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Should Medical Providers be allowed to refuse treatment?

Discussion in 'Fred's House of Pancakes' started by Wildkow, Aug 4, 2007.

?
  1. Yes

    17.4%
  2. No

    65.2%
  3. Ethical only

    0 vote(s)
    0.0%
  4. Religious only.

    0 vote(s)
    0.0%
  5. Requires BOTH ethical and religious.

    8.7%
  6. I don't know.

    8.7%
  1. Wildkow

    Wildkow New Member

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    I have heard about some doctors refusing to administer Viagra based upon religious grounds. To me that sounds heretical and sacrilegious considering that we were told to go forth and multiply! :D :p :rolleyes:

    Wildkow
     
  2. huskers

    huskers Senior Member

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    If you are a doctor, pharmacist, nurse, whatever...you made that career choice. People needing medications/treatment should be able to count on getting it. If I had a restaurant and you came in and ordered a steak...what would you think if I came out and said you can't eat meat today...it is a Friday during lent. You say I'm not Catholic. I say so what. (I know...bad example but you can see how this can get out of hand). ;)
     
  3. airportkid

    airportkid Will Fly For Food

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    Kow, what was it you were saying about people's personal beliefs being harmless, uninterfering --- ??? Looks like one hell of an interference to me.

    How many children are denied (I know it's illegal but it still happens) medical treatment because of their parents' religious beliefs?

    That the issue of a physician deliberately WITHHOLDING therapy on IRRATIONAL (religious) grounds even raises to the level of a serious question is frightening enough, let alone that it probably actually occurs.

    Mark Baird
    Alameda CA
     
  4. galaxee

    galaxee mostly benevolent

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    i've already read plenty of stories of pharmacists refusing to dispense oral contraceptive prescriptions based on religious grounds. you know how pissed off i would be if i went to fill my rx and someone essentially told me how to live my life? it would be UGLY.

    i say if you've entered the field you know what the capabilities of medical technology can and will be as science progresses in our understanding of how the body works in such intimate detail. if you don't want to deal with a certain aspect of medicine, find a specialty that has nothing to do with that. but no specialty will ever be free of controversy...
     
  5. Neicy

    Neicy Member

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    This question has no blanket answer. I researched ethical dilemmas in nursing practice for a senior term paper some years ago. I came up with as many questions as answers. Do I particpate in an abortion if I personally believe it's killing even though it is legal? Maybe - is the mother's life in danger? Do I choose to work somewhere else? Yes. Do I assist in inserting a feeding tube when the person is dying of Alziemers anyway but the spouse insists? Personally I don't agree, but do I have the right to impose my beliefs on someone else? Or do I not partipate in that one either? How about the newborn that is born lacking a brain? The mother chose not to abort on religious grounds. Where does the line fall between what is "comfort measures" and what is "administering treatment"? You can put the breathing tube in to make breathing easier, but to remove it later causes death. I don't think there is one answer to cover all circumstances, which is why hospitals have ethical committees. I certainly can't answer for anyone but myself. We must all make our wishes known, and hope that they are respected in the end.
     
  6. EricGo

    EricGo New Member

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    In private practice, medicine is a tort contract. Both parties have to agree. In my state if a physician does not want a patient, the medical ethics board requires that assistance be given to find someone else, and treatment proffered for 30 days if requested.

    Discrimination based on sex, age, ethnicity, or religion is illegal.

    I'll be amused to hear what the pharmacists who refused to dispense OCP have to say when they are kicked out of the physician office. Pseudo-christians always have trouble understanding that the sword cuts both ways.
     
  7. efusco

    efusco Moderator Emeritus
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    Whoa boy...
    No doctor should be forced to do/prescribe anything if it falls outside his moral/ethical/religious values and he/she is uncomfortable doing so. That should be the presumption we start with. NOONE, no matter their profession, should be forced to do something unethical, immoral, or against their strong religious beliefs.

    Now, there must be exceptions. In a case of life and death, when there are no available providers otherwise able to provide the requested services, and other emergency situations where no other reasonable means can be found.

    Using the Viagra example...first I don't know of any ethical or religious reason it couldn't be prescribed (care to share your story with us Kow? ;-) ), but if there was one this is a completely elective medication that serves no critical medical roll...it's akin to a nose job. There are medical risks with it being prescribed/used and it's well within the physician's judgement whether to prescribe or not. There are a dozen physician's per block and a million internet resources to obtain that medication from and there is no reason to force any physician to violate his/her own personal ethics/values/religion just to provide it.

    Where things get sticky are with issues like emergency contraception/abortifacents. I think the majority of us prescribe. The hospital I work for is Catholic and allows its prescription only in cases of alleged sexual assault. Personally I think that those are situations where one should swallow one's values for the sake of the concerned individual. There is no 'life' that's being ended, most of the time conception hasn't even occured. And if it has you're no further along than 8-16 undifferentiated cells. Time is critical and obtaining a physician appointment can be difficult and could cause delays beyond the time where such meds can be safely used...once that passes you're forcing the woman to decide on continuing the possible pregnancy or having a true abortion of an otherwise viable fetus. I feel that pharmacists should be equally conscious of these facts and have an equal responsibility to 'do the right thing'...if there are other pharmacists in the group that are willing then they should be called in, if there are other pharmacies available they should be refered there. If none of the above then the pharmacist should fill the script...I think the situation could be defined an emergency due to the time factor and circumstances.

    I haven't answered the poll b/c I don't think the available answers convey my point of view on this.
     
  8. galaxee

    galaxee mostly benevolent

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    i'm glad a couple of doctors have chimed in here- obviously they're the ones steeped in the business of medical care day in and day out, and the rest of us have experience with medicine only indirectly, whether as patients or otherwise.

    however, saying that nobody should ever have to do things they object to in their work is pretty idealistic IMO, evan. i don't relish in the least chopping the head off a lab rat, and neither do any of my co-workers. we kinda have to, to work in this field.

    i suppose this is mostly an issue with physicians who deal with all types of patients and conditions. in the last year or so we've seen the highly specialized side of medicine- spine orthopedists, neurologists, pain management, etc. my view is that there are tons of specialties out there. just as, if i was ethically/morally/religiously prohibited from animal research i could find another area of research to participate in, i feel that an MD could find work to do where s/he is not presented with these types of conflicts in their daily job. yes, they would have to do more training and start over building rapport in their field. as would i, most likely. but if you find you've made a choice that presents yourself with a lot of moral dilemmas, it may be time to reconsider why you do what you do...
     
  9. Godiva

    Godiva AmeriKan Citizen

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    No one is asking Doctors or Pharmacists to break the law.

    I should think that anyone that had problems regarding their personal ethics, morals and/or religion would be aware of the common practices of the medical profession and if they had a problem with that would seek other employment.

    Contraception is a common prescription and perfectly legal. If a pharmacist has a problem filling that prescription, maybe they shouldn't be a pharmacist.

    When I go to a vegetarian restaurant I don't expect them to serve me a steak. But when I go to a regular restaurant and order a steak, I expect it to be served. If the waiter is a vegetarian and has a moral, ethical and/or religious reason for not serving steak...then he shouldn't be working there. It's not like he didn't know the menu when he applied for the job.
     
  10. efusco

    efusco Moderator Emeritus
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    <div class='quotetop'>QUOTE(galaxee @ Aug 4 2007, 09:15 PM) [snapback]490719[/snapback]</div>
    I didn't say that, but there are few if any other professions where one is compelled to do things against their ethics. You do not have to chop the heads off of lab rats, there are other things within the scope of your training that you can do. If one of your professors came to you and told you you had to cut off the heads of still born human fetuses would you do that? Not illegal (let's assume), but I would say well beyond your moral comfort level.

    My comments were longwinded I realize, but I tried to make the point that there are exceptions where I think a responsible physician will/should do the right thing within the scope of his practice even if he objects morally. If it's legal in my state should I be compelled to prescribe a known addictive medication upon the word of the patient that he 'needs' it? No way. I might refer said patient to a collegue who's more versed in the appropriate use of the med and making an accurate diagnosis. If someone comes to me in the ER asking for Viagra should I have to prescribe it? No way, again. I'm going to refer the guy to a Urologist who can make a better informed decision. There are ways around almost all issues and I have the autonomy to make descisions about how I treat my patients. As an ER doc I don't get much choice about whom I treat...and neither do the patients get much choice about who's treating them when they come to the ER...it's a pretty unique situation. But I do not have to prescribe any medication that I don't feel comfortable prescribing for whatever reason except in the case of emergency or life and death. A private practitioner has even more freedom in making those descisions...as do the patients have more freedom in selecting a physician whom they are compatible with. A Muslim woman will not choose a male gynecologist.
    Exactly, a Muslim man is not going to become a gynecologist. A urologist is very unlikely to have any hangups about prescribing Viagra. A GP/FP may have a bit more complicated patient population, but again, if he/she isn't comfortable he/she has the ability to refer a patient elsewhere for whatever needs the patient has. There is absolutely no need to compele him/her to violate their personal ethics.

    Godiva,
    So no Muslim should ever be a physician in the US b/c a patient of the opposite sex might be assigned to them as a patient and then that physician would either be forced to examine, against their religious beliefs, that patient or completely abandon the practice of medicine...to what, work in a 7/11. Becoming a physician does not mean I abandon my autonomy and ethics. I do have a responsibility to my patients and I will fulfill that, but that can be by referal to another physician, offering an alternative treatment, whatever, but it does not mean I have to violate my beliefs and morals vs giving up medicine. Again, excepting an emergency.

    Also, Godiva, extending your example. If a customer comes into a vegetarian restraunt and brings in a slab of steak and demands the chef cook it should he have to? I'm sure you'd say "no". You shouldn't compel someone to do something against their values in that situation.

    In medicine we don't have a tattoo or a sign on the door that says what values we have and what types of 'food' we won't serve. A reasonable doctor that has a come in for a visit to request that Viagra and subsequently tells the patient that he doesn't believe in prescribing it will usually comp/no-charge the visit and offer a referal. The Chef at the restraunt might do the same, point the customer to the steakhouse down the road...the customer gets his steak, the chef maintains his values.
     
  11. burritos

    burritos Senior Member

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    I have fellow colleagues that won't write the morning after pill based on religious principles. Fine with me. It's their choice and though I don't agree with their choice, I respect their right to have that stance. They have no problem referring the patients to me in which I'll readily oblige the patient with plan B. Referring to me, they are actively participating in the chain of events that ends in the same result anyways. So if anything, it's just creating a delay for the patient. If this delay causes the patient to miss the window of opportunity to take the plan B, then the patient might unintentionally get pregnant, which of course more than likely result in medically performed abortion. I wonder if they realize their refusal to write plan b, but willingness to refer to someone who will write plan b does nothing to decrease abortions and increases the likelihood of a medical abortions? And if they do know this, are they fine with it? I won't ask them cause it's not my business how they legally practice medicine.
     
  12. Godiva

    Godiva AmeriKan Citizen

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    <div class='quotetop'>QUOTE(efusco @ Aug 4 2007, 10:25 PM) [snapback]490745[/snapback]</div>
    If a Muslim Physician is so religious he cannot see female patients then he better not become an OB/GYN because he can expect to see women. If he's that religious, I suggest proctology. Or he can try research, but he may have female colleagues or lab assistants. And I doubt they'll be required to wear burkas.

    Again, this muslim physician knows the expectations of his job. If he feels he cannot take female patients due to his religion, he better not take that job. I'm sure there is some medical profession that would allow this devout Muslim to be protected from the female form.

    No, I would not take a steak into a vegetarian restaurant and demand it be cooked and served. I also can't think of any reason I would visit a proctologist.

    And I'm sure the Muslim physician's male receptionist/secretary would tell any female who called to set up an appointment for herself that "the doctor isn't seeing any new patients at this time."

    And he better not expect any money from the government in any form. Religion or not, that's discrimination based on gender.
     
  13. fshagan

    fshagan Senior Member

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    <div class='quotetop'>QUOTE(Neicy @ Aug 4 2007, 05:15 PM) [snapback]490681[/snapback]</div>
    Its nice to see an opinion from someone who has to actually face the issue. In your research, was there any discussion you saw of individuals refusing but making sure the patient was taken care of? An example I'm thinking of has to do with pharmacists, where a company can allow a pharmacist to defer filling a prescription like the morning-after pill to another member of the staff, without the patient even knowing they are doing so. It seems to me that's a good solution in these cases.

    Most people would agree with an emergency abortion to save the mother's life, but a lot of doctors just won't do "regular" abortions; they send their patients off to a clinic that does it, just the way they send their patients who need surgery off to a specialist. Is that a problem for people?
     
  14. zapranoth

    zapranoth New Member

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    This discussion is, practically speaking, a bit of a wank, because these kinds of issues don't arise very often.

    Comes up once in a while. But the actual situations in which a patient comes to *harm* (not inconvenience, but harm) from someone's reluctance to do something.. it just doesn't happen much.

    I refer women to have abortions if they want them. I don't agree with it. But it's not my choice. I don't know how to do an abortion surgically, so the matter is easy -- I just pass the case on. Much better that than having someone do it that I don't know can do it well and safely.

    Most things, though, fall into the realm of my judgement and my practice style. Very, very much of medicine is in this realm. Collectively, practice style becomes the thing called "standard of care."

    But by and large, this thread ascribes more power to harm to doctors than most of us generally would even have the chance to wield, much less the desire to.
     
  15. Spoid

    Spoid New Member

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    <div class='quotetop'>QUOTE(Godiva @ Aug 4 2007, 10:06 PM) [snapback]490773[/snapback]</div>
    If there were something wrong with your poop chute, I would recommend you go to a proctologist. That's what they do.

    There's a big difference between being an owner and an employee of a business. As an owner, you get to decide how your business operates. As an employee, you get to decide to work there or not (assuming everything is legal...) For example, if you are a vegetarian and can't stand the sight of meat, don't work at Sizzler. But if you open up a restaurant, you have the choice of making it vegetarian or not.

    Many doctors and few (growing smaller every day) pharmacists own and run their own business. If they don't want to dispense birth control as part of their business, that should be their right. But if the Dr. or Pharmacist is an employee, then they need to follow company guidelines.

    And nobody should be expecting money from the government, except at tax time.
     
  16. efusco

    efusco Moderator Emeritus
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    <div class='quotetop'>QUOTE(Godiva @ Aug 5 2007, 12:06 AM) [snapback]490773[/snapback]</div>
    The point of the discussion is that if confronted with a request to do something against one's morals/ethics/religions should the provide be compelled to fulfill that request simply because they happen to be a physician.
    Your arguement seems to be that anyone who decides to be a physician should fulfill any such request put to them and if they are not someone able to do so they shouldn't be a physician. What you're asking for here is a world of physicians without ethics or values. Is that really what you want?

    I repeat, physicians are free citizens just like everyone else. We tend to go into practices that fit our personalities. Someone against abortion won't work for an abortion clinic. But if a woman came to an OB/GYN who did not work in an abortion clinic and didn't believe in performing abortions and demanded an abortion then you're argueing that all that physician's civil rights/liberties and freedoms should be thrown down the drain and she/he be compelled to perform the requested procedure.

    Sorry Godiva, you're just flat on the wrong path here. I understand the point you're trying to make, but when when the rubber hits the road of reality it just falls apart. You, and the government do not have the power to force me to prescribe or treat in any way that I feel is unethical...and you should be glad for that.
     
  17. MarinJohn

    MarinJohn Senior Member

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    Wild, do you believe a helicopter rescue worker should be allowed to leave your family stranded on your roof during rising flood waters because he's jewish and you had painted a cross on your roof?

    How would you feel if you were in your Prius and being swept down river during a rainstorm, and that same rescue worker declined to help you because he strongly believes Americans should only drive made-in-America cars?

    Of course YOU don't (nor do I) but to them it's a moral issue, vs. an ILLEGAL issue. In my profession I am often asked to guide persons toward illegalities so they can save wads of money. I don't. I do the best I can for their situation using all legal means.
     
  18. Wildkow

    Wildkow New Member

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    <div class='quotetop'>QUOTE(airportkid @ Aug 4 2007, 04:09 PM) [snapback]490666[/snapback]</div>
    Don't believe I have ever said that but I will stand corrected if you can find an example.

    Wildkow
     
  19. Wildkow

    Wildkow New Member

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    <div class='quotetop'>QUOTE(efusco @ Aug 4 2007, 06:24 PM) [snapback]490702[/snapback]</div>
    LOL! It wasn't me! Honest! :lol:

    http://www.google.com/search?hl=en&saf...iagra+treatment

    BTW, How dare you!

    Wildkow
     
  20. efusco

    efusco Moderator Emeritus
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    <div class='quotetop'>QUOTE(Wildkow @ Aug 5 2007, 11:52 AM) [snapback]490889[/snapback]</div>
    Sure Kow, whatever! ;) Besides, you'd have never respected me if I didn't take the opportunity when it presented itself!