All posts in Ethics

I Morally Object to Your Health Care

Ms. Nicole Arteaga’s story opened our eyes to something that is not infrequent, educating the masses that according to U.S. federal law health care providers have the right to refuse to provide health care if it is against their personal morals. I have encountered pharmacists who would not fill my patients’ prescriptions and I have worked with OB/Gyns who would not prescribe birth control under the protection of this law. There is an OB/Gyn at the University of Utah who will not give contraception to his unmarried patients. Do you think a law allowing pharmacists to refuse to fill Viagra prescriptions would ever come to pass? Yet when it comes to reproductive health care surrounding the uterus and people who have one, this is a perfectly reasonable approach to providing medical care. After all, we’ve been discriminating against women in health care for centuries, why stop now?

The “Church Amendments”(yes, that is their common name) protect health care providers (doctors, nurses, pharmacists, administration, etc) from being discriminated against if they refuse to participate in performing or assisting in performing an abortion or sterilization procedure that would be contrary to their religious beliefs or moral convictions. TL;DR: I can’t be discriminated against for providing sterilization or abortion care, my hospital can’t be denied grants/financial aid if it refuses to train in abortion or sterilization care, and I can’t be fired for not providing abortion or sterilization care if it is against my moral views.

A “Conscientious Objector” is someone who exercises the right to refuse to perform military service based on freedom of thought, conscience or religion. Essentially, someone in a position of lesser power has the right to refuse orders from someone in a position of greater power if the actions asked of them would violate their personal morals. It is clear how this works as applied to the military, however it has been argued that it cannot be applied to the medical field. The health care provider is in the position of greater power, and the patient is at their mercy. Thus, the “conscientious objection” cannot be applied lest it put the patient in danger.

I know what you’re thinking: “But no doctor (or nurse, pharmacist, etc) should be forced to do a procedure he or she is uncomfortable with,” and that is true. However, that statement is subject to underlying issues that have nothing to do with personal morals: training knowledge/skill, medical ethics, and evidence-based medicine. First of all, if I am not trained to do something (like a heart transplant), I am going to object to performing one based on the principle medical ethic “nonmaleficence.” Also, patients come to me all the time requesting procedures that I am uncomfortable performing because to perform them is not standard medical care as guided by evidence-based medicine. Just because someone “wants a hysterectomy” does not obligate me to provide one: a less invasive and safer procedure may result in the same outcome (eg, placing an IUD) and the patient must be informed of all options and risks (AKA informed consent). If I counsel someone that an IUD would be more appropriate than a hysterectomy, and I refuse to perform the hysterectomy, it is not due to personal beliefs or religious morals: it is because it goes against nonmaleficence and it may not be standard of care. I have training and knowledge that my patients do not have, and it is my job to inform them of all options and the risks involved with each. If they insist on a procedure that violates medical ethics and standard of care, I am then obligated to refer them to another physician.

Full disclosure: I conscientiously object to performing circumcisions. More accurately stated, I do not perform circumcisions due to lack of medical necessity and inability to obtain patient consent. My personal beliefs are not exercised in this decision. Instead, I utilize guidance from the core medical ethical principles and do not perform circumcision procedures.

I am morally opposed to smoking, but I would never refuse to treat someone for lung cancer because of my personal beliefs. If you are morally opposed to violence, you should not design military weapons. If you are morally opposed to eating meat, you should not be a butcher. If you cannot perform all of the duties of your profession, you should find a different profession.

Responsibility Beyond Medicine

Excerpt from “The Hippocratic Oath” (modern version), cited from Wikipedia:

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I have the unique privilege to work in a specialty of medicine that deals with some of the most intimate personal and health issues that exist. On a daily basis I counsel women regarding libido, sexually transmitted infections, partner violence, desires for pregnancy and desires to not be pregnant to give a few examples. In a few minutes’ time I must gain the trust of a total stranger in order to provide them with optimal health care as a regular part of my job; add to this the challenge of addressing these sensitive issues and reward when able to make a difference in someone’s life and you can see why I love my profession.

Interlaced with these sensitive matters are some of the most controversial and charged political topics that have come to be major foci of lawmakers across the country. Women’s reproductive organs have once again  become one of the hottest commodities over which to gain political control. Over 250 bills are being pushed through legislature right now that are anti-choice, anti-women, and anti-physician and it seems that most citizens are blissfully unaware.

I do not pretend to understand why there is such force behind trying to control women’s reproductive organs and, in turn, their bodies and their lives but I have sworn to advocate for them. Physicians take an oath to do what’s right, to care for their patients and advocate for them when they are unable to do so for themselves. This also includes taking political action whenever possible as becoming politically involved is the epitome of advocating for the basic human rights of the general public.

Physicians owe it to their patients, especially OB/Gyn’s where women’s health is concerned, to make their voices heard in politics. It is a crucial part of the responsibility we embrace as healthcare providers and patient advocates. We must not stand aside and watch in silence as human rights are compromised.

Patients, Doctors, Legislators- Green Journal