Discussion in 'Pre-Medical Allopathic [ MD ]' started by Psycho Doctor, 09.17.04.
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Is there any law or moral/ethical obligation?
I would imagine that if they are against abortion, they'd be in a specialty that doesn't involve performing abortions.
You may get training in the procedure, but if you're an Ob/Gyn, you're not under any obligation to provide the service. Some schools, most notably Georgetown, don't even cover it.
When you get an abortion, it is generally performed by a gynecologist. However, the vast majority of gynecologists do not perform abortions, so yes it is definitley possible to be a gynecologist who doesn't perform abortions. I'm sure that if you didn't want to provide that service, no hospital or medical system would force you to do so - but you probably would have an obligation to pass your patients who are interested in abortions along to another doctor who does perform them. Thats just my thoughts, I don't really know exactly how it all works!
yea i suppose, didn't know if you could ever be calle din to assit if ypu're covering a related practice.
are you forced to observe/assist in med school/residency?
Nope, you have no obligation.
The last part is incorrect. You are under no moral or legal obligation to act complicitly in an abortion by referring the patient to an abortionist.
exactly. we just had an OB/GYN come in and talk about this last week.
Yes, the Dean of the medical school comes in, puts the gun to your head, and tells you to start slicing away or else. In fact, if you're not fast enough he'll shoot you in the leg so you'd better get that anatomy book out now.
Come on. Five seconds of thought should have told you that with anti-abortion people making up some decent-sized portion of the population they're not going to be forced to do something they consider murder.
A friend of mine has a mother who is a nurse. They attempted to force her to perform an abortion because they were short-staffed, gave her hell, and when she threatened to sue, they backed off.
You're under no obligation whatsoever to assist in an abortion.
yikes, those are the cases i was concerned about
Although you're not obliged to perform abortions, I believe a doctor is required to provide post-abortion care... not sure though.
that's ok, i wouldn't have a problem with that; thanks
I asked my boss, a doctor himself, about abortions. He said that while you do not have to know how to do one or have to perform one unless you opt to perform that service, you should know how to treat a woman who has had one and needs medical help because of it.
you don't HAVE to do anything you don't want to do. In fact, if you don't want to, you don't have to dissect in the anatomy lab for first year. Just watch your partner(s) do it and you can learn anatomy just as well. Of course, I don't recommend this.
Just a point to ponder:
Does a doctor have to prolong a life if s/he is morally opposed to needless suffering or brain-dead patients being kept on life-support? To make the point more salient, let's assume in the case to be considered, that the patient can't make the decision for him/herself, and has left no clear instructions to the matter. Does a doctor in this case have to do something that s/he may be morally opposed to?
Discuss amongst yaselves. The topic is the civil wah.
i think that in this case the patient's immediate relatives' decision would take precedence over any decisions the doctor makes. but can the doctor choose not to perform euthanasia if he is opposed to it even if the relatives want it?
It's interesting that the classical Hippocratic oath states:
"I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art."
You are not obligated to perform a procedure you are morally or ethicallly opposed to. However, I think most MD's, especially those trained in medical ethics, would deem refusing to refer a patient to someone who performed the procedure (especially based on YOUR beliefs) unethical.
Are you going to refuse a patient birth control because you are catholic? Or refuse to council on STD prevention because you don't believe in AIDS?
Physician's have every right to uphold thier own beliefs. However, they do not have the right to deny patient's treatment and force thier own beliefs on others.
Euthanasia is illegal, my friend. So uh, you should probably not ask this question at interviews
i meant physician-assisted suicide... i know it's not legal in most states but there have been precedents set to make it justifiable in certain circumstances. how would this factor into a case where the decision is made by a patient's relatives?
Very well put Roja. It is part of your duty as a physician and your moral obligation to the patient to transfer the pateint's care to another physician. To do any less is abandonment.
As far as termination of life support goes: if a patient left no living will or advanced directives and is now incompetant to give medical consent, it would be up to the patient's surogate (usually the next of kin) to make the decision that they feel the patient would have wanted (ie: not what they themselves might want). In cases where there is conflict between the family's wishes and what the patient's physician's feel is the best course of action, the hospital ethics committee may be consulted to offer their opinion. If no resolution can be found, and the physicians or hospital feel strongly about their position, they can take the matter to a court of law to attempt to override the family's decision.
There is absolutely nothing unethical about not refering a patient for an abortion.
In my own practice I will counsel patients on the many negative aspects of abortion (including psychological) and also bring up the many alternatives to abortion. I will not refer anyone to an abortionist-ever. To me, it would be the same as having a hitman kill someone for me.
From experience with patients who have had abortions and patients who have carried their child and given it up for adoption I would say that the ones who chose to keep their baby are much more psychologically stable.
I would say that you have a selection bias in your 'study'.
Do you have any kind of objective data to support your statement?
and just because you don't think its unethical, doesn't mean it isn't.
I'm curious- what practice is this? As your previous posting has you as a fourth year medical student in 2004.
first of all, i'm not catholic and i don't have anything against birth control pills; that's very different from abortion. One is merely preventing conception...life, the other is killing life, that which was already conceived.
Don't believe in AIDS??? AIDS is a very real disease, how can one not believe in it? BTW, i have volunteered in an AIDS hospice and held the hands of dying AIDS patients...so i do believe it is real. Of course i'd counsel people and instruct them on STDs....where did you get the idea from that i would be opposed to it?
I would not deny patients treatment of any kind...all i said is i could not perform an abortion....and i didn't think standing by my beliefs would be infliciting it on my patients.
I absolutely agree. And not referring a patient for an abortion is not abandonment; the patient is free to find another doctor who is willing to perform such a procedure. I woud not want to be responsible of killing a baby, even indirectly.
i think she is saying how she plans to practice medicine.
Roja is just trying to clarify what can happen when Dr's try to impose their own belief systems on a patient.
You will not be forced to perform an abortion in med school or residency. Even if you choose to specialize in OB-Gyn you will not be made to do abortions. In fact, from what I am told, many programs do not offer training in abortions. I know that there are fewer and fewer physicians who are trained and willing to perform the procedure. Good news for pro-life people, bad news for the pro-choice folks.
first of all, there was no assumption as to if you were catholic or wether you held someones hand. These were illustrative points that had nothing to do with you directly to make create an example.
The example being that beliefs are relative. That there are physicians that believe birth control (especially minors) to be wrong. that counsiling on STD's to be immoral. They are denying thier patietns basic medical care because of thier own beliefs. Or in other cases, enforcing thier own beliefs onto others.
Regardless of if you like it, you ARE obligated to refer your patients to a physician that will perform medical services that you have chosen not to provide. If you NEGLECT to offer a referral, then you are neglecting your patients right to recieve those services.
And if something happens to your patietn (say your young woman who wanted an abortion because she didn't want the child and then had an ectopic that ruptured) better hope your malpractice is strong.
Nobody said being an MD is easy. I absolutely ABHORE working in peds because of all the negligent parenting I see. I am not talking about gross mistreatment. But just bad parenting. However, I have to put my own beliefs behind and deal iwth it.
If you are goign to be an OB/GYN, you are in no way obligated to perform procedures that are against your belief. however, you should realize that you will then be put in situations where you will ethically need to refer someone out. And if it is that big of an issue for you, then this should be something you should consider when you pick your specialty.
And if you pick your specialty with the hopes of enforcing your beliefs on others, you should not be surpised when it comes time deal with the consequences: politically, legally etc
In addition, one of the responsibilities of the physician when severing the doctor/patient relationship is to direct the patient's care to another physician. the doctor patient relationship is a contract - one in which it is easy for them to fire you and harder for you to fire them. The patient can walk out the door and just not some back. Its a bit more complicated when the doctor decides to end the contract.
I understand where you are coming from, but at this time in our country abortion is a treatment option that women have the right to choose. You have the choice not to participate, but the patient has the right to know her options. You may certainly advise a patient on what you feel are the best options for her and why, but ultimately it is her choice.
Isn't it ironic that I am studying for a Health Law and Ethics exam Monday?
Again, great post Roja.
roja, since you're an ms could you help me with this? this goes back to my previous post to which i didn't get an answer, but just a cheap jab about how ignorant i am about this.
i know physician-assisted suicide and euthanasia are illegal in almost every state and that the AMA protects me from having to carry out these practices if i'm against them. but what if the family wants it and the patient wants it? to whom would i defer my decision if i didn't feel like doing it but thought it was the right thing to do? ethicists only make recommendations right? is there any way to leave the doctor out of actively mercy-killing someone?
Nicely put, beanbean.
I think one of the harder things about being an MD is realizing that one of the many sacrifices we make is that we do not necessarily have to luxury of exluding those that don't conform to our own sense of morality.
I still have to medically treat the dingus who just killed two people in a drunk driving accident. I don't get to take out my frustration or my own beliefs out on that person.
The same goes for this issue. If detaching yourself from your own morals with regards to such an issue is not an option, then you owe it to your patients and your field to select yourself out of that field.
this is one of the main reasons I decided not to do peds. I knew I would have a very difficult time distancing myself from what I believe to be the right and wrong of issues regarding children. Since I knew I would have a difficult time, I decided not to go into that field.
ok, i thought you had directed your response to me. I basically agree with your points in general. Well i suppose if i had to refer a patient who wanted an abortion i'd refer her to another doctor and let them discuss the options. I don't have to know if he/she will perform the procedure.
Actually, I am a resident. however, it doesnt' change the issue currently. MD-assisted suicide is illegal. and thus, it doesnt' matter that hte family and the patietn want this. If you assist them, then you are breaking a law. you can not only do jail time but you can loose your liscence. the ethics committees are usually called in when a patietn does not have an advanced directiveand there is conflict in the family from individuals with equal 'legal power' int he next of kin group.
And not to belittle your question, but to make it a little clearer. I have patients that are drug addicts that want me to prescribe morphine so they can sell it. Their families might also. Its still illegal and I am under no ethical standard to do so.
thanks for the response... and sorry by the way for calling you an ms. you sounded like you had the experience of an ms (more than us in other words), but i didn't see the pgy-2 in your signature.
Its not a problem. I'm glad I sound like I have enough experience to be an MS.
Your question is a good one.. (or at least an interesting twist). It may one day be an issue that MD's have to deal with if it ever becomes legal. right now, MD"s are protected by the law.
Physicians are allowed to prescribe levels of narcotics to keep terminally ill patients free from pain and comfortable. It is okay if the dose also happens to quicken the time to the patient's inevitable death. It is not okay to prescribe a dose with the intent for it to be lethal. If a patient wants to kill themselves before a terminal illness progresses to that point, they will find a way. I have a friend with scleroderma - horrible disease. At the present time she is doing very well and her disease is not progressing; however, she has made it very clear that she will take her own life before she is bedridden, unable to move or feed herself. She has no plans to complicate things by involving her physician or her family who could then face legal consequences. It will be her decision and hers alone.
at my school's ob/gyn rotation, it was an option to go and see/participate in an elective abortion.
i saw some D&C procedures for spontaneous abortions; it's a quick procedure.
the answer is no.
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