Need help with abortion ethics question

[Miami_med]

A doctor's main purpose is to serve and aid the patient with whatever means possible. (just like the responsibility of the gov. is to serve and aid the people). Religious or moral beliefs of the doctor should not be factored into patient treatment. You must still take the patients best interest to mind which is why if I were faced with this abortion case I would first talk to the patient about seeking counseling. The next step would be to (after they seek or refuse counseling) inform them about the dangers of abortion (such as future infertility). If they still want to go through with it then the abortion would occur.

I completely disagree with you, but your analogy is correct in one way. A doctor functioning without a moral code would most likely act in a manner consistent with the level of amorality witnessed in government. Above all things, a doctor is a person. Pretending the doctor is not a person doesn't make it not so. Pretending that a doctor doesn't have a moral code doesn't make it disappear. Pro-choice has to work both ways. As a physician, I do not intend to be some kind of automiton who mindlessly acts mindlessly according to someone else's meta-analysis.

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[older than you]

Meh, Belly lady or whatever your name is, I have never heard someone get so much mileage out of something that didn't happen. As in, you weren't aborted. I will say it again; almost being aborted is not a personal experience. It seems the only thing almost being aborted hurt was your psychological health, you know, that thing you don't give credence to. And the reason people have been alluding to your certainly dubious future as an MD is that your complete refusal to even discuss a patient’s options shows that there really is something a little disquieting in that, Meh, head of yours. This is of course evident by your accusation that Trustedwoman said she would have aborted you by merely sharing her actual experience, which actually happened. And you said you don't buy into the psychological health excuse, don't you realize? That is your platform baby!

 

[popbirch]

This debate is endless, if it could be solved on an internet forum someone would have figured out already. Some people don't believe that value is intrinsic to a person, that their value is derived from their actions. And someones actions are what give a person value or no value. But there in lies another key ingredient to this dissonant discussion is "what is valuable?" Life alone? or more than that. There are a lot of living things on the planet that are alive that we could care less about. Living things that can make choices? There really isn't a whole lot of evidence that choice exists, but mere confusion between choice and chaotic determinism.

The debate usually hinges on the semantics of 'life' or more frequently degrades into shouting matches that leaves the opponents more vehemently joined with their already formed opinion. The discussion is not pragmatic, its not real. There is no way to objectively tell what has value, it is an opinion. If there were a way to tell life wouldn't be so hard to figure out.

Its hard to see how someone else could choose for an abortion when you yourself have come through that experience and obviously value your life. But for every good outcome there as many bad ones. On both sides of the debate there are negative outcomes, unwanted children born to abusive and neglect filled homes or aborted children that mothers regret losing for the rest of their lifes. Its not an easy choice, but to carte blanche recommend that there is an easy answer doesn't fix the problem. Not every child who wasn't aborted went on to have a good life. (http://www.violentacres.com/archives/69/the-most-merciful-death-is-baby-death , this is a shocking story of one such instance, its graphic so don't read it if don't want to hear disturbing things)

But even some children who were conceived and were wanted go through terrible things. Its not helpful to the debate to polarize the issue into abortions for all or abortions for none, or let me lay out every possible scenario where I feel abortions are warranted. Its irrelevant what you believe. People need to be given information and supported during what could possibly be the hardest decision they have ever or will ever make. And then supported after they have made that decision. There are too many cirumstances and too many individual belief systems to make generalized statements and prohibitions about. And because it is an individual issue it needs to be left up to that individuals situation to come to a decision.

 

[DropkickMurphy]

I also don't understand the level of venom directed against physicians who are trying to live and practice according to a moral code which, other than not wanting to perform or refer for elective abortions, is not that much different than anybody else's.

Personally I don't have any venom for anyone refusing to do a procedure they find morally or personally repulsive (if I could get out of my med school OB rotations by refusing to deliver babies on moral grounds, I'd do it in a second).

The world is not going to explode if a few physicians try to live a decent and morally upright life. God knows there's not too much of that gonig around.

Normally, I agree with nearly every word that you post Panda, but I have to dissent on the matter at hand. I think more of us than you would like to think do live what we classify as decent and morally upright lives (I know I do). It's just that the morals we operate by happen to differ from yours (or for instance, unlike Mercaptowhat'shisname, I don't let religious tenets dictate black and white standards when what I am dealing with is a definite shade of grey).

 

[Wanna_B_Scutty]

For whatever it's worth, Belly will not have to refer (or even refer to someone else for a referral)- at least not as long as she is anywhere that receives federal funding. The following 2 laws apply to any institution that recieves federal $$$:


Medical Training Nondiscrimination Act of 1995
`SEC. 245. (a) IN GENERAL- The Federal Government, and any State that receives Federal financial assistance, may not subject any health care entity to discrimination on the basis that--
`(1) the entity refuses to undergo training in the performance of induced abortions, to provide such training, to perform such abortions, or to provide referrals for such abortions;
`(2) the entity refuses to make arrangements for any of the activities specified in paragraph (1); or
`(3) the entity attends (or attended) a postgraduate physician training program, or any other program of training in the health professions, that does not (or did not) require, provide or arrange for training in the performance of induced abortions, or make arrangements for the provision of such training.


Complete Text of the Hyde-Weldon Amendment
(1) None of the funds made available in this Act [the federal Health and Human Services appropriations bill for Fiscal Year 2005] may be made available to a Federal agency or program, or to a State or local government, if such agency, program, or government subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions. (2) In this subsection, the term "health care entity" includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.

 

[Wanna_B_Scutty]

I don't let religious tenets dictate black and white standards when what I am dealing with is a definite shade of grey).

What makes you think the moral question of abortion necessarily has to have anything to do with religion? I'm borderline agnostic- but I'm still pro-life. Why shouldn't there be room in secular morality to question the wisdom of letting the bigger, more powerful human being decide the moral status of the weaker, dependent human being? Especially when the bigger, more powerful human being has something to gain? Normally we call such a situation a conflict of interest.

 

[kelaskov]

If you're planning on seeking abortion training- please post your comments and information on the new thread Abortion Provider Training.
Many thanks!

http://forums.studentdoctor.net/showthread.php?t=376346&highlight=future+abortion+providers

 

[knv2u]

Personally, I don't see what the problem is. There is an ethical dilemma here, but it's not yours. If she wants an abortion all she has to do is check the yellow pages for "abortion providers." The preceding column is usually "abortion alternatives." She doesn't need a referral from you to go to one of these places, and you being against it won't stop her either. I think the best answer to this question is simply to advise her of a good, local (free) women's services center that specializes in pre-abortion and alternatives counseling (plus let's not forget post-abortion counseling). If she wants an abortion she already knows where to go...so referring her to a counseling service is the best option, even if you're ok with abortion. It's the ultimate irrevocable decision, so it's only reasonable to consider the other options first.

I suppose one snag to this whole thing is the "referral" issue. Part of the question could be that she needs your referral for her HMO to pay for the specialist/procedure. First of all, if she's going to use her parent's medical insurance then they will find out anyway...so it's best to encourage her to talk to them beforehand (assuming emancipation state). Secondly, the only thing I can say is that when I worked at CIGNA no referral was required for OB/GYN or abortion procedures. Obviously this will not be the case with every insurance company, but I would imagine the two top possibilities will be 1) no coverage or 2) no referral. If abortion is covered, requiring a referral for something like this could be considered hindering a woman's right to an abortion (since her PCP must "approve" her to go have it done), so I think it's reasonable that the above two plan types will be number one and number two.

This.

 

[knv2u]

Not in any more of a sense that taking out any other clump of cells (biopsy, cancer, etc) is killing.

Removal of the cells you speak of does not kill an entire organism.

 

[knv2u]

I'm even fine with doctors giving their personal opinions to their patients (though I wouldn't on this matter, it's none of my business) as long as they refrain from judging and coercing, and as long as they refer appropriately.

This is a fairly reasonable compromise IMO.

 

[knv2u]

Quite the contrary; you don't seem to be very well-informed about teens and their cognitive development. You are making them into little adults, and the science isn't there to support what you are saying. Appreciation of consequences doesn't fully kick in until well after 14, knowledge of their bodies, resources, support networks, and other concepts require a lot more insight than the typical teenager possesses.

I could very well be judgmental, but given my clinical background in medical ethics, I think I'm qualified to state when an opinion might be uninformed, contradictory, or poorly argued.

I find it excessively ironic that you admit that "[a]ppreciation of consequences doesn't fully kick in until well after 14, knowledge of their bodies, resources, support networks, and other concepts require a lot more insight than the typical teenager possesses." Since a good number of your posts address informed consent, isn't part of informed consent having the ability to understand and rationally process the information that is provided to you? If so, your argument above would support the inference that a 14 year old is unable to give informed consent and thus should not be referred to an abortionist by the physician. Rather, the parents should be contacted to make the decision on behalf of their very young daughter, which seems inconsistent with the tenor of your posts.

Also, with regards to scientific "evidence," I find it disconcerting how many social scientists and the APA can take seemingly contradictory positions when they find it convenient. At times, some in the APA have suggested that the competency necessary for abortion decisions is there, yet, the same organization wrote an amicus brief in Roper v. Simmons to argue that the same population/age group lacks the ability to process information effectively, understand the nature and consequences of their action, to effectively evaluate alternatives, or to evaluate their resources/support networks such that they cannot be held responsible for other life and death situations that are more clear cut (i.e. capital murder). How can they not be mentally competent to make a decision (and thus suffer the consequences under law) for the latter which is fairly clear, but be more than competent to make another life or death decision that is admittedly much more complex (i.e. abortion)?

 

[knv2u]

Nope. If you, as a physician, are morally opposed to elective abortion it wouldn't matter whether or not there were other physicians in town. The patient is out of luck. She's either going to have the baby or find a back-alley abortionist which is, either way, her choice.

You guys are "pro-choice," right? Why is it that you make such a big deal about abortion being a woman's exclusive choice about which no one may dare comment and then you try to drag everybody into it?

I also don't understand the level of venom directed against physicians who are trying to live and practice according to a moral code which, other than not wanting to perform or refer for elective abortions, is not that much different than anybody else's. The world is not going to explode if a few physicians try to live a decent and morally upright life. God knows there's not too much of that gonig around.

+1