceptable" alternatives are quite distasteful. Best to let nature take its course and let mother & baby die than to directly cause the death of a fetus? I guess as long as you are standing by and watching someone die, it isn't murder. Funny how you still end up with blood on your hands.
 
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