Woman Denied Emergancy Contraception On Religious Grounds (In Ireland)

nozzferrahhtoo

drkpower wrote: »

The problem with this approach is that the doctor-patient relationship is not a typical contracting situation. Many many patients attending are relatively unfamiliar with their doctor and attend on a relatively urgent basis (not an emergency per se, but they are concerned and require prompt treatment). In the context of when people choose to attend their doctor, expecting them to research their GPs and Hospitals in the manner you suggest is too onerous on the patient. The doctor-patient situation warrants more general rules of application to all and those rules should put the onus on the doctor to arrange a referral to another doctor where one doctor cant provide the required treatment, ensuring that there is as little detriment to the patient as possible.

Agreed. I meant my comment retrospectively. Not that the girl in question should research the GP before hand.

If someone does not provide the service you want, do not go back to them a 2nd time and use word of mouth to inform others too.

Clearly this doctor has lost this girls business for life, and probably most of the business of anyone she tells her story to. I hope this is so, and I hope it happens for every patient he/she has and they slowly put themselves out of business.

If, like I said before however, that doctor works for someone else and was expected to provide the service that he/she did not, then I hope the doctor in question becomes jobless soon.

Stercus Accidit

Shenshen wrote: »

Religious freedoms only extend until they touch on the personal rights of other people.

People have a right to medical treatment, and a doctor has no right to refuse it on religious grounds.

+1, very well said, religion has a nasty habit of being 'personal' when being defended but habitually affecting the rights of others in reality.

Shenshen

nozzferrahhtoo wrote: »

I am always a little nervous about coming down too hard on all doctors for this. For me it should depend on who the doctor works for as to whether I agree or disagree with the above.

If the doctor works for a state run organisation, facility, hospital etc then of course he should not be allowed refuse to give the morning after pill on religious grounds. He was hired by an employer to do a job, he signed a contract saying he would do that job, and if he can not do his job then he should be fired instantly. He should have made his employer aware of the religious conflict before being hired. A muslim, for example, would not get away with signing up to be a chef in a restaurant, then on day 1 pointing out "oh by the way I will be refusing to work with pork, didn't I mention?".

However if a doctor opens their own private practise, or a muslim opens their own restaurant then why should he be forced to perform a service he does not want to perform? If I start any business selling a service or goods, no one comes along and forces me to provide goods or services that I do not want to provide. If a guy who owns an auto garage tomorrow decides never to work on another German car, who are we to force him for example? It is HIS business and he can choose to make choices that will ruin his business and reduce his customer base all he likes.

In these cases I just hope natural selection does it’s work. People will learn that Doctor X does not provide services that they want, so they go to Doctor Y instead and I hope Doctor X goes out of business naturally because no one wants a doctor that does not provide the full services.

There are just two problems with this :

1) The doctor in question provided an out-of-hour service, and while it was possible for the woman to travel some 150 km to the next out-of-hours doctor, I don't feel anybody in a country the size of Ireland should be reasonably expected to travel such a distance to seek medical attention.

2) The service doctors provide is quite unique and utterly vital, unlike a restaurant or a garage.
If you don't like the restaurant, don't go there. If the garage won't fix your car, get a hire car until another garage can fix it.

If you need medication now, you may not have either of these options.
It probably wouldn't be an issue in Dublin or Cork or Galway, where you can expect a number of doctors to provide out-of-hours service at any given time, and where there is the infrastructure to allow you to get from one to the other within an hour or so.
Going from Tralee to Cork is quite a different matter. And nobody ought to be required to do so just to gain access to required medication.

drkpower

I hope most here would agree with a doctor not being entitled to refuse treatment in an emergency. And what classes as an emergency is a matter up for debate.

But what about in the non-urgent situation? Should a doctor (for reasons of 'conscience') be entitled to refuse treatment?

Shenshen

drkpower wrote: »

I hope most here would agree with a doctor not being entitled to refuse treatment in an emergency. And what classes as an emergency is a matter up for debate.

But what about in the non-urgent situation? Should a religous doctor (for reasons of 'conscience') be entitled to refuse treatment?

I would tackle that geographically... if he can refer to another doctor close enough who will be available for the treatment, I wouldn't mind if the doctor suggested to the patient to move to the other one.
I'm not sure I would be happy about letting doctors outright refuse any kind of treatment based on religious feelings... where would you draw the line, after all?

oeb

Shenshen wrote: »

1) The doctor in question provided an out-of-hour service, and while it was possible for the woman to travel some 150 km to the next out-of-hours doctor, I don't feel anybody in a country the size of Ireland should be reasonably expected to travel such a distance to seek medical attention.

Everything else aside, I still wonder why this lady needed to travel to Cork to see another out of hours doctor. South Doc would also have had different doctors on duty in Listowel (about 40 min away), Castleisland (20 min away) and Killarney (25 min away).

dashboard_hula

kmick wrote: »

If I were a woman I would have one of these pills in my handbag just in case.

Unfortunately, morning after pills are single use, and prescribed by a GP every time. So the only way in Ireland to get away with carrying a handy spare, would be to lie to a doctor about having unprotected sex, then filling the prescription and carrying it about. Tbh, if you're going to do that, then might as well carry the condoms, and if condoms aren't going to be present (drunkenness, rape, drugs, loss of mental faculties), then we're back to requiring the morning after pill within 72 hours of sex.

If a doctor objects to prescribing the morning after pill, then he has every right to do so. However he should then not be pulling the night shift in an emergency GP position in a remote and isolated part of the country. The chances of him having to turn away a woman with no alternative method of seeking medical treatment without a lot of expense or difficulty are much higher. And that, they have no right to do. Certainly not as employees or contractors of the HSE.

drkpower

Shenshen wrote: »

I would tackle that geographically... if he can refer to another doctor close enough who will be available for the treatment, I wouldn't mind if the doctor suggested to the patient to move to the other one.
I'm not sure I would be happy about letting doctors outright refuse any kind of treatment based on religious feelings... where would you draw the line, after all?

I actually meant to remove 'religous'. Should any doctor (for reasons of conscience) be able to remove themselves from a treatment situation?

Personally i feel they should. But i appreciate that drawing a line is difficult, for sure. What if the reason of conscience is 'homeless people disgust me' rather than 'i dont believe in abortion' or 'i cant let a JW patient die for lack of a blood transfusion'? Who decides what is a proper reason of 'conscience'?

Its a toughie alright. My view is that any reason is a valid matter of conscience as long as it doesnt breach equality legislation. That will lead to injustices for sure, but as long as the patient suffers no real detriment, then I am not overly concerned. If the reasons are frivilous/vexatious, then the Medical Council can still act to discipline a doctor. That does leave them playing the 'moral police' to an extent, alright, but the alternative of putting in place a blanket no exceptions rule is overly onerous on the doctor.

amacachi

This has confirmed my desire to become a doctor just to see what kind of stupid **** I could get away with by claiming religious reasons. Obviously I don't mean in any serious situations where there's real danger, but maybe just refusing insulin to diabetics or inhalers/steroids to asthma sufferers.

nozzferrahhtoo

Shenshen wrote: »

2) The service doctors provide is quite unique and utterly vital, unlike a restaurant or a garage. If you don't like the restaurant, don't go there. If the garage won't fix your car, get a hire car until another garage can fix it.

I am afraid I still do not see the difference. At the end of the day it is a business and a business the person set up for himself, so it should be up to that person to provide the services he wants to provide as long as it does not break established regulations of his industry.

Now I plead ignorance here, as I do not know what the standards of having a medical license say on this subject and maybe ALL doctors should have to provide this pill, and if they do not they are in violation of their permits. If it is not a requirement of holding the permit however, I am not sure what we can honestly claim this doctor has done wrong, except for being a bit of an arse.

It sounds good on paper, what you are trying to say, I get that. However we are in dangerous ground here where you are essentially advocating that people be forced to do something, merely because they can do it, because it is deemed an emergency.

I for one have a rare blood group. If someone of that blood group were dying beside me and for whatever reason I refused to give blood, should I be forced to do so merely because I can and there is an emergency?

I agree with you it is a sorry state of affairs that this patient (allegedly) had only one single option in a 150km radius, I really do. That is not the fault of the doctor who is not providing the service required however. Your beef should be with your local government for not providing adequate Womens Health centres with our tax money, or with the government for making such types of contraception so difficult to obtain, especially out of hours.

At the end of the day however, I would baulk before suggesting that anyone else who set up their own business, with their own money, at their own risk, in their own time should be told by US what services or products they have to provide whether they like it or not.

Dades

I think I'm with nozzferrahhtoo on this one.

A self-employed doctor should have the right to not prescribe drugs that conflict with his own moral code. I don't think becoming a doctor forces you to have to administer any and every drug/treatment available.

This might be superseded in cases where someone's life is on the line, but I don't see the morning after pill in that bracket. It's ridiculous to not prescribe it, I agree, but not illegal or inexcusable.

What might be useful in such situations is an individual statement of practice for GPs that delineates what they will and will not do.

drkpower

nozzferrahhtoo wrote: »

I for one have a rare blood group. If someone of that blood group were dying beside me and for whatever reason I refused to give blood, should I be forced to do so merely because I can and there is an emergency?

I dont think that is an appropriate analogy; the potential inconvenience and adverse effect on you in being forced to provide blood far outweighs any such effect on a doctor forced to treat someone against tyheir moral code (in all but the most extreme situations). Further, by signing up to the rules of the profession, the doctor knew what unpleasant situiations he may have to face; by having a rare blood group, we could hardly say you signed up to having to give it away:eek:.

As for the overall argument, I have to re-emphasise the nature of the services a doctor provides, and the nature of health services in gerneral. Almost every doctor is engaged in providing a public health service. While self-employed, GPs deliver a public health service. It is not directly comparable to most other services. A patient must be entitled to treatment (even if it is not a life or death scenario) which is ony subject to the laws of the State (and the regulations made by the stautorily created regulatory body of the profession), and not subject to the individual doctor's concerns. This is and can only be subject to one exception; where there is another doctor available within the required timeframe for treatment who is suitably trained and equipped to provide whatever treatment is required.

PDN

drkpower wrote: »

Further, by signing up to the rules of the profession, the doctor knew what unpleasant situiations he may have to face;

Didn't the doctor sign up to a set of rules that said he wouldn't be forced to violate his moral principles?

nozzferrahhtoo

drkpower wrote: »

I dont think that is an appropriate analogy; the potential inconvenience and adverse effect on you in being forced to provide blood far outweighs any such effect on a doctor forced to treat someone against tyheir moral code (in all but the most extreme situations). Further, by signing up to the rules of the profession, the doctor knew what unpleasant situiations he may have to face; by having a rare blood group, we could hardly say you signed up to having to give it away:eek:.

By learning to swim I also realise that I might face the situation that I see someone drowning and I might be the only person around that can save them. This does not mean I MUST jump in and save someone either. Just because someone CAN do something, does not mean they MUST do something.

In your words however someone should be forced to provide a service they do not wish to provide, if in your eyes they are not „inconvenienced“ by it?

I am not sure I can go with that either. My right to open a business and provide the services I want to provide is not reliant on how convenient it is to me.

To use your own words in the last line. By opening a business "we could hardly say you signed up to having to" provide the same services as everyone else in the same field as you.

We could do with more doctors, not less, and telling every would be doctor that becoming a doctor means they MUST provide every single service on a given list, barr none, is clearly not the way to achieve this either.

Again it is MY choice whether to open my own business with MY money, and it is therefore MY choice what services I will provide. No one else can make that choice for me. I would not just say this about doctors either, but also about chemists, who similarly can carry what products they choose to, without being forced to stock the pill if they so wish.

And this is from someone who is 100% for legalization of abortion, the pill, lowering the age of consent for the purchase of condoms and who things the religion based reasons the doctor used in this case are a heap of tosh and I would tell him to his face if the opportunity arose.

Delirium

Crazy stuff. So people are supposed to do a religious background check on their local GPs (assuming there are more than one) so as to know which to go to.

Some people would have to travel 20-30km each way to their 'local' GP and to then be told to do an additional 150km trip to get a prescription is nonsense.

If the doctor is going to take that line with regards to providing an out of hours service, they should stop working in the out of hours service. Let the doctors who will provide all medications that are legally available do the out of hours service.

The doctor can refuse to go against their religious beliefs during regular hours as there would hopefully be other doctors in the town that would provide an alternative.

Grumpypants

Galvasean wrote: »

Ah but Strobe, would forcing someone to have an unwanted pregnency not be considered casing harm?

she wasnt forced to have the baby though only to drive to Cork or wait untill monday morning when a different doctor would be open.

Shenshen

oeb wrote: »

Everything else aside, I still wonder why this lady needed to travel to Cork to see another out of hours doctor. South Doc would also have had different doctors on duty in Listowel (about 40 min away), Castleisland (20 min away) and Killarney (25 min away).

That I honestly wouldn't know...
But if I had to imagine her relying on public transport, the bus to Cork was maybe the next available option?

sonicthebadger*

nozzferrahhtoo wrote: »

By learning to swim I also realise that I might face the situation that I see someone drowning and I might be the only person around that can save them. This does not mean I MUST jump in and save someone either. Just because someone CAN do something, does not mean they MUST do something.

In your words however someone should be forced to provide a service they do not wish to provide, if in your eyes they are not „inconvenienced“ by it?

I am not sure I can go with that either. My right to open a business and provide the services I want to provide is not reliant on how convenient it is to me.

I think as has been pointed our before, this is not simply a business. It is a public service.

If I was a firefighter could I save all the white people first because my religion says black folks are animals? If that's my opinion I'm not fit to work in that job. Same goes for doctors. As someone posted earlier, if part of your job is to do something you find morally reprehensible (like killing children because Adolf says it's cool), consider resignation. Evil is a small man afraid for his job.

As for standing on a beach and watching someone drown even though you CAN save them. If it's not your job to save them then you only have yourself to answer to, if it is your job then why did you take it if you don't want to help people in trouble in the water?

oeb

Shenshen wrote: »

That I honestly wouldn't know...
But if I had to imagine her relying on public transport, the bus to Cork was maybe the next available option?

The bus from Tralee to Cork stops at both Killarney and Macroom. Both places (Like Cork and Tralee) are part of the south Doc scheme so would have had a local GP on call.

Shenshen

nozzferrahhtoo wrote: »

I am afraid I still do not see the difference. At the end of the day it is a business and a business the person set up for himself, so it should be up to that person to provide the services he wants to provide as long as it does not break established regulations of his industry.

Now I plead ignorance here, as I do not know what the standards of having a medical license say on this subject and maybe ALL doctors should have to provide this pill, and if they do not they are in violation of their permits. If it is not a requirement of holding the permit however, I am not sure what we can honestly claim this doctor has done wrong, except for being a bit of an arse.

It sounds good on paper, what you are trying to say, I get that. However we are in dangerous ground here where you are essentially advocating that people be forced to do something, merely because they can do it, because it is deemed an emergency.

I for one have a rare blood group. If someone of that blood group were dying beside me and for whatever reason I refused to give blood, should I be forced to do so merely because I can and there is an emergency?

I agree with you it is a sorry state of affairs that this patient (allegedly) had only one single option in a 150km radius, I really do. That is not the fault of the doctor who is not providing the service required however. Your beef should be with your local government for not providing adequate Womens Health centres with our tax money, or with the government for making such types of contraception so difficult to obtain, especially out of hours.

At the end of the day however, I would baulk before suggesting that anyone else who set up their own business, with their own money, at their own risk, in their own time should be told by US what services or products they have to provide whether they like it or not.

Again, a preson's rights stop where another person's rights begin.
You can't be forced to give blood to anybody, as it would violate your right to self-determination where your health and body are concerned.
And a doctor has a duty to provide medical service. if they have an issue with that, they should look for an alternative profession. Can you imagine a garda refusing to assist somebody on religious ground? Or a fireman refusing to help somebody trapped by fire, because he happens to be Muslim and the trapped person is a woman who isn't wearing appropriate covering? (I'm reaching, I know, but I'm just trying to illustrate my point).

A doctor doesn't exactly operate independently... and this doctor in particular was working with SouthDocs to provide emergency service. Which he then refused on religious grounds.
Nobody forced him to work with them, if he hadn't chosen to do so another doctor would most likely have worked that particular shift, and the woman would not have needed to travel at all.

nozzferrahhtoo

sonicthebadger* wrote: »

I think as has been pointed our before, this is not simply a business. It is a public service.

There is a reason it is called a "private practice"

It is a public service if he works for one of our public state run hospitals or the like. You use the analogy to the fire service, or you could have also mentioned the police. These are however public funded and owned services.

This is NOT so of a medical graduate who using his own money starts a private practice, and the analogy to fire fighters you used therefore does not apply.

Shenshen wrote: »

Can you imagine a garda refusing to assist somebody on religious ground?

No because as I just said in this post above, and in other posts, a garda works for the state, not himself, and he knew what his job was when he signed up for it. The analogy simply does not apply. It is entirely different to someone setting up their own business, privately, with their own time and funds.

The garda work for us. A doctor in a state hospital works for us. A doctor on the corner who set up his own practice works for himself.

Shenshen wrote: »

A doctor doesn't exactly operate independently... and this doctor in particular was working with SouthDocs to provide emergency service. Which he then refused on religious grounds.
Nobody forced him to work with them, if he hadn't chosen to do so another doctor would most likely have worked that particular shift, and the woman would not have needed to travel at all.

Then as I said you and I have no disagreement. I am talking about the difference between private practice and employment only. IF indeed the doctor in question was working for someone else, and that employer expects a certain service to be provided by it's staff, then I fully agree the doctor in question should be fired instantly in this story. As you say he would have taken the position in full knowledge of what was expected of him and he then refused to perform this duty. You will get ZERO argument from me on that one. Fire his ass.

Dades

Becoming a doctor gives you the right to practice as a doctor, it does not give everyone else the right to be treated by you regardless of the situation. Or does it?

Shenshen

Dades wrote: »

Becoming a doctor gives you the right to practice as a doctor, it does not give everyone else the right to be treated by you regardless of the situation. Or does it?

Good question... I was always under the impression that being a doctor gave you the duty to treat people, not the right...

Dades

A duty to treat a 'sick' patient, perhaps. But is that the case here?

Very interestingly here's two versions of the hippocratic oath from wiki:

Classic Version wrote:

I swear by Apollo the Physician and Asclepius and Hygieia and Panaceia and all the gods, and goddesses, making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant:
To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art–if they desire to learn it–without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken the oath according to medical law, but to no one else.
I will apply dietic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.
I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.
I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.
Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves.
What I may see or hear in the course of treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep myself holding such things shameful to be spoken about.
If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honoured with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.

Modern Version wrote:

I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.
I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.
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 will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

robindch

Dades wrote: »

A duty to treat a 'sick' patient, perhaps. But is that the case here? Very interestingly here's two versions of the hippocratic oath from wiki:

Regardless of the rights and the wrongs of the issue, I always wondered about that inconsistency.

Would any doctors in the audience care to comment?

Memnoch

I have to confess I've see-sawed on this issue a lot.

I can understand if a doctor has an issue with giving the OCP if they genuinely believe they are committing murder, then we can't really force them to adminster it.

The solution perhaps is to make the OCP a little more easily available. Like in the UK where a patient can get it directly from the pharmacist.

While I respect the doctor's religious views in this instance, it's unfair for that view to be imposed upon the women concerned. A reasonable compromise is what I've suggested above, though I'm sure the Catholic majority of Ireland would never agree to this.

enda1

Dades wrote: »

I think I'm with nozzferrahhtoo on this one.

A self-employed doctor should have the right to not prescribe drugs that conflict with his own moral code. I don't think becoming a doctor forces you to have to administer any and every drug/treatment available.

This might be superseded in cases where someone's life is on the line, but I don't see the morning after pill in that bracket. It's ridiculous to not prescribe it, I agree, but not illegal or inexcusable.

What might be useful in such situations is an individual statement of practice for GPs that delineates what they will and will not do.

I disagree.

A self-employer taxi driver can not refuse to pick someone up for any religious reasons for example. A condition of having a medical license and being allowed call yourself a doctor should include the ability and to treat any present illness/condition.

The way it currently is appears to not be this case (which is sad) and so the doctor acted well within his rights - which ironically I would consider immoral!

Memnoch

enda1 wrote: »

I disagree.

A self-employer taxi driver can not refuse to pick someone up for any religious reasons for example. A condition of having a medical license and being allowed call yourself a doctor should include the ability and to treat any present illness/condition.

The way it currently is appears to not be this case (which is sad) and so the doctor acted well within his rights - which ironically I would consider immoral!

I get where you are coming from. The whole issue of public service and discrimination does muddy the waters a little.

For example, what if someone's personal beliefs prevented them from serving gays? Or allowing them to stay in their B&B

What then, if ANOTHER person's personal beliefs prevented them from serving blacks? Or allowing them to stay in their B&B.

So on the whole I agree strongly with the principle that people MUST put their personal beliefs aside when working with members of the public and this is even more important in essential service industry jobs such as policing or medicine.

However, I think the issues around the particular subject of THIS thread have to be the exception.

This is because we cannot yet say with ANY real scientific authority at what point life begins.

Deep down I sometimes wonder if the religious actually are right on this issue and if we are really committing mass murder and if perhaps one day our knowledge of life will make us realise this. But while the issue remains ambiguous, I find it difficult to force someone to take an action that they believe is tantamount to murder, when I have little to no evidence to prove that it is not.

Condoms is going too far. But conception? I just don't know.

enda1

Memnoch wrote: »

I get where you are coming from. The whole issue of public service and discrimination does muddy the waters a little.

For example, what if someone's personal beliefs prevented them from serving gays? Or allowing them to stay in their B&B

What then, if ANOTHER person's personal beliefs prevented them from serving blacks? Or allowing them to stay in their B&B.

So on the whole I agree strongly with the principle that people MUST put their personal beliefs aside when working with members of the public and this is even more important in essential service industry jobs such as policing or medicine.

However, I think the issues around the particular subject of THIS thread have to be the exception.

This is because we cannot yet say with ANY real scientific authority at what point life begins.

Deep down I sometimes wonder if the religious actually are right on this issue and if we are really committing mass murder and if perhaps one day our knowledge of life will make us realise this. But while the issue remains ambiguous, I find it difficult to force someone to take an action that they believe is tantamount to murder, when I have little to no evidence to prove that it is not.

Condoms is going too far. But conception? I just don't know.

I understand where you are coming from, but its being decided that the procedure is illegal and not in contradiction with our abortion laws.

Well we had a referendum as an Irish people to allow it so personal opinion I believe shouldn't come into it.
Don't like the rules of the land?
Clear off! (or change them) (not aimed at you Memnoch)

Memnoch

enda1 wrote: »

I understand where you are coming from, but its being decided that the procedure is illegal and not in contradiction with our abortion laws.

Well we had a referendum as an Irish people to allow it so personal opinion I believe shouldn't come into it.
Don't like the rules of the land?
Clear off! (or change them) (not aimed at you Memnoch)

I get it. But we are having an ethical discussion here.

As I said, the simplest solution is to take this kind of decision out of the hands of the doctors.

As you've pointed out above. The Irish public has already agreed that woman CAN have the OCP WHEN they need it. And in that context, it is wrong of a doctor to take that away from her through an imposition of the doctor's morality.

drkpower

nozzferrahhtoo wrote: »

To use your own words in the last line. By opening a business "we could hardly say you signed up to having to" provide the same services as everyone else in the same field as you.
We could do with more doctors, not less, and telling every would be doctor that becoming a doctor means they MUST provide every single service on a given list, barr none, is clearly not the way to achieve this either.

Nozz, I think you focussed a little too much on my use of the word 'inconvenience'. That was perhaps inappropriate (although in my defence, i also used the word 'adverse effect';)). The detriment to a doctor forced to treat a patient does not equate to the potential detriment to you having to give your blood, or jump into save a drowning individual.

But the more important part is the nature of the service. As I said, the vast majority of doctors in this country are part of the provision of a state-funded and mandated public health service, even if they are self-employed or in the private sector. They literally sign up to that. Further, in order to practice here they must obtain a certificate and practice according to profession-wide ethical standards. They literally sign up to that. It does not mean that they must provide every service - that would be completely impractical - but it does not mean they can refuse to provide a service they are qualified and competent to provide without arranging for that patient to be seen by another doctor (or treat, if no alternative is available).

The right to health care is accepted as a de facto human right in this country. Therefore, it is not at all comparable to the majority of services. As a basic right, it should be adminstered by the State, alongside rules made by the State (or the state-created regulatory bodies).

Of course, there is a balance to be struck and doctors who have a conscientious objection must be considered. Therefore the appropriate balance is to allow the doctor to remove themselves from the therapeutic relationship if, and only if, there is no detriment to the patient.

drkpower

robindch wrote: »

Regardless of the rights and the wrongs of the issue, I always wondered about that inconsistency.

Would any doctors in the audience care to comment?

Very simple. The Hippopotamus Oath is not actually taken by any doctor (in Ireland anyway). The ethical guidelines a doctor must follow are those made by the Medical Council. The HO is an irrelevency.

Can I also just nail this private practice thing once and for all - its remarkable how many people consider it applies here. Doctors (public, private, self employed, whatever) do not operate under the same freedoms when it comes to practice as other professionals; while they can choose not to treat someone, that right is seriously circumscribed. So even if a doctor practises in a purely private institution, they would not be entitled to refuse to treat someone in an emergency.

But in any case, in the case at hand, a 'self-employed' GP working in an out-of-hours co-op is providing a public service under a contract with the State - so calling him a private practitioner, as such, is ridiculous anyway.

Dades

drkpower wrote: »

So even if a doctor practises in a purely private institution, they would not be entitled to refuse to treat someone in an emergency.

People seem to be ignoring the nature of what was requested here, however. This isn't a life/death situation, she wasn't ill or in danger of developing a disease. Could the morning after pill even be called a "treatment"?

No one disagrees that there is an onus on doctors to treat patients - but could the lady in question be classed as a patient?

robindch

PDN wrote: »

The state will prosecute you if you break the law, and your religious beliefs shouldn't, and won't, protect you. [...] Using analogies about breaking the law here seems particularly inappropriate.

I wasn't using an analogy -- I was simply commenting up on sensa's post in which the idea of "religious freedom" was interpreted as granting the freedom to act as one believes one's religion requires.

On the contrary, Section 44 of the constitution makes it fairly clear that the state guarantees the right of people to believe what they want to and to enact these beliefs, but only so far as they don't adversely influence "public order or morality", however one chooses to define these terms.

Constitution of Ireland, 44.2.1 wrote:

Freedom of conscience and the free profession and practice of religion are, subject to public order and morality, guaranteed to every citizen.

Consequently, while it's (rightly) almost impossible to show that somebody's private belief is detrimental to public order, it's quite easy to show that many instances of the acting out of the consequences of a private belief are. And the state does not guarantee that right, as sensa appears to have thought.

the_syco

drkpower wrote: »

Jehovahs Witness

Question: Could a Jehovahs Witness refuse the save a persons life if it meant performing a blood transfusion?

nozzferrahhtoo wrote: »

Clearly this doctor has lost this girls business for life, and probably most of the business of anyone she tells her story to. I hope this is so, and I hope it happens for every patient he/she has and they slowly put themselves out of business.

And not just his business, but also the entire SouthDoc service may be blacklisted because of this one individual.

oeb wrote: »

Everything else aside, I still wonder why this lady needed to travel to Cork to see another out of hours doctor. South Doc would also have had different doctors on duty in Listowel (about 40 min away), Castleisland (20 min away) and Killarney (25 min away).

She had to goto Cork to a doc that would give her an after-morning pill. Who's to say that the doc in Cork was the nearest doc that would give her the pill, as opposed to the nearest doc?

=-=

How about the SouthDoc didn't want to give him insulin as it went against the Doctors belief? Now, this is more f**ked up than you may think. If the person had to travel to another doc or die, driving along the road would be a danger to others, as the person may pass out. An extreme situation, but unless the person wrote down that he had gone to the doctor, no-one may know why he suddenly veered to the right and caused a multi-car-crash, wiping out entire families, all because one doc wouldn't do his job.

Sensationalist maybe, but I wonder has it happened?

drkpower

Dades wrote: »

People seem to be ignoring the nature of what was requested here, however. This isn't a life/death situation, she wasn't ill or in danger of developing a disease. Could the morning after pill even be called a "treatment"?

No one disagrees that there is an onus on doctors to treat patients - but could the lady in question be classed as a patient?

Absolutely; do not confuse 'emergency' or 'urgent' with 'life-threatening' or 'limb-threatening'. The releveny guidelines refer to 'emergency circumstances'; nowhere does it say life threatening situations. Providing analgesia/anaesthesia in labour would be considered to be an 'emergency situation' and it is neither life or limb-threatening nor is it necessary per se. Nor is the woman suffereing from any illness.

My own view is that if the woman was up against the 72 hour limit for the use of the MAP (although that limit itself is arguable), it would be considered an 'emergency circumstance', if there was no chance of her obtaining a prescription from a different doctor. If it was the morning after, or even after that, it wouldnt be an 'emergency circumstance'.

drkpower

the_syco wrote: »

Question: Could a Jehovahs Witness refuse the save a persons life if it meant performing a blood transfusion?

No, unless there was another (non-JW) doctor to whom the patient could be refered in the appropriate timeframe.
It works in reverse though; a doctor is not obliged to treat a JW who is insistent on not receiving a blood transfusion (assuming they can be referred to an alternative doc in the appropriate timeframe).

aidan24326

sesna wrote: »

Also use of an abortifacient is more than just an "ethical whim" the GP had.

To take the MAP is to kill a tiny clump of a few cells, not a person. Right now little clumps of cells are naturally aborting in thousands of women all over the world. Right this minute. It happens all the time, and I don't see where the huge moral dilemma comes into it. A person didn't get murdered here, a few cells did (if indeed she was technically pregnant at all, which she probably wasn't).

Dades wrote: »

People seem to be ignoring the nature of what was requested here, however. This isn't a life/death situation, she wasn't ill or in danger of developing a disease. Could the morning after pill even be called a "treatment"?

No one disagrees that there is an onus on doctors to treat patients - but could the lady in question be classed as a patient?

Well since there's a danger of unwanted pregnancy surely that should be classified as pretty urgent. Not life threatening but a serious issue nonetheless. It's not like she presented with a sore throat. Unwanted pregnancy can have major repercussions.


Thing is where does the line get drawn here? Are doctors allowed to get away with refusing the MAP just because it specifically relates to the hugely emotive issue of abortion?

How much does being in private practise allow you to get away with? Can a muslim doctor refuse to treat jews except in life threatening emergencies? What about a staunchly christian doctor refusing to treat gay men?

I very much agree with those who say that doctors, even in private practise, are not running a private business in the way a shop or restaurant owner would be. It's a public service performed under license by the Irish Medical Council and in conjunction with the HSE, and to that extent doctors' hands should be tied on this. You can't refuse treatment on religious grounds fullstop. If some medical interventions (such as the MAP) are to your disliking then too bad. Don't become a doctor in the first place if your religious beliefs make aspects of the job distasteful.

PDN

enda1 wrote: »

I disagree.

A self-employer taxi driver can not refuse to pick someone up for any religious reasons for example.

Actually he can. If you phone up a Jewish taxi driver and demand he take you to the airport on Saturday morning, he is perfectly within his rights to say, "Sorry, I don't work on Saturdays because of my religion, but I'll give you the number of another taxi driver who should be able to help you."

Of course anti-discrimination legislation exists, but in the case of the doctor he was obviously not discriminating if his policy is to refuse to give the MAP to anyone irrespective of their colour, creed, or sexual orientation.

Shenshen

Dades wrote: »

People seem to be ignoring the nature of what was requested here, however. This isn't a life/death situation, she wasn't ill or in danger of developing a disease. Could the morning after pill even be called a "treatment"?

No one disagrees that there is an onus on doctors to treat patients - but could the lady in question be classed as a patient?

There is an issue about effectiveness. The morning-after pill is about 99% effective for about 12 hours after. After that, the effectiveness drastically decreases.
By forcing the woman to let more time pass, the doctor risks the loss of effectiveness and eventually pregnancy.

And what's left then? Having a child she never wanted, or travel to Britain for an abortion.

Nemi

nozzferrahhtoo wrote: »

A muslim, for example, would not get away with signing up to be a chef in a restaurant, then on day 1 pointing out "oh by the way I will be refusing to work with pork, didn't I mention?".

Just as an aside, that kind of issue actually cropped up in a case recently. However, as happens in real life, the case was a bit convoluted.

Hare Krishna chef ‘forced out of job for eating fish and eggs’.

nozzferrahhtoo wrote: »

However if a doctor opens their own private practise, or a muslim opens their own restaurant then why should he be forced to perform a service he does not want to perform?

I've read the thread to the end, so apologies if someone else has raised these points.

For a third of the population (Medical Card holders), the GP is providing a State-funded service. So, for those cases, it would see reasonable for the State to determine what a GP is obliged to do.

For the other two-thirds, it is a private transaction. So, much as you say, it is just a matter of personal preference. Perhaps some people would actually want their GP to be a devout RC, or whatever.

Yet, this is an out-of-hours service. Hence, I'd have thought any GP on duty would have to work within the general scheme of ethics, and not the personal ethics belong to his personal practice. Because, as I understand it, the way those arrangements work is you just see whatever GP is on the out-of-hours rota, and not your own GP. If that GP has different ethics to the GP you've chosen, then you're not getting the service you expected.

Shenshen

PDN wrote: »

Actually he can. If you phone up a Jewish taxi driver and demand he take you to the airport on Saturday morning, he is perfectly within his rights to say, "Sorry, I don't work on Saturdays because of my religion, but I'll give you the number of another taxi driver who should be able to help you."

Of course anti-discrimination legislation exists, but in the case of the doctor he was obviously not discriminating if his policy is to refuse to give the MAP to anyone irrespective of their colour, creed, or sexual orientation.

Of course it would have been well within that doctor's rights not to open his office on that particular day, and have someone else cover the out-of-hours.

However, he chose to open. Imagine the taxi drivers shows up, looks at you, says, sorry, no knackers, and drives off? You would have every right to make a complaint against him.

Choosing you working hours and choosing who you serve and who you don't are quite different issues.

drkpower

Nemi wrote: »

For the other two-thirds, it is a private transaction.

Again, to correct this misperception, it may be a 'private transaction' but that does not make it one where both parties have the usual freedoms that two contracting parties have. The relationship is regulated by the State and there are certain obligations that must be followed.

Just as the taxi driver must give you a receipt (except in certain situations), a doctor must treat you (except in certain defined situations). That is both a fact and, in my view, desirable given the nature of the relationship between the parties and the service being provided.

Herbal Deity

Dades wrote: »

No one disagrees that there is an onus on doctors to treat patients - but could the lady in question be classed as a patient?

An abortion is a lot more costly, serious and risky than taking the MAP.

By not prescribing the MAP, the doctor is increasing the woman's risk of death by surgical complications.

Dades

Why people insist with these erroneous race arguments?

Discrimination is refusing to act because of the person requesting the action. The doctor at the center of this was not interested in who was requesting the drugs, but that he felt prescribing the drugs to anyone was, to a degree, murder in the eyes of his religion.

This is not a discrimination debate - it is a debate as to whether doctors can choose not to administer certain treatments in certain cases.

My own view is that although it may have been an emergency for the lady in question - it was not a medical emergency in the sense that people are suggesting it was.

Herbal Deity wrote: »

An abortion is a lot more costly, serious and risky than taking the MAP.

By not prescribing the MAP, the doctor is increasing the woman's risk of death by surgical complications.

That argument is tenuous at best, if you factor in ovulation, chances of conception, going to term, the age, financial, and mental state of the woman in question.

magicbastarder

edit: point already made above.

Nemi

Dades wrote: »

My own view is that although it may have been an emergency for the lady in question - it was not a medical emergency in the sense that people are suggesting it was.

Is this the nub of the issue? Does medical emergency mean situations where someone will immediately expire? Or does it include situations where you'll merely be crippled for life?

And, clearly, the dispensing of this particular drug on this particular visit does not provoke an emergency. It simply causes a huge inconvenience. Maybe making access to the morning after pill hugely inconvenient isn't such a bad thing, if it reminds folk in rural areas that they'd want to employ a little more forward planning.

magicbastarder

Dades wrote: »

My own view is that although it may have been an emergency for the lady in question - it was not a medical emergency in the sense that people are suggesting it was.

if i turned up at a doctor in a situation where i'd been parasitised, and if immediate action was not taken, an organism would start growing inside me, and sucking nutrients out of me, to the point where it weighted several kilos before bursting out of MY GENITALS, i'd deem that to be an emergency by anyone's standards.

p.s. life is beautiful.

Nemi

magicbastarder wrote: »

if i turned up at a doctor in a situation where i'd been parasitised, and if immediate action was not taken, an organism would start growing inside me, and sucking nutrients out of me, to the point where it weighted several kilos before bursting out of MY GENITALS, i'd deem that to be an emergency by anyone's standards.

Yeah, but, aren't you, erm, of the male persuasion?

Memnoch

Dades wrote: »

Why people insist with these erroneous race arguments?

Discrimination is refusing to act because of the person requesting the action. The doctor at the center of this was not interested in who was requesting the drugs, but that he felt prescribing the drugs to anyone was, to a degree, murder in the eyes of his religion.

This is not a discrimination debate - it is a debate as to whether doctors can choose not to administer certain treatments in certain cases.

It is a discrimination debate because the situation results in defacto discrimination by post code. I.E. if you live in an area where such a doctor works and there is no other doctor in the vicinity then you do not have the same access to treatment that someone in a different area does. Ofc it is the states' responsiblity to ensure adequate medical coverage, but if the state is counting on this doctor to provide that to said region, then it becomes a problem.

My own view is that although it may have been an emergency for the lady in question - it was not a medical emergency in the sense that people are suggesting it was.

The consequences of pregnancy on a woman and her body are quite strong, especially of an unwanted pregnancy. Regardless of what we may personally think (and my own greyness on this issue is outlined above), the Irish electorate has decided that women can have the OCP when they need it. Individual doctors should not be able to use their position of power to then deny them this service.