Medical ethics

Discussion in 'The Healthy Penis' started by DC_DEEP, Jul 17, 2006.

  1. DC_DEEP

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    Mods, feel free to move this to another category if needed. It overlaps a few issues, so I thought it would be ok in the "healthy penis" section.

    I'll start with a scenario, but leave out a few descriptive details, just to get some opinion before continuing. There are several concepts I want to bring out later, so please bear with me.

    Scenario 1: An ambulance is called. The driver chooses not to transport this particular patient, and calls her boss requesting that another driver handle it. The boss fires her on the spot, and calls another driver. The patient is transported. The fired employee files a discrimination suit against her former boss.

    Who was in the right? Did the driver discriminate against the patient, or did the boss discriminate against the driver?

    Scenario 2: A doctor writes a prescription for a man, who takes it to his pharmacy. The pharmacist refuses to fill the prescription because of the man's marital status. Thoughts? Comments?
     
  2. S1: The driver discriminated aginst the patient and, if that driver violated any part of that companies (the ambulance's) contract or code of conduct, the boss had evry right and should fire the driver (someone could have died).

    S2:I doubt a national chain drug store (Walgreens, Duane-Reedy, CVS) would not right the perscription cause they just want money. Yet, if they wanted to they would be perfeclty in their rights to refuse the perscription (someone could have died but, not the same as an emergency & chances are there are other drug stores).
     
  3. findfirefox

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    A story like this happened sometime ago, I posted this in a thread a while back,

    They should never refuse to help someone under any circumstance. The driver should have been fired.

    Time to go to a new pharmacy and alert the management of the store because I doubt action will be swift.
     
  4. root00

    root00 Member

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    S1: Not only did the ambulance attendant violate company policy, they may also may have violated legislative mandates by not completing their "duty to act". if the sanctioning state has a right to refuse service then her boss would be liable.

    S2: Is it any different then a pharmacist not filling birth control Rx's?
     
  5. DC_DEEP

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    Thanks for the responses so far. Now for the details that make ya go... hmmmm.

    S1: The patient was being transported from one hospital to another. The driver saw on the patient's chart that the patient was scheduled for an elective abortion at the other hospital. The driver refused because that procedure went against her religious beliefs.

    S2: The man's prescription, properly written by a licensed physician, was for an erectile dysfunction drug. The pharmacist's religious beliefs were that "sex was reserved for the relationship of husband and wife," and the patient was not married.

    While I can certainly understand that a person may not want complicity in actions contrary to their belief system, I do not understand why anyone would pursue a career where they KNOW they may come across situations at odds with their personal feelings.

    I am familiar enough with the healthcare professions education industry to know that some of the classes these "professionals" MUST attend and pass include ethics. They know, early on, that their chosen profession includes some things they may find distasteful - but they have been licensed. If you don't want to dispense birth control drugs, or treat homosexuals, or give a single woman a physical exam so she can adopt from out of country, then you really should not be in those professions where that may be required of you. Wouldn't it be really silly for a member, of one of the churches which doesn't allow transfusions, to get a job as a phlebotomist at the American Red Cross and then refuse to draw blood?
     
  6. Pensive Josh

    Pensive Josh New Member

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    I think both scenarios are appalling. If you let personal beliefs interfere with your job, then you are in the wrong profession. This is part of the reason that I am against organized religion. I feel that it breeds intolerance towards other people, and in a world where views are already very polarized, the last thing we need is something that will drive people further apart. That's just my two cents.
     
  7. college22punk9

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    Yes, if you can't do your job for whatever reason, personal beliefs, physical limitations, ect.... guess what, you are in the wrong profession.

    Scenario #1: The driver discriminated against the patient calling for help. The boss had every right to fire an employee who isn't doing their job.

    Scenario #2: Who's pharmacy ahs their marital status on file? (first)
    Secondly, Why would it matter if they were married or not. I guess the more important issue I could see a pharmacist saying is "i'm not filling this because you are sexually active. I mean what is so medically different from a married person other than just ANY one?

    scenario #2 doesn't have enough details. Lots of pharmacists refuse to fill prescriptions. it's part of their job to double check and make sure the DR isn't prescribing a mix of things that will be harmful to the patient. If the DR makes an error in writing the script and the pharmacist picks up on it, they will refuse it.

    the end
     
  8. DC_DEEP

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    Thanks, C22p9, the details were in my second post. The first issue was a transfer from one hospital to another, not a 911 call or accident pickup; the second, the pharmacist was NOT making a medical decision, he was making a moral decision. I don't have the details, and I have never had a pharmacist request that type of information "for file". Just my guess, but he probably mentioned (intentionally, maliciously) something like "This should improve things with your wife" or "be sure your wife understands that with this medication..." to which the patient may have responded "I'm not married." Just a guess, those details were not in the article I read. But it was clear that the sole reason that the prescription was not filled was that the man was not married.
     
  9. samhung

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    I am a physician, so I will give my opinion of these situations based upon the canonical requirements of medical ethics.

    1) The paramedic/EMT is not given the luxury of refusing to transport the patient in this type of emergency situation. No health care professional can refuse to provide emergency care when needed, and this goes for everyone from a physician to a nurse to a pharmacist to a respiratory therapist to an EMT/paramedic.

    2) The pharmacist should have told the patient that she could not fill the prescription and should have directed him to a pharmacy that would.

    The three rules of medical ethics are written in stone and are non-negotiable. They are: 1) primum non nocere, or Latin for "first do no harm" - this is the most important; 2) explain all available therapeutic options including the good, bad and ugly for each of them; and 3) respect the choices made by the patient or authorized representative.

    A health care professional may choose not to offer certain services or therapeutic modalities based on their individual values, beliefs and morals, but must provide alternatives to the patient should they elect a procedure or therapeutic modality that they choose not to offer. A pharmacy/pharmacist is free not to offer contraception, and is under no legal obligation to do so, provided that another pharmacy is available that will dispense it. There isn't much room for negotiation in this respect, but a health care professional is absolutely permitted to exercise his/her individual beliefs, conscience and moral values but they end where the patient's rights start. In a life-threatening situation, all bets are off and the first canon, primum non nocere, rules the roost.

    There is a school of thought that says that health care professionals are to do only as they are ordered. That is not how a profession is practiced and the exercise of that judgment, consistent with ethical requirements, is the core of being a "professional", but that also means following the rules and providing alternatives.
     
  10. baseball99

    baseball99 New Member

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    excellent post.....you're right on.

    When I was a student rotating through OBGYN there was a procedure i could never do depending on circumstance. It is called Dilatation and Curettage......basically this is opening the cervix and sticking a tube hooked up to suction into the uterus and sucking everything out. This procedure is used for many different things, including elective abortions (termination of pregnancies). When the procedure was done because of an incomplete abortion or a complete abortion with retained products of conception (placenta, etc) I had absolutely no problem doing it. However, when it was done early in a pregnancy with the sole reason to terminate the pregnancy I could not do it. I was never forced or looked down upon
     
  11. sares

    sares New Member

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    well, I'm looking down upon you right now. I hope you didn't end up in OBGYN practise, because the discrimination you have described is deplorable. completely disgusting. and this is speaking as the mother of a baby boy.

    you didn't have the whole story. you can't judge anyone in that circumstance. I believe it shouldn't even need to be spelled out like this, and no woman needs to give a "good reason" for retaining control of her body. but consider, for all you know, one of those girls could have been a rape victim. or a carrier of a genetic abnormality she didn't intend to saddle a child with.

    shame on you.
     
  12. findfirefox

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    I agree with you, you can not judge people with this job. You need to drop your ideas and morals at the door and pick them up when you leave.
     
  13. Ethyl

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    She didn't perform her duties. Employees who don't perform their duties eventually lose their jobs. It's that simple.

    What made the pharmacist think he was promiscuous? Maybe he likes a full erection when he masturbates.

    Neither do I.

    Or if they want to practice and keep their religious beliefs intact, they should open their own clinic and provide services as they see fit. If they plan to work in the general public sector, they should expect to do their job regardless of their religious beliefs.
     
  14. baseball99

    baseball99 New Member

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    what the hell are you talking about? I mean are you freaking serious?!?!?! I chose not to perform elective termination or pregnancies, how does that make me bad? I never judge anyone in that position but I should not be forced to carry out a procedure against my beliefs, whether or not i am a doctor. Next off, approximately only 30% of OBGYNS do elective terminations. A woman can have all the control over her body she wants but I dont have to be a part of her abortion. You are completely missing the point here. There is no judgement, there is no bias, its personal choice.....just as that woman chooses to terminate, myself or any other medical professional can choose not to scrub in on the case. I said I have no problem doing an incomplete abortion, complete with retained POCs but i could never do an elective termination and that does not make me any less of a person. If the womans life was in jeopardy now you are talking about a completely different situation. I took an oath to do no harm. I believe life begins at conception. I can not do harm to the unborn child.....that is MY CHOICE. There are people willing to do the abortions so the woman will have no problem getting it done if she wants but no one should ever be forced to partake in something they are morally against when it is elective.

    Shame on you for jumping on me for that without reading what i was saying.....interestingly not one single female obgyn at the hospital im at will do an elective termination, only several male ones will do it.....so dont turn this into a female issue. I choose not to judge people who want a termination and i choose not to judge people who perform them so i demand the same respect and unbiased for what i believe. How dare you challenge that.
     
  15. baseball99

    baseball99 New Member

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    I agree and disagree. You can maintain a sense of being unbiased and not judge people but there is no reason to drop your morals at the door. As long as you offer all options unbiased and can refer to another doctor who is willing to do a procedure, write a script or if a pharmacist is against dispensing a med but refers to one who will, there is nothing wrong with that. When you pass on judgement or your morals on others then you are wrong.....but there is absolutely nothing wrong with not doing something you are uncomfortable with.....it would be along the same lines of forcing a Jehovah's witness to take blood because theyre anemia is severe and they need surgery and in their mind damn them to eternal suffering.....we are doctors, we are people and we are human.....we are not God and have no right to pass our morals on to others nor act against our morals
     
  16. Sklar

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    I think we have a pretty good consensus that scenario #1 the driver did wrong.

    Here is Washington State, we are having a similar issue with scenario #2. It turns out that a family owned, state wide drug store has decided to not stock or fill prescriptions for the morning after pill. The family has stated that it goes against their religous morales.

    They were taken to the state pharmacy board to try and force them to fill/stock the prescription. The pharmacy board agreed with the drug store that they did not have to fill that prescription if they felt it violated their religous morales.

    Boy, did the shit hit the fan on that.

    People were talking about boycotting the store and legal law suits.

    I'm just scratching my head thinking, isn't this a free market? Do you sue Safeway because they don't carry a full line of Kosher products?

    People are so think skinned now a days, it's not funny.

    A store has the right to stock or not stock certain items. You can't force someone to sell something they don't want to sell.

    The fact that they are a pharmacy is no different. This store has made their policy very clear and it's posted where people can see it.

    Sure they might lose customers over it but on the flip side, they will gain customers who share those same religous morales.
     
  17. Ethyl

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  18. baseball99

    baseball99 New Member

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    I disagree with that specific incident bc many medications are prescribed off-label.....even oral contraceptives can be used to treat many different problems, not only avoiding pregnancy

    the main issue some pharmacists have is with RU-486 or the morning after pill which pretty much is only used to prevent embryo attachment by making the uterus unfavorable.....

    At first I thought it was appalling for anyone to deny it but after becoming so much more educated with experience in the field I have come to realize it is their choice to dispense it or not. There is nothign wrong with that. Now if they try and lecture you or deny you from obtaining it elsewhere thats wrong.....if they dont carry a product they should refer you somewhere that does.....that is the appropriate thing to do
     
  19. Dr Rock

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    who lives in the east 'neath the willow tree? Sex
    you really are a nauseating little turd, aren't you? who the fuck do you think you are to refuse to perform a necessary medical procedure based on something as ephemeral and inconsequential as your "beliefs"?

    what with all the drivel you've already spewed on this forum, it comes as no surprise to learn that you're a fetus freak as well. still, i guess at least now there's no danger of any impressionable newcomer to this forum accidentally taking you seriously.
     
  20. findfirefox

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    Baseball I still disagree with you, I still think that its wrong for you to turn someone away because of what you "believe". "Well you want an abortion? Well go away."

    How nice. What if I refused to treat someone because they had a button that said "One man One Woman Vote Yes Measure 41" and I said no because I don't think that's right and it would make me "uncomfortable" but someone else will be there soon.

    I will disagree with you until the end of time.
     
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