Author Topic: Survey: Doctors' personal beliefs can hinder care
Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 4:16am Subject: RE: Survey: Doctors' personal beliefs can hinder care
malkieD2 posted:
KK posted:
When I referenced groups like that before, you specifically said:
malkieD2 posted:
The others are associations, and not an indication of the law. Besides, they state best practises and guidelines, not the actual law.
You specifically dismissed the exact same source when I used it in reference to consent. Do you therefore conceed the consent issue completely? Or should we ignore your source?


I dismissed the same source as not indicating what the law states regarding certain situations. The point I previously made has not changed, and does not contradict the point I am currently making. The resource is not an indication of the law, but is an indication of the purpose of healthcare.

I am using the reference to point out what the purpose of healthcare is; a point which you are unable to argue against.
Except I have argued against it.

I don't have to provide a different definition of the purpose of healthcare in order to prove that you can't speak for everyone in the matter. All I have to do is show that there are others who disagree with you either in the actual definition, or in the interpretation of that definition. I've done that. DM is one such example. The many shield laws and the support they have received from medical associations is another.

Those prove either that your definition of the purpose of healthcare is not absolute, or that your interpretation of that definition is not the only one. Either way, it completely proves my point that you lack the authority to speak for the entire medical profession, and instead can only speak for yourself.

Do you like sugar on your porridge? You're basically making the same argument as the "no true Scotsman" fallacy. You must not be a Scotsman because no true Scotsman would use the no true Scotsman fallacy. tongue You are basically saying that a true medical professional would agree with your argument of things, and you simply dismiss or ignore those who disagree as not being professionals. Since that is a clear example of the "no true Scotsman" fallacy, you must not be a true Scotsman.

(And I say all that as an American of Scottish ancestry.)

Kimball Kinnison

 

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malkieD2 
Title: EuroMod™-JCC - FFUK-RSA Emeritus
Registered: Jun '02
6241_R2-D2
Date Posted: 8/6/07 4:30am Subject: RE: Survey: Doctors' personal beliefs can hinder care
ok, allow me to steer this in a slightly different direction.

In your opinion, what is the ultimate point of healthcare?

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 5:07am Subject: RE: Survey: Doctors' personal beliefs can hinder care
malkieD2 posted:
ok, allow me to steer this in a slightly different direction.

In your opinion, what is the ultimate point of healthcare?
A "different" direction? You tried that already and I already answered you. Go back and reread the discussion if you have any questions.

As I said before, it's not about what I think the purpose of healthcare is. It's not my place to force my beliefs or values on anyone else, just like it's not your place to force your beliefs or values on anyone else.

Actually, I'll bite. The purpose of healthcare is to improve society as a whole, and more specifically to improve the quality of life for the people within society.

Of course, that improvement of the quality of life applies to more than just the physical health of individuals. You have to include the ethics side of things, which demands considering the rights of everyone involved. Performing an unethical procedure, for example, might improve the health of the specific patient, but cause far greater harm to society as a whole. Therefore, the procedure would not fall within the purpose of healthcare. (Similarly, unethical experiments might produce results that save hundreds or thousands of patients, but they would still fall outside the purpose of healthcare.)

Let me give you an example. It would likely save many lives to compel the donation of organs from people who are executed by the state. After all, from just one prisoner you could get a heart, lungs, kidneys, a liver, and various other organs. You could even require them to donate large amounts of blood just prior to their execution (after all, they won't be using it afterwards). As a medical professional, you would have to admit that such an approach could save many people's lives, couldn't it?

And yet, such an approach would be extremely harmful to society as a whole. It would be completely unethical because it violates the rights of the condemned prisoners. There's nothing to stop a condemned prisoner from requesting that their organs be donated (or from donating dangerous amounts of blood prior to execution), but compelling it would be extremely harmful.

For that matter, it's not even limited to condemned prisoners. You could save a lot of lives by making organ donation mandatory, as opposed to optional. After all, the people killed in car accidents (as just one source) won't be using those organs anymore. Couldn't it easily be argued that such practices constitute following "Make the care of your patient your first concern"? After all, they are putting the needs of their patients first over the rights and desires of the deceased.

Note also that the purpose you quoted doesn't say "only concern", but "first concern". Just because something is your first concern doesn't mean that it automatically overrides all other concerns. At most it means that it is given greater weight than other concerns.

The problem is that your approach harms society as a whole by making one group's rights subservient to another group's rights. The greatest benefit to society as a whole comes with preserving the maximum rights for the maximum number of people. Therefore, a solution that protects the rights of both doctors/pharmacists and the rights of patients is better for society (and therefore more within the purpose of healthcare).

Under either purpose (the one you gave or the one I gave) there is more than enough latitude to offer many other options besides violating the rights of the doctors and pharmacists. Again, there are compromises available, so there is no need to take such an absolutist approach.

Kimball Kinnison

 

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malkieD2 
Title: EuroMod™-JCC - FFUK-RSA Emeritus
Registered: Jun '02
6241_R2-D2
Date Posted: 8/6/07 6:10am Subject: RE: Survey: Doctors' personal beliefs can hinder care
Personally I would have organ donation as opt-out, not opt-in. Infact, I'd *almost* go as far to suggest that organ donation should be mandatory, but I appreciate this is not the feelings of everyone. If I died tomorrow I'd be grossly upset if my organs where not given to others to improve their quality of life.

KK posted:
The purpose of healthcare is to improve society as a whole, and more specifically to improve the quality of life for the people within society


Absolutely. So, be denying healthcare you are decreasing the quality of life for society. A doctor/pharmacist will come to no physical harm by prescribing contraception, whereas the patient certainly could come to harm from an unwanted pregnancy.

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 6:34am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 6:36am (1 edits total) Edited By: Kimball_Kinnison
malkieD2 posted:
Personally I would have organ donation as opt-out, not opt-in. Infact, I'd *almost* go as far to suggest that organ donation should be mandatory, but I appreciate this is not the feelings of everyone. If I died tomorrow I'd be grossly upset if my organs where not given to others to improve their quality of life.
I'm also an organ donor, and have been listed as such since I first got a learner's permit at age 15.

However, that is my choice, and not something that I can force on anyone else. To do so would be unethical. How can you support the right of a person to control their body with respect to abortion on one hand, and yet insist that they don't have the right to control their body with respect to organ donation on the other hand?

malkieD2 posted:
KK posted:
The purpose of healthcare is to improve society as a whole, and more specifically to improve the quality of life for the people within society


Absolutely. So, be denying healthcare you are decreasing the quality of life for society. A doctor/pharmacist will come to no physical harm by prescribing contraception, whereas the patient certainly could come to harm from an unwanted pregnancy.
malkieD2, you have a PhD, and so you should be able to demonstrate a basic level of reading comprehension. Your last post failed to do that. Go back and reread what I wrote in the very next sentence:
Kimball_Kinnison posted:
Of course, that improvement of the quality of life applies to more than just the physical health of individuals.
The quality of life of people within society is determined by far more than just physical health. A person in perfect health who is denied their basic rights (such as freedom of religion or belief) has a far poorer quality of life than someone with less perfect health who has their rights secured against infringement. That's why so many freedom fighters are so willing to die for their rights. In the words of Patrick Henry, "Give me liberty or give me death."

You place the physical health above everything else, to the exclusion of other critical factors in determining quality of life. You are free to interpret things how you like, but that doesn't make your interpretation the only one, nor does it make you right. Especially, your interpretation of my words is not more correct than my own. I know what I said far better than you do.

Kimball Kinnison

 

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Vaderize03 
Title: Manager Emeritus
Registered: Oct '99
14744_Darth Vader
Date Posted: 8/6/07 6:51am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 6:52am (1 edits total) Edited By: Vaderize03
Kimball, that's a beautiful argument, but answer this:

If health is more than just physical, why has the new supreme court basically rejected the notion of psychological harm from unwanted pregnancy, gutting Doe v Bolton? (which lays the legal framework for not only attacking abortion rights in general at the constitutional level, but also for banning rape exceptions, since psychological harm is one of the key components of a rape).

Would you argue that denying a woman emergency contraception doesn't cause psychological harm, or that an unwanted pregnancy resulting from such a denial wouldn't?

We differ in the idea of which "harm" is greater. To me, the patient's health in all it's aspects should always come before that of the provider if a conflict exists. To you, denying the provider's rights is potentially a greater harm.

We have come to a meeting of the minds on the technical aspect of referral, but we have not reached a philosophical compromise.

What an interesting dilemma....

Peace,

V-03

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 7:04am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 7:05am (1 edits total) Edited By: Kimball_Kinnison
Vaderize03 posted:
Kimball, that's a beautiful argument, but answer this:

If health is more than just physical, why has the new supreme court basically rejected the notion of psychological harm from unwanted pregnancy, gutting Doe v Bolton? (which lays the legal framework for not only attacking abortion rights in general at the constitutional level, but also for banning rape exceptions, since psychological harm is one of the key components of a rape).

Would you argue that denying a woman emergency contraception doesn't cause psychological harm, or that an unwanted pregnancy resulting from such a denial wouldn't?

We differ in the idea of which "harm" is greater. To me, the patient's health in all it's aspects should always come before that of the provider if a conflict exists. To you, denying the provider's rights is potentially a greater harm.

We have come to a meeting of the minds on the technical aspect of referral, but we have not reached a philosophical compromise.

What an interesting dilemma....

Peace,

V-03
You're asking the wrong person on that one. Remember, I've long advocated that abortion isn't a constitutional issue, and so it should be handled by the individual states. That means that each individual state would have to strike its own balance for what constitutes "quality of life" as mentioned in the definition I provided. To that end, I'd say that the entire question of psychological harm shouldn't even be touched on by the Supreme Court.

I would point out that if you are going to bring psychological harm into the equation, you also need to consider the psychological harm that comes from denying anyone their rights. And there are still ways to mitigate the harm you describe, most of them relating to how the specific doctor handles the situation.

For example, there is a difference between a doctor saying "I won't prescribe you an emergency contraceptive because that would be a sin" to a patient, and the doctor simply saying "Doctor ____ will be by in a few minutes and he will help you take care of that." Both of them are refusing to provide the prescription that they object to, but one is far more diplomatic and less harmful than the other. In effect, the act of providing a referral would mitigate a lot of the alleged psychological harm.

Of course, it doesn't stop the doctor from being an ass, just like the law doesn't stop anyone else from being an ass. But last I checked, being an ass was not illegal in and of itself.

Kimball Kinnison

 

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malkieD2 
Title: EuroMod™-JCC - FFUK-RSA Emeritus
Registered: Jun '02
6241_R2-D2
Date Posted: 8/6/07 7:13am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 7:16am (1 edits total) Edited By: malkieD2
KK posted:
malkieD2, you have a PhD, and so you should be able to demonstrate a basic level of reading comprehension. Your last post failed to do that. Go back and reread what I wrote in the very next sentence:


Patronise me all you like, it doesn't alter the fact that my point stands. A doctor/pharmacist will come to no physical harm from prescribing contraceptives. I very clearly and deliberately used the word "physical", perhaps you need to brush up on reading comprehension. Society simply will not suffer from a doctor/pharmcist providing the best healthcare possible, and directly addressing the medical needs of the patient. Anything else goes completely against the benefit of society.

Strip a society of all of its mod-cons and healthcare becomes the number one priority.








You are argueing that quality of life includes the right to freedom of personal choice, and my point is that when weighed up directly against the physical health of a patient a doctor/pharmacist is not providing the best healthcare possible when not issuing them contraception.

Vaderize03 put it down in words extremely well when he posted :- "To me, the patient's health in all it's aspects should always come before that of the provider if a conflict exists. To you, denying the provider's rights is potentially a greater harm.". That's the central core, and the ultimate purpose of healthcare - there are no conditions to this fact.

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 7:33am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 7:37am (1 edits total) Edited By: Kimball_Kinnison
malkieD2 posted:
Patronise me all you like, it doesn't alter the fact that my point stands. A doctor/pharmacist will come to no physical harm from prescribing contraceptives. I very clearly and deliberately used the word "physical", perhaps you need to brush up on reading comprehension.

You are argueing that quality of life includes the right to freedom of personal choice, and my point is that when weighed up directly against the physical health of a patient a doctor/pharmacist is not providing the best healthcare possible when not issuing them contraception.
Actually, my point deals with quality of life for society as a whole, not just for each individual.

malkieD2 posted:
Vaderize03 put it down in words extremely well when he posted :- "To me, the patient's health in all it's aspects should always come before that of the provider if a conflict exists. To you, denying the provider's rights is potentially a greater harm.". That's the central core, and the ultimate purpose of healthcare - there are no conditions to this fact.
The ultimate purpose of healthcare is the benefit of society as a whole. This is usually done through application on an individual level, but that doesn't mean that individual concerns outweigh the effects on society as a whole.

My argument isn't that the harm done to the patient is less than the harm done to the doctor. It's that the harm done to the patient in having to get a referral to another provider is less than the harm done to society as a whole by infringing the doctors' rights. You position takes no account for the ramifications to society because it focuses completely on the individual.

Once more, let's use my death row example. It's not allowed to force organ donation from condemned prisoners in the US or the UK. In fact, in places where that is done, it is looked down upon as being highly unethical. Why is that? After all, it saves lives, and the prisoners are being executed, so they don't need those organs anymore.

The answer is simple. Because the harm to society in violating the rights of those prisoners if far greater than the benefit that comes from fixing the physical health of a few patients. That's why the Allies destroyed much of the medical data collected by Nazi doctors in the various concentration camps. The unethical means used to produce that data taints it, and makes any further use of it contributory to the crimes against humanity that spawned it.

In effect, you are demonstrating severe tunnel vision by refusing to even look at the societal ramifications. There is far more at stake than just the health of the patient, and responsible healthcare policy needs to take that into account.

Kimball Kinnison

EDIT: And yes, society would suffer from compelling doctors to violate their beliefs when there are other alternatives. It would suffer in that it creates a precedent to weaken the right to freedom of belief, to freedom of conscience, and moves towards making individuals nothing more than automatons of the state.

Remember, I'm not advocating that doctors simply be able to refuse providing contraceptives to patients with nothing further (which I agree would be extremely harmful to society). I'm arguing that they should be able to refuse as long as they refer to someone else who will provide the service. In other words, I am proposing a system that mitigates the effects of the doctor's refusal, and yet also mitigates the harm that would come from violating the doctor's rights.

 

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malkieD2 
Title: EuroMod™-JCC - FFUK-RSA Emeritus
Registered: Jun '02
6241_R2-D2
Date Posted: 8/6/07 8:13am Subject: RE: Survey: Doctors' personal beliefs can hinder care
..............................at the expense of healthcare for the patient, which is unacceptable. It doesn't matter than a referral can be obtained.

 

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SkyeLightrider 
Registered: Jan '03
41993_Tyber Zann
Date Posted: 8/6/07 8:43am Subject: RE: Survey: Doctors' personal beliefs can hinder care
DM posted:
--------------------------------------------------------------------------------
The provision of pregnancy termination is not a requirement of practice. As has been stated ad nauseum, referral is all that is necessary.
--------------------------------------------------------------------------------

Malkie Posted:

So you personally don't believe in giving a patient the best healthcare possible?




Malkie, seeing as I'm an engineer and not a doctor, I do have one quick question:

Since when has pregnancy been considered a disease that needs to be cured?

I understand your position as a member of the field. However, IIRC, the Hippocratic Oath states that a doctor shall do no harm to any patient for that would be unethical.

Taking that into consideration, I think Kimball is right with this fundamental question.

When does the pregnancy stop being one patient and start being two patients?

With that question in mind, any issue with abortion does become a question of ideology. Even in the medical community, there is no standard to when this occurs. Are there two patients at conception, or is it not until birth? I work in the medical profession on EMR software and I know that as soon as a pregnancy is confirmed a new epsiode is opened that tracks both the mother and child's health. Is it that point when we have medical records on the growing baby that it is a patient? Since there is no legal or medical definition for when exactly the baby becomes patient #2, wouldn't the doctor or pharmacist refusing treatment for believing the child (or bunch of cells that will be a child) to be a viable patient be perfectly acceptable in upholding the Hippocratic Oath?

Hence, Kimball is right in the sense that this arguement is purely ideological, and any law that forces someone to treat what they consider a living patient as a "health risk" to another patient could be construed as unethical and/or a violation of the provider's rights to provide healthcare to, in their opinion, two patients instead of just one. Unfortunately, any attempt for the medical or legal community to even try to standardize the turning point so to speak of when one patient becomes two will have the same stigma of forcing one ideology over another.

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 8:46am Subject: RE: Survey: Doctors' personal beliefs can hinder care
malkieD2 posted:
..............................at the expense of healthcare for the patient, which is unacceptable. It doesn't matter than a referral can be obtained.
You position is at the expense of a free society, which is unacceptable. It doesn't matter that the patient would be temporarily inconvenienced.

See? Two can play that game.

Kimball Kinnison

 

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Fire_Ice_Death 
Registered: Feb '01
41184_Borsk
Date Posted: 8/6/07 8:53am Subject: RE: Survey: Doctors' personal beliefs can hinder care
A free society doesn't mean that you can just pick and choose what you'll do at your job. As has been repeated: If you can't do the job then don't go into that field.

 

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Kimball_Kinnison 
Registered: Oct '01
6249_Veers
Date Posted: 8/6/07 8:58am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 9:00am (1 edits total) Edited By: Kimball_Kinnison
Fire_Ice_Death posted:
A free society doesn't mean that you can just pick and choose what you'll do at your job. As has been repeated: If you can't do the job then don't go into that field.
And, as has been repeated quite a bit in response to that, according to many laws, professional associations, and individual doctors and pharmacists, it's not and absolute part of their job. If they have the right to refuse (as many laws protect), then it is only part of their job if they choose to do it.

Repeating the mantra "It's part of their job" doesn't make it the truth.

Kimball Kinnison

EDIT: And actually, a free society does mean that you can "pick and choose what you'll do at your job". In a free society, employment is determined by mutual contract between employer and employee. Mutual meaning that both sides agree to the job duties and negotiate them to their liking.

 

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DeathStar1977 
Registered: Jan '03
7850_Luke Skywalker
Date Posted: 8/6/07 10:39am Subject: RE: Survey: Doctors' personal beliefs can hinder care - Date Edited: 8/6/07 10:39am (1 edits total) Edited By: DeathStar1977
Although this has become the great circular thread...

And actually, a free society does mean that you can "pick and choose what you'll do at your job". In a free society, employment is determined by mutual contract between employer and employee. Mutual meaning that both sides agree to the job duties and negotiate them to their liking.

But as you know this isn't absolute. A business needs a state license (or some variance) to operate, and must operate under those laws. What I (and others) seem to be saying is that part of what should be required for a pharmacy to obtain/sustain a license would be that all legit prescriptions should be filled. Yes, there is freedom of religion, but there isn't freedom to pick and choose what job you want. One has to fulfill the qualifications and obligations that are required by the employer AND as required under law.

Anyway, I'm kinda surprised that the change in laws regarding abortion clinics in Missouri generated such little discussion. For a change of pace, I thought I'd repost it:

Mo. tightens abortion clinic regulations

By DAVID A. LIEB, Associated Press Writer Fri Jul 6, 6:05 PM ET
JEFFERSON CITY, Mo. - Missouri abortion providers will face new regulations for their clinics and new restrictions on teaching sex education classes under a bill Gov. Matt Blunt signed into law Friday.


The measure places more abortion clinics under government oversight by classifying them as ambulatory surgical centers. Planned Parenthood has said the law could force it to spend up to $2 million to remodel one of its clinics and halt medical abortions at another site.

The law also bars people affiliated with abortion providers from teaching or supplying materials for public school sex education courses, and it allows schools to offer abstinence-only programs.

Blunt proclaimed the law "one of the strongest pieces of pro-life legislation in Missouri history" as he spoke from a cross-shaped lectern during a signing ceremony in the sanctuary of Concord Baptist Church.

The Republican governor said he has no qualms if the stricter state oversight causes hardships for abortion clinics.

"I say if they can't meet the same basic requirements that other (medical) providers do, then they should shut down," Blunt said.

Missouri Right to Life, which backed the measure, argued that groups like Planned Parenthood have a conflict of interest in supplying sex education materials because they could make money if female students go to their clinics. Blunt echoed that concern, saying sales of material to public schools were a "significant source of revenue" for the group.

Planned Parenthood said it provides sex education materials to schools for free and its staff members who teach sexual health and education lessons in 41 Missouri schools are trained not to discuss abortions. An official with Planned Parenthood, which has several staffers who visit public schools, called the profiteering assertion "political propaganda."

"Essentially, what Governor Blunt and the Legislature is doing is saying that teens need to be protected from information, not from sexually transmitted infections or unintended pregnancies," said Peter Brownlie, chief executive officer of Planned Parenthood of Kansas and Mid-Missouri.

The state already licenses facilities that get at least half of their revenue or patients from abortions. Only one, a Planned Parenthood clinic in St. Louis, falls under that licensing requirement.

The Department of Health and Senior Services said the new law would require three other clinics to be licensed. The department didn't identify them, but Planned Parenthood said its offices in Columbia and Kansas City would be affected.

The organization is considering a legal challenge.

 

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