On refusal to provide care (Updated x 2)
I posted about a study before that showed male, religious physicians are likely to refuse to provide treatment they don’t believe in — which generally means refusing contraceptive methods including abortion to young, vulnerable women. An article in MSNBC today tells the same tale with a bit more of a personal twist — but not even over abortion, but emergency contraception. For rape victims. (via Kevin, M.D.)
While there is something to be said for the argument that the physician ultimately decides on what treatments to offer a patient, there is nevertheless the “standard of care” that doctors are obliged to meet. If someone comes in with certain concerns, you’d better manage those in a way that’s congruent with what is considered acceptable practice by your peers. If you faily, you’re likely to face a lawsuit, fines, public censure, and the loss of your license. Unfortunately, at least in the US, it appears acceptable to refuse a rape victim prophylaxis for an extremely likely sequela of the said rape.
“But pregnancy is not a disease,” say the commentators, but a “natural state of being.” Tell that to the young woman who for the next nine months will have a parasitic lump of cells exert its hormonal influence on her body, causing her to be at increased risk of thrombosis, syncope, nausea and vomiting, edema, etc; who at the end of that will have severe pain and potentially life-threatening hemorrhaging; and who for a lifetime will have the duty of care for an unwanted child fathered by a rapist.
Is it Natural? Yes, absolutely. (But so is infection, cancer, war, disaster, and death by a million causes).
It it Just? No — certainly not. Especially when we have a solution to the patients’ complaint and concern that is a lower risk than not acting.
If you’re a Jehova’s Witness and an MD, can you refuse otherwise indicated blood transfusions to your patients because you feel it is against your religion? If you feel it is ethically unjust to spend virtually all healthcare dollars in vain, on the brain dead or getting there octagenarians who fill the ERs, medicine wards, and ICUs of the nation , can you refuse to admit the next emaciated old woman, so far into dementia that she can’t even recognize her own mouth long enough to use it to eat something?
Update: Alison posted a comment at Kevin, M.D. with some good questions that are better than my examples above:
If a man were to present to the ER with upper left quadrant chest pain, would it be appropriate for the ER doctor to refuse to examine him because it’s against her religion to touch men? Or refuse to refer him to another doctor because the only other doctor working the ER that night was also a woman, albeit not of the same religious belief?
Would it be appropriate for a hospital to hire ER physicians who refused to examine opposite-sexed patients because their religions tell them it’s immodest? And who denied them access to other doctors of the opposite sex?
Update 2: The Well-Timed Period has a great post with further comments on this issue:
So, to sum up, if you’re a female patient of reproductive age:
1. Medical decision: Based on what your doctor feels in his/her heart, not science.
2. Doctor’s visit: Not about you and your medical problem; rather, about religion. [The doctor's, of course, you silly goose.]
3. Treatment: It’s not about receiving adequate medical care. It’s about receiving something, at some point, somehow, somewhere. [Kinda like magic, really. Do-it-yourself magic.]
4. Indication for treatment: If, and only if, your life is in danger.
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