Deny applicants who object to performing abortions and physician assisted suicide?

[deleted480308]

I think we may fundamentally disagree on your first comment. (EDIT: im on mobile, re-reading originally this came off more passive aggressive than i intended!) Personally, I think that medication and medical access should not cost much if at all to a patient. Physicians and drugmakers should be compensated for their time and work of course. Ideally, I personally would like this to be done through a program that means a patient would pay little to nothing for accessing medical care and treatment. I understand if you feel differently, as it seems you do!

Your second comment, though, concerns me. I really would recommend learning more about reproductive healthcare access! I’m thinking of the United States in all my comments, but stigma blocking access to birth control is a serious healthcare problem. To name a few common scenarios: safe, informed reproductive healthcare access for teens, young adults dependent on a guardian’s insurance coverage for healthcare access, and adults whose employers refuse to include birth control in their insurance coverage. I truly do not mean this in a negative or mean way. I really do want to encourage you to look into this topic further!

I'm a doctor and prescribe those meds. Pills can bought quite cheaply even without insurance, there are TONS of places to get free condoms, and abstinence is free. I can prescribe the meds without a parent's permission or knowledge. No one is "blocking" them. You're simply mistaken about how this works.

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[caterwaiter]

I'm a doctor and prescribe those meds. Pills can bought quite cheaply even without insurance, there are TONS of places to get free condoms, and abstinence is free. I can prescribe the meds without a parent's permission or knowledge. No one is "blocking" them. You're simply mistaken about how this works.

Good lord. I don't know if you've ever attempted to purchase birth control without insurance, but as someone who *has*, I can tell you that it is NOT always cheap. It varies widely. In addition, contraception is not the only thing birth control is prescribed for.

@gerbell Your replies have been thoughtful and well-intentioned, but I doubt @sb247 is planning on opening their mind or considering anyone else's experiences anytime soon.

 

[deleted480308]

Good lord. I don't know if you've ever attempted to purchase birth control without insurance, but as someone who *has*, I can tell you that it is NOT always cheap. It varies widely. In addition, contraception is not the only thing birth control is prescribed for.

@gerbell Your replies have been thoughtful and well-intentioned, but I doubt @sb247 is planning on opening their mind or considering anyone else's experiences anytime soon.

don't move the goals posts, it's dishonest.

We're talking about the ability to fairly reliably not be pregnant for a "reasonable" amount of money....and that's absolutely possible right now

 

[VA Hopeful Dr]

Good lord. I don't know if you've ever attempted to purchase birth control without insurance, but as someone who *has*, I can tell you that it is NOT always cheap. It varies widely. In addition, contraception is not the only thing birth control is prescribed for.

@gerbell Your replies have been thoughtful and well-intentioned, but I doubt @sb247 is planning on opening their mind or considering anyone else's experiences anytime soon.

Walmart has three birth control pills available for $9 a month.

You can get a depo shot at CVS for $40 with a coupon.

You can buy 36 Trojan condoms on Amazon for $15.

is every form of birth control affordable? Of course not. Just like hamburger meat cost significantly less than a good steak. But there are plenty of options affordable for people with no insurance.

 

[LizzyM]

contraception is not the only thing birth control is prescribed for.

This is where I really have a problem with "free birth control". Why should people who have a condition that can be treated with birth control pills get their medication for free while people with other health conditions have to pay for medications? If the indication for birth control pills is something other than contraception, it should not be free.

 

[VA Hopeful Dr]

This is where I really have a problem with "free birth control". Why should people who have a condition that can be treated with birth control pills get their medication for free while people with other health conditions have to pay for medications? If the indication for birth control pills is something other than contraception, it should not be free.

Nope. Otherwise you'd just be less than truthful.

Kinda like how Catholic-affiliated OBGYN offices have the highest rates of dysmenorrhea in the country...

 

[gerbell]

This is where I really have a problem with "free birth control". Why should people who have a condition that can be treated with birth control pills get their medication for free while people with other health conditions have to pay for medications? If the indication for birth control pills is something other than contraception, it should not be free.

Wouldn't that be incredibly hard to control for? And why bother erecting arbitrary barriers to therapies that could improve someone's quality of life? Also, differentiating between "pregnancy preventing" and "treating other health conditions" is kind of moot, since any form of contraceptive is going to prevent pregnancy in addition to whatever other benefits it gives.

 

[deleted480308]

Wouldn't that be incredibly hard to control for? And why bother erecting arbitrary barriers to therapies that could improve someone's quality of life? Also, differentiating between "pregnancy preventing" and "treating other health conditions" is kind of moot, since any form of contraceptive is going to prevent pregnancy in addition to whatever other benefits it gives.

You don't have to control for anything, the patient can pay for it themselves if the doctor offers it

 

[FutureInternist]

I am aware that I am making a “slippery slope” argument, but I cannot help but wonder what happens if a religious doctor refuses to perform a procedure on a pt of another religion, due to their beliefs?

When I signed up to be an organ donor, my mother only allowed it (I was < 18) if the organs would go to a Muslim.

Since religion can and is used to justify so many things, and there is usually no argument against it... I believe X, so I will/will not do Y.

Some of the current religious arguments against allowing gays equal rights were the same ones that people used to deny blacks their rights for so long.
Same justification but for a different population.. Am I allowed to refuse to treat a gay person? If I am the only doc in rural Podunks-ville then does that mean that the gay guy who has been living there his whole life now has to move?

There are many “contracts” one makes when one is dealing with the public.
Government says car companies must have seatbelts and other standards, airlines must allow child seats as a free baggage item, places of mass gatherings must have well lit Exit signs, fire extinguishers etc etc.

I would say that our profession also has a certain contract and a minimum standard of care that must be met.

It is already legal in multiple states to fire someone just for being gay... does that mean that all those people need to uproot their lives and move?... what if all the docs decide not to treat a particular group?

 

[AMEHigh]

Don't we then need to dedicate more resources at this stage of this issue? It shouldn't be a surprise to anyone that sex leads to pregnancy. Do you think the biggest issue is the lack of birth control options? I have to admit I am fairly naive about this because my wife and I have never had issues with access to inexpensive birth control (with and without insurance).

The unintended pregnancy rate has continued to decrease as access to affordable birth control and more options has become available. Of course it’s not perfect everywhere and with the new Title X restrictions, we’ll see what happens. So yes birth control access is certainly a factor.

However, even with perfect use of hormonal birth control pregnancy still happens. Just this month I’ve had 1 patient who was on depo who didn’t miss any shots get pregnant, 2 (maybe 3?) patients with an IUD in place get pregnant and a patient who was on OCPs who said they didn’t miss any pills get pregnant.

 

[deleted480308]

I am aware that I am making a “slippery slope” argument, but I cannot help but wonder what happens if a religious doctor refuses to perform a procedure on a pt of another religion, due to their beliefs?

When I signed up to be an organ donor, my mother only allowed it (I was < 18) if the organs would go to a Muslim.

Since religion can and is used to justify so many things, and there is usually no argument against it... I believe X, so I will/will not do Y.

Some of the current religious arguments against allowing gays equal rights were the same ones that people used to deny blacks their rights for so long.
Same justification but for a different population.. Am I allowed to refuse to treat a gay person? If I am the only doc in rural Podunks-ville then does that mean that the gay guy who has been living there his whole life now has to move?

There are many “contracts” one makes when one is dealing with the public.
Government says car companies must have seatbelts and other standards, airlines must allow child seats as a free baggage item, places of mass gatherings must have well lit Exit signs, fire extinguishers etc etc.

I would say that our profession also has a certain contract and a minimum standard of care that must be met.

It is already legal in multiple states to fire someone just for being gay... does that mean that all those people need to uproot their lives and move?... what if all the docs decide not to treat a particular group?

Private individuals should be able to pick their clientele for whatever stupid and/or horrible reason they want or for none at all

They should also be able to limit their scope in the same manner. You being the only doctor in a location does not negate your autonomy

 

[deleted480308]

The unintended pregnancy rate has continued to decrease as access to affordable birth control and more options has become available. Of course it’s not perfect everywhere and with the new Title X restrictions, we’ll see what happens. So yes birth control access is certainly a factor.

However, even with perfect use of hormonal birth control pregnancy still happens. Just this month I’ve had 1 patient who was on depo who didn’t miss any shots get pregnant, 2 (maybe 3?) patients with an IUD in place get pregnant and a patient who was on OCPs who said they didn’t miss any pills get pregnant.

It is a risk one takes with sex. Fully agree that none of those methods are 100%

 

[FutureInternist]

Private individuals should be able to pick their clientele for whatever stupid and/or horrible reason they want or for none at all

They should also be able to limit their scope in the same manner. You being the only doctor in a location does not negate your autonomy

Right... and if you are in an accident and the EMT has a hatred for mustachioed gentlemen who appeared in awesome TV shows, they are allowed to let you die.

Bus drivers can refuse to transport black folks?

Firemen can refuse to try to put out a fire in an Asian’s house?

A Muslim doc can refuse to perform surgery on a Jewish person?

I have read through all of your posts on this thread... and quite a few on others so I know I will not change your mind, but perhaps someone else who is on the edge, can use this as food for thought.

 

[damon30]

I just don't think this issue is common enough that medical applicants should be outright rejected. If a patient elects for the aforementioned procedures, and their current doctor refuses, then can't they simply request another doctor? Not stating an opinion on the issue, just asking about the technicalities here.

 

[Lawpy]

I just don't think this issue is common enough that medical applicants should be outright rejected. If a patient elects for the aforementioned procedures, and their current doctor refuses, then can't they simply request another doctor? Not stating an opinion on the issue, just asking about the technicalities here.

The current issue lies with the fact that doctors can refuse to refer the patient to other doctors/clinics providing the procedures.

 

[Lawpy]

Right... and if you are in an accident and the EMT has a hatred for mustachioed gentlemen who appeared in awesome TV shows, they are allowed to let you die.

Bus drivers can refuse to transport black folks?

Firemen can refuse to try to put out a fire in an Asian’s house?

A Muslim doc can refuse to perform surgery on a Jewish person?

I have read through all of your posts on this thread... and quite a few on others so I know I will not change your mind, but perhaps someone else who is on the edge, can use this as food for thought.

It depends on whether there are specific federal laws that force doctors to override religious beliefs and provide care to patients even when such care violates their religious/moral beliefs.

 

[FutureInternist]

It depends on whether there are specific federal laws that force doctors to override religious beliefs and provide care to patients even when such care violates their religious/moral beliefs.

Well that is kind of the point that arguing for a law to allow someone to do that, is a road we don’t want to go down.
There are millions of people who use religion to justify one action or another and since its “religion” you can’t argue against it.

 

[Lawpy]

Well that is kind of the point that arguing for a law to allow someone to do that, is a road we don’t want to go down.
There are millions of people who use religion to justify one action or another and since its “religion” you can’t argue against it.

Without laws banning discriminatory behavior, physicians can do whatever they want. It stinks that religion can be highly expansive and possibly hinder care but that's the risks that come with physician autonomy

 

[FutureInternist]

I just don't think this issue is common enough that medical applicants should be outright rejected. If a patient elects for the aforementioned procedures, and their current doctor refuses, then can't they simply request another doctor? Not stating an opinion on the issue, just asking about the technicalities here.

There are time sensitive issues.
There are “no other docs take my insurance” issues.
There are “I already took a day or part of it off from my hourly wage job and cannot afford or will be in trouble if I ask for another day” issues. etc etc

 

[FutureInternist]

Without laws banning discriminatory behavior, physicians can do whatever they want.

True... and that is why laws that allow one to fire someone just for being gay, or refuse a service for whatever reason someone’s fried brain comes up with, need to be repealed

 

[Lawpy]

True... and that is why laws that allow one to fire someone just for being gay, or refuse a service for whatever reason someone’s fried brain comes up with, need to be repealed

I thought they were repealed already by Civil Rights Act? Discrimination allowed for by religion is a hot topic issue fueled by culture wars unfortunately. I really think doctors should be secular when practicing and separate religious beliefs from clinical practice but it doesn't seem to be likely anytime soon.

 

[Cornfed101]

I thought they were repealed already by Civil Rights Act? Discrimination allowed for by religion is a hot topic issue fueled by culture wars unfortunately. I really think doctors should be secular when practicing and separate religious beliefs from clinical practice but it doesn't seem to be likely anytime soon.

I think this is a good point, but the difficulty is with the two procedures listed in the OP: abortion and physician-assisted suicide. In these two procedures, the physician is participating in taking a life (if the physician is pro-life in the abortion debate).

If the argument is that a physician should be able to discriminate and deny service of any kind, then I think that is ridiculous. I believe in physician autonomy, but you shouldn't become a physician if you aren't going to treat blacks due to your neo-nazi upbringing. An extreme example, but you get the point.

 

[Lawpy]

True... and that is why laws that allow one to fire someone just for being gay, or refuse a service for whatever reason someone’s fried brain comes up with, need to be repealed

Also reading more about it, private practices and hospitals serve as organizations (whether businesses or nonprofit), so they're required by laws to be nondiscriminatory?

But that's a different issue from requiring physicians to refer patients to get abortions, since the issue is about referring for elective procedures that the doctor doesn't feel comfortable. Abortion is a hot topic here but it could refer to unnecessary procedures or procedures that can harm patient care despite physician education?

 

[Lawpy]

I think this is a good point, but the difficulty is with the two procedures listed in the OP: abortion and physician-assisted suicide. In these two procedures, the physician is participating in taking a life (if the physician is pro-life in the abortion debate).

If the argument is that a physician should be able to discriminate and deny service of any kind, then I think that is ridiculous. I believe in physician autonomy, but you shouldn't become a physician if you aren't going to treat blacks due to your neo-nazi upbringing. An extreme example, but you get the point.

It got off topic a bit because of the scope of religious freedoms. Discrimination laws are in place because private practice offices, hospitals, clinics etc effectively serve as organizations providing services for the public and can't discriminate by law.

 

[deleted480308]

Right... and if you are in an accident and the EMT has a hatred for mustachioed gentlemen who appeared in awesome TV shows, they are allowed to let you die.

Bus drivers can refuse to transport black folks?

Firemen can refuse to try to put out a fire in an Asian’s house?

A Muslim doc can refuse to perform surgery on a Jewish person?

I have read through all of your posts on this thread... and quite a few on others so I know I will not change your mind, but perhaps someone else who is on the edge, can use this as food for thought.

The EMT would be unlikely to find a company willing to employ them if they wouldn’t treat everyone and the market of customers would put up with a company that had that policy getting a municipal contract, so that example doesn’t work for you. Neither does the bus driver or the fireman

Doctors should be able to decline taking any patient for any reason and without needing to supply one. Maybe they cannot find an insurance contract willing to deal with that or a hospital system, but they should be able to maintain their license

No, I will not likely change my mind. Freedom is important

 

[damon30]

The current issue lies with the fact that doctors can refuse to refer the patient to other doctors/clinics providing the procedures.

Is there currently no system or regulation requiring doctors to present alternatives?

There are time sensitive issues.
There are “no other docs take my insurance” issues.
There are “I already took a day or part of it off from my hourly wage job and cannot afford or will be in trouble if I ask for another day” issues. etc etc

Aside from the "no doctors take my insurance" issues, can't the time-sensitive nature of this problem be solved by communication between the doctor and patient about the procedure before the patient comes in?

 

[FutureInternist]

Is there currently no system or regulation requiring doctors to present alternatives?



Aside from the "no doctors take my insurance" issues, can't the time-sensitive nature of this problem be solved by communication between the doctor and patient about the procedure before the patient comes in?

Possibly.

But that would require the doctor to go over a list of what they do or do not do, since pts would assume all “standard of care” care is provided.

There can always be a workaround, the question is whether we should allow that to be needed in the first place.

Are we OK with the examples myself and others have provided to be the norm? If yes, then that is a very dangerous situation we are headed towards.

 

[FutureInternist]

The EMT would be unlikely to find a company willing to employ them if they wouldn’t treat everyone and the market of customers would put up with a company that had that policy getting a municipal contract, so that example doesn’t work for you. Neither does the bus driver or the fireman

Doctors should be able to decline taking any patient for any reason and without needing to supply one. Maybe they cannot find an insurance contract willing to deal with that or a hospital system, but they should be able to maintain their license

No, I will not likely change my mind. Freedom is important

There are limits to freedom all over the place.

You are not allowed to take an 18 wheeler and drive it through red lights.
Your contract with the government that allows you to drive, binds you to following the laws set by that government.

I am more agreeable to the situation in which a doctor states ahead of time what they would be comfortable with, provided there are alternatives available.
But, again, if I am the only doc available in X sq miles, I should not be able to say “No Blacks”.

The “company” in the docs’ case is the government, so they should then be able to deny licenses to folks that don’t abide by the standards set, just like the bus driver or EMT etc.

 

[deleted480308]

There are limits to freedom all over the place.

You are not allowed to take an 18 wheeler and drive it through red lights.
Your contract with the government that allows you to drive, binds you to following the laws set by that government.

I am more agreeable to the situation in which a doctor states ahead of time what they would be comfortable with, provided there are alternatives available.
But, again, if I am the only doc available in X sq miles, I should not be able to say “No Blacks”.

The “company” in the docs’ case is the government, so they should then be able to deny licenses to folks that don’t abide by the standards set, just like the bus driver or EMT etc.

Your making a dishonest analogy with the truck driver and you know it

That’s not an appropriate role for govt. voluntary association is a pretty important principle

 

[FutureInternist]

Your making a dishonest analogy with the truck driver and you know it

That’s not an appropriate role for govt. voluntary association is a pretty important principle

I don’t think I am... but we do have whole states that allow people to be fired for just being gay.
Is that “freedom” to discriminate more important than the uprooting of lives... I say No.

If it’s OK for a private individual to discriminate then there is no reason not to expand that to the govern itself.

 

[Lawpy]

The EMT would be unlikely to find a company willing to employ them if they wouldn’t treat everyone and the market of customers would put up with a company that had that policy getting a municipal contract, so that example doesn’t work for you. Neither does the bus driver or the fireman

Doctors should be able to decline taking any patient for any reason and without needing to supply one. Maybe they cannot find an insurance contract willing to deal with that or a hospital system, but they should be able to maintain their license

No, I will not likely change my mind. Freedom is important

I don't think doctors are allowed to openly discriminate against people.

 

[deleted480308]

I don’t think I am... but we do have whole states that allow people to be fired for just being gay.
Is that “freedom” to discriminate more important than the uprooting of lives... I say No.

If it’s OK for a private individual to discriminate then there is no reason not to expand that to the govern itself.

You are not thinking clearly. It is (or should be) appropriate for it to be legal for individuals to discriminate because their interactions should be voluntary. It is not at all appropriate for govt to be allowed to discriminate because the govt has a bully pulpit that is unequaled.

 

[deleted480308]

I don't think doctors are allowed to openly discriminate against people.

I agree with that statement as a reflection of current law but am talking about what should be.

 

[FutureInternist]

You are not thinking clearly. It is (or should be) appropriate for it to be legal for individuals to discriminate because their interactions should be voluntary. It is not at all appropriate for govt to be allowed to discriminate because the govt has a bully pulpit that is unequaled.

Thanks for belittling my thinking.

It is the individuals that make up the government, (via voting) so when you allow it to happen at a smaller scale, and it goes unchecked then you end up with whole states allowing gays to be fired, allowing centers to not allow adoptions to gay couples etc.

Would it be OK if Wal-Mart (the #1 employer in many states) all of a sudden decided to not hire any Blacks?

Happy Thanksgiving, and I hope you never run into trouble where you need help and our denied cos of someone else’s prejudice.

 

[deleted480308]

Thanks for belittling my thinking.

It is the individuals that make up the government, (via voting) so when you allow it to happen at a smaller scale, and it goes unchecked then you end up with whole states allowing gays to be fired, allowing centers to not allow adoptions to gay couples etc.

Would it be OK if Wal-Mart (the #1 employer in many states) all of a sudden decided to not hire any Blacks?

Happy Thanksgiving, and I hope you never run into trouble where you need help and our denied cos of someone else’s prejudice.

The market would handle that if walmart went stupid and racist because they would lose customers because our society actually isn’t largely racist. We don’t need govt to decide who you have to deal with

 

[Lawpy]

I agree with that statement as a reflection of current law but am talking about what should be.

Idk i think things will get a lot worse without antidiscrimination laws because a lot of Americans have been very truly evil for decades to centuries that it required laws to stop their behavior for progress to happen and society to improve. Maybe in an ideal society, voluntary association can happen and people won't discriminate each other, but the US is far from an ideal society. If anything, we need even stronger enforcement of antidiscrimination laws to crack down on prejudices and discrimination that persist today.

 

[deleted480308]

Idk i think things will get a lot worse without antidiscrimination laws because a lot of Americans have been very truly evil for decades to centuries that it required laws to stop their behavior for progress to happen and society to improve. Maybe in an ideal society, voluntary association can happen and people won't discriminate each other, but the US is far from an ideal society. If anything, we need even stronger enforcement of antidiscrimination laws to crack down on prejudices and discrimination that persist today.

That’s not how that works, far less racism now than then

 

[Lawpy]

The market would handle that if walmart went stupid and racist because they would lose customers because our society actually isn’t largely racist. We don’t need govt to decide who you have to deal with

The market doesn't work efficiently because people aren't rational and there are information barriers involved. The market was ineffective in the segregation period for decades and minorities were kept being treated as substandard consumers with lower priority. That translated to bad living and working conditions until the government stepped in and enforced antidiscrimination laws to stop the behavior and change the market.

 

[Lawpy]

That’s not how that works, far less racism now than then

It's far less racism now because of antidiscrimination laws. It's still not great now when the government and society become dysfunctional

 

[deleted480308]

The market doesn't work efficiently because people aren't rational and there are information barriers involved. The market was ineffective in the segregation period for decades and minorities were kept being treated as substandard consumers with lower priority. That translated to bad living and working conditions until the government stepped in and enforced antidiscrimination laws to stop the behavior and change the market.

With the internet there is far more informational transparency now than ever in history, the market would work just fine

 

[deleted480308]

It's far less racism now because of antidiscrimination laws. It's still not great now when the government and society become dysfunctional

The laws are not what changed people, people had changed prior to laws enough to ask for the laws. A hundred years of school desegregation and intermarriage have done far more than any law about private interactions

 

[Lawpy]

With the internet there is far more informational transparency now than ever in history, the market would work just fine

There's also the intentional spead of bad and fake information

The laws are not what changed people, people had changed prior to laws enough to ask for the laws. A hundred years of school desegregation and intermarriage have done far more than any law about private interactions

There are a lot of people that hated those changes, which is why the society relied on passing and enforcing laws to ensure their protection of freedoms. Voluntary association doesn't work if the discriminating groups have a lot of power to make large scale structural changes that makes the lives of minorities a lot harder.

I think we're getting off topic from the thread since it's not about discrimination. And the issue of referring religious procedures is important and unrelated to the topic. Will continue elsewhere as needed

 

[deleted480308]

There's also the intentional spead of bad and fake information



There are a lot of people that hated those changes, which is why the society relied on passing and enforcing laws to ensure their protection of freedoms. Voluntary association doesn't work if the discriminating groups have a lot of power to make large scale structural changes that makes the lives of minorities a lot harder.

I think we're getting off topic from the thread since it's not about discrimination. And the issue of referring religious procedures is important and unrelated to the topic. Will continue elsewhere as needed

Most of the original anti discrimination laws were to stop the govt from discrimination or to stop the govt from requiring private discrimination