astra_nomer | (no subject)

The last couple mornings, I got in the car and heard these reports about ethics guidelines for ob/gyns, being put forth by the American College of Obstetricians and Gynecologists. Getting angry first thing in the morning isn't really a pleasant way to start your day.

From yesterday's report:

The guidelines require physicians to make referrals for abortions or other procedures they don't wish to perform themselves. But there is still confusion over whether a doctor would actually lose his or her certification as a specialist for refusing to make a referral.

At issue is an opinion released in November by the ACOG ethics committee. Among other things, it says physicians "have the duty to refer patients in a timely manner to other providers if they do not feel they can in conscience provide the standard reproductive services that patients request."

And from today's:

Obstetrican-gynecologists who don't want to perform or refer for abortions are not at risk of losing their board certification after all.

...

Pro-life Ob/Gyns complained that that would require them to make abortion referrals, something they morally opposed. And in his letter, Leavitt said that could violate federal laws protecting health workers' conscience rights.

"Pro-life Ob/Gyn" sounds like some kind of oxymoron. I gotta say, if you're going to be an ob/gyn, you have an ethical obligation to provide the full range of reproductive services, from pap smears and baby delivery to birth control prescriptions and abortions. If you have a problem with that, become an orthopedist or something. You're a doctor, you're supposed to treat your patient, not preach at her for what you perceive as her moral failings.

Next we'll find that doctors are in their rights not to treat overweight people for diabetes, because gluttony is a sin, too. Bah.

Flat | Top-Level Comments Only

Umm...

Okay, the fact that I want to say "what the hell are these docs missing?" makes me wonder if it's something I'm missing on my end.

But I sure can't figure out what that is...

Let me know when you figure it out, because I seem to be missing the same thing...

I don't think the pro-life ob-gyn example is parallel to the diabetes/overweight people example. The pro-life ob-gyns believe -- whether you believe it or not -- that abortion is murder, and therefore that they, by providing referrals, would be accomplices to murder. Not that (or not just that) their patients are doing something wrong, but that they themselves are complicit in sin. That's completely different from the overweight/diabetes example, in which the doctor is not expected to aid in murder, or otherwise personally commit some sort of heinous act.

You may not believe abortion is murder. I don't believe abortion is murder. And yeah, operating from that perspective it's a simple matter of health care access and differences of opinion. But I don't think it's productive to analyze these doctors' actions as if they're seeing things from your perspective, and I don't think a useful path to a solution lies in condemning them for wanting to avoid something that is, from their perspective, a grave and uncrossable line.

I still stand by my statement that unless you are willing to let women make their own decisions about their reproductive health, you should not be in the business of taking care of reproductive health. There are plenty of other branches of medicine to pursue that won't raise this moral dilemma.

Also, I think there are very few people who believe that abortion is murder and also believe that women full human beings, up to and including having active sex lives.

I do think there's a big difference between not doing something and refusing to refer. The latter, because of the way health insurance works, ends up meaning "I prevent your health care from paying for your treatment."

But it does seem kind of plausible that someone could be an ObGyn that does pap smears and diagnoses and takes ultrasounds, but doesn't do abortions or caesareans because they didn't specialize in surgery, or doesn't perform IVF because that requires a specialized lab.

So maybe not an ethical obligation to *provide* the full range of services, but an ethical obligation to allow and enable your patients to receive the full range of services that they need.

The thing is, if you're an ob/gyn and doing pre-natal care for pregnant women, you are going to be performing D&Cs on a regular basis anyway. There are enough instances where pregnancies go horribly awry that you need to be able to perform that operation. As it turns out, a D&C is exactly what a first trimester abortion is. So there the physician is making a personal judgement call about whom to provide this particular service for.

Also, my interpretation of "refer" in this context is more broad, as in suggesting the name of another physician to see. (I think generally speaking, women can see an ob/gyn without referrals.) So if you're refusing to refer, you are explicitly denying access to the care being sought.

(I'm kind of hoping that

capsicumanuum will chime in about her experience, but I think she's given up the internet for Lent [/tongue-in-cheek].)

Caesareans rose to prominence in part because they are easier to teach than a forceps delivery. Seems counterintuitive -- major surgery, easy?!? -- and of course the best case for forceps is much better than a c-section, but the worst case for forceps is pretty bad and apparently fairly common. And it's hard to see in advance who's going to be good with forceps (it's one of those art things where you have the touch or you don't), whereas I guess any random monkey in med school can learn to do c-sections.

Add to that that one of the things driving the high c-section rate in this country is liability concerns; people see themselves as more liability-proof in the event of a bad outcome if they did the c-section, because that way they can say they were doing everything they could.

And add to that that sometimes you actually need to.

I can absolutely see not having the equipment on hand to do one -- as I hazily recall rather a lot of equipment was involved -- but I can't see someone in that specialty not knowing how.