Thanks for posting this. I had no idea that the situation was so dire for access to IUDs. I wonder if a part of that, though, is simply the result of them not being terribly popular. After the whole Dalkon Shield thing in the '70s, IUDs in general became identified with the terrible side effects of that one particular product; to my knowledge, it’s only recently that they’ve been marketed again at all. I believe both Mirena and the copper IUD you got have only been reintroduced in the last five years or so. A lot of people simply aren’t really aware of them as a birth control method, and others are still leery because of their history. It may be that their unavailability in pharmacies is mostly the result of not wanting to have expensive stock on hand of something that people just don’t purchase very often.
In an ideal world, I would probably agree with you. But the fact is that “conscientious” refusal to provide the morning-after pill (including what I believe is worldwide policy at Wal-Mart, which in some communities is likely the only pharmacy available) is making it very, very difficult for many women to access it. If everyone had the benefit of a truly free market (in the ideal economic sense, with an unlimited choice of suppliers) then permitting such a thing would be reasonable - but most people don’t, and it strikes me as a bad trade-off to assuage one person’s morals by denying a reasonable choice to hundreds or thousands of others. And I’ve already explained why I’m less accepting of this moral position than of many others; I think it’s a position predicated on a lot of phenomena besides personal ethics.
Unfortunately, there’s a tendency to use this place’s generally beneficial cultural preference for hard evidence as a rhetorical tool - contradict an argument with demands that something be proven with empirical data, even if clear evidence is impossible to gather in the first place. I’d be grateful if you could find me a link, though. (Can anyone tell that this is a topic I feel really strongly about? :))
It could be restricted in the same way that pseudoephedrine (Sudafed) is now- it’s kept behind the counter at pharmacies, you have to show an ID to get it, and someone, somewhere, keeps track of how often you buy it, and limits the amount you can buy in a given time period. But pseudoephedrine is still an OTC drug- you don’t need a prescription for it. That restricts when you can buy it somewhat- you have to go to the pharmacy when it’s open, as opposed to any time when the store is open- but you don’t need a doctor’s appointment or a prescription to get it. It’s much easier for me to get allergy medicines containing pseudoephedrine than it is for me to get prescription medicines (I take both regularly).
I wouldn’t have a problem with Plan B being subject to similar regulations. That would keep most people from using it as their primary method of birth control, but make it more easily available than requiring a prescription.
Well, the obvious solution is putting drugs in everyone’s drinking water so that men don’t produce sperm at all. Duh.
(OTC EC has been approved for Canada as well. We’ll let you know when you can hop across the border for some if your doctors and pharmacists are too fanatical to do their jobs.)
Oh, I should mention that I had an occasion to get Plan B a couple of years ago here in Calgary - it was as simple as waiting to see the doc at a walk-in clinic, telling him that the condom broke, getting the prescription, getting it filled, taking it, feeling nauseous for a day, and life went on. There were no questions beyond, “So, the condom broke?” “Yep.” No moral judgements from the nurses, doctors, or pharmacists. I would have been absolutely shocked if there had been - that’s none of their damned business.
That’s reasonable… However, it places an unfair stigma on it. Pseudoephedrine is carefully controlled because criminals steal it from drug stores in great quantities to make crystal methamphetame. A common cold medicine is being used in the manufacture of illicit and dangerous illegal drugs. With EC, it’s not dangerous, it doesn’t get you high or give you a buzz, you can’t overdose on it. But by restricting it, it puts that same stigma on it - like you’re somehow doing something wrong or shameful in buying it. It shouldn’t be like that.
There are a lot more who do than you might think. The marchers tend to get the attention, but there are many, many people working behind the scenes, trying to get mothers the help they need so they can be good parents to their babies.
It might have come across that way, but that is not what I meant. (And I am reasonably sure of what I meant )
You are correct; the USA is much larger then the Netherlands and BC has been available longer then in the Netherlands.
What I found barbaric, however, it the " moral" interfering. The probing personal and judgmental attitude of the docs and nurses involved. There would have been an outcry at that attitude over here if it still existed.
I’m reminded of the time, about 1990, that gay marriage became legal in the Netherlands. There were quite a few Dutch civil marriage officials that didn’t want to do the job; gay marriage was against their beliefs and so they did not want to be the " civil minister" at those marriages. The difference with the Amarica situation in the OP was thhat beforehand, and after a lot of debate if they should be fired, they were put on a list so they wouldn’t have to do gay marriages. But couples were protected from these people; a gay couple applying for marriage is simply referred to a minister in the same department who has no problem about it.
There is, thank God, no such thing as an initial interview in which the couple has to withstand the judgmental questions of the civils servant. " So, you two men want to be married? You’re monogamous, I hope, and refrain from anal sex? Otherwise, I’m afraid I can’t help you".
The whole idea of a woman dependent on medical assistance for something that is legal in her country, that might affect her greatly, and finding herself unexpectantly at the mercy of a doctor’s personal opinions and finds herself being judged and condescended to and, even worse, denied help within the small time-frame she has to seek treatment; THAT I find barbaric.
I agree, there ARE health risks if you use them all the time. But there is no law in the world that will prevent people from being stupid. If something is known to be harmless if used once or few times far between, but dangerous if used all the time, and this fact is made very clear, then the people who take them all the time and get sick have only themselves to blame.
There is an OTC cold medicine (Xymelin?) that your’e not supposed to use for more then two weeks in a row. Whenever I buy a bottle, the clerk at the pharmacy reminds me of this, in a friendly, proffessional way (not sure if this is policy, but happens all the time). Maybe something similiar for morning-afters?
And if you had to judge if things should be OTC based on the possibility that someone could possibly harm themselves by taking a ridiculous amount, then almost nothing would be OTC. Pain killers are dangerous in large doses. Carrots are dangerous in large doses (though i don’t suppose you’d be able to eat that much.)
Why can’t you ask? Or do we place the onus on the doctor to inform everyone of the availability of what has been called the “abortion pill” and then tell them that they will not prescribe it?
I’m willing to bet that many women wouldn’t even think to ask until they’re looking for it. It’s something that (I hope) wouldn’t be part of their everyday lives.
Because it wouldn’t fucking occur to me that my doctor is a moralizing asshole practicing substandard medicine!
(And, I’ll just state it again for shits and giggles: it’s only been called “the abortion pill” by misinformed people and by idiots! Emergency contraception is not the same chemical, nor does it work by the same mechanism as “the abortion pill”: RU-486.)
Emergency contraception is safe and effective and is the standard of practice in emergency situations. Any doctor who knows he isn’t willing to follow the standard of practice should make that clear ahead of time - just like a doctor who is opposed to x-rays, or casting broken limbs or high blood pressure medication or vaccines should make it known. I have no problems with alternative practitioners, but if your practice is alternative (read: not the medical standards and practices of the day) then yes, you have a responsibility to divulge that information before seeing someone as a patient. Some people make this known by becoming chiropractors, osteopaths or homeopaths - all “doctors” of a very different modality than what you can rightly expect from an MD. If you have MD behind your name, I expect you to be willing to authorize me any legal treatment that I do not have a *medical *contraindication for.
Your job as an MD is to monitor and support my physical health, not my moral health.
None of those questions was determining a medical contraindication. Had she been asked if she was a heavy smoker, obese or suffered liver or kidney disease, or if she was currently on antibiotics, those might have been appropriate screening questions - they all could identify potential medical reasons why emergency contraception might not be the best medical choice.
Are there? Do you have cites for that? I wouldn’t be so sure, or the FDA wouldn’t have approved them for OTC-with-a-pharmacist. Word is that asprin wouldn’t be approved OTC if it came out today - ergo, the emergency contraception is likely less harmful than asprin. In these days of outrageous lawsuits, the FDA is not in the business of releasing very controversial medicine to OTC status without incredible assurances of safety - so much so that very useful and only slightly potentially harmful drugs (like Phenylpropanolamine) are pulled when most reasonable doctors think they shouldn’t be.
I’m not inclined to try to defend doctors who judge the morality of their patients…that is a bit much for me! But I do feel compelled to defend the US. The thing about the US is that it is a huge, huge country that is essentially made up of many different cultures. It is a very difficult thing to get all these various groups to agree on anything, much less something that is so loaded with emotion as this issue is. This is why the concept of the states works so well here…not only can the states make their own laws (within certain reason), but each one kind of has its own culture. These days they blur together more than they used to, due to the “globalization” of everything, but the basic concept is that people can find places to live that are comfortable for them, and not infringe on others’ desire to do the same. I can assure you that where I live, getting Plan B (or any kind of birth control, or an abortion) without judgment would not be a problem. If getting this kind of medical care is important to a person, they would be well advised to live reasonably near a large metro area where attitudes are more liberal. On the other hand, if a person has very conservative values, they often prefer to live where most of the population feels likewise. Their attitudes may seem backwards to some people, but it is a huge misconception that these kinds of attitudes are rampant across the US and there is no place to live that is safe from them. We have a fairly delicate balancing act here in the US where each side of the political spectrum tries to keep the other side from imposing their will on people who are of differing opinions from them, and the genius of keeping the states independent from the Federal government is that the Feds can’t get too involved in taking sides. This leaves the people the opportunity to have some control over what happens in their local area.
I want to also say that I am a person who lives in a place where the general political attitude is very, very different from mine, so I know that there are people who live in places where they DON’T feel entirely comfortable, or have a certain resentment that they don’t seem to have a voice in government. I choose to live here because the politics are less important for me than some other factors. However, there are places not far from me where things are very, very different that I could easily move to. This is the beauty of the US…the freedom of choice.
As I said before, your position is reasonable, although it’s not the position I would champion – and it sounds like you agree that MY position is reasonable, although it’s not the position you would champion.
See, this is what I like – a recognition that the opponent is reasonable, even if wrong. Too bad we can’t see this more around here, and I truly appreciate seeing when it is here.
Does this include abortions? Can doctor exercise no moral discretion?
I thought we had already determined that the story was likely Bullshit.
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Word is that asprin wouldn’t be approved OTC if it came out today - ergo, the emergency contraception is likely less harmful than asprin.
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Huh? One does not follow from the other. Otherwise you would be able to use that argument for ALL prescription drugs which would mean that Aspirin is the most dangerous drug on earth. Here’s an example: morphine requires a prescription, if aspirin came out today, it would require a subscription, ergo morphine is likely less harmful than aspirin.
You should just leave it at “I want the freedom to exercise choice AND I want everyone to support my exercise of that choice”
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