morning after pill

[wikiality]

A question for discussion: If a person has moral objections to prescribing the morning after pill under any circumstance, should he or she definitely not go into emergency medicine?

Looking forward to hearing peoples' views on this.

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[Sweet Tea]

Not really on topic for this forum, but I'll bite.

I say yes, because I think it's unethical to deny access to appropriate medical care.

 

[SolidGold]

should he or she definitely not go into emergency medicine?

I say one issue shouldn't prevent someone from going into a whole field of medicine. One can avoid patients such as this if their personal ideals are conflicted.

 

[NinerNiner999]

I say nobody who lets their personal morals interfere with good evidence-based medicine should go into medicine, period.

 

[Hard24Get]

I say nobody who lets their personal morals interfere with good evidence-based medicine should go into medicine, period.

Yah, I'm kinda with Niner, here. Sure, you could go scurrying over to ask someone else to prescribe it (if that's not against your morals, too), but if someone was sexually assaulted (or just made a stupid mistake), you have a clinical obligation to be the one to think ahead and suggest this treatment as opposed to abortion/adoption/dec. quality of life. Much better for the mother and the unwanted child.

Besides, if you morally object to things like this, do you want to work with the EM patient population?

 

[Jejton]

If this is the only issue then [Bwhy not[/B] ask someone else to write the prescription ? I am a little ignorant on the topic, but is the morning after pill that large a percentage of the treatments done in an ER?

 

[The White Coat Investor]

Yah, I'm kinda with Niner, here. you have a clinical obligation to be the one to think ahead and suggest this treatment as opposed to abortion/adoption/dec. quality of life. Besides, if you morally object to things like this, do you want to work with the EM patient population?

Say what?

An emergency doctor takes care of emergent conditions. Possibly getting pregnant certainly doesn't qualify. Possibly getting HIV probably does. There is a big difference between prescribing prophylactic antiretrovirals and prescribing the morning after pill. The morning after pill can be taken up to 72 hours later and still be effective. Let's see...Friday evening at 1700 until Monday morning at 0900=64 hours. If an emergency doc doesn't want to prescribe it, there should be plenty of opportunity for the primary to do so or for the patient to seek out an urgent care center or whatever.

And this has nothing to do with evidence based medicine. It is a moral issue.

And Sweet Tea, we (being the medical profession) deny access to appropriate medical care all the time, usually because a patient can't pay for it. In fact, the only conditions we're legally obligated to take care of are labor and emergent medical conditions.

P.S. I prescribe it but I've had some co-workers who don't. Usually the nurses just bring the chart to me and I see the patient. I don't even really examine the patient other than to lay eyes on them. I usually check an HCG to make sure they aren't pregnant already. It isn't a big deal. I certainly wouldn't stay out of EM for it. It won't be long before it is available over the counter anyway IMHO.

 

[membsr-8890]

Say what?

The morning after pill can be taken up to 72 hours later and still be effective.



The pill is still effective up to 72 hours, but its more effective the earlier it's taken after unprotected sex. You're screwing your patient out of some important percentage points the longer you wait.

As for the argument of the patient presenting on a Friday...
your patient probably won't present immediately after intercourse (maybe she goes to sleep for 8 hours first, then takes an hour to get ready to go to the ED, then sits in the waiting room for another 3 hours). If this happens to be Friday, this kills the 72 hour window over the weekend.

 

[TexPre-Med]

A question for discussion: If a person has moral objections to prescribing the morning after pill under any circumstance, should he or she definitely not go into emergency medicine?

Looking forward to hearing peoples' views on this.

I think the kind of people who ask this question shouldn't go into EM.

 

[EctopicFetus]

There are lots of moral issues in EM. I would disagree with some of my colleagues on this forum for a few reasons. Let me say I am pro-choice and I would have NO problem rxing this but...

1) if you are a very religious person it might be against your beliefs to do this. You might believe that this is murder. This doesnt preclude you from seeing drunks etc.

2) Possibly being pregnant is NOT an emergency IMO. Go to planned parenthood or some other similar org.

3) I think people who dont ask questions are the people who shouldnt go into EM. The number of moral and ethical issues we face is wide and varied.

Discuss..

 

[TexPre-Med]

So EM physicians are in the profession of savings murderers, drug dealers, and pimps while supplying addicts and sometimes drug dealers.

Yet, we definitely should not help women with their legal rights.

WTF?

Go to Dermatology. No ethical issues there.

 

[Wahoo]

I think the kind of people who ask this question shouldn't go into EM.
__________________
Texas Tech Class of 2010

I think as a 1st year med student you don't have a clue who should or shouldn't go into EM.


(Edit: Didn't mean to offend any 1st years out there -- just wanted to point out how ridiculous Tex's comment was.)

 

[EctopicFetus]

So EM physicians are in the profession of savings murderers, drug dealers, and pimps while supplying addicts and sometimes drug dealers.

Yet, we definitely should not help women with their legal rights.

WTF?

Go to Dermatology. No ethical issues there.

Yep! We help those who have emergent needs. Of course because the system is jacked we also VOLUNTARILY perform primary care.

Women might have the RIGHT the choice, but they do NOT have the right to FORCE someone to help them with their choice. You get this? Just because you come to the ED and ask for something doesnt mean I HAVE to give it to you.

Oh and in Derm there are also ethical issues they just arent usually as complex.

 

[a_ditchdoc]

Ectopic,

Your statement comes off sounding a bit pompous. At a minimum, if someone happens to have been raped, it should be your moral responsibility to help prevent an unwanted pregnancy in addition to the STDs you are trying to prevent.

ditch

 

[EctopicFetus]

Ectopic,

Your statement comes off sounding a bit pompous. At a minimum, if someone happens to have been raped, it should be your moral responsibility to help prevent an unwanted pregnancy in addition to the STDs you are trying to prevent.

ditch

im not trying to be pompous and like I said I would personally treat but to say someone who wouldnt shouldnt be an ED doc? WTF? Also morality is different than legality. Morally I honestly and personally dont think I need to rule out a dude with CP for the 15th time THIS MONTH who left AMA 10 times prior.. Legally I will and ill smile through it.

Legally, I have to keep the homeless drunk until he sobers up, morally I want to let him sleep on a bench.

i knwo some of this comes off as cold but im just trying to make a point.

I mean imagine if someone forced you into doing something you DID NOT want to do. If someone told you to go murder someone it doesnt mean you should. Some people are very religious and fell that by doing this they are commiting murder. Why force this upon people?

Again, I would I am fiercely pro-choice but I think you have to understand the points of the other folks.

I mean in all seriousness. lets not involve STDs etc in this discussion. I dont know for sure but I would guess GC/Chlamydia etc would not show up within 2-3 days of having sex with someone.

If we focus on the issue of pregnancy and that alone I can see how some people could EASILY justify not treating if this conflicted with their personal beliefs!

 

[mikecwru]

A question for discussion: If a person has moral objections to prescribing the morning after pill under any circumstance, should he or she definitely not go into emergency medicine?

Looking forward to hearing peoples' views on this.

I don't think this is a problem as long as the doc is honest about it with his/her group and realizes that the patient has the right to the treatment even if they don't agree with it and the doc has the responsibility to refer. "Refer" shouldn't mean come back for a second ED visit. The opposing doc should go to another doc on for the rx, or work out a system where scripts are already made out or can be dispensed from the pyxis. If the doc is so opposed that they would ban the treatment even with the steps above, then yes, I think they're going to have a problem with our specialty.

 

[Hard24Get]

Say what?

An emergency doctor takes care of emergent conditions. Possibly getting pregnant certainly doesn't qualify. Possibly getting HIV probably does. There is a big difference between prescribing prophylactic antiretrovirals and prescribing the morning after pill. The morning after pill can be taken up to 72 hours later and still be effective. Let's see...Friday evening at 1700 until Monday morning at 0900=64 hours. If an emergency doc doesn't want to prescribe it, there should be plenty of opportunity for the primary to do so or for the patient to seek out an urgent care center or whatever.

If you are going to treat the rape victim, why only partially treat them? How many rape victims do you know that would wander from person to person, explaining their story and hoping to get help? Many victims don't even come in at all. I certainly undeerstand not wanting to treat someone who voluntarily had unprotected sex, but the reality is that you are stacking up points against society when you do this.
And I mentioned having someone else prescribe it, but that also depends on the OP's "morals" whether they would be willing to do this.

I bet all you people who are so cavalier (rather than just morally opposed)about such a huge women's health issue are men.

 

[Sweet Tea]

Plan B is available OTC for women 18 and up in several states already, and with any luck it'll be nation-wide soon. And that's a beautiful thing for all concerned.

 

[DocWagner]

To be honest with you guys, some of you need to back down...just a tad. If you have a moral objection with the morning after pill, simply don't prescribe it or ask a partner or fellow resident to do so.
It is perfectly ok to do that. You are not a robot. You may have many of things in the ER that effects you emotionally...that is all about being human.

I would never fault a partner for having problems with "plan B" (the brand name for morning after pill).
But remember, the "morning after pill" should ONLY be considered Emergency Treatment in the case of rape and only after a rape/sexual assault evaluation has been performed.

Emergency Medicine is a very emotional job...but to be good at it, you must maintain your personal values...why, because once you "change" as a person, you likely lose the qualities that made you a good physician to begin with.

 

[Seaglass]

Many many people will go into a job that is solo coverage for a big part of the day. What would you do then? Solo coverage hours usually occur when offices aren't open.

 

[AmoryBlaine]

To be honest with you guys, some of you need to back down...just a tad. If you have a moral objection with the morning after pill, simply don't prescribe it or ask a partner or fellow resident to do so.
It is perfectly ok to do that. You are not a robot. You may have many of things in the ER that effects you emotionally...that is all about being human.

I would never fault a partner for having problems with "plan B" (the brand name for morning after pill).
But remember, the "morning after pill" should ONLY be considered Emergency Treatment in the case of rape and only after a rape/sexual assault evaluation has been performed.

Emergency Medicine is a very emotional job...but to be good at it, you must maintain your personal values...why, because once you "change" as a person, you likely lose the qualities that made you a good physician to begin with.

Excellent post. I think people have a big misunderstanding when it comes to stuff like this.

If you are a practicing member of a religion that forbids use of the MAP you can't just say "well this is my responsibility as a physician." I doesn't work like that. That would be like saying to a Muslim "you have to eat bacon today because we are all eating bacon." Plan B is legal, but then again so is bacon. So was slavery. So is killing your wife in some parts of the world. Legal does not equal good or correct.

The argument about EBM is silly. There's plenty of good evidence that injecting concentrated KCl will spot a heart, that doesn't mean we should do it.

No patient has the right to demand a physician do something he or she finds morally objectionable. People should not be excluded from EM for not wanting to provide plan B.

Disclaimer: I would probably provide Plan B.

 

[a_ditchdoc]

I mean in all seriousness. lets not involve STDs etc in this discussion. I dont know for sure but I would guess GC/Chlamydia etc would not show up within 2-3 days of having sex with someone.

You are correct. However, many people treat rape victims prophylactically for STD's so that they do not have to experience the trauma of having them show up later and be further degraded by another visit and exam.

I am surprised by some of the responses on this thread. People are certainly entitled to their opinions, but I am also allowed to think they are closed minded and failing their patients. I would hope that my sister/daughter/neice would not have some of you as care providers if they ever needed it.

Sigh...

 

[c.bear]

Just to add my 2 cents in to the pot:

I think if you are morally opposed to the treatments in women's health, you probably should find a medical profession where it is not an issue. I mean geeze just avoid ob-gyn, family, and em. Don't subject patients to even longer waits while you find someone else to treat them....or to your own personal objections to the treatment options (I've known students to actually lecture pts on how to be a good Christian/Catholic....).

EM is full of lots of these moral debates. One needs to be able to seperate their personal opinions from their PATIENT'S moral beliefs and the optimal treatment for the pt. Our job is to treat the patient within their moral beliefs/contstraints!

It saddens me that we cannot put the patient first.

 

[AmoryBlaine]

You are correct. However, many people treat rape victims prophylactically for STD's so that they do not have to experience the trauma of having them show up later and be further degraded by another visit and exam.

I am surprised by some of the responses on this thread. People are certainly entitled to their opinions, but I am also allowed to think they are closed minded and failing their patients. I would hope that my sister/daughter/neice would not have some of you as care providers if they ever needed it.

Sigh...

You're allowed to think that, but in point of fact you are being just as "closed minded." Why? Because you are saying that doctors are not entitled to religious beliefs.

Alot of people view the morning-after pill as murder. I don't agree with that, but I respect their views and their rights to carry those views. I therefore don't demand that people do things that they think are hugely morally objectionable, and I don't label them "closed-minded" for that.

This is a really big deal for some people, and alot of really smart people hold widely variant opinions on the topic.

 

[EctopicFetus]

Plan B is available OTC for women 18 and up in several states already, and with any luck it'll be nation-wide soon. And that's a beautiful thing for all concerned.

I Agree. A lot of emergency contraception is basically taking more than a normal amount of OCPs. Why this isnt over the counter is purely religious/conservative bs. Can you sense the libertarianism coming out?

 

[AmoryBlaine]

Just to add my 2 cents in to the pot:

I think if you are morally opposed to the treatments in women's health, you probably should find a medical profession where it is not an issue. I mean geeze just avoid ob-gyn, family, and em. Don't subject patients to even longer waits while you find someone else to treat them....or to your own personal objections to the treatment options (I've known students to actually lecture pts on how to be a good Christian/Catholic....).

EM is full of lots of these moral debates. One needs to be able to seperate their personal opinions from their PATIENT'S moral beliefs and the optimal treatment for the pt. Our job is to treat the patient within their moral beliefs/contstraints!
It saddens me that we cannot put the patient first.

You could not possibly be more wrong.

What if an old guy showed in your ED with a big sacral decub, covered in his own feces and on a trach. He then scribbles out on a piece of paper "kill me please, I want to die." Would you treat that patient within his moral belief system?

My guess is you would throw your own personal belief in there and fail to OD him with morphine. It saddens me that you would not put that patient first.

 

[EctopicFetus]

Should OB/GYNs be forced to perform elective D&Cs? I mean they are the ONLY people who are really trained in this. As a student we had a bunch of OB attendings who worked for some christian organization as well and simply didnt do elective D&Cs in non-rape, non-danger to the mothers life scenarios.

This IMO is much more of an issue than in the ED. I find it interesting that Docs and future docs think that personal beliefs should be tossed because our patients want something that we oppose. We treat disease in the ED, so I dont think that anyone has issues treating STDs but terminating pregnancy might be an issue.

Oh and FWIW I dont think anyone on here has yet to say that they would personally NOT rx plan B, rather we are saying no one should be forced to do so.

I dont rx things I am not comfortable with. I had a lady come in asking for weird tests to be run and rxs for octreotide and a few other things I had never rxed. I told her I couldnt rx these things cause I wasnt comfortable.

Again pt request/demand doesnt mean much if I dont feel comfortable doing it or if it isnt necessary.

 

[EctopicFetus]

You could not possibly be more wrong.

What if an old guy showed in your ED with a big sacral decub, covered in his own feces and on a trach. He then scribbles out on a piece of paper "kill me please, I want to die." Would you treat that patient within his moral belief system?

My guess is you would throw your own personal belief in there and fail to OD him with morphine. It saddens me that you would not put that patient first.

I was also about to reply to the above post. You did it. I might have done it a little differently but you got the point across.

In the ED things are a little different but other docs not bound by EMTALA do not have to treat ANYONE they dont want to. Just a thought.

 

[c.bear]

You could not possibly be more wrong.

What if an old guy showed in your ED with a big sacral decub, covered in his own feces and on a trach. He then scribbles out on a piece of paper "kill me please, I want to die." Would you treat that patient within his moral belief system?

My guess is you would throw your own personal belief in there and fail to OD him with morphine. It saddens me that you would not put that patient first.

Oh come on!!! That is a weak slippery slope argument. But ok...I will entertain the thought: I'll add that any treatment should be within the moral restraints of the patient and the LEGAL SYSTEM. But assisted suicide is a topic within itself.

I really do try to work within a patient's value system.

 

[AmoryBlaine]

Oh come on!!! That is a weak slippery slope argument. But ok...I will entertain the thought: I'll add that any treatment should be within the moral restraints of the patient and the LEGAL SYSTEM. But assisted suicide is a topic within itself.

I really do try to work within a patient's value system.

It's not a slippery slope argument at all. Many, many people believe that pregnancy termination and assisted suicide are exact moral equivalents.

 

[Sweet Tea]

Oh come on!!! That is a weak slippery slope argument. But ok...I will entertain the thought: I'll add that any treatment should be within the moral restraints of the patient and the LEGAL SYSTEM. But assisted suicide is a topic within itself.

I really do try to work within a patient's value system.

Agreed...not the same thing at all.

 

[TexPre-Med]

Say you have seen a guy on the evening news for shooting some guy (you could even pretend you knew the guy he killed). A week later he ends up in your ED for getting beat to he!! in prison and you are the only EM physician on.

Legally, you have to stabilize this patient don't you?

My point is......."the individual who has moral problems with the morning after pill are normally the same type of people who have problems with the above scenario and others that are morally questionable."

John 12:48 "the word that I have spoken will judge him in the last day."

Whether or not you are against the morning after pill does not mean you should withhold treatment as an EM physician IMO. If you believe it a sin then fine, but do not judge people. That is not your purpose.

Secondly, withholding plan B in the ED does not change anything but increase costs of healthcare. Now the same woman has to get worked up elsewhere, because some physician wouldn't do that which is already been decided.

You know that EM is a field which is almost half primary care (rough estimate - please don't argue this point because I don't care), so IMO you should be prepared for FP patients like plan B.

IMO - the ideal EM physician should walk through that ED door KNOWING he/she will treat ANYONE that walks through his/her doors within LEGAL limits.

 

[c.bear]

It's not a slippery slope argument at all. Many, many people believe that pregnancy termination and assisted suicide are exact moral equivalents.

Are you sure those people aren't just trying to get out of vag exams? j/k
(trying to lighten things up)

Seriously...this is why it is called ethics...
I do realize there are people that equate even BC to assited suicide; I am not one of them, obviously.

 

[TexPre-Med]

It's not a slippery slope argument at all. Many, many people believe that pregnancy termination and assisted suicide are exact moral equivalents.

Then do not go into a specialty that requires you to terminate pregnancies or kill people in Oregon. Simple as that.

Simple as that.

You should not bring your politics or religious beliefs into question when helping a patient. As long as its legal, I'll do anything to help a patient, and I am proud of that. Besides if you do not do it, someone else will. What have you changed? NOTHING

Have a problem with early pregnancy terminations? Then go into Ortho or ENT etc. and spend your free time lobbying on capitol hill. I wish you the best.

 

[DocWagner]

Remember, there is NO CORRECT ANSWER in this situation. The idea of "first, do no harm" is clearly up for debate, it is not a definition but rather a "concept". That being said, the physician's moral and personal value set is important in the overall ability of the physician.
Therefore, your desire to prescribe "plan B" makes you neither a bettor nor worse physician. You could prescribe "plan B" but yet be a ruthless, unfeeling physician and do more harm than good.
It is NOT your ability to prescribe that makes you sensitive to the sexual assault patient, but you ability to listen to the patient, perform an efficient exam, and refer the patient to social services etc.
Yes I have and do prescribe plan B for my sexual assault patients, ONLY when they want the pills.
But the idea that those that chose NOT to prescribe "plan B" should neither practice EM or are unfeeling is an absolute *****ic approach to medicine and smells of inexperience in both life and medicine.

 

[AmoryBlaine]

Are you sure those people aren't just trying to get out of vag exams? j/k
(trying to lighten things up)

Seriously...this is why it is called ethics...
I do realize there are people that equate even BC to assited suicide; I am not one of them, obviously.

Ha ha ha ha. Probably, everyone has ulterior motives. I also don't agree that the two are morally equivalent. I'm just arguing that all this talk about docs having to do stuff they are not comfortable with is nonsense.

 

[TexPre-Med]

Remember, there is NO CORRECT ANSWER in this situation. The idea of "first, do no harm" is clearly up for debate, it is not a definition but rather a "concept". That being said, the physician's moral and personal value set is important in the overall ability of the physician.
Therefore, your desire to prescribe "plan B" makes you neither a bettor nor worse physician. You could prescribe "plan B" but yet be a ruthless, unfeeling physician and do more harm than good.
It is NOT your ability to prescribe that makes you sensitive to the sexual assault patient, but you ability to listen to the patient, perform an efficient exam, and refer the patient to social services etc.
Yes I have and do prescribe plan B for my sexual assault patients, ONLY when they want the pills.
But the idea that those that chose NOT to prescribe "plan B" should neither practice EM or are unfeeling is an absolute *****ic approach to medicine and smells of inexperience in both life and medicine.

"ONLY when they want the pills" huh?

Glad you don't force it on anyone! hhahahahah

 

[Tired Pigeon]

You should not bring your politics or religious beliefs into question when helping a patient. As long as its legal, I'll do anything to help a patient, and I am proud of that.

Patients are not coming into your ED for moral, political, or religious instruction.

 

[DocWagner]

I'm glad you were able to learn alot from the post...

You were the person who stated "As long as its legal, I'll do anything to help a patient, and I am proud of that. Besides if you do not do it, someone else will. What have you changed?"

The idea of consent prior to treatment is not a new concept, therefore you must discuss "plan B" with your patient. A patient must give verbal consent in this case, thus my comment "if they want the pills".

 

[AmoryBlaine]

Then do not go into a specialty that requires you to terminate pregnancies or kill people in Oregon. Simple as that.

Simple as that.

You should not bring your politics or religious beliefs into question when helping a patient. As long as its legal, I'll do anything to help a patient, and I am proud of that. Besides if you do not do it, someone else will. What have you changed? NOTHING

Have a problem with early pregnancy terminations? Then go into Ortho or ENT etc. and spend your free time lobbying on capitol hill. I wish you the best.

If you notice I didn't say I wouldn't prescribe it. I'm not going into a specialty that requires me to terminate pregnancies. I'm going into EM. There is no specialty that requires you to terminate pregnancies.

Be careful when you start saying "people that do/think/believe X should not go into Y specialty." I could just as easily make the argument that people who don't at least look at Annals and Academic Emergency Medicine each month should not go into EM. I guarantee you that following the literature that closely would add more to your value as an EP than not prescribing plan B would subtract from it. Do you read Annals and AEM? I do, I'm as proud of that as you are of your willingness to do "everything."

 

[TexPre-Med]

If you notice I didn't say I wouldn't prescribe it. I'm not going into a specialty that requires me to terminate pregnancies. I'm going into EM. There is no specialty that requires you to terminate pregnancies.

Be careful when you start saying "people that do/think/believe X should not go into Y specialty." I could just as easily make the argument that people who don't at least look at Annals and Academic Emergency Medicine each month should not go into EM. I guarantee you that following the literature that closely would add more to your value as an EP than not prescribing plan B would subtract from it. Do you read Annals and AEM? I do, I'm as proud of that as you are of your willingness to do "everything."

My point is.......why subject yourself to practicing in a field that routinely brings in the patients you are morally against treating????

There are plenty of specialties out there, almost all of which have fewer moral problems than EM. Why choose the one that gives you the greatest chance of seeing patients that conflict with your morals???

 

[trkd]

Holy cow! What a firestorm here. I'll bite as well.

First, I will point out what a very wise FP doc once taught me about working within the lines. He was a catholic that worked in a catholic hospital system where he could not provide abortions of any sort (pill, D&C, etc). He would not even write the suggestion in his notes, nor did he want to do them if he was allowed to. However, he would tell the woman ALL the options available AND provide them with the phone number and clinic hours of the planned parenthood around the corner. This was the best he could do.

Now if you are in the ED and come across this situation, NOT providing all the options to a woman in ANY situation is wrong, period. In this country it is legal, and therefore it should be an option available. If you don't want to rx it, fine, have a partner do it. If you don't rx it but don't want to have someone else do it, wrong specialty and certainly harming more than helping the patient which again, may even mean wrong profession all together.

Do not make your patients live by YOUR morals. Allow the patient to live by THEIR morals as long as it is within the law.

If you are on single coverage and are opposed to rx'ing it, I feel it is you OBLIGATION to you patient who wants it that you find a doc in the hospital (or next closest place) that will rx it. Simple as that.

As for sending pts to their primary, I think that is ridiculous. Many pts don't have one, many will not see another doc after being refused by one, many pts don't have money to see 2 docs in the same paycheck, many people are too embarassed to repeat the story twice (many times even once), and, finally, many women who may have been raped may not say so and when this woman asks for it in a "non-rape" situation and it is refused, you may have made a mistake for which that woman will live with for the rest of her life.

Seriously people, there is a way to live within your own morals while allowing others to live within theirs. For this you must be open minded and do what a doctor is meant to do, provide his/her patients with the medical care they need or find someone who can.

 

[c.bear]

amen...

Stirring the Pot: And I guess for those of you that believe an MD does not have to do this that or whatever in their specialy due to values....Do you also believe pharmacists have the right to deny this that or whatever (bc, morning after pill, ritalin)?

Perhaps the second slipper slope of the conversation...but I am post call.

 

[AmoryBlaine]

My point is.......why subject yourself to practicing in a field that routinely brings in the patients you are morally against treating????

There are plenty of specialties out there, almost all of which have fewer moral problems than EM. Why choose the one that gives you the greatest chance of seeing patients that conflict with your morals???

The point, my friend, is that some people do not see the prescription of EC to be "treatment."

You didn't answer my question.

 

[EctopicFetus]

Patients are not coming into your ED for moral, political, or religious instruction.

I certainly dont lecture people on issues that are non medical. I do know of people who use their MD as a way to "preach" to people and I personally find this unprofessional and offensive. That being said I dont know that what they are doing is illegal.

 

[AmoryBlaine]

Holy cow! What a firestorm here. I'll bite as well.

First, I will point out what a very wise FP doc once taught me about working within the lines. He was a catholic that worked in a catholic hospital system where he could not provide abortions of any sort (pill, D&C, etc). He would not even write the suggestion in his notes, nor did he want to do them if he was allowed to. However, he would tell the woman ALL the options available AND provide them with the phone number and clinic hours of the planned parenthood around the corner. This was the best he could do.

Now if you are in the ED and come across this situation, NOT providing all the options to a woman in ANY situation is wrong, period. In this country it is legal, and therefore it should be an option available. If you don't want to rx it, fine, have a partner do it. If you don't rx it but don't want to have someone else do it, wrong specialty and certainly harming more than helping the patient which again, may even mean wrong profession all together.

Do not make your patients live by YOUR morals. Allow the patient to live by THEIR morals as long as it is within the law.

If you are on single coverage and are opposed to rx'ing it, I feel it is you OBLIGATION to you patient who wants it that you find a doc in the hospital (or next closest place) that will rx it. Simple as that.

As for sending pts to their primary, I think that is ridiculous. Many pts don't have one, many will not see another doc after being refused by one, many pts don't have money to see 2 docs in the same paycheck, many people are too embarassed to repeat the story twice (many times even once), and, finally, many women who may have been raped may not say so and when this woman asks for it in a "non-rape" situation and it is refused, you may have made a mistake for which that woman will live with for the rest of her life.

Seriously people, there is a way to live within your own morals while allowing others to live within theirs. For this you must be open minded and do what a doctor is meant to do, provide his/her patients with the medical care they need or find someone who can.

This argument is much easier to make when you are the one telling someone to do something they find objectionable and you do not. It gets much more tricky when you are the one being told to do something.

In certain countries, assisted suicide is legal. I would refer you to my previous example. If you were doing some sort of visiting professorship in Amsterdam and some old guy asked you to help him die by your logic you would HAVE to do it. Would you put your money where your mouth is and push the meds?

 

[trkd]

The point, my friend, is that some people do not see the prescription of EC to be "treatment."

You didn't answer my question.

I think you have to go by what most docs in the profession would consider a treatment (even many religiously opposed docs will say it is a treatment, though not one they approve of). If you are looking for an exact, I suppose you could go by what the law considers a treatment. You cannot go by what your religion tells you is a treatment. No disrespect but this is the wrong country for that (legally and also by popular vote of Pro-choice vs Pro-life).

 

[EctopicFetus]

amen...

Stirring the Pot: And I guess for those of you that believe an MD does not have to do this that or whatever in their specialy due to values....Do you also believe pharmacists have the right to deny this that or whatever (bc, morning after pill, ritalin)?

Perhaps the second slipper slope of the conversation...but I am post call.

Now perhaps this might come off as pompous but....

1) I think that even if you are on single coverage and you are morally opposed to this you still shouldnt be forced to oppose your morals on this issue. There are OBs out there etc.

Using this logic should someone in OB who is trained in these issues far more than we are refuses to do this should they not go into OB? Personally, while these are "big" issues its not like in the ED or even in OB more than a small % of patients are coming to you for this issue unless you work at planned parenthood or some other similar organization.

For what its worth doesnt explaining all the options include giving the baby up for adoption etc?

Bottom line is this.. I think most of us (other than Amory) would prescribe plan B etc.. but saying someone who wouldnt doesnt belong in EM is a joke. My social beliefs are very much to the left but if someone thinks this is equal to murder how could you insinuate that if they oppose this they should choose another field if everything else about this field appeals to you.

Frankly, if i never had to do another pelvic my life I would be much happier. That being said it is necessary to evaluate life threatening conditions in women, so I do them. Possibly being pregnant is NOT an emergency and seeing ones OB is possibility as well.

In the case of rape I will agree this is a little more challenging.

 

[trkd]

This argument is much easier to make when you are the one telling someone to do something they find objectionable and you do not. It gets much more tricky when you are the one being told to do something.

In certain countries, assisted suicide is legal. I would refer you to my previous example. If you were doing some sort of visiting professorship in Amsterdam and some old guy asked you to help him die by your logic you would HAVE to do it. Would you put your money where your mouth is and push the meds?

I would actually but that is because I believe there is a place for assisted suicide (though I won't do it here because it is not legal). But I see your point and I also don't envy your position. Putting my own beliefs aside I think you certainly must accept that part of this profession is that you must find someone to provide what you cannot if that is what the patient wants/needs and you can't provide it.

If you couldn't remove a bit of glass from someone's eye for whatever reason (essential tremor, etc), would you not find someone that could? I am not trying to minimize the importance of your religious beliefs to you but you have to see that making your patients live within YOUR abilities alone is wrong.

 

[DocWagner]

let me reiterate this point of consent.

The idea of "plan B" is a double edged sword. It is not considered the "standard of care", and while I have prescribed it, I do put myself in a potentially legal dilemma. Consent for this treatment is very important and MUST be written in the chart by the physician (example: I have explained the treatment to the patient and she has verbalized understanding of the treatment and side effects. This includes cessation of pregnancy etc. The patient appears to comprehend instructions and is a competent adult).
I look forward to the first "but the doctor never said it would kill the baby" lawsuit. Or the "but I was under mental duress and could not make a reasonable decision".

Cover your butts, because, once again, this is not the standard of care, nor is it considered a "life or limb" situation or a situation that could lead to a worsening medical condition. (the idea of refusal to treat a STD is different as PID, infertility, TOA, or sepsis could potentially develop).

From the Pit,
You friendly EM attending.