Doctors refusing to treat patients on the basis of...

[Hanzo Hasashi]

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...personal religious beliefs.
Source: http://articles.latimes.com/2008/aug/23/news/OE-SLOAN23

...political affiliations.
Source: http://www.slate.com/id/2249956

How do you guys feel about this? My religious beliefs will surely play a role in how I treat my future patients. I don't believe in abortions or assisted suicide. I know there are other controversial topics as well. Is it unethical/illegal to deny such services? Or is it okay just as long as you have the patient's best interest in mind and refer to another physician?

Thanks all!

 

[Procyon]

I also don't believe in abortions or assisted suicide. Incidentally, I've been meaning to ask this around here for some time: is being involved in a pro-life group on campus not a good idea when you're planning to apply to med school? (I.e., will it like, spark an abortion debate at an interview or something?)

 

[dr zaius]

I feel like refusing to treat someone based on political beliefs is rather absurd. I can see allowing this to begin a slippery slope to perhaps denying someone care based on race, etc.

Refusing to perform a procedure because the physician feels it is against their religion seems ethical. Refusing to even see a patient because they lead a lifestyle the physicians thinks is wrong seems, well, wrong.

 

[illegallysmooth]

I feel like refusing to treat someone based on political beliefs is rather absurd. I can see allowing this to begin a slippery slope to perhaps denying someone care based on race, etc.

Refusing to perform a procedure because the physician feels it is against their religion seems ethical. Refusing to even see a patient because they lead a lifestyle the physicians thinks is wrong seems, well, wrong.

👍

 

[Geekchick921]

There is a thread on the Ob/Gyn forum about being a pro-life OB. It is doable, and referring to a physician that will perform an abortion is fine. If you choose that specialty, however, you will want to make sure you choose a residency program where training in abortions is optional.

That said, you will probably still need to learn the procedure. A dilation & evacuation (D&E) is a common method of abortion that is also performed on women that have miscarried in the second trimester but not passed all the products of conception. (Someone please correct me if I'm wrong).

I am very interested in Ob/Gyn, personally, and I would certainly prescribe birth control, and I would perform therapeutic abortions, but not elective ones. I would refer to a physician that would, however.

 

[phospho]

Not that I don't think that refusing to treat someone because of political beliefs is a bit out of line, BUT, I do believe that medicine, like every other profession, is a business, and is a service that we as future doctors give to people.

With that said, I believe I have the right to do whatever the hell it is that I want to do with my skills, as long as what I'm doing is legal. People need to stop thinking of medicine as a prophecy. It's a business venture just like any other profession. If you don't have the skills to use your learned knowledge, your student loans will haunt you for the rest of your life, and at that point you can say that your business venture went wrong.

I know quite a few doctors who have decided to stop seeing patients with medicare. Not worth their time. I applaude (sp?) them for doing what they believe in, and stop giving in to all this crap about "giving our lives to help everyone". I ain't no Mother Teresa, and I would like the freedom given to every other person in the country - to do what I want with my degree (again, if what I'm doing is legal).

I can see why someone would disagree with what I said. That's just my personal opinion though.

 

[TexasPhysician]

I refuse to treat patients who aren't ridiculously good looking like myself....

 

[Drrrrrr. Celty]

Hmm I don't find either of these to be a problem for me. I'm neither religious nor politically skewed to a certain side ( ind). However I think that of course the physician has the right to refuse to do certain things.
But for others, there is a little thing called the Hippocratic oath. A physician should preform abortions if their is medical trouble or if the child that's going to be birthed is a deficit bound to live a painful life.

Other then the seriousness. I don't think it really matters. If a physician rejects a gay couple, well good for him! They'll go to another physician who will preform the procedure.

Though I'm slightly interested in the constitutional view on this. Since freedom of religion and Roe v. Wade conflict in this situation.

 

[RadioCure]

I support the right of any physician to refuse to do any sort of procedure, but also support the right of a hospital or organization to fire or not hire a doctor based on what they will/won't do. There may also be some "informed consent" style issues that would have to come into play. For example, if a doctor who is a Jehovah's Witness refuses to do blood transfusions, it may be their duty to inform the patient that such a procedure could save their life if they get a different doctor.

 

[CoolWhipp]

"In the United States, we all are free to practice our religion as we see fit, as long as we do not interfere with the well-being of others by imposing our religious views on them. If physicians or other healthcare providers who have religious objections to legal medical treatments will not at a minimum inform their patients about those treatments and refer them to others who will deliver them, they should act in a way that is consistent with their convictions and the well-being of their patients and find other professions."

 

[sustentacular]

I personally know I would never inseminate someone who is psychotic (even if she's currently in a rare period of lucidity and can make the decision), a patient with a history of polysubstance abuse, or a patient who has no financial ability to care for the child (remember the doc who helped octamom get pregnant?). It could be argued that all of those people have the right to decide on their own medical care, but I also should have a right not to participate in it. If these physicians feel that a same sex couple would provide inadequate care it should be their right to refuse to participe their care.

Ah, so gays are equivalent to substance abusers and psychotics in their inability to care for children?

 

[Drrrrrr. Celty]

Ah, so gays are equivalent to substance abusers and psychotics in their inability to care for children?

I'm not sure if that's what he was aiming to say. If he was however then he's a ***** to a heightened level.

 

[sustentacular]

Not what I was going for, no. You must be fun at parties

Certainly sounds like what you were going for.. and thanks I'm an effing blast.

 

[mvenus929]

Ah, so gays are equivalent to substance abusers and psychotics in their inability to care for children?

I think it was more like... I can see a physician refusing to inseminate one who will be an unfit parent (psychotics, substance abusers), and if a couple fails to meet this physician's minimum requirements for being fit parents, the physician has the right not to perform the procedure. If this couple happens to be gay...

I think a physician has the right to refuse any procedure he or she finds objectionable, for whatever reason. I think a lot of these reasons are stupid, but I support the right for refusal of care. However, it is not ethically correct to also withhold information about such treatments, especially if they are in the patient's best interest.

 

[ncguy2005]

Ah, so gays are equivalent to substance abusers and psychotics in their inability to care for children?

Why wouldn't you just re-read what he said before making a statement like this? Its like asking for a huge (and unnecessary) debate.

And as a side note, I don't think thats what he was going for at all. I sensed zero bias or discrimination in his post.

 

[TooMuchResearch]

I think the refusal to artifically inseminate the gay couple is constitutionally protected and I once again shudder at the Califoria Supreme Court's political activism. I think a physician has every right not to partipate in fertility treatments for someone he believes will be an unfit parent, and 'unfit' is very much in the eye of the beholder. I personally know I would never inseminate someone who is psychotic (even if she's currently in a rare period of lucidity and can make the decision), a patient with a history of polysubstance abuse, or a patient who has no financial ability to care for the child (remember the doc who helped octamom get pregnant?). It could be argued that all of those people have the right to decide on their own medical care, but I also should have a right not to participate in it. If these physicians feel that a same sex couple would provide inadequate care it should be their right to refuse to participe their care.

I think the refusal to treat people based on their political affiliations is reasonable provided that it's not an emergent situation. People have recently developed the idea that they are entitled to our services regardless of their ability to pay us in return, their compliance, or even their basic politeness. I honestly think it would be best to confront this situation now, at an individual level, rather than wait until we hit the point that Germany/Israel did where we are all walking out on strike and leaving the hospitals empty.

What if she gave you a signed statement saying you wouldn't have any responsibility for the kid, you know, after you inseminated her. 😉


But yes, physicians, to an extent, can refuse to do things they find unethical. The patient has the option to take their health care dollars to someone smart enough to accept them.

 

[morning]

I think there are always things that people find unethical and will not do. Personally, if I make it to the point where I am an independent, board certified MD...I would never perform a circumcision on a boy, nor would I get behind any sort of "ritual nick" on a girl. There has to be some line about how discriminatory a physician can be before they're a danger to their existing patients, but to say that all independent physicians must perform EVERY procedure they are licensed to do is really stretching it and setting yourself up for trouble down the line, too.

 

[Drrrrrr. Celty]

I think there are always things that people find unethical and will not do. Personally, if I make it to the point where I am an independent, board certified MD...I would never perform a circumcision on a boy, nor would I get behind any sort of "ritual nick" on a girl. There has to be some line about how discriminatory a physician can be before they're a danger to their existing patients, but to say that all independent physicians must perform EVERY procedure they are licensed to do is really stretching it and setting yourself up for trouble down the line, too.

The "ritual nick" is considered illegal by the US government. Male circumcision isn't.

 

[redsquareblack]

Why wouldn't you just re-read what he said before making a statement like this? Its like asking for a huge (and unnecessary) debate.

And as a side note, I don't think thats what he was going for at all. I sensed zero bias or discrimination in his post.

May not have been what he/she was going for, but it was sloppily worded, and that's how it came out. You might not like it, but there it is.

Yep, even re-read it.

 

[scalab]

I think the refusal to artifically inseminate the gay couple is constitutionally protected and I once again shudder at the Califoria Supreme Court's political activism. I think a physician has every right not to partipate in fertility treatments for someone he believes will be an unfit parent, and 'unfit' is very much in the eye of the beholder. I personally know I would never inseminate someone who is psychotic (even if she's currently in a rare period of lucidity and can make the decision), a patient with a history of polysubstance abuse, or a patient who has no financial ability to care for the child (remember the doc who helped octamom get pregnant?). It could be argued that all of those people have the right to decide on their own medical care, but I also should have a right not to participate in it. If these physicians feel that a same sex couple would provide inadequate care it should be their right to refuse to participe their care.

Right, and I think black people are unfit to raise kids. *****.

 

[Mute98]

I think a physician has the right to refuse any procedure he or she finds objectionable, for whatever reason. I think a lot of these reasons are stupid, but I support the right for refusal of care. However, it is not ethically correct to also withhold information about such treatments, especially if they are in the patient's best interest.

I agree with this. withholding information is extremely unethical and it is imposing ones beliefs on another.

 

[morning]

The "ritual nick" is considered illegal by the US government. Male circumcision isn't.

So? What does that have to do with what I said?

 

[hithere3387]

The "ritual nick" is considered illegal by the US government. Male circumcision isn't.

check out this sweet debate:

http://forums.studentdoctor.net/showthread.php?t=719465

 

[Drrrrrr. Celty]

So? What does that have to do with what I said?

I find it improper to both say them in the same sentence.

 

[Drrrrrr. Celty]

check out this sweet debate:

http://forums.studentdoctor.net/showthread.php?t=719465

I don't think there's much of a debate. Being circumcised makes life a lot easier.

 

[sustentacular]

Why wouldn't you just re-read what he said before making a statement like this? Its like asking for a huge (and unnecessary) debate.

I read it just fine the first time, and wasn't trying to incite a debate. Discriminating against patients based solely on their sexual orientation is wrong. No debate about it.

 

[hithere3387]

I don't think there's much of a debate. Being circumcised makes life a lot easier.

My opinion has always been the same as yours. Until I began reading this thread, that is.

me thinks you didn't click the link 😉

 

[christina30]

I find it improper to both say them in the same sentence.

Ditto. Male circumcision and the ritual of female circumcision are in no way comparable.

 

[Practitioner]

The only way I'd be inclined to refuse treating a patient is if the patient isn't involved in their own treatment AND has behavior that's detrimental to their health.

I have particular religious leanings, but I think it's less ethical to enforce or judge others by my beliefs than it is to put aside my beliefs and treat an informed patient according to their wish.

"I don't agree with you so I can't treat you" is worse than "I don't agree with you, but if you understand fully what you're asking for here it is" and leaving it to the Higher Being to judge the ethics behind it.

Performing an abortion might leave me feeling sick on a personal level, though. Otherwise my moral compass rarely points north and my world has every shade of gray but no complete black or white.

 

[morning]

I find it improper to both say them in the same sentence.

I didn't say it for a circumcision debate - there's a marvelous one on the linked thread. But I do find it kinda odd that a single pinprick is considered to be more damaging than the permanent removal of the entire foreskin...really, really odd.

 

[redsquareblack]

I didn't say it for a circumcision debate - there's a marvelous one on the linked thread. But I do find it kinda odd that a single pinprick is considered to be more damaging than the permanent removal of the entire foreskin...really, really odd.

Err... because that "single pinprick" is a concession, an expression of "tolerance" for cultures that routinely perform unnecessary, dangerous procedures on women for the sole purpose of preventing the enjoyment of sex.

Which is pretty messed up, if you ask me.

 

[Hanzo Hasashi]

"I don't agree with you so I can't treat you" is worse than "I don't agree with you, but if you understand fully what you're asking for here it is" and leaving it to the Higher Being to judge the ethics behind it.

How about, "I don't agree with you, but the other doctor does, so you should go to him/her." 🙂

 

[hithere3387]

Err... because that "single pinprick" is a concession, an expression of "tolerance" for cultures that routinely perform unnecessary, dangerous procedures on women for the sole purpose of preventing the enjoyment of sex.

Which is pretty messed up, if you ask me.

I've read some of his previous posts on the subject, and I believe that he's arguing that it seems odd that we would tolerate unnecessary, potentially dangerous procedures for men which leads to less enjoyment in sex with little to no medical benefit when we don't tolerate it for women.

 

[christina30]

I've read some of his previous posts on the subject, and I believe that he's arguing that it seems odd that we would tolerate unnecessary, potentially dangerous procedures for men which leads to less enjoyment in sex with little to no medical benefit when we don't tolerate it for women.

And we're saying that you can't compare them - the purpose of female circumcision is to completely remove pleasure from the equation, and it also causes very severe complications for females, if not immediately following the procedure, then as adults (in childbirth, mainly). This kind of mutilation can't be compared to the simple removal of a man's foreskin.

Now back to the subject at hand.

 

[Hoody]

me thinks you didn't click the link 😉

that link is full of bad information (supported by people of the medical community which is, well, a little shocking)...

first of all, circumcision is not correlated with lower penile cancer risks. in other words, being uncircumcised does not put you at higher risk for penile cancer.

secondly, circumcision does not decrease your risk for HIV transmission. In fact, its just the opposite. Circumcision increases your chances of HIV transmission.

In the end, male circumcision is one of the few, if not the only, routinely performed procedures in which the RISKS outweighs the BENEFITS.

There is evidence supporting the above. do your own research.

 

[redsquareblack]

I also have a deep and abiding hatred for judicial activists and would challenge anyone to find the part of California's constitution that guarentees the right of lesbian couples to recieve artificial insemination from anyone that provides the procedure. There are, in fact, things that the constituiton just doesn't mention, and when the constitution is silent it should be left to individual conscences to decide what is right rather than judicial fiat.

Exactly! Like when those damned activist judges ruled anti-miscegenation laws unconstitutional in the Loving decision. Man I hate judicial activism.

ALSO: Constitutions don't work the way you seem to think they do.

 

[hithere3387]

And we're saying that you can't compare them - the purpose of female circumcision is to completely remove pleasure from the equation, and it also causes very severe complications for females, if not immediately following the procedure, then as adults (in childbirth, mainly). This kind of mutilation can't be compared to the simple removal of a man's foreskin.

Now back to the subject at hand.

Fair enough. But I was commenting because I thought that the way the post that I quoted was phrased unfairly implied that morning tolerated female circumcision.

 

[morning]

And we're saying that you can't compare them - the purpose of female circumcision is to completely remove pleasure from the equation, and it also causes very severe complications for females, if not immediately following the procedure, then as adults (in childbirth, mainly). This kind of mutilation can't be compared to the simple removal of a man's foreskin.

Now back to the subject at hand.

That is precisely why a pinprick WOULDN'T work...it completely misses the point of what FGM is about. But I don't think the actual process of a single pinprick is more damaging than male circumcision and it's pretty ridiculous to say so. No one in their right mind would say that a needle point is worse than removing 10% of a baby's penis instead of letting the poor kid choose when he's older. And I would note that this debate is American and African. The rest of the world does not understand our infatuation with a cosmetic procedure performed on an infant's penis. I wonder what the rate of elective adult circumcision is in Europe? I can't imagine it's very high. People who grow up with their foreskins are generally happy to keep them, whereas people who don't never get the choice.

 

[redsquareblack]

Blah, blah, blah.

Imma let you finish, but first I wanted to say that your name is particularly funny for this discussion.

 

[hithere3387]

that link is full of bad information (supported by people of the medical community which is, well, a little shocking)...

first of all, circumcision is not correlated with lower penile cancer risks. in other words, being uncircumcised does not put you at higher risk for penile cancer.

secondly, circumcision does not decrease your risk for HIV transmission. In fact, its just the opposite. Circumcision increases your chances of HIV transmission.

In the end, male circumcision is one of the few, if not the only, routinely performed procedures in which the RISKS outweighs the BENEFITS.

There is evidence supporting the above. do your own research.

I think you've misunderstood my position. I agree with you and the debate within that link lead me to that conclusion. Much of the information that you state is inaccurate is argued as such in that thread.

 

[Drrrrrr. Celty]

My opinion has always been the same as yours. Until I began reading this thread, that is.

me thinks you didn't click the link 😉

I did, It just didn't change my opinion. I know a few uncircumcised guys ( primarily born in the old country where they don't do it) who would love to get rid of it because it tends to be rather uncomfortable for most. (TMI, I know)

Alright this topics digressed from the original point.

 

[RySerr21]

I think the refusal to artifically inseminate the gay couple is constitutionally protected and I once again shudder at the Califoria Supreme Court's political activism. I think a physician has every right not to partipate in fertility treatments for someone he believes will be an unfit parent, and 'unfit' is very much in the eye of the beholder. I personally know I would never inseminate someone who is psychotic (even if she's currently in a rare period of lucidity and can make the decision), a patient with a history of polysubstance abuse, or a patient who has no financial ability to care for the child (remember the doc who helped octamom get pregnant?). It could be argued that all of those people have the right to decide on their own medical care, but I also should have a right not to participate in it. If these physicians feel that a same sex couple would provide inadequate care it should be their right to refuse to participe their care.

I think the refusal to treat people based on their political affiliations is reasonable provided that it's not an emergent situation. People have recently developed the idea that they are entitled to our services regardless of their ability to pay us in return, their compliance, or even their basic politeness. I honestly think it would be best to confront this situation now, at an individual level, rather than wait until we hit the point that Germany/Israel did where we are all walking out on strike and leaving the hospitals empty.

you dont see the problem with that? what about being a same sex couple makes them inadquate parents?

 

[sustentacular]

How nice of you to declare that there is no debate about one of the most hotly debated topics in the United States. I'm glad you settled that.

Equal rights for homosexuals WILL be a reality in the very near future. Nothing you bitch about will change that.

+1 to the poster who cited Loving v. Virginia. It's a very accurate analogy.

 

[morning]

Imma let you finish, but first I wanted to say that your name is particularly funny for this discussion.

The basis of our democracy is the fundamental belief that the people, as a whole, is the best group to trust with our moral compass. Attempts to pass the moral buck to a group of WWII era lawyers seems to defy both the spirit of our founding fathers and all common sense.

I thought the basis of our democracy was equality for all. Allowing the majority to decide the rights of the minority is going to go wrong 99% of the time, no matter how much faith you have in human decency.

I've read some of his previous posts on the subject, and I believe that he's arguing that it seems odd that we would tolerate unnecessary, potentially dangerous procedures for men which leads to less enjoyment in sex with little to no medical benefit when we don't tolerate it for women.

Yup, and I am female.

 

[redsquareblack]

The fact that judicial activsm occasionally manages to guess the way the collective conscience is heading (weren't there less than a dozen states with miscegenation laws when the decsion was passed?) rather than going dead in the opposite direction (dread scott) does not make it less wrong.

Well, if you're that ticked about judicial activism, you should probably start with Marbury v Madison, which established the concept of judicial review in the first place.

Also, yes, constitutions were at the very least designed to work in the nice, simple way I would like to see them work again: where people need to actually change the constituiton for what is in the constitution to change, and where laws are evaluated based on the intent with which they were written.

Ah, an originalist! With a bit of reflection, methinks you'll reconsider that last part.

As for the rest, constitutions merely outline the government's duties. Governments may only do those things specified by the constitution, in other words. Constitutions are not, on the other hand, a place where the rights of citizens are enumerated.

The idea that if something isn't specifically mentioned in the constitution, it isn't a constitutional right, is laughably simplistic.

 

[Drrrrrr. Celty]

Equal rights for homosexuals WILL be a reality in the very near future. Nothing you bitch about will change that.

+1 to the poster who cited Loving v. Virginia. It's a very accurate analogy.

When I read articles about people who are the most highly trained individuals and highly educated still are against them. It makes me feel like that reality will be a very far away future.

 

[hithere3387]

Yup, and I am female.

My mistake. But, in my defense, you do dress rather ambiguously. 😉 😀

 

[morning]

It is not, in fact, laughable to think that either citizens or their elected representatives should need to write and ratify a law for a law to exist, and one of the worst developments in the history of this nation was the proliferation of 'laws' and 'rights' that had never been codified by any authority and in fact were inveted based on whatever beliefs are currently fashionable amoung the current elite. It's made it infintely harder for citizens to link their own actions and activism to the laws that govern them, whch is just about the opposite of what the founding fathers intended.

This isn't a complicated concept: the Constitution says what is says and not anything more than that. If the words themselves are ambigiuous you go back and make a good faith attempt to figure out what they were trying to accomplish. If you want the Constituion to say something different you have to change it by writing an ammendment. If it doesn't say anything about a subject (i.e. gay rights) then it just doesn't say anything about that, and citizens are free to follow their consciences.

And if the majority votes for an amendment making homosexuals having sex illegal?

Or...alcohol?

What do you do if the majority wants a constitutional amendment that is clearly discriminatory?

 

[redsquareblack]

It is not, in fact, laughable to think that either citizens or their elected representatives should need to write and ratify a law for a law to exist, and one of the worst developments in the history of this nation was the proliferation of 'laws' and 'rights' that had never been codified by any authority and in fact were inveted based on whatever beliefs are currently fashionable amoung the current elite. It's made it infintely harder for citizens to link their own actions and activism to the laws that govern them, whch is just about the opposite of what the founding fathers intended.

This isn't a complicated concept: the Constitution says what is says and not anything more than that. If the words themselves are ambigiuous you go back and make a good faith attempt to figure out what they were trying to accomplish. If you want the Constituion to say something different you have to change it by writing an ammendment. If it doesn't say anything about a subject (i.e. gay rights) then it just doesn't say anything about that, and citizens are free to follow their consciences.

No, see, it's comments like this thatlead me to believe that you don't understand what a constitution does.

 

[sustentacular]

When I read articles about people who are the most highly trained individuals and highly educated still are against them. It makes me feel like that reality will be a very far away future.

Well I guess near and far are relative, eh?