Medical ethics

MASSIVEPKGO_CHUCK

Legendary Member
Joined
Aug 9, 2003
Posts
41,064
Media
0
Likes
41,243
Points
718
Location
New Jersey, USA
Sexuality
100% Straight, 0% Gay
Gender
Male
samhung said:
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.
I think you're confusing morality with obligation.


The fact remains is that the hpyothesises dealt in more moral issues than professional issues. A liscenced pharmacist's moral issues should NOT play any part in obtaining a prescription for erectile dysfunction or whatever souly predicated on the customer's marital status, unless the scrip was obtained illegally and not in the prescribing physician's handwriting. Then the pharmacist would have just cause to refuse to do it.

As to the ambulance driver, her moral views of abortion are immaterial when her job is to aid in taking others to the hospital for treatment. And as such they risk the patients life when her morality supercedes her professionalism.
 

rob_just_rob

Sexy Member
Joined
Jun 2, 2005
Posts
5,857
Media
0
Likes
43
Points
183
Location
Nowhere near you
I guess the moral of this thread is: You can't expect medical personnel to always have your best interests at heart, any more than you can expect that of your boss, your broker, your waiter or the guy selling you cigarettes. Well, maybe a little more than the last guy. :cool:

I think from childhood, a respect for doctors is instilled in us (after all, they're where you go when you are at your most vulnerable - when you're sick). But despite their expensive training, doctors are just as fallible as the rest of us.
 

headbang8

Admired Member
Joined
May 15, 2004
Posts
1,618
Media
12
Likes
809
Points
333
Location
Munich (Bavaria, Germany)
Sexuality
80% Gay, 20% Straight
Gender
Male
samhung said:
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.

Veering off-topic:

Samhung is absolutely right. A business can turn away any customer it likes, as long as it's not for any of the tightly-defined reasons described in the law.

You can't turn away a customer because of his race, ethnicity, religion, or gender. You CAN turn away a customer based on his dress, social behaviour, or how much money you think he will earn you. (All of which have been masks for open discrimination in the past)

A good reason for medical practice not to be based on a pure business model, IMHO.
 

baseball99

Experimental Member
Joined
Mar 21, 2006
Posts
871
Media
0
Likes
14
Points
163
Sexuality
100% Straight, 0% Gay
Gender
Male
rob_just_rob said:
I guess the moral of this thread is: You can't expect medical personnel to always have your best interests at heart, any more than you can expect that of your boss, your broker, your waiter or the guy selling you cigarettes. Well, maybe a little more than the last guy. :cool:

I think from childhood, a respect for doctors is instilled in us (after all, they're where you go when you are at your most vulnerable - when you're sick). But despite their expensive training, doctors are just as fallible as the rest of us.

if a doctor refuses you care with no alternative he does not have your interest at heart.....if you are seeking an abortion and he refers you to a colleague he trusts and will do it for you he still has your best interest at heart. For a lot of doctors the main problem with abortion is the ending of a potential life. It doesnt matter who is pro choice, etc.....For a lot of doctors performing abortions opens a gate where soon euthanasia will be commonplace and if euthanasia becomes common, who makes the decisions and how. Thats the slippery slope. Recently the anesthesiology board is recommending that anesthesiologists dont perform executions because >98% disagree with it.....because legal or not youre still ending a life and that is against everythign a doctor stands for.....the difference with abortion is when you consider life has begun
 

DC_DEEP

Sexy Member
Joined
Apr 13, 2005
Posts
8,714
Media
0
Likes
93
Points
183
Sexuality
No Response
baseball99 said:
...if you are seeking an abortion ...the main problem with abortion ...For a lot of doctors performing abortions .....the difference with abortion is when you consider life has begun
baseball, I keep trying to steer the bulk of this discussion away from abortion, and you keep bringing it back. Is there some issue, other than a couple of posts by pro-choicers? You seem almost obsessed. You cannot seem to grasp what I'm trying to debate here. I don't really care if you choose not to perform abortions. That's not the topic. If you performed an on-demand abortion for a Jew and not for a Christian, that WOULD BE ON TOPIC. A little focus, please.
 

samhung

Sexy Member
Joined
May 25, 2006
Posts
160
Media
0
Likes
29
Points
248
Gender
Male
Chuck:

I'm not confusing anything in this issue, since it affects my practice every day.

Outside of death and taxes being the only two certain things in life, to a health care professional the ethics by which we practice are all but genetically encoded into us. That includes using our personal moral values and professional judgment as a single entity in guiding how we treat our patients. To a licensed health care provider, there is no difference between morality and obligation. We sacrificed a lot of our personal beliefs when we entered the profession and those ethics were pounded so heavily into us during our education and training. We see no difference between what we are obligated to do and how we do it. You cannot separate the two as things are not that convenient for us. We entered our professions willingly, and when we did so we voluntarily took on a set of obligations that do not exist to the general public. If you were a licensed health care professional, you would understand that. Hell, it would be part of you inseparable from all others.

I do not know if you are a licensed health care professional or not, but I find it interesting that so many people who have no such designation find it necessary to tell us how to practice. As I said earlier, as long as there was no bias shown to a protected class (e.g. race, ethnicity, etc.), any health care professional is free to refuse service to any patient as long as it is not a life-threatening situation. It sounds as though a lot of people believe they are entitled to a medication simply because they show up at a pharmacy with a prescription. You are not entitled to the medication if the pharmacy is following the law and chooses not to provide the medication to all of its customers or if the pharmacist chooses not to do business with you in a legal manner.

As to the earlier comment that no one should have to take off work to find a different pharmacy, well that person took time off to see their doctor and obtain the prescription after an appointment. Presenting that prescription to the pharmacist is legally the same type of patient:provider encounter as that doctor's appointment to regulators. It is funny that so many patients are more than willing to wait for a physician to look at them, but get impatient when a pharmacist takes a few minutes to fill their prescription. Ultimately, what has more immediate impact on your life, the doctor's appointment or the act of putting a potentially dangerous chemical entity into your body for the first time or a higher/lower/different dosing of the same?

For what it's worth, pharmacists have a hell of a lot more training in human pharmacology than any physician. It's what they do and I am glad they do it. It certainly makes my job a lot easier knowing that they are there as a safety check on my prescribing. Many patients are not forthcoming about what medications they are, but if they use the same pharmacist or pharmacy, at least they have that information and can catch potential problems.

Professionals are simply human beings with a particular knowledge base that is intended to be applied in a certain manner and under very heavy standards of conduct. The pharmacy is not a bank and the pharmacist is not a teller who simply gives out drugs in exchange for a written piece of paper, and a physician is not someone who simply sees patients, goes "hmmm" and writes out a prescription.
 

DC_DEEP

Sexy Member
Joined
Apr 13, 2005
Posts
8,714
Media
0
Likes
93
Points
183
Sexuality
No Response
samhung said:
... the earlier comment that no one should have to take off work to find a different pharmacy, well that person took time off to see their doctor and obtain the prescription after an appointment. Presenting that prescription to the pharmacist is legally the same type of patient:provider encounter as that doctor's appointment to regulators....
samhung, you are taking my comments out of context. Actually, I don't like waiting two and a half hours for an appointment with my doctor. I understand that many patients don't know how to deal with an appointment, and are often the cause of delays. But by the same token, the doctor and his practice should show me the same considerations: if I'm late, don't cancel my appointment, but re-work the schedule. Put the next patient in my place, and put me in his. Your office should have no higher expectation of my punctuality than I should have of yours. And yes, I already took time off work to get to my doctor's appointment. My employer doesn't appreciate it much if I have to take off 3 days work to get one issue dealt with. Fortuantely, most of my health care is through the Veterans Administration, and they have a 20-minute rule: They try their best to be no more than 20 minutes past your appointment time, and request that patients do the same.
For what it's worth, pharmacists have a hell of a lot more training in human pharmacology than any physician. It's what they do and I am glad they do it. It certainly makes my job a lot easier knowing that they are there as a safety check on my prescribing. Many patients are not forthcoming about what medications they are, but if they use the same pharmacist or pharmacy, at least they have that information and can catch potential problems.
Please re-read my posts #49 and 54 in this thread.
[/quote]
 

baseball99

Experimental Member
Joined
Mar 21, 2006
Posts
871
Media
0
Likes
14
Points
163
Sexuality
100% Straight, 0% Gay
Gender
Male
DC_DEEP said:
baseball, I keep trying to steer the bulk of this discussion away from abortion, and you keep bringing it back. Is there some issue, other than a couple of posts by pro-choicers? You seem almost obsessed. You cannot seem to grasp what I'm trying to debate here. I don't really care if you choose not to perform abortions. That's not the topic. If you performed an on-demand abortion for a Jew and not for a Christian, that WOULD BE ON TOPIC. A little focus, please.

my bad.....its bc i viewed this thread as kinda abortion or no abortion kind of thing so i really wasnt lookin at it from any other angle. I'm far from obsessed, like i said I really dont think about the issue all that often in my field. Interestingly today we have a major dilemma with a Jehovahs witness in training.....at first she didnt want a transfusion, now she does but her husband is trying to stop it.....
 

dhagelin3

Just Browsing
Joined
Jul 24, 2006
Posts
7
Media
0
Likes
0
Points
146
Location
Tampa Bay area, Fl
Sexuality
90% Gay, 10% Straight
Gender
Male
[

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.[/quote]

Perhaps you don't know the whole story of the man in question. I can't speak for him, but I personally know a Dr., who when he was 14 his mother remarried to a man of the Jewish faith. When the stepfather saw his son hadn't been circumcised he insisted to his wife she take him for the procedure. (my question is--what stepfather is looking at his nude 14 yr old?) The mother finally gave in to her husband's demands and took her nearly hysterical 14 yr old screaming he didn't want the procedure done. After the act was completed the step father was not satisfied w/ the amount of skin the dr removed and insisted the boy go back to be recircumcised. This time the mother did not yield to his demands. When the boy grew up, went to medical school, one day when class was working on cadavors he was instructed to dissect the penis. He refused---most adamantly, saying he would never cut a man's penis during his practice. His stand was honored, he went into practice, and has never, never cut a penis, whether neonatal or as an adult. He also has a "right" to his convictions. And where are the women who have so much to say about THEIR rights to THEIR bodies but not allowing their sons a choice to be sexually complete?
 

dhagelin3

Just Browsing
Joined
Jul 24, 2006
Posts
7
Media
0
Likes
0
Points
146
Location
Tampa Bay area, Fl
Sexuality
90% Gay, 10% Straight
Gender
Male
baseball99 said:
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.

Bravo.....so sick of hearing about female rights issues when persons as your self are denied your. Most females seem to have no qualms about having their newborn sons' penis ripped to shreds for no medical reason. where are HIS rights? Sorry on them........................................
 

DC_DEEP

Sexy Member
Joined
Apr 13, 2005
Posts
8,714
Media
0
Likes
93
Points
183
Sexuality
No Response
OK, I HAVE TO ASK, WHAT IS SO DIFFICULT TO UNDERSTAND ABOUT THE TOPIC OF THIS THREAD? THE TOPIC OF THE THREAD IS NOT WHETHER OR NOT A PROVIDER REFUSES TO PROVIDE THE SERVICE, PERIOD. IT IS ABOUT WHEN A PROVIDER WILL PROVIDE THE SERVICE TO ONE PERSON, BUT NOT ANOTHER, BASED SOLELY UPON PERCEIVED MORALS. MORALS AND ETHICS ARE NOT THE SAME THING. REFUSING TO CUT ANY PENIS IS NOT THE SAME THING. REFUSING TO PERFORM ANY ABORTION IS NOT THE SAME THING. REFUSING TO DISPENSE ANY ED DRUGS IS NOT THE SAME THING. THIS IS NOT AN ABORTION THREAD, THIS IS NOT A CIRCUMCISION THREAD.

This is about providing transportation for a patient whose treatment the driver agrees with, but not to a patient whose treatment the driver disagrees with. This is about a pharmacist basing his willingness to dispense an ED drug to a man based upon the patient's marital status. It is about biased and bigoted treatment provided by health care professionals. Nothing more.
 

MASSIVEPKGO_CHUCK

Legendary Member
Joined
Aug 9, 2003
Posts
41,064
Media
0
Likes
41,243
Points
718
Location
New Jersey, USA
Sexuality
100% Straight, 0% Gay
Gender
Male
DC_DEEP said:
OK, I HAVE TO ASK, WHAT IS SO DIFFICULT TO UNDERSTAND ABOUT THE TOPIC OF THIS THREAD? THE TOPIC OF THE THREAD IS NOT WHETHER OR NOT A PROVIDER REFUSES TO PROVIDE THE SERVICE, PERIOD. IT IS ABOUT WHEN A PROVIDER WILL PROVIDE THE SERVICE TO ONE PERSON, BUT NOT ANOTHER, BASED SOLELY UPON PERCEIVED MORALS. MORALS AND ETHICS ARE NOT THE SAME THING. REFUSING TO CUT ANY PENIS IS NOT THE SAME THING. REFUSING TO PERFORM ANY ABORTION IS NOT THE SAME THING. REFUSING TO DISPENSE ANY ED DRUGS IS NOT THE SAME THING. THIS IS NOT AN ABORTION THREAD, THIS IS NOT A CIRCUMCISION THREAD.

This is about providing transportation for a patient whose treatment the driver agrees with, but not to a patient whose treatment the driver disagrees with. This is about a pharmacist basing his willingness to dispense an ED drug to a man based upon the patient's marital status. It is about biased and bigoted treatment provided by health care professionals. Nothing more.

Dig it, that's exactly what I've been straining to do all my posts, except that alot of the posters here don't seem to realize that this is more about the moral obligations of an ambulance driver and pharmacists than the code of ethics of a doctor.