OB/GYN Personal Morals Issue

[Guest ABC]

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I know an M3 who is Catholic and just started doing an OB/GYN rotation at a public hospital. She is extremely upset that she will have to participate in procedures (abortion, hysterectomy, tubal ligation) or make referrals for those procedures because they are in direct conflict of her faith. Can anyone give some advice on what she can do to resolve this problem?

Her clerkship director told her that the assignments have already been made.

 

[smq123]

I know an M3 who is Catholic and just started doing an OB/GYN rotation at a public hospital. She is extremely upset that she will have to participate in procedures (abortion, hysterectomy, tubal ligation) or make referrals for those procedures because they are in direct conflict of her faith. Can anyone give some advice on what she can do to resolve this problem?

She doesn't have to particiapte in abortions or tubal ligations if she doesn't want to. Not sure about whether or not she'd have to make referrals.

HYSTERECTOMIES are in conflict with her faith?! 😕

 

[SoCuteMD]

She doesn't have to particiapte in abortions or tubal ligations if she doesn't want to. Not sure about whether or not she'd have to make referrals.

HYSTERECTOMIES are in conflict with her faith?! 😕

Yeah, I was wondering about this too. I did ob/gyn at a Catholic hospital and they didn't do tubals (uh, well, supposedly) but they did many hysterectomies.

As for making referrals, for some reason I thought that ob/gyns who refuse to provide abortion services were obligated to refer out those seeking abortions. Thus, your friend should have, at the very least, been prepared for this aspect of the clerkship. I'm sure smq knows more than I do on this issue though.

ETA: A little planning on her part could have made your friend's ob/gyn rotation a lot more pleasant - I'm sure that if she'd brought it to the attention of the clerkship director even as recently as a month ago she would have been placed on different services or at a different hospital.

 

[SouthernSurgeon]

Ok, as a fellow Catholic med student, here's my $.02:

1) Your friend absolutely does not have to participate in tubals, terminations, etc.

2) That being said, Catholic med students tend to get themselves in a mess in these situations. Why? They don't handle the issue well, and just spontaneously freak out at the team when an objectionable issue comes up.

What your friend needs to do is talk to someone now (before the rotation really gets going) - either the clerkship director or (if that person doesn't seem sympathetic) your dean of students. Discuss how to handle these issues before they become a big problem. It may be as simple as the clerkship director talking to the chief resident on that service. Or they may assign you to a rotation like gyn/onc where you can just avoid these types of cases.

I don't know what the solution would be at your particular school - but the key is communicating your concerns ahead of time, before you are in the "heat of the moment"

 

[SouthernSurgeon]

As for making referrals, for some reason I thought that ob/gyns who refuse to provide abortion services were obligated to refer out those seeking abortions .

This is the opposite of the current laws in most states. Catholic physicians have no obligation to provide referrals for abortions.

edit: I can't really see how a student would end up in a situation where they were making referrals...

 

[PeepshowJohnny]

HYSTERECTOMIES are in conflict with her faith?! 😕

To a Catholic, a hysterectomy for a non-life threatening cause is like taking your car to the junkyard because the paint got chipped.

Use that that thing until it prolapses to your knees, ladies.

 

[montessori2md]

http://www.catholicinsight.com/online/church/vatican/article_475.shtml

You know, it wasn't all that long ago that people thought epidurals were the devil's work too....it's a wonder the Church is ok with those, and C-sections too.

 

[EM2BE]

Be reminded that hysterectomies are okay if they are done for a medical reason outside "I don't want to have any more babies."

As far as the procedures go, if it is a bigger hospital, there may be other, more acceptable procedures going on that your friend can go in on instead of those she is opposed to. Agree with those above that a conversation could prevent the friend from bursting out at the wrong point, but the conversation can also cause conflict and/or affect the grade. I know morals are supposed to be put in front of grades, etc, but I also know some people that aren't that strong about their faith to do this.

 

[smq123]

As for making referrals, for some reason I thought that ob/gyns who refuse to provide abortion services were obligated to refer out those seeking abortions.

I'm not sure if they are actually. I don't think so, since most abortions are elective procedures. If they were for life threatening reasons, I think that most OB/gyns, even the very religiously devout, would not refuse to do them.

No IVF, birth control (of course), or infertility treatments too...

Eh. IVF and infertility treatments aren't a big deal, since very few 3rd year med students have any exposure to REI. Heck, most OB/gyn residents will never see a single infertility treatment, outside of clomid injections.

Birth control is kind of a bigger deal. You DO need to know how to counsel patients about birth control, even if it's for hormonal imbalances.

Be reminded that hysterectomies are okay if they are done for a medical reason outside "I don't want to have any more babies."

I sincerely hope that there are no OB/gyns in this country that are offering hysterectomies to avoid pregnancy, or agreeing to do them for that reason.

In a day and age where there are not one, but TWO, available IUDs on the market, hysterectomy as birth control is a ridiculous idea.

 

[howelljolly]

This is the opposite of the current laws in most states. Catholic physicians have no obligation to provide referrals for abortions.

edit: I can't really see how a student would end up in a situation where they were making referrals...

Where did you get that from?

I trained in a Catholic hospital where they made it abundantly clear that allthough the hospital will not perform any terminations of pregnancy, the physician is obligated to provide referrals... because a) the act of providing a referral isn't forbidden by the church. .... and b) the physican is obligated to ensure that the patient has access to a safe abortion, even if they dont perform it. And this obligation must be fulfilled by a referral.

Apparently, if the mother gets a coat hanger abortion and bleeds out, after being turned away from the Catholic hospital, the hospital is still responsable.

 

[SouthernSurgeon]

Where did you get that from?

I trained in a Catholic hospital where they made it abundantly clear that allthough the hospital will not perform any terminations of pregnancy, the physician is obligated to provide referrals... because a) the act of providing a referral isn't forbidden by the church. .... and b) the physican is obligated to ensure that the patient has access to a safe abortion, even if they dont perform it. And this obligation must be fulfilled by a referral.

Apparently, if the mother gets a coat hanger abortion and bleeds out, after being turned away from the Catholic hospital, the hospital is still responsable.

Here is a good start:

http://www.studentdoctor.net/pandabearmd/2005/12/13/a-subversive-thought/

The catholic hospital you are at may choose to refer - but they are under no legal obligation to do so in most states.

 

[howelljolly]

interesting... im sloshing through websites on this topic. I still dont know if its "most" states...

But it seems regardless of the physician's or institutions policy, an "indirect referral" may be required. Id est, you dont have to tell the patient "Go to Dr.X, and he'll do it." But you may be required to tell the patient that even though you won't do the abortion, some other physician physician will - and not to go to some random guy with a wire hanger.

 

[SouthernSurgeon]

interesting... im sloshing through websites on this topic. I still dont know if its "most" states...

But it seems regardless of the physician's or institutions policy, an "indirect referral" may be required. Id est, you dont have to tell the patient "Go to Dr.X, and he'll do it." But you may be required to tell the patient that even though you won't do the abortion, some other physician physician will - and not to go to some random guy with a wire hanger.

A website I read a while back (Catholic source I think) claimed that >40 states had some version of a "conscience clause" type law. I will try to look for it again.

I think the belief now is that there is enough widespread access to abortion (and awareness of its availability) that there is no obligation for referral.

From the Catholic perspective, most (devout) Catholics believe that the referral is complicit with the act, and thus are strongly opposed to obligatory referral laws.

 

[Guest ABC]

I spoke to my priest today about this. This is what he had to say:

1. Hysterectomies are permissible for medical reasons.

Regarding the other procedures, there are 2 categories in which they fall:

1. Formal cooperation - This is when you are actively involved in the procedures of abortion and tubal ligation. This is a major sin.

2. Material cooperation - This is when you make referrals for these procedures. This is permissible by the Catholic Church. This is a lesser sin that can be taken care of with confession.

These two categories reflect the "gray areas of sin" that are addressed by the Catholic Church.

SouthernIM, I would really appreciate your posting the states with the "concscience claus".

 

[howelljolly]

A website I read a while back (Catholic source I think) claimed that >40 states had some version of a "conscience clause" type law. I will try to look for it again.

I think the belief now is that there is enough widespread access to abortion (and awareness of its availability) that there is no obligation for referral.

From the Catholic perspective, most (devout) Catholics believe that the referral is complicit with the act, and thus are strongly opposed to obligatory referral laws.

Seems that there is a conscience clause in many states, though I cant figure out how many. However, I think the direct vs. indirect referral plays in here. They might get you out of having to make a direct referral, but not an indrect one.

The is definitely NOT the case that there is enough awareness about abortion and birth control so that a physician is not obligated to make some sort of referral. Patients are so grossly underinformed about these things its mind-boggling. And again, if a patient does something dangerous after a physician neglected to inform them adequately, the doc is held liable. The courts will never assume that the public is aware of all of their alternatives. Especially when the patient drags you into court and tells the judge and jury that all you told her was that you won't do the procedeure....

Look at the case thats going on now, a doc is being sued for 400grand because he didnt adequately inform a deaf patient about their condition because he communicated in writing rather than in sign language. And this is out of pocket, not covered by malpractice.

 

[SouthernSurgeon]

And again, if a patient does something dangerous after a physician neglected to inform them adequately, the doc is held liable.

I think that's the whole point of the conscience clauses - to prevent the doctor from being liable in a case like that.

 

[howelljolly]

I think that's the whole point of the conscience clauses - to prevent the doctor from being liable in a case like that.

In a way... its not that the doctor is not held "liable" when invoking the conscience clause. Its that they can not be reprimanded by their instituteion. They can still be held civilly liable i think.

And these laws protect the patient as well... so....

Im not that versed in the Law

Wheres Law2Doc when you need him?

 

[bjackrian]

I spoke to my priest today about this. This is what he had to say:

1. Hysterectomies are permissible for medical reasons.

Regarding the other procedures, there are 2 categories in which they fall:

1. Formal cooperation - This is when you are actively involved in the procedures of abortion and tubal ligation. This is a major sin.

2. Material cooperation - This is when you make referrals for these procedures. This is permissible by the Catholic Church. This is a lesser sin that can be taken care of with confession.

These two categories reflect the "gray areas of sin" that are addressed by the Catholic Church.

SouthernIM, I would really appreciate your posting the states with the "concscience claus".

I actually wrote my undergraduate thesis on this issue (Catholic medical ethics), and your priest is almost right. The distinction between formal and material cooperation is correct, but the church views both as wrong. Formal cooperation actually incurs a "latae sententiae" excommunication. That means that excommunication occurs by virtue of the act itself. In other words, in the eyes of a church, if a person participates in an abortion, he/she is considered excommunicated from the church even without action by the pope or a bishop. Incidentally, most of the other sins for which this occurs involve the church hierachy (e.g., trying to kill the pope, pretending to be a bishop, pretending to take confession as a priest, etc.).

On the material cooperation front, the church still views this as a sin, but it does not incur an automatic excommunication so it is seen as a "less bad" sin. This becomes an issue in Catholic hospitals because while Catholic hospitals are required to refer for abortions, birth control, etc. in at least some states, the church believes that it is immoral for them to do so. This results in a conflict between what the church is telling them to do and what the government is telling them to do and buts both Catholic hospitals and physicians working in Catholic hospitals in an awkward position. To date, there is no formal way around this problem.

If you are interested in the issue, you're welcome to read my thesis: http://home.gwu.edu/~brianjac/writing/Thesis.htm

FWIW, I don't agree with the above positions, but I thought it only fair that the church's positions be explained.

 

[Baditude]

I thought the Catholic church made a distinction between voluntary abortion (for birth control more or less) and a medically necessary abortion (tubal pregnancy incomplete spontaneous abortion etc).
I found on my Ob rotation someone was always willing to switch a surgery or a office visit with me if I did not feel good about what was happening. I had a different issue than you have ......I do not think most of these people should be having children...if you can not support yourself, if you do not have a place to live, if you do not have food, heat etc in the dump you live in you should not be having MORE children. I had a 25yo who was on baby #9 that is ridiculous!! Then I see 10 year old rape victims ...... they should be allowed to have an abortion to avoid the mental anguish from having to think about the rape every single day for the rest of their lives not to mention the damage done to her body because she is not physically mature enough to give birth I could go on and on and on.
There has to be wiggle room some where.
I have 2 children who I love with all my heart and I would have loved to have more but I could not raise them properly, educate them, clothe them, feed them etc the way they should be if I did so my husband had a vasectomy so I did not need major surgery and you can not tell me that God would look at that as a sin. I sure can not see an all loving God, who gave us all a brain and expects us to use those brains, could possibly punish someone for doing something that is in the best health, financial, personal and mental health of a family. Maybe I am wrong but I just don't think so.
I understand the need in the past for larger families. There was a huge infant mortality rate and young children died all the time from pneumonia, flu, tetanus etc. Larger families were also need to run family farms in order to be able to feed everyone and work the land but today those conditions are no longer present and I think that God set us on this path knowing improvements would be made and life adjustments would be made over all these years. But again maybe I am wrong.

 

[SouthernSurgeon]

I thought the Catholic church made a distinction between voluntary abortion (for birth control more or less) and a medically necessary abortion (tubal pregnancy incomplete spontaneous abortion etc).

Yes, that is correct. The reasoning is that in the case of say an ectopic, the intent underlying the procedure is to treat a disease in the mother (and, as an unintended but necessary consequence the baby will die).

The ridiculous baby-popper-outers was unbelievable and really pretty sad. I personally didn't make any kind of stink out of prescribing birth control - I realize that isn't in line w/ the Catholic church's thinking, but these women's problems were so different than anything I could relate to that I don't think I'm in any kind of place to judge.

Also, while the church says that birth control is bad, it also says that premarital sex is bad - and I don't really feel like the two things are additive. That is, I can't reason how it is a "worse" sin for a woman to have premarital sex with a condom than it is for her to have premarital sex without one. In those kind of cases I felt like the only issue we could effectively address was protecting the woman's health.

 

[bjackrian]

Yes, that is correct. The reasoning is that in the case of say an ectopic, the intent underlying the procedure is to treat a disease in the mother (and, as an unintended but necessary consequence the baby will die).

Yup. The principle is called double effects--it's the same thing that makes it morally permissible (in the church's view) to give high doses of morphine to a terminally ill patient with the intent of controlling pain even if that hastens that patient's death. Because the intent is good (controlling pain) the second effect (hastening death) is disregarded)

Also, while the church says that birth control is bad, it also says that premarital sex is bad - and I don't really feel like the two things are additive. That is, I can't reason how it is a "worse" sin for a woman to have premarital sex with a condom than it is for her to have premarital sex without one. In those kind of cases I felt like the only issue we could effectively address was protecting the woman's health.

There's actually a huge debate about this and double effects in Africa. If the intent of offering condoms is to prevent HIV transmission, then perhaps the second effect is contraception so it's morally permissible. Highly controversial in Catholic ethics, but it's definitely out there as a theory. Having said that, the official position is that contraception is bad period even if there are other mitigating factors.

 

[237696]

Yup. The principle is called double effects--it's the same thing that makes it morally permissible (in the church's view) to give high doses of morphine to a terminally ill patient with the intent of controlling pain even if that hastens that patient's death. Because the intent is good (controlling pain) the second effect (hastening death) is disregarded

Wow, that "double effects" principle could be a formal logics nightmare. Could it not be argued that the purpose for an elective abortion is noble (preserving a rape victim's mental health, preventing a situation in which a child would go without food, love, etc.) and the death of a fetus is the secondary effect? How is the distinction between a worthy or noble intent and an insufficient one determined without subjectivity? How would this apply to a selective reduction following IVF, where the intent may be to save the lives of both the mother and as many fetuses as possible?

 

[bjackrian]

Yup. The principle is called double effects--it's the same thing that makes it morally permissible (in the church's view) to give high doses of morphine to a terminally ill patient with the intent of controlling pain even if that hastens that patient's death. Because the intent is good (controlling pain) the second effect (hastening death) is disregarded

Wow, that "double effects" principle could be a formal logics nightmare. Could it not be argued that the purpose for an elective abortion is noble (preserving a rape victim's mental health, preventing a situation in which a child would go without food, love, etc.) and the death of a fetus is the secondary effect? How is the distinction between a worthy or noble intent and an insufficient one determined without subjectivity? How would this apply to a selective reduction following IVF, where the intent may be to save the lives of both the mother and as many fetuses as possible?

It comes from Thomas Aquinas if you want to read the original source. Essentially, it is subjective--you're right. It is usually described as weighing the consequences. Quoting from my essay linked above:

Aquinas developed what has become known as the principle of “double effect.” Simply put, double effect means that if a person performs an act with an intent of doing good, yet unintentionally causes harm, the action is morally justified. To illustrate the argument, Aquinas uses the example of self defense. He believes killing is wrong in all cases, but he ponders what one should do if she is violently attacked. Aquinas argues that the person is justified in killing her attacker to save her own life despite the evils of killing another person. In his own words," Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental."[127]

Aquinas foresaw the dangers inherent in this mode of thinking. It is easy for a person to hide his or her intentions, using the principle of double effect to justify a manifestly unjust action. To try to account for this, Aquinas argued that any act justified by double effect must be proportional to the justification. For example, a person who murders someone who stepped on her toe would not be justified. Thus, “though proceeding from a good intention, an act may be rendered unlawful, if it be out of proportion to the end.”[128] This principle of double effect would be developed further and would come to play a crucial role in the church’s theology of death.

and

The New Catholic Encyclopedia describes the modern concept of the principle of double effect as having four characteristics:
(1) The act itself must be morally good or at least indifferent.
(2)The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
(3) The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.
(4) The good effect must be sufficiently desirable to compensate for the allowing of the bad effect.[145]

Based on that logic, the examples you cite of cases to provide abortion seeking a good effect would probably not meet criteria 2 and 3 (the church would argue that there are other ways to help mental health, provide food, etc.) and that the direct effect of the abortion is not preventing bad things by rather killing a fetus. To the best of my knowledge, the Church hasn't spoken specifically to IVF reductions because they oppose IVF.

Hope that helps. Like I said, I don't agree with the above, but can at least (hopefully) explain it coherently.

 

[237696]

Thanks for taking the time to post a thoughtful reply. It did clarify and illuminate a little. But you're right, the fact that there is still some subjectivity involved with weighing the magnitudes of the intentions and effects and the certainty that alternative actions exist, leaves this wide open for logical criticism and debate. I suppose in the condoms debate the church could argue that there are alternatives to preventing HIV (not having sex in this case). But I'll leave it there; I'm not out to try and change anyone's mind. And of course I understand that it's not necessarily your belief.

 

[howelljolly]

If you'll permit me this forum for a short tangential soapbox. Since I have the attention of some seemingly smart folks that are versed in Christan ethics. If I hear another person who subscribes to Christian ethics assume that someone who is not Christian could not possibly have any ethical framework... and the same goes for an athiest (that since they dont believe in a higher power, that they also dont have any personal ethics)... Im going to scream.

A non-Christian or an atheist is usually capable of reading Theories of Ethics, and if not, they usually subscribe to universal or non-religeous ethics (such as 'do no harm', or 'do unto others'... 'tit for tat' '....which would cause pain if it were done to you'....'...wishes for his brother what he wishes for himself'... etc)

My point is that there are other ethical frameworks out there. Ethical frameworks need NOT rely on a God. If I hear that assumption again, im going to quit medical school, and go for a PhD in Philosophy and write the worlds longest dissertation on Ethics.

Ok... back to the discussion.

 

[MeowMix]

Let's be realistic: most MS3s on OB/Gyn rotation have so little involvement in procedures that it's really a non-issue. They can usually easily disappear from the room without anyone knowing or caring, at a large public hospital. All this person has to do is find something else to do during these morally objectionable cases.

They will virtually never be expected (or allowed) to be the primary person counseling a patient making such a choice. They should at least be present so they can learn about and understand the process of informed consent, so they can educate their patients and in turn provide informed consent.

Finally, a tubal is really not a big deal in itself, and I feel any future doctor should at least have some idea of what it involves (again so she can counsel patients). Remember, your job is to learn about what is MEDICALLY indicated, and to provide resources so that a patient can receive that treatment, even if it conflicts with your moral principles. Sometimes a tubal IS indicated, even within the framework of the Catholic health directives.

BTW, I really hope that if you have such strong objections to these procedures, you will equally exempt yourself from Catholic-prohibited IVF and similar procedures for couples undergoing fertility treatments.

 

[Law2Doc]

Let's be realistic: most MS3s on OB/Gyn rotation have so little involvement in procedures that it's really a non-issue. ...

Agreed. You'll get to catch a baby or two, do a bunch of PAP tests, write a ton of mag notes, and maybe assist in removing a fibroid or repairing a prolapse. The folks posting about concern of being involved in abortions during third year simply are worrying about nothing. There might be tubals and d&cs going on, but they aren't that common things for a 3rd year to be involved in, and nobody is going to have an issue with you bowing out for religious reasons. As for referrals, you aren't the doctor, you don't have a patient as a 3rd year, so no, you don't get to make (or not make) a referral. Now if you actually go into the field of OBGYN as a devout catholic, you are setting yourself up for failure because you are turning your back on a sizable chunk of the field. But for med school you are worrying over nothing.

 

[SouthernSurgeon]

But for med school you are worrying over nothing.

Disagree to an extent. Just saying "don't worry about it, you won't see any of that stuff" is kind of dismissive. At my program, I saw (or I guess would have been expected to see) everything short of abortions that typically raises concerns for Catholics . Even on routine C-sections we would frequently have tubals performed at the same time. Birth control, IUDs, and abortions were frequently discussed in clinic (where we were expected to be the first person to interview the patients).

I didn't have a huge issue personally (just luck of the draw, I guess) but I know a number of Catholic classmates who had a very traumatizing 4 weeks.

I agree that you can discuss your religious concerns and get out of these types of procedures, but a lot of students are hesitant to do so out of fear for their grades (or out of fear of being mocked by residents - which happened frequently last year at my program). It can be a difficult position.

 

[howelljolly]

Agreed. You'll get to catch a baby or two, do a bunch of PAP tests, write a ton of mag notes, and maybe assist in removing a fibroid or repairing a prolapse. The folks posting about concern of being involved in abortions during third year simply are worrying about nothing. There might be tubals and d&cs going on, but they aren't that common things for a 3rd year to be involved in, and nobody is going to have an issue with you bowing out for religious reasons. As for referrals, you aren't the doctor, you don't have a patient as a 3rd year, so no, you don't get to make (or not make) a referral. Now if you actually go into the field of OBGYN as a devout catholic, you are setting yourself up for failure because you are turning your back on a sizable chunk of the field. But for med school you are worrying over nothing.

I think this is a good point. I was thinking that I personally have an ethical disagreement other aspects of OB/Gyn. But, it wasnt my place to make the call, and so my issue didnt really make a difference. However, though I was never really considering this as a career option, I found that my ethical unrest with the field was part of the reason I wouldnt go into it.

So, as L2D said. if you intend to practice OB/Gyn with a Catholic ethical system, youre setting yourself up for internal frustration, and economic failure.

 

[howelljolly]

Disagree to an extent. Just saying "don't worry about it, you won't see any of that stuff" is kind of dismissive. At my program, I saw (or I guess would have been expected to see) everything short of abortions that typically raises concerns for Catholics . Even on routine C-sections we would frequently have tubals performed at the same time. Birth control, IUDs, and abortions were frequently discussed in clinic (where we were expected to be the first person to interview the patients).

I didn't have a huge issue personally (just luck of the draw, I guess) but I know a number of Catholic classmates who had a very traumatizing 4 weeks.

I agree that you can discuss your religious concerns and get out of these types of procedures, but a lot of students are hesitant to do so out of fear for their grades (or out of fear of being mocked by residents - which happened frequently last year at my program). It can be a difficult position.

I think something that might help you is to dig deeper into the philosophy behind why birth control is forbidden. I dont know anything about it myself... but it seems that you are taking "birth control" and all it entails on face value... both from the medical and the religious standpoint. Maybe if you look into WHY it is not allowed, you might be able to make sense of things.

Like I said, I dont know anything about it myself, but... theres often a narrow specific reason for broad religious rules (take for example Kosher foods).... so finding out why, might help you understand that maybe your patients situation does or doesnt apply to the rule.....

 

[SouthernSurgeon]

I think something that might help you is to dig deeper into the philosophy behind why birth control is forbidden. I dont know anything about it myself... but it seems that you are taking "birth control" and all it entails on face value... both from the medical and the religious standpoint. Maybe if you look into WHY it is not allowed, you might be able to make sense of things.

Like I said, I dont know anything about it myself, but... theres often a narrow specific reason for broad religious rules (take for example Kosher foods).... so finding out why, might help you understand that maybe your patients situation does or doesnt apply to the rule.....

I have done a bit of reading on it, but I'm still often at a loss (see my post earlier in this thread - I didn't really push on the birth control issue much, and I usually am pro-barrier methods with patients because of STDs). I agree that more personal education would help me understand these things better - but then again, I'm done with OB and I'm never looking back, so it kind of falls lower on my list of priorities at the moment. 😉

But my only point was, I know a lot of Catholic students who had very upsetting experiences on their OB clerkship. And in fact, one of the main things they found upsetting was the number of people saying (essentially) what law2doc said - that the rotation was no big deal, and there was no reason to be upset. But they were upset, and they felt like no one took their concerns seriously.

 

[eyesarecool]

I think this is a good point. I was thinking that I personally have an ethical disagreement other aspects of OB/Gyn. But, it wasnt my place to make the call, and so my issue didnt really make a difference. However, though I was never really considering this as a career option, I found that my ethical unrest with the field was part of the reason I wouldnt go into it.

So, as L2D said. if you intend to practice OB/Gyn with a Catholic ethical system, youre setting yourself up for internal frustration, and economic failure.

Wrong! Simply Wrong! I know of multiple "Catholic ethical system" physicians who are doing quite well. They are all happy with standing up for what they believe in, and none of them, and I repeat, none of them are facing "economic failure." Therefore, I politely request that you refrain from using rhetoric that intends to persuade this false idea. Thank You.

 

[howelljolly]

Maybe if they could articulate why they were so upset, things could be helped. But the assumption probably is that they are so profoundly upset, that its because of religious... er.... extremism? and so, is ignored.

As Law2Doc said... its no big deal, so any passionate unrest is probably seen as an overreaction.

 

[howelljolly]

Wrong! Simply Wrong! I know of multiple "Catholic ethical system" physicians who are doing quite well. They are all happy with standing up for what they believe in, and none of them, and I repeat, none of them are facing "economic failure." Therefore, I politely request that you refrain from using rhetoric that intends to persuade this false idea. Thank You.

Oh bother. Did I.......or did I not.....say that I trained at a Catholic Medical Center?

OK, economic failure is over to top. But, contraception is a HUGE part of OB/Gyn

speaking of overreaction....

 

[MeowMix]

I saw (or I guess would have been expected to see) everything short of abortions that typically raises concerns for Catholics.

Seeing is not doing. It is extremely difficult for me to understand what you find so repugnant and traumatic about witnessing a tubal that is done at the patient's request, particularly when further pregnancies might be dangerous to the woman's health or result in an even more crappy life for her and her existing 10 kids. Nothing is being killed. If this is so evil, how on earth do you feel about men masturbating?

I stick with my assertion that in order to be a competent physician, you should at least have a good idea of what is involved so that you can counsel the patient about her MEDICAL options. And you should be able to keep your personal stuff out of it enough that the patient can talk openly and honestly about his/her needs. You are a doctor, not a priest.

 

[EM2BE]

Seeing is not doing. It is extremely difficult for me to understand what you find so repugnant and traumatic about witnessing a tubal that is done at the patient's request, particularly when further pregnancies might be dangerous to the woman's health or result in an even more crappy life for her and her existing 10 kids. Nothing is being killed. If this is so evil, how on earth do you feel about men masturbating?

I stick with my assertion that in order to be a competent physician, you should at least have a good idea of what is involved so that you can counsel the patient about her MEDICAL options. And you should be able to keep your personal stuff out of it enough that the patient can talk openly and honestly about his/her needs. You are a doctor, not a priest.

That is against the Catholic religion as well.

I agree with what was posted above that anyone with really strong religious beliefs should probably not do OBGYN unless they will have another person in practice willing to take up the "slack" that you are creating with these beliefs. How you make a living is up to you.

 

[SouthernSurgeon]

Seeing is not doing. It is extremely difficult for me to understand what you find so repugnant and traumatic about witnessing a tubal that is done at the patient's request, particularly when further pregnancies might be dangerous to the woman's health or result in an even more crappy life for her and her existing 10 kids. Nothing is being killed. If this is so evil, how on earth do you feel about men masturbating?

I stick with my assertion that in order to be a competent physician, you should at least have a good idea of what is involved so that you can counsel the patient about her MEDICAL options. And you should be able to keep your personal stuff out of it enough that the patient can talk openly and honestly about his/her needs. You are a doctor, not a priest.

This kind of condescending/judgmental attitude is what gives Catholic med students so much trouble on their OB rotations. You at the same time (a) tell me my beliefs are stupid and (b) tell me I'm going to be a bad doctor because of them. Why can't people even try to understand (or if you don't understand, at least respect) Catholics' beliefs?

As for "seeing, not doing" - tell that to the Catholic student I know who unexpectedly had the scissors passed to her in the midst of the tubal she watched - the physician thought he was being cool by including her and letting her be the one to cut the fallopian tube, but she hadn't explained her issues beforehand and got really upset by this.

As for masturbating...well, I don't particularly want to see that any more than I want to see a tubal.

 

[howelljolly]

I think that saying that Catholic students are traumatized by being involved in contraceptive or TOP procedures is a bit dramatized. Granted Im not one of them... but...

Every med student, not just the Catholic flavored ones, has their personal ethics and morals tested at one time or another... whether thats on OB/Gyn, Psychiatry, in the ICU, Pediatrics....

I submit - the case of a Roman Catholic mother who on her 8th pregnancy, and delivers a baby who was prenatally diagnosed with a malformation that is incompatable with life. Some of the students and housestaff might be traumatized to watch the little baby scream in terror for an hour, before she dies.

Or - some students might be traumatized being asked to pull the tube of a Terminal Wean in the ICU...
or by having to do chest compressions on the 87 year old lung cancer patient whos family doesnt want a DNR.

There are at least three sides to every ethical issue, and theres people on each of them. So to excuse yourself from an issue just because your value system has a name, seems to me a bit unfair.

Blood and guts, death, ethics, and painfully long hours are what we signed up for by choosing to become physicians. You can choose a practice which minimizes what you dont want to have to deal with. But we cant escape it all.

 

[DrSno]

I know an M3 who is Catholic and just started doing an OB/GYN rotation at a public hospital. She is extremely upset that she will have to participate in procedures (abortion, hysterectomy, tubal ligation) or make referrals for those procedures because they are in direct conflict of her faith. Can anyone give some advice on what she can do to resolve this problem?

Her clerkship director told her that the assignments have already been made.

I honestly cannot believe that in this day they would allow a medical student to not participate in certain procedures because of their "faith". Seriously, aren't we students of science? 😡😕👎

 

[MeowMix]

Why can't people even try to understand (or if you don't understand, at least respect) Catholics' beliefs?

I am training in a Catholic residency program. I am very, very familiar with the Catholic health directives. Though there are many restrictions I disagree with, I am bound by them even if I think they are stupid. So I think you can give me credit in the living-together-in-mutual-peace department.

There are plenty of Catholics who not only support but PRESCRIBE birth control (yes, most Catholic programs do this), who are homosexual, who condone abortion (see the Religious Coalition for Reproductive Choice), and who have a wide range of beliefs on reproductive health care. The majority of my Catholic patients are using birth control and have had sex before marriage, both of which are prohibited.

My expectation of medical students is that you will think carefully about these issues, and will challenge yourself to consider situations in which these black & white rules might not be in the patient's best interest. Your training is providing excellent opportunities for you to do all of this. What about a patient who presents to you for prenatal care following a successful IVF procedure? Would you refuse care because the way in which she got pregnant was prohibited?

Your friend with the scissors should have explained to her attending beforehand that she could not participate in the procedure. That's all she needed to do. It did not need to be a problem. Your friend assigned to her rotation should have spoken with the clerkship director ahead of time. That did not need to be a problem either.