OK, talked to my Dad about this(semi-retired OB/GYN).
Medical students generally just observe, hands-on is mainly done by interns/residents. These procedures would usually only be encountered if going into OB/GYN specialization.
The procedure for a “normal” D&C, when no pregnancy is suspected is the basically same procedure as an abortion. Specifically there is can be a case of “missed abortion” where the women’s body has not attempted to discharge the failed pregnancy. In these cases the D&C performed is exactly like the D&C performed during an abortion-on-demand because the cervix must be forced open, unlike in a failed miscarriage where the job is already partly done by the body.
A OB/GYN cannot opt out of learning these procedures on moral grounds. As a resident my father had the option to refuse to do an abortion-on-demand but not a failed miscarriage or missed abortion. Therefore the procedure is learned regardless, making this argument moot.
–Learning how to perform a D&C is not a skill one would learn in med school, generally, even if one wanted to. That training would be found in an OB/GYN residency program, and probably in a family practice program. As an internal medicine resident, I don’t expect I’ll ever perform a D&C, nor will anyone ever ask me to.
–The skills required for an elective abortion are the same skills one would need to do a D&C for any other reason, so anyone who has finished an OB/GYN residency should be able to do one. The question is whether a program can require a resident to perform elective abortions.
–My thoughts? Yes, a program should be able to do so, but it should say so up front, and it shouldn’t be able to tack that on as a requirement later on. That way, those who don’t want to do them can simply find a program that doesn’t require it.
Learning how to perform abortions should definitely be part of the training of someone wanting to become an OB/GYN, although it may be too specific for someone else.
My point here is mainly that one should respect both the letter and spirit of the law. Roe v. Wade established the legality of abortion, but it should be more than simply legal. That is, it should be available. I’m not trying to force beliefs onto anyone else (I hope that’s not how it’s coming across…). Doctors specializing in the field can have the freedom to practice, or not practice, abortions as they feel fit. But abortion is commonly done and should be treated as a standard surgical procedure. As opposed to the attitude that yes it’s legal, however it’s a frivolous and optional thing to learn.
Well, they’re already required to know how to determine if a patient’s dead, hey? My bet is that particular class doesn’t require someone getting executed right then and there.
Poly, you’ve misstated the Catholic position here: since abortion is viewed as murder, the “no excepions” policy extends even to this case. (Keep reading, folks, I’m going somewhere with this!) The church has never adopted a “utilitarian” position whereby in any situation, one human life can be viewed as more valuable than another.
But, (here it comes, folks), that doesn’t mean the woman is supposed to roll over and die. It just means an alternative method has to be sought whereby the unborn child isn’t directly killed, but rather, the child dies as an unintended consequence of the surgery. Might sound cruel, but if it helps, I’d imagine that this would be a last resort scenario as you’d want to explore options that could save the lives of both first.
There’s an old moral principle called the double effect, where an action can have a good and a bad effect at the same time. To be licit, the double effect has four limits:
The action is good, such as excising an infected part of the human body.
The good effect (saving the mother’s life) is not obtained by means of the evil effect (death of the fetus).
There is sufficient reason for permitting the unsought evil effect that unavoidably follows. (The mom’s going to die.)
This is key: The evil effect is not intended in itself, but is merely allowed as a necessary consequence of the good effect.
Another example would be self-defense: killing sucks, but your intent is to save your life, not to kill the attacker.
The National Conference of Catholic Bishops has said such operations are morally licit.(1) Although viewed as indirect abortons, they’re justified under the double effect principle above so long as the intent is not to kill the child. Hence, as you mentioned, surgery would be licit and neither the physician nor the mother would have any moral culpability.
In rereading your post, I think you might have only been misstating a Catholic position. But I do think it should be made clear that the Catholic church has never, under any circumstances, said that an induced abortion of a live child is licit.(2) (But, like I said, you can and should use any method to save a mother’s life as long as the unborn child’s death is indirect.)
(1) Ethical and Religious Directives for Catholic Health Failities (1971), paras. 10-17.
(2) I’m not sure if an induced abortion of a stillborn child would be wrong; I’ve never seen it discussed, but since the child is by definition dead, no murder could possibly be taking place. On the other hand, my boss just told me the other day about his wife’s miscarriage, and how, just before it happened, the doctor wasn’t sure if the child was dead or not when he recommended an abortion. Kinda scary to think that somebody might accidentally abort a live child thinking it was a dead one.
This is interesting - I hadn’t realised this. Thinking about it, I would say fair enough in Saudi, if they want to concentrate on one gender. However such a practising certificate should not then be valid in other countries, and more training and qualifications should be requried. In any non-Islamic country, someone only experienced with one gender should not be considered qualified as a doctor, and should not be allowed to practice as one.
Re abortion training: as has been pointed out above, there seems to be little difference in procedure between elective abortion surgery and medically necessary procedures, so how can a qualified doctor be unqualified in the basic technical procedures anyway?
Re later-term abortions: don’t doctors still have to deliver stillbirths early, eg foetuses that die in the third trimester?
So technically, all doctors should have the basic skills. What they may not have is the experience of dealing with woman needing/having elective abortions, counselling them before and afterwards, and so on.
I don’t particularly mind if my doctor for personal ethical or religious reasons refuses to carry out a legally-permitted though controversial procedure. As long as they were able to refer me to another doctor who could.
I don’t like the idea of med students being able to “opt out” of whatever procedures they find distasteful for whatever reason. Abortions are a legitimate medical procedure (“legitimate” in this case having nothing to do with morals) that, like it or not, are performed regularly in the US. Learning about the procedure DOES NOT MEAN that you’re ever going to have to do it. One learns a lot of things in med school that don’t factor into one’s area of specialty, yet remains a part of a general medical education.
Then again, I’ve never liked the argument that learning about something immoral is equivalent to its practice. Sheesh, people.
Just to add another possible analogy…are state-appointed defense lawyers allowed to NOT take on a case if they are ‘morally opposed’ to the perpetrator? ( I honestly do not know what the situation is here).
But what would be the situation if a barrister (attorney) KNEW his/her client was guilty of a particularly heinous crime? Does that give the attorney the right to step down from the case???
kambuckta"But what would be the situation if a barrister (attorney) KNEW his/her client was guilty of a particularly heinous crime? Does that give the attorney the right to step down from the case???"
That is sooo another thread.
I’m sure everyone here can see that this Salon article was a paper tiger to get the pro-choicers riled up. In a more right leaning magazine the title would be “Some suggest mandatory abortion training”. The discussion is meaningless as doctors will end up with the same knowledge. Shodan
“I suppose even anti-death penalty medical technicians should be compelled to learn to supervise an execution”
I don’t know how silly you are trying to be but surely you can see that inserting an IV is not unique to lethal injection.
First of all, let us assume that all medical students learn about abortion ie., that it exists as a medical procedure. That said, all OB/Gyn residents in this country learn how to do medically necessary D&C’s as well as how to treat ectopic prgnancy and early fetal demise. They are therefore qualified to perform any of these procedures, many of which are essentially the same as those used for elective abortions. However, I do not feel that all students should be trained in elective abortion and/or forced to participate in them. If you consider this a subspecialty, you can consider an analogy to infertility treatment. Not all Ob/Gyn residents perform IVF-the ones that intend to specialize in this field seek special training. If a resident has a moral objection to IVF-they can opt out of performing this procedure. The same should be true of purely elective abortions. Let those that want the training obtain it, as long as the others are qualified in emergency treatment. Also. you need to consider Catholic Institutions. Should they be forced to train procedures that contradict their beliefs? I did my ER training in a Catholic Hospital, where I was forbidden to even mention birth control to a 15 year old who had 2 children and had just had a miscarriage. While I found it appalling that I could not even give her the number of Planned Parenthood (hell, I did anyway-may have been why my grade was so low) how far should this private hospital be pushed to offer treatment against it’s fundamental principles? I think when it comes to purely elective procedures, the trainee has the right to opt out-I think the more interesting question is whether a training institution is required to offer training for those that desire it?
If Polycar was thinking about the same article I am, what it said was the last ob/gyn with training in abortion or the last doctor who would perform abortions in Montana had moved or retired. I’ve seen figures in Ms. Magazine which also indicate how few counties have doctors who can perform abortions. While I realize this may not be considered an acceptable cite for this topic due to undue bias, I’ll see what I can did up tomorrow.
By the way, welcome back, Polycarp, I’ve missed you.
WV are you familiar with the axiom “see one, do one, teach one?”
that’s how medicine works.
no. i don’t want to know how to do elective surgical abortions, because i will not be performing them. ever.
doesn’t mean that i will not read about it in the OB/GYN textbooks, answer questions on exams and otherwise be totally familiar with the procedure.
yes i would perform D&C for heavy periods, incomplete spontaneous abortion etc.
yes i would operate to remove an ectopic foetus.
yes i would give a woman RU486 (she takes the pills, i do not shove them down her throat…sorry it’s my fine line)
you cannot say that a woman has the right to choose but a doctor doesn’t.
One practise which many public hospital staff (especially the nurses in the O&G wards) here find distasteful is Catholic hospitals admitting women as private patients, sending them over to a public hospital or a secular private hospital to have a TOP performed and then having them returned to the Catholic hospital for recovery. The Catholic hospital pays the other hospital for the surgery charges and pockets the (exorbitant) private patient bed fees while all the time knowing what procedure is taking place but keeping its hands technically “clean”.
Last I checked, I was still a medical student. Still. Anyway, I haven’t done an Ob/Gyn rotation yet, I do know that elective D&Cs/D&Es/abortion whatever you want to call them, are not part of the rotation around here. We have plenty of opportunity for students to go watch at Planned Parenthood, which is all completely optional. I pretty much agree with this policy, even though I am a staunchly pro-choice.
I think that there is enough to learn during normal rotations that elective procedures, in general, are not in the forefront of what you learn. I’m sure if you wanted to learn breast augmentation, you could do a plastics subspecialty rotation. Just like if you want to learn elective D&C, you can do a Planned Parenthood rotation.
Emergency D&Cs and medically indicated planned D&Cs are another story. We still (in general) value the mother’s life over the fetus. D&C is a standard Ob/Gyn procedure, it is a standard Ob/Gyn treatment which is still necessary. It is a tool which is the endpoint of many diagnostic trees. If a medical student can’t follow that decision tree to its outcome because they are ignorant of D&Cs, they are medically negligent. It is the goal of medical school to train compotent physicians, and this should be part of the training. This doesn’t mean every medical student should be able to perform D&C, they should know the procedure, its indications, its complications, and how it is generally done. Just like I don’t know how to do a Whipple procedure (an enormously complicated surgery where the head of the pancreas, the lower part of the stomach, most of the duodenum, most of the bile ducts and the gall bladder are removed), but I know when one is needed, the general procedure, and the complications.
I do think that every Ob/Gyn should be trained to do a D&C, and should be compotent in performing them. But that is an issue for residency programs.
Surely a Dotors licence should reflect the procedures they have and have not been trained to perform. If a doctor is not trained to perform a termination then it is unethical and should be illegal for them to do so.
Students should not be forced to learn a procedure they find immoral. However there may be commonly accepted procedures, other then abortion, an individual might find offensive. There are surgical procedures that improve the lives of those who recieve them (ie, plastic surgery?) but are not seen as ethically justified or necessery by some doctors, again if the individual lacks the training then they don’t perform the procedure. A country could always attract a few foreign doctors if the locals aren’t willing to meet demand, after all the birth of a child unwelcomed is a horrible and irresponcible thing (in my veiw of course).
