OB/GYN against contraception?

[Hurricane]

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http://www.cnn.com/2006/POLITICS/11/17/family.planning.ap/index.html

Contraception, abortion foe to head family-planning office
POSTED: 1:09 p.m. EST, November 17, 2006

WASHINGTON (AP) -- The Bush administration, to the consternation of its critics, has picked the medical director of an organization that opposes premarital sex, contraception and abortion to lead the office that oversees federally funded teen pregnancy, family planning and abstinence programs.

The appointment of Eric Keroack, a Marblehead, Massachusetts, obstetrician and gynecologist, to oversee the federal Office of Population Affairs and its $283 million annual budget has angered family-planning advocates.

Keroack currently is medical director of A Woman's Concern, a Christian nonprofit. The Dorchester, Massachusetts-based organization runs six centers in the state that offer free pregnancy testing, ultrasounds and counseling.

It also works to "help women escape the temptation and violence of abortion," according to its statement of faith. And it opposes contraception, saying its use increases out-of-wedlock pregnancy and abortion rates.

"A Woman's Concern is persuaded that the crass commercialization and distribution of birth control is demeaning to women, degrading of human sexuality and adverse to human health and happiness," its contraception policy reads in part.

"The appointment of anti-birth control, anti-sex education advocate Dr. Eric Keroack to oversee the nation's family planning program is striking proof that the Bush administration remains dramatically out of step with the nation's priorities," Cecile Richards, president of the Planned Parenthood Federation of America, said in a statement.

A message left with A Woman's Concern was not immediately returned Friday.

Keroack's appointment as deputy assistant secretary for population affairs does not require Senate confirmation. He is expected to start work in the next several weeks, Department of Health and Human Services spokeswoman Christina Pearson said.

The department's assistant secretary for health, Dr. John Agwunobi, cited Keroack's experience in working primarily with "women and girls in crisis" in lauding his appointment.

"He regularly speaks to youth audiences on sexual risk behaviors and has been nationally recognized for his work on preventing teen pregnancy," Agwunobi said.

Politics aside, I don't think I've ever personally met an ob doc who was opposed to contraception, so I'm curious how this works in practice. Do they tell your patients up front that you are morally opposed to an entire class of meds and not to bother calling for a plan B script?

 

[dpmd]

It also makes me wonder whether they would be against prescribing OCP's to treat dysmenorrhea, PCOS, dysfunctional uterine bleeding, and endometriosis.

 

[curious1]

not telling patients about all their contraceptive options could be considered malpractice

 

[Hurricane]

not telling patients about all their contraceptive options could be considered malpractice

I agree. I also think it is malpractice when some religious hospitals make it their policy to not inform rape victims about emergency contraception options. It's one thing if you choose to go to a doctor or hospital knowing in advance about this policy. But if a rape victim calls 911, and they are unlucky enough to have been raped in the catchment area of one of these hopsitals and never get a choice in the matter, that's wrong.

 

[beetlerum]

I agree. I also think it is malpractice when some religious hospitals make it their policy to not inform rape victims about emergency contraception options. It's one thing if you choose to go to a doctor or hospital knowing in advance about this policy. But if a rape victim calls 911, and they are unlucky enough to have been raped in the catchment area of one of these hopsitals and never get a choice in the matter, that's wrong.

But if you're morally opposed to contraception, it gets complicated. You might believe it's morally wrong to encourage people to commit a wrong act (using contraception).

 

[Hurricane]

But if you're morally opposed to contraception, it gets complicated. You might believe it's morally wrong to encourage people to commit a wrong act (using contraception).

I would argue that hiding information from patients so they won't make choices you disagree with is morally ambiguous at best.

Informing the patient of what options exist and letting her decide for herself does not equal encouraging. Also, because time is of the essence with EC, censoring that information in effect removes a choice that is currently the patient's legal right, whether they like it or not. Esp since a rape victim brought by EMS doesn't typically choose which hospital the ambulance brings them to - she just had the added misfortune of being raped in the wrong city block. If they want the law to change, they can write their congressman.

I just can't see why someone who is morally opposed to contraception would go into OB/GYN knowing that it's such a large part of that particular field's scope of practice. (Same with the pharmacists who refuse to dispense OCs.) It seems akin to a scientologist going into psychiatry. And if a scientologist did go into psychiatry, then refused to prescribe an antipsychotic to his schizophrenic patient, he'd be subject to lawsuits, censure by the AMA, legal action, etc. Why do Christians get a free pass when they refuse on moral grounds to do something that's in their job description?

 

[beetlerum]

I would argue that hiding information from patients so they won't make choices you disagree with is morally ambiguous at best.

But again, to somneone who thinks it's really immoral, it's not just something they disagree with. Let me give you an example. Suppose you had a patient whose newborn had a terrible problem that would require lifelong care. Now let's say you knew of a surefire way for the parents to kill the child without getting caught. Would you offer advice so they could decide whether to murder their newborn? Of course not, because you believe (I'm assuming) that it's really immoral to murder a newborn, and you wouldn't want to encourage that in any way, even by giving information.

Now you'll say this is an absurd comparison. I agree. However, that's because we don't think it's immoral to use contraception. The really problem here isn't that you think doctors should provide advice on doinig things they consider immoral. The problem is that you adamantly disagree with the position that using contraception is terribly immoral.

To be honest, I wouldn't respect someone who considered contraception to be immoral but gave patients information to help them engage in this practice the person regarded as immoral.

However, I have trouble respecting the belief that contraception is immoral in the first place.

I just can't see why someone who is morally opposed to contraception would go into OB/GYN knowing that it's such a large part of that particular field's scope of practice.

Yeah, I agree. And you should still be subject to malpractice suits, because malpractice is based on the standard of care, not on your personal opinions about right and wrong.

 

[Hurricane]

But again, to somneone who thinks it's really immoral, it's not just something they disagree with. Let me give you an example. Suppose you had a patient whose newborn had a terrible problem that would require lifelong care. Now let's say you knew of a surefire way for the parents to kill the child without getting caught. Would you offer advice so they could decide whether to murder their newborn? Of course not, because you believe (I'm assuming) that it's really immoral to murder a newborn, and you wouldn't want to encourage that in any way, even by giving information.

Now you'll say this is an absurd comparison. I agree. However, that's because we don't think it's immoral to use contraception. The really problem here isn't that you think doctors should provide advice on doinig things they consider immoral. The problem is that you adamantly disagree with the position that using contraception is terribly immoral.

To be honest, I wouldn't respect someone who considered contraception to be immoral but gave patients information to help them engage in this practice the person regarded as immoral.

However, I have trouble respecting the belief that contraception is immoral in the first place.

Infanticide is so morally repugnant to the vast majority of our society that it is illegal. Thus I do not have an obligation to provide information about that to my patients. Contraception OTOH, while immoral to some, has been deemed legal by the society in which we choose to live, work and benefit from. More than that, it has been deemed standard of care by the boards that certify us doctors to practice, i.e. it is recommended. When you sit for your boards, you agree to abide by these recommendations. Thus it is malpractice to purposely withold information about an accepted medical option to a patient.

I do not believe it is the doctor's place to impose their moral beliefs onto their patients. They should rise above their personal political agendas and let the patient exercise her right to make an informed decision among all of the medically and legally accepted treatment options. Give an opinion if asked, but do not lie or withhold information. If the doctor feels so passionately about this issue that he can't allow his patients the autonomy to which they are entitled, then perhaps they've picked the wrong vocation, and they should become involved in politics, religion, activism, etc rather than direct patient care.

If, using your example, our society came to accept infanticide - congress passed a law decriminalizing it, the medical boards accepted it as standard of care, the FDA approved medications for this indication - then I would have an obligation to give this information to my patients, along with viable alternatives. And let them choose. I wouldn't like it, so I'd probably try to avoid putting myself in situtations requiring me to treat patients with which this issue would come up. And in my spare time, I'd write my congressman, write opinion pieces and make monetary contributions to activist groups that support my beliefs.

I guess the underlying question is: who do you put first - your patient or yourself?

 

[beetlerum]

I guess the underlying question is: who do you put first - your patient or yourself?

It is true that our society (not all societies) feels that way about infanticide. But I find your idea of morality by consensus a little disturbing. Suppose you were a physician in the time of slavery. Would you abide by the morality of that day? Isn't the point of morality that it is more fundamental than just what people think. Can't we say that the morality of some societies was just plain wrong? It was wrong for society to support slavery, it was wrong for the Third Reich to kill jews, etc.

And it is the whole idea of morality that you impose it on others. I mean, an infant killer could say you're imposing your morality on him, one he doesn't necessarily share. A moral belief is one that applies by definition to everyone. There's no "it's immoral for me to kill, but not for you." It is hard for us to understand, but certainly someone could feel the same way about contraception. I think the answer is rather than to say that there are acceptable moral beliefs and there are unacceptable moral beliefs. It is simply not immoral to use contraception. Anyone could adopt a different rule for their personal behavior, but they're simply wrong if they try to turn it into morality.

Malpractice is a totally different story. That's based on a communally set standard.

 

[8744]

not telling patients about all their contraceptive options could be considered malpractice

No. It's can't. Same with not referring for or discussing abortion. Sorry.

Now, I don't imagine too many OB-Gyn groups would want to hire this guy and he might lose privileges at some hospitals but if he's willing to go it alone there's not too much anybody can (or should) do to stop him.

I am always amazed at how conservative most of you are. You talk a good game about celebrating diversity and being open-minded but you are lightening-quick to jump on anybody who does things differently. As if one guy who doesn't want to give out birth control is really a threat to your weltanschung.

The correct response is to not get all sanctimonious and puritanical and say, "Different strokes for different folks. I'd never go to that doctor but you know what? That's just me and while I don't agree with the guy, I'll fight for his right to live his ideals."

 

[8744]

Infanticide is so morally repugnant to the vast majority of our society that it is illegal. Thus I do not have an obligation to provide information about that to my patients. Contraception OTOH, while immoral to some, has been deemed legal by the society in which we choose to live, work and benefit from. More than that, it has been deemed standard of care by the boards that certify us doctors to practice, i.e. it is recommended. When you sit for your boards, you agree to abide by these recommendations. Thus it is malpractice to purposely withold information about an accepted medical option to a patient.

I do not believe it is the doctor's place to impose their moral beliefs onto their patients. They should rise above their personal political agendas and let the patient exercise her right to make an informed decision among all of the medically and legally accepted treatment options. Give an opinion if asked, but do not lie or withhold information. If the doctor feels so passionately about this issue that he can't allow his patients the autonomy to which they are entitled, then perhaps they've picked the wrong vocation, and they should become involved in politics, religion, activism, etc rather than direct patient care.

If, using your example, our society came to accept infanticide - congress passed a law decriminalizing it, the medical boards accepted it as standard of care, the FDA approved medications for this indication - then I would have an obligation to give this information to my patients, along with viable alternatives. And let them choose. I wouldn't like it, so I'd probably try to avoid putting myself in situtations requiring me to treat patients with which this issue would come up. And in my spare time, I'd write my congressman, write opinion pieces and make monetary contributions to activist groups that support my beliefs.

I guess the underlying question is: who do you put first - your patient or yourself?

Are you ****ing crazy? All 299,999,999 Americans besides me could decide that killing children was hunky dory and it would still be wrong and I would have nothing to do with it.

Oh yeah. I'm going to help you kill your baby but it'll make me really, really mad and I'm so going to write my congressman!

You demonstrate perfectly the inexplicable lack of moral clarity in the modern world. I have my faults and I am certainly no plaster saint but I believe I know what Christ wants me to do. If that conflicts what my patient wants then I'm just gonna have to take God's side. Sorry.

500th time I have said this: Medicine is not a cult. You don't have to surrender your morality, your political beliefs, your friends, or family to its service. It's just a job, more interesting and better paying than most but still a job.

All of you should recoil in disgust at anybody in the medical profession who asks you to violate your own moral code, whatever it is, and you should rally around people who are probably pretty decent doctors, just a little off the mainstream.

In this sense I, for one, will fight for your right to practice medicine in accordance to your beliefs even if your beliefs are contradictory to mine.

 

[8744]

Infanticide is so morally repugnant to the vast majority of our society that it is illegal. Thus I do not have an obligation to provide information about that to my patients. Contraception OTOH, while immoral to some, has been deemed legal by the society in which we choose to live, work and benefit from. More than that, it has been deemed standard of care by the boards that certify us doctors to practice, i.e. it is recommended. When you sit for your boards, you agree to abide by these recommendations. Thus it is malpractice to purposely withold information about an accepted medical option to a patient.

I do not believe it is the doctor's place to impose their moral beliefs onto their patients. They should rise above their personal political agendas and let the patient exercise her right to make an informed decision among all of the medically and legally accepted treatment options. Give an opinion if asked, but do not lie or withhold information. If the doctor feels so passionately about this issue that he can't allow his patients the autonomy to which they are entitled, then perhaps they've picked the wrong vocation, and they should become involved in politics, religion, activism, etc rather than direct patient care.

If, using your example, our society came to accept infanticide - congress passed a law decriminalizing it, the medical boards accepted it as standard of care, the FDA approved medications for this indication - then I would have an obligation to give this information to my patients, along with viable alternatives. And let them choose. I wouldn't like it, so I'd probably try to avoid putting myself in situtations requiring me to treat patients with which this issue would come up. And in my spare time, I'd write my congressman, write opinion pieces and make monetary contributions to activist groups that support my beliefs.

I guess the underlying question is: who do you put first - your patient or yourself?

You have it backwards. The patient who asks you to act contrary to your beliefs is attempting to impose his moral beliefs on you, not the other way around.

Apparently, not only do patients now feel entitled, for free, to your time, your services, your equipment but now they are entitled to dictate your morality.

Amazing.

 

[erichaj]

Are you ****ing crazy? All 299,999,999 Americans besides me could decide that killing children was hunky dory and it would still be wrong and I would have nothing to do with it.

Oh yeah. I'm going to help you kill your baby but it'll make me really, really mad and I'm so going to write my congressman!

You demonstrate perfectly the inexplicable lack of moral clarity in the modern world. I have my faults and I am certainly no plaster saint but I believe I know what Christ wants me to do. If that conflicts what my patient wants then I'm just gonna have to take God's side. Sorry.

500th time I have said this: Medicine is not a cult. You don't have to surrender your morality, your political beliefs, your friends, or family to its service. It's just a job, more interesting and better paying than most but still a job.

All of you should recoil in disgust at anybody in the medical profession who asks you to violate your own moral code, whatever it is, and you should rally around people who are probably pretty decent doctors, just a little off the mainstream.

In this sense I, for one, will fight for your right to practice medicine in accordance to your beliefs even if your beliefs are contradictory to mine.

What if (and I'm not saying either way) but what if I run an abortion clinic. You said in your last sentence that you will "fight for my right to practice medicine in accordance to my beliefs". So that means you have to support doctors who work in abortion clinics and do abortions even if their view is contradictory to yours, RIGHT?

 

[RisingSun]

Oh yeah. I'm going to help you kill your baby but it'll make me really, really mad and I'm so going to write my congressman!

Hurricane wasn't advocating killing babies - he was making the point that regardless of how you feel about a medical option, as a physician you have a duty to present that option to your patient as an alternative. He/she said that it was morally repugnant and not something that he would ever practice. Mentioning something as a viable, legally accepted (though morally contentious) alternative is not the same thing as doing it.

Shouldn't our role be to at least discuss alternatives with our patients, regardless about how we feel about them? The ball is then in the patient's court on how to act.

 

[erichaj]

Hurricane wasn't advocating killing babies - he was making the point that regardless of how you feel about a medical option, as a physician you have a duty to present that option to your patient as an alternative. He/she said that it was morally repugnant and not something that he would ever practice. Mentioning something as a viable, legally accepted (though morally contentious) alternative is not the same thing as doing it.

Shouldn't our role be to at least discuss alternatives with our patients, regardless about how we feel about them? The ball is then in the patient's court on how to act.

Our role is to educate. You don't have to write for pain pills or OCPs or anything else. You do have to educate.

The patient can then choose how they want to proceed based on the information available and treatments available to date.

This physician acted arrogantly.

 

[beetlerum]

Our role is to educate. You don't have to write for pain pills or OCPs or anything else. You do have to educate.

The patient can then choose how they want to proceed based on the information available and treatments available to date.

This physician acted arrogantly.

So what is the scope of what the physician has to recommend, assuming medical relevance? Anything that is legal? Anything that society considers moral, however that is determined?

 

[erichaj]

So what is the scope of what the physician has to recommend, assuming medical relevance? Anything that is legal? Anything that society considers moral, however that is determined?

1. Morality is not the physicians concern when giving medical advice. What I mean by that is that if a physician is against abortions he still has to tell the patient that this option there. He can say that his opinion is that he does not like the option.

2. Lets say a patient has cancer and you are an oncologist. Lets say you know of an experimental procedure (like many of the treatments now) (not alternative) and you choose not to share it with your patient. If the patient dies and the family finds out, they can sue you for not disclosing all the treatment options. If you look at consent forms, they will talk about complications, and alternative treatments available.

3. The scope that the physician has to educate the patient about is the standard of care. What is acceptable currently in the United states for care for a specific disease or treatment.

OCPs are considered standard of care. You don't have to write for them, but you do have to educate your patient if they ask or find someone that will.

 

[beetlerum]

1. Morality is not the physicians concern when giving medical advice. What I mean by that is that if a physician is against abortions he still has to tell the patient that this option there. He can say that his opinion is that he does not like the option.

2. Lets say a patient has cancer and you are an oncologist. Lets say you know of an experimental procedure (like many of the treatments now) (not alternative) and you choose not to share it with your patient. If the patient dies and the family finds out, they can sue you for not disclosing all the treatment options. If you look at consent forms, they will talk about complications, and alternative treatments available.

3. The scope that the physician has to educate the patient about is the standard of care. What is acceptable currently in the United states for care for a specific disease or treatment.

OCPs are considered standard of care. You don't have to write for them, but you do have to educate your patient if they ask or find someone that will.

If you think a doctor always must follow the standard of care, consider this scenario. Suppose it became socially accepted and legal to murder girls who didn't start menstruating by a certain age? Since other doctors accept it, it becomes a part of the standard of a care. Does a doctor then have the duty to mention that as a medical option for girls who are approaching that age without menstruating?

Is it even possible to avoid morality in this conversation? We are talking about a doctor's duties, what he "should" do. Isn't this a matter of professional ethics?

Then there's the development of the evolving standard of care. Should it include anything that's legal? What the community considers ethical? Since the standard evolves through practice, it doesn't seem so easy to separate the "standard of care" from what a doctor should do in an individual case.

 

[Hurricane]

No of course I wasn't advocating baby killing. 🙄 That's what I get for trying to play along with such an absurd hypothetical example.

Anyway, I still stand by my statement that it's not the physician's place to impose his moral beliefs onto his patients. The alternative smacks of arrogance as it implies that one's patients are too feeble minded to think for themselves or make decisions based on their own moral code, which must surely be wrong if it differs from that of Doctor Knows Best.

Also, as others have pointed out, there is a difference between educating and facilitating. A physician is well within his rights to not prescribe OCs or ECs, but not to lie or willfully withhold information about their existence or availability in an effort to manipulate the patient into making a "choice" he agrees with. Informed consent is one of the tenents of medicine, and patients are deprived of this right when physicians behave in this manner.

Panda, I enjoy your blog and have always respected your comments on SDN even when I disagree with your position. But are you really advocating being dishonest with your patients for fear they might disagree with you??

 

[beetlerum]

No of course I wasn't advocating baby killing. 🙄 That's what I get for trying to play along with such an absurd hypothetical example.

Anyway, I still stand by my statement that it's not the physician's place to impose his moral beliefs onto his patients. The alternative smacks of arrogance as it implies that one's patients are too feeble minded to think for themselves or make decisions based on their own moral code, which must surely be wrong if it differs from that of Doctor Knows Best.

Also, as others have pointed out, there is a difference between educating and facilitating. A physician is well within his rights to not prescribe OCs or ECs, but not to lie or willfully withhold information about their existence or availability in an effort to manipulate the patient into making a "choice" he agrees with. Informed consent is one of the tenents of medicine, and patients are deprived of this right when physicians behave in this manner.

Panda, I enjoy your blog and have always respected your comments on SDN even when I disagree with your position. But are you really advocating being dishonest with your patients for fear they might disagree with you??

So when the standard of care is defined, what is the scope of options? Anything that's legal? Does that mean if we outlawed contraception, you would say that's off the table?

And in my hypothesis about menstruation, you would say the physician is obligated to educate the parents about the option of killing the girl?

Final point, I mentioned this before, but it got ignored: isn't morality something we're supposed to impose on others? Don't you say people shouldn't do things because they're immoral, and judge them when they do those things? If I say that I want to kill my sister because she annoys me, wouldn't you say I shouldn't because it's immoral? That seems like imposing your morality on me yet it seems fine. If you see a man about to kill a baby and you stop him, and he complains that you're imposing your morality on him, don't you think the proper answer is that yes, you're imposing it on him because people shouldn't kill babies. Morality refers to things we think people should or shouldn't do, apart from their own preferences.

 

[trustwomen]

Now, I don't imagine too many OB-Gyn groups would want to hire this guy and he might lose privileges at some hospitals but if he's willing to go it alone there's not too much anybody can (or should) do to stop him.
As if one guy who doesn't want to give out birth control is really a threat to your weltanschung.

The correct response is to not get all sanctimonious and puritanical and say, "Different strokes for different folks. I'd never go to that doctor but you know what? That's just me and while I don't agree with the guy, I'll fight for his right to live his ideals."

Um, this guy IS a threat to our "worldview" (now wouldn't it have been easier to just write that?). He is now in charge of the FEDERAL FAMILY PLANNING PROGRAM, as the OP stated. Appointed position, no legislative input. Most OB/GYN groups wouldn't want to hire him, you're right, but he's just dandy for GWB. Keroack has some wacky claims ("premarital sex sets off a biochemical process that permanently changes your brain and interferes with the ability to forge a solid relationship later on", stuff like that - totally discredited by the scientific community).

I'd never go to that guy, but he will wind up influencing if not making policy for a whole lot of people who would never have chosen to go to him either. Kinda like David Hager, GWB's appointee at the FDA - the OB who not only refused to give birth control to his unmarried patients, but also prescribed (only) prayer as a cure for menstrual pain.

This isn't just some unprofessional hack of a doctor that upsets his patients - it's a guy with actual power and influence. That is indeed disturbing. (Though there have been so many other disturbing appointments to so many important posts in the past six years, I'll admit I'm a bit stumped why people are suddenly mentioning this one. Bravado due to reclaiming the legislature, perhaps?)

 

[erichaj]

So when the standard of care is defined, what is the scope of options? Anything that's legal? Does that mean if we outlawed contraception, you would say that's off the table?

And in my hypothesis about menstruation, you would say the physician is obligated to educate the parents about the option of killing the girl?

Final point, I mentioned this before, but it got ignored: isn't morality something we're supposed to impose on others? Don't you say people shouldn't do things because they're immoral, and judge them when they do those things? If I say that I want to kill my sister because she annoys me, wouldn't you say I shouldn't because it's immoral? That seems like imposing your morality on me yet it seems fine. If you see a man about to kill a baby and you stop him, and he complains that you're imposing your morality on him, don't you think the proper answer is that yes, you're imposing it on him because people shouldn't kill babies. Morality refers to things we think people should or shouldn't do, apart from their own preferences.

IF you come up with some unrealistic scenario, this discussion will never go anywhere. What if someone from mars came here and said we shoud all be gay. come on. come back to reality.

Moral are what others that feel they are right about something place on others. These may be different for most but most can agree that murder is not appropriate.

Now you have to agree on the definition of murder. And I can say that most have.

Murder and birth control pills are hardly the same thing.

I know where YOU are going with it. because YOU think that any kind of contraception is murder. So, don't use it and don't force your views on others.

Laws are made for the masses, not for just one group. Democracy is about everyone not just a group of people. If everyone felt like you there would be no need for voting or laws.

Get over yourself.

 

[beetlerum]

I know where YOU are going with it. because YOU think that any kind of contraception is murder. So, don't use it and don't force your views on others.

Aren't you trying to impose your view that they're not the same?

 

[erichaj]

Aren't you trying to impose your view that they're not the same?

I'm simply saying that if you walk into a doctors office, and ask about it, it is his or her obligation to either tell the patient where they can go to get the info they need or educate them in it.
That is a neutral stance. It means that I won't try to CHOOSE for the patient. I'm not the moral monitor, I'm their doctor. I won't impose my moral views on someone else. I won't tell them my value system is better.

If I did those things OR if I felt that it is my obligation to do those things then I would be a very rigid person. There is a name for some of those rigid people, they are called terrorists.

So, I would not want to be so rigid.

 

[trustwomen]

Final point, I mentioned this before, but it got ignored: isn't morality something we're supposed to impose on others? Don't you say people shouldn't do things because they're immoral, and judge them when they do those things? If I say that I want to kill my sister because she annoys me, wouldn't you say I shouldn't because it's immoral? That seems like imposing your morality on me yet it seems fine. If you see a man about to kill a baby and you stop him, and he complains that you're imposing your morality on him, don't you think the proper answer is that yes, you're imposing it on him because people shouldn't kill babies. Morality refers to things we think people should or shouldn't do, apart from their own preferences.

There is a way that society imposes morality on its members. It's called the law. There is a way that doctors impose their collective morality on others. It's called accepted standards of practice. Anything that goes above and beyond those things in the attempt to impose morality on others is unprofessional and inappropriate in my opinion.

Now, in the US you have a lot of leeway to impose your "above and beyond" views on others' care. At least when those views are conservative christian ones: you'd have a hell of a time defending the right to refuse to refer for circumcision, for instance. But you get to legally refuse to refer for abortion or contraception, or even discuss it. In saner countries you cannot do this. You are expected to conform to the standard of care that has been deemed acceptable and appropriate for the community, just like a Jehovah's witness physician is expected to order and perform blood transfusions that are against his or her moral vision of the world.

 

[beetlerum]

There is a way that society imposes morality on its members. It's called the law. There is a way that doctors impose their collective morality on others. It's called accepted standards of practice. Anything that goes above and beyond those things in the attempt to impose morality on others is unprofessional and inappropriate in my opinion.

Now, in the US you have a lot of leeway to impose your "above and beyond" views on others' care. At least when those views are conservative christian ones: you'd have a hell of a time defending the right to refuse to refer for circumcision, for instance. But you get to legally refuse to refer for abortion or contraception, or even discuss it. In saner countries you cannot do this. You are expected to conform to the standard of care that has been deemed acceptable and appropriate for the community, just like a Jehovah's witness physician is expected to order and perform blood transfusions that are against his or her moral vision of the world.

Fair enough, this seems like a coherent position. But I think this view would have to commit you in my hypothetical to saying that yes, the doctor should provide information on killing the girl as an option. Because you are saying that morality should only enter the picture in the profession's collective decision making to create the standard of care. Dissenting views cannot enter into how an individual doctor practices.

Complaining that the hypothetical is unrealistic is silly. That's the point. Anyway, it's not quite as unrealitic as it may seems. It is not impossible to imagine a society that could have that rule. Some societies have come close to endorsing the killing of infant girls.

Another problem with this view is that it seems to create a false dichtonomy between the creation and application of the standard of care.

 

[dpmd]

I don't think anyone is saying that you shouldn't have your own moral beliefs. I don't think anyone is even saying you should advocate for and encourage treatments that are against your beliefs. It sounds like people are stating that you should present all medically relevant alternatives for a patient before proceeding with treatment. This is what is done during the formal "informed consent" process for surgeries and such.

However, I believe that this process is the root of all good patient care. If a patient comes in with high blood pressure, the physician should inform the patient of various methods of controlling this, expected side effects of various medications versus lifestyle changes, and then provide a medical opinion based on the best interest of the patient. It could be that the patient has no desire to make any lifestyle changes, and doesn't want to take anything that might affect their sex life. In that case, the physician has to work within this framework and try to help the patient. It does not mean the physician has to tell the patient what a repulsive slug they are and that if they don't want to exercise they should just go away and die-even if the physician feels strongly in personal responsibilty as a value.

If a patient comes in stating they want to have sex and not worry about having a baby you have to either be willing to discuss the medically accepted ways of doing this, or be willing to say that your beliefs don't allow you to provide this info, but here is someone else you can discuss this with. If we want to go with your example, if the parents asked about how to kill the kid you could say that you don't believe in killing kids but here is the name of someone you could discuss this with (if it was considered standard healthcare for nonmenstruating girls to be killed-a highly unlikely scenario in this culture). If they don't ask, you don't have to bring it up, just like you don't have to ask every girl if they want birth control.

 

[trustwomen]

Fair enough, this seems like a coherent position. But I think this view would have to commit you in my hypothetical to saying that yes, the doctor should provide information on killing the girl as an option. Because you are saying that morality should only enter the picture in the profession's collective decision making to create the standard of care. Dissenting views cannot enter into how an individual doctor practices.

Complaining that the hypothetical is unrealistic is silly. That's the point. Anyway, it's not quite as unrealitic as it may seems. It is not impossible to imagine a society that could have that rule. Some societies have come close to endorsing the killing of infant girls.

Another problem with this view is that it seems to create a false dichtonomy between the creation and application of the standard of care.

I never complained about, or addressed, any hypotheticals. I think you are thinking of someone else.

If a profession required me to do things I find immoral I would not enter that profession. It's one of the reasons I'm not in law or business. I would not be able, as a CEO, to fulfill my legal requirement to protect my shareholders' interests if it meant violating my moral beliefs (and I can think of so many situations in which this could happen). That's why I didn't and wouldn't go into that field. I would never practice medicine in Saudi Arabia no matter how much money they throw at me, because I could never meet the standards of practice over there without losing my mind.

If I understand your hypothetical correctly, what I would do is quit medicine entirely, in disgust, and get really vocal and political about what I thought was morally wrong in the legal options available. Or (more likely) move somewhere where I could practice medicine with a clear conscience (while simultaneously getting really vocal and political about what's happening in my previous country). I already have a mental list of countries I could move to if Canada goes all freaky right-wing.

 

[Hurricane]

Final point, I mentioned this before, but it got ignored: isn't morality something we're supposed to impose on others? Don't you say people shouldn't do things because they're immoral, and judge them when they do those things?

There is a difference between 1) being upfront and stating that you are morally opposed to something and therefore cannot provide a particular service to your patient and 2) lying and omitting information in an effort to manipulate your patient into making the "decision" that you believe is the morally correct one. Dishonesty - no matter how noble the intentions - undermines trust and the principles of informed consent.

In saner countries you cannot do this. You are expected to conform to the standard of care that has been deemed acceptable and appropriate for the community, just like a Jehovah's witness physician is expected to order and perform blood transfusions that are against his or her moral vision of the world.

I like this example. If Jehovah's Witnesses or Scientologists started lying to patients and not adhering to the standard of care, you can bet the medical establishment as well as the media would be up in arms. Why do right-wing Christians get a free pass in this country?

And I missed this part earlier:

The correct response is to not get all sanctimonious and puritanical and say, "Different strokes for different folks. I'd never go to that doctor but you know what? That's just me and while I don't agree with the guy, I'll fight for his right to live his ideals."

So the correct response is "different strokes for different folks" with regard to the doctor. But in regard to a patient with an opposing moral viewpoint, it's ok to lie and mislead them? That is a very arrogant and paternalistic attitude IMO. What makes a physician's moral compass more valid than that of their patient?

 

[docparacristo]

You all seem to be very informed on this issue. This is my first post here, so if it seems disorganized I apologize. First of all, I would argue that any doctor has a right to refuse a particular service that they are morally opposed to. If a patient inquires about certain types of contraception that may be, in the eyes of this ob-gyn, opposed to his concept of personhood, he or she has the right to say I'm opposed to that treatment. If the patient asks why, then he or she has the right to express why in their medical or personal opinion.

Now, having said that, somebody brought up a great point. If the patient is ever malliciously lied to, there is no way that should ever be excused. I would encourage all of us here to consider how we would react if we were asked to provide a service we were opposed to, whether the reasons be faith based, experience based, or medicine based.

Dios le bendiga en todo

Todd

 

[Miami_med]

There is a way that society imposes morality on its members. It's called the law. There is a way that doctors impose their collective morality on others. It's called accepted standards of practice. Anything that goes above and beyond those things in the attempt to impose morality on others is unprofessional and inappropriate in my opinion.

Now, in the US you have a lot of leeway to impose your "above and beyond" views on others' care. At least when those views are conservative christian ones: you'd have a hell of a time defending the right to refuse to refer for circumcision, for instance. But you get to legally refuse to refer for abortion or contraception, or even discuss it. In saner countries you cannot do this. You are expected to conform to the standard of care that has been deemed acceptable and appropriate for the community, just like a Jehovah's witness physician is expected to order and perform blood transfusions that are against his or her moral vision of the world.

There are so many things wrong with this very small post, I don't know where to begin. I know plenty of people who did not circumcise their children. I know one couple that wanted to, but no physician who took their insurance would do one for fear of legal reprocussions. It is perfectly sane for a doctor to not perform a procedure or dispense advice that is contradictory to their moral foundation. If there is no deceit, the patient can choose to see another doctor. Doctor's are not automitons who mindlessley follow arbitrary standards. You wouldn't want a person treating you in a way THEY disagreed with. I think we could all agree that a system that allows for opting out is worth it in the name of valid disclosure.

P.S. A JW can practice medicine without giving blood transfusions. He just has to choose a practice that doesn't give them. He can't prevent a patient from getting one, but he doesn't have to give it.