Medical ethics

[rob_just_rob]

Just checking here - if you are justified in not performing abortions because you don't believe in them, are you equally justified in refusing to treat black people (or gays, or jews, or what have you) because you don't like them?

And I'm talking morally justified, not legally justified.

 

[DC_DEEP]

Thanks, Samhung, I was hoping to get some MD or PharmD opinion in here. Your response made perfect sense, but left out one of the biggest sticking points for me: what about HC professionals who will perform a procedure or dispense a drug for one patient, but not another, simply because of his "beliefs?"

The article that got me thinking about this more in depth was in the Washington Post a day or two ago. One woman was in the process of adopting a baby from Mexico, and for whatever reason, she was required to have a physical/clean bill of health. The doctor she went to was ready to perform the physical, but when he found out she needed it to adopt, and she was single, he refused, saying "a baby needs a mother and a father." Or the pharmacist who will fill a prescription for an ED drug for a married man but not a single man?

Mercurialbliss, the pharmacist in question in S2 was a roman catholic. Many, but not all, but many, roman catholics still go by the old canon "every sperm is sacred" and believe that a man should never ever shoot a load unless it is into his wife's snatch.

I'm still going out on a limb here and saying that if your conscience requires you to give preferential/discriminatory treatment, health care is not the profession for you.

 

[baseball99]

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.

elective abortions are not medically necessary. are you too retarded to see that? Incomplete abortions or complete abortions with retained products is one story, rape is another story, a woman who has been pregnant 7 times and is 21 years old and uses abortions as a means of contraception is another. Who the fuck am i as you so eloquently stated? I am a human being, capable of holding my own beliefs. Do you really think doctors walk around as mindless drones doing everything a patient demands of them? Are you kidding? You have every right for your beliefs and mine are actually quite liberal. I remember out of a rotation of 25 students, 2 would perform elective abortions. So the other 23 including myself are wrong? I dont think so. Women have the right to choose over their body but you can not force someone else to do the procedure. This is not mindless dribble, this is the real world. You show me where every single elective abortion is medically necessary and i will tell you then that i am wrong. You seem to form a lot of strong opinions on anyone who holds an opinion different from you. On a side note, I think the whole thing with Jehovah's witnesses is kind of silly and doesnt make any sense to me but i can not just transfuse one because I know its best even tho its against what they believe. The world you're imosing is dangerous

 

[B_horribleperson]

fire both there asses. then drop them off in the middle of the pacific ocean.

 

[baseball99]

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.

You're not turning them away. You are providing them with someone willing to do the procedure. I dont see how this is any different than surgeons who only perform 1 type of surgery even tho they are perfectly qualified to perform hundreds......If you refuse treatment and there is a bad outcome for the patient then you are wrong but you are under no circumstance obligated to do so if there are others willing.....

 

[baseball99]

Just checking here - if you are justified in not performing abortions because you don't believe in them, are you equally justified in refusing to treat black people (or gays, or jews, or what have you) because you don't like them?

And I'm talking morally justified, not legally justified.

Actually as a physician you can tailor your practice any particular way you choose morally. It happens every day. There are doctors who refuse to see poor people bc they dont want to deal with medicaid or the ridiculously insulting reimbursements. There are people who accept only cash. Abortion is a touchy subject for many people. I'm not on a moral high horse or whatever. As a physician you are supposed to remain as neutral and professional as possible. If anything comes in the way of that the next best thing to do is refer to someone who can take over. This goes for everything including not being able to treat some old guy because he looks like your abusive father, etc. Doctors are human and anything that comes in the way of being able to treat unbiasedly is grounds for referral. Knowing when something is beyond you is a skill

 

[that_other_guy]

My mother was an OB-GYN and faced the abortion question numerous times. While she did believe that it was not morally correct, she did do it for her clients as firstly, the woman's choice for her body and secondly, much better than if she had gone to a third party outside of my mother's knowledge. She believed that if a woman was going to put herself through the emotional stress that is an abortion, it needed to be done in a warm, caring, and loving environment.

just throwing that in there

 

[DC_DEEP]

Actually as a physician you can tailor your practice any particular way you choose morally. ...

Ok, I'll ask you again. What about a care provider who will provide a specific service for one person, but not for another, based simply upon the provider's perception of a moral issue, such as providing that service to a married person but not to a single person?

 

[baseball99]

My mother was an OB-GYN and faced the abortion question numerous times. While she did believe that it was not morally correct, she did do it for her clients as firstly, the woman's choice for her body and secondly, much better than if she had gone to a third party outside of my mother's knowledge. She believed that if a woman was going to put herself through the emotional stress that is an abortion, it needed to be done in a warm, caring, and loving environment.

just throwing that in there

yep, there are doctors who will outright refuse, others who will disagree but still do it and others that have no problem with it whatsoever.....but dont for one second think every single obgyn will perform abortions.....there are 12 attendings at my hospital and only 2 do the procedure. The other 10 dont have to worry about it because there are those there that will do it. There is no amount of money or anything you could ever say to convince them otherwise. They are excellent and very well-known obgyns.....They are not wrong for not wanting to perform a particular procedure.....they would be wrong if they refused care and didnt help the girl find someone who could help. They would be wrong if they tried repeatedly to change her mind or lie to her about side effects that dont exist. They would be wrong if she was underage to call her parents.....but they are not wrong by not wanting to perform the procedure. There is a huge difference

 

[baseball99]

Ok, I'll ask you again. What about a care provider who will provide a specific service for one person, but not for another, based simply upon the provider's perception of a moral issue, such as providing that service to a married person but not to a single person?

I dont think the issue is as simple as you are trying to make it. I dont think its so black and white. My honest opinion, outright discrimination is wrong. Everyone deserves medical care. Do i think someone should outright refuse to see homosexuals, people with HIV, blacks, puerto ricans, short people.....absolutely not. If a doctor will provide one standard of care to one group but deny another group that same standard then yes they are absolutely wrong.
But a doctor is a human being too, not a mindless drone. I had to take a patient onto my service because my colleague said the patient reminded him of his alcoholic father. My colleague would find himself becoming very angry with the man and not able to practice the best medicine. He was mature enough, smart enough, and had enough respect for the man to transfer him to another service. Of course in an ideal situation you would separate yourself but that just wont ever happen. I know doctors who have transferred patients from their service to Infectious Disease because of suspected meningitis and they have young children at home and dont want to potentially expose them. I know of doctors who have been wrongfully sued and wont treat lawyers because they cant focus on the medicine. As long as the patient doesnt suffer and there is medical help available there is no problem.....I am not talking about an emergency procedure. For example, a woman can come ot the OR with an inevitable abortion (meaning her cervix is open, water broke, maybe some tissue is comin through the cervix) and the woman is severely hypotensive, bleeding, etc.....I dont know of a single OBGYN that would say no i wont perform the abortion. However, on theother hand, a 21 year old girl, pregnant 7 times, has no live children came in because she refuses to wear condoms or use any protection.....im sorry but you can not tell any obgyn they have to do the abortion.

Heres an interesting story. There was a black man in the ER the other day screaming at everyone, cursing everyone and calling everyone a racist. He was completely disruptive and interefering iwth other peoples treatment.....He was doing this because a "white" guy got prescribed a brand name Beta Blocker for his heart but he got prescribed an ACE inhibitor......no matter how much you explained to this guy that a beta blocker has not been shown to improve outcomes in blacks but ACE inhibitors have the louder he screamed racism

im very happy im in a particular field where i dont deal with this situation at all.....the worst thing im worried about is making sure a woman isnt pregnant before she gets a CT scan so the fetus or baby is not exposed to radiation.....

 

[DC_DEEP]

I dont think the issue is as simple as you are trying to make it. I dont think its so black and white. My honest opinion, outright discrimination is wrong.

That's the direct question I was asking... about outright discrimination. For the full article, see

http://www.washingtonpost.com/wp-dyn/content/article/2006/07/15/AR2006071500846.html

There are 3 related articles, "Right of Conscience," "Seeking Care, and Refused," and "I had no other choice."

I understand completely when there are medical reasons behind the medical decisions. I don't have a problem with that. That is the best way to give medical care. I do have a problem when a doctor tells a patient "I will not give you a clean bill of health if you are unmarried and you need it for an adoption application. If you were married, it would be different."

 

[baseball99]

That's the direct question I was asking... about outright discrimination. For the full article, see

http://www.washingtonpost.com/wp-dyn/content/article/2006/07/15/AR2006071500846.html

There are 3 related articles, "Right of Conscience," "Seeking Care, and Refused," and "I had no other choice."

I understand completely when there are medical reasons behind the medical decisions. I don't have a problem with that. That is the best way to give medical care. I do have a problem when a doctor tells a patient "I will not give you a clean bill of health if you are unmarried and you need it for an adoption application. If you were married, it would be different."

I completely agree with you. Standard of care should be equal to all.....if you choose to do or not to do procedures it should apply to everyone. Medicine should remain unbiased and a person's marriage status, gender, sexual orientation etc should have absolutely not influence on anything

 

[SomeGuyOverThere]

Quite frankly, you shouldnt let personal beliefs get in the way of provideing a service, period.

I mean, if I was a vegitarian, I wouldnt open a Butcher's shop... that'd be stupid.

By the same token, if you are crazy enough [sorry - devout enough] to refuse to do this that and the other thing for gay people, or unmarried couples or whatnot, why the fuck are you working in a service sector where you are bound to have to deal with such people at some point?!

 

[Dr Rock]

elective abortions are not medically necessary.

um, if you don't wanna give birth, they are. the patient's reason, or non-reason, for deciding that is none of your concern. you're being paid to do a job. if you don't wanna do it, you can't take the money.

 

[baseball99]

Quite frankly, you shouldnt let personal beliefs get in the way of provideing a service, period.

I mean, if I was a vegitarian, I wouldnt open a Butcher's shop... that'd be stupid.

By the same token, if you are crazy enough [sorry - devout enough] to refuse to do this that and the other thing for gay people, or unmarried couples or whatnot, why the fuck are you working in a service sector where you are bound to have to deal with such people at some point?!

Right.....treatment should not be different for gay people, unmarried, etc. That is what I have been saying. But if a doctor is uncomfortable doing a procedure it does not make him or her a bad doctor for not doing it. If it is medically necessary that is one thing.....I know plenty of dermatologists who refuse to do Botox injections.....doesnt mean they should be forced to because the patient wants it. I disagree with you tho.....you shouldnt let personal beliefs get in the way of a patient receiving medical care. If you disagree you refer unbiased and in a caring way. If you were a 18 year old girl would you rather have an abortion done by someone who disagrees and has no interest in doing it or by someone who can relate and performs them regularly? I would imagine most would choose the second doctor but it does not make the first one a bad doctor.

Also, like I said before in my field I will never have to perform an abortion.....ever. I'm not in surgery, obgyn or family practice so I have no surgery rights whatsoever. I just want you to understand there is a huge difference between denying medical care (which includes telling the patient they are wrong and immoral etc) and referring the patient to a doctor better suited to treat that patient.

 

[baseball99]

um, if you don't wanna give birth, they are. the patient's reason, or non-reason, for deciding that is none of your concern. you're being paid to do a job. if you don't wanna do it, you can't take the money.

Ok, they are not medically necessary as in not doing the procedure will not kill the patient. They maybe emotionally necessary or necessary for other reasons in the patients life, financial status etc.....but that is a big difference from medically necessary. Medically necessary includes angiography and stent placement for people who have heart attacks to keep the coronary arteries open so the heart doesnt die, etc. I'm paid to do a job and give my patients the best care possible. If something they want is outside of my area of expertise or involves something like an abortion, I would refer to another doctor with a better understanding and even willingness to treat. You would never leave a patient out in the cold, there is always someone to help. There is not a doctor I know of that would ever allow someone to say you WILL do X, especially if it makes you uncomfortable. Just please understand there is a huge difference between denying care and referring when something is outside your area or makes you uncomfortable.....there is a huge difference and not seeing the difference is like calling anything wet: water

 

[rob_just_rob]

Actually as a physician you can tailor your practice any particular way you choose morally. It happens every day. There are doctors who refuse to see poor people bc they dont want to deal with medicaid or the ridiculously insulting reimbursements. There are people who accept only cash. Abortion is a touchy subject for many people. I'm not on a moral high horse or whatever. As a physician you are supposed to remain as neutral and professional as possible. If anything comes in the way of that the next best thing to do is refer to someone who can take over. This goes for everything including not being able to treat some old guy because he looks like your abusive father, etc. Doctors are human and anything that comes in the way of being able to treat unbiasedly is grounds for referral. Knowing when something is beyond you is a skill

You didn't answer my question.

 

[baseball99]

Just checking here - if you are justified in not performing abortions because you don't believe in them, are you equally justified in refusing to treat black people (or gays, or jews, or what have you) because you don't like them?

And I'm talking morally justified, not legally justified.

I'll answer your question succintly. There is a huge difference between a procedure and a person of ethnic background. You can be against abortion and not want to perform them but you hold that belief for white, black, asian etc. It is wrong to deny a specific group of people medical treatment. It would be wrong to offer them different standards of care. Denying someone complete medical care because of an ethnic background or sexual orientation is wrong. There is a huge difference between that and not wanting to perform a procedure for anyone and if people can not see that then it truly is scary. I have friends that agree with abortion but still wont perform it. When i was rotating as a student 20 out of the 25 students said they would perform abortions and when the time came only 2 of them were actually able to do it. Does that make 23 of us horrible human beings.....absolutely not. There is a humanistic side to medicine and if you are implying that that should be removed, that doctors should have no morals and do whatever society wants or what they're ordered to do then you dont even understand how scary that will be. I suggest you look up the book The Nazi Doctors and read about the atrocities that occurred on human beings. The doctors were ordered to do things, pressured by colleagues and you'll see the spiral effect downward

 

[Mirai]

Religion getting in the way? YOU DON'T SAY?!

Religion is a curse and everyone knows it.

 

[baseball99]

Religion getting in the way? YOU DON'T SAY?!

Religion is a curse and everyone knows it.

it has nothing to do with religion.....for many people it has to do with when you consider life begins. This is nothing to do with religion. I know people who dont believe life begins until it is viable outside of the womb.....that limit is 24 weeks with intense medical care. For others it begins when there is a heartbeat, others consider it once the embryo is in the uterus. And still others consider once the egg is fertilized. These are not religious beliefs its what you consider the beginning of life and whether or not you are comfortable taking it into your own hands to end it if it is beyond what you consider the beginning of life. Personally I dont believe I have the right to end life, whether that is an abortion or mercy killing an elderly patient by overdosing their morphine. I will not apologize or be singled out and attacked.....the vast majority of physicians feel the same way and its apparent in the literature. I took the oath to do no harm and i apply that in the best way i can.....i did not take an oath to be judge and jury.

Im definitely far from a right wing conservative.....I believe in stem cell treatments and i think its ridiculous its being blocked.