Posted on 11/02/2012 11:14:12 PM PDT by Slings and Arrows
When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.
So I spoke with her. I explained that over the course of her career she would undoubtedly see people from all walks of life with a myriad of religious and or personal practices. I explained that medical care is not about fulfilling any personal need beyond the need to help.
I gave the example of a doctor who is a Jehovah’s Witness. Refusing to order a blood transfusion would be both unethical and malpractice.
I had an OB/GYN who practiced the same religion discuss how he felt that he could prescribe contraception and still honor his Church.
None of this mattered. In her eyes prescribing contraception was an affront to her religion.
“What if you don’t council a patient about condoms and she gets HIV?” I asked.
No answer.
“Do you think it’s ethical for a woman to take time out of her day to come for a well-woman exam and not leave with the contraception that she wants and needs?”
Silence.
“What if that woman leaves your office without birth control, gets pregnant, and is then beaten to death by her partner as pregnancy puts her at increased risk for domestic violence related homicide?” I persisted.
“My patients will know I won’t prescribe birth control or discuss condoms. They will get the Creighton method,” she said.
“How? Will you have a sign? Will your receptionist tell every patient who calls?” I asked.
If the answer had been, “I realize my personal belief system puts me at odds odds with the standard of care so I’m headed for pathology,” I would have commended her for her insight and given her a passing grade with a note about her contraception issues on her transcript.
But she responded that she was going to be a family doctor.
I spoke with the Chief of OB/GYN and the Dean of the Medical School. They agreed that refusing to be involved in any way with contraceptive or safe sex counseling should result in a failing grade on the clinical component of the rotation.
They agreed, that is until she lawyered up. A public fight about teaching contraception would just be too much, you know?
Shortly thereafter I resigned as the director of medical education for OB/GYN and left for a different state.
If a doctor can refuse to discuss contraception, essentially proselytizing to patients, then we should not be surprised that some pharmacists will refuse to dispense it and be protected by the law.
Ask yourself, do you want your own health care provider to consider their own religious or personal beliefs first before offering you medical care? If so, then everything is up for grabs. Everything. From blood transfusions and addiction medicine to fertility therapies and weight loss therapies because it all depends on how you interpret any given scripture.
The only religion that my patients see me practice is medicine. Anything else, in my opinion, is malpractice.
Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.
“Shortly thereafter I resigned as the director of medical education for OB/GYN”
Ahh, the sweet smell of victory in the morning. Olog-hai - this is a rear guard action. She’s covering up her own retreat in order to shore up her ‘reasonable position’. What she’s left out you can drive a truck through.
Let’s quote that part again - she tried to destroy a conservative woman and prevent her from being a pharmacist. And she lost.
Problem solving is exactly what I like about pharmacy! It ties in well with that whole helping-sick-people-get-better thing.
This physician provides a logically incoherent sequence of consequences to a decision the student has made. One could regress consequences as far back as one wants and never provide a logical causal relationship to explain consequences of decisions patients may or may not choose to make during their lives. It is reasonable that the physician-to-be make clear up-front her reservations so patients can make informed decisions regarding the physicians concerns. The physician-to-be will, in any case, be obligated to conform to standard of care practice.
Believe me, I’m very aware of that little interaction. Adding depressants to depressants isn’t so hot either.
In fairness, I haven’t actually run into a doctor who prescribed Vicodin to an alcoholic. I have run into doctors who prescribed Vicodin to patients already on hepatotoxic medications with an absolute contraindication to acetaminophen, though.
Minor correction: The student was a medical student. I'm the pharmacy student.
Ben Stein made a documentary a few years back titled: “Expelled: No Intelligence Allowed.” The film got a horrible review from Scientific American, once a highly technical science journal that today is a dumbed down political tract with a science theme.
Stein’s movie, which included a lot of interviews with scientists, was about the theory of Intelligent Design and how it has been censored in the academic world in favor of Darwinism. He ties together Darwin, the Godlessness of mainstream science, Eugenics and the Third Reich.
http://www.imdb.com/title/tt1091617/
*low_whistle*
Situations like that are pharmacists have a right NOT to fill a prescription if they think it will endanger the health of the patient.
My hat is off to a Fred Kohl who posted the following comment on the blog:
“Please note, this was not an “intern,” but a STUDENT. Medical students can go on to ANY field of medicine, including a lot that would never, ever have prescribing contraceptives as part of their practice (radiology, dermatology, pathology, etc come to mind). However, for most
medical schools, doing a rotation in OB/GYN is a required part of the curriculum; so, even radiologists, pathologists, etc, need to spend a month or two following around Ob/Gyn’s and seeing what they do. From what Dr. Gunter describes, this was NOT an intern or resident training to be a GYN. SO basically, you, Dr. Gunter, etc, are saying this student should never be a doctor, of any sort, because they don’t agree with Dr. Gunter’s secular humanistic point of view, and opted out of something they find morally problematic? Even if it’s something they’d never have a reason to do in their field of medicine?
For another thing, it’s not entirely clear that oral contraceptives are not abortofaceant. There have been peer-reviewed journal articles that suggest otherwise (http://triggered.stanford.cloc..., and the manufacturer’s label states that inhibition of an implanted embryo is a mechanism of action (which, for many, is morally problematic). While you may not see this as a problem, many do. And thus, if Dr. Gunter’s point of view is followed, NO ONE who sees this as morally problematic should be a doctor,
period. Again, that may not be YOUR point of view, but it the point of view of some people out there.
The American Medical Association (AMA) has long had a standard that if a physician has a moral objection to a treatment requested by a patient, their obligation is to (a) inform the patient that is the case, and (b) tell the patient where they can get the service/treatment they desire. It has also been a long-held paradigm of training that it is unethical for supervising physicians to force students (or residents) under their charge to perform acts that they find morally problematic, and make other arrangements (or care for the patient, themselves). These principles protect the patient from being abandoned, AND allows physicians to not be compelled to do something they find objectionable.
So basically, back to Student X, after graduation might have two things happen. A) She might be a radiologist, dermatologist, whatever, and when someone asks for contraception, she says “I’m a radiologist. I read X-Rays. You need to see a GYN for that.” Or, B), she might go into some primary care field where contraception is practiced by many, and say “Well, I don’t happen to do that. This is why I happen not to; you’re certainly free to pursue a different choice. If you’d still like to pursue that, here’s how/where you could.” (Or even do what Dr. Gunter did mention, and simply have the receptionist tell people when they call for an appointment).
However, under Dr. Gunter’s “ethical” standards and practices, this would-be-physician was compelled to do something she identified as morally objectionable, under threat of losing her ability to have a job!
In the end, this student “lawyered up” because Dr. Gunter (in her crusade to force every medical student she came across to take her moral stance on medicine and life) violated long-held, AMA-sanctioned ethical standards, and in the process violated this woman’s constitutionally protected civil rights.”
Agreed on all counts.
To me, it is like getting past admin, and the front office, and the people that get the glory, and finally getting back there where the scientists are, the people putting things together, that know what works, what doesn’t, and in what proportions.
Pharmacists never pose, they can’t pose, they would never dream of posing, they do science and medicine.
I’ve heard good things about it, but haven’t seen it.
Thank you! When I start practicing, I hope I will live up to your expectations.
*raised_eyebrow*
You pointed out that Dr Jen left her position soon after this incident. Given the information in Mr Kohl's post, I wonder if she was asked to resign.
Thank you for posting this thread. I enjoy reading intellectual discussions and read the entire lengthy list of blog comments. There were excellent comments and points presented from various perspectives on the issue.
I highly recommend reading the source article and comments for anyone interested in medicine, abortion, religion, individual rights....
http://www.kevinmd.com/blog/2012/11/religion-patients-practice-medicine.html
I just placed it in the comments section, but I should make note that the methods this likely now-physician wished to practice, the Creighton method, has been found to be both an effective means of pregnancy prevention and of pregnancy conception in peer-reviewed medical journals.
http://epublications.marquette.edu/cgi/viewcontent.cgi?article=1015&context=nursing_fac
Heaven forbid Catholic universities should have anything to add to the practice of medicine.
No doubt our current (and soon to be former) President would attempt to undermine research such as this given the chance.
The doctor’s moral code appears to be rather inflexible ~ rigid even ~ and based remarkably on a sociopatic view of who is in charge.
You’re very welcome.
one does suppose that method and other practices could reduce Ms Fluke’s $3,000 per year condom bill substantially.
Patients can always ask for a different doctor. It’s not that hard. Let the doctors be the doctors they want to be, and if the patients want a different doctor, patients get switched to different doctors all the time. For all sorts of reasons.
The basic logic that is (illogical) is that “because there are people with many different personal beliefs, YOU therefore have to cave on your own beliefs” - is bullcrap.
Who are they to say you are the one who has to cave? Who are THEY to say because they let everyone’s beliefs slide without question, that THAT is the morally superior view to take? It’s morally the wimpiest, chickening-out position you can take. Bottom line is just because everyone has a right to their own view, that doesn’t automatically make their viewpoint right or equal to yours.
Hitler, Mao, Stalin, Mugabe, Pol Pot, etc all had their fricking viewpoints. Didn’t mean it was equal to yours, or morally right.
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