This isn't good for anyone (On Medical Ethics)

A standard medical school interview question goes like this:

Q: A woman comes to you for an abortion. What do you do?

There are several ways to answer this. For example, you perform the procedure. More likely though, you would refer the patient to someone who could do the procedure (if you weren’t trained to do that). The other answer may be that you aren’t comfortable with it so you would refer them to another physician for it. These are "correct" answers. There is a wrong answer, however. That wrong answer goes something like this:

A: I think abortion is murder. Life begins at conception. I wouldn’t do it. Period. I would send the patient home to have the baby.

Prepare to get grilled. You will get grilled not necessarily on your views (although most educated people would be very curious about these black and white views – there is no nervous tissue for about 14 days post-fertilization, we can create a “fairly” viable embryo with no sperm (SCNT), we fertilize eggs and simply fail to implant many times during attempts to get pregnant (conception is only a part of life beginning), we fertilize many eggs during in vitro fertilization yet few seem to mind this, etc.), but rather you will get grilled on failing to provide your patient with adequate care. If you feel you cannot do the standard of care that is LEGAL and asked of you, then you are obliged to find that patient adequate care. If this isn’t how things worked, imagine the upheaval it would cause in medicine: Some right-wing neoconservative doctor doesn’t “believe” in evolution and he refuses to curb his over-prescribing of antibiotics, saying that nothing is evolving (of course, it’s hard to imagine people PRACTICING medicine that is based on evolution and not understanding it, but it happens). Superbugs continue to develop. Take it a step further, a doctor fails to give a young lady the HPV vaccine when she requests it because he feels she shouldn’t be having sex. He tells her to go home and not have sex. However, her religious system doesn't ban sex. Then she gets HPV-18, which is strongly linked to cervical cancer.

Just a short time ago these things were unconscionable.

I recently had a discussion with medical students here. I was horrified at what I found out I had missed in the states. President Bush signed new “conscience” rules in December of 2008 before leaving office. I could not believe what I read. In short, the new law allows a doctor to refuse a service because of a moral belief (I have no problem with this; just make the referral) AND not inform the patient of where to get care or that care is available. In other words, a physician can now legally wrap his morals into his care to a degree like never before. In other words, a woman can ask for the HPV vaccine and essentially told not only “no” but also not given a referall to anywhere else. In fact, the doctor is now ok to say no and explain why it is morally wrong to get it to the patient.

Is this what we want? Do we want someone trained to advise us on health issues spilling their morals into care that much? One could argue that all beliefs will affect that intimate doctor-patient relationship (and I agree), but where do we draw the line? Now a doctor can refuse a legal procedure, fail to refer you to someone else, and even counsel you on why he doesn’t do what you asked. So now what?

“That ethics policy, however, from the American College of Obstetricians and Gynecologists, had less to do with whether doctors should be willing to perform abortions or other potentially controversial services, and more to do with what they should do if they were unwilling to perform them (bold mine). In those cases, according to the policy, doctors should tell patients upfront and refer them to someone who is willing to provide the services.
Under the new regulations, however, such referrals will not be required.”

The AMA and various other medical societies opposed this action.

If you are like most people that will read this, you are a Christian and are so mainly because it is the religious story of your culture/people/family. No one argues about this.

But pretend you were some other religion that believed that there was no such thing as psychiatric illness. So when you see a patient that is severely depressed, rather than giving them the standard of care, you explain to them that you don’t believe it is right to take those drugs. You send them home. To me this is disgusting. Treat the patient or find someone who will – this is your JOB! If you find something about your job that doesn’t agree with your “morals”, then work to change it or quit. But do your job. Patients should be taken care of.

Or imagine you rush your son to the hospital, short of breath and weak. You find out his heart is failing and he needs a transplant. Imagine if there were a heart available but the doctor simply couldn’t bring himself to do the transplant – he considered the heart to be the “soul” of the person. Besides this not being correct, he now wouldn’t have to refer you to the surgeon who could do it, instead being likely to counsel you on how God has a plan (or the heart is the soul or anything else) and to say goodbye.

Or imagine that you’re seeing your physician about getting rid of syphilis; however, your physician feels that STIs are punishment for wrongdoing and refuses to provide care. Now he does not have to refer you to another physician for care. Now imagine that this is the only urologist within 50 miles. You are now out of options. You will not receive the standard of care for a disease that is easily curable. And that’s legal. (I think you now see the point; this crashes right into what really is legal, the standard of care, etc.)

The whole thing is an abomination.

Interestingly, I received an email out of the blue from a good friend of mine. She just wanted to share her strange story of late. She knew nothing of this law. She told me that suddenly upon returning to her usual OB/GYN this year she has had an incredible amount of trouble getting contraceptives. Insurance has denied the IUD, and her primary care doc suddenly is making it very difficult to obtain the pill. She was baffled.

One of her friends commented to her, "maybe their religious views are getting in the way of your care."

My friend went on to tell me that she couldn’t imagine her friend was right because she has been going to this doctor for years with no problems until this year. She knew nothing about this new law. I was upset. Here I am, now hearing about how it plays out with patients, unbeknownst to them! Her friend was right on target.

People that agree with this law (perhaps you?) agree with it because they think that their views are the views that their doctor will have. Just imagine for a second that he doesn’t share those views. Now he is free to deny you care that you may need. The issue isn’t with what the doctor does or doesn’t do; the issue is with what he does in the event he feels uncomfortable. Does he uphold some professional standard of care or not?My friend is currently searching for a new doctor. Interviewers for medical school must be scratching their heads; one of the most clear-cut ethical decisions a clinician can make is now being turned on its head, and not for the good. This isn’t good for anyone.