Med Students and Abortion

[dsblaha]

http://www.lifesite.net/ldn/2004/mar/04031801.html

I know this is in Canada but not passing an Ob/GYN rotation because one refuses to perform an abortion seems outrageous. Do you think this could happen in the US or is it school specific?

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[mlw03]

First off, I wholly agree with the school. Refusing to perform an abortion is one thing, but refusing to refer his patient to another physician is crossing the line. DOCTORS DO NOT GET TO IMPOSE THEIR MORALS ON THEIR PATIENTS. abortions are legal and a legitimate medical procedure (ie, it's not quackery). if you don't want to do it, you at least owe it to the patient to refer them to another OB. remember what happened before abortions were legal? it's like prohibition - it doesn't deter the practice, it just takes it to back alleys. do we really want to go back to the days of back-door abortions, performed in an unsafe, unregulated manner? or how about coat-hanger abortions? yes, this is gruesome, but it happened in the past when abortions were illegal, and would happen again if roe v. wade is ever overturned. try as much as the government and Christrian conservative would like, but women want abortions, so women will have abortions. the question is whether they have them in a competant OB's clinic, or in the back-alley of someone's apartment complex.

also, i'm not a fan of slippery-slope arguments, but if an OB is allowed to not refer a patient to another OB for an abortion, what's next? a family practice doctor refusing to refer a smoker to a cardiologist because the doctor doesn't approve of smoking? i know this is a stretch, but the role of the doctor is to act in the best interest of the patient, not to impose their particular beliefs unto the patient.

last, i could very well see a medical student being failed in the US were the circumstances the same.

Originally posted by dsblaha
http://www.lifesite.net/ldn/2004/mar/04031801.html

I know this is in Canada but not passing an Ob/GYN rotation because one refuses to perform an abortion seems outrageous. Do you think this could happen in the US or is it school specific?

 

[juddson]

Personally,

I'd like to see a report of this incident from something other than "Lifesite". I'm guessing we might not be getting the whole story.

Judd

 

[dsblaha]

I agree with both of you. The doctor does have an obligation to refer the patient to someone else. I can't imagine it would be hard for a patient to find a doctor on her own though.

I am sure Lifesite is biased but I doubt other news sources care about such an occurence.

 

[theringworm]

This is very interesting. During my interviews this year something very similar came up. The physician asked me what I would do in the following scenario, "Pt comes in with a terminally ill disease, is in a lot of pain and has been for several months. Pt has pretty much given up hope and no longer has a desire to live. Pt wants you to assist him in his death (aka. Physician assisted suicide). My response: Due to my moral and ethical beliefs I would decline to participate in this procedure. I would try and counsel the pt, etc. etc. I would also provide the pt with a name of a different physician who is known to perform this type of procedure. The doctor then says, by you providing a name of a physician who does these procedures you are actually participating in something you don't support. I paused............yea, but I don't feel right about leaving the pt w/o someone else to contact. If I just said no I can't do it and left, I could be help responsible for neglect or something. Of course he was probably just playing "devils advocate" and he does have a good point, but it seemed as almost he strongly felt that if you don't want to participate in it, then you shouldn't give recommendations of someone else who does either. Like it wouldn't fall under your responsibilities as a physician. Not sure if this even relates really but it was interesting to me.

 

[Ranger47]

Originally posted by mlw03
a family practice doctor refusing to refer a smoker to a cardiologist because the doctor doesn't approve of smoking?
[/B]

That is not a very good comparison at all. Not refering someone to be treated for something is very different from abortion. People need to take responsibility for their actions. I personally would never suggest abortion. People know that it is an option, and if they want it, they can ask.

 

[celticmists18]

Originally posted by Ranger47
That is not a very good comparison at all. Not refering someone to be treated for something is very different from abortion. People need to take responsibility for their actions. I personally would never suggest abortion. People know that it is an option, and if they want it, they can ask.

hmmmm. seems to me that the comparision is pretty good. in fact, with the smoking analogy it entirely your fault while when it comes to abortion you know what they say . . . its takes two to tango. taking all that into consideration maybe you should reconsider your remark about people needing to take responsibility for their actions. lastly, as a physician your are ethically required to inform your patient of EVERY possible course of treatment, you don't get to censor an option because you don't agree with it.

 

[dsblaha]

Right after posting I wanted to change my mind. I would not refer the patient because it participating in it. A doctor has an obligation to do what is right at all times and if you believe that abortion is wrong you should not enable it.

Also just because people are going to do something anyway is not reason to make it legal. If that were the case then drug use and many other things should be legal.

 

[celticmists18]

something else to add: My dad is a practicing OBGYN. We got to talking about abortion one night and he told me that when he started he was a staunch pro-lifer. but as the years went on, and he say more and more things he changed his stance. now he doesn't necessarily condone them, but he sees the necessity for them in some situations.

 

[medic8m]

Originally posted by dsblaha
Right after posting I wanted to change my mind. I would not refer the patient because it participating in it. A doctor has an obligation to do what is right at all times and if you believe that abortion is wrong you should not enable it.

Also just because people are going to do something anyway is not reason to make it legal. If that were the case then drug use and many other things should be legal.

This makes no sense for sooo many reasons...

 

[mlw03]

Whatever your opinion of abortion, it is a legit medical treatment. Refusing a referral for a legit medical condition is the same whether it's for abortion or for a cardiology consult.

This isn't about responsibility - it's about the obligations of the physician. And don't be so sure all patients know abortion is an option - they probably do, but the role of the physician is the explain ALL legit medical options to the patient and let the patient choose what is best for them. That's the nature of the job - if someone doesn't like it, then they shouldn't go into medicine.

Originally posted by Ranger47
That is not a very good comparison at all. Not refering someone to be treated for something is very different from abortion. People need to take responsibility for their actions. I personally would never suggest abortion. People know that it is an option, and if they want it, they can ask.

 

[Mistress S]

Hasn't this debate being done hundreds of times? I don't think any new points in the abortion debate are going to be raised here. Anyone interested in reading arguments for and against abortion, the responsiblities of a physician in regards to this, etc. should just do a search, they will get enough material to fill a book within a few minutes.

 

[dsblaha]

Of course the arguments have been made and when we are all doctors we can make our own decisions.

I was more interested in whether or not a medical student should be penalized for not performing and abortion.

 

[aidan73]

OK, I wanted to reply because I have been in this situation.

I am currently pregnant with a healthy baby girl, this is our third pregnancy. First was a miscarriage very early, our second we decided to terminate very late in the second trimester.

We found out via ultrasound at 2 months that he had certain markers for Down Syndrome. We had several level 2 u/s with a perinatologist that confirmed the markers and scheduled an amnio. The perinatologist also found some other physical abnormalities with his heart, lungs and kidneys. Once the results from the amnio came back it was positive for Down Syndrome. We were way more concerned with the physical problems than with the Downs, when asked my OB could not give us the reassurance that the baby would survive for any length of time, and if he did, it would most likely be with the help of machines, etc. No quality of life at all. We decided to end the pregnancy. My OB told us she did not do that procedure BUT did refer us to someone who did. I totally respect her view on the situation, but I am glad she gave us the referral. It was one less thing I had to worry about during a very emotionally stressful time.

When we made the decision to try again, I was very, very scared. We both had been thru genetic testing and counseling after what happened with our baby boy and everyone assured us that we did not stand any greater chance of this happening again as anyone else in the general population. Needless to say, I still had a hard time relaxing until the maternal-fetal specialist confirmed that this baby is 100% healthy.

I have always been Pro-choice, I just never thought I would have to make that choice.

 

[MedAppGurl]

thanks aidan73 for sharing that rather personal story with us. that sort of situation is hard to cope with. i also appreciated hearing it from the patient's perspective, which is just as important in this argument - yet seems to be neglected.
good luck with the baby!

 

[EMPOWERurSELF!]

People know that it is an option, and if they want it, they can ask.

Personally, I'm also against abortion like Ranger47, but I really disagree with this point that he/she made. Would I ever likely reccommend an abortion outright to a pt? NO. But as a physician it will be my job and obligation to give ALL clients ALL choices what they choose to do with a pregnancy whether I like it or not.

More importantly, think about the mindset and emotions of most women when they're at the doctors while experiencing this. They're probably nervous, scared, etc. whether rich or poor, a teen or older, married or unmarried, or whatever. And I'm sure we all know how difficult and embarassing (though it shouldn't be) it can be to talk to a nurse or doctor about ANYTHING personal thats going on with our body, especially in a case like this. The empathetic thing (I think) to do in any case is to bring up ALL treatment options, not leave the topic of abortion up to the patient to bring up, and not judge any patient, though I'm sure its sometimes difficult to do.

 

[cardsurgguy]

This ***** doesn't deserve to be a physician.

One must be able to detach their own personal beliefs from their practice as a physician. They must give the patients all treatment options and let the patient decide for themselves and not censor anything that doesn't agree with their belifs. I wouldn't have the slightest problem whatsoever if a physician would not perform the abortion, but to censor it as a treatment option is pathetic.

In essance, in between the time they leave home for the work day, and the time they drive back home after the day is over, they should practice medicine as if they were a blank slate of morals, almost as if they didn't even have any morals or personal beliefs, just evaluating situations strictly based on objective science and reason, and nothing, absolutely nothing subjective (especially not religion, considering that anything remotely religiously related is automatically extremely subjective).

 

[stomper627]

Originally posted by Ranger47
People know that it is an option, and if they want it, they can ask.

People know that CABG is an option, and if they want, they can ask.

Amazing how just switching one word would get you sued. You are a physician and it is your responsibility to discuss the options that are available....if you do not, you are committing malpractice. I hope you have a good attorney.
stomper

 

[IOE]

all doctors must know how to perform an abortion...thats a part of the physician-training. The best way to learn a procedure is to perform it!! once that is done...then u can allow ur believes, ideologies or whatever to come in...BUt there're limitations to that as well...i find what this doctor did very very arrogant.....if he didn't want to treat her then its up to him but refusing to refer her is just way too much.

personally i am a big supporter of abortions....I'll encourage it whenever i can and i'll perform as much as i can in my career...matter of fact i'll even try to convince ppl who don't need it to change their minds!!!

PRO-CHOICE IS A MUST!!!!!

 

[blackopal]

I definitely think that doctors should have a right to refuse to participate in elective abortions - or, for that matter, any other elective procedure that they have a moral objection to.
Doctors absolutely must have the right to follow their own consciences. In certain social contexts, "acceptable medical practice" has been a tool of abuse. Think of the cruel medical experiments that Nazi doctors performed. Think of forced sterilization of the poor and "genetically inferior" in America a few decades ago. I would like to think that each of us would refuse to participate in such atrocities even if the social climate changed to condone them once more. It is very dangerous to put doctors in the role of robots that merely carry out the presently "fashionable" social views, rather than thinking individuals with autonomy.

Just as some women sincerely believe they need an abortion for their social well-being, there are still some cultures out there who sincerely believe that female circumcision is "necessary" for a girl's social well-being. So if a patient comes to you asking you to cut off their baby girl's clitoris, does that mean that you need to see to it that it gets done in order to avoid imposing your western morality on them? After all, isn't it safer for a surgeon to cut the girl's clitoris in sanitary conditions than for the parents to do it themselves?

Going by the attitude that "objective" science is the only standard for what a doctor should participate in, it isn't inconceivable that someday infanticide could be legalized.
"To a biologist, birth is as arbitrary a milestone as any other. Many mammals bear offspring that see and walk as soon as they hit the ground. But the incomplete 9-month-old human fetus must be evicted from the womb before its outsize head gets too big to fit through its mother's pelvis. The usual primate assembly process spills into the first years in the world. And that complicates our definition of personhood." -according to Steven Pinker
So if the social climate changes to embrace infanticide as a "necessary" procedure for women who find parenthood overwhelming, or to cull children whose disabilities were undiagnosed until birth, would you feel obliged to participate in it? To force ALL medical students to kill a newborn infant?
Obviously I don't agree. In fact, I would never want to go to an ob/gyn who performed abortions.

The problem with making comparisons to refusing to refer for medical treatments like CABG is that the vast majority of abortions in America are for social reasons, not medical reasons.
I would agree that a doctor who didn't want to help a woman dying from a ruptured ectopic pregnancy is negligent, but I don't think a doctor is negligent for choosing not to be involved in a teenager's elective abortion - or breast implants, circumcision, or other procedures that are not medically necessary.

 

[Spitting Camel]

Originally posted by IOE

1) all doctors must know how to perform an abortion...thats a part of the physician-training.

2) personally i am a big supporter of abortions....I'll encourage it whenever i can and i'll perform as much as i can in my career...matter of fact i'll even try to convince ppl who don't need it to change their minds!!!

1) That is not true. I will decline to learn how to do an abortion, let alone do an abortion as a practicine physician. I will, however, issue referrals because that is part of a doctor's duty.

2) This is just as bad as refusing to do an abortion and refusing to refer a patient. I would fail YOU if you went up to patients saying "So, can I offer you an abortion today?" or better yet "Have you and your husband considered abortion as an alternative to giving birth to a child that you may want?" You are way off on this one, buddy. I would reevaluate this view if I were you.

 

[stomper627]

Originally posted by blackopal
The problem with making comparisons to refusing to refer for medical treatments like CABG is that the vast majority of abortions in America are for social reasons, not medical reasons.
I would agree that a doctor who didn't want to help a woman dying from a ruptured ectopic pregnancy is negligent, but I don't think a doctor is negligent for choosing not to be involved in a teenager's elective abortion - or breast implants, circumcision, or other procedures that are not medically necessary.

I concede your point about the CABG, but try the same quote (that I quoted) and insert a social treatment of birth control (a social choice).

Originally posted by Ranger47
People know that it is an option, and if they want it, they can ask.

Yes, because we all know that teens often ask for things. YOU have to be the responsible physician and bring things up.
People know that birth control pills are an option, and if they want it, they can bring it up.......
Or how about.....depression and suicide....hmmm.....the patient knows antidepressants/counselling are an option, and if they want it, they can bring it up.
You dont have to be involved. BUT you do HAVE to give someone all the legal options they have. If that means refering to someone else, so that that dr can do it, you have fulfilled you legal requirement. To do nothing is ILLEGAL!!!!!

stomper

 

[evines]

Originally posted by mlw03
also, i'm not a fan of slippery-slope arguments, but if an OB is allowed to not refer a patient to another OB for an abortion, what's next? a family practice doctor refusing to refer a smoker to a cardiologist because the doctor doesn't approve of smoking? i know this is a stretch, but the role of the doctor is to act in the best interest of the patient, not to impose their particular beliefs unto the patient.

This analogy is way off. A closer analogy would be the family practice doctor who refuses to refer a smoker to a really great cigar shop.

 

[DMO]

I partially agree with Blackopal. Morals and ethics alone should not govern decisions, but they should be considered in the overall decision making process. It is very difficult to determine which side of the abortion debate is right. The beliefs and values that we have obtained have come from our culture and religion. Being exposed to those beliefs and values as a child, they become ingrained into our mind. Those who support pro-life have the same intensity of belief as those who support pro-choice.

If the patient or baby is in danger due to the pregnancy, abortion should be an open option. However, the situation that is the most controversial is when the patient wants an abortion due to personal desire or interest. In that situation, our ethics and morals battle the law. In most cases, the law wins.

I don't know what I'm even talking about. Come here frothy, cold beer.

 

[Ryo-Ohki]

Great stuff, IOE.

Let's add a sarcasm class to your abortion class.

 

[Sweet Tea]

I'd really like to know the whole story on this-- this website seems just a wee bit biased. We don't know what context the student was operating under-- is he against all abortions, or would he be willing to refer someone who medically needed an abortion to someone willing to perform the procedure? I can completely understand refusing to learn how to perform an abortion, but refusing to refer someone who needs one is another thing altogether.

 

[HollyJ]

I was more interested in whether or not a medical student should be penalized for not performing and abortion.

Okay, but that is not the case here. The student was penalized for refusing to perform an abortion AND refusing to refer patients for the procedure. That makes this a different kettle of fish.

 

[pillion]

Hello all,
Nice lively chat you've got going on here. A few questions...

DMO: "Morals and ethics should not govern decisions, but they should be considered..."

What governs one's decisions if not ethics/morals? Isn't that what ethics is... the principles that govern one's actions?

mlw03: "Doctors do not get to impose their morals on their patients. Abortions are legal..."

If abortion used to be illegal, how did it become legal? If doctors imposed their morals then (ie. abortions is needed), why shouldn't they impose them now (ie. abortion is not needed)?

cardsurgguy: "One must be able to detach their own personal beliefs from their practice as a physician."

Do you believe that health is a good that should be cultivated? Shouldn't you approach your patient with total disinterestedness with neither a preference for health or sickness, life or death?

IOE: "Pro-choice is a must!"

Absolutely.... why should we even have laws? Don't they limit our freedom?

dsblaha: "A doctor has an obligation to do what is right at all times..."

If only we all knew what that was....

 

[cardsurgguy]

cardsurgguy: "One must be able to detach their own personal beliefs from their practice as a physician."

Do you believe that health is a good that should be cultivated? Shouldn't you approach your patient with total disinterestedness with neither a preference for health or sickness, life or death?




I'm going to approach my patients without a preference for anything. I'm going to give them ALL the options available and allow them to make the decision

unfortunately, many doctors forget that the patient has a right to control their health, and even whether or not they even want to be healthy, patients have the right to not be healthy, or to do activities which decrease their health, you can't force somebody to live healthy

I'm not saying I'm going to give all options as equally good, of course I'm going to advocate for options that are healthier for the patients, but I will still give all available options, and use OBJECTIVE SCIENCE AND REASON AND NOT MY PERSONAL BELIEFS AND MORALS to formulate pros and cons for each option, this is what I meant by not using personal beliefs and morals

I've seen many doctors in critical care medicine (which is where I've worked mostly) who forget what I've said in the above couple of paragraphs who have a very strong "preference for life" as you say, who wind up treating way too aggressively someone who has a negligible chance of living with any remote quality of life, and as a result keep people alive in pain and in general a zero quality of life state, it's disgusting, they should be ashamed of themselves. this is what happens when you let your "preferences" take over logical and scientific thought and reason

 

[Sweet Tea]

I can completely understand why a physician would be unwilling to perform an abortion that was not medically necessary. Physicians have a duty to themselves to stick to their morals, but that does not give them the right to force their morals on anyone else. In a situations where an abortion is medically necessary to ensure the health of the mother, the mother has the right to refuse the abortion, and the physician still has the right to refuse to perform it, however, he must transfer the patient's care to someone who will do the procedure (although I have to admit it would REALLY piss me off if my doctor decided that saving my life was against his code of ethics, but that's just me). He has no right to endanger someone else's life for the sake of their morals.

That's why I want to know the whole story on this case-- we don't know the context of the student's dismissal. I don't see anything wrong with refusing to learn how to perform an abortion, but refusing to refer someone for a needed medical procedure is another thing.

 

[dsblaha]

I agree with you sweet tea.

Aiden's personal example is one in which I would refer her to another physician. But unfortunately, the vast majority of abortions are because the baby is inconvenient to the mother's life, and in such a situation I would not refer the patient.

Each situation has to be evaluated separately.

Cardsurrguy: You do not disclose all available options to patients. If you are an OB/Gyn and your patient is pregnant you don't immediately suggest the option of an abortion. It is something the mother has to decide. If she doesn't know abortion is an option (something I find hard to believe) then that his her problem.

Clearly women who want abortions know it exists otherwise they would not request it. If they are able to find a doctor who won't perform one I'm sure they are capable of finding a doctor who will.

"if you stand for nothing, you will fall for everything"

 

[irie]

It is unethical for a physician to use his or her advantageous position in the patient-physician relationship to promote moral agendas.

 

[stomper627]

Originally posted by dsblaha
I agree with you sweet tea.

Aiden's personal example is one in which I would refer her to another physician. But unfortunately, the vast majority of abortions are because the baby is inconvenient to the mother's life, and in such a situation I would not refer the patient.

Great....I hope that you have a good lawyer.....and a lot of money....as you have now just committed malpractice. Wake up people....it is the LAW, you have to give patients every option.
stomper

 

[dsblaha]

If its the law then so be it. It is not worth a malpractice lawsuit.

It just seems odd to me that if a patient wants some bizaare(?) procedure that I do not think is in their best interest that I am obligated to refer to someone willing to do it and thereby condone it.

 

[stomper627]

Originally posted by dsblaha
If its the law then so be it. It is not worth a malpractice lawsuit.

It just seems odd to me that if a patient wants some bizaare(?) procedure that I do not think is in their best interest that I am obligated to refer to someone willing to do it and thereby condone it.

No....its not odd....it happens everyday in every medical office/hosptial around the country....its called SECOND OPINION!!! And it IS the patients right to choose to do it. It is their body....not yours.....cardssurg has stated it very well...

Me personally....I would never perform one. Just dont think I could (also dont want my practice bombed). But I have no problem giving them someone who will

Here is a hypothetical for you moral pushers....I have a 16 year old male who is a very promiscuous homosexual....but has remained in the closet, and doesnt want any of his friends or family to find out. He has come to you for advice and has heard that one of his partners has "some disease"....he knows very little of safe sex and the use of condoms. What do you do? Are your morals involved?
just curious....as so many of you cant separate your morals from your clinical judgement.....
stomper

 

[docjolly]

I'm grappling with this issue of ethics myself..

I personally am strongly opposed to abortions, but I do understand that it is a legal medical procedure. Hence, according to the law of the land, women do have the right to have abortions. With that being said, I'm not sure what I would do..

Obviously, I would not consent to performing an abortion. However, am I still firmly holding onto my beliefs if I refer a patient to another doctor who would perform the procedure? Is referring the patient still not equivalent to performing the procedure myself? Also, would I be held liable by the courts to perform the procedure, even if it is against my own spiritual belief system???

I'm really struggling with this issue and what I would do..

<<<sighing>>>

 

[Chrisobean]

im sorry but i think a doctor should be required to learn every medical technique regardless of their beliefs, especially if they are going EM, OB/GYN, etc. whether or not they choose to actually perform them is another story, but they should at least know how to do them. in an emergency, there wont be time to refer to another abortion provider.

 

[dsblaha]

In that situation I would give advice that I thought would best help my patient, such as recommending condom use as well as recommending a lifestyle change.

This example does not apply to abortion because it is for the baby's life I am concerned.

Just to be sure I understand the law: A patient walks into the office wanting prenatal care and does not mention abortion. Am I obligated to tell her about the option of abortion, wouldn't she find that insulting?

Maybe I don't understand your point. If a patient wants a second opinion on how to manage his/her health there is nothing wrong with that. If a patient wants a specific procedure because their mind is already made is a different situation, in essence to find someone to do a job I won't do.

For example, my wife was going to have her wisdom teeth removed and she wanted to be knocked out. There are very few oral surgeons who do this anymore. Not a single one would refer us to a office that would do the procedure knocked out. We had to call places throughout the entire county just to find one. I didn't feel as though the oral surgeon was obligated to refer us, we did the leg-work ourselves.

 

[Cerberus]

I fully support the right to abort premeds

 

[stomper627]

Originally posted by dsblaha

Just to be sure I understand the law: A patient walks into the office wanting prenatal care and does not mention abortion. Am I obligated to tell her about the option of abortion, wouldn't she find that insulting?

No...she because she is asking about prenatal care, she has already decided on the issue of keeping the child....but she does have the right to switch later (unless 3rd trimester).
What about the scared 15 year old girl. Would you let her know that she has options? Adoption, Abortion, keeping it?
If she does keep it....are you really providing the best for that child....BOTH of them.
Look...if I had my own views....I think condoms should be free at high schools, I think teenage girls should ALL be on depo, I think all addicts should be sterile or on birth control. But I cant force my views on my patients....so what gives you the right to do it?
I can tell you have not worked with a very large patient population in an exceedingly underserved area.
stomper

 

[jvarga]

A couple of thoughts that may (I hope) help some of you out. When a women comes to her first prenatal visit, there is a standard questionaire that the physician and nurse (separately) are required to fill out with the patient. The questions deal with the mother's medical history and her social situation (married, single, who do you live with, history of domestic violence, is the father involved, etc). One of these questions is "do you intend on continuing the pregnancy and, if so, do you intend on keeping the baby when it is born?" It should go without saying that a woman who answers "yes" to these questions should not be offered the various alternatives to terminating her pregnancy. However, if she says "no", it is the physicians duty of informing (don't confuse this with performing) the patient of her options including elective abortion (be it surgical or medical...as long as it is legal according to your local regulations) and adoption. A smart person would realize that this question gives you an excellent opportunity to address the issue without having to crudely ask the patient "do you want to terminate?" In addition, please realize that you have every right to emphasize the course of action which, in your professional opinion, would best suit the patient. However, dont confuse emphasize with impose. Remember, you still HAVE to inform them of all of their options and refer them to those physicians that are willing to perform the therapy that they seek.

Now to address the student scenario. As a student, you should never be placed in a situation where you have to perform an abortion or refer a patient to an abortion center. These cases should be reserved for the residents/staff. If the situation does arise, you have every right (as a student) to refuse to perform the procedure on the basis of moral grounds. YOU CANNOT BE FAILED FOR REFUSING TO PERFORM AN ABORTION. If you are, I would strongly suggest you involve the Faculty, epartment Head, Dean of Students, Chancellor, lawyers, etc. for this would be a violation of your personal rights. Nobody could force you to perform an abortion, but you can be found liable if you prevented someone from obtaining one (i.e. by not referring, or by not properly counseling the patient on the available options)!

Hope this helps!

 

[Sweet Tea]

nice post, jvarga.

i still really want to know the whole story-- it seems so ridiculous that a student would be failed for not performing an abortion when you don't even have to witness an abortion during your third-year rotations if you don't want to. maybe they do things differently in canada, but i just can't see any school failing someone for not performing an abortion.

 

[dsblaha]

Thank you jvarga. That is the best explanation I have seen, if only you had posted earlier.

 

[pillion]

I keep hearing advocates of abortion assert that moral views should not be imposed. Let's be honest.... BOTH sides of the debate want to impose their moral view. It just so happens that the government has imposed onto us the moral view that allows for abortion. If the government changes that law, opponents of abortion will still be imposing their morals, but with the force of law. And let me guess... those who keep clammerring about the legality of abortion will be as devoted to the anti-abortion law as to the present pro-abortion law.

Whether or not abortion "should be" permissible will always be a moral/ethical question and cannot be answered by "science." Science gives us facts about the world, but people's ethical views decide what to do with those facts. Sometimes those ethical views are crytallized into law, and sometimes they are not. Either way, people's beliefs and morals cannot be separated from the decisions they make, whether in medicine, politics, or at home. To think they can be separated is an illusion....

 

[celticmists18]

Originally posted by pillion
I keep hearing advocates of abortion assert that moral views should not be imposed. Let's be honest.... BOTH sides of the debate want to impose their moral view. It just so happens that the government has imposed onto us the moral view that allows for abortion. If the government changes that law, opponents of abortion will still be imposing their morals, but with the force of law. And let me guess... those who keep clammerring about the legality of abortion will be as devoted to the anti-abortion law as to the present pro-abortion law.

Whether or not abortion "should be" permissible will always be a moral/ethical question and cannot be answered by "science." Science gives us facts about the world, but people's ethical views decide what to do with those facts. Sometimes those ethical views are crytallized into law, and sometimes they are not. Either way, people's beliefs and morals cannot be separated from the decisions they make, whether in medicine, politics, or at home. To think they can be separated is an illusion....

The government has NOT imposed any kind of morals by allowing abortions. At this point in time, with the way things are, it is up to the INDIVIDUAL to decide what they believe is morally correct (to have a abortion or not). If the law was changed and abortions banned then the government would have made the decision for us, and thus would be imposing morals.
However, pillion's post had nothing to do with the original issue regarding the med student being ousted. Personally I agree with the decision because the student refused to refer the patient to another physician. If your moral beliefs make caring for a patient impossible it is your ethically duty to remove yourself from the situation and send them to another doctor.

 

[pillion]

If a physician does not refer the patient, the physician has not imposed any moral views. The phsyician has only acted in accord with his/her own moral views. A physician who "is against" abortion, but refers the patient elsewhere, is not really against abortion. That physician has adopted the moral view that "it's up to the individual to decide." Is that what a physician is? A servant who does whatever the patient wants, be it life, death, sickness, or health? Individual's have choices, but freedom is not an absolute right.

celticmists: "If your moral beliefs make caring for a patient impossible it is your ethical duty to remove yourself from the situation and send them to another doctor."

First, a physician who does not refer the patient (even at the expense of his career) is doing so because the physician cares for both the patient and the patient's baby. But you're probably refering to the patient's view of caring, ie. whatever the patient wants.
Second, why do you talk about "ethical duty" as if there is some objective standard that we're all obliged to follow? Sounds imposing...

 

[wxgirl2006]

The only morality that the American government is trying to impose upon its citizens is the same "morality" found in the Constitution of the United States of America. The Supreme Court was protecting a woman's privacy rights by allowing abortions to become a legal option.

The Constitution is the law of the land: love it or leave it.

 

[celticmists18]

Amen wxgirl!

pillion: YOU ARE MISSSING THE POINT! This is my last attempt the try and get you to understand my point. As many people have said in previous posts, as a physician you are suppose to put your personal moral and ethics beliefs aside when treating a patient, they should not come into play and if you can't put them aside you need to not be involved. There are "objective" standards you are obliged to follow, that is why so many people have posted that you have an ethical duty to inform your patient of ALL of their options. These guidelines are set by the AMA and once you are a licensed physician you are REQUIRED to follow them or you are committing malpractice.

 

[Rahul3000]

It is high handed and morally impermissable for a physician to make a decision for their patient by witholding information and refusing to offer alternative treatments that are acceptable by general medical standards. What if a physician came from a culture where cutting people open was regarded as inhumane and wrong, and so they didn't refer someone with acute appendicitis to a surgeon who could easily remove the offending organ? Moral standards are relative and shouldn't be involved with medical practice.

I think it is possible to be a caring and compassionate physician without incorporating ideologies. I agree with the medical school and also think that the medical student should be failed from the class because they imposed personal beliefs onto their patient. If I ever were to get married and have a child, I probably wouldn't even think about abortion, but that doesn't mean that the option should be taken away from me. As Jvarga pointed out, there are tactful ways to bring the option up, which wouldn't offend patients.

Regarding whether abortion be from a medical or social standpoint, I don't think it matters. Doctors have the responsibility of providing medical care, and therefore they should know how to perform abortions (which is why the student should be failed - refusing to learn a procedure is silly) for instances when pregnancy can result in death of the mother, such as in ectopic pregnancies or situations akin to the one aidan73 was put in. If its elective for social reasons, I agree with Blackopal in that the doctor shouldn't be forced to perform the procedure, but I believe physicians have the responsibility to give the patient alternatives and options so they don't have to resort to extreme measures, as mlw03 alluded to, that are unsafe. If they were forced to have "coat-hanger abortions", it would be because of negligence of their physician without doubt, regardless of whether it was done from moral concern or not.

 

[stomper627]

Originally posted by pillion
If a physician does not refer the patient, the physician has not imposed any moral views. The phsyician has only acted in accord with his/her own moral views. A physician who "is against" abortion, but refers the patient elsewhere, is not really against abortion. That physician has adopted the moral view that "it's up to the individual to decide." Is that what a physician is? A servant who does whatever the patient wants, be it life, death, sickness, or health? Individual's have choices, but freedom is not an absolute right.

celticmists: "If your moral beliefs make caring for a patient impossible it is your ethical duty to remove yourself from the situation and send them to another doctor."

First, a physician who does not refer the patient (even at the expense of his career) is doing so because the physician cares for both the patient and the patient's baby. But you're probably refering to the patient's view of caring, ie. whatever the patient wants.
Second, why do you talk about "ethical duty" as if there is some objective standard that we're all obliged to follow? Sounds imposing...

Hmm....Pillon are you the God I pray to? If so....are you going to answer the one about me getting that ortho spot? If not, when did you get the powers to play him? You DO NOT have any right to treat/ or not treat any patient, without giving them all the options that are known. THAT IS CALLED MALPRACTICE AND YOU WILL LOSE YOUR MEDICAL LICENSE!!!!!!!!!!!!!!!!!!!!!!!!!!! Its the same thing with starting a patient on a new drug....if you dont go over some of the major side effects....you have committed malpractice.
I think you seriously need a course in medical ethics and medical law....
stomper