Medical ethics

rob_just_rob

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baseball99 said:
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.

Very well, but this contradicts what you said here:

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.
(Italics added)

So why can't racist doctors refuse patients?

Or - what about a white supremacist doctor who refuses to perform abortions on white women, but will happily perform the procedure on hispanic, asian, or black women?

My point is, when an individual goes to medical school, he or she is no doubt aware that a) abortion is legal and b) women sometimes have abortions. So, he/she knows that he/she may be called upon to do it - it's part of the job. If I refused to do the parts of my job I don't like (and there are a few of them :tongue: ), I would be strongly encouraged by my organization to find a new career. Why is it that doctors don't face that obligation? Or for that matter - why would someone who has strong anti-choice convictions go into a branch of the medical profession that might bring this conflict into play?

I take your point that if there are other doctors available to do the procedure, an objecting doctor should be allowed to step aside. But unfortunately, there are places where there are few qualified doctors, and allowing some of those few to step aside will often mean that the procedure isn't available for those who need it. This makes the patient a hostage of the doctor's version of morality.
 

baseball99

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rob_just_rob said:
Very well, but this contradicts what you said here:

(Italics added)

So why can't racist doctors refuse patients?

Or - what about a white supremacist doctor who refuses to perform abortions on white women, but will happily perform the procedure on hispanic, asian, or black women?

My point is, when an individual goes to medical school, he or she is no doubt aware that a) abortion is legal and b) women sometimes have abortions. So, he/she knows that he/she may be called upon to do it - it's part of the job. If I refused to do the parts of my job I don't like (and there are a few of them :tongue: ), I would be strongly encouraged by my organization to find a new career. Why is it that doctors don't face that obligation? Or for that matter - why would someone who has strong anti-choice convictions go into a branch of the medical profession that might bring this conflict into play?

I take your point that if there are other doctors available to do the procedure, an objecting doctor should be allowed to step aside. But unfortunately, there are places where there are few qualified doctors, and allowing some of those few to step aside will often mean that the procedure isn't available for those who need it. This makes the patient a hostage of the doctor's version of morality.

I understand what you're saying and what youre pointing out as my contradiction, i was not thinking of racism but of other examples. The thing with abortion is you will never be able to force a doctor to end a life, case closed. A woman has a right to choose and a woman has control over her own body. She can make the final decision regarding terminating a pregnancy before a certain number of weeks.....the thing is no matter what people say, it is not a medically necessary procedure. And the woman's right to choose does not supercede a doctor's autonomy, just as a doctors autonomy does not supercede a womans right to choose.
 

DC_DEEP

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rob_just_rob said:
...Why is it that doctors don't face that obligation? Or for that matter - why would someone who has strong anti-choice convictions go into a branch of the medical profession that might bring this conflict into play?...
My guess is that not everyone may agree on the exact meaning of primum non nocere. Micro or Macro? The woman or the fetus? The Lady or the Tiger?

Baseball99 finally answered me directly, and I'm ok with his answer. My ethics question, ladies and gents, is not about a doctor who refuses to perform a specific procedure on anyone. It's about a health care provider who will, based on personal beliefs rather than medical reasons, perform a service for one patient but not another patient.
 

Ethyl

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baseball99 said:
I understand what you're saying and what youre pointing out as my contradiction, i was not thinking of racism but of other examples. The thing with abortion is you will never be able to force a doctor to end a life, case closed. A woman has a right to choose and a woman has control over her own body. She can make the final decision regarding terminating a pregnancy before a certain number of weeks.....the thing is no matter what people say, it is not a medically necessary procedure. And the woman's right to choose does not supercede a doctor's autonomy, just as a doctors autonomy does not supercede a womans right to choose.

What if giving birth to a child ends the life of the mother? Is it still "medically unnecessary"?
 

MASSIVEPKGO_CHUCK

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DC_DEEP said:
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?

S1: The driver's personal feelings/preferences in driving anyone should not interfere with her job. Not only does that indicate discrimination hands down, but it also includes dereliction of duty. Not to mention possibly risking the life of the patient. She has no case when she refused to do her job. Period, end of story.


S2: A pharmacist's responsibility ends at filling the prescription for the customer. The customer's personal life is totally irrelevant to him & could be misconstrued as dereliction of his job.
 

DC_DEEP

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mercurialbliss said:
What if giving birth to a child ends the life of the mother? Is it still "medically unnecessary"?
We will never come anywhere near concensus on the abortion issue. Although it does bring up a few interesting points. I know some physicians will not perform a D&C, period. But D&C is often used to treat other conditions totally unrelated to pregnancy. Sometimes, that curmudgeonly old uterus just needs a good scraping. Birth control pills are often used to treat a variety of conditions unrelated to preventing conception. For a provider (doctor or pharamcist or any other) to make morality assumptions and refuse to provide those services or medications is a violation of professional ethics.

I noticed a couple of comments in some of the other posts in this thread regarding the legality of some of these things. NEVER assume a law exists, and NEVER assume a law does anything in particular, not even from its popular title. The only way to know is to read the actual laws.

States with current laws which allow a pharmacy or pharmacist to refuse to fill a legally written prescription: AR, GA, SD.

States with proposed legislation as above: MN, WI, IL, IN, MO, OK, TN, WV, NH, NY, NJ.

States with current laws which allow a range of health care providers to refuse services: IL, MS

States with proposed legislation as above: WA, SD, MO, MI, AL, WV, VT, RI.

Only CA currently has laws requiring a pharmacist to fill a legally written prescription; IL has professional regulations, but not law.

States with proposed legislation to require filling of legally written prescriptions: AZ, MN, MO, WI, MI, WV, PA, NY, NJ, MD.

As you can see, there is some debate and conflicting proposed legislation in several states.

And most states have "at-will" labor laws, so don't be too quick to assume workers' rights.
 

baseball99

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mercurialbliss said:
What if giving birth to a child ends the life of the mother? Is it still "medically unnecessary"?

Please elaborate on "ends the life of the mother".....if you are talking about the woman dying because he had a ruptured uterus or a multitude of other conditions that can cause maternal death thats one thing but im not sure if thats what you mean.....if it is what you mean then the life of the mother is always put first. If the baby is viable some physicians would work to do the best care for both but if the choice is between the mothers life and the babys life, the mother comes first.....
 

Matthew

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DC_DEEP said:
Only CA currently has laws requiring a pharmacist to fill a legally written prescription;

Thank goodness! Makes me glad to live in Cali.
 

DC_DEEP

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Matthew said:
Thank goodness! Mkes me glad to live in Cali.
Right! I know this will ruffle a few feathers, but it is my opinion that a pharmacist should ONLY EVER refuse to fill a prescription when he knows it may have harmful interactions with other drugs; even in that case, he should call the prescribing physician to discuss it.

I have had my pharmacist call my physician before to confirm dosing, or to confirm the requested number to dispense, but I have never met up with one who refuses to dispense an otherwise perfectly good prescription. Nor have I ever had a pharmacist ask my marital status.
 

MASSIVEPKGO_CHUCK

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DC_DEEP said:
Right! I know this will ruffle a few feathers, but it is my opinion that a pharmacist should ONLY EVER refuse to fill a prescription when he knows it may have harmful interactions with other drugs; even in that case, he should call the prescribing physician to discuss it.

I have had my pharmacist call my physician before to confirm dosing, or to confirm the requested number to dispense, but I have never met up with one who refuses to dispense an otherwise perfectly good prescription. Nor have I ever had a pharmacist ask my marital status.
And I wouldn't disagree on that point either there, DC. A pharmacist's responsibility is to take the script from the patient, check for existing meds, and advise of possible interaction between those meds. He/she can also call the prescribing physician for further advise on that.That aside, No pharmacist can refuse to fill a sexual aid prescription for a customer souly based on their marital status and the pharmacist's own moral views.
 

rob_just_rob

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DC_DEEP said:
We will never come anywhere near concensus on the abortion issue.

Understatement of the year candidate right there.

Not to yank this thread off topic (as it has been interesting thus far) but as I've said before, people will be arguing over abortion long after same-sex marriage becomes an accepted reality.
 

samhung

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DC_DEEP said:
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.

To clear up a few misconceptions here on the nature of professional ethics vs. personal moral values:

1) I am very familiar with the Washington case, and although many disagree with it, it is entirely within the province of any health care professional to refuse to offer any therapeutic modality as long as that standard is applied fairly, consistently and without exception. Just as there are hospitals that do not offer specific services, e.g. open heart surgery or cosmetic procedures, the same standard applies to individual health practitioners. Health care is the most regulated area of human life, without exception. Those regulations exist to protect patients and that is the only reason that professions are regulated in the manner in which they are, e.g. most of them are self-regulating with a majority of the licensure and regulatory bodies being composed of professionals in that area.

2) The US health care system is not run on a single payer, limited-provider model and in most circumstances, you are free to choose a provider that will meet your needs. Like it or not, health care is a business. The standards by which health care professionals conduct their business and the places in which they practice their professions are regulated in a different context, but if service is refused for one reason or another, as long as there was no bias related to ethnic, religious, racial or other protected classes, you are quite free to choose another provider. Unless you belong to an HMO or other insurance plan that by design limits the choice of provider, you are free to find a physician or other health care provider that will do things your way, as long as legally permissible. The one thing that kept coming up in the Washington case, the idea that the customer(s) affected were somehow unable to use a different pharmacy, is abjectly ludicrous and stupid on its face value. Given the almost fungal-like proliferation of chain pharmacies in every grocery store and on every corner, it sounded like the people making the argument were just plain fucking stupid. Okay...my editorial opinion there.

3) The core of any profession, be it in health care, law, accounting or whatever, is the trust formed between the patient/client/customer and the professional acting on their behalf. An inherent part of this is the exercise of educated professional judgment consistent with ethical standards. Part of that judgment is the ability to choose which services you may offer and which you will not. A health care professional is free to use his/her personal values and beliefs in those choices. That is an individual right. The laws which govern professional conduct specifically provide that only the regulators of that profession may dictate how that professional judgment is used. A non-professional has no legal authority, unless provided by law or regulation, to force a professional to do something against that professional judgment as it is the essence of what is a "profession".

Sorry to interject my personal opinion in #2, but I am getting a bit sick and tired of listening to people who only exist to whine about something. That's why I don't practice psychiatry.
 

samhung

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MASSIVEPKGO_CHUCK said:
No pharmacist can refuse to fill a sexual aid prescription for a customer souly based on their marital status and the pharmacist's own moral views.

Not true. If the pharmacy has a stated policy that it will not dispense certain types of medications, and as long as this standard is applied consistently, fairly and without exception, the pharmacist CAN refuse to fill a prescription. They are also free to refuse to fill prescriptions when they do not have the stock, if they are not a provider under whatever insurance plan is presented by the customer or for any other reason other than bias against any legally protected class. Just showing up with a prescription does not entitle you to the medication or even to consideration for having it filled. Just like there is a due process for civil and criminal court proceedings, so is there for any patient:professional encounter in health care.

As long as the situation is not an emergency or life-threatening, any health care professional is free to refuse service to anyone. Just like a business can refuse to provide service, so can a health care provider. I can and have refused patients for many reasons, up to and including they way they have treated other physicians. No health care professional is obligated to be a punching bag, and I am equally permitted to notify a patient that I will no longer provide care to them. That is a very rare exception, but it does occur and there are very specific regulations (as there are for anything in health care) attached to that situation.
 

DC_DEEP

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samhung said:
If the pharmacy has a stated policy that it will not dispense certain types of medications, and as long as this standard is applied consistently, fairly and without exception, the pharmacist CAN refuse to fill a prescription.
The operative phrase here being consistently, fairly, and without exception. For a pharmacist to stock a medication, but dispense it only to married persons, does not sound to me like it meets these criteria. Sure, the fellow was free to shop around to find a pharmacy who will fill that particular prescription. But if he has been using that particular pharmacy for a few years, then suddenly has a problem if the Rx calls for sildenafil citrate, well, that's not ok. Nor is it ok for someone to have to take off work and drive around town looking for a pharmacy whose policy IS consistent, fair, and without exception.
I can and have refused patients for many reasons, up to and including they way they have treated other physicians.
Reminds me of the "Seinfeld" episode, where Elaine gets notes in her chart that she is a difficult patient, then no doctors will see her... not that there's anything wrong with that.
No health care professional is obligated to be a punching bag,
I could not possibly agree more.
 

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DC_DEEP said:
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.

Proof that Christianity is still the cause of many of the world's problems. People with narrow minds can hide behind whatever religious umbrella suits them in order to perpetrate unspeakable horrors on humanity in the name of a deity who, were he here to defend himself, would probably be sick to the stomach at what his alleged followers are doing.
Health service providers should do some sort of psychological screening to keep people with backward and potentially dangerous thought patterns from joining their forces.
Whatever happened to "Thou shalt not kill", "Turn the other cheek", and "Do unto others as you would have them do unto you"? Some act as though their religious beliefs were a buffet from which to pick and choose.

"Why me, Lord? Where have I gone wrong? I've always been nice to people. I don't drink or dance or swear. I've even kept Kosher just to be on the safe side. I've done everything the bible says, even the stuff that contradicts the other stuff." -Ned Flanders
 

DC_DEEP

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longseangalway said:
...a deity who, were he here to defend himself, would probably be sick to the stomach at what his alleged followers are doing.
longsean, I think I'm in love with you, for so many reasons... (your Simpsons quote is not helping matters.) Yeah, not to mention that jesus basically bitch-slapped the Pharisees in each of their faces when he healed the sick (people who should have been shunned to begin with) on the sabbath (a high crime, cardinal blasphemy) because he didn't give a shit about their rules, helping those people was first and foremost on his mind. One of my favorite bumper stickers: "Jesus, protect me from your followers!"
...Some act as though their religious beliefs were a buffet from which to pick and choose.
One of my greatest points of contention with pretentious "conservative" holier-than-everyone-else-including-jesus christians. They quote one verse from Paul's Letter to the Corinthians, but refuse to obey/follow all the other verses. Seems to me that such behavior would make any real god exceptionally furious, to the point of torturing them for eternity.
"Why me, Lord? Where have I gone wrong? I've always been nice to people. I don't drink or dance or swear. I've even kept Kosher just to be on the safe side. I've done everything the bible says, even the stuff that contradicts the other stuff." -Ned Flanders
Hi-dly ho, neighborino! That's just fine and dandy, like sour candy!
 
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samhung said:
The pharmacist should have told the patient that she could not fill the prescription and should have directed him to a pharmacy that would.

Although not life and death, employees of advertising agencies sometimes choose not to work on accounts they find morally objectionable - others within the same company do the job - take an anti-smoking advocate who is asked to work on a cigarette account.

In this case, the pharamaCIST who is an employee of the pharamACY could have found a manager and asked someone else to fill the prescription.
 

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Abortion is just one of those controversial issues that will never have a right answer. I'm personally pro-choice because a woman has the right to do whatever she wants with her body. On the other side, I can see how people defend the rights of the fetus. But when you are a medical professional, it is my belief that you need to try your best to help the patient. If it conflicts with your morals, then that's just too damn bad. Moral debates are best left out of medicine because refusing to provide healthcare to someone based on whatever criteria is just a slippery slope, and is bound to lead to more discrimination.
 

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Pensive Josh said:
Abortion is just one of those controversial issues that will never have a right answer. I'm personally pro-choice because a woman has the right to do whatever she wants with her body. On the other side, I can see how people defend the rights of the fetus. But when you are a medical professional, it is my belief that you need to try your best to help the patient. If it conflicts with your morals, then that's just too damn bad. Moral debates are best left out of medicine because refusing to provide healthcare to someone based on whatever criteria is just a slippery slope, and is bound to lead to more discrimination.

the point is no doctor has to provide medical care outside of an emergency. Only in times of emergency are strict protocols to be followed. Beyond that a doctor has every right to refuse treatment, etc. I know a ton of docs who are pro-choice but still wont perform an abortion. Just because someone is pro-choice does not mean they want to do every abortion possible. For me its not necessarily a religious thing, its when I consider life to begin. This is all based on an unbelievably awesome ethics class i took at my university. I made the ethical decision of when I consider life to begin and I made the ethical decision not to end life unless it is absolutely medically necessary for the mother (ie she is hemorrhaging, etc). That is my personal decision. I know certain people who will perform abortions late in the first term with no thought.....thats their decision and i wont think anything bad of them. Refusing care is not a slippery slope when done in a respectful way.