Can a Dr. refuse to prescribe emergency contraception?

Factual Questions
1

Warning *** Rambling and incoherence may follow. Poster is very aggitated.***
I have convinced a friend of mine that she doesn’t have to wait in agony to see if she becomes pregnant after a really stupid mistake… if she does emergency contraception. The problem is “her doctor doesn’t do that”. So I tried to get it through my doctor. Guess what she doesn’t do that either.
This is the same woman who tried to convince me to start the pill last week!!! Now she doesn’t do that?

What the hell? Can a Doctor refuse to prescribe birth control pills, just because they will be used for emergency contraception? They are the exact same things she was going to prescribe last week the only difference is their intent.
Forget boycotting Walmart people, lets boycott the Doctors.

2

When I saw this topic, I had to laugh. I mean, I envision a guy hopping back and forth, hurrying back to the NoTell Motel “C’mon Doc! Hurry up!” But that’s not what you meant, I see.

My suggestion is to just not tell the Dr. you want the pills for emergency “contraception”.

“Owls will deafen us with their incessant hooting!” W. Smithers

3

Frankd6: My suggestion is to just not tell the Dr. you want the pills for emergency “contraception”.

Trouble is, the doctor will do a pregnancy test first, as birth control pills will cause birth defects and/or abortion. (Naturally, because that’s why MONTY2’s friend wants them.)

Looks like her only options are [ul][li]wait and see[]abortion[]adoption[/ul][/li]
A little sooner, and all she would’ve needed was $1 for a 20 oz Coke. :slight_smile:

4

This could be total baloney, but I was told many, many years ago, that birth control pills do not make a very good after-the-fact form of birth control because, depending on a lot of factors (1) they may not terminate the pregnancy and (2) they may cause birth defects in the early fetus. If there’s any truth to this or even if not, but the doctors are just overly careful, perhaps this explains their reluctancy. I thought a D&C was the standard “emergency” birth control procedure???

5

Not all birth control pills are created alike. They come in different formulutions, with varying proportions of estrogen and progesterone (sp?). It has been found that a certain formulation is effective in preventing pregnancy (sometimes by preventing implantation, which is the aspect which upsets the pro-life folks) if taken at a high dose within a day or so after the “accident”. So, unfortunately, you can’t expect that a double dose of regular birth controls pills will do the trick. “Emergency birth control” then is the correct formulation as the corect dosage, which is why it has to be prescribed specifically.
As to the doctor not prescribing it? Well, I think he/she’s a…oh never mind…I guess I can accept that a physician might have a different value system than mine, but I’d certainly be shopping around for a new one when I found that out. In the meantime, family planning clinics generally WILL provide this service. If your friend is still within about 72 hours, it may still be a possibility. Good luck.

6

Call Planned Parenthood. They’ll help you out. And give 'em a good donation while you’re at it - they’re a great place, helped me many a time when I was young, stupid, and full of questions.

7

She has until Wed 7/29 to be worry free. I was able to do emergency contraception two years ago thanks to the wonderful people at Planned Parenthood. They were regular birth control pills only a much larger dosage. It cost me $75.00 for peace of mind.

Sounds stupid but both of us are practically broke till Friday. With insurance, which we both have, it would only cost us $5 - $14 to prevent an unwanted pregnancy. There is always the chance that she may not be pregnant, but why risk it. If she does turn out to be pregnant, (everyone cross your fingers) she could always get an abortion, but who wants to go through that?
I just can’t understand my doctor. I have already called the insurance company and swithched providers but that doesn’t really help us out today. I just wish there were something I could do. I mean what if it were me in her shoes? I was floored when my doctor said no. I should have known something was up when her nurse didn’t know what emergency contraception was. Who do I complain to? What are my rights?
I am frustrated at my doctor. I can understand that she may have moral reasons for not performing emergency contraception on herself, but she is my doctor dammit! I just want to bang my head against the wall!!!

8

The difference is the Pill prevents you from getting pregnant. The “Morning After” pill doesn’t prevent pregnancy, it makes a woman miscarry. Even though it is only a few days, a lot of doctors see that as terminating a pregnancy.

9

I also meant to say that doctors do not want women to use this as a form of birth control because it is not responsible birth control and also because it is very harsh on the woman’s body.

10

Ah… I see the effect of more Walmart propaganda upon the minds of the general public. The morning-after pill does not cause a miscarriage. It prevents the formation of a fetus. No miscarriage occurs since no fetus is formed. Hate to break it to you, but a woman does not become pregnant the instant a man’s semen enters her body. The process of the merging of a sperm and egg to form a zygote takes about 72 hours from the point of ejaculation until implanting in the uterine wall and cell division. Hence the 72 hour window during which the morning after pill may be effective. Under no definition of abortion or miscarriage does the morning after pill operate. It may be a drastic way of preventing pregnancy, but it still operates on the same principle as any other form of birth control: get to the sperm and/or egg before they merge to form a fetus.

Jason R Remy

“Open mindedness is not the same thing as empty mindedness.”
– John Dewey Democracy and Education (1916)

11

In med school we’re told that if you don’t want to do a procedure, give a drug, or make a recommendation because of your “personal beliefs”, the ethical thing to do is refer the patient to someone who will. Of course, managed care makes this difficult, and I’m pretty sure it never happens anyway.

Dr. J

12

Call your local Emergency room - many of them will provide emergency contraception (no pun intended).

13

First, let me me say I whole-heartedly endorse Dr. J’s statement that referral to someone willing to help is the best solution.

But…

The “moment of conception” is something to hash out in the Great Debates forum, so I’ll just say that a great many religions teach that conception occurs the instant the sperm unites with the egg. Yes, it takes a while between that instant of union & implantation, but during that time cell division IS occurring. In fact, implantation is feasible because some cells of the zygote have become different enough from the “fuure baby” cells to grow into the uterine lining and develop into a placenta. Does a zygote=embryo=fetus=baby? I don’t profess to know, but my personal beliefs are such that I would not prescribe a morning-after pill, with possible exceptions for rape.

Birth control pills (BCPs) taken before-the-fact work on several levels:
First, and foremost, they are supposed to prevent ovulation. No egg = no baby, no matter how many sperm get there.

Second, they make the swim inhospitable for sperm, lessening the chances of fertilization should an egg happen to be in the wrong place.

Third, they make the uterine lining less receptive to implantation, so that if ovulation did occur, and a sperm did find the egg, it would not implant, and would pass out of the uterus with the next menses.

Fourth, they cause destabilization of the uterine lining (by suddenly decreasing the progesterone levels). If the developing placenta has not implanted deeply, the whole thing is flushed out with the next menses.

RU-486, or several birth control pills taken shortly after sexual activity, act through the 3rd and 4th mechanism listed above. The difference is intent:

BCPs, when taken a priori, are usually intended to prevent conception. Some people do find the other mechanisms of action unacceptable, and opt for other forms of birth control that do not interfere with pregnancy should conception occur.

Morning-after pills are intended to prevent a pregnancy from progressing to the point of being recognized as such. The very intent is to allow a developing zygote/embryo… to be flushed away without the woman/mother ever having to acknowledge the fact that she destroyed a mass of tissue with the potential to become a human being. Is this less emotionally devastating to woman? Almost certainly. Might it be all the more wrong for its insidiousness/palatability? Again, I can’t pretend to have all the answers.

Abortions are intended to terminate fully established, recognized pregnancies. Few seem to question whether a physician has the right to decide whether (s)he will perform abortions. I hope I have created in your minds the sense that conception, and contraception, do not exist as yes/no black-or-white entities but run a vast spectrum of gray.

Monty2, I am sorry for the distress you & your friend are going through right now. Consider asking your doctor if she can recommend another doctor who is comfortable providing this prescription for your friend. Or, try Planned Parenthood as other posters have suggested. But realize that your doctor is probably not being judgmental towards you and your friend; I expect she is upholding her perceived responsibility to “do no harm” to all involved, including the (possible) baby.

Sue from El Paso
members.aol.com/majormd/index.html

14

Please, this is misinformed and misleading. A woman is NOT pregnant within the 72 hour window. RU-486 and Preven operate on very different mechanisms and principles. RU-486 will cause a miscarriage of a developing fetus. Preven (or the mega-dose of Birth Control Pills) will have no effect on the pregnancy beyond the 72 hour window from ejaculation to implantation. It will not cause spontaneous misscarriage of the developing fetus. Its effect on the developing fetus can be harmful, but that is why the 72 hour window exists, not because of some legal redefining of pregnancy, but because it is inneffective in its intended use (pregnancy prevention) after the 72 hour window.

A puddle of semen will, under favorable conditions (in the presense of an egg in a uterus for about 72 hours) cause the development of a human baby, but does that make you opposed to masturbation?

Jason R Remy

“Open mindedness is not the same thing as empty mindedness.”
– John Dewey Democracy and Education (1916)

15

Athena wrote:

Agreed, except:

  1. They don’t take Blue Cross.

  2. The wait can be much longer than at a typical doctor’s office.

  3. The communication between staff members is about as flawless as that between a tow truch dispatcher and a tow truck driver; I had to remind the lady giving me the urine cup that it was for a gonnorhea/chlamydia test and that they needed a dirty sample.

  4. The one time I did ask them for a form to send to my insurance company, the insurance company threw the whole thing out because one of the codes they used was obsolete. (This is partially the fault of the find-any-excuse-you-can-to-reject-a-claim mentality of most insurers, but if PP had used a current form it wouldn’t’ve happened.)

16

Your premise that pregnancy begins at implantation is belief, not fact. In my earlier post, I clearly stated that my premise that pregnancy begins with egg & sperm uniting was a religious teaching, implying that anyone with different beliefs is free to reject it (but not to assert that their belief is fact).

During the “72 hour window”, the fertilized egg has all the genetic material needed to develop into a baby. The egg rapidly begins dividing; by the 16 cell stage (about 24 hours IIRC), cell differentiation is beginning to occur. IF (big if, I’ll grant you) one believes that this fertilized egg is the earliest stage of pregnancy, then it follows that any intervention with the intent to prevent the zygote from implanting is terminating/aborting a pregnancy, not preventing it.

I am not misinformed; nor am I attempting to mislead. I am not asserting that my personal belief regarding the moment a pregnancy begins is the only one, or the most correct one, just that it is the position of many religious faiths. An individual physician must be allowed the latitude to practice medicine in a way that is true to his/her beliefs. Ideally, a group or HMO network should include providers encompassing a range of beliefs.

Sue from El Paso
members.aol.com/majormd/index.html

17

Your religion may define a human life any way it pleases. Some religions define a sperm as a human life. Whatever. But “abortion”, “miscarriage”, “fetus” and “pregnancy” are medical terms with medical definitions. These can be found in any medical dictionary, such as here or here. RU-486 terminates a pregnancy; Preven or lots-o-BCPs do not.

The statement “No egg = no baby, no matter how many sperm get there.” doesn’t indicate a difference between pre- and post-intercourse BCP use. Contrast this with:
“No attachment to the uterine wall = no pregnancy, no matter how many zygotes get there.” Both simply remove an essential component for a pregnancy to begin.

I guess a doctor could refuse to prescribe Preven, prescribe BCPs, or even reqest a sperm sample if (s)he wants, but a referral to another doctor should be the minimum a doctor should do. I feel that the patient should be warned, perhaps with a sign reading “Certain legal and valid healthcare options may be unavailable to you at this office due to the our physician’s religious belief that life begins before pregnancy.”

Your Quadell

18

tracer:

Hmmm… apparantly the level of care at Planned Parenthood differs with each office. I’ve had the pleasure of visiting offices in three different states, and I’ve had very good service at all of them. In fact, I wish they DID take insurance directly - I’d still go to them.

Correct me if I’m wrong, but I was under the impression that there are a large percentage of pregnancies that are spontaneously aborted by the body. I seem to remember a friends mother, who is an RN, telling her that most sexually active non-contraceptive using women will have had at least one or two zygotes flush out with her period, without the woman ever even knowing she was pregnant. Some work, some don’t. That’s just the way it is.

19

Thanks, Quadell, for proving my point. There is no consensus definition for pregnancy; or when life begins.

We’re really on the same side, here. While I feel strongly about a doc’s right to practice in accordance with his/her own ethical standards, I agree that (s)he should help a patient obtain care (s)he is unwilling to provide directly. I am troubled by WalMart’s apparent decision to not make a morning-after contraception option available, when in so many rural communities they are the only game in town because they’ve shut down the mom & pop drug stores in the name of “free enterprise”.

Sue from El Paso
members.aol.com/majormd/index.html

20

PS…

MONTY2 - I suspect this is too late for your friend, but for anyone else out there who may find themselves in the same situation:

Sue from El Paso
members.aol.com/majormd/index.html