Should Doctors Have to Provide Their Beliefs to Patients

[TitanTiger 21,064]

Did I say that ?

Your responses, to me, implied it. Particularly when you start off like this:

There are many specialties in medicine and few involve prescribing birth control. A doctor that isn't willing to serve his clients' basic needs isn't performing his job in an ethical manner.

If I've gotten the wrong idea based on this and subsequent responses, simply state your position on the matter with an eye toward distinguishing it from what I've gleaned.

I don't expect a doctor to perform abortions, but getting a pill that prevents unwanted conception is something any gynecologist needs to be willing to do-- unless they want to work in a religious setting and are unequivocally clear about the limits of their practice. Any doctor that seeks to limit patient options of standard medical practices such as birth control pills without being abundantly clear up front is acting unethically in my opinion. A patient shouldn't have to schedule an appointment, take time from work, wait to see the doctor and then get a mini sermon. Advertise yourself as a doctor who insists that all patients be content to live within the confines of your religion. If one wants to limit their practice, then limit the practice in a very clear way.

So we essentially agree? You would prefer that doctors prescribe BC pills regardless of their beliefs but don't think they should be required to so long as they are upfront about their policies with patients and potential patients?

I still think it is unethical for a gynecologist to not prescribe birth control for non health related reasons, but if they are consistently and abundantly clear about the limits of their practice , that shouldn't arise.

On that point we'll just have to agree to disagree. I don't see anything wrong with wanting to order one's practice around the repair and healing of the human body so it can function as intended rather than including procedures which break or impair the normal function of the body. And I say this as one who is not opposed to birth control in principle. I can understand someone wanting to help patients using that philosophy and think we should be open-minded enough as a society to allow for it. In fact, I think a lot of matters that generate much heat and noise these days would be of little matter if people on both sides could do that. Just let people be.

[TexasTiger 14,070]

Did I say that ?

Your responses, to me, implied it. Particularly when you start off like this:

There are many specialties in medicine and few involve prescribing birth control. A doctor that isn't willing to serve his clients' basic needs isn't performing his job in an ethical manner.

If I've gotten the wrong idea based on this and subsequent responses, simply state your position on the matter with an eye toward distinguishing it from what I've gleaned.

I don't expect a doctor to perform abortions, but getting a pill that prevents unwanted conception is something any gynecologist needs to be willing to do-- unless they want to work in a religious setting and are unequivocally clear about the limits of their practice. Any doctor that seeks to limit patient options of standard medical practices such as birth control pills without being abundantly clear up front is acting unethically in my opinion. A patient shouldn't have to schedule an appointment, take time from work, wait to see the doctor and then get a mini sermon. Advertise yourself as a doctor who insists that all patients be content to live within the confines of your religion. If one wants to limit their practice, then limit the practice in a very clear way.

So we essentially agree? You would prefer that doctors prescribe BC pills regardless of their beliefs but don't think they should be required to so long as they are upfront about their policies with patients and potential patients?

I still think it is unethical for a gynecologist to not prescribe birth control for non health related reasons, but if they are consistently and abundantly clear about the limits of their practice , that shouldn't arise.

On that point we'll just have to agree to disagree. I don't see anything wrong with wanting to order one's practice around the repair and healing of the human body so it can function as intended rather than including procedures which break or impair the normal function of the body. And I say this as one who is not opposed to birth control in principle. I can understand someone wanting to help patients using that philosophy and think we should be open-minded enough as a society to allow for it. In fact, I think a lot of matters that generate much heat and noise these days would be of little matter if people on both sides could do that. Just let people be.

There's no indication this doctor took the steps to inform potential customers/patients which indicates to me he doesn't respect differing views.

If I own a pharmacy and I hire a pharmacist who later tells me he won't dispense birth control, should I be allowed to fire him ? What about antihistamines that alter the normal functioning of the body , like most medicines do ? What about a clerk that doesn't want to ring them up ?

[TitanTiger 21,064]

There's no indication this doctor took the steps to inform potential customers/patients which indicates to me he doesn't respect differing views.

We agree. In fact, I would say that he should have not charged her at all for her visit, not filed in on her insurance so she could still use her yearly free visit and from that point forward made his policies clear up front. I wouldn't be opposed to a law that requires such.

If I own a pharmacy and I hire a pharmacist who later tells me he won't dispense birth control, should I be allowed to fire him?

I don't know. If I owned a pharmacy, I could see that coming into play possibly. On the one hand, I wouldn't carry certain prescription drugs on matters of conscience. But we would carry birth control pills. If I'd hired a devout Catholic pharmacist, I'd try to make arrangements for one of the other ones to fill those Rx's if he/she felt they couldn't do that.

What about antihistamines that alter the normal functioning of the body, like most medicines do ? What about a clerk that doesn't want to ring them up ?

Given that even the most restrictive group when it comes to BC (the Catholic Church) allows for therapeutic use of BC pills for non-pregnancy related health issues, I think it's reasonable to sell other drugs that treat medical problems even if they have side-effects that weren't the intended use.

I'm sure if we think hard enough we can come up with difficult cases. But I still think it's worth the effort to try to work with people and not either force them into a moral quandary unnecessarily or make a host of professions off limits to people of faith and moral conscience.

[TexasTiger 14,070]

There's no indication this doctor took the steps to inform potential customers/patients which indicates to me he doesn't respect differing views.

We agree. In fact, I would say that he should have not charged her at all for her visit, not filed in on her insurance so she could still use her yearly free visit and from that point forward made his policies clear up front. I wouldn't be opposed to a law that requires such.

If I own a pharmacy and I hire a pharmacist who later tells me he won't dispense birth control, should I be allowed to fire him?

I don't know. If I owned a pharmacy, I could see that coming into play possibly. On the one hand, I wouldn't carry certain prescription drugs on matters of conscience. But we would carry birth control pills. If I'd hired a devout Catholic pharmacist, I'd try to make arrangements for one of the other ones to fill those Rx's if he/she felt they couldn't do that.

What about antihistamines that alter the normal functioning of the body, like most medicines do ? What about a clerk that doesn't want to ring them up ?

Given that even the most restrictive group when it comes to BC (the Catholic Church) allows for therapeutic use of BC pills for non-pregnancy related health issues, I think it's reasonable to sell other drugs that treat medical problems even if they have side-effects that weren't the intended use.

I'm sure if we think hard enough we can come up with difficult cases. But I still think it's worth the effort to try to work with people and not either force them into a moral quandary unnecessarily or make a host of professions off limits to people of faith and moral conscience.

Sounds great in theory, but once a principle is set, you apply it across the board to all religious beliefs. What about a clerk or pharmacy tech-- it may not be a "profession" in the same sense as a pharmacist, but their belief may be as sincere. And it may not make sense in a business model to staff more than one pharmacist at a time-- most places only have one. Do you tell your customer to come back later at a time more convenient for your staff? Do your customers resent feeling judged, i.e. they are doing something the person supposedly serving them believes is so grossly immoral, he doesn't even want a hand in it. Should folks that feel morally compromised by working in a secular setting and being asked to do things that typically occur in that setting seek employment in settings more consistent with their beliefs? A doctor can usually establish his on practice and some pharmacists may own their business, especially in small towns, but most pharmacists these days work for large corporations.

This potentially opens a huge door:

Many medications contain at least 1 inactive ingredient, the consumption of which may be prohibited by certain religions or personal beliefs. Gelatin, a common inactive ingredient in capsule shells, is made from the bone, skin, and connective tissue of animals, primarily pigs and cattle, but also poultry and fish.^5,6 Stearic acid, made from the fat of cows and pigs (ie, tallow), is often seen in its salt form in medications.⁶ For example, magnesium stearate has binding and lubricating properties that help lubricate and aid in the ejection of tablets from the tablet press, the machine used during product manufacturing.

http://www.healio.co...-regimen-design

[TitanTiger 21,064]

See, the thing about "feeling judged" is part of the problem. You live in a pluralistic society. That doesn't mean that some secular morality gets priority over all others. It means we need to learn to give each other some grace. If I went to my urologist for a vasectomy and he told me as a devout Catholic he doesn't perform such procedures...I know that means he finds it morally objectionable but so what? Unless he scolds me, I feel kind of silly feeling "judged." We have differing views on a moral issue. So be it.

[TexasTiger 14,070]

See, the thing about "feeling judged" is part of the problem. You live in a pluralistic society. That doesn't mean that some secular morality gets priority over all others. It means we need to learn to give each other some grace. If I went to my urologist for a vasectomy and he told me as a devout Catholic he doesn't perform such procedures...I know that means he finds it morally objectionable but so what? Unless he scolds me, I feel kind of silly feeling "judged." We have differing views on a moral issue. So be it.

If you get that surgery you get it once . Prescriptions may be refilled 240 times over 20 years. I'm not sure it's comparable-- but back to my question. How would approach the concerns I mentioned as a business owner ? And you avoided the tougher questions.

[TitanTiger 21,064]

This potentially opens a huge door:

Many medications contain at least 1 inactive ingredient, the consumption of which may be prohibited by certain religions or personal beliefs. Gelatin, a common inactive ingredient in capsule shells, is made from the bone, skin, and connective tissue of animals, primarily pigs and cattle, but also poultry and fish.^5,6 Stearic acid, made from the fat of cows and pigs (ie, tallow), is often seen in its salt form in medications.⁶ For example, magnesium stearate has binding and lubricating properties that help lubricate and aid in the ejection of tablets from the tablet press, the machine used during product manufacturing.

http://www.healio.co...-regimen-design

I could be wrong but I'm pretty sure that kosher and halal dietary laws have to do with the Jewish person or Muslim consuming such foods themselves (or kosher/halal foods contaminated by forbidden substances), not selling something to people that contains non-kosher or halal parts. I would think that medicines could be dispensed in a way that they don't touch the capsules themselves such as wearing disposable medical gloves.

[TitanTiger 21,064]

See, the thing about "feeling judged" is part of the problem. You live in a pluralistic society. That doesn't mean that some secular morality gets priority over all others. It means we need to learn to give each other some grace. If I went to my urologist for a vasectomy and he told me as a devout Catholic he doesn't perform such procedures...I know that means he finds it morally objectionable but so what? Unless he scolds me, I feel kind of silly feeling "judged." We have differing views on a moral issue. So be it.

If you get that surgery you get it once . Prescriptions may be refilled 240 times over 20 years. I'm not sure it's comparable-- but back to my question. How would approach the concerns I mentioned as a business owner ? And you avoided the tougher questions.

Well, I think it is comparable. The principle of the matter doesn't change because of frequency. If you went to a pharmacy that didn't offer BC pills or had a pharmacist that wouldn't fill them, that only has to happen once. After that, you could get your Rx filled elsewhere such as a WalMart, many grocery store chains or even mail order. I seriously doubt one is going to have to subject themselves to "judging" 240 times unless they're just too dense to take their business elsewhere.

In terms of the business owner, I think there might be some situations where you can't accommodate. If you can only hire one pharmacist, perhaps you make it known that since they will be the only one on staff, the person in this position will have to fill Rx's for any medicine we carry. If I can work something out with another pharmacy in a town relatively close maybe they can fill those Rx's and we'll go pick them up so our customer doesn't have to. If I can't I would hire someone who could fulfill the requirements the owner has set. And it's highly likely the SCOTUS would back me as the test is the least restrictive means test and whether or not there exists an accommodation. For instance in the Hobby Lobby case they cited that there was a mechanism already in place for non-profits that the gov't could use to provide the desired contraceptives to Hobby Lobby employees that wanted them. But if there is no other reasonable method around it, it likely goes the other way.

I just think you start from a position that's "let's find a way to do this if we can where everyone can get what they want without trampling on anyone else's rights" rather than a default position of "people of faith need not apply if you have any moral qualms about certain aspects of jobs in the public sphere."

[Proud Tiger 4,261]

Titan......I think that last sentence is the most profound thing I have read on the board in a long time. To bad we can't carry on discussions in here with that approach. Maybe we all need to get the first part of the sentence on a card pasted to our computer.

[TitanTiger 21,064]

Here's a pretty easy way around the issue of your local pharmacist not wanting to fill certain Rx's for conscience reasons:

Free Home Delivery of Your Prescriptions

Walmart.com offers FREE home delivery of all prescriptions, including 90-day generic prescriptions for $10.* Save time by managing your refills or setting up auto refills online. No gimmicks, just hundreds of medications priced to help you save money.

http://www.walmart.com/cp/Pharmacy-Home-Delivery/1042239

[Kassc22 0]

I worked in a pharmacy. I never worked with a pharmacist who refused to fill BC pills; the morning after pill was a different story. After it went OTC it was an even bigger problem. I worked for a large chain. The pharmacy manager had control over what was stocked on the shelves. He never ordered it. Every now and then it would come from corporate on auto order. Two of the pharmacists and the mananger refused to sell or fill prescriptions for Plan B. If there was a tech on site who would sell it or a pharmacist filling in who would then if it was asked for it would be sold. If no one in the building was willing to sell it, then the person was simply told it was out of stock.

[Texan4Auburn 1,626]

Meanwhile, muslims are killing women in honor killings for religious reasons, but we focus on something so trivial as a woman not getting what she wants, and then whining about it. GO TO ANOTHER DOCTOR, IT'S THAT SIMPLE. Good grief.

And as a country we are complaining about the cost of health care, how it is delivered, its quality and premiums and deductible costs in insurance. In this case you have a patient that used her one insurance payed gynecologist visit for the year, and at the end she was informed that he did not include prescriptions for birth control... where many women go to get theirs.....and would have to see another one (more cost to her) until she went Chicago on him. In this case you have all of it... delivery, quality, insurance allowance.

Also those of us that are going into medical administration and will be working in private practices or hospitals, will have a stake and personal responsibility in seeing that a ethical standard of care is delivered. So yes for me a woman going to a doctor that is normally expected to deliver services, and not being informed prior to service that some normal services are not available is more than trivial.

[Texan4Auburn 1,626]

I would say if I were a doctor in that field, and I could not in good conscience prescribe contraceptives or certain forms of contraceptives, I would make sure that my patients knew that beforehand. In all those forms a new patient fills out, I would have one that states the policy of my practice on such things and have them sign it and instruct the tech that first works the patient up to ask them if they understood the form that stated our policy on BC. If at that point the patient objected, I would allow them to end the visit and there would no charges accrued.

All that said, I don't think the answer to our coming years is to discourage more people from going in to medicine. We're going to need all the doctors we can get. If some of them have moral beliefs that preclude them from performing certain procedures or prescribing certain medicines, so be it. They should disclose those policies before hand and then people can decide if they can live with those policies or they'd rather see a different doctor.

Same thing goes for pharmacies. If a pharmacy decides they aren't going to carry certain kinds of drugs, such as contraceptives or RU-486 for instance, they should be allowed the freedom to do that. No business should be compelled to carry a product.

Completely fair and I agree and respect the fact that you would be sure that she was not charged for any services.

On the subject of Doctors and their fields I agree with both you and TexasTiger.

Titan's side: A doctor decides to go into private practice, or is in a group practice, as long as his patients are made aware before hand of what he will and will not do then I have no problem with him not performing or doing a prescription. In private you let them go find another doctor, they knew what was going on. In group you can let them find their own doctor elsewhere, or in the case of say BC you let one of the other doctors write the prescription. As an administrator I would tell the doctor do what you do I will take care of the rest, to which I would then ask the other doctor to write the prescription. I'm assuming if, unless all the members were of the same religion, he would be comfortable with others performing certain duties.

TexasTigers side: There are some doctors that are expected to perform procedures regardless of beliefs in situations. Wanting to be a ER doctor and a devout Jehovah's Witness, in a nondenominational or other denominational hospital, is probably a very very bad career decision. If a bus of children flips over and there are dying children all over the place and I'm in a administrative position over that ER then I don't give a damn what your religion is, you knew the drill, you took the job, now you give blood transfusions and provide them the standard of care set out by this facility. Same for a ER doctor that is a devout Catholic. If the standard of care of my facility is to provide Plan B for rape, or to terminate a pregnancy due to dangers then you do it.

Course I think some states protect the doctors and allow them to walk away, will have to look into that.

Then this even brings in a larger question. Should I be allowed to use religion as a decision factor in hiring. While I know you are not suppose to discriminate based on religion, what do you do about one who based on religion will deviate from your standard of care and in a hospital setting such a ER directly impact the health and lives of others.

[alexava 6,974]

I think most of us agree. You can't make him do anything he don't believe in. I presume he don't provide this info upfront and publicly because it would really limit his bottom line. therefore it is my opinion he is a greedy sob and might be in the wrong field. He in fact robbed her of a insurance provided dr visit. Theft is also a sin.

[Texan4Auburn 1,626]

Oh, and I have a feeling that the woman in the first story must have gotten a really really nasty look. Though I spent about 2 years in Chicago and the women there can be very strong, stubborn, and bitchy. So I suspect the tongue lashing had nothing really to do with religion but more of the fact of how he responded and her realization of what just happened. Can guarantee you she knows how Catholics act, fact people just assume your Catholic in Chicago and I'm guessing alot of those are probably very forthcoming with what they will and will not do in regards to birth-control.

[homersapien 12,172]

My vasectomy was performed by an ex-Army doctor. It was not pleasant.

[Elephant Tipper 430]

Outlaw otc abortifacients.

[channonc 466]

Outlaw otc abortifacients.

Plan B and Ella are not abortifacients. They are not the same as RU486. Plan B/Ella will not abort a pregnancy.

[Elephant Tipper 430]

Outlaw otc abortifacients.

Plan B and Ella are not abortifacients. They are not the same as RU486. Plan B/Ella will not abort a pregnancy.

Then clearly you view the destruction of a fertilized egg as just "taking out the trash". Since you didn't mention the iud I infer that you concur that method to be an abortifacient, just as I assert Plan B and Ella are. As the iud functions to deprive the fertilized egg of the ability to attach to the uterine wall, so do Plan B and Ella. Starvation of the fertilized egg will cause the body to reject (abort) the withering fertilized egg. Btw, starve your baby and it's a crime punishable by imprisonment. Starve the beginning of life and you're lauded a heroine by NOW.

Also, the flyers for Plan B and Ella, for their disclaimers, state that they may cause abortion, unless in recent months the FDA has reversed itself on that ruling.

[AUDub 11,784]

A little research goes a long way, ET.

[channonc 466]

Just because you say that's how something works, that's not actually how it works. The IUD prevents fertilization at all, by either killing the sperm (copper IUD), just like spermicide or thickening cervical mucus to prevent sperm from even reaching the uterus (hormonal iud). Killing sperm does not equal abortion.

Plan B and Ella work to prevent or delay ovulation. In fact, all disclaimers for these drugs state:

"Plan B One-Step is not the same as RU-486, which is an abortion pill. It does not cause a miscarriage or abortion. In other words, it does not stop development of a fetus once the fertilized egg implants in the uterus. So it will not work if you are already pregnant when you take it."

[Elephant Tipper 430]

Just because you say that's how something works, that's not actually how it works. The IUD prevents fertilization at all, by either killing the sperm (copper IUD), just like spermicide or thickening cervical mucus to prevent sperm from even reaching the uterus (hormonal iud). Killing sperm does not equal abortion.

Plan B and Ella work to prevent or delay ovulation. In fact, all disclaimers for these drugs state:

"Plan B One-Step is not the same as RU-486, which is an abortion pill. It does not cause a miscarriage or abortion. In other words, it does not stop development of a fetus once the fertilized egg implants in the uterus. So it will not work if you are already pregnant when you take it."

According to the FDA Ella will terminate a pregnancy (I'm addressing just this drug for lack of time).

http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022474s000lbl.pdf

8.1 Pregnancy

Pregnancy Category X. [see Contraindications (4).]

Use of ella is contraindicated during an existing or suspected pregnancy.

There are no adequate and well controlled studies in pregnant women.

Ulipristal acetate was administered repeatedly to pregnant rats and rabbits during the period of organogenesis.

Embryofetal loss was noted in all pregnant rats and in half of the pregnant rabbits following 12 and 13 days of dosing, at

daily drug exposures 1/3 and 1/2 the human exposure, respectively, based on body surface area (mg/m2).

There were no malformations of the surviving fetuses in these studies. Adverse effects were not observed in the offspring of pregnant rats

administered ulipristal acetate during the period of organogenesis through lactation at drug exposures 1/24 the human exposure based on AUC. Administration of ulipristal acetate to pregnant monkeys for four days during the first trimester caused pregnancy termination in 2/5 animals at daily drug exposures 3 times the human exposure based on body surface area.

AND, children now have the ability to walk into a drug store and purchase as many packages of Ella they wish with unrestricted access. Various scenarios allow for the repeated abuse of this drug which might result in abortion. IF the desire is to terminate the pregnancy using Ella, then there is a high percentage of success according to the research I cite.

The information you cite is incomplete. No disclaimer in any of that literature is ever made that abortion is ever a real possibility (hear no evil, see no evil ?). Only within the drug company's strict parameters is the non-abortion therapy promoted (depending on when you consider life begins, too). Do you really believe that the user will actually say, "Oh, it's day 7. I can't use Ella now" ? That would be naive. I believe she and/or her parents will read between the lines about Ella's contraindication for pregnancy, especially as the FDA's research becomes more widely known. (NOTE: the research presented by the FDA is restricted to either the use as prescribed or a hugely exaggerated overdose. No in-between data are presented to give a broader scope of understanding. For marketing purposes maybe ?)

My regard for innocent life is higher though than the standard that the Ella issue presents which is the attempted interception of a fertilized egg from implantation. To me, once the egg is fertilized it IS a human being who truly bears the image of God and is precious no matter how infinitesimal. Human intervention to thwart its implantation is abortion. To support the prescribed use of Ella you must regard the fertilized egg as unwanted debris, an inconvenience, rather than a responsibility and gift from God.

[AUDub 11,784]

...My regard for innocent life is higher though than the standard that the Ella issue presents which is the attempted interception of a fertilized egg from implantation. To me, once the egg is fertilized it IS a human being who truly bears the image of God and is precious no matter how infinitesimal. Human intervention to thwart its implantation is abortion. To support the prescribed use of Ella you must regard the fertilized egg as unwanted debris, an inconvenience, rather than a responsibility and gift from God.

Playing fast and loose with the term abortion, I see. I suppose you think the 80 or so percent of fertilized eggs that don't make it to implantation without intervention of any sort could be considered miscarriages, too.

[Elephant Tipper 430]

...My regard for innocent life is higher though than the standard that the Ella issue presents which is the attempted interception of a fertilized egg from implantation. To me, once the egg is fertilized it IS a human being who truly bears the image of God and is precious no matter how infinitesimal. Human intervention to thwart its implantation is abortion. To support the prescribed use of Ella you must regard the fertilized egg as unwanted debris, an inconvenience, rather than a responsibility and gift from God.

Playing fast and loose with the term abortion, I see. I suppose you think the 80 or so percent of fertilized eggs that don't make it to implantation without intervention of any sort could be considered miscarriages, too.

WOW ! I had you wrongly pegged BB. Thought you were a smart guy. Guess you missed history classes so you could go toke a few.

For the past 2,000 years it's been the teaching of the church that the destruction of a fertilized egg is considered abortion. Actually, this view precedes Christian dogma. It doesn't have to be implanted. Since the abortionists, which I assume you support, have come en masse in the past few decades they've decided to play "fast and loose with the term abortion" in order to make it more appealing.

[AUDub 11,784]

WOW ! I had you wrongly pegged BB. Thought you were a smart guy. Guess you missed history classes so you could go toke a few.

Do you plan on discussing this like an adult, or are we going to start flinging ad hominem attacks?

For the past 2,000 years it's been the teaching of the church that the destruction of a fertilized egg is considered abortion. Actually, this view precedes Christian dogma. It doesn't have to be implanted. Since the abortionists, which I assume you support, have come en masse in the past few decades they've decided to play "fast and loose with the term abortion" in order to make it more appealing.

Right. 2,000 years.

Going to play fast and loose with history, too? Up until about 400 years ago, we weren't even aware viviparous animals had eggs. Google Nicolas Steno.