Ethics in Medicine

[medredu]

Hi, I'm a junior in undergrad and pre-med. I was wondering how medicine works in the case the patient's desires/needs interfere with the physician's beliefs (moral, religious, etc.). For example, what if your patient asks to be prescribed for birth control or wanted an abortion, but your religious beliefs interfere with this? Do doctors have the right to object, BUT refer the patient to other doctors willing to do so? Or do doctors have to do whatever the patient wants? Religion is a very important part of my life and I don't to get in the situation of losing my license, jeopardizing the patient, etc. This is why I have been thinking of switching to dentistry... I'm not trying to sound like an dingus, ofc I want what's best for the patient, but I cannot afford to reject my beliefs. Any input is appreciated.

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[deleted1077312]

You can refer patients or just take jobs at religious based hospitals; half of them are anyway

 

[Select All That Apply]

Hi, I'm a junior in undergrad and pre-med. I was wondering how medicine works in the case the patient's desires/needs interfere with the physician's beliefs (moral, religious, etc.). For example, what if your patient asks to be prescribed for birth control or wanted an abortion, but your religious beliefs interfere with this? Do doctors have the right to object, BUT refer the patient to other doctors willing to do so? Or do doctors have to do whatever the patient wants? Religion is a very important part of my life and I don't to get in the situation of losing my license, jeopardizing the patient, etc. This is why I have been thinking of switching to dentistry... I'm not trying to sound like an dingus, ofc I want what's best for the patient, but I cannot afford to reject my beliefs. Any input is appreciated.

What is the patient's decision making capacity. Are they oriented? Are they appropriate? Reaffirm outcomes and goals. Do this patient still want to still receive CPR when their decisions are self-jeopardizing. Establish a plan for if the patient becomes unable to make decisions due to LOC. Who are the stakeholders most relevant to the patient? Family? MDPOA? And then if it's a major issue within a hospital does there need to be an ethics board involves in order to determine future progress of care.

 

[NITRAS]

I think you’d be surprised how many of the OB/GYNs don’t prescribe abortifacients or perform elective abortions. Most of them don’t, and even fewer PCP’s.

Do you have any other concerns?

 

[Med Ed]

Hi, I'm a junior in undergrad and pre-med. I was wondering how medicine works in the case the patient's desires/needs interfere with the physician's beliefs (moral, religious, etc.). For example, what if your patient asks to be prescribed for birth control or wanted an abortion, but your religious beliefs interfere with this? Do doctors have the right to object, BUT refer the patient to other doctors willing to do so? Or do doctors have to do whatever the patient wants? Religion is a very important part of my life and I don't to get in the situation of losing my license, jeopardizing the patient, etc. This is why I have been thinking of switching to dentistry... I'm not trying to sound like an dingus, ofc I want what's best for the patient, but I cannot afford to reject my beliefs. Any input is appreciated.

If you're willing to refer there is generally no problem.

If you're not willing to refer then dentistry sounds like a fine idea.

 

[medredu]

If you're willing to refer there is generally no problem.

If you're not willing to refer then dentistry sounds like a fine idea.

Ok this makes more sense. Is the term 'conscientious objection' still in practice? And I don't have a problem with referrals. But, definitely if I were in that situation, I'd give my patient all the options that are available to them first, and refer as well.

 

[medredu]

I think you’d be surprised how many of the OB/GYNs don’t prescribe abortifacients or perform elective abortions. Most of them don’t, and even fewer PCP’s.

Do you have any other concerns?

I am just afraid of legal consequences if I still do decide to go the medicine route. I'm sure more of this stuff is dealt with OB/GYNs and possibly other specialties, so in that case would it be best to look into other specialties later down the road? For example, would a radiologist or ENT doc come across situations like this (apart from residency)? I really don't want any lawsuit or my license revoked.

 

[medredu]

You can refer patients or just take jobs at religious based hospitals; half of them are anyway

Ok thanks. For some reason some random person not on this site told me I'd get in serious trouble and that "most health systems will not allow providers to refer based on political/religious beliefs since it can risk their status with CMS". They were also like "choosing not to treat a patient on the basis of your own political beliefs is illegal and/or opens you up to major medical malpractice liability". Is this even true?

 

[Goro]

I am just afraid of legal consequences if I still do decide to go the medicine route. I'm sure more of this stuff is dealt with OB/GYNs and possibly other specialties, so in that case would it be best to look into other specialties later down the road? For example, would a radiologist or ENT doc come across situations like this (apart from residency)? I really don't want any lawsuit or my license revoked.

Doctors can and have been sued for ANY reason. You WILL be sued int he course of your career. You have to get used to this. What people miss is that it's harder to win the lawsuit against the doctor.

If the fear of being sued is making you hesitant about Medicine, then definitely pick a different a career.

 

[medredu]

Doctors can and have been sued for ANY reason. You WILL be sued int he course of your career. You have to get used to this. What people miss is that it's harder to win the lawsuit against the doctor.

If the fear of being sued is making you hesitant about Medicine, then definitely pick a different a career.

Ok that's what I heard of, though. So being sued at least sometimes is very common? None of my family is in medicine and I've never asked anyone about this.

 

[Goro]

Ok that's what I heard of, though. So being sued at least sometimes is very common?

Yup.

Let's some some doctors in here and see what they have to say:

@Med Ed
@wysdoc
@Moko
@gyngyn
@LunaOri

 

[LizzyM]

There are ways to navigate these waters. In all likelihood, you will be able to find mentors at your school, including, perhaps a campus minister or chaplain from your faith community, who can help you understand your obligations and options. I do know someone who chose geriatrics in part to avoid issues related to reproduction.

To your most recent question: could it be that there is a misunderstanding? You can't refuse to treat patients of a specific religion or who have political beliefs different than your own as that is discrimination. You do have the right to refer patients who want/need a procedure or prescription that you are not willing to provide due to your religious objections.

 

[medredu]

Yup.

Let's some some doctors in here and see what they have to say:

@Med Ed
@wysdoc
@Moko
@gyngyn
@LunaOri

Thank you so much!

 

[medredu]

There are ways to navigate these waters. In all likelihood, you will be able to find mentors at your school, including, perhaps a campus minister or chaplain from your faith community, who can help you understand your obligations and options. I do know someone who chose geriatrics in part to avoid issues related to reproduction.

To your most recent question: could it be that there is a misunderstanding? You can't refuse to treat patients of a specific religion or who have political beliefs different than your own as that is discrimination. You do have the right to refer patients who want/need a procedure or prescription that you are not willing to provide due to your religious objections.

Thank you. And no, that's not what I was saying. I don't care about a patient's background, I would treat any patient regardless their religious affiliation, etc. My only concern is having to do procedures that the patient wants that's sincerely against my religious beliefs. I totally respect their decision, but I don't want to be the person to have to do it. So I was wondering about referals.

 

[Goro]

Thank you. And no, that's not what I was saying. I don't care about a patient's background, I would treat any patient regardless their religious affiliation, etc. My only concern is having to do procedures that the patient wants that's sincerely against my religious beliefs. I totally respect their decision, but I don't want to be the person to have to do it. So I was wondering about referals.

This type of thing is a common interview question.

 

[voxveritatisetlucis]

This may become a problem in some states (see California) that move to a Medicare for all type model. The govt could just say “if you don’t do X, Y, and Z procedures, then you aren’t allowed to practice medicine or get reimbursed in this state”

 

[LizzyM]

This may become a problem in some states (see California) that move to a Medicare for all type model. The govt could just say “if you don’t do X, Y, and Z procedures, then you aren’t allowed to practice medicine or get reimbursed in this state”

That would likely be in conflict with federal law.

Conscience and Religious Nondiscrimination

OCR enforces laws and regulations that protect conscience and prohibit coercion on issues such as abortion and assisted suicide (among others) in HHS-funded or conducted programs and activities.

www.hhs.gov

 

[medredu]

That would likely be in conflict with federal law.

Conscience and Religious Nondiscrimination

OCR enforces laws and regulations that protect conscience and prohibit coercion on issues such as abortion and assisted suicide (among others) in HHS-funded or conducted programs and activities.

www.hhs.gov

I also had a question about situations that are dire in the patient's case. What if a physician does not giving birth control or do an abortion due to let's say it's an ectopic pregnancy. Would the physician still be able to refer (for religious reasons) or is this against the law because serious medical complications could occur to the patient if not treated immediately?

 

[medredu]

This type of thing is a common interview question.

Based on one's answer to these ethical interview questions, does you stance on certain things deter you from an acceptance? Would my answer deter me?

 

[medredu]

How do your moral beliefs and desire for religious adherence supersede what the patient is seeking for themselves? How can any physician who has taken an oath to somehow able to say for reasons other than the best interests of the patients, not help them with the treatment options they seek? And how does your refusing to do it but willing to refer them to another provider who will remove any of your own religious obligation to your involvement in such an act? And how does your religious belief, because of your position as a physician, now get imposed on your patient by your unwillingness to provide care, treatment, etc? Does this patient now lose the right to the way they want to practice their religious values?

If you believe as an American that you have the right for religious freedom, then it is your obligation that you provide that right to all others, especially your patients as a physician. If my comments cause a firestorm or uproar on here, I damn well hope so. I cannot think of anything, utterly anything more un-American, than taking demanding your freedoms and rights that way the you practice them be imposed on others especially after you have taken an oath.

I understand your point of view. If I were to become a physician, most definitely do I want to do my best to help the individual. But, as a Christian, it is a sin to cause others to sin. Even though it is their choice to have an abortion or whatever, I am still engaging in this sin. Now, every Christian is different and everyone has their own special circumstances, but to me, the Word of God comes first. You can call me crazy, but to me it's very important. As physicians, we are also human. We also have our personal beliefs and rights. This is why I asked about referrals and such. Not that I even want to be an OB/GYN in the future. Maybe I should just switch into dentistry instead.

 

[LizzyM]

How do your moral beliefs and desire for religious adherence supersede what the patient is seeking for themselves? How can any physician who has taken an oath to somehow able to say for reasons other than the best interests of the patients, not help them with the treatment options they seek? And how does your refusing to do it but willing to refer them to another provider who will remove any of your own religious obligation to your involvement in such an act? And how does your religious belief, because of your position as a physician, now get imposed on your patient by your unwillingness to provide care, treatment, etc? Does this patient now lose the right to the way they want to practice their religious values?

If you believe as an American that you have the right for religious freedom, then it is your obligation that you provide that right to all others, especially your patients as a physician. If my comments cause a firestorm or uproar on here, I damn well hope so. I cannot think of anything, utterly anything more un-American, than taking demanding your freedoms and rights that way the you practice them be imposed on others especially after you have taken an oath.

Physicians should have autonomy when choosing the scope of their practice and should be permitted to decide what they will or will not do, particularly when it comes to elective procedures. I may want a procedure or a prescription that the doctor feels is unsafe or unwarranted and the physician should have the right to decline and refer me to someone else. Also, it is possible for a physician's office to inform potential patients of limits to care provided by that physician/office so that someone doesn't even become a patient if they are looking for specific services that the physician does not provide.

 

[Goro]

Based on one's answer to these ethical interview questions, does you stance on certain things deter you from an acceptance? Would my answer deter me?

Do have Loma Linda and LUCOM on your school lists.

I ask some very oblique interview questions designed to suss out whether one's religious beliefs can prevent one from providing care to patients that are entitled to. I have rejected people who did not give me good answers. And no, I'm not sharing.

Spare us the angst about your beliefs. You do you and let Fate take its course.

 

[TelemarketingEnigma]

I also had a question about situations that are dire in the patient's case. What if a physician does not giving birth control or do an abortion due to let's say it's an ectopic pregnancy. Would the physician still be able to refer (for religious reasons) or is this against the law because serious medical complications could occur to the patient if not treated immediately?

If you are uncomfortable treating an ectopic pregnancy, let me definitely suggest that a career in ob/gyn is not the right path for you. ectopic pregnancies do not have any realistic chance of leading to a living birth, but very much are life threatening for the mother. And if you are practicing in a setting where you are the only ob/gyn available in that setting (ie, you're the on call physician at a small hospital when an unstable ectopic comes into the ED) I don't believe you could ethically refuse treatment of an emergency like that. in most other specialties you may be able to avoid direct involvement in things you find objectionable, but you may not be able to avoid all exposure to them during your training (medical school rotations and/or residency).

primary care may also be tricky. you could certainly refer out things like birth control, with the recognition that you may lose patients that way - a PCP who refused to prescribe me OCPs would not be a PCP I would return to, for example. You'll also need to grapple with what else makes you uncomfortable - is ordering STI testing or discussing safer sex practices or prescribing viagra for a gay or unmarried patient "supporting sin" to you? that will come up in primary care as well. Depending on how firmly your lines are drawn, you may have more or less difficulty avoiding these things.

 

[Med Ed]

This may become a problem in some states (see California) that move to a Medicare for all type model. The govt could just say “if you don’t do X, Y, and Z procedures, then you aren’t allowed to practice medicine or get reimbursed in this state”

Now you're just trolling.

 

[Med Ed]

Maybe I should just switch into dentistry instead.

Honestly, I think this would save you a lot of heartache.

 

[medredu]

If you are uncomfortable treating an ectopic pregnancy, let me definitely suggest that a career in ob/gyn is not the right path for you. ectopic pregnancies do not have any realistic chance of leading to a living birth, but very much are life threatening for the mother. And if you are practicing in a setting where you are the only ob/gyn available in that setting (ie, you're the on call physician at a small hospital when an unstable ectopic comes into the ED) I don't believe you could ethically refuse treatment of an emergency like that. in most other specialties you may be able to avoid direct involvement in things you find objectionable, but you may not be able to avoid all exposure to them during your training (medical school rotations and/or residency).

primary care may also be tricky. you could certainly refer out things like birth control, with the recognition that you may lose patients that way - a PCP who refused to prescribe me OCPs would not be a PCP I would return to, for example. You'll also need to grapple with what else makes you uncomfortable - is ordering STI testing or discussing safer sex practices or prescribing viagra for a gay or unmarried patient "supporting sin" to you? that will come up in primary care as well. Depending on how firmly your lines are drawn, you may have more or less difficulty avoiding these things.

Actually, now thinking, situations like ectopic pregnancies do require termination since it can be a harm to the mother. But yeah, I am not thinking of going into obgyn. And yeah, I'm not sure about primary care. I could aim for specialties outside of primary care such as ENT, radiology, patho, etc. but who knows in terms of competitiveness, etc.

 

[medredu]

Honestly, I think this would save you a lot of heartache.

Probably the heartache, but certainly not the debt :/

 

[CantFindMeNowAdcoms]

Hi, I'm a junior in undergrad and pre-med. I was wondering how medicine works in the case the patient's desires/needs interfere with the physician's beliefs (moral, religious, etc.). For example, what if your patient asks to be prescribed for birth control or wanted an abortion, but your religious beliefs interfere with this? Do doctors have the right to object, BUT refer the patient to other doctors willing to do so? Or do doctors have to do whatever the patient wants? Religion is a very important part of my life and I don't to get in the situation of losing my license, jeopardizing the patient, etc. This is why I have been thinking of switching to dentistry... I'm not trying to sound like an dingus, ofc I want what's best for the patient, but I cannot afford to reject my beliefs. Any input is appreciated.

I think there are a few wise answers above. I’ll add my perspective as a Christian who considers religion a major part of my life as well. (As an aside: I found that interviewers were friendly about this. I had few questions about it despite obvious involvement on my application, and I was accepted to those schools.)

Your question is important. I personally would recommend a few things. First, the CMDA (CMDA Home – Christian Medical & Dental Associations® (CMDA)) is a Christian organization for dental/medical students. It has chapters at many medical schools offering mentorship and training specific to the integration of faith and care. Second, I would spend time wrestling with these ethical questions. There is a complexity to the issues that warrants your attention. Ectopic pregnancy was one brought up several times; there are others of course. Third, do not be completely dismayed. You can provide tremendous care to folks in either field. The opportunities to serve others seem endless, and there are plenty of examples of physicians and dentists (religious or not) serving underserved patients in the USA and beyond. Jesus healed the sick and came for the broken-hearted. He cares for the vulnerable. It’s a good desire to want to be like Him in this way.

Feel free to PM me if you have more specific questions.

 

[CantFindMeNowAdcoms]

How do your moral beliefs and desire for religious adherence supersede what the patient is seeking for themselves? How can any physician who has taken an oath to somehow able to say for reasons other than the best interests of the patients, not help them with the treatment options they seek? And how does your refusing to do it but willing to refer them to another provider who will remove any of your own religious obligation to your involvement in such an act? And how does your religious belief, because of your position as a physician, now get imposed on your patient by your unwillingness to provide care, treatment, etc? Does this patient now lose the right to the way they want to practice their religious values?

If you believe as an American that you have the right for religious freedom, then it is your obligation that you provide that right to all others, especially your patients as a physician. If my comments cause a firestorm or uproar on here, I damn well hope so. I cannot think of anything, utterly anything more un-American, than taking demanding your freedoms and rights that way the you practice them be imposed on others especially after you have taken an oath.

I’ve appreciated your advice over the years across the forums, but in this case it seems that the AMA disagrees with you. What am I missing from their statement? Are they just wrong? Physician Exercise of Conscience