Gilding the Conscience

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I was reading an article in the Atlantic the other day about tubal ligation, an extremely common form of surgical sterilization, not being allowed in the US at Catholic hospitals. You can read the article here. Truthfully, at the time it went in one eyeball and out the other. Yeah, yeah, that’s not news…

Today I was thinking, though.

Remembering, actually.

So here I am posting.

I never learned how to place an IUD in residency. We were not allowed to use them because of religious stipulations placed in the residency program’s charter. Or some such thing. So an extremely reliable, safe, and popular form of birth control was off the table for the physicians in training at the program and therefore also not available for their patients.

Along those same lines, a fellow resident approached me within the first week or two of residency, asking me to write his birth control prescriptions for him. He was planning to join a religious order upon graduation and had a moral issue with the whole concept of birth control.

So I agreed.

I often wondered how he delivered the news to his female patients. He was a good fellow. I don’t imagine he said, “I am sorry, I think birth control is sinful and you are going to hell.” Still, how did he have that kind of conversation? How did his patients feel about his views and about themselves afterwards?

I have prescribed the morning after pill. I have also refused to prescribe the morning after pill to the same person. I have placed IUDs. I am a huge fan of birth control. I do not think abortion should be illegal, but I don’t ever wish to perform one.

At any rate, what role does morality have in medicine? What is the difference between morality and ethics? Is there a difference? What do you want to see in your own physician? If your own morality can be influenced so much by family, friends, religion, politics, etc., can it even be trusted?

Tell me what you think.

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128 thoughts on “Gilding the Conscience

  1. Wow that’s a tough one. We were faced with a lot of decisions of the like when we went through IVF (ICSI) three times. It was a very tough time. Sadly unsuccessful.
    I think I would appreciate a doc saying to me, “For my own reasons I can’t do this for you but I can refer you to someone who could.” Then it’s for their reasons and I don’t feel judged. Does that make sense? I can respect that what’s right for one person may not be for another.

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  2. I had a doctor who was of child bearing age before I moved from Scottsdale, Az. to this dreaded Dallas, Tx. I was having a VERY rough time with menopause symptoms and the quality of my life had plummeted. She confirmed by a blood test that I was indeed in menopause and she said, “We are not going to treat it. You’ll just have to suck it up.” I almost laughed when I was leaving her office. Maybe she should just suck it up, I was thinking. Within a week I had a new doctor who prescribed bio-identicals and within 10 days I felt like a million bucks. I don’t know the answers to the morality and ethics questions for other people. I just know what works and doesn’t work for me. I want my doctor to be a partner, a champion for my health and someone who does not judge me for any reason. One of the blessings in Dallas is that I found her.

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  3. From my prespective, I would define moraltiy as something that resides within each person. It is how each person interprets right from wrong. Ethics is more the collective interpretation of right from wrong.
    Both are essential to your partice as a doctor and as a human being. Morally speaking the doctor that was unable to prescribe birth control was respecting his own moral beliefs and by referring his patients to some else he was respecting ethical practice.
    Leslie

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  4. When I go to my doctor, I want his/her opinion solely based on clinical evidence based research. If I want a lesson on morality, I will go somewhere else. If I ask for help with physical symptom management, I want him/her to have the most recent knowledge on the subject. And if they don’t I expect them to find out before they prescribe. I am totally against the government or anyone else telling me what to do with my body. That includes birth control to death. If I want it over, I want someone to tell me I need counseling. Upon counseling, if I still want out of here, say I am terminal, then I want the help to do it the least evasive and painful manner. I have very strong feelings on any coercion of life altering choices based on someone else’s beliefs. This is where clinical disassociation is critical.

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    • Clinical dissociation is a nice term. I like that! BUT, should a physician be required to leave their own morals behind by virtue of their profession? Is there a way to reach a compromise, I wonder?

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      • Why certainly. as the person said before me…work for clinics, hospitals and so forth that have the same principals. But if you are a GP, it means general practice. If I go to a Catholic hospital, I would understand their hesitation on birth control. So if you are against abortion, or free choice, don’t work for Planned Parenthood. As an teacher, I would not work in a parochial school or any religious based school. Now I won’t work for a district which is doing Common Core. My choice.

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  5. Oddly enough, I’ve had the same conversation recently about politics and politicians. Only the question was: do you rather have politicians that represent the views of his/her constituents, or politicians who stand up for their own moral viewpoint?

    Personally, I give the same answer to the doctor question as I gave to the political one: I’d like someone who is honest enough to let me know their viewpoint up front so that I can be comfortable with someone who shares my views. When I had my vasectomy (many, many years ago), the first doctor to whom I was referred told me flat out that, even though I’d already sired children, my current wife had not given birth so he would not perform the operation. Upon my prompting, he added that he believed a woman’s purpose on this planet was to have babies. I was happy to hear his opinion. I also left his office so fast there were burn marks in his rug.

    I feel the same way about Pharmacists that don’t want to give out birth control. As long as they tell the truth to their prospective employer during the job interview, then I don’t care. Any major drug store will either make arrangements for someone else to be available to hand out the nesc. drugs or simply won’t hire that person because they do not meet the job requirements.

    Everyone who has a job has to meet certain job requirements, whether it’s a doctor, a pharmacist, or a politician. I think that if you don’t want to do abortions, then you shouldn’t go to work at an abortion clinic. If you don’t want to hand out birth control, then don’t work at a place that hands out birth control. And if you don’t want to pass laws that make life better for people, stay out of politics.

    But that’s just me. I’m a bear. What do I know?

    Liked by 7 people

    • Certainly, the urologist should have been much more up front about his views before the appointment was even made. In a system such as the US’s, that visit cost you a copay for sure, and may have even been a couple of hundred dollars applied to your deductable that would then be your sole responsibility. All of that to be told no because your wife needs to be impregnated? Gah!

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  6. I’m all about pro-choice. I don’t want politicians or preachers deciding what I should or should not do with my body. That’s said, I’m still pro-choice, which also respects other people’s rights to not participate in any form of medical birth control or to be opposed to abortion. However, AND THIS IS HUGE, I don’t think, if you are paying for insurance, your insurance company or employer should be able to decide those things for you. I do think a government program should pay for birth control for those in need.

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  7. Wow. Fantastic question. I can’t give a better answer than what I’m already reading here. My thoughts are along the same lines but my wording wouldn’t be as clear so I will just continue to read these and appreciate the sharing here.

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  8. I think if a doctor has certain beliefs which will impact how he/she treats patients, the employer and patients should both know upfront what they are. I’m uneasy with the idea of doctors proscribing their personal morality in patient care but at the same time don’t want emotionless clinicians who treat people like numbers or “meat slabs,” and cannot help but think the two are connected – that is, emotions and morality come as a duo.

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  9. I’m not going to write a book-length comment. I could. Easily. I’m not going to read the comments of others yet, either…

    Morals are not dependent upon religion, any religion. Ethics are not dependent upon any religion. Right and wrong have changed throughout the centuries, with and without religion.

    If a physician’s religion is going to affect the way s/he provides medical care, s/he should have a big, freaking disclaimer somewhere that states so. Some people will flock to them for that reason; others will choose to go elsewhere. I realize there is a problem where choice is not available.

    While I don’t think a physician should be made to do something that is against his/her belief system, abortion being one such situation, I don’t think legal & proper medical treatment should be able to be withheld from patients because of religion either. Where is the line drawn, too? If you pray hard enough you don’t need antibiotics, according to some.

    :::rips opinionated typing fingers away from keyboard:::

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    • Yes, where do you draw the line. If someone gets to draw the big line in the sand for everyone, who is that person and where is that line and why they get to pick? I am fairly liberal in my views compared to some, but my views are not right for everyone, either. Nor should they be. My views, however, should never, ever be used in such a way that they cause disrespect or harm to a patient.

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      • And too often they do cause harm and are disrespectful. My short stay in SE Kentucky brought that to my attention. The only medical facilities anywhere were religious-affiliated. The stories I heard about what doctors said to patients, usually female patients… you would not believe. That population also took this abuse as normal. :::tries to stop typing:::

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  10. Beautiful piece, VD.

    I worked as an ethicist at a Catholic hospital and my eyes were OPENED wider than they ever have been. I think morality makes up part of one’s own heart and soul. It’s internal; it’s within. I think ethics is more in the mind and has more of a universal aspect; what is acceptable among the masses. I absolutely think a doctor* needs to have room in their practice to hold on to their morality. But I also think that doctors need to be very aware of what is acceptable among society, and handle situations that are dissonant with their own morality with GRACE, and direct their patient to someone who can help them.

    Now with that said, I think doctors need to be open to what their practice will look like and choose a specialty accordingly. For instance, there is an OB/GYN in my city who won’t prescribe birth control. It baffles me that he would go into this specialty if he won’t practice a very big part of the specialty. Abortion can be argued as well (why would an obgyn who doesn’t want to do abortions go into obgyn?) although that is a much smaller piece to the specialty than birth control.

    I love the last question that you pose. I’ve never thought about it like that. And now that I’m thinking about it, I don’t know if one’s own morality can be trusted. I obviously want to think I can trust my own morality, but I still mess up everyday. But does the fact that I know that I mess up mean I can trust my own morality? And now I’ll keep pondering…

    * I say doctor since that’s what your piece discusses, but I think this obviously must extend to everyone involved in patient care. There was a fascinating and incredibly sad case a number of years ago that involved a Catholic hospital in Arizona losing its Catholic status because a small group of doctors and nurses were involved in an abortion. But the situation was HORRIFIC: Fetus was going to die no matter what, Mom had pulmonary hypertension and would die if she carried the baby, Mom had multiple other children at home that needed her to mother them. She couldn’t be transferred to a non-Catholic hospital (the obvious solution) or else she’d die. So the abortion was performed. And I believe it was a nurse who came forward since she couldn’t live with herself.

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    • What an awful, awful, horrible situation. There is an OB/Gyn in my area who also refuses to prescribe birth control. He told my patient that he believed it was morally wrong and a sin against God. Not sure that was necessary, putting it like that…

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      • That’s just crazy! So do you agree that there’s line between an obgyn not prescribing birth control and an obgyn not wanting to participate in an abortion? The difficult thing is many people believe that taking birth control is, in essence, having abortions. What I’ve been told is that if the birth control doesn’t stop ovulation altogether, it makes an uninhabitable environment for a fertilized egg, so the fertilized egg will never attach (and thus be aborted). So it does make sense that someone would see this as an abortion if they believe life starts at conception. What’s funny is I do believe that life starts at conception, but this birth control argument doesn’t jive with me. And that’s why there’s so much controversy with all of it because there is no easy answer!

        But regardless, I still firmly believe that someone should not choose to practice a specialty and then refuse to practice a large part (THE largest part?) of that specialty.

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      • The abortion thing gets a bit dicey. Someone with an ectopic pregnancy (pregnancy outside the uterus) needs surgery to remove the fetus or a chemical abortion to prevent dying. Is that morally wrong? Some feel it is and I am not sure they need to be practicing as an Ob/gyn. Birth control does not cause abortions. Here is a great post from someone else about this: https://drjengunter.wordpress.com/2014/07/01/an-obgyns-opinion-on-the-supreme-court-hobby-lobby-and-contraception/

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    • I think I remember reading about that case – very sad all around. With that case specifically, though, the thing is I have no idea whether I agree with the decision or not. From the coverage I found, I have no idea whether they did the usual hack-n-slash abortion or whether they simply forced the delivery of the baby and allowed the resulting death to naturally occur.

      To me, there’s a HUGE difference, because the first option egregiously ignores the personhood of the baby (*) (for example, no one who advocates for assisted suicide / right to die would want to die the way most babies die in abortions), and the second option allows the certain death to occur naturally, but sooner, and in a manner that allows the mother to survive. I would think the second option would be acceptable even in the Catholic ethical system, because there is precedent that it’s okay to give a terminally ill person enough drugs to be as comfortable as possible, even if it’s in a dose that hastens their death. But you’re the ethicist, so feel free to correct me!

      (*) Setting the obvious debate on the personhood of a pre-born human for a minute, because it was at a Catholic hospital, and Catholic ethics on the sanctity of life from conception until natural death are clear and well-established.

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  11. VD, this is a great post on an important subject.

    I’ve read all the comments and I basically agree with them. Why should someone who might have to prescribe birth control and/or perform a necessary abortion become an OBGYN? Those folks with moral dilemmas should, as pointed out above, choose their specialties accordingly. I don’t think there are any moral issues to being an orthopedic surgeon … And those pharmacists that refuse to dispense birth control should be fired, IMHO. that is not their position or their decision in their rolls as healthcare professionals. Their job is to know about drugs and their effects and to fill prescriptions, to understand drug interactions, to educate their patients. It is not to decide who gets what. That is the doctor’s job in consultation with the patient. And while I know better than most that pharmacists are not simply pill counters, in these cases, that’s all they need to do. Shut up and do it.

    You raise another issue that I honestly do fear. I believe in letting people go when it is their time. But nearly all my doctors are affiliated with a Catholic Hospital. If things go south for me, are they going to prolong my life — against my wishes — because of their belief in the sanctity of life? Does that include respirators and dialysis? I love my doctors, but it is of great concern to me.

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      • I had heard of it once, a long time ago, and never given it a thought until you posted this. I think I may bring it up to my doctor!

        On the other hand, what was once a lone standing hospital/med school is now part of a huge consortium, so who knows who gets to make any kind of decisions. Probably MBAs!

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    • The ethicist above may want to correct me, but to the best of my understanding, a dying person cannot be denied “ordinary care” which is understood to be food and water. That’s it.

      If a person wants to refuse anything that would extend their life, that’s their right. I think the logic is, at that point, God / Mother Nature / Odin (insert deity or higher power of choice here) has decided that person’s life may be allowed to end. You CAN prolong it if you want, but you don’t have to.

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      • Elyse –

        That’s a great question. I don’t know if a feeding tube counts or not – I seem to recall during the Terry Schiavo case that issue was debated but it’s been years (and I was kinda young then) so I don’t really remember the substance of any of it at this point.

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  12. What I saw my mother go through spilling out child after child, every year, all because the church told her she had to abide by her husband’s needs, well, that didn’t fly well with me. After many years of observation, I am of the opinion a woman’s body is sacred and her own to make such important decisions as birth control. If a woman decides to use abortion as a means of birth control, that is a totally different matter all together. I don’t believe in killing life, yet, if there are extenuating circumstances involved, such as rape, malformed fetus, and the mother’s health is at risk, then abortion should be considered. This is such a touchy subject, because it stirs up so much emotion. Do we even have the right to terminate life? Even in those circumstances I stated? Life is precious. Women in poor countries have so little say over what to do with their own bodies, and so bring to birth too may children. I could write a book here. I think I will stop here. Tough subject.

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  13. Here in Ireland there is no abortion and the morning after pill was gp only up to a couple of years ago, yet 4000 travel to Britain each year for a termination. Just before Christmas we had an awful case of a girl aged 27 who had a brain hemorrhage. She was clinically dead but 16 weeks pregnant. It took three weeks for the high court proceedings to sanction turning off her life support. They didn’t do so until after Christmas. The girl had two young children already. It was so cruel.
    I am anti abortion myself, but not for anyone else, if that makes sense.

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    • Makes total sense. A similar case occured in Texas, but not for religious reasons. It was based on a law that was said to protect the unborn. Took much longer for that one to make its way through the courts…

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  14. This is a weighty issue, no doubt. People need to keep in mind that birth control pills are used for a variety of reasons, not just birth control (heavy menses, painful menses, etc.), and I hate to think of a woman not being offered this valid form of treatment just because the doctor has a religious objection.

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  15. I think that if a medical person finds something goes against their beliefs then they have a right not to do it but should be respectful of their patient and refer them elsewhere. I had an experience when I was a student nurse that is applicable but it was bad for the patient. There was a young woman in the hospital, and I was working as a Nurse’s aide, she came in for an induced abortion. She was in a type of labor and the RN who was the only other nurse on the unit refused to go into the patient’s room to help her and told me it was because of her beliefs. She sent me in to help her. I was a bit over my head because I was just starting as a Nursing student at the time. I did my best to coach the woman in Lamaze breathing. After the fetus was delivered she wanted to know what it looked like. I remember the charge nurse did not want to deal with that either. So I described the fetus to the young woman. It looked like a little fully formed baby. I talked to one of my instructors afterward and she said it may have been better for the mother to see the baby. I just remember how I felt so unsure of myself.

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  16. Lady Pink Rose’s comment about “spilling out child after child” was true for my mother as well. It was the 1960’s, she was Catholic and her Dr. was Jewish, but for some reason, there was a restriction for having a tubal ligation until a woman had given birth to at least 6 children. So, guess what, I am one of 6 children. It seemed so arbitrary to me; I don’t even think this was a valid practice; but no one at that time ever challenged their physician. Times have changed.

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  17. Looks like I was late to the party this time. You’ve received some wonderful comments. I’ll take a different approach. This kind of conundrum, if amped up, would make a great conflict in some of your fiction. It has the added benefit of something important for readers to think about.

    I need a doctor whose morals and ethics will let him/her give me superpowers.

    PS: I will never refer to you as VD.

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    • Thank you for avoiding the VD. I thought about changing my handle, but the Victo Dolore is too dear to my heart. I actually was thinking about this vein in the fictional work. I have thrown a lot of ethical delimmas into it already and this would make a juicy next step. Particularly if it gave them super powers… πŸ˜‰ Thank you!

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  18. Here’s a question. In home care, we send aides out to help the infirmed in their home. We have patients who refuse care because the aide is black. The majority of our aides are black and they are all very competent and caring. Do we have to find an aide who meets the beliefs of the patient or does the agency have the right to deny them aide service even if it means they will suffer? They may not have any other choice of provider because of payer and have to use our service…Sort of the other side of the coin.

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    • This is such a fantastic question. Even the bigotted need care. When I moved my office from a more rural area to a more urban area, I had a ton of patients follow me. As soon as I hired an African American front desk person, however, conflicts started to errupt between her and my older patients. Apparently, there were things those people would take from a white person that they would not take from anyone else of a different skin color. Some of them would just come right out and say, “I’m not coming back because you have a black person working for you.” Some of these people I sort of expected but many of them completely surprised me that they were harboring such racism. They had plenty of choices, however, so I told them they needed to go elsewhere. In a hospital setting or in a home health situation, that is a tougher issue. It can be used a teaching point, but most of these people are not going to change their stupid, ignorant views so the lesson is lost on them. Plus, you are sending the staff into a situation that is uncomfortable and possibly dangerous for them (physically or legally) so if I were making the decision I would probably make the decision based on what was best for my staff.

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  19. I’d like to see religious organizations get out of health care. That would allow secular hospitals to enter communities and make available services that people of differing beliefs would otherwise have no access to.

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  20. When I see a doctor I want to get the facts. I want to get my options. I don’t want to have someone’s religious belief swaying my decision. I don’t need to feel guilt in a doctor’s rooms. I want compassion. I want to feel that I am being listened to. I want to feel comfortable and not feel stupid for asking any questions relating to my health. I would like to hear an opinion. But if I don’t agree with the opinion I also reserve the right to go somewhere else. All that in the 10-15 minute time slot!

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  21. Sorry, my comment didn’t sequence in the replies the way I intended. I meant it to be a reply to your comment, “…BUT, should a physician be required to leave their own morals behind by virtue of their profession?”

    And my reply is yes, a physician should be required “to leave their own morals behind by virtue of their profession.” Only I would disagree that dispensing birth control is not “leaving your morals behind.” I would ask what is immoral about preventing unwanted pregnancy?

    As a physician, wouldn’t denying that care be unethical? And, as a mother who surely can empathize with the desperation of an unwanted pregnancy, wouldn’t that be immoral to deny that care to another woman?

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    • Dang. Lost my whole comment. Stupid smartphone. I agree with you completely that prescribing birth control is not an immoral thing. Not one bit. I have really great, sound arguments to that effect, too. But there are physicians out there who disagree. I don’t think we can force them to write those prescriptions or kick them out of the profession. That goes back to personal freedoms. However, not being up front about those beliefs before a patient even walks in rhe door smacks of dishonesy. After your pelvic exam is NOT the time you want to be hearing about your physician’s moral isaues with birth control. (Here, let me take your money, violate your body, and then leave you to figure out the whole birth control thing on your own.)

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  22. I wrote something about this once… http://thegentlegiraffe.wordpress.com/2014/06/29/an-open-letter-to-chantal-barry/
    Maybe I have a slightly different viewpoint since I specialize in a “woman’s health/advocacy” type of medicine. Despite what I wrote here about birth control and putting personal beliefs aside in medicine, I don’t think I would be willing to perform abortions. This isn’t really just because of my moral beliefs (I would never have one myself), but also because it’s not an essential service, I can easily refer to clinicians who would do it in a timely manner, and there is so much other “personal risk” as a provider of that service that I am not willing to take. I do, however, believe it is my responsibility to know and understand the procedures and how they are done, the complications and side effects, andI certainly would never imply to patient that having an abortion is wrong.

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    • I probably could provide an abortion if there were a medical need where the life of the mother was in danger or there was no posibility of viability, as in the case of anencephaly. I have, in fact, written for chemical abortion in cases of ectopic pregnancy. So I guess when I say that I would not ever, that is not really the case. Elective abortions I have a hard time with, personally. I do not begrudge any woman the right to have one, however. Thanks for the link! That woman sounds like an awful human being.

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      • I feel like we have similar stances. I agree that there is, to me, a difference in providing a “medically necessary” TA than an elective one. And, it is all morality because, as you suggest, a script for medical TA is exactly the same for necessary vs. elective, as is the the D&C for 1st trimester necessary, elective, or missed abortions.

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  23. Great topic. I agree with comments here. I am pro choice but was very careful to make sure I never had to make such a heart wrenching decision with an unwanted pregnancy. I am appauled at the level of suffering some women are put through regarding personal choice. Humans have created their own moral dilemma. I am a biologist and have observed that while wild animals will fight to try to save their young, when circumstances become too dire through situations such as flood, draught, famine, etc. they do not hesitate to sacrifice their young in order for the parent to survive for another reproductive cycle. The kangaroo for instance, can go into diapause with an embryo during times of drought and will activate development again when conditions improve. At such rough times the pouched joey may be pulled out and left to die. It sounds cruel – we would label it as murder, but in the longterm “survival of the fittest” this makes sense. So my point is, for humans to put the life of a non-viable fetus ahead of the mothers does not make sense to me especially if the mother’s life us in danger. I will also say a bit off topic, that nothing pissed me off more than when the insurance companies would cover Viagra but not birth control. What utter nonsense. Thank goodness birth control has wider coverage now. “Slowly stepping off soapbox”.

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    • I am not sure Viagra is covered. Most of my male patients don’t fill their Rxs because of the prohibitive cost. They DO, however, pay for vacuum pump devices and some other treatments for ED and so you have a very valid point. I still have women who do not have birth control coverage and yes, that pisses me off, too. Cover for the expensive pregnancy and then cover the expensive dependent child, but don’t cover the cost of comperably cheap birth control? Makes no sense. Your tidbit about kangaroos was fascinating.

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    • How different would human gender politics be if we could go into diapause and/or terminate pregnancies on command without medical intervention?! Talk about a game-changer!

      I’ve often thought marsupials have the right idea with the whole birthing teensy babies to finish gestation in a pouch thing. Such a better system than what we have (and convenient! How cool would it be to have a pouch?).

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  24. Personally, I feel about birth control the same way I feel about abortion: Whether or not you, I or anyone feels they are “ethical”, they ARE necessary. If birth control is not available, women WILL get pregnant, and then even more women will require abortions. If Abortions are not available in a sterile, medical environment, they will get them at a “do it yourself” back alley “clinic.” My grandma told me back in her teenage years (the 1930s), women would drink kerosene and castor oil to terminate a pregnancy! An aborted child is an unwanted child. If the woman carrying said child admittedly does not want it, are they going to be as likely to practice good prenatal care? If not, are prospective adoptive parents likely to want to adopt a child born with severe physical and mental handicaps or addicted to drugs or alcohol? Furthermore, is the same society that prevented that mother from obtaining birth control then also partially responsible for the same mother abusing her unwanted child? I think it is the medical center’s duty to provide such options as birth control, and the moral consequences are between the patient and God. (That said, and now that I’ve stepped down from my soapbox, I can totally see why you would not want to perform an abortion, and frankly I wouldn’t want to, either.) One more thing, how is it logical that one doctor who doesn’t believe in writing scripts for birth control feels fine to refer his patients to someone else to write them the same script? I don’t believe it is moral to take illegal narcotics. So not only will I not deal them, but I also won’t refer a friend to another friend where they can obtain them. Just saying. πŸ™‚

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  25. I think I’m going to make enemies on both sides here, but you asked for my opinion so here goes. I’m a firm and longtime believer in God, and the Bible. I study, and I study, and I study some more. I just can’t find it clearly stated anywhere, and I can’t bring myself to believe, that the God I trust in would ever deny a medical procedure to one of his children who was in honest and sincere need of it. So first of all, anytime one of these procedures can be shown to be necessary for the health of the person involved, whether that be physical or emotional health, I’m going to side with the procedure. But I would continue to hope that there would always be great thought put into these acts before any action is taken. The argument that a woman should be entitled to abortion services because it’s her body can only go so far, like in the case of her physical or emotional safety which I’ve already said. But just as she has a right to determine what happens with her body, she also has a right to learn about safe sexual practices and adult responsibility, and I think morality and ethics demand that she exercise those rights also. And the man should not be exempt either, birth control works both ways. So basically I guess I’m just saying that I would hope these things never lose their weight, their significance if you will, and that they never be entered into without due consideration. With all that said, I don’t believe the Church is in any position to be deciding whether a person who is going to be practicing medicine for a living should or should not have access to full and complete training. If they want to make those kind of decisions, then they had better get themselves out there to the universities and start gathering up the required Phd’s to prove to me that they’re capable of making decisions of that nature, because to tell you the truth, even as a Christian of over 45 years, its been more than 20 since I’ve let the Church be responsible for my Spiritual welfare, so I really don’t think I’m prepared to let them start taking care of my physical, or emotional, or psychological welfare. So let me see, I think that means my answer is, “No”.

    Liked by 2 people

    • I love your last few sentences here, which kind of highlight my point on morality. It IS flexible. It evolves in people over time. There were things that I considered hard and fast rules in my twenties that I would be ashamed to admit now in my fourties. I don’t think God gave me the right to sit in judgement over other people. At least I don’t want that responsibility because I am a fallable, flawed human being. I have changed my stance from rules to more of a love based approach, personally. Does this action show love? Does it come from a place of love? If yes, then that is probably safe. As you say, the emotional consideration as an allowance for abortion can be broadly interpreted.

      Liked by 1 person

      • I, too, have dropped the Pharisaism with age. You pose some difficult questions but ones neither doctor nor patient can ignore. Each person has to name his, her values, draw boundaries, and identify colleagues and the person on the other side of the exam table who can best work with us. So glad to see you generating such rich discussions. =)

        Diana

        Liked by 1 person

  26. Ooooh that’s a tricky one. I think that it is perfectly acceptable for a GP to have their own moral views on abortion and birth control. However, if a patient required these services then, in my opinion, the GP should be able to point them in the direction of someone who would be able to help them, without judgement. There are so many ifs and buts though. Is there a difference between say, performing an abortion at 12 weeks or 26 weeks, especially if it was an elective one? That seems to be more of an ethical dilemma. I know nurses can refuse to look after women who have had abortions if they have a moral objection to it. What about treating/looking after a person who you know is a paedophile, rapist or murderer? In the medical profession, it is expected that of course everyone is treated the same, but we are all human. with our own morals. It is still a tricky one to answer!

    Liked by 1 person

  27. I was a surrogate mother for my sister. During those nine months, I experienced first-hand those that saw it as unethical and immoral (God doesn’t want her to have children, who are you to go against his will?) and those that saw it as miraculous. We chose to go with the miracle.

    Liked by 3 people

    • You are amazing! I would have a hard time doing that, and not because I think it is unethical. The physical toll alone would be enough to selfishly give me pause. I find it interesting that people would question you in the midst of the pregancy itself. The horse has already left the barn, people. They would probably be the ones who would be against termination… in other situations. You are my hero in another way now. Wow.

      Liked by 2 people

      • “I find it interesting that people would question you in the midst of the pregnancy itself.”

        Oh I’m not surprised at all – remember these are generally the same people that are up in arms about what a horrible thing single parenthood is and how people shouldn’t ever have kids outside of marriage … but they are also against abortion. Completely (intentionally?) oblivious, of course, to the fact that if you shame single, pregnant women, you’re going to get more abortions.

        Liked by 1 person

  28. As a physician, I think that you have to do what is right within your beliefs. Any other route would bother you forever. You have the distinct responsibility to practice medicine within your code of honor, which can be a very difficult call. Kudos to your commitment to the patient.

    Liked by 2 people

  29. It is complicated. I used to train young GP’s- Family Practitioners., In the UK, we provide most contraceptions. I had some trainees who had a problem in prescribing certain types of contraception or refer for termination of pregnancy because of religious reasons. Talking about it, I said ” Yes, that is OK, but you must provide a non judgemental advice telling them where to go instead. ANd you must make sure you do not make them feel guilty or worthless , It is not about you, it is about them. You can say you are sorry you do not do this, but they can go to Dr…., and you will arrange it. Even then, it was complicated., In the end, we put a notice in the waiting room:
    Unplanned pregnancy or complicated Family Planning problem? You can see the following doctors…”
    It gave patients a choice.

    Liked by 3 people

  30. That is a very tough and very huge question… I don’t know the answer but I’d lean towards saying that morality of this nature should not be part of medicine. I think introducing morality, subjective as it is, could lead to a large box of problems down the road, conflicts with people who have other beliefs, etc… it’s the body you’re trying to fix, I guess, rather than the soul.

    Liked by 1 person

  31. I actually had a related instance a few weeks ago at the pharmacy while working, one of my coworkers walked by and practically all the Plan B’s fell off the shelf when she walked past them. She then proclaimed how they are “haunting her” (shes a conservative Christian I guess?) and did not care to pick them up off the ground! Of course since I had to go pick them up we had a long conversation that turned into a discussion about how she basically disproves of everyone that comes to get any type of birth control medication/device! How can you be in healthcare and have a narrow mentality like that? Regardless who walks in they have their own decisions and life to fulfill and more power to them for making a choice than being guilted into a situation they dont want… It’s shocking that people aren’t as open minded you would think them to be in the year 2015.

    Liked by 1 person

    • Agreed. Most of those people don’t care to become informed. I can say that because I used to be one of them. Then one day I delivered the baby of a twelve year old girl and saw cases of rape and incest and all of the sudden the world was no longer black and white. It wasn’t even shades of gray. It was red. The world was red.

      Liked by 1 person

  32. The availability of contraception is something everybody needs to consider not just from a moral or ethical point of view but also from a practical one as well. When I say practical, I guess I’m talking about something of a reality check. My kids are about to turn 11 and 9 and my son will start high school next year. Whether I want to know about it or not, there will be kids in his year when he starts high school who will be having sex and doing drugs too for that matter. Our family goes to Church and has our faith and we do things like skiing and sailing together. I cook with my kids. This is a good start but there is still free will. There is still, as there always has been, the thrill of the moment which can lead even the most moral and Christian of characters astray. World leaders have been lured into sex outside marriage so what makes people think some teenage kid is going to have the willpower when more mature members of our community don’t?
    My approach with my son, which I’m going to start putting in motion now, is to start explaining to him about the cost of child support. If you muck around and get caught out, that’s going to cost. My son is better at maths than understanding a lot of what he might see as “mumbo jumbo”. He currently think $50.00 is a lot of money so this will get him by the short and curlies.
    My daughter is going to be more difficult. I am currently trying talk to her about appropriate dressing, which at her age, really is the tip of a very big iceberg. She’s pretty, skinny and popular enough. While 9 sounds dreadfully young to be talking about boys, the last 6 years have gone very quickly with my son and while I start thinking about preparations for high school, it only seems like yesterday that he started school xx Rowena

    Liked by 2 people

  33. Pingback: My Article Read (1-11-2015) | My Daily Musing

  34. I think it is fine for a physician to say for his or her moral belief they can not do this procedure but will refer the person to another qualified doctor that will perform the procedure. There is no reason for that person to feel they are being judged. Everyone is entitled to their personal belief’s. Just because one is in the medical field they should not have to do anything that goes against that. Perfectly acceptable.

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  35. “At any rate, what role does morality have in medicine?”

    I know I’m a bit late to the comment party but this is a really big topic and I wanted to make sure I thought about it first.

    My answer is that morality absolutely has a role – ESPECIALLY in science and medicine. The scientific process itself is morally neutral – we perform experiments, we get data, we use data. So far so good. It’s morality and ethics that help us decide what types of experiments are acceptable and which are out-of-bounds.

    The Nazis technically performed good science – they did experiments, they got data, and they used data. But I don’t think it’s a stretch to say that with our ethical understanding, what they did was WAY unacceptable. And that’s where ethics comes in – nothing in science itself tells us that Nazi experiments were unethical; it’s ethical principles that do that.

    Morality and ethics apply to medicine for the same reasons – they guide us to help determine what is acceptable and what is not.

    I agree with previous posters that a doctor’s / clinic’s / hospital’s ethical boundaries should be easy to see for any prospective patients.

    “If your own morality can be influenced so much by family, friends, religion, politics, etc., can it even be trusted?”

    That’s a great question – I think everyone has a responsibility to examine what they think and believe and understand WHY they think and believe certain ways. What ethical principles do I think are true and immovable? Why? What is the logical extension of those principles? And of course – how do they apply to the very messy, morally gray world we live in?

    I’ll be honest, the only REAL medical ethical issues I understand are sanctity of life issues. I know from a Catholic perspective there are theology of the body issues with birth control and other things, but like other people have pointed out, virtually every form of birth control has legitimate medical uses OUTSIDE of the contraceptive purpose. So I have a hard time picturing a good doctor who, even though they might object to birth control personally on theology of the body grounds, would: 1) never EVER prescribe birth control for ANY reason; 2) deny a patient birth control even for the contraceptive purpose. It’s not like there’s a life-or-death issue (to the best of my understanding).

    With regard to birth control / Plan B especially, facts are important. It was drilled into me growing up that birth control pills, IUD’s, and the like are all abortifacients. Which, if you believe that life begins at conception, is a really scary thought. It’s not good enough to just say, “Well I believe it ends a life and you don’t, so let’s just agree to disagree and both continue on our merry way.” No – facts matter, and facts that impact the sanctity of life debate need to be found, verified, and accepted, because they are (literally) matters of life and death. From what I’ve read, supposedly even Plan B doesn’t impact implantation – supposedly it will emergency-stop ovulation but it won’t be effective for anything beyond that. Supposedly, all the FDA-required labeling about how all the different forms of birth control COULD impact implantation is pure speculation based on the best knowledge at the time on the interaction of all the hormones. I’ll admit that I would like to believe that, so for now I will because I lack the medical expertise to independently verify or refute any of that.

    TL/DR: We absolutely need morality and ethics in medicine, and science as well. We should do our best not to shy away from differences of opinion, especially in sanctity of life issues, because we NEED to continue to try to work them out. Ideally we will get to a point where we can all agree on some basic ethics, but I’m not holding my breath.

    Liked by 1 person

    • Thank you so, so much for spending time thinking about this tooic and contributing your comments! I agree that morals/ethics are crucial to medicine but the recognition that my morals are not yours is critical, as it approaching those differences with respect and humility. There are physicians who refuse to prescribe birth control for any reason, even those that do not involve contraception.

      Liked by 1 person

  36. Very thoughtful and humane blog. There are so many facets to this and some are misogynistic without intent(for the most part). I read where one female OB/GYN was horrific in her bedside manner. To the point that I would actively dissuade women from even entering her lair. She to me, is a traitor to women and the sovereignty of women’s choice. Just my opinion.

    Liked by 1 person

      • Amen sister. A bit about me. I saw my mother horribly mistreated and my dad threatened to kill her when I was five years old. The next thing I know is wandering in our village in Fairbanks, AK crying and not finding our home until a neighbor helped out. I am haunted to this day and the pain for my mom’s ordeal and the pain of suffering women gives me heart to help and not be just a complainer. :Life is too short for dealing with misogynists and misanthropic men.

        Liked by 1 person

  37. A very thoughtful post! I have never had an abortion and took great care only to get pregnant when I was ready to. But I will defend a woman’s right to an abortion to the very last. It’s not the government’s or the church’s place to decide whether a woman should have to carry a pregnancy to term, whether it’s the result of a mistake or a criminal act, such as rape. And if a pharmacist is going to refuse to prescribe birth control or a morning after pill, he/she should get another job that she/he can perform in good conscience.

    Liked by 1 person

  38. Should we ask soldiers in a war zone to make a moral choice each time before they pull the trigger? Or the bus driver whether he’s going to stop to pick up black passengers? Or the teacher whether she feel happy teaching Jewish kids? No. Why should doctors be able to get out of doing their job of healing the sick and relieving distress because there are some things their priest wouldn’t approve of? We have elected representatives to make the laws. If we don’t like a law we have to protest, and if we form a majority the law will be changed. Doctors, in my opinion, shouldn’t be in the position of picking and choosing which of the legally available recourses they will perform, for the extremely spurious reason that it’s against their religious beliefs.

    Liked by 1 person

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