Emergency Contraception
Should physicians have the right to refuse to prescribe it? Should pharmacists have the right to refuse to fill it?
I say yes, under general principles (although I have personally never refused such a request).
#1 Dinosaur says no. Read the comments for a great discussion.
What say you?
(Of course, since Plan B is OTC now, the discussion is moot. But I still think it's an interesting topic nonetheless)
I say yes, under general principles (although I have personally never refused such a request).
#1 Dinosaur says no. Read the comments for a great discussion.
What say you?
(Of course, since Plan B is OTC now, the discussion is moot. But I still think it's an interesting topic nonetheless)
posted by scalpel at 3:28 PM
18 Comments:
Scalpel, I agree that it's an interesting subject.
My personal opinion is that individuals should be allowed to follow their conscience, no matter what profession they're in.
It's my opinion that you have a responsibility to remain faithful to your own beliefs, primarily, and that what you do for a living, even when it's a "calling" like medicine, comes afterward.
You will either be a tool in the hands of your profession, or it will be a tool in your own. I would prefer to deal with a physician who's true to his/her own beliefs, even if I don't agree with those beliefs, or am inconvenienced by them.
Also - I don't agree with Dr. Dino that refusing to provide certain treatments makes you useless to medicine. That's like saying that those single issues are the foundations for the entire profession, and that if you're not willing to compromise yourself, you're a bad doctor.
I like Dr. Dino, but I feel that this is a very narrow way of seeing things.
Simply, I think that if your beliefs prevent you from being able to be the best doctor for your patients...
...you should not be a doctor.
Part of being a professional is putting your patients' interests first, and acting in their interest rather than your own.
I vote with Dino in this case. As a patient, I'm seeking medical treatment. Is it necessary for me to ask my docs' religious and philosophical beliefs before I go to them? Or am I destined to find out after it's too late and I've paid for the visit and now must track down another doctor? What about my neighborhood pharmacist? Do I have to interview him as well? Oh, but wait, I'm not allowed to ask those things.
I agree that people should be allowed to follow their consciences, but where does one draw the line in the medical field? Does the doc who's a Jehova Witness have the right to throw his arms up and say, "Sorry, you want a blood transfusion, get someone else."?
If I need a doc, I have a reasonable expecatation they'll be there for me. My seeing them shouldn't turn into a religious debate, because I really don't care. If docs and pharmacies want to pick and choose what standards of care they're going to provide, they need to put it in their advertising and let the public know beforehand that they're not full service people.
We recently had a woman from a very religious (Protestant) background who bled to death after a botched home-abortion attempt.
Your rights begin where my body ends. If anti-BC folks (and I'm sorry, but you've really got to be a moron if you think that BC "ends a life") want to picket pharmacies, hand out literature, start groups to help out pregnant mothers...that's fine. If my pharmacist wants to give me my BC pills *and* hand me a pamphlet on how I'm killing mah 9238723289 sperm babies, that's fine.
And yes, I've lived in places where if the pharmacist decided to not fill BC scripts, I would have to drive quite a way to get my script filled.
Not that it matters much, anyway. We're slowly eating away at Roe v. Wade.
I think it would be okay for a doc to refuse to give Plan B (if it wasn't OTC) or any other reasonable approved treatment for religious reasons if there was another doctor readily available who could. That doc should make his or her position known clearly to the rest of the group when he or she starts the job or when he or she decides they won't give the pill.
It gets a little more iffy morally if the doc is in private practice because the patient would have to undergo an unnecessary 2nd doctor's visit, perhaps making the Plan B ineffective due to the lag time between visits.
For pharmacists, I think they should be able to stock whatever drugs they want because it's a private business.
My 2 cents: Although I am not a "morning after"usher, or an abortion advocate personally, I think that a Pharmacist/MD has a right to refuse if it interferes with their personal or religous choices. I know I personally could never bring my self to assist with an abortion-even though I do object to other women having them. If giving this made them feel this was, they should not have to do it. Now for the patient, I do think this information should be OPENLY posted for thier patients to know ahead of time-possbilby in their office, or when the HIPPA form is signed.
If drs and pharmacists allow their personal beliefs then they don't need to be drs and pharmacist. They should have their PATIENT's best interest at heart. With the refusal to prescribe the pill or contraception, they only have THEIR best interest at heart. If they choose to practice medicine then they need to make it clear to EVERY patient before they are seen what their beliefs are so that the patient can make arrangements to have THEIR medical needs met and not have their time or money wasted.
P.S. I like the Jehovah's Witness and blood transfusion example.
The official policy of the American College of Emergency Physicians states that:
"A victim of sexual assault should be offered prophylaxis for pregnancy and for sexually transmitted diseases, subject to informed consent and consistent with current treatment guidelines. Physicians and allied health practitioners who find this practice morally objectionable or who practice at hospitals that prohibit prophylaxis or contraception should offer to refer victims of sexual assault to another provider who can provide these services in a timely fashion."
So a referral to Walgreens would be appropriate, I assume, now that Plan B is OTC. Individual physicians are not obligated to provide emergency contraception directly, though I personally support such intervention.
(cross posted at Dino's)
As a sleep specialist, this issue does not affect me personally.
I agree with the posters who stated that doctors should act in their patient's best interest. However, what patients request is not always in their best interest. Many doctors feel that they are acting in their patients' best interest when they follow their conscience.
Good point about acting in the patient's best interest not always equaling doing what they want.
For my part, as someone who has only ever been a patient...
I think it's rather disingenuous to demand the choice to take this drug (or regular birth control pills) and then wish to deny choice to the prescribing doctor/dispensing pharmacist.
I also know that when, God willing, I get through nursing school I'll be seeking employment specifically in a Christian hospital, in hopes that I won't be called upon to do anything I'd find morally objectionable.
As a physician, I would not perform an abortion. I have and do provide "morning after pills". I see a difference and that is all that matters to me.
Should someone consult me that wishes an abortion, I will point them out to someone that will do the procedure.
That is my obligation as a physician, IMHO, as it is to send someone to a surgeon for a problem that I cannot resolve.
I was typing and sleping at the same time when I posted last time..this is the way it was supposed to read...(sorry for the error)...
My 2 cents: Although I am not a "morning after" pusher, or an abortion advocate personally, I think that although abortion is in my eyes soley a womans choice, I feel a Pharmacist/MD has a right to refuse if it interferes with their personal or religous choices.
I know I could never bring my self to assist with an abortion-even though I do not object to other women having them. If giving this medication to a patient makes them feel the same way, they should not have to do it.
Now for the patient, I do think this information should be OPENLY posted for thier patients to know ahead of time-possbilby in their office, or when the HIPPA form is signed. I do think a referral to a participating provider is apropriate as well.
When I went to nursing school, we were taught to put aside our own personal issues of all kinds in order to best help our patient meet their needs. Had a bad day? Keep it quiet. Dog died? Put your head down and immerse yourself in the patient. Don't believe in abortion. Keep your opinions to yourself and do your job.
I realize this is not always practical and that we do not live our lives or do our job by consulting a text book, but it seems to me that respecting another person's needs is not only our priority but itis kinda our duty while we are performing as paid professionals.
Just my 2 bits.
The interesting part of this question, for me, is whether or not it's actually possible to force someone to give treatment or medication against their moral beliefs. We're not talking about a situation where you have a gun to your head.
If you truly hold that value inviolable why agree to work in a facility where those medications and treatments are dispensed, by your hand or another? Are you less complicit if you refuse to touch the drug or procedure but your paycheck is still funded by them?
For my 2 cents, ample mechanisms already exist by which you can refuse to do something you find objectionable.
I agree with what "er doctor" said... your personal beliefs should not stop you from doing what is best for the patients you are caring for.
Interesting thought "Michael Rack, MD" about doctors acting in their patients best interest, but what happens when the patients request is not always in their best interest. This can become a gray area, and who makes the decision now? Where does the doctor's best interest stop and the patient's right to choice regarding their health begin? Whether their choice is "right or wrong"....
Once you start denying care for non-medical reasons, you've destroyed the bond of trust between doctor and patient.
Speaking as a patient, I rely on you to provide care or if you're unable or unwilling, to ensure that care is provided. I rely on your employer to ensure I receive care. I rely on licensing boards and regulators to ensure that care is provided and that you and your employer be sanctioned if you are negligent in your provision of care.
We all have choices to make in life and while I don't want to force people to be bound by my personal or religious beliefs in a professional setting, likewise I don't want my medical care held hostage by the non-medical beliefs of my putative provider.
Frankly, if your job may involve activities you find so morally objectionable that you can't perform them, perhaps you need to reevaluate your career and choose a path more amenable to your character and beliefs, rather than risking someone else's health and the trust placed in your profession.
In a previous career, I did radiological and accident analysis at a nuclear plant; acute & long-term offsite dose calculations, estimating releases of radioiodine from accidents, etc. Like you, I was responsible for the health and safety of the public, often times under the pressures of time and circumstance. If I had decided not to perform my job, my professional duty, because of my strongly-held beliefs, I have no doubt I would've been terminated, and I would not be surprised if I would have faced legal consequences, civil penalties or criminal charges.
You can question whether the comparison between engineering and medicine is valid and whether the moral quandries faced by a personal physician are comparable to those faced by an impersonal analyst. In turn, I have to ask why should you as a professional be allowed the privilege of avoiding what you consider morally reprehensible work and I as a professional may not?
As a patient, I certainly hope you will be upfront about your beliefs if they are going to affect my medical care. When I am choosing my family doctor, I want to know that you are limiting my choices.
However, there are two areas where I see even this being problematic.
First, my health insurance determines which doctor I see. If I am in the very stressful situation of having a limited choice of doctors and a very narrow-minded insurance provider, I would argue my choices are severely constrained. Fine, I may be able to afford to pay for certain treatments out of pocket -- do you think the bus driver or convenience store worker is in the same situation?
Second, when I am faced with an emergency and I don't have a choice, your beliefs have to take a back seat. We aren't talking about a mere inconvenience here.
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