Question of Medical Ethics...

[docjolly]

Hi Everyone,

I'd appreciate any honest answers about the question I have below...SUPPOSE that you, as a future/current physician, encounter a patient who is strongly considering having(but not absolutely sure that she wants ) an abortion. But, due to your own personal religious or ethical beliefs, you (in your heart) want to persuade her to keep the child. What would you do?

Again, thanks for your help

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[AverageMan]

There was a debate about this in the lounge a few weeks ago. Not about abortions, but about physicians forcing their religions on their patients. There's a lot of viewpoints on it, but basically it comes down to where the line is about what you can talk to and force a patient to do. Just because you feel an abortion is wrong doesn't mean it's necessarily appropriate to make your patient do something she doesn't want. You have to figure out how to make objective decisions as a physician regardless of how you feel about the situation. Many expectant mothers have doubt about their child and when a woman asks about an abortion it is your duty to explain everything you can without imposing your own bias on her. Telling her that God will be vengeful upon her if she does it isn't what needs to be said at that moment. It is your duty to explain exactly what is involved and make sure she understands the consequences not in a theological sense but in a practical sense (such as, that her baby will be gone forever, and she may regret her decision later). Realize that other people's religions and beliefs may be different than yours, so it is not necessarily your place to lecture them.

 

[DocWannaBe85]

I don't feel that ANY physician should let their own religous beliefs supercede those of the patient.

 

[JasmoneLUMC]

keep in mind also, a conviction against abortion is not necessarily born out of religious convictions. "pro-life" does not equal religious views - obviously, it can be linked. there are plenty of community agencies, including non-religious ones that will house and assist pregnant mothers, as well as adoption agencies. if you are against abortion and you discuss it with a patient who is vacillating between having one or not, it may in the best interest of both of you to recommend her to such an agency.

 

[MrSosa]

As a physician, your only concern should be her health and the safety of the procedure given her current health status, including whether she has had an abortion in the past, and how many if more than one.....and other stuff like that.
You shouldn't "want" to persuade her to do anything but consider her own health. If anything, you might consider recommending she speak to some kind of counselor first. By bringing you're personal ideas into it, you're crossing the line. Cultural sensitivity is a big thing nowadays and abortion is an issue that goes deep into many peoples' cultural backgrounds. Personally, if I were a woman and I felt my doctor was trying to persuade me against abortion becuz of his religious beliefs, I wouldn't trust him anymore.

 

[goobernaculum]

You shouldn't "want" to persuade her to do anything but consider her own health.

It's exceedingly difficult to distance yourself from your moral convictions and your job as a health profession, especially because there are many ethical issues that you will encounter in the wards. Remember...you're a common citizen too, and you're just as free to offer your opinion as anyone else is. To be fair, however, if you're against abortion and your patient is thinking about having one, you should tell her about her options in carrying out the procedure. But hell no...don't let anybody tell you what you can and can't say in your practice or your hospital. It seems to be an implied "rule" especially among liberal circles and university settings. If you don't think abortion is morally right, you can tell that to your patient. And, of course, same goes if you think abortion is okay.

 

[docjolly]

Please let the replies keep coming...
I appreciate them...

By the way, please note that the hypothetical situation mentioned and the physician in the situation do not necessarily represent my own personal views...The question arose out of a discussion I had with a few friends, and I wanted to obtain a wider range of opinions...

 

[idq1i]

Refer your patient to a colleague who is more capable of taking care of the patient's needs

 

[MrSosa]

Originally posted by goobernaculum
But hell no...don't let anybody tell you what you can and can't say in your practice or your hospital. It seems to be an implied "rule" especially among liberal circles and university settings. If you don't think abortion is morally right, you can tell that to your patient. And, of course, same goes if you think abortion is okay.

I totally agree with you in that you should say w/e you think. But in a situation like this, u shouldn't be trying to influence the patient. I mean, if she asks ur opinion, ok, but u should make it clear that it's YOUR opinion. Whether u oppose it or not, abortion is a legal option, and u shouldn't make ur patient feel like it's wrong. Believe it or not, sometimes abortion is the best option, and a woman should feel as comfortable as possible with that decision.

 

[CH3CH2OH]

Originally posted by idq1i
Refer your patient to a colleague who is more capable of taking care of the patient's needs

agreed

if abortion is against your religious/moral values - don't perform it. and refer the patient to someone who does.

 

[Gleevec]

Originally posted by goobernaculum
It's exceedingly difficult to distance yourself from your moral convictions and your job as a health profession, especially because there are many ethical issues that you will encounter in the wards. Remember...you're a common citizen too, and you're just as free to offer your opinion as anyone else is. To be fair, however, if you're against abortion and your patient is thinking about having one, you should tell her about her options in carrying out the procedure. But hell no...don't let anybody tell you what you can and can't say in your practice or your hospital. It seems to be an implied "rule" especially among liberal circles and university settings. If you don't think abortion is morally right, you can tell that to your patient. And, of course, same goes if you think abortion is okay.

I agree you should have your opinion, but as a physician in a position of power, your personal opinion would go beyond that of the average joe on the street into the realm of undue influence.

You ought to tell the patient all the possible alternatives, but I would never go on a moral diatribe or attempt to influence the patient one way or another, regardless of my beliefs. It's important for patients to have autonomy, and for doctors to realize that patients have a right to make their own decision.

 

[alexPDX]

When I see a physician I want him or her to help me with my physical or mental condition, not my spiritual one. For doctors to impart their moral beliefs to patients, especially when vulnerable, is highly unethical. If you have strong beliefs against abortion, you should refer that person to someone else, as mentioned by another poster. By the way, it would be just as wrong for a physician to force an abortion on a woman because of a strong pro-abortion belief. If I would take my girlfriend to my family physician for a contraception consult and I would get a lecture on the evils of contraception, I would never go back to her.

 

[kito]

Politics and theology goes out the window. If the procedure is medically necessary and you are qualified to perform it, you have a duty to perform it in the instance of urgency or if nobody else is available. If, however, it is not medically necessary, and the person insists that it be performed, then I would tell the person to quit playing doctor, and take a hike.

 

[LaurieB]

I've thought about this quite a bit since I think I would be uncomfortable influencing a woman's decision either way. It's a very personal decision and I know women who have regreted it and others who got a new lease on their life by choosing to have an abortion.

If it were my patient, I would explain both pregnancy and abortion to her in medical terms - what to expect, possible outcomes, what she needs to do over the time period involved. Then, I would encourage her to visit an abortion clinic and an adoption agency or family planning center before making her decision. If she were resolute, I would refer her to someone who would perform the procedure.

 

[Tezzie]

Originally posted by ankitovich
If, however, it is not medically necessary, and the person insists that it be performed, then I would tell the person to quit playing doctor, and take a hike.

Oh so if a man came and asked about a vasectomy, you would tell him to take a hike?

A lot of medical procedures these days are "lifestyle" operations and not really necessary. It's up to the discretion of the physician to perfom those or not. He should not waste a patients time with their silly philosophies. Give the patient the *facts* and let them make their own decision.

On the abortion issue - a physician is not there to fill a spiritual need. He is not there to impose his religious convictions on patients. He should warn the patient about the dangers of abortion. Then say that he doesn't perform them and refer the patient to another physician OR perfom it.

 

[kito]

Originally posted by Tezzie
Oh so if a man came and asked about a vasectomy, you would tell him to take a hike?

Spoken like a consummate school girl. Vasectomies do not terminate fetuses. That's the difference, genius.

 

[Tezzie]

Originally posted by ankitovich
Spoken like a consummate school girl. Vasectomies do not terminate fetuses. That's the difference, genius.

Spoken like the complete jejune tool you usually are. You originally said :

"If the procedure is medically necessary and you are qualified to perform it, you have a duty to perform it in the instance of urgency or if nobody else is available. If, however, it is not medically necessary, and the person insists that it be performed, then I would tell the person to quit playing doctor, and take a hike."


I don't see the word "fetus" anywhere in the above paragraph.

 

[farrago]

Originally posted by Tezzie

On the abortion issue - a physician is not there to fill a spiritual need. He is not there to impose his religious convictions on patients. He should warn the patient about the dangers of abortion. Then say that he doesn't perform them and refer the patient to another physician OR perfom it.

I wonder when religion will cease to have a hold over the abortion debate. Eh?

The state of being a physician can't hijack your own, human responsibility to contemplate the morality of various actions and act on your conclusions. Or, perhaps it can, if physicians, and the other commoners, abdicate their decision-making ability in matters of High Importance to another decision-making body.

[Because I see these possibilities: 1) the physician as a commoner, a peer - if you can blab about abortion with your friends, offer your opinion, and have others offer theirs - then your physician can do the same; 2) the physician as higher moral authority, by virtue of being a physician; it might be justified in certain cases where the doctor's medical knowledge is of decisive importance; and 3) the physician as impotent observer/practitioner, a slave to the authority of others, including that of the patients]


If you paint the physician as an imposing, moral authority who is capable of exercising undue influence over a patient, what does that say about the patient? In a society where we value our opinions as citizens, and where we believe in our ability to come to sound conclusions, I see no problem with scenario 1 above.


Note: Just so that someone does not bring up again these non-issues: we aren't talking about the substitution of one's opinions for medical judgement, or the forceful prevention of someone from obtaining legally available services.