Is it a moral Issue?

[Noyac]

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Hypothetical question here:
Pt comes to ER with heavy vaginal bleeding and 8 wks pregnant. There is a heartbeat but it is falling, currently 115 bpm. OB wants to do a D&C. Do you do it?

 

[sevoflurane]

Sounds like the patients life may be at risk with heavy bleeding. If the OB is adamant that this is the way to go and mom is onboard and understands the situation, I would not hesitate. I've had a collegue ask me to do an organ harvest on a 3 year old in the past. I didn't like it, but someone had to do it.

 

[pgg]

Hypothetical question here:
Pt comes to ER with heavy vaginal bleeding and 8 wks pregnant. There is a heartbeat but it is falling, currently 115 bpm. OB wants to do a D&C. Do you do it?

What does the patient want?

 

[inmyslumber]

Morals are internal to each individual. If your morals regard doing the case is "wrong," you should be able to abstain if you can find another anesthesiologist to cover the case.

If no other anesthesiologist is available and/or if it is an emergency, you should do the case regardless of your morals.

 

[Noyac]

Morals are internal to each individual. If your morals regard doing the case is "wrong," you should be able to abstain if you can find another anesthesiologist to cover the case.

If no other anesthesiologist is available and/or if it is an emergency, you should do the case regardless of your morals.

Really? Interesting!

 

[pgg]

I actually think this is a very straightforward case.

If the woman's life is in danger from the bleeding and the patient consents, of course you do the procedure. If you won't, you've got no business being an anesthesiologist or any other healthcare worker. What are we here for, if not to provide lifesaving treatment to dying people?

If the woman refuses the procedure for any reason, you don't do the procedure. Her reasoning is irrelevant. Informed adults can refuse lifesaving treatment and choose to die.


It only gets gray if you have reason to believe the bleeding is not serious (ie, you doubt the OB's diagnosis and prognosis) and in that case your moral obligation is the same as for any other proposed surgery for which you have reasonable doubt that the surgeon has the correct diagnosis or prognosis. The presence of ~8 week size products of conception here is just a red herring.

 

[IanMcGalt]

I actually think this is a very straightforward case.

If the woman's life is in danger from the bleeding and the patient consents, of course you do the procedure. If you won't, you've got no business being an anesthesiologist or any other healthcare worker. What are we here for, if not to provide lifesaving treatment to dying people?

If the woman refuses the procedure for any reason, you don't do the procedure. Her reasoning is irrelevant. Informed adults can refuse lifesaving treatment and choose to die.


It only gets gray if you have reason to believe the bleeding is not serious (ie, you doubt the OB's diagnosis and prognosis) and in that case your moral obligation is the same as for any other proposed surgery for which you have reasonable doubt that the surgeon has the correct diagnosis or prognosis. The presence of ~8 week size products of conception here is just a red herring.

I agree with every word of that except calling her tiny baby 'products of conception'. It's dehumanizing! 😛

 

[pgg]

I agree with every word of that except calling her tiny baby 'products of conception'. It's dehumanizing! 😛

I'm not trying to be offensive (and I certainly wouldn't use that phrase when speaking to the patient!) but I chose to use those words here very deliberately. It is not a baby or a human being. An 8 week fetus is not viable; there is exactly ONE person here, the pregnant woman, and she is bleeding heavily and needs a surgical procedure.

Any attempts to make this case revolve around a "tiny person" suggests that someone is more interested in politics or point-making than the urgent or emergent care of the actual patient, and that is wrong.

 

[IanMcGalt]

I'm not trying to be offensive (and I certainly wouldn't use that phrase when speaking to the patient!) but I chose to use those words here very deliberately. It is not a baby or a human being. An 8 week fetus is not viable; there is exactly ONE person here, the pregnant woman, and she is bleeding heavily and needs a surgical procedure.

Any attempts to make this case revolve around a "tiny person" suggests that someone is more interested in politics or point-making than the urgent or emergent care of the actual patient, and that is wrong.

I wasn't trying to start a whole thing about it, hence the tongue out emoticon.

 

[aneftp]

Hypothetical question here:
Pt comes to ER with heavy vaginal bleeding and 8 wks pregnant. There is a heartbeat but it is falling, currently 115 bpm. OB wants to do a D&C. Do you do it?

How about we rephrase it adding its 3pm and u are lowly W2 employee about to get out of hospital.

If I were in this situation. I'd used my catholic religion and not do the case and go home.

This is how it's going to work with more people becoming W2. There are many subtle ways u can be a cog in the wheel as a W2.

 

[Mman]

How about we rephrase it adding its 3pm and u are lowly W2 employee about to get out of hospital.

If I were in this situation. I'd used my catholic religion and not do the case and go home.

This is how it's going to work with more people becoming W2. There are many subtle ways u can be a cog in the wheel as a W2.

Being a W2 employee doesn't exempt you from having to do work if you are under contract to provide a service. If it's after hours you might be entitled to OT pay for it, but it doesn't prevent you from having to work. If you choose to not do a case because of a moral issue you had better have that leeway in your contract or you are probably providing cause for firing (unless you live in a right to work state in which case it doesn't matter and you can be fired for no reason anyway).

 

[aneftp]

Being a W2 employee doesn't exempt you from having to do work if you are under contract to provide a service. If it's after hours you might be entitled to OT pay for it, but it doesn't prevent you from having to work. If you choose to not do a case because of a moral issue you had better have that leeway in your contract or you are probably providing cause for firing (unless you live in a right to work state in which case it doesn't matter and you can be fired for no reason anyway).

Nope. It will be extremely difficult to fire someone who invokes religion.

I've seen it done time and time again.

It's not only a moral issue. U got the US constitution backing in. No group stands a chance in court trying to justify firing someone who invokes religious causes.

And many savvy employees now keep track of other members of groups who have bad outcomes to protect themselves in case their employer tries to terminate them. It becomes very messy.

 

[Mman]

Nope. It will be extremely difficult to fire someone who invokes religion.

I've seen it done time and time again.

It's not only a moral issue. U got the US constitution backing in. No group stands a chance in court trying to justify firing someone who invokes religious causes.

And many savvy employees now keep track of other members of groups who have bad outcomes to protect themselves in case their employer tries to terminate them. It becomes very messy.

Yeah I'm going to go ahead and disagree with you on that. I will guarantee you a court victory for the hospital if they fired a physician with a contract requiring them to provide services and the physician refused on religious grounds to offer life saving treatment to a patient in need. No leg to stand on. If they had religious issues with the services in the contract, those would've needed to be brought up before signing the contract. Can't let a patient potentially die because you didn't like the morals of the procedure and you were the only person around to help.

Now obviously if another qualified physician was there to take your place promptly it'd be a different story.

Then again in the many right to work states you can just be fired without a reason given even if it's really because of a religious issue and the employer cannot be sued. As an employer I love living in a right to work state. I don't have to have cause to fire anybody. In fact it's best I don't provide them a reason because then they can't sue me for that reason violating some right.

 

[aneftp]

Yeah I'm going to go ahead and disagree with you on that. I will guarantee you a court victory for the hospital if they fired a physician with a contract requiring them to provide services and the physician refused on religious grounds to offer life saving treatment to a patient in need. No leg to stand on. If they had religious issues with the services in the contract, those would've needed to be brought up before signing the contract. Can't let a patient potentially die because you didn't like the morals of the procedure and you were the only person around to help.

Now obviously if another qualified physician was there to take your place promptly it'd be a different story.

Then again in the many right to work states you can just be fired without a reason given even if it's really because of a religious issue and the employer cannot be sued. As an employer I love living in a right to work state. I don't have to have cause to fire anybody. In fact it's best I don't provide them a reason because then they can't sue me for that reason violating some right.

I have worked in a right to work state (Florida). Believe me hardly any employer gets fired without cause. The way professional contracts are written unless you let the employee out with zero day notice, you probably cannot fire them without cause.

Let me know next time you don't like someone and fire them without cause. What most professional companies do is either let the contract expire and not renew or give them their 30-60-90 days notice.

My close buddy in Florida was involved in a situation (not religious) back in 2006 when they tried to fire him without cause (big argument with one of the big money revenue generation surgeons over patient care). There was a physical encounter. Hospital wanted him gone asap but wanted to keep the surgeon. Frankly they were both at fault, both hot heads. The anesthesia group tried to fire him immediately without pay. Let's just say legal counsel (along with forcing group to write that he left group on good grounds and any mention of negative verbally or written about him would result in monetary penalty to the group). And that's the key. Force the group and hospital not to write a negative evaluation why you left.

He ended getting paid almost 3 months salary. Not bad for $10K in legal fees to collect over $100K.

I guess you can write into the contract when they first sign that they can be terminated without clause at any time in a right to work state. I wouldn't know any idiot who would ever sign a contract like that. Most professional contracts are two way streets with a little give.

Getting back to the D and C. It all depends. True emergency? Urgent? Any available other anesthesia personnel? Those factors will all play into the situation.

 

[deleted9493]

It is impressive if an OB can detect a fetal heartbeat at 8 weeks. Choosing to not treat the mother here is a moral issue because choosing not to, compromises two lives instead of one.

 

[Planktonmd]

If the vaginal bleed is not massive and the patient is stable then maybe a second opinion is needed.
Not every first trimester bleed is a miscarriage.
If the patient and the OB insist that they want to terminate the pregnancy despite no immediate threat to the mother's life, then this might be a disguised intentional abortion and the anesthesiologist has the right to refuse if this contradicts his/her religious or moral convictions.

 

[MaximusD]

"Heavy vaginal bleeding" was the verbage used. I would expect that one of two things happened (1) spontaneous abortion or (2) attempted and f*cked elective abortion in the back of a van. The OB/Gyn is the subject-matter expert -- I trust that they would have done an effective workup and possibly a TV/US to further evaluate prior to this assessment and plan of action. I agree that at 8 wks, the OB/Gyn was extremely fortunate to have found a FHR to start with. I would ensure it'd been compared to the mother's to ensure they aren't actually finding the pulse of the abdominal aorta etc. I would then, of course, verify whether the mother is stable. I'd also want to ascertain what steps have been taken to mitigate the blood loss. However, given the presentation I am going to assume...

(1) The patient's life is in jeopardy due to impending hemorrhagic shock
(2) The patient is at high risk of sepsis if no action is taken to remove the presumed products of conception
(3) #1 and/or #2 can lead to death

This isn't an elective case. The role of morals in this patient's care plan is marginal at best. I'd do the procedure... y'know, when I'm an attending anesthesiologist

 

[Mman]

Let me know next time you don't like someone and fire them without cause. What most professional companies do is either let the contract expire and not renew or give them their 30-60-90 days notice.

Let you know when? It happens all the time. We've probably canned 10 people in the last 2 years without cause. Now we still give them a paycheck for another 1-2 months because we are nice and don't want to financially ruin them. But letting them go requires no special reason other than their services are no longer required. Giving somebody notice of 30 or 60 days isn't firing them for a reason, it's just giving them a heads up that they better start looking for another job.

In non right to work states you generally have to provide proof of why somebody was fired. Bad evals, criminal evidence, etc. Right to work means you don't have to provide any reason or proof.

 

[BuzzPhreed]

It is very hard to simply non-renew someone. You better have some justification. Even in right to work states it can be considered tantamount to being fired and lawsuits often ensue.

 

[aneftp]

Let you know when? It happens all the time. We've probably canned 10 people in the last 2 years without cause. Now we still give them a paycheck for another 1-2 months because we are nice and don't want to financially ruin them. But letting them go requires no special reason other than their services are no longer required. Giving somebody notice of 30 or 60 days isn't firing them for a reason, it's just giving them a heads up that they better start looking for another job.

In non right to work states you generally have to provide proof of why somebody was fired. Bad evals, criminal evidence, etc. Right to work means you don't have to provide any reason or proof.

Why even give them 30-60 days pay? U fire them without cause. U don't owe them a dime.

Let me know when you terminate the next guy or gal with no 30-60 day pay. There is a huge difference letting someone go immediately without cause and no pay than telling them "hey things aren't working out....you need to find another job but we'll still pay u 30-60 days". Unless it's written in the contract.

I've dealt with 8 offered contracts in Florida in the past 7 years. Each one of them has between a 30-90 day termination "without cause".

So you are telling me you sign people to contracts that doesn't have a "without cause" termination? And people don't read their contract? Something doesn't make sense.

If I were given a contract that specifies zero days notice without cause. I would not sign it. Or amend it so I would be offered the same zero day notice to leave group without cause as well. If it comes to that point both parties will probably agree it's not worth doing signing.

 

[Mman]

Why even give them 30-60 days pay? U fire them without cause. U don't owe them a dime.

Let me know when you terminate the next guy or gal with no 30-60 day pay. There is a huge difference letting someone go immediately without cause and no pay than telling them "hey things aren't working out....you need to find another job but we'll still pay u 30-60 days". Unless it's written in the contract.

I've dealt with 8 offered contracts in Florida in the past 7 years. Each one of them has between a 30-90 day termination "without cause".

So you are telling me you sign people to contracts that doesn't have a "without cause" termination? And people don't read their contract? Something doesn't make sense.

If I were given a contract that specifies zero days notice without cause. I would not sign it. Or amend it so I would be offered the same zero day notice to leave group without cause as well. If it comes to that point both parties will probably agree it's not worth doing signing.

I don't even know where to begin. We are nice so we would never terminate somebody without paying them 1-2 months salary. It's just mean. But that's being given a reason or not for termination, not whether or not you get some pay beyond the firing. In a right to work state, it's that you don't need to supply them with a reason for the termination. In other states, you need to prove a reason and if you can't prove it they can sue you over it. In a right to work state, if they attempt to sue you for the termination it will be dismissed regardless of whether you pay them beyond the date of termination. At least that's how it works here and my understand that it is the same elsewhere.

Hell, our attorneys suggest we never provide a reason for a termination. If we give them a reason then they could challenge it. No reason means no challenge. Their contract contains standard language about requirements for the job and that they may be terminated if their employment is no longer needed or if they are unable to fulfill the requirements of the job. That's why right to work states are so attractive to employers.

 

[aneftp]

I don't even know where to begin. We are nice so we would never terminate somebody without paying them 1-2 months salary. It's just mean. But that's being given a reason or not for termination, not whether or not you get some pay beyond the firing. In a right to work state, it's that you don't need to supply them with a reason for the termination. In other states, you need to prove a reason and if you can't prove it they can sue you over it. In a right to work state, if they attempt to sue you for the termination it will be dismissed regardless of whether you pay them beyond the date of termination. At least that's how it works here and my understand that it is the same elsewhere.

Hell, our attorneys suggest we never provide a reason for a termination. If we give them a reason then they could challenge it. No reason means no challenge. Their contract contains standard language about requirements for the job and that they may be terminated if their employment is no longer needed or if they are unable to fulfill the requirements of the job. That's why right to work states are so attractive to employers.

So your contract contains no "notice period" by either employer or employee? I'd be fine with it if it's a two way street. So you guys don't mind if the guy or gal working just decides to quit immediately on their own accord? If I see a contract like that I'd just treat it as a locums contract and not a long term contract.

Every contract I've seen has a notice period by employer or employee in Florida. Usually 30-90 days "without cause" aka "we don't need you and don't need to give a reason"

I know right to work laws very well. Originally had to do with unions trying to prevent employment unless you pay union dues.

The thing many employers run into big problems if they try to terminate immediately without further pay in professional world is when the fired employee threatens discrimination.

A discrimination lawsuit or threat of it will eat your resources alive if that fired employee has their ducks all lined up against the employer. And that's where my buddy ended up using. My buddy threaten discrimination in Florida. Hospital took no action against white surgeon who has long history of anger management problems but took action against my buddy (who's Indian American).

 

[Mman]

We require 2 weeks notice from the employee. It's a pretty standard contract in our area and I've never had someone that wanted a job back out because of contract language.

 

[BuzzPhreed]

That's why right to work states are so attractive to employers.

Anybody can sue anyone at anytime and for any reason. That's when the real negotiations begin.

 

[Mman]

Anybody can sue anyone at anytime and for any reason. That's when the real negotiations begin.

No, that's when the judge laughs and tells the plaintiff to pay their attorney for the waste of time.

Anybody can file a lawsuit for anything. It actually has to be based in reality to have a judge be willing to take it to trial and not dismiss it. I once saw a lawsuit "filed" on a handwritten piece of paper by the HS dropout with most of the words misspelled.

 

[BuzzPhreed]

We're not talking about highschool dropouts here. You can creatively lawyer up just about anything. Often the mere threat of a lawsuit is enough to get people to the table. And people will usually give something just to avoid the cost of getting the lawyers involved.

But, you want to talk stories, eh? I worked in an at-will state years ago while in college in an office with an admin who routinely showed up late, called her boyfriend in Italy on the company line, and took two hour lunches. Finally the boss had had enough and fired her one morning when she showed up after 11:00 AM hungover. Result? $10,000 out of court settlement to avoid a wrongful termination lawsuit. She had all kinds of sexual harassment allegations ready to come out of the woodworks, true or not.

In other words, don't be naive. You f*** with the wrong person, you're going to pay $10k just to get rid of them. And you'll think it's a bargain.

 

[Mman]

We're not talking about highschool dropouts here. You can creatively lawyer up just about anything. Often the mere threat of a lawsuit is enough to get people to the table. And people will usually give something just to avoid the cost of getting the lawyers involved.

But, you want to talk stories, eh? I worked in an at-will state years ago while in college in an office with an admin who routinely showed up late, called her boyfriend in Italy on the company line, and took two hour lunches. Finally the boss had had enough and fired her one morning when she showed up after 11:00 AM hungover. Result? $10,000 out of court settlement to avoid a wrongful termination lawsuit. She had all kinds of sexual harassment allegations ready to come out of the woodworks, true or not.

In other words, don't be naive. You f*** with the wrong person, you're going to pay $10k just to get rid of them. And you'll think it's a bargain.

We are 0 for forever at being sued for firing somebody. It's far more expensive for an individual to hire an attorney to file a lawsuit than it is for a corporation to use lawyers that are already on retainer when the individual has no chance of winning.

I mean you get fired and you really can't win a lawsuit. Are you going to spend $5000 in legal fees trying to get an extra bone thrown your way when you probably can't win if it goes to trial? I mean it'd be a waste of your own money of which you don't have as much any more.

 

[BuzzPhreed]

There are plenty of lawyers who'll take a case on the chances of getting a cut of the settlement. It's called the spaghetti theory. It takes them about 5 minutes to write a letter on letterhead. They may not win anything but they'll take a case in the chance that they will. Just the threat, my friend. They get "go away" money a lot more often than you think. You don't even need to necessarily involve the courts. I knew a lawyer in Atlanta whose entire practice was founded on this principal. Total scumbag. Also very wealthy.

 

[aneftp]

We require 2 weeks notice from the employee. It's a pretty standard contract in our area and I've never had someone that wanted a job back out because of contract language.

2 weeks notice is nothing.

I've looked at contracts in South Florida (both coasts), and Orlando and never seen any contract 2 weeks notice unless it's a revolving locums contract or per diem. Most are 60 days out clauses.

Change your contract to 90 days notice and let me know when you pay them for only 1 month since you are "being nice" and try to apply the right to work law. See if they try to recoup you for the other 2 months notice you owe them.

That's why I got suspicious. No employer is dumb enough to try to "fire" someone for no reason with an existing contract that stipulates 60-90 days notices on both parties even in a right to work state.

 

[aneftp]

We are 0 for forever at being sued for firing somebody. It's far more expensive for an individual to hire an attorney to file a lawsuit than it is for a corporation to use lawyers that are already on retainer when the individual has no chance of winning.

I mean you get fired and you really can't win a lawsuit. Are you going to spend $5000 in legal fees trying to get an extra bone thrown your way when you probably can't win if it goes to trial? I mean it'd be a waste of your own money of which you don't have as much any more.

Your situation is completely different. 2 weeks notice isn't worth going after with in terms of getting paid. You are talking about going after 10-15K of money when it involves 5-10K of legal fees. Once you start dealing with longer 60-90 days notices (without cause) and try to fire them and not pay them, than the monetary clawback makes it's a very sticky situation for the employer.

Especially if they have dirt on the other employer partners and try to sue for discrimination. You'll be surprise how many people keep logs and spreadsheets of events at work to protect themselves.
But most of the time, it's an amicable breakup. My sister's group has a 90 day out clause. They will just tell people to go find another job. Give them a "heads up" like you mention. Those people usually leave and find employment elsewhere rather quickly and both sides are happy (for the most part).

 

[BuzzPhreed]

You'll be surprise how many people keep logs and spreadsheets of events at work to protect themselves.

Me being one of those people at my last job. That's basically how I got out of my ridiculously long contracted notice. I involved lawyers behind the scenes, but none actually had to get directly involved. I had enough dirt on them in the short time I was there that it would have gotten very ugly very quickly if they hadn't agreed to let me walk away early. And they knew it.

In this business pretty much everyone is at least a little dirty. When you are clever enough to find it and know how to use it you can nullify most things in any contract.

 

[Mman]

I think there is some confusion between notice periods for terminating contracts and reasons for terminating contracts. Right to work states mean you don't need a reason to terminate a contract. It has nothing to do with a previously agreed upon notice period. In a non right to work state you often have to provide a reason for the termination and that reason can be disputed in a lawsuit.

 

[aneftp]

I think there is some confusion between notice periods for terminating contracts and reasons for terminating contracts. Right to work states mean you don't need a reason to terminate a contract. It has nothing to do with a previously agreed upon notice period. In a non right to work state you often have to provide a reason for the termination and that reason can be disputed in a lawsuit.

There is no confusion.

You cannot terminate someone's contract even in a right to work state where the contract stipulates a notice period (2 weeks 30 days 60 days etc) where you can end the contract "without cause".

If you are a smart employer you put an expiration date on the contract (regardless of state). Contract ends regardless if it's a non right to work state; the contract has ended and employee cannot do anything about it.

Many places are moving towards yearly contracts with 60 day opt out periods. Solves many of the headaches.

 

[BuzzPhreed]

^^^^ Correct.

Even in a right to work state the employment contract terms will often supersede the legal framework of that state's employment laws.

 

[Mman]

There is no confusion.

You cannot terminate someone's contract even in a right to work state where the contract stipulates a notice period (2 weeks 30 days 60 days etc) where you can end the contract "without cause".

If you are a smart employer you put an expiration date on the contract (regardless of state). Contract ends regardless if it's a non right to work state; the contract has ended and employee cannot do anything about it.

Many places are moving towards yearly contracts with 60 day opt out periods. Solves many of the headaches.

Correct. And there is nothing required about a termination notice period in a contract. I've never suggested that breaking the wording of the contract was legal. No anesthesia practice anywhere near us has has language about a termination notice in their contract. Why would any employer be dumb enough to include such language? There isn't a shortage of prospective employees beating down the door looking for a job.

 

[aneftp]

Correct. And there is nothing required about a termination notice period in a contract. I've never suggested that breaking the wording of the contract was legal. No anesthesia practice anywhere near us has has language about a termination notice in their contract. Why would any employer be dumb enough to include such language? There isn't a shortage of prospective employees beating down the door looking for a job.

All the contracts I've seen in Florida have had notice periods with my long term contracts.

Honestly your 2 weeks notice period should be treated as a long term locums contract by people signing them. You probably are just better off paying them 1099 and be done with that.

Right now over supply. Agree with you on that.

 

[BuzzPhreed]

Right now over supply. Agree with you on that.

In some areas. Don't sign a sh*tty contract. That's the bottom line.

 

[aneftp]

In some areas. Don't sign a sh*tty contract. That's the bottom line.

Depends. Some MDs (or any professional non MD, non healthcare) can get in way over their heads financially. They literally have less than 2-3 months of savings. Many of them have household expenses at least $10K a month.

I've had friends make 500K for years and literally have no money for a rainy day because they spent it all (fast cars, big homes, nice vacations) you name it. Some people get desperate. My friend has a surgery center contract in Central Florida. He's literally low balled some MDs and paid them only $100/hr 6 hour guarantee some days.

I know of a group on the Florida coast that makes both MDs and CRNAs sign in and they pay them per 15 minutes. Not even by the hour. It's that crazy at some places. And this is a private practice group. You may be better just working for a Sheridan with the way some private practice groups function in Florida.

 

[BuzzPhreed]

I've had friends make 500K for years and literally have no money for a rainy day because they spent it all (fast cars, big homes, nice vacations) you name it. Some people get desperate.

Well that's just stupid. The 'MC Hammer' syndrome.

And Florida should just be off limits now. No one should go there in its current state. Let 'em drown in their own greedy stupidity.

 

[BuzzPhreed]

Hypothetical question here:
Pt comes to ER with heavy vaginal bleeding and 8 wks pregnant. There is a heartbeat but it is falling, currently 115 bpm. OB wants to do a D&C. Do you do it?

Back to the original post by Noyac.

If you are on call and you have a duty to respond you better do this case or find someone else who is willing to do it. Quickly. If something bad happens you won't be able to defend your decision in court. Even during a regular OB delivery you have only one patient in the room that is your responsibility and that is the mother.

Unless of course you want your name all over Huffpo and USA Today.

 

[Numbex]

Let you know when? It happens all the time. We've probably canned 10 people in the last 2 years without cause. Now we still give them a paycheck for another 1-2 months because we are nice and don't want to financially ruin them. But letting them go requires no special reason other than their services are no longer required. Giving somebody notice of 30 or 60 days isn't firing them for a reason, it's just giving them a heads up that they better start looking for another job.

In non right to work states you generally have to provide proof of why somebody was fired. Bad evals, criminal evidence, etc. Right to work means you don't have to provide any reason or proof.

Not quite. "Right to work" is a somewhat misleading catchphrase having to do with whether employees at a union shop can be required to pay (or "join") the union as a condition of employment (as specified in the union contract). What you are writing about is the general principle of at-will employment. A minority of states recognize a duty in all employment relationships to maintain a covenant of good faith and fair dealing (Florida not being one of them) which may thereby prohibit terminations in bad faith, based on malice or even, in its most extensive case, without a justified cause.

(By the way, I'm just being a Wikipedia lawyer here - wanted to clear up the nomenclature.)

 

[Numbex]

Back to the original post by Noyac.

If you are on call and you have a duty to respond you better do this case or find someone else who is willing to do it. Quickly. If something bad happens you won't be able to defend your decision in court. Even during a regular OB delivery you have only one patient in the room that is your responsibility and that is the mother.

Unless of course you want your name all over Huffpo and USA Today.

Not to mention that it is unethical and unprofessional conduct to refuse to render necessary emergency care to your patient (and if you're on call, she is your patient unless and until you arrange for someone else to cover you.) This could get you in trouble with the hospital's medical staff as well the state medical board regardless of whether there is a bad outcome. So, doctor, are you willing to bet that your assessment of the situation is more accurate than that of your OB (keeping in mind that the question of emergent necessity follows the standard of care of a prudent OB, not anesthesiologist. So, do you have that knowledge base to make such an assessment?)

 

[BuzzPhreed]

So, doctor, are you willing to bet that your assessment of the situation is more accurate than that of your OB (keeping in mind that the question of emergent necessity follows the standard of care of a prudent OB, not anesthesiologist. So, do you have that knowledge base to make such an assessment?

Are you talking (preaching) to me? I agree with you. Just clarifying because you quoted me.

Look, you refuse to do this case and you're just as bad as those bible-thumping idiots in some rural Kansas pharmacy who refuses to dispense the "morning after" pill to some young person who is terrified - for whatever reason - that she might have made a grave mistake the night before. I think God actually has a special place in hell for those judgmental jackoffs who jam their own beliefs down someone else's throat. And they should be fired on the spot if it is found out simply for not doing the job they were paid to do - dispense lawful medications. I don't think they can win that one in any court.

 

[Noyac]

Ok, good discourse here.
This thread was just to present a situation that I have seen on more than one occasion. I don't currently work with anyone that would have refused this case but I have seen crna's that would refuse this. But that is different because they know if they refuse it on a moral basis the anesthesiologist will just do the case.

 

[Numbex]

Are you talking (preaching) to me? I agree with you. Just clarifying because you quoted me.

Look, you refuse to do this case and you're just as bad as those bible-thumping idiots in some rural Kansas pharmacy who refuses to dispense the "morning after" pill to some young person who is terrified - for whatever reason - that she might have made a grave mistake the night before. I think God actually has a special place in hell for those judgmental jackoffs who jam their own beliefs down someone else's throat. And they should be fired on the spot if it is found out simply for not doing the job they were paid to do - dispense lawful medications. I don't think they can win that one in any court.

No. It was a general response and/or response to the OP, concurring and expanding on your statement.

 

[jetproppilot]

Hypothetical question here:
Pt comes to ER with heavy vaginal bleeding and 8 wks pregnant. There is a heartbeat but it is falling, currently 115 bpm. OB wants to do a D&C. Do you do it?

Without hesitation.

 

[Random Anesthesiologist]

I'm not trying to be offensive (and I certainly wouldn't use that phrase when speaking to the patient!) but I chose to use those words here very deliberately. It is not a baby or a human being. An 8 week fetus is not viable; there is exactly ONE person here, the pregnant woman, and she is bleeding heavily and needs a surgical procedure.

Any attempts to make this case revolve around a "tiny person" suggests that someone is more interested in politics or point-making than the urgent or emergent care of the actual patient, and that is wrong.

Actually, it is a human being. A DNA test would prove it. And it's not that impressive for an OB to get a fetal heartbeat at 8 weeks with a transvaginal ultrasound. I'm not generally a PC person or the most "sensitive". But my "morals" would be with preservation of life, and have actually had a bloody miscarriage early on. So there's perspective on my end from a few different sides of the fence. If this is truly a case of "she needs a d&c or she's going to die" (I'm assuming with ablation) kind of bleeding, then I would do what I have to. Thankfully this is rarer than women electing to have abortions for non-life threatening reasons, which I wouldn't be involved in.

 

[BuzzPhreed]

Actually, it is a human being. (sic) Thankfully this is rarer than women electing to have abortions for non-life threatening reasons, which I wouldn't be involved in.

So is a fertilized zygote by that definition. Doesn't mean it's capable of sustaining life on its own.

And what does HER decision have to do with YOU? Part of being a doctor is separating your personal beliefs and the needs of the patient.

 

[Random Anesthesiologist]

So is a fertilized zygote by that definition. Doesn't mean it's capable of sustaining life on its own.

And what does HER decision have to do with YOU? Part of being a doctor is separating your personal beliefs and the needs of the patient.

A fertilized zygote is still human. Not a tree, not a cat. You are entitled to your opinion about "personal beliefs" but I'm entitled to not be a slave, either. I am perfectly within my legal and ethical rights as a physician to decline to provide anesthesia for an elective abortion (in the absence of a life-threatening condition, as I previously stated). There is nothing about that, that makes me less of a doctor or a bad doctor.

You sound like you are borderline trying to shame me, or anyone else who holds a similar opinion on this matter. Or maybe you are drawing conclusions about how I would react. Maybe you're not, it just kind of seems that way. Maybe you misunderstood when I wrote above that "I would do what I have to", meaning do the case with emergent bleeding. Otherwise, it's not like I would be rude about it or mean to the patient by declining an elective case. A person's reasons for abortion are their own, and that's their business. Someone else can help them. Maybe I have to reiterate, if they're in an emergent situation, I'll help them, because that would be unethical to not do that. No judgment. If they're not in an emergent situation, someone else can.

Also, I'm definitely not looking for a fight. I'm just a stickler on the "human" thing, which is much different from viability. I just wanted to throw out an honest, different perspective. Your opinion is respected.