Apart from the moral/ethical question (and I’m not getting into that debate), abortion is FIRST AND FOREMOST a medical PROCEDURE, and ALL Dr’s should be trained in ALL aspects. Whether they choose to perform an abortion once they are practicing is entirely their prerogative. However, my personal (and ever so humble) opinion is that a DR who refuses to terminate a pregnancy has a moral and ethical obligation, in the interests of his patients physical and/or mental wellbeing, to refer her to someone who will.
And WV_Woman, the techniques involved in the removal of a partial miscarriage are the same as for a ‘complete’ abortion. It is still an abortion, and one that I would hope my gynae would have had some training in. There are times when an ‘abortion’ is NOT a choice.
Saen??? where do you get off saying that most people disagree ‘fundamentally’ with abortion?? Ahem, I’d REALLY like to see a cite for THAT one…:rolleyes:
Sorry for the ambiguity there…I meant that Dr’s who say, specialise in ENT should be conversant with all aspects of ENT disorders and treatments.
Ditto gynaecologists should be trained in terminating pregnancies, even if they do not choose to perform them in private practice.
Hope that clears up the confusion.
I’m afraid I don’t agree with your starting point, which is to ignore the moral implications of an abortion. Whatever one’s personal views on abortion (and I’m not going there, thanks :eek: ), I don’t think it’s possible to take the view that it’s just another medical procedure. What other medical procedure has been to the Supreme Court of the U.S., has triggered such intensive debate, and has been the subject of ethical and moral analysis the way abortion has been? There is a moral issue here.
I also don’t agree with some of the analogies that are being put forward, like the amputation example, because I don’t think they raise anything like the same moral issue. No-one is quoted in the article as saying that they have moral objections to amputation, rather they say they don’t enjoy performing one. That’s a different kettle of fish entirely from someone who says they have a moral objection to performing an abortion. It is the moral implications of abortion that is triggering the debate here.
Nor do I agree that Monty’s reference to being trained to kill by the military is at all analogous. That’s a job requirement for the members of the armed forces. Conscientious objectors cannot be forced to take that training nor to serve in the armed forces, if they can show that they have a moral objection to doing so. By contrast, a doctor can choose not to participate in abortions and still practise medicine - it’s not a job requirement in same way.
Nor do I agree with the relevance of the comment in the article that law students have to take criminal procedure “whether or not they ‘object’ to crime.” This triggered a big WTF? for me, for a few reasons. First, if you fervently “object” to crime, odds are you want to take criminal procedure, to learn how to put the bad guys away.
Second, the training in law school is different from medical training - it’s not hands on. You can learn criminal procedure solely from books, without any clinical experience. I’m assuming to be trained in abortions, the student would have to assist/participate to some degree, which is exactly what raises the moral issue.
And third, I’ve never heard of a law student who objected to learning about criminal procedure on moral grounds; it sounds like a weird hypothetical the author pulled out of her butt. Come back to me on that point when you’ve got some concrete examples, thanks.
So, with all those preliminary comments out of the way, I would think that once it is accepted that there are moral issues surrounding abortion, I think it follows that the views of students must be respected, which in turn means that the degree of education a student in an ob-gyn program gets in the procedure depends on that student’s views of the morality of the procedure.
If a student says that in his/her moral system, all abortions are immoral, then I think it’s not proper to require the student to learn about them, other than a general instruction through the books. I don’t think that they can be required to take any clinical practicum that requires them to assist in any way with a procedure they believe is morally wrong. (And note, I’m assuming that it’s not that they are judging the patient; I’m assuming that their position is that it would be morally wrong for them to do/assist in the abortion themselves.)
If a student believes that abortions can be a moral option in certain cases (i.e. - to save the woman’s life), then they should be required to study the procedure to the extent compatible with their beliefs, even if they don’t think they will use the procedure very often.
And if a student says that he/she does not consider it immoral, then they should also be required to learn about it.
I thought the OP was talking about all medical students, but now I’m shocked to learn that there are obstetric gynacologists who don’t know how to perform abortions. Sure, it is often an elective procedure, but sometimes it is a necessary medical procedure, sometimes also an emergnecy procedure. I’m horrified at the thought that a mother could be allowed to die because her doctor had a moral objection to even learning how to perform a life-saving procedure on her. I would not be comfortable going to a doctor who would be unable to save my life if I had an incomplete miscarriage or an ectopic pregnancy. I’m incredulous at the fact that in 88% of US medical schools, abortion isn’t even offered within the regular program. The point isn’t even whether students should be allowed to opt out - it looks more like they have to opt in.
IMHO, not all medical students should be required to study abortion procedures, because medicine is a very wide area and there are a huge number of subjects to fit in before specialisation. However, once the student has decided to specialise in obstetrics, ER, or any other specialism where the ability to perform an abortion may be useful,* a certain level of knowledge of abortion should be mandatory.
If students are allowed to opt out of learning abortion procedures, are they alsxo allowed to opt out of learning about contraception, if they are against their principles? How about resuscitation of severely disabled newborns? There are medical students who believe it’s kinder to let such infants die (no cite, only personal experience of comments made by a few doctor friends of mine [they are a tiny minority, of course, but they do exist]) - can they opt out of learning how to perform these procedures? Perhaps students should be allowed to opt out of treating people with AIDS, because they are morally against promiscuity or homosexuality. Of course, not all patients with AIDS are gay or promiscuous, but not all abortions are elective, either.
These are extreme examples, true, but valid: if you allow students to opt out of one procedure because of their morals, how can you make anything mandatory?
All the same, as someone pointed out, if all students in ob-gyn programs were required to learn abortion procedures, there might be a problem of drop-outs. If it is possible for enough knowledge of this procedure to be gained from hands-off experience, this option should be available (but there should be a high standard of theoretical knowledge at least). Perhaps a doctor would be able to let us know if this is practical.
In the UK it would be essential knowledge for a GP - general practitioner, who covers all a patient’s general needs, with much less specialist referral than happens in the US. Knowledge of abortion procedures would be essential for those who work in remote locations such as the outlying isles where access to specialist services in an emergency is often impossible.
I recall being shocked at reading in the early 1990s that the last ob/gyn practitioner in Montana had moved out of state. Here you have the third largest state, by area, in the nation, with no specialist in “female problems” (as they used to call them). That constitutes a lot of country without one.
Begging to differ with the right-to-life contingent, I think that there is an exceptionally good reason why all physicians with a emergency medicine, GP/family practice or ob/gyn specialty should have training. To explain it, let me set the following scenario:
N-town is a small city somewhere in the Northeast. About 65% of the population claims to be Catholic; about half of them are “practicing Catholics.” Among these latter are the local ob/gyn specialist and a married woman with significant ovario-uterine problems who, being a good Catholic, has not practiced birth control. She is now pregnant, the fetus being well before “viability”, her pregnancy has, for reasons I don’t have the expertise to hypothecate, become life-threatening for both her and the unborn child, and of course she (and her physician) are opposed to “abortion-on-demand” as morally wrong.
The proper procedure in this case is an abortion – to save the one life that can be saved, that of the woman, since if she dies the fetus will die as well. And under those specific circumstances neither doctor nor woman will be guilty of sin under Catholic doctrine – and I presume no conservative evangelical would condemn them either.
Granted this is an extreme case, but so are many others. The classic “welfare mother who has an abortion annually” is equally a straw man. I presume nobody in this thread would have a problem with surgery (or a chemically induced “abortion”) to remove an ectopic pregnancy, a tragically common event where neither mother nor embryo will survive without intervention. More common scenarios could be devised where persons opposed to most circumstances that might lead to abortion might find themselves in one of the circumstances in which they would feel abortion to be proper.
There may be black-and-white standards on what is right and wrong for many of us. But applying them to specific circumstances raises issues where the coloration is less than clear.
. I would not be comfortable going to a doctor who would be unable to save my life if I had an incomplete miscarriage or an ectopic pregnancy.
One, it could be argued that ending an ectopic pregnancy isn’t really an abortion. It is absolutely impossible for a baby implanted in the fallopian tube to grow to term and the mother will die. In the event of an EP, a partial, or sometimes complete, hysterectomy is performed. All OBs know how to do that.
Second, if you were to have an incomplete miscarriage, that would require a D&C. It would not be an abortion because the baby is already dead. All OBs know how to do D&Cs, too.
WV Woman: So effectively you’re restricting your definition of “abortion” to the removal of an unborn baby from its mother under circumstances you consider immoral?
I’m not trying to be confrontational here, just to grasp what you’re saying. Are there in fact procedures that you would include under the term “abortion” as a medical procedure that you would consider acceptable morally under given (perhaps improbable) circumstances? Or do you restrict the term to the purely elective (and in your eyes therefore always immoral?) cases?
Maybe it’s just me, but I found that article to be too vague in terms of what was actually meant by training to perform abortions. I can’t imagine that what was meant was training in performing a D&C, not the way the article went on about part of the problem being that abortions are not commonly performed in clinics, not hospitals (abortions may not commonly be performed in hospitals, but I bet D&C’s are). But if the article isn’t about doctors not being trained to perform D&C’s, what is it about? Exactly what is it that the doctors are not being trained to do? Is there some medical procedure that is only used in cases of elective abortion, never after a spontaneous incomplete miscarriage or other complication (such as fetal demise), and is never done on a emergency basis? If there is such a procedure (and I don’t know that there is), then I don’t have a problem with ob/gyns not being forced to learn it.
Does that baby have ANY chance whatsoever of growing for 9 months and then being born? No.
After a certain point, the tube will rupture, thus the baby dies, and maybe Mom too. No matter how you look at it, the result of an EP is death for the baby, no exceptions.
I’m not sure it could be considered an abortion in that case, since there is NO CHANCE that the kid can live.
Correct me if I’m wrong, but isn’t a D&C the same procedure performed in an early-term abortion?
When my second baby died at 14 weeks in utero, the doctor referred the the procedure he performed as an abortion or as a D&C (he used both terms at different times, I mean).
Personally, I can’t imagine an OB/GYN NOT knowing how to do the procedure, regardless of whether he chooses to do it in h/h practice or not.
Can a urologist decide not to learn to sterilize a male patient? It’s generally elective, and can be considered a moral decision as well.
I don’t know where to draw the line. Prof december’s point is that the school’s requirements should fully apply to all students. An individual student should not be able to opt out of a portion.
She has similar feelings about female Muslim students who wish to opt of of studying aspect of the male body, which are forbidden to females by their religion.
The idea of “two birds with one stone” is to actually hit the birds, NP. First off, it’s exactly analogous in that the job requirement for the military (excepting certain COs) is to be able to kill if needed. The job requirement for the medicos is to be able to save the patient’s life by the appropriate means. If that means carrying out an abortion, then apparently that means carrying out an abortion.
But I guess you and WV would rather the patient just suffer.
Second, “abortion training” can still be book training and simulation without actually requiring the abortion of a fetus. That’s why my analogy works: “killing training” didn’t require any actual killing.
First off, I must apologise for the egregious typos in my last post. If you could see the state of my keyboard, you’d be amazed I don’t make more mistakes.
WVWoman
Actually, the treatment for ectopic pregnancy is not hysterectomy, but chemical abortion if caught early enough, or (most commonly) a laparotomy (linkand another link
Basically, in order to treat women with these complications, the OBGYN’s must learn how to perform abortion procedures. Perhaps it might be possible for the students to learn these procedures purely in circumstances of spontaneous abortion, but I can’t imagine many mothers happily allowing a classful of medical students to be present during such emotionally harrowing surgery. And since this surgery is usually performed under local anaesthetic, I imagine she might well object. So where are these students to learn these essential skills? Well, at abortions…
Couldn’t medical schools offer mandatory classes on abortion in the context of a medical necessity (ectopic pregnancies, etc) and a seperate optional class on abortion in the context of the elective procedure? Wouldn’t that allow for doctors capable of saving the lives of mothers in pregnancies gone wrong without forcing the issue of elective abortion?
[ironic hijack]
Abortion was legal in the US till 1840. The MD’s then started a campaign to take away the rights to do abortions from the midwifes, since they wanted the business. The lobbying succeded, but the MD’s hade fully realized what they took on themselves. Not being able to cope, and clearly anable to say… “no, we were wrong, the midwifes are actually qualified” they opted to lobby for making it illegal. By 1845 it was made so.
As always: follow the money. Moral wasn’t the issue.
[/ironic hijack]
I thought the OP was talking about all medical students, but now I’m shocked to learn that there are obstetric gynacologists who don’t know how to perform abortions. Sure, it is often an elective procedure, but sometimes it is a necessary medical procedure, sometimes also an emergnecy procedure. I’m horrified at the thought that a mother could be allowed to die because her doctor had a moral objection to even learning how to perform a life-saving procedure on her. I would not be comfortable going to a doctor who would be unable to save my life if I had an incomplete miscarriage or an ectopic pregnancy. I’m incredulous at the fact that in 88% of US medical schools, abortion isn’t even offered within the regular program. The point isn’t even whether students should be allowed to opt out - it looks more like they have to opt in.