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Author Topic: Doctors and the "conscience clause"  (Read 1030 times)

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Offline Pumpkin Seeds

Re: Doctors and the "conscience clause"
« Reply #25 on: June 18, 2014, 07:36:21 PM »
Certainly, but they are doing their job.  Otherwise they would lose their license.  If any other professional simply said, I do not offer that service then the matter would be dropped.  That is all the physician is saying is that he or she does not provide that service. 

Offline Rogue

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Re: Doctors and the "conscience clause"
« Reply #26 on: June 18, 2014, 07:42:04 PM »
I believe that when someone takes on a job, they are aware of what that job entails. If this job is at an OB-GYN or abortion clinic, I believe that all aspects of woman's health should be supported there and all choices should be the patients. To me this means if a Doctor wants to be a part of this practice, they should be prepared to do their job including abortions, because the primary focus should be a female's health. If they simply can't afford to have to equipment, that is acceptable. If not, then I don't approve of it. Simple as that.

I'll admit a lot of my previous arguments have had to do with the idea that there is such a thing as public versus private sector (and maybe that there should be in the US....), but the fact is a person knows what they're doing when they choose a field to go into. If someone chooses to be a Gynecologist, they shouldn't be choosing to do so so that they can stop access to birth control or abortions.

Elective procedure is a very loaded term for me because I found out some wonderful things when I was young. If a person has depression, according to TRIcare (which I'm pretty sure you know as someone in the medical field is the US military's insurance), they qualify for breast implants, botox and any other "elective surgeries". A bit later on the I found this out scale: On the other side, a transgendered person has to muddle through with their insurance what is considered elective and medically necessary despite it being necessary for their mental well being. Mental well being has a bit of a hold on what's elective or not. And in enough cases, abortion isn't elective. And unfortunately there's a timestamp on how long you can wade through red tape with this one to decide on a per person basis.

Offline Sabby

Re: Doctors and the "conscience clause"
« Reply #27 on: June 18, 2014, 07:53:44 PM »
Certainly, but they are doing their job.  Otherwise they would lose their license.  If any other professional simply said, I do not offer that service then the matter would be dropped.  That is all the physician is saying is that he or she does not provide that service. 

Of course a doctor can refuse to do something they aren't trained to do. That's a given. This is about whether a doctor can refuse to do something that IS a part of their job because they find it unethical.

Medicine is an institution. If a procedure is unethical, it should just be flat out removed from that institution. It shouldn't be up to one person inside the institution to decide which procedures are right. If I had to have a blood transfusion in order to save my life or save me much pain and suffering, I don't want a doctor to have the power to refuse me because they disagree with blood transfusions, as some do. Sure, send me to another doctor if ya can. I'm sure I'd get help eventually, but why allow that complication to exist, when it has the capacity to KILL ME?

Doctors have a job to do. If they disagree with what that job entails, then they need to find another.
« Last Edit: June 18, 2014, 08:21:00 PM by Sabby »

Offline Pumpkin Seeds

Re: Doctors and the "conscience clause"
« Reply #28 on: June 18, 2014, 08:26:46 PM »
Sabby, we have already talked about medically necessary and life saving.  Please review previous discussions.

Offline Sabby

Re: Doctors and the "conscience clause"
« Reply #29 on: June 18, 2014, 08:56:08 PM »
Okay then, we'll ignore life saving procedures.

Why should a doctor be able to refuse a service at all? They spent years in medical school and took the job, knowing what it entails. They know what they're in for. Why should a doctor be able to say to me "Another doctor in my position might be able to do this procedure for you, but I'm choosing not to"

How is that okay?

Offline Pumpkin Seeds

Re: Doctors and the "conscience clause"
« Reply #30 on: June 18, 2014, 09:03:01 PM »
Seriously?  Why should a doctor be able to refuse service at all?  I don’t know, because they want to?  There are some doctors that prefer doing knee replacements over hip replacements.  That is their choice and so they choose to do those and not the others.

Offline Sabby

Re: Doctors and the "conscience clause"
« Reply #31 on: June 18, 2014, 09:16:49 PM »
And why is that okay? Why is it okay for a doctor, someone who has taken on a list of responsibilities, to pick and choose which they feel like doing? "Oh, you wan to be a doctor? Well, you need to do X, Y and Z" "Well, I don't want to do Z" "Well, you can be a special kind of doctor who only does X! They don't do Z. But you can't be a normal doctor so long as you refuse to do Z. Sorry" If they want to specialize in a certain thing, then go do that. Be a heart specialist if that's your thing. But why should they be allowed to refuse a procedure that IS one of their duties?

For instance, lap band surgery. Say a surgeon refuses to perform lap band surgery because they think it's a crappy way to drop weight. Why should they be allowed to refuse this surgery, when they are a surgeon?

If it's a part of your job, you do it.
« Last Edit: June 18, 2014, 09:20:49 PM by Sabby »

Offline Valthazar

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Re: Doctors and the "conscience clause"
« Reply #32 on: June 18, 2014, 09:25:09 PM »
Sabby, that isn't how the medical field works.  You want doctors to specialize in fields that they excel in, and feel comfortable doing.  Orthopedic surgeons may be trained to do hip procedures, but may only do knee replacements.

Offline Sabby

Re: Doctors and the "conscience clause"
« Reply #33 on: June 18, 2014, 09:28:38 PM »
This isn't about refusing to do a surgery because they aren't that skilled in that field, or prefer another, it's about refusing on ethical grounds. I want to know how that is okay.

Example, a doctor can refer you to a college who is more suited for what you need. That's fine, I got no problem with that. But what I'm referring to is when the doctor says "I won't do that, I think it's wrong".
« Last Edit: June 18, 2014, 09:38:09 PM by Sabby »

Offline Pumpkin Seeds

Re: Doctors and the "conscience clause"
« Reply #34 on: June 18, 2014, 09:37:30 PM »
I do not understand how that is not okay.  I do not understand how a professional who deals with life and death decisions, deciding that in his opinion he does not want to commit murder, is simply not enough of a reason.  A doctor is not a McDonald’s menu of treatments to be ordered from and then expected to do as they are told.  These are not only professionals in their field, but authorities to be recognized and respected.  Forcing someone to do something against their conscious is honestly reprehensible.  Performing an abortion is a small aspect of what an OBGYN is trained to do.  Just as knee replacements are a small part of what an orthopedic surgeon is trained to do.  Yet a physician does not simply take every case that walks into their office for a consultation. 

The doctor’s only responsibility is to give protect their patient.  If the physician refuses to accept someone as their patient, then they bear no responsibility or duty to that patient.

Offline Rogue

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Re: Doctors and the "conscience clause"
« Reply #35 on: June 18, 2014, 09:42:56 PM »
I don't believe the use of sugar replacements is ethical based on personal research and bias (because I find them to be as bad as sugar). However, if I do not use them in my job, I can get in trouble and eventually fired.  I find the thought of giving children gigantic sized fraps unethical but I have to do it cuz it's my job, regardless of the health issues I'm inadvertently causing. But I do it because it's my job.

A Gynecologist who is trained in doing abortions should do one if being paid for it. Simple as that. They know their job. They signed up for it when they went to medical school and trained to do abortions. If they didn't want to do it, they shouldn't have learned how to.

Doctors have a much higher ability to choose what field they want to go into. If they didn't want to deal with abortions they should have chosen a different field.

Offline Sabby

Re: Doctors and the "conscience clause"
« Reply #36 on: June 18, 2014, 09:44:21 PM »
Then I refer you once again to my lap band analogy. The doctor does not say "I know someone who would be better then me at doing this, you might want to see them instead" they say "I won't do that, I find it wrong"

I want you to address that last scenario. Pointing out that doctors have different fields they are strong/comfortable in is completely irrelevant to the question of refusal on ethical grounds.

I don't believe the use of sugar replacements is ethical based on personal research and bias (because I find them to be as bad as sugar). However, if I do not use them in my job, I can get in trouble and eventually fired.  I find the thought of giving children gigantic sized fraps unethical but I have to do it cuz it's my job, regardless of the health issues I'm inadvertently causing. But I do it because it's my job.

A Gynecologist who is trained in doing abortions should do one if being paid for it. Simple as that. They know their job. They signed up for it when they went to medical school and trained to do abortions. If they didn't want to do it, they shouldn't have learned how to.

Doctors have a much higher ability to choose what field they want to go into. If they didn't want to deal with abortions they should have chosen a different field.

Quoted for truth.


Offline Valthazar

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Re: Doctors and the "conscience clause"
« Reply #37 on: June 18, 2014, 09:52:02 PM »
A Gynecologist who is trained in doing abortions should do one if being paid for it. Simple as that. They know their job. They signed up for it when they went to medical school and trained to do abortions. If they didn't want to do it, they shouldn't have learned how to.

Physicians are often billed/reimbursed by procedures they perform in a hospital setting, and in a private setting, they have even more autonomy in this regard.

Even as a medical student, no one is forced to perform an abortion if it goes against their beliefs.

Offline kylie

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Re: Doctors and the "conscience clause"
« Reply #38 on: June 18, 2014, 11:49:10 PM »
            I'm not prepared to say individuals should do abortions if they have an issue with them, unless (maybe and IF, to begin with, somewhere?) the field has somewhere ruled that they have to as a matter of professional routine. 

            However, I think it's unreasonable for them to refuse to lay out available options, shut off entire public institutions, or to neglect to mention other places to go (particularly if they are asked for more info).  And when doctors do this and their community seems to be piling on laws and activist groups that do everything they can to make sure you have to drive for days to find a venue, it all begins to feel more like a conspiracy. 

            At the very least, someone needs to be very, very clear:  If consultation with any given doctor about pregnancy does not include such information about medically viable choices which may or may not be matters of quality of life and economic as well as ethical survival for many people...  (Pregnant women who don't want to imagine a child -as well as the parents- suffering in whatever corner of this society, do so have ethics too.)  Then what can just any random woman assume it reasonably does include?  Cause for all I know, to pick one example:  There may be certain doctors who believe they should not tell people birth control exists either!  Or any number of things.

             Pumpkin, one thing..  I believe above, you said in the same post that hospitals doing it or not doing it is an administrative problem but individual doctors should decide for themselves -- whereas in this case, the doctor who decided attempted to claim that it was an administrative decision for the whole hospital.  I don't see how it can work both ways.
« Last Edit: June 18, 2014, 11:55:19 PM by kylie »

Offline meikle

Re: Doctors and the "conscience clause"
« Reply #39 on: June 19, 2014, 12:00:41 AM »
Certainly, but they are doing their job.  Otherwise they would lose their license.  If any other professional simply said, I do not offer that service then the matter would be dropped.  That is all the physician is saying is that he or she does not provide that service.

the relevant part about conscience clause laws is that you can be hired to perform abortions, say "I disagree ethically with that procedure" after getting the job, and your employer can't fire you for it.

this likewise applies to people like pharmacists, who really aren't people's doctors but are protected by the conscience clause laws if they choose to interfere with a patient's actual doctor's service or treatment plan.
« Last Edit: June 19, 2014, 12:06:09 AM by meikle »

Offline Pumpkin Seeds

Re: Doctors and the "conscience clause"
« Reply #40 on: June 19, 2014, 12:17:24 AM »
First, I would point out that the hospital the original poster was speaking about is located in Europe.  I can only speak to the healthcare system and hospital setup in the United States of America.  Various countries in Europe have different healthcare laws and methods.  The United States typically treats physicians as independent contractors with some exceptions, but those are exceptions.

Also if a gynecologist consents to perform an abortion, then the gynecologist has now signed a contract with the patient stating the procedure will be performed and is then bound by law to give proper care and treatment to their patient.  So once the physician agrees to perform a procedure, then the woman becomes their patient and is then accorded protections and has a right to demand the procedure agreed upon between them.  I do not dispute that a physician “quitting” their care is unethical and is actually illegal.  A physician may relinquish care of a patient, but only to another agreed upon physician that meets the criteria and is willing to care for the patient.  Doing otherwise is considered patient abandonment and is illegal.

A medical doctor learned to do many things while in school.  Doctors are able to perform, in theory, any basic procedure or at least have a rudimentary understanding of how to do so.  Obviously doctors go into specialties due to the complexities of different fields.  Do you expect a physician to do every possible procedure and treatment that they were taught while in medical school and residency?  Gynecology deals with a large variety of issues, of which abortion is a small one, and demanding that a physician stand ready to do every single aspect of a field or be fired is bordering on ludicrous.  Nobody expects that of any other profession.

Also, doctors are not actually given as much choice as you think.  Much of their decision depends on availability of residency programs, medical politics, performance and location.

As for your issue about sugar tablets, that is you being willing to violate your own ethics.  I cannot justify forcing a doctor to violate their ethics because you do so.  A doctor faces repercussions for their refusal, just as you would.  They lose a potential patient, lose business and can get into trouble with whatever institution they may represent.  Not to mention possible lawsuits and such.  God forbid the doctor was wrong and there was actually a life threatening complication lurking there as well, they could face civil and criminal charges.

Lap band is an elective surgery.  If the physician does not feel that the patient will benefit from the procedure, then they do not have to perform the procedure.  That is part of their responsibility in correctly counseling their patients.  I know many doctors that are not in favor of gastric bypass, lap band or any weight loss surgeries.  Many physicians do feel that diet and exercise are still the best avenues for weight loss and the promotion of health.  Others feel differently. 

Once more, if a physician does not take someone as a patient then that person can hold no expectations of that doctor to counsel them or treat them.  Medicine does not absolve people of alleviating their own ignorance or taking responsibility for their actions and care.

They do not have to fire the physician, but he will not do any business at the hospital.  The hospital can then fire him for not generating an income or making their abortion unit or clinic profitable.  So while the hospital would applaud the physician for adhering to their ethical code, they would replace the doctor with a  physician that will perform the surgeries and generate them revenue.
« Last Edit: June 19, 2014, 12:18:46 AM by Pumpkin Seeds »

Offline KalebHyde

Re: Doctors and the "conscience clause"
« Reply #41 on: June 20, 2014, 04:51:52 AM »
Pumpkin has stated these issues far better than I can, but a single point I would like to bring up concerns the idea that,to paraphrase, if a doctor does not wish to violate his beliefs, he should simply find another profession.  At least in the US, there is a growing shortage of qualified physicians due to many factors better left unspoken here.  I do not know the actual percentages, but to remove the conscience clause and force say 20% of OBGYNs out of the profession for refusal of one procedure would likely put women's health in far greater risk.
Of course doctors have a responsibility to the life of the mother.  Aside from those instances, abortion is truly by choice and the mother should be presented with as much information as possible.  That includes all sides of the issue.  I personally do not understand the idea that it is better to terminate the child rather than to allow for adoption.  To me it is chance vs no chance, but I realize this thread is not about that.  It just makes little sense to me to force others to abandon their values when other options exist.