doesn't this violate the hippocratic oath? the "right of conscience" rule...

[masterofmonkeys]

Informing is seen as complicity in many scenarios. Abortion is such a controversial thing that I definitely would support this in that context. However, if someone thought it was immoral to treat patients of a different religion/race/language, I would find that harder to accept.

The part about not referring bothers me, but I do understand the moral/ethical argument for it.

And, as someone mentioned, abortion IS forbidden in the original Hippocratic Oath - you know, the one the hypocritical medical school administrations edit to drop the "inconvenient" parts.

Yeah, like the part about a doctor never performing surgery.

How many of us have our old professors come to live with us after they retire, by the way?

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[drmwvr]

Then your mind lacks basic logical skills.

Touche..Well played Tired. I, however, am not tired, so I won't be so prickly when I ask, 'if some provider is in a situation where he objects to his participation on moral grounds (say an elective D and E for argument's sake) and there is no state conscious clause protecting him in "opting out", what is his next step when his attending/hospital administrator/employer says that he does't have a choice?' This isn't being compelled to do/participate in the procedure? Lucky for me, logic skills can be taught. I'm rested and all ears.

 

[Tired]

Touche..Well played Tired. I, however, am not tired, so I won't be so prickly when I ask, 'if some provider is in a situation where he objects to his participation on moral grounds (say an elective D and E for argument's sake) and there is no state conscious clause protecting him in "opting out", what is his next step when his attending/hospital administrator/employer says that he does't have a choice?' This isn't being compelled to do/participate in the procedure? Lucky for me, logic skills can be taught. I'm rested and all ears.

There is a difference between governmental compulsion and private compulsion. A big difference. Private entities have the right to run their businesses as they choose, and if that means mandating employees carry out certain tasks, so be it. The individual then makes the choice of whether they will follow their beliefs or find employment elsewhere.

It is wrong for government to compel an individual to violate their personal/religious beliefs in order to practice their profession. It is equally wrong for the government to compel a business owner to violate their personal/religious beliefs by making them employ an individual who will not provide services they want their business to offer.

Those who want to stand up for their beliefs should be allowed to do so. But that does not mean we violate others' rights to shield them from all consequences of their choice. Following your conscience sometimes requires sacrifice.

 

[drmwvr]

There is a difference between governmental compulsion and private compulsion. A big difference. Private entities have the right to run their businesses as they choose, and if that means mandating employees carry out certain tasks, so be it. The individual then makes the choice of whether they will follow their beliefs or find employment elsewhere.

It is wrong for government to compel an individual to violate their personal/religious beliefs in order to practice their profession. It is equally wrong for the government to compel a business owner to violate their personal/religious beliefs by making them employ an individual who will not provide services they want their business to offer.

Those who want to stand up for their beliefs should be allowed to do so. But that does not mean we violate others' rights to shield them from all consequences of their choice. Following your conscience sometimes requires sacrifice.

What's the difference? Either they can or cannot force someone to violate their conscience. Public or private, if there is no law that allows someone to opt out, they can be forced. As it stands now, private companies cannot force someone to violate conscience where there is a statutory prohibition. I didn't bring up forcing a private business to hire someone against its will, but that wouldn't be conscience related anyway. It does compel businesses to hire certain types of people in that it favors certain employee demographics in awarding gov't contracts.

That said, should someone opposed to abortion seek employment at planned parenthood? No. Not that they'd be hired. But when an ob gyn wants to add abortion services to his practice at a Catholic hospital (say he had to go all the way across town prior) they don't have a leg to stand on. On what basis can they tell him 'no'? "Oh, well, Catholics don't do that" will not do if there is no legal protection. This scenario would surely be challenged as unconstitutional and end up at the Supreme Court. That is cold comfort though, as the court becomes less sympathetic to anti-abortion advocates. I don't think it is that far fetched and I do think that, if legally challenged, the individuals in question will lose. If accomodations are made for the objector and no one sues, the point is moot. Someone will sue, though.

 

[Tired]

What's the difference? Either they can or cannot force someone to violate their conscience. Public or private, if there is no law that allows someone to opt out, they can be forced.

Sorry, you don't get to dismissively say "public, private, it's all the same". There is a substantial difference that has been in place since the founding of this republic, and it is a failure of your middle-school civics class that you don't understand this.

1) Americans historically take a dim view of governmental compulsion. In fact, the entire consitution is one big restraint on the government from compelling individuals to do things.

2) When government interferes with a business' ability to hire who they want, and provide whatever legal services they choose, that is the definition of governmental compulsion, just in the opposite political direction to you.

3) The real issue here is that you want public and private protection for the views you agree with, but not for the counter viewpoint. That is understandable, but not consistent with basic American values.

 

[drmwvr]

Sorry, you don't get to dismissively say "public, private, it's all the same". There is a substantial difference that has been in place since the founding of this republic, and it is a failure of your middle-school civics class that you don't understand this.

1) Americans historically take a dim view of governmental compulsion. In fact, the entire consitution is one big restraint on the government from compelling individuals to do things.

2) When government interferes with a business' ability to hire who they want, and provide whatever legal services they choose, that is the definition of governmental compulsion, just in the opposite political direction to you.

3) The real issue here is that you want public and private protection for the views you agree with, but not for the counter viewpoint. That is understandable, but not consistent with basic American values.

Oh, Tired, you are a sassy git.Warning:You're endearing yourself to me!

As to #'s 1.) Agree, totally, to your great relief, I'm sure.

2.) Can't tell here if you agree with me here or not. Will say though that issues from imminent domain to environmental regulations involve gov't compulsion. I, like you, I think, oppose gov't compulsion.

3.Despite your great and credible authoritarian tone in proclaiming what I want, eeek, you are wrong there. I want the free excersice of conscience for everyone irrespective of whether I agree with him or her. If I haven't made it clear already, sometimes that free excercise means not holding certain jobs. Sometimes it isn't necessary to avoid those jobs if accomodation is a possibility.

Cheers, my sassy friend!

 

[Tired]

3.Despite your great and credible authoritarian tone in proclaiming what I want, eeek, you are wrong there. I want the free excersice of conscience for everyone irrespective of whether I agree with him or her. If I haven't made it clear already, sometimes that free excercise means not holding certain jobs. Sometimes it isn't necessary to avoid those jobs if accomodation is a possibility.

If you agree with the first two points I made, then you should understand what I mean when I say it is compulsion to force an employer to keep an employee who refuses to do their job. Why disagree? Why compel a private company to employ someone who won't do what the boss tells them to do?

BTW, I've spent years cultivating the authoritarian tone, so thanks for noticing. It works even better in person.

Cheers, my sassy friend!

Dude, how come gay guys are always hitting on me on SDN?

 

[236116]

BTW, I've spent years cultivating the authoritarian tone, so thanks for noticing. It works even better in person.

Dude, how come gay guys are always hitting on me on SDN?

I always thought you were a gay guy.

 

[236116]

That said, should someone opposed to abortion seek employment at planned parenthood? No. Not that they'd be hired. But when an ob gyn wants to add abortion services to his practice at a Catholic hospital (say he had to go all the way across town prior) they don't have a leg to stand on. On what basis can they tell him 'no'? "Oh, well, Catholics don't do that" will not do if there is no legal protection. This scenario would surely be challenged as unconstitutional and end up at the Supreme Court. That is cold comfort though, as the court becomes less sympathetic to anti-abortion advocates. I don't think it is that far fetched and I do think that, if legally challenged, the individuals in question will lose. If accomodations are made for the objector and no one sues, the point is moot. Someone will sue, though.

People who are anti-abortion have lied and gotten hired and then cannot be fired because they cite religion.

It could work, actually, even if FOCA is passed... Being a quasi-religious organisation gives them a different status than regular ol' secular hospitals. Of course, even they can't actually force someone to perform abortions. In any case, you'd have to be really f*cking stupid to ask the Catholics for an abortion practice.

 

[drmwvr]

BTW, I've spent years cultivating the authoritarian tone, so thanks for noticing. It works even better in person. quote]

Who is hitting on whom?

 

[Substance]

A doctor who does not condone abortion for moral reasons should not be required to refer a patient to another doctor.

Speaking solely from a Roman Catholic standpoint, if a doctor were to refer a patient to another doctor who would perform an abortion, that would be equal to the parable in the New Testament of Pontius Pilate referring Jesus' fate to the general populace who he knew would desire crucifixion. Pilate is still seen as a Hell-bound murderer in the Bible even though he did not kill Jesus with his own hands nor did he order his death - he just referred him to people who would want him killed. The Bible sees no difference.

An extremely devout Christian doctor would see abortion in a similar light, and would choose not to refer, lest he burn in the fires of Hell for eternity.

I believe that it is the individual's right to not be forced to do something their morality prohibits, barring anything that harms the general populace. Refusing to refer an abortion does not harm the general populace nor is elective abortion an absolutely necessary medical procedure(barring rare cases where birth or continued pregnancy would kill the mother and/or fetus). It causes inconvenience, but does not eliminate the possibility of abortion for the patient.

Nonetheless, a devoutly Christian doctor should proudly let his patients know ahead of time that he is Christian, and does not perform or refer abortions or any such procedures that contradict his religious beliefs. With this knowledge, patients could decide if the doctor is right for them. Otherwise, failure to refer an abortion could be construed as a "bait-and-switch" tactic.

In closing, this topic is mired in emotional hogwash from both sides, and a truly pragmatic solution will never be found. It would serve devout Christians well to avoid any field where the issue of abortion is even touched upon.

 

[236116]

A doctor who does not condone abortion for moral reasons should not be required to refer a patient to another doctor.

That's disgusting.

I believe that it is the individual's right to not be forced to do something their morality prohibits, barring anything that harms the general populace. Refusing to refer an abortion does not harm the general populace nor is elective abortion an absolutely necessary medical procedure(barring rare cases where birth or continued pregnancy would kill the mother and/or fetus). It causes inconvenience, but does not eliminate the possibility of abortion for the patient.

What, are we to wait until the mother's brought in after shoving a hanger so far inside her she's punctured bowel? Then is it medically necessary? What if she's mentally unstable and thinks the baby is an alien implant and decides to cause a couple of car wrecks before jumping off a bridge? What about the victims of rape? Nine-year-olds? 89-year-olds? People with 7 kids who can't support another who are on the pill and using condoms? (I know someone who used both perfectly and they both failed... twice.) What if you're the only one on her insurance in 100 miles?

Refusing to refer harms the general populace as you are harming a member of the general populace.

It would serve devout Christians well to avoid any field where the issue of abortion is even touched upon.

Then stay out of medicine, nursing, pharm, psych, public health, politics, education, etc.

You can't join the military and refuse to shoot because your morals suddenly prohibit killing people. And stop trying to impose your morals on me. Your job as a physician is to do what is right for your patient, regardless of what some book or an old dude in a city you've never been to tells you.

 

[docB]

That's disgusting.

And that’s not a counter argument. It’s an opinion.

What, are we to wait until the mother's brought in after shoving a hanger so far inside her she's punctured bowel?

The idea that we should let the ill advised possible reactions to a situation totally govern our policies toward the initial situation is not reasonable. If a guy isn’t paid enough he might go rob a bank. Are we obligated to pay him more because of the possibility?

What if she's mentally unstable and thinks the baby is an alien implant and decides to cause a couple of car wrecks before jumping off a bridge? What about the victims of rape? Nine-year-olds? 89-year-olds? People with 7 kids who can't support another who are on the pill and using condoms? (I know someone who used both perfectly and they both failed... twice.) What if you're the only one on her insurance in 100 miles?

Would you be happy if we created exemptions for each of these highly unusual situations (you can be in charge of verifying the pill and condom “used correctly” thing)? I imagine not. I suspect that anything but carte blanche abortion on demand would fail to satisfy you. So I suspect that bringing up these fringe cases is just an attempt to obfuscate.

You can't join the military and refuse to shoot because your morals suddenly prohibit killing people. And stop trying to impose your morals on me. Your job as a physician is to do what is right for your patient, regardless of what some book or an old dude in a city you've never been to tells you.

I disagree that there is no place in medicine for people with moral objections to certain things. However you can take heart in knowing that the consensus and balance of political power are tipping your way. Therefore you will be able to impose your morals on me. Enjoy.

 

[236116]

Would you be happy if we created exemptions for each of these highly unusual situations (you can be in charge of verifying the pill and condom “used correctly” thing)? I imagine not. I suspect that anything but carte blanche abortion on demand would fail to satisfy you.

Define "highly unusual". And while you're at it, how exactly would you propose confirming rape victimhood? There's a reason such a large amount of rapes aren't reported. Are you going to have an age limit? Under 13's can have all the abortions they want, but 14+ are a bunch of dirty sluts who should burn in hell? What about the crack ****** who are going to abandon the kid (who's going to be born with a fck ton of problems) in a dumpster? The 16-yo who got knocked up by her boyfriend and drowns the newborn?

You know what? You're exactly right, up until an estimated 27 weeks. Then Baby Mama is SOL and she can give the kid up and next time double check the expiration date on her damn condoms.

Oh, wait. Contraceptives are really aborticifants and thus good, moral, people can't use them.

I disagree that there is no place in medicine for people with moral objections to certain things. However you can take heart in knowing that the consensus and balance of political power are tipping your way. Therefore you will be able to impose your morals on me. Enjoy.

Thank god. The overly-religious-can't-keep-it-to-themselves have ruined enough.

I have no morals. But I'll enjoy it anyway.

 

[cpants]

What, are we to wait until the mother's brought in after shoving a hanger so far inside her she's punctured bowel? Then is it medically necessary? What if she's mentally unstable and thinks the baby is an alien implant and decides to cause a couple of car wrecks before jumping off a bridge? What about the victims of rape? Nine-year-olds? 89-year-olds? People with 7 kids who can't support another who are on the pill and using condoms? (I know someone who used both perfectly and they both failed... twice.) What if you're the only one on her insurance in 100 miles?

I don't know what makes you think that people are going to go on murderous rampages because a doctor says "I'm not comfortable referring you to someone for that procedure." I think a much more likely consequence would be the patient opens the phone book, goes on the internet, calls their insurance company, or uses any of the infinite other ways they could find an abortion provider.

With regard to your friend getting pregnant twice while using a condom and OC perfectly, I am calling BS. As per the FDA, a condom with perfect use will result in 3% of women getting pregnant over the course of a year. Multiply that 3% from condom use alone times the .5% failure rate of progestin only OC (it's .1% for progestin/estrogen BTW), and you get a .015% chance of getting pregnant while using both methods perfectly. That means less than 2 in 10,000 women would get pregnant in a year of sex using both methods perfectly. The odds against this happening twice to your friend, even using typical use instead of perfect use statistics, are astronomical.

You can't join the military and refuse to shoot because your morals suddenly prohibit killing people. And stop trying to impose your morals on me. Your job as a physician is to do what is right for your patient, regardless of what some book or an old dude in a city you've never been to tells you.

No one is telling you not to provide or refer for abortion services. In fact no one is imposing anything on you at all. Yet you are attempting to impose your moral judgment that abortion is appropriate and your opinion of what is "right for your patient" on every practicing physician.

 

[236116]

No one is telling you not to provide or refer for abortion services. In fact no one is imposing anything on you at all. Yet you are attempting to impose your moral judgment that abortion is appropriate and your opinion of what is "right for your patient" on every practicing physician.

1. she's mentally unstable.
2. astronomical but not impossible. what about the british couple who had interracial twins twice?

Who ever it was that I was quoting wants to get rid of abortion b/c his morals prohibit it.

 

[cpants]

1. she's mentally unstable.
2. astronomical but not impossible. what about the british couple who had interracial twins twice?

Who ever it was that I was quoting wants to get rid of abortion b/c his morals prohibit it.

Ok, I find it a lot easier to believe that your friend sucks at using birth control than that she hit the equivalent of winning the lottery. But as you said, it's not impossible.

The person you quoted was not advocating an abortion ban (at least not in the post you quoted). All he said was that a physician should not be legally obligated to participate in abortion, providing it or referring for it. AND, he even qualified the opinion with an exception for the truly rare emergent cases where the mother's life is in jeopardy.

 

[Miami_med]

I think that there would be severe disagreement amongst reasonable people as to whether an elective abortion on a mentally ill individual (who is well enough to consent but supposedly too ill to call another doctor) is a public good. I really have no issue with the idea of referring for an abortion, but It's amazing how far people will go in order to make people comply with their personal opinions. There is no magic code that everyone in private practice medicine has to comply with the random standards imposed by someone else's picture of the "public good." Most of the attempts at this have created a whole series of unfunded mandates that drive up the cost of medicine for everyone. Doctors are not slaves. They do not need to comply with someone else's moral code.

There is no reason why physicians shouldn't be able to say that they don't provide or refer for a service. Period. The ideas in this thread stink, running in the same vain as that court case that punished the doctor for not hiring an interpreter. We should be fighting to make ourselves NOT the slaves of the whims of the public, and we should have enough respect for each other to allow other physicians to practice autonomously and according to their personal needs, desires, and capacities in practice. If you want to provide abortions, provide them. If you want to refer for them, refer for them. No one in this thread is trying to make them illegal.

 

[236116]

The person you quoted was not advocating an abortion ban (at least not in the post you quoted). All he said was that a physician should not be legally obligated to participate in abortion, providing it or referring for it. AND, he even qualified the opinion with an exception for the truly rare emergent cases where the mother's life in jeopardy.

Why just those cases?

I don't understand that. And I don't understand the "maybe" rape exclusions.

 

[cpants]

Why just those cases?

I don't understand that. And I don't understand the "maybe" rape exclusions.

It's not that difficult to understand. If the mother is going to die unless the abortion happens that means the fetus dies either way. In these cases you are actually saving a life by performing the abortion.

Rape exclusions are not acceptable to most pro-lifers. As far as a pro-life physician is concerned, a fetus is an innocent life regardless of whether it is the product of a loving marriage or a random rape.

 

[dragonfly99]

I disagree with "conscience clause" laws allowing health care providers to not inform patients about all legal medical options. This includes refusal to refer for consideration of a therepeutic abortion, and it includes pharmacists not wanting to dispense birth control pills (unless the pharmacist is running his own privately-owned pharmacy). No doctor should be forced to participate in doing an abortion, but that is quite different than saying a doc should be able to withhold information from a patient. Those are two entirely different things.

A patient may want/need to know what are her options, medically speaking, at a particular point in her pregnancy. If you cannot have a free and fair discussion of these with her, you need to refer. If you are a pharmacist and I want birth control pills and you can't dispense those to me, you shouldn't be working at a large chain store pharmacy (CVS, Walgreen's, etc.) where it is part of your job description. And if you are running your own private pharmacy, I'd say you are required to inform me about alternative locations/pharmacies that WILL dispense the Pill. Otherwise you are imposing your morals on ME.

Also, someone implied in one of the threads above that a "Catholic may believe such and such" and a "strong Christian may believe such and such". This makes it sounds like Catholics are not Christians, which is untrue. A lot of evangelical protestants try to talk about Catholics vs. "Christians" as if they are two separate groups. Catholics ARE indeed Christians.

 

[Substance]

I disagree with "conscience clause" laws allowing health care providers to not inform patients about all legal medical options. This includes refusal to refer for consideration of a therepeutic abortion, and it includes pharmacists not wanting to dispense birth control pills (unless the pharmacist is running his own privately-owned pharmacy). No doctor should be forced to participate in doing an abortion, but that is quite different than saying a doc should be able to withhold information from a patient. Those are two entirely different things.

A patient may want/need to know what are her options, medically speaking, at a particular point in her pregnancy. If you cannot have a free and fair discussion of these with her, you need to refer. If you are a pharmacist and I want birth control pills and you can't dispense those to me, you shouldn't be working at a large chain store pharmacy (CVS, Walgreen's, etc.) where it is part of your job description. And if you are running your own private pharmacy, I'd say you are required to inform me about alternative locations/pharmacies that WILL dispense the Pill. Otherwise you are imposing your morals on ME.

Also, someone implied in one of the threads above that a "Catholic may believe such and such" and a "strong Christian may believe such and such". This makes it sounds like Catholics are not Christians, which is untrue. A lot of evangelical protestants try to talk about Catholics vs. "Christians" as if they are two separate groups. Catholics ARE indeed Christians.

I had said earlier that to Christians, referring for an abortion is the same as performing it in the context of mortal sin. A doctor with the fear of Hell in them will never condone referring the patient to an abortion practicing doctor.

I do not see this as withholding information: the existence of abortion is known to mostly everyone in the developed world, and this information can easily be found via the internet and other doctors. What the doctor is doing by not referring is refusing to participate in an exercise that is not medically necessary and not religiously sanctioned. The doctor is restricting access passively. He is not saying "You cannot have an abortion". He is saying "I will not participate in this abortion in any way". Unfortunately, in some places such as Canada, for a patient to self-refer to a specialist that performs abortions is extremely difficult, since all referrals have to go through a primary care doctor. Nonetheless, this is an access problem that mires the whole system. It is not a product of any physician's moral belief system.

Furthermore, as I have mentioned in the above post, any doctor with such strong Christian beliefs should express these beliefs openly with patients before the patients make the decision to take this particular doctor on. Such religious beliefs do affect practice styles which may not be in agreement with certain patients.

As an epilogue, I will add that I am completely secular. I am merely providing arguments for the existence of a conscience clause that would protect the personal and spiritual beliefs of physicians, and thus preserve physician autonomy.

 

[docB]

You’re switching back and forth between sarcasm and what I suspect are real assertions so often it’s a little hard to figure out what you’re saying. Remember that sarcasm sometimes doesn’t come across in writing as well as it does in speech.

Define "highly unusual".

The cases you mentioned were: a mentally ill woman who thinks she’s carrying an alien, rape victims, 9 year olds, 89 year olds and women who had birth control failures. With the exception of the birth control failure one I’d say all of those are “highly unusual.” I’d say highly unusual in this sense can mean any situation other than a woman finds herself pregnant and for reasons relating to personal convenience and circumstances doesn’t want to be.

And while you're at it, how exactly would you propose confirming rape victimhood?

I wouldn’t. You brought up that situation. I mentioned it to argue that you were unlikely to be satisfied with any policy other than unrestricted abortion access. It appears I was correct.

There's a reason such a large amount of rapes aren't reported.

Which is? And more to the point why is that relevant here?

Are you going to have an age limit? Under 13's can have all the abortions they want, but 14+ are a bunch of dirty sluts who should burn in hell?

See you’re assuming that I’m making some moral judgment against pregnant teens and think of them as “dirty sluts.” I don’t. I am more concerned about the people who are “having all the abortions they want” because using abortion as contraception is inappropriate.

What about the crack ****** who are going to abandon the kid (who's going to be born with a fck ton of problems) in a dumpster? The 16-yo who got knocked up by her boyfriend and drowns the newborn?

Again that goes to my previous question about setting policy because of the possible ill advised actions of someone.

You know what? You're exactly right, up until an estimated 27 weeks. Then Baby Mama is SOL and she can give the kid up and next time double check the expiration date on her damn condoms.

This is one of those can’t tell if you’re being sarcastic or not situations.

Oh, wait. Contraceptives are really aborticifants and thus good, moral, people can't use them.

You’re making some interesting assumptions about me and my views here,

Thank god. The overly-religious-can't-keep-it-to-themselves have ruined enough.

and here.

I have no morals. But I'll enjoy it anyway.

I’m sure you will. Let me point out a few things that you don’t know though:

I am actually pro abortion on demand. I am not at all religious. I favor abortion because I don’t think most people in the general population are competent to raise children. I am also reluctant to fund these poorly cared for children who will (as you alluded to in your dumpster baby with a “ahem” ton of problems comment) have to be supported by the state. As a fiscal conservative I see the millions of abortions as being cheaper than paying taxes to support those millions cradle to grave.

I do however think that abortion comes at a great cost morally and psychologically. Abortion may not be murder per say (although I think it might be) but it is clearly a practice that in any society decreases the value and sanctity of human life. Additional the waste of human potential is daunting. Have we aborted many great thinkers and lost their potential contributions? It’s likely we have in at least some instances.

I think that anyone who subscribes to the “it’s just a piece of tissue” and no restrictions whatsoever ideals without reservations is not really considering the issues or physiology involved and is molding their stance to their wishes and politics. It would be nice if there were no consequences for many of the choices in life but that is not reality. That type of liberal mentality makes me recall the characters in Alice in Wonderland who profess to believe in many impossible things every day.

As for the religious zealots I don’t like evangelism and I don’t like to see people try to impose on others. I do support their right to believe what they want which includes believing that abortion is murder. I wish that they would accept their role as advisors trying to dissuade people from making the abortion choice rather than fighting it out in the courts and elections but now I’m through the looking glass.

As far as this thread goes I don’t think that anyone should be forced to prescribe or perform things to which they are morally opposed. I also agree with Tired that businesses and practices should not be required to hire those with moral objections.

I echo what Substance said about standing for the right of healthcare professionals to retain autonomy. I take that stance largely due to my own reservations about the issue. I also have seen it born out again and again that those who loudly advocate one side or the other without any deference to the monumentally serious complexities of the issue are deluding themselves and have taken up the mantel of propagandists rather then thinkers.

 

[Regnvejr]

So this is basically only about abortion/birth control.

Pharmacists have refused to give out ADHD stimulants because they believed ADHD was being overtreated. It goes way beyond the right-to-life nuts.

We are not here to impose our worldview onto patients, we are here to serve them. Trying to serve them by restricting information or access, to claim that we know what is best for them and that we are the experts in their lives, that's just sophistry.

 

[Regnvejr]

The "Freedom of Choice Act" or FOCA, which PE Obama has promised to sign will prohibit any obstacle to health care (read:abortion) by facility or provider. It will sweep away any state enacted regulation such as parental consent or conscience clauses. Facilities such as Catholic run hospitals, it is feared, will be in violation of federal statute if they do not provide abortion services and will be subject to closure. In short, there will be nowhere to go if you have a moral objection to these procedures. That law is on the way. Problem just getting underway.

Catholic hospitals deliberately bought up hospitals and clinics in rural areas to obtain a religious monopoly in large geographical areas. They deliberately created the problem, and now they want to whine about being called on it? What a bunch of hypocrites.

 

[Regnvejr]

Also, over the things that we keep arguing about, it is not clear what helping the patient actually is. It is subjective. Is an abortion best for the patient? The patient thinks yes. The physician thinks no. That's just the way of it sometimes. "Better" is not always obvious, and this question has nothing to do with professional obligation.

I guess you missed the part of ethics class about enhancing patient autonomy. Seems like you are insisting that you are the expert in your patients life?

You can refuse to participate in an action that is outside your scope of practice or which you feel uncomfortable doing. But you cannot refuse to refer, you cannot mislead or make their "consent" uninformed. You cannot as a pharmacist keep prescriptions you don't want to fill, thus preventing care elsewhere.

All of these things have been done, and the providers rightfully have been charged or lost employment over it.

Now we get a law for crybabies whining over not being able to control their patients' lives. Disturbing and unprofessional.

 

[Regnvejr]

A doctor who does not condone abortion for moral reasons should not be required to refer a patient to another doctor.

Such a physician should not be allowed to obtain a license. A physician who want to push personal beliefs and lifestyles onto their patients based on something other than scientific medicine, such physicians area danger to their patients' wellbeing, not to mention that they are fragrantly violating medical ethics of autonomy and beneficence.

Speaking solely from a Roman Catholic standpoint, if a doctor were to refer a patient to another doctor who would perform an abortion, that would be equal to the parable in the New Testament of Pontius Pilate referring Jesus' fate to the general populace who he knew would desire crucifixion. Pilate is still seen as a Hell-bound murderer in the Bible even though he did not kill Jesus with his own hands nor did he order his death - he just referred him to people who would want him killed. The Bible sees no difference.

Irrelevant, as the Bible is neither a medical textbook, nor a medical license manual.

An extremely devout Christian doctor would see abortion in a similar light, and would choose not to refer, lest he burn in the fires of Hell for eternity.

You don't have to refer outside your scope of practice. But if a procedure potentially is in your scope, then refusing to do the procedure AND refuse to refer to others who can do those procedures, then you are imposing your morals onto the patients, robbing them of their autonomy and right to self-determination in their own lives. Such an unethical physician should not be allowed to hold a license.

I believe that it is the individual's right to not be forced to do something their morality prohibits, barring anything that harms the general populace. Refusing to refer an abortion does not harm the general populace nor is elective abortion an absolutely necessary medical procedure(barring rare cases where birth or continued pregnancy would kill the mother and/or fetus). It causes inconvenience, but does not eliminate the possibility of abortion for the patient.

It is a flagrant violation of the medical ethics you appear to not have learned about.

Nonetheless, a devoutly Christian doctor should proudly let his patients know ahead of time that he is Christian, and does not perform or refer abortions or any such procedures that contradict his religious beliefs. With this knowledge, patients could decide if the doctor is right for them. Otherwise, failure to refer an abortion could be construed as a "bait-and-switch" tactic.

That would be appropriate.

In closing, this topic is mired in emotional hogwash from both sides, and a truly pragmatic solution will never be found. It would serve devout Christians well to avoid any field where the issue of abortion is even touched upon.

And how about pharmacists refusing to dispense OC or ADHD medications?

 

[Regnvejr]

As far as a pro-life physician is concerned, a fetus is an innocent life regardless of whether it is the product of a loving marriage or a random rape.

Rather antrophomorpic. Non-sensate, non-sentient cells are not "innocent." You are bordering on hyperbole here.

 

[Regnvejr]

I had said earlier that to Christians, referring for an abortion is the same as performing it in the context of mortal sin. A doctor with the fear of Hell in them will never condone referring the patient to an abortion practicing doctor.

Then it is inadvisable for that physician to be in a field where their scope of practice could put them in the position of having to do that. If the physician is aware of a personal quirk that could become an issue, then it is the responsibility of that physician to make sure that it never becomes an issue.

I do not see this as withholding information: the existence of abortion is known to mostly everyone in the developed world, and this information can easily be found via the internet and other doctors.

True for ALL medical information. So that would mean that you want the right to withhold all medical information from patients, or that you are a hypocrite. Go check your ethics book again. As physicians, we are in an unequal power-relationship with our patients, these patients depends on us. As such, it is our DUTY to bend over backward, making sure that we don't abuse that power to inflict non-medical opinions on our patients. I can advice them per my special medical skills. But to try to hide things from them or decide that they don't need to know something, that violates informed consent. Meaning that when the lawyer is done with me, the patient owns my practice.

What the doctor is doing by not referring is refusing to participate in an exercise that is not medically necessary and not religiously sanctioned.

Pain medication is not medically necessary. A LOT of what we do is not medically "necessary." Ethics require that we do what is best for our patient, though, and not what we personally feel would be best for them or for us. If the physician is unable to see that, then they do not deserve a medical license, and in fact, somebody should actively work on removing that license. It would make them directly violate medical ethics, and patients would be better of with another physician who cares more about them that his/her own personal beliefs.

As an epilogue, I will add that I am completely secular. I am merely providing arguments for the existence of a conscience clause that would protect the personal and spiritual beliefs of physicians, and thus preserve physician autonomy.

You are providing arguments directly in opposition to medical ethics, a very serious issue per the power issues in physician-patient relationships.

 

[Regnvejr]

I do however think that abortion comes at a great cost morally and psychologically.

Given that we operate on evidence-based medicine:

Major B et al. (2000). "Psychological responses of women after first-trimester abortion. Archives of General Psychiatry, 57, 777-784.

Russo NF et al. (1997). The relationship of abortion to well-being: Do race and religion make a difference? Professional Psychology: Research and Practice, 28, 23-31.

Lydon J et al. (1996). Pregnancy decision making as a significant life event: A comittment approach. Journal of Personal and Social Psychology, 71, 141-151.

Gilchrist AC et al. (1995). Termination of pregnancy and psychiatric morbidity. British Journal of Psychiatry, 167, 243-248.

Cozzarelli C et al. (1994). The effects of anti-abortion demonstrators and pro-choice escorts on women's psychological response to abortions. Journal of Social and Clinical Psychology, 13, 404-427.

Major B et al. (1992). Psychosocial predictors of adjustment to abortion. Journal of Social Issues, 48, 121-142.

Russo NF et al. (1992). Abortion, childbearing and women's well-being. Professional Psychology: Research and Practice, 23, 269-280.

Adler NE et al. (1992). Psychological factors in abortion: An overview. American Journal of Psychology, 47, 1194-1204.

Adler NE et al. (1990). Psychological responses after abortions. Science, 47, 248, 41-43.

Dag g PKB (1991). The psychological sequelae of therapeutic abortion-Denied and completed. American Journal of Psychiatry, 148, 578-585.

Blumenthal SJ (1991). Psychiatric consequenses of abortion, an overview. In NL Scotland (ed.). Psychiatric aspects of abortion, pp. 17-38. Washington, DC: American Psychiatric Press.

Zabin LS et al. (1989). When urban adolescents choose abortion: Effects on education, psychological status, and subsequent pregnancy. Family Planning Perspective, 21, 248-255.

Mueller P et al. (1989). Self-blame, self-efficacy, and adjustment to abortion. Journal of Personal and Social Psychology, 57, 1059-1068.

Schwartz RA (1986). Abortion on request: The psychiatric implications. In JD Butler et al. (eds.). Abortion, medicine, and the law (3rd ed.; pp. 323-340). NY: File.

Major, B et al. (1985). Attributions, expectations, and coping with abortion. Journal of Personal and Social Psychology, 48, 585-599.

David HP (1981). Postpartum and postabortion psychotic reactions. Family Planning Perspective, 13, 88-92.

Shusterman L (1979). Predicting the psychological consequenses of abortion: Social Science Medicine, 13, 683-689.

National Academy of Sciences (1975). Legalized abortion and the public health. Washington, DC: author.

Adler, NE (1975). Emotional responses of women following therapeutic abortion. American Journal of Orthopsychiatry, 45, 446-454.

Athanasiou R et al. (1975). Psychiatric sequellae to term birth and induced early and late abortions. Family Practice Perspectives, 5, 227-231.

Abortion may not be murder per say (although I think it might be) but it is clearly a practice that in any society decreases the value and sanctity of human life.

Murder is the illegal killing of a person with malice forethought. Please try to avoid emotional histrionics. And a society that feel it ok to enslave and oppress women into a theocracy, that society certainly cheapens the value and sanctity of the woman's life, making her a second-class slave.

So lets drop the lame, anti-abortion revisionist linguistic hyperbole; we are supposed to be rational, not prone to emotional histrionics in our field.

Additional the waste of human potential is daunting. Have we aborted many great thinkers and lost their potential contributions? It’s likely we have in at least some instances.

And possibly a few Hitler, Pol Pot, Timothy McVeigh, Ossama bin Ladins etc. The what-if game is boring.

I think that anyone who subscribes to the “it’s just a piece of tissue” and no restrictions whatsoever ideals without reservations is not really considering the issues or physiology involved and is molding their stance to their wishes and politics.

I could say the same for your side. But this is not an abortion-tread, it is an ethics tread, the ethics of denying and hiding treatment options from patients.

It would be nice if there were no consequences for many of the choices in life but that is not reality. That type of liberal mentality makes me recall the characters in Alice in Wonderland who profess to believe in many impossible things every day.

Ah, now it is apparently time for the ad hominems. Should we talk about what the Conservative/Fascist mentality of pro-life reminds me off?

as this thread goes I don’t think that anyone should be forced to prescribe or perform things to which they are morally opposed. I also agree with Tired that businesses and practices should not be required to hire those with moral objections.

The problem is the lack of referral, not handing back scripts, and in other ways trying to prevent the patient obtain medical care elsewhere just because you don't agree with the treatment.

 

[docB]

Please try to avoid emotional histrionics. And a society that feel it ok to enslave and oppress women into a theocracy, that society certainly cheapens the value and sanctity of the woman's life, making her a second-class slave.

And I'm the one stooping to hyperbole?

BTW that little button at the lower right with the quote marks is the multi quote button. Using it makes it so you don't have to post a zillion individual posts.

 

[Regnvejr]

And I'm the one stooping to hyperbole?

Could it have to do with pro-lifers not taking as well as they give?

How would you address a pharmacist refusing to fill a script for Adderal XR or hand the script back because they don't think ADHD need to be treated? You're in Wyoming, the client lives 3 hrs away and per it being a stimulant, the prescription requires a paper script, and the client has the Senior math finals next morning.

How far does "conscience" allow one to drastically mess up a client's life?

 

[cpants]

Rather antrophomorpic. Non-sensate, non-sentient cells are not "innocent." You are bordering on hyperbole here.

Anthropomorphic, really? I don't really see a problem with assigning human attributes to something that is indisputably human. Not everyone believes a fetus is just some kind of tumor in the uterus.

Clearly there is a line where it is no longer morally acceptable to terminate a pregnancy. Do you really think it is ok to dismember and remove a viable 35-week fetus with forceps? I would hope not. Since we can't define the line where a fetus is truly a life medically, drawing that line is the prerogative of the provider.

Could it have to do with pro-lifers not taking as well as they give?

How would you address a pharmacist refusing to fill a script for Adderal XR or hand the script back because they don't think ADHD need to be treated? You're in Wyoming, the client lives 3 hrs away and per it being a stimulant, the prescription requires a paper script, and the client has the Senior math finals next morning.

How far does "conscience" allow one to drastically mess up a client's life?

Geographic location does not reduce or change the rights of a pharmacist. In this country, no matter where you live, you can have any prescription filled by mail in a matter of days. If the person let his script run out so far that he has to wait a couple of days to get it, that isn't the pharmacist's problem. I have no problem with a pharmacist who refuses to fill any script for any reason. If that pharmacist works for someone else, however, they better follow their employer's rules, or risk termination.

 

[236116]

Clearly there is a line where it is no longer morally acceptable to terminate a pregnancy. Do you really think it is ok to dismember and remove a viable 35-week fetus with forceps? I would hope not. Since we can't define the line where a fetus is truly a life medically, drawing that line is the prerogative of the provider.

You do realise that that happens so rarely it almost never happen? While less than 2% of abortions occur after 21 weeks, most of those that do are the other sort of D&(a letter) where the brain is removed. A fetus is a ~life when it is viable, therefore, 25 weeks.

Geographic location does not reduce or change the rights of a pharmacist. In this country, no matter where you live, you can have any prescription filled by mail in a matter of days.

Do you not understand insurance? Why is this not a required class in medical school: What Practice is Really Like. The Bull**** You Will Have to Deal With from Insurance Companies to Properly Care for You Patients. Getting **** Done When Everyone Else is Being a Dickhead and Trying to Push Their Morality on Someone Else Even though That is a BAD BAD Thing.

 

[cpants]

I realize that late-term abortions are rare. My point was that there is a point where abortion becomes unacceptable to almost everyone. If someone decides to place that point earlier in gestation, what is the problem?

I am pro-choice, BTW. Unlike a lot of pro-choicers though, I am pro-choice for both the woman and the physician.

 

[dragonfly99]

cpants, your argument in the post just above this one I think holds as far as it being wrong to force a doc to actually perform an abortion. Withholding medical information and/or not telling someone about other providers who can perform a procedure is a totally different ball of wax. Many patients are not as educated as we are, some are not as smart...cannot assume that "they will be able to find information about whatever they want" on the internet, etc. And patients shouldn't have to go around from pharmacy to pharmacy just trying to get someone to fill an Rx for birth control pills...that is just ludicrous beyond belief. Some people are too poor to have a car, or live out in the boondocks and this could be REALLY hard for them, or even impossible.

And the idea of pharmacists not having to dispense any and all legal medications I think is just ludicrous. What if you have a scientologist pharm tech or pharmacist who doesn't believe in meds for mental illness...can he/she decide not to dispence SSRI's and antipsychotics? This line of reasoning that people can just declare things are "against their beliefs" and decide to impose those beliefs on the patient is a very dangerous one for patients. There is a moral difference between DOING something (i.e. you the doc being the one to DO an abortion, or you the doc giving a lethal medication for euthanisia, for example) and giving information (i.e. you the doc acknowledging that you don't perform abortions b/c you don't believe in them, but referring the patient to Planned Parenthood, or that you live in Oregon but don't believe in assisting folks in ending their lives but will refer to a different doc). Medical ethics requires that we put the patient first and respect patient autonomy. Withholding medical information from them and/or withholding legal medications from them is just unethical in my book.

I totally understand people being morally against all abortions, but it's legal in this country in certain instances. If you don't feel you can deal with that, then I think it's a bad idea to go into any primary care field or OB/Gyn, as that is an issue that's going to come up periodically and you can't just decide for your patients that they will or won't have an abortion. What if one of your patients wanted to decide what church you should attend, how you should raise your kids, who you should marry, etc.? When you decide whether your patient can get an abortion or not, you are making a potentially life changing decision for them without informed consent.

 

[cpants]

A pharmacy is a retail business like any other. They can choose to sell or not sell whatever products they want. If this is inconvenient for a patient, they will choose to take their business elsewhere. A simple phone call to the doctor's office should easily get them a referral to an adequate pharmacy. If a pharmacist is opposed to dispensing common medications, they won't be in business long. I understand this may be inconvenient. Inconvenience for patients is not a reason to impose your morals on a pharmacist or physician.

 

[Miami_med]

I guess you missed the part of ethics class about enhancing patient autonomy. Seems like you are insisting that you are the expert in your patients life?

You can refuse to participate in an action that is outside your scope of practice or which you feel uncomfortable doing. But you cannot refuse to refer, you cannot mislead or make their "consent" uninformed. You cannot as a pharmacist keep prescriptions you don't want to fill, thus preventing care elsewhere.

All of these things have been done, and the providers rightfully have been charged or lost employment over it.

Now we get a law for crybabies whining over not being able to control their patients' lives. Disturbing and unprofessional.

I never stated that anyone should mislead anyone. I said that a provider should be able to state, "I do not provide that service, you'll have to go elsewhere." I did attend that lecture, and to any extent that it violated the previous statement, it was a stupid lecture.

I am not going to get into an argument with you, because it would clearly be a lost cause. I will point out that if anyone has an agenda, I would count all of your replies on multiple threads and guess that it is probably you. Claiming that my opposition to forcing people to involve themselves in a process that they disagree with is part of some theocratic oppression of women is laughable. I am not overly religious, and I generally don't care if women have abortions. My argument could just as easily apply to liposuction. I don't think that abortions should get special consideration. In that respect, I believe in treating women (and procedures that apply on to them) the same as I believe in treating everyone else. I believe that patients have the right to see whomever they wish and the right to consult whomever they wish. Physicians have the right to offer whichever services (including referrals) that they wish. How this violates autonomy or makes women second class citizens is entirely lost on me.

Here's what I do care about. Your views here in my opinion are exactly why as a profession, we are ceasing to be a profession. We are no longer highly trained autonomous professionals, but peons forced to run at the whims of individuals who think that they know better than we do in terms of how to run our practice. I'm sure that soon enough, you there will be plenty of people of like mind to yourself crowding the halls of congress in order to make sure that the same *****s that brought us the "stimulus package," and "the war on terror," rain some ridiculous law down upon all of us that completely eliminates any sense of private property, private ownership, autonomy, or respect. Then physicians will be the ones who are enslaved second class citizens. You will have your wish. Abortions for all and autonomy for none.

 

[docB]

Could it have to do with pro-lifers not taking as well as they give?

Hmmmm. Well you quoted from the post where I explained I'm not a pro-lifer but didn't catch that part apparently. Here it is again: http://forums.studentdoctor.net/showpost.php?p=7593976&postcount=73
I simply acknowledge the complexity of the situation.

 

[Regnvejr]

Anthropomorphic, really? I don't really see a problem with assigning human attributes to something that is indisputably human. Not everyone believes a fetus is just some kind of tumor in the uterus.

Unless it is a hydatidiform mole. That aside, trying to imply the fetus as a person or a baby, or whatever revisionist linguistic hyperbole may be ok for the usual lying crap pro-life right-wing terrorist. But as a medical professional, that's inexcusable and unethical.

Clearly there is a line where it is no longer morally acceptable to terminate a pregnancy.

The consensus is developing to be at sentience, when the thalamocortical tract connects.

Do you really think it is ok to dismember and remove a viable 35-week fetus with forceps?

But then, fetuses at 35 weeks are not aborted unless per dire medical emergencies. So you are no better than the lying pro-lifers in their hyperbole and dishonesty. Seems like you are utterly rejecting scientific honesty here. A disturbing trait in somebody who supposedly is going to become a medical professional. Nothing wrong in discussing abortions and having a difference of opinion, but distortions, sophistry and hyperbole does not bode well for your career. We ARE held to a higher standard. Please rise to the occasion.

I would hope not. Since we can't define the line where a fetus is truly a life medically, drawing that line is the prerogative of the provider.

And nobody would force you to perform an abortion. HOWEVER, (please pay attention, this point was made previously) you cannot refuse to refer is the patient want this. Nor can you deliberately hide options from the patient because you morally disagree with their wishes.

Geographic location does not reduce or change the rights of a pharmacist. In this country, no matter where you live, you can have any prescription filled by mail in a matter of days. If the person let his script run out so far that he has to wait a couple of days to get it, that isn't the pharmacist's problem.

Even if it is the morning-after pill? Now you are downright being silly. You really need to study up on this, as it clearly can become an issue. And rest assured that if someday the lawyer comes to you about this, and get an inkling that your professional interaction with patients is tainted by personal politics, then it is mainly a matter of how big a settlement you offer. Ethics guidelines are not just for the safety of the patient, but also for the physician being able to show actions were ethical and therefore not subject to litigation.

If you cannot accept this, then I recommend you make a beeline out of clinical medicine.

I have no problem with a pharmacist who refuses to fill any script for any reason. If that pharmacist works for someone else, however, they better follow their employer's rules, or risk termination.

Rest assured that the state who licenses that pharmacist will have serious reservations about such a pharmacist.

I realize that late-term abortions are rare.

Careful about terminology. In the medical sciences, "late-term" is considered after 1st trimester.

My point was that there is a point where abortion becomes unacceptable to almost everyone. If someone decides to place that point earlier in gestation, what is the problem?

The problem is that you then end up hurting the woman. To utterly ignore her rights as a sentient, sensate person is another point where you raise serious issues about your ability to become a clinician.

A pharmacy is a retail business like any other.

They are licensed health-care providers. BIG difference. It would behoove you to learn the difference. There are duties and obligations for licensed health-care providers that don't befall regular retail businesses.

They can choose to sell or not sell whatever products they want. If this is inconvenient for a patient, they will choose to take their business elsewhere.

Not if they are the only retail pharmacy within 50-100 miles. When there is a geographical monopoly, then the rules change. Not every part of the nation has 10 chains in every block.

A simple phone call to the doctor's office should easily get them a referral to an adequate pharmacy.

You better figure out right now that physicians do not have time to check up on what pharmacies carry what stock or refuse what kind of stock.

If a pharmacist is opposed to dispensing common medications, they won't be in business long.

And yet it happens.

I understand this may be inconvenient. Inconvenience for patients is not a reason to impose your morals on a pharmacist or physician.

Per their license agreements, they are not allowed to inconvenience their patients for non-scientific reasons. If you cannot accept this, then I share dragonfly's concern about you making it in a field involving direct patient care. There is a reason you were taught ethics beyond just not going and sleeping with your patients. The professional ethics are the standards of care. If you are begging to get sued, just go ahead and deliberately violate the ethics for personal, political reasons.

 

[Regnvejr]

I never stated that anyone should mislead anyone. I said that a provider should be able to state, "I do not provide that service, you'll have to go elsewhere."

And you have to provide referrals, or it is abandonment of the patient. The government and licensing agencies take a dim view of abandonment.

I did attend that lecture, and to any extent that it violated the previous statement, it was a stupid lecture.

I recommend, instead of calling ethics lectures stupid, you start paying a lot of attention to them. lawyers certainly do.

..I don't think that abortions should get special consideration.

It doesn't.

In that respect, I believe in treating women (and procedures that apply on to them) the same as I believe in treating everyone else. I believe that patients have the right to see whomever they wish and the right to consult whomever they wish. Physicians have the right to offer whichever services (including referrals) that they wish.

If the procedure is within your scope of practice, then you don't have a choice about providing referrals. Your license depends on it.

Here's what I do care about.....

Irrelevant rant, nothing to do with the duty to provide services.

 

[cpants]

Unless it is a hydatidiform mole. That aside, trying to imply the fetus as a person or a baby, or whatever revisionist linguistic hyperbole may be ok for the usual lying crap pro-life right-wing terrorist. But as a medical professional, that's inexcusable and unethical.

I know you must think it sounds smart to write something like "revisionist linguistic hyperbole", but it doesn't really make sense. Also quite ironic to, in the same sentence, accuse someone of linguistic hyperbole, and then describe anyone who considers a fetus a person as a "lying crap pro-life right-wing terrorist".

The consensus is developing to be at sentience, when the thalamocortical tract connects.

Maybe, but regardless of what the consensus is, people will have their disagreement. Don't forget that the consensus once was that Earth was flat and the sun revolved around us. If you want to define the beginning of life at that point in neural development, fine.

But then, fetuses at 35 weeks are not aborted unless per dire medical emergencies. So you are no better than the lying pro-lifers in their hyperbole and dishonesty. Seems like you are utterly rejecting scientific honesty here. A disturbing trait in somebody who supposedly is going to become a medical professional. Nothing wrong in discussing abortions and having a difference of opinion, but distortions, sophistry and hyperbole does not bode well for your career. We ARE held to a higher standard. Please rise to the occasion.

Again you missed the point. I wasn't trying to claim that 35-wk abortions are a big problem or a common occurrence. I was merely using it as an example of a time when almost everyone would find performing abortion objectionable. I'm sorry I even brought it up.

And nobody would force you to perform an abortion. HOWEVER, (please pay attention, this point was made previously) you cannot refuse to refer is the patient want this. Nor can you deliberately hide options from the patient because you morally disagree with their wishes.

The problem is you equate refusing to refer and deliberately hiding options. Saying "I won't discuss or participate in this", is a lot different than saying "You can't have an abortion, it's not an option, it's illegal" or anything like that. Refusing to participate is not lying or misleading a patient. If a physician does lie or mislead, of course he is in the wrong.

Even if it is the morning-after pill? Now you are downright being silly. You really need to study up on this, as it clearly can become an issue. And rest assured that if someday the lawyer comes to you about this, and get an inkling that your professional interaction with patients is tainted by personal politics, then it is mainly a matter of how big a settlement you offer. Ethics guidelines are not just for the safety of the patient, but also for the physician being able to show actions were ethical and therefore not subject to litigation.
If you cannot accept this, then I recommend you make a beeline out of clinical medicine.

Let me explain something to you. If someone chooses to live in the boondocks they limit their access to medicine in all ways. That includes access to physicians, surgeons, imaging, and yes, pharmacies. Because patients live in a place with limited access, that does not reduce the rights of the providers in the area, or require them to provide non life-saving treatment to which they object. Geographical location does not change our rights. They are inherent.

Let's take the example of the pharmacist, the only one within 100 miles. Say he finds birth control morally objectional and refuses to dispense it. We come in and force him to modify his "unethical" behavior. What happens? He probably closes up shop and walks away, and now everyone is driving 100 miles to get their meds. Great solution.

It is the responsibility of the patient to acquire their own care and to get their own medications. For the morning-after pill example, there are several possible solutions that don't involve trampling the pharmacist's rights. The patient could drive 100 miles and get the medication. Inconvenient, but effective. The physician, knowing the only pharmacy within 100 miles does not dispense birth control, could keep a small supply of morning-after pills in his office. The patient could fill a script for the morning-after pill in advance, either by mail or the next time she is near the 100-mile-away pharmacy, and have it on hand in case of emergency. With a little foresight and personal responsibility, there will not be an issue.

Rest assured that the state who licenses that pharmacist will have serious reservations about such a pharmacist.

There are many pro-life pharmacies around the country which do not sell OCs.

The problem is that you then end up hurting the woman. To utterly ignore her rights as a sentient, sensate person is another point where you raise serious issues about your ability to become a clinician.

Nonsense. A woman is not injured by having inconvenient access to birth control. If she does not like the businesses in her locale, she can easily move to a more hospitable town. Furthermore, in the US, every medication is available by mail in a few days. No matter where you live, there is access to legal, properly prescribed medication. I find it curious that you are seemingly obsessed with an invented right to convenient drug access, while you have no problem trampling on the rights of healthcare providers who are also "sentiate, sensate persons".

Per their license agreements, they are not allowed to inconvenience their patients for non-scientific reasons. If you cannot accept this, then I share dragonfly's concern about you making it in a field involving direct patient care. There is a reason you were taught ethics beyond just not going and sleeping with your patients. The professional ethics are the standards of care. If you are begging to get sued, just go ahead and deliberately violate the ethics for personal, political reasons.

Of course you can inconvenience patients for non-scientific reasons. You can close up shop to go out of town for a few weeks, you can only open the store from 4-5AM every morning, you can accept payment only in the form of cashier's check. Basically you can do whatever you want, within the limits of the law. Market forces, not force of law, dictate the conveniences you provide to your patients.

 

[Miami_med]

The fact that someone at a licensing board or running a lecturing course stated that something is or is not ethical does not inherintly make it so. Licensing boards stated that abortions were unethical in many states not overly long ago, and losing one's license was about the least of the possible penalties for doing so. With that in mind, I think that there are many here on this board that would argue that licensing boards can be wrong on issues of medical ethics.

 

[236116]

If someone chooses to live in the boondocks

Not everyone gets a choice as to where they live, *******.

It is the responsibility of the patient to acquire their own care and to get their own medications. For the morning-after pill example, there are several possible solutions that don't involve trampling the pharmacist's rights. The patient could drive 100 miles and get the medication. Inconvenient, but effective. The physician, knowing the only pharmacy within 100 miles does not dispense birth control, could keep a small supply of morning-after pills in his office. The patient could fill a script for the morning-after pill in advance, either by mail or the next time she is near the 100-mile-away pharmacy, and have it on hand in case of emergency. With a little foresight and personal responsibility, there will not be an issue.

A raped kid doesn't have that option. A woman who can't take three hours off work to drive out there doesn't have that option. A woman whose insurance doesn't support mail order doesn't have that option. A woman who trusts her physician and other providers to do the thing that is most appropriately medically indicated doesn't have that option, she is ignorant of the fact that there are still "people" who would deny her the right to do what she wants with her own body and all its constituent parts which would include any embryo/fetus. And is it even legal for a physician to hand out EC like that? What if he's out of town?

Nonsense. A woman is not injured by having inconvenient access to birth control. If she does not like the businesses in her locale, she can easily move to a more hospitable town. Furthermore, in the US, every medication is available by mail in a few days. No matter where you live, there is access to legal, properly prescribed medication.

You are an idiot. It is injurious, it's the reason women used to turn to back alleys and hangers and parsley tea. Do you realise that BC isn't used just for contraception? That it's used for controlling cystic disease and terrible periods that destroy weeks of a woman's life at a time?

You can't just pick up and move, the real world doesn't work that way. Life for real people doesn't work that way.

I'd really like to live in this shiny, everything is available if women weren't such whiny ***** who can't just put up and shut up and let me impose what I want and what I believe even though I'm never going to be in their situation world that you seem to inhabit. It must be nice. I know I'd certainly like to never have to hear about a kid having her daddy's baby or a college girl who looked away from her drink for a second too long or a mother of 5 who simply can't have another kid and the damn condom broke who are all desperate for access to proper reproductive healthcare- which you seem to want to deny them.

 

[Regnvejr]

Right on Jurrasicpark. The persons who believe that others are not hurt from these persons pushing their morals on them, those people are delusional or just don't give a damn in the best antisocial fashion.

 

[Pharmavixen]

A pharmacy is a retail business like any other. They can choose to sell or not sell whatever products they want. If this is inconvenient for a patient, they will choose to take their business elsewhere.

Not sure about American laws, but where I practice, I am compelled to fill all rxs presented to me unless I have an iron-clad EBM reason not to, or if it's a narcotic rx and I can't verify its legitimacy. My college does have a "Morality Clause" that allows pharmacists who have religious objections to OCPs to not dispense them, but otherwise, we are not allowed to pick and choose what rxs we want to fill.

I used to work at a store where a local doctor was writing rxs for addicts. These scripts were ridiculous: 20 Tylenol #3, 15 Percocet, 20 Valium 10 mg, 30 Seconal 100mg, etc, all for the same person. So I told my boss that I was not going to fill any more rxs from Dr. Smith. She phoned the pharmacist's college to see if it was okay for me to do this, and they told her no; I can't just blanket not fill rxs from a licensed physician. If I did that, they could charge me with professional misconduct.

This doctor has since had his license taken away.

 

[Miami_med]

You are an idiot. It is injurious, it's the reason women used to turn to back alleys and hangers and parsley tea. Do you realise that BC isn't used just for contraception? That it's used for controlling cystic disease and terrible periods that destroy weeks of a woman's life at a time?

Everyone is welcome to disagree, even fervently. However, I will remind everyone of the TOS, where name calling and personal attacks are not allowed. Please carry on.

 

[Miami_med]

The debate here isn't what the law is. It is about what it should be. The argument largely being put forth by one side is that failure to provide abortion referrals is a violation of professional ethics. The other side is largely saying that either this isn't really about professional ethics at all, or atleast that what is professed as professional ethics in this case is incorrect.

I'm still not sure why a provider of any sort shouldn't have autonomy in determining which services are provided no matter how horrible the incident. If a boulder falls on your roof, and the roofer is out of town, you can't demand that the plumber come fix it now. This is true even if the plumber knows how to fix a roof. This is true even if it's -25 outside in a blizzard. You might argue that the individual could just leave the devastated house and go stay in a hotel, but that would be taking personal responsibility for one's situation. That is clearly not expected of anyone anymore.

Also, all of the examples quoted of woe have nothing to do with like 99% of abortion procedures performed. Even if I agreed that abortion was a medical standard in these cases, and even if I agreed that people should be compelled to provide a service because someone decided it was a "standard," teenage rape victims are just not that large a percentage of the population getting abortions. The majority are adult women who became pregnant the old fashioned way. That's why a lot of these arguments really don't hold water. It's hard to argue that a woman is an autonomous being in control of her own body with the right to make all decisions regarding the consequences of sex while simultaneously saying that she is too stupid to look abortion up on the internet or the phone book or find a ride to the next town. I think that you aren't giving people enough credit. The argument about abortion provision actually sounds a bit paternalistic if not downright misogynistic. The poor helpless women would never be able to find an abortion provider if the great doctor doesn't personally give her a referral.

This is NOT an immediate life threatening emergency.

 

[Regnvejr]

The debate here isn't what the law is. It is about what it should be. The argument largely being put forth by one side is that failure to provide abortion referrals is a violation of professional ethics. The other side is largely saying that either this isn't really about professional ethics at all, or atleast that what is professed as professional ethics in this case is incorrect.

I'm still not sure why a provider of any sort shouldn't have autonomy in determining which services are provided no matter how horrible the incident. If a boulder falls on your roof, and the roofer is out of town, you can't demand that the plumber come fix it now. This is true even if the plumber knows how to fix a roof.

Downright silly. A podiatrist won't be expected to refer, nor will a cardiologist. But if you are an OB/GYN or an FP, then the issue of it being inside your scope of practice does come into effect. As such, such providers are required to refer.

If I didn't "believe" in ADHD, I certainly would be required to refer elsewhere if parents presented with concerns about a kid. Refusing to do so is an offense that can lose me my license.

I suggest you learn the law before graduating, so you're able to obtain and hold a license.

Also, all of the examples quoted of woe have nothing to do with like 99% of abortion procedures performed. Even if I agreed that abortion was a medical standard in these cases, and even if I agreed that people should be compelled to provide a service because someone decided it was a "standard," teenage rape victims are just not that large a percentage of the population getting abortions. The majority are adult women who became pregnant the old fashioned way.

The reason for abortions is irrelevant. If the abortions are within your scope of practice and you do not refer, then at some point, the licensing agency will come after you. If you don't like it, then I strongly recommend you finding a field where any personal objections you, have are outside of your scope of practice.

That's why a lot of these arguments really don't hold water. It's hard to argue that a woman is an autonomous being in control of her own body with the right to make all decisions regarding the consequences of sex while simultaneously saying that she is too stupid to look abortion up on the internet or the phone book or find a ride to the next town.

The issue is that not all abortion providers advertise. Some are doing a few abortions as long as there is no political fall-out (ie. getting shot in the back when cooking dinner for his kids, as happened to Dr. Gunn).

You do not have to provide abortions. But if you are an OB/GYN who does not "believe" in abortions, then you better be prepared to refer to someone else if the patient asks. Not doing so certainly WILL cost you your license. You can rant against this or claim it unfair or whatnot, but you are forewarned. If you have political, personal hangups about something, it is your job to make sure those personal beliefs never get inflicted on the patients.

I get patients that want certain things done and I feel they are clinically not warranted and I tell them. But I also make sure that I provide them the option of seeing another provider that might give a second opinion.

I think that you aren't giving people enough credit. The argument about abortion provision actually sounds a bit paternalistic if not downright misogynistic. The poor helpless women would never be able to find an abortion provider if the great doctor doesn't personally give her a referral.

This is NOT an immediate life threatening emergency.

But if it is i=your scope of practice, then you are required to at least refer. You can whine about this all you want, but REALITY is that you are wrong.

 

[Miami_med]

Repeatedly stating that I am wrong does not make me wrong. The argument is circular. If a physician doesn't provide a service, it is immediately outside the scope of practice of the physician by definition. I won't say it again, but I never said that physicians should have the right to say that abortion doesn't exist. I simply said that they should have the right to not provide or refer for the service. As for me personally, I am not in OB/GYN or FM, and I don't have a moral objection to referrals. I'm looking out for the autonomy of my colleagues whose personal beliefs about the way they want to practice medicine I hold to be equally dear to your own.

I don't believe that law=morality or ethics. Repeatedly stating that it does doesn't change the fact. Even if it did, I'm also not aware of any case in which someone lost a medical license for not referring a patient for an abortion. I would be interested to hear about it if you've got one. I'm also not sure that everyone would agree with you that this is in fact a standard of care.

Perhaps in your state of Wyoming, the dominant culture is highly opposed to abortion. Where I live, it is the opposite. You're far more likely to be villified for not supporting abortion here. There is no reason why there has to be a national sameness of all healthcare provision just as there is no sameness in all national culture.