Mandated referrals for abortions.

Great Debates
1

On NPR this morning I heard a report regarding how Gynes are free to refuse to perform abortions or even to prescribe a morning after pill but are considered by their professional organization to be required to refer to someone who will do those things.

If I was a Gyne I’d be concerned that my withholding information about available options that I do not provide would expose me to liability. If that pregnancy then proceeds because I withheld information and results in some complication then I would be at fault, I’d think.

What are your thoughts?

2

When you’re the only gynecologist for miles around, you have a special responsibility. If you’re in the city, it’s simple to say, "There are other options, but I object to even talking about them. Two doors down, immoral Dr. Santiago will help you, but I won’t. (A doc who does this, turning away a patient without giving her a legal service she wanted, would be unethical to charge her for an office visit, IMO.) A doc who’s the only gyno in eastern Montana, though, should make the referral or tell the patient how to get Plan B®. I don’t object to the doc expressing a moral opinion, but the patient’s needs are more important than the doc’s morals. The same goes for the pharmacist.

Lots of Jewish obstetricians deliver gentile baby boys without circumcising them. I presume they ask God to forgive them for that. Why can’t pro-life doctors and pharmacists serve the patient and ask for forgiveness?

3

[QUOTE=AskNott]
Lots of Jewish obstetricians deliver gentile baby boys without circumcising them. I presume they ask God to forgive them for that.
[/QUOTE]

They wouldn’t have to. There’s no mandate to circumcise everyone, just Jews. The obligation to not kill people, though, extends to all people (with some exceptions, none of which are relevant here), and the pro-lifers believe that embryos and fetuses are people.

4

[QUOTE=Anne Neville]
They wouldn’t have to. There’s no mandate to circumcise everyone, just Jews. .
[/QUOTE]

I didn’t realize there was a mandate for them to circumcise Jews. I thought it would be done by a rabbi or religous official in a ritualized setting.

5

I don’t have any problem with the requirement. Please note that it is a requirement set by the professional organization, not a government mandate. It has to do with the ethics of the medical profession.

Patients have a right to informed consent. That means that the doctor has an obligation to provide full, factual information about all options. If the doc can’t or won’t provide one of those treatment options (and/or information about such), then s/he has an obligation to refer the patient to someone who can and will.

Is it OK for a Roman Catholic physician to refuse to tell patients about birth control?

Is it ethical for a “pro-life” doctor to ignore a valid DNR order signed by a terminally ill patient?

Is it acceptable for a Jehovah’s Witness physician refuse to provide blood transfusions to a Gentile patient in an emergency?

It’s all the same thing. The physician’s beliefs do not override the rights of the patient.

6

[QUOTE=The Flying Dutchman]
I didn’t realize there was a mandate for them to circumcise Jews. I thought it would be done by a rabbi or religous official in a ritualized setting.
[/QUOTE]

They wouldn’t be obligated to see that anyone other than their own son was circumcised- that mitzvah applies only to the father. It’s also not done until eight days after the baby is born, for another reason why an obstetrician wouldn’t be expected to do it.

If the father can’t or doesn’t want to circumcise his own son, he hires a mohel to do it. A mohel may or may not be a rabbi, but will have some training in Jewish law as it applies to circumcisions (and will also have some medical training). It’s done as part of a religious ceremony called a bris or brit milah.

7

[QUOTE=DSeid]
If that pregnancy then proceeds because I withheld information and results in some complication then I would be at fault, I’d think.

What are your thoughts?
[/QUOTE]
I’m pro choice. That is pro choice all the way. Unless there is an urgent medical issue I don’t think the state or anyone else should interfere with a doctor’s conscience. Should midwives be obligated to make abortion referrals?

Doctor’s have divided themselves into all kind’s of specialties which allows them to avoid procedures which they not want to perform. And most of them can’t give you a decent referral for each and every type of request.

It should be the job of the state to ensure however that the medical profession has a referral list that the public can go to for information. I’ve used such a list looking for an appropriate lawyer, and it works quite well.

8

[QUOTE=The Flying Dutchman]
I’m pro choice. That is pro choice all the way. Unless there is an urgent medical issue I don’t think the state or anyone else should interfere with a doctor’s conscience. Should midwives be obligated to make abortion referrals?

[/quote]

A midwife is not a doctor, and I don’t know why a midwife would even be involved so early. In any case, the patients’ rights should triumph. if a doctor for some reason feels that pain is good for you, makes you stronger, should he be permitted not to prescribe a pain-killer?

How odd. My insurance is set up so my GP makes referrals to all sorts of other specialties - in fact it is kind of required. In any case, I believe the situation is that the patient went to an ob-gyn who refused to do the abortion and refused to make the referral, so it was in the same specialty.

Sorry. I’d much rather get a referral from a trusted physician than from some state compiled list or a web site. Why would a state list be better than the yellow pages? And why would we want to make a woman under stress have to call multiple doctors and no doubt be told that she is a murderer several times?

9

[QUOTE=Anne Neville]

If the father can’t or doesn’t want to circumcise his own son, he hires a mohel to do it. A mohel may or may not be a rabbi, but will have some training in Jewish law as it applies to circumcisions (and will also have some medical training). It’s done as part of a religious ceremony called a bris or brit milah.
[/QUOTE]

Do Orthodox fathers commonly do circumcisions themselves? I’ve only known it done using mohels. Usually on the kitchen table. :slight_smile:

10

No. I’ve never been to a bris where the father did the circumcising himself, and I’ve been to plenty. Being a mohel requires extensive training and certification, and many of them are also doctors. (One of the only ones I know is actually my husband. He doesn’t practice, and hasn’t since he received the training a decade ago, when he was studying in yeshiva before college. (At the time, he thought he might want to be a rabbi, perhaps in a far-flung community, and was trying to gather up useful skills - he can also kosherly slaughter poultry. Of course, he ended up in finance, and tends not to have much call for either talent.) I’m not totally thrilled at the prospect of him circumcising our hypothetical son(s), either - he’d need a refresher course first before I let him near the kid with a knife. I’m amazed that he and his teacher were able to persuade that first pair of parents to entrust their baby to him!)

Never seen a circumcision done on a kitchen table, either - in the Orthodox world, they’re mostly done in a synagogue, towards the end of morning services, with a sit-down breakfast afterwards. It’s always a big group affair, one that probably wouldn’t fit in a kitchen, because you get whatever family and friends can make it on what’s usually a weekday morning.

Orthodox fathers have the obligation to ensure their sons are circumcised once the kid hits the eighth day of life, and can delegate somebody else to do it. If the kid reaches bar mitzva (age 13, when one is considered responsible for one’s own actions) without being circumcised, it becomes his own responsibility. Nobody else has any obligations in the matter, including (of course) any medical personnel.

But we should probably end the hijack, which isn’t really relevant to the OP.

11

[QUOTE=Voyager]
Sorry. I’d much rather get a referral from a trusted physician than from some state compiled list or a web site. Why would a state list be better than the yellow pages? And why would we want to make a woman under stress have to call multiple doctors and no doubt be told that she is a murderer several times?
[/QUOTE]

Unfortunately, we’re talking about doctors that refuse to do a requested procedure. How can I be sure that that doctor will give me a referral? Sure, I’d rather a referral, but I’d also like for there to be a backup list for use when that referral isn’t available.

12

[QUOTE=GilaB]
(At the time, he thought he might want to be a rabbi, perhaps in a far-flung community, and was trying to gather up useful skills - he can also kosherly slaughter poultry. Of course, he ended up in finance, and tends not to have much call for either talent.)
[/QUOTE]

Just as a sidenote, it’s important, if your husband takes the jobs up again, he not get the mohel and shochet duties confused.

13

Does he list them on his resume, though?

14

[QUOTE=GilaB]
N Being a mohel requires extensive training and certification, and many of them are also doctors. (One of the only ones I know is actually my husband. He doesn’t practice, and hasn’t since he received the training a decade ago, when he was studying in yeshiva before college. (At the time, he thought he might want to be a rabbi, perhaps in a far-flung community, and was trying to gather up useful skills - he can also kosherly slaughter poultry. Of course, he ended up in finance, and tends not to have much call for either talent.) .
[/QUOTE]
Oh damn. No self control. I can’t pass it up.

He’s in finance? Of course he uses those skills. He deals with schmucks and chickens all the time. Sometimes you just need to cut them off.
Back to the op. Anyone agree with me that there would be a medicolegal liability for the pregnancy that continued as a result of withheld information?

15

[QUOTE=Voyager]
Sorry. I’d much rather get a referral from a trusted physician than from some state compiled list or a web site. Why would a state list be better than the yellow pages? And why would we want to make a woman under stress have to call multiple doctors and no doubt be told that she is a murderer several times?
[/QUOTE]
I’m sure there are plenty of doctors who prefer not to do abortions for religious reasons who would never, ever call a patient a murderer. Your assertion that she would “no doubt” be called one is ridiculous hyperbole.

I think it’s a good idea to have a state-compiled list or website. If the list is of doctors who provide abortions, then she wouldn’t HAVE to call multiple physicians and be called a murderer. That’s the whole point. And if her alternative is calling around the yellow pages, then how does she know the referral is being given by a “trusted physician?” She doesn’t even know the person.

Even if a person’s OB-Gyn provides abortions, he or she may refer them to someone else. If I wanted to get one today, I doubt I could walk into my doctor’s office and expect him to do it, even if he does provide them (I’m not sure if he does or not, as I’ve never asked). For one thing, he doesn’t have the equipment to do surgical procedures in his office, so he would have to send me to the hospital. If he wasn’t available to run over there to do it, he would no doubt refer me to someone. Or, he might be on a month’s vacation, in which case I’m sure his office would refer me to someone. I think whatever the reason a doctor can’t provide a certain (legal) service is irrelevant…I would still expect a doctor to give a referral to somone who can/will.

16

[QUOTE=Anne Neville]
The obligation to not kill people, though, extends to all people (with some exceptions, none of which are relevant here)
[/QUOTE]

Why aren’t they relevant?

I consider them relevant. There are situations where humans kill humans and we don’t call it “murder”. At least not automatically.

• In war, participants (generally male) are actively expected to shoot holes in each other. Not only is it considered OK to kill in self-defense, it is considered OK to kill on a first-strike attack basis when it is war. Even if it is an unjust war. Not automatically: Lt William Calley was widely considered to be a murderer. Josef Mengele was not considered to have behaved in an appropriate manner. Those aren’t the best examples, even; Even one’s lethal treatment of one’s avowed enemy forces in wartime may be regarded as murder under some possible circumstances.

• In pretty much any situation where one is directly under attack and has reason to believe one is in imminent peril, one may strike back using lethal force, in self-defense. There is a bit of grey area here: would a “reasonable person” think there was a danger of being killed if they did not kill first? What about when the risk does not appear to (necessarily) be a risk of death but of dismemberment, getting raped, getting beat up, etc? Not that one necessarily knows where the invasive humiliations will stop if one does not stop them pre-emptively. But yeah, not automatically OK here either. Bernie Goetz on the NY subways did not get a free pass.

•Pregnant women can abort the embryos and fetuses they are carrying. They’re alive and human but they are also simultaneously part of the women’s own bodies and living parasitically on them. Being pregnant can be wonderful when it’s what you want, but can be horrid when it is not what you want, and women can have abortions to quit the process. Here, too, is some grey area: while early-phase abortions can be accomplished without even knowing one is pregnant, utilizing menstrual extraction which can be performed without the aid of a medical professional, more complex techniques are defined as medical procedures and the necessary equipment is relegated to medical professionals only, without whose cooperation no abortion can occur. And once again it’s not automatic: the later the pregnancy, the more compelling the reason for abortion needs to be to outweigh the increasing state interest in the right of the potential baby to come to term. There is a widespread consensus that women should not use abortion in lieu of birth control and that if you are going to abort you should make up your mind and do so early on soon after you discover that you are pregnant, although extenuating circumstances are relevant there too.
Why would the other exceptions somehow be “irrelevant”? They are all unusual, exceptional cases. Situations where we as a species have come to feel that not all cases of humans killing humans are murders.

Abortion is serious, it is heavy, it is killing, it is a solemn act decided upon, hopefully, with appropriate gravity by the gravid person who gets to make the decision. She’s the one who gets to live with having made it, one way or the other, more centrally than any other human.

I think there’s a certain attitude that women have no business making such somber life-and-death decisions. I also continue to think that there is a sexually punitive attitude (“fucking slut spread her legs and let some guy fuck her, she should not be allowed to abort if she gets knocked up, that’ll teach her to keep her fucking knees together; if she didn’t want to be pregnant she should not have been fucking around”). I know the leaders of the pro-life movement are not subtle about it, I’ve read their writings, so it’s largely a matter of whether or not the rank & file of the pro-life movement is infected with that attitude as well. (Or, in all fairness, the more sociological variant, that “Society is better off when females’ sexuality is curtailed by concern over unplanned pregnancy…an ideal society is one in which males can have access to females only when they have earned it by being substantial wage-earners and where females can only choose mates who can suppose them and whatever kids they may have economically”).

Screw that shit.

So… it’s killing. Some other forms of killing of humans is not considered murder. We may not love it but we accept it and we generally do not harass the participants. We are pragmatic. War is. Life is sometimes violent and self-defense is. And yeah, abortion is. If you got a problem with that, explain yourself.

17

AHunter3, I both agree and disagree.

It’s not about women not being allowed to make life or death decisions. Unfortunately, abortion became tied to the women’s lib movement, which is a progressive movement. Which means it’s opposed by conservative elements of society, etc.

The problem is, the right to abortion (or lack thereof) is a political truth to many people relating to the “sexual independence of women”- this is total crap, it’s a medical procedure with risks either way. If you’re going to allow a voluntary medical procedure, by God make sure they know just what the hell they’re electing to do, or be morally responsible for any negative consequences.

I was under the impression that doctors were required to refer you to a physician willing to do a procedure they weren’t- I gather from the above debate that this is a law specific to the state I live in.

18

I agree that gynecologists and primary care providers should be required to give a patient contact information for abortion providers on request, and to give the patient accurate and morally unbiased information about the procedure.

But in the interest of the devil’s advocacy, let me offer another situation that might compare. (This isn’t a hypothetical–it has happened to me more than once.) Say a young man comes to me who says he has been struggling with homosexuality for years. He has heard that there are doctors and camps and such out there who claim to have “converted” gay people, and asks me to refer him to such a place. Should I be ethically required to do so?

I wouldn’t, and the short reason why not is that abortion is a recognized and legitimate medical procedure while de-gaying therapy is rejected by all the major medical authorities as ineffective and potentially psychologically damaging. But there are people who claim to have been coverted by such therapy. The patient may think that his homosexuality is so morally unacceptable that even if there’s only a 1% chance of conversion and a much bigger chance of psychological damage, it might be worth it to him. I believe he should have that choice, but I want no part in it. Truth be told, even if such therapy were actually effective I’d have trouble making the referral.

Just a thought for comparison.

19

If they don’t want to do abortions, then they shouldn’t become doctors. Their right to exercise their moral opinion should only extend to where it impacts my own.

The conservatives are creating every restriction they can, with the goal of eliminating opportunities where abortion can occur. It’s really time to put an end to that foolishness.

Doctors need to pay for 18 years of child support for any fetus they won’t abort, if an abortion is what the woman wanted. And if the government is going to force pregnancy onto unwilling brood mares, then the government needs to pay for it, including 18 years of child care – otherwise it’s forced employment without compensation, which fits the legal definition of slavery.

20

[QUOTE=DoctorJ]
But in the interest of the devil’s advocacy, let me offer another situation that might compare. (This isn’t a hypothetical–it has happened to me more than once.) Say a young man comes to me who says he has been struggling with homosexuality for years. He has heard that there are doctors and camps and such out there who claim to have “converted” gay people, and asks me to refer him to such a place. Should I be ethically required to do so?
[/QUOTE]

Does your professional organization see “de-gaying” as a part of your job description? Does the average “reasonable person” on the street see “de-gaying” as part of your job description? Does the state legislature mention “de-gaying” in the scope of practice section of your licensure law?

If all of the above can be answered with an honest “no”, then I think you’re entirely and completely off the hook here. Since at least two (professional organization and reasonable person) and probably three in most states (scope of practice) include “abortion” for obstetricians, then I think we can hold them to, if not providing services, at least providing referrals for the service.

Add in the fact that abortions are not new (no one invented a new morally questionable technology after they were invested in med school), so they knew going into the field that abortions are part of the field, and I just don’t see any ethical way around it. I’m willing to extend the “choice” part of pro-choice to doctors very grudgingly; the least they could do is to extend the “choice” to me in return - at someone else’s office if need be.