Why do 85% of GPs not provide abortion services? - mod warning in OP (01/01/20)

thomasdylan

SusieBlue wrote: »

A womans right to choose is superior to a doctors right to disagree with that choice. She is more important.
Its very basic stuff, to be fair.

Are you saying that if a woman wants an abortion her doctor should be obligated to perform it?

volchitsa

Shefwedfan wrote: »

The mental health.....

Seriously, keep digging at some stage you might admit the statement was stupid and crude

There’s nothing about mental health in Irish law concerning first trimester abortions. You’re confusing it with UK law.

SusieBlue

thomasdylan wrote: »

Are you saying that if a woman wants an abortion her doctor should be obligated to perform it?

No, but he should be legally obliged to refer her to a doctor who can. I have no issues with doctors who have conscientious objections, but continuity of care is important, especially with such a time critical issue (the 3 day wait etc).

There absolutely should be penalties and repercussions for those who refuse to refer women to doctors who are willing to provide the service.

volchitsa

thomasdylan wrote: »

Are you saying that if a woman wants an abortion her doctor should be obligated to perform it?

If I want a flu vaccine, and there’s no medical counter indication, should a doctor be obligated to perform it?

thomasdylan

SusieBlue wrote: »

No, but he should be legally obliged to refer her to a doctor who can. I have no issues with doctors who have conscientious objections, but continuity of care is important, especially with such a time critical issue (the 3 day wait etc).

There absolutely should be penalties and repercussions for those who refuse to refer women to doctors who are willing to provide the service.

It makes more sense to me to have a list of services where abortion is provided available online. It seems a bit antagonistic to require GPs who conscientiously object to refer to somewher that will perform an abortion. Particularly when in practice, I'd imagine theres not a referral letter but just contact info for the service given. Post abortion follow up is probably best with the original GP though.

thomasdylan

volchitsa wrote: »

If I want a flu vaccine, and there’s no medical counter indication, should a doctor be obligated to perform it?

I'm happy to answer your question, even though I see you haven't answered the question I asked you.

Refusal to provide abortion is protected in pretty much every health service. Refusal to provide a procedure is protected as long as the doctor has strongly held moral or ethical beliefs. The onus is on the doctor to justify that the refusal is based on personal ethics. If they refuse to give a flu vaccine they need to justify it. If they cannot justify it there's an issue. If they were to try to justify it based on incorrect medical beliefs I'd say that would be a fitness to practice issue.

SusieBlue

thomasdylan wrote: »

It makes more sense to me to have a list of services where abortion is provided available online. It seems a bit antagonistic to require GPs who conscientiously object to refer to somewher that will perform an abortion. Particularly when in practice, I'd imagine theres not a referral letter but just contact info for the service given. Post abortion follow up is probably best with the original GP though.

And I would also agree that this would be the most straightforward option, only for the fact that as recently as New Years Day we had hundreds of protestors picketing our national Maternity hospital, harassing and intimidating pregnant women, with no regard for their circumstances.
Some of those women who may have just gotten some bad news about a much wanted pregnancy, or had a miscarriage or stillbirth, and absolutely no regard or respect was shown to them.

News spread that one of my local GP offices was offering abortion services and the do-gooders were parked outside for months, imposing on innocent people going about their medical business, the vast majority of whom were probably not availing of any abortion services at all.

We all have a right and should be entitled to avail of medical care without interferance or harassment. For that reason, a list of GP's who provide the service just isn't feasible. Unfortunately the No protesters just can't be trusted in that sense. They see their right to protest as superior to everyone else's right to see their doctor.
It would leave the clinic and its patients wide open to abuse and that's in no ones best interests.

Perhaps if the implemention exclusion zones come in, it would be possible. But there's also resistence on that front so you can't win.
A list of doctors who are unwilling to provide the service would be a safer option all round, particularly because there's little to no chance of anyone protesting & picketing outside their clinics.

keano_afc

SusieBlue wrote: »

We aren't talking about born children, we are talking about pre 12 week gestated fetuses. To you they may be the same thing, but to most, and according to the law, they are not. She is his patient. The contents of her womb is not the patient.

Regardless, the bolded is a direct contradiction of the fact that we voted in favour of repealing the 8th.
We voted in favour of women being put first and being able to end their pregnancy before 12 weeks if they want to. Therefore doctors cannot legally do "what is necessary to ensure the survival of the child". A womans right to choose is superior to a doctors right to disagree with that choice. She is more important.
Its very basic stuff, to be fair.

Nobody ever argued that the mother wasnt more important, which is why 8th amendment specified that the right to life of the unborn was only upheld while practicable. The mother's life always took precedence.

Any time my wife has visited her doctor early in her pregnancies she has been advised how to alter her lifestyle where necessary to ensure her child has the best conditions to develop. This is because her doctor viewed her unborn child as his patient too, and just because you support the right to kill it doesnt invalidate this.

SusieBlue

keano_afc wrote: »

Nobody ever argued that the mother wasnt more important, which is why 8th amendment specified that the right to life of the unborn was only upheld while practicable. The mother's life always took precedence.

Any time my wife has visited her doctor early in her pregnancies she has been advised how to alter her lifestyle where necessary to ensure her child has the best conditions to develop. This is because her doctor viewed her unborn child as his patient too, and just because you support the right to kill it doesnt invalidate this.

Except it didn't, because "upheld while practicable" is subjective and will mean something different to each person. Subjectiveness is dangerous when we're talking about medical law, which is why it caused so many issues, which is why the repeal movement was started.
It was a bad, dangerous law that tied doctors hands during emergencies.

As for the second point, that's not what you said. You said "a doctor will do what is necessary to ensure the survival of that child." That directly contradicts the law we just repealed.
Now you're talking about maternal health & guidelines, which is an entirely different subject matter altogether.

AndrewJRenko

keano_afc wrote: »

A doctor that does not prescribe medication that kills an unborn child is no way putting any of his/her patients at risk.

A doctor that ignores the physical and mental health of the pregnant woman is most certainly putting their patients life at risk.

thomasdylan

SusieBlue wrote: »

Perhaps if the implemention exclusion zones come in, it would be possible. But there's also resistence on that front so you can't win.
A list of doctors who are unwilling to provide the service would be a safer option all round, particularly because there's little to no chance of anyone protesting & picketing outside their clinics.

Yep exclusion zones would be great. Harassment of patients is really wrong. Hopefully it'll die down and stop but there going to be the odd nut that the legislation needs to be brought in for.

Dyr

I don't know but I imagine Ruth Coppinger will be around soon enough to tell everyone why

AndrewJRenko

keano_afc wrote: »

Nobody ever argued that the mother wasnt more important, which is why 8th amendment specified that the right to life of the unborn was only upheld while practicable. The mother's life always took precedence.

You're trying to rewrite history now. The 8th amendment specifically gave the mother equal rights to life with the unborn. The 'practible' limitation was about how far the laws of the state went to defend and vindicate that right. It did not limit the actual right itself.

And many people pointed out this danger at the time.

The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.

thomasdylan wrote: »

It makes more sense to me to have a list of services where abortion is provided available online. It seems a bit antagonistic to require GPs who conscientiously object to refer to somewher that will perform an abortion. Particularly when in practice, I'd imagine theres not a referral letter but just contact info for the service given. Post abortion follow up is probably best with the original GP though.

Antagonistic to expect a referral? That's where GPs really should start leaving the service, if they're not prepared to refer a patient for a legal service.

thomasdylan

AndrewJRenko wrote: »

Antagonistic to expect a referral? That's where GPs really should start leaving the service, if they're not prepared to refer a patient for a legal service.

What I meant was that there's a cohort of doctors who don't want to be involved with providing abortion. They'd want to avoid referring for abortion so a list of places where it is provided makes sense. Having to go to a GP who doesn't provide abortion when all they're going to do is give you a list of places that do it doesn't make sense to me.

keano_afc

AndrewJRenko wrote: »

A doctor that ignores the physical and mental health of the pregnant woman is most certainly putting their patients life at risk.

This is why abortion was legal in these specific circumstances under the 8th.

Rewriting history indeed.

crossman47

Heart Break Kid wrote: »

Why are you feeding the troll. Doesn't matter if abortion is ethically moral or not. Its legal and thats it.

What would be more interesting, would be finding out why so few GPs provide abortion services. Is it a genuine strain on the current services they provide. Is it cost prohibitive and the value provide by the state to perform not financially feasible or is it simply because they hate women, end of story.

None of the above. They do not believe in ending the life of an unborn child. They are entitled to that belief even if the state says its ok.

SusieBlue

crossman47 wrote: »

None of the above. They do not believe in ending the life of an unborn child. They are entitled to that belief even if the state says its ok.

They can hold that belief, but they should be obliged to refer the woman to a doctor who can fulfil the service. Their beliefs do not trump her right to medical care.

volchitsa

Gynoid wrote: »

And when people happily break the news at 12 weeks that they are expecting, what is it that "the people" know they are expecting?

(Oh, Im not going to do ideological battle with you Volchitsa, about constructs like personhood, there are some divides that will never be spanned. So be it.)

They are expecting a baby. By definition, that means they don't yet have one.

If I'm expecting a great job offer any day now, clearly I don't yet have that job.

thomasdylan wrote: »

I'm happy to answer your question, even though I see you haven't answered the question I asked you.

Refusal to provide abortion is protected in pretty much every health service. Refusal to provide a procedure is protected as long as the doctor has strongly held moral or ethical beliefs. The onus is on the doctor to justify that the refusal is based on personal ethics. If they refuse to give a flu vaccine they need to justify it. If they cannot justify it there's an issue. If they were to try to justify it based on incorrect medical beliefs I'd say that would be a fitness to practice issue.

And providing abortion used to be illegal and severely punished in just about every western country. So what? That changed because some people argued that it should be legal, and their case was felt to be convincing.

I'm arguing that it is an abuse of the term conscientious objection to extend it from conscripted soldiers who had no choice about joining the army (the original meaning) to medical personnel who joined voluntarily.

It may take some years for my view to become mainstream, but that's okay.

I'd agree that doctors who joined before the law changed might have an argument to be exempted, but it should be made very clear that this is a temporary thing, and that young people going in for medicine now can be expected to provide all legal medical services when they qualify.

I don't believe that medics' personal ethics should be allowed to limit a patient's medical treatment. That really is a slippery slope. If staff decided that a drug addict, or a criminal, should not be treated for HIV, should that be accepted as conscientious objection? Maybe I want all paedophiles to die a horrible death - so why should I have a treat a convicted paedophile who has a heart attack or a traffic accident?

ETA: this question, I'm dipping in and out so may have missed it. OTOH, if it was you who asked about the detail of the law, sorry no I'm not going to go searching. I don't know what you're trying to prove, it's obvious to anyone that (as my example above shows) currently the situations allowing for CO to be claimed are very limited. It's not a general right. I don't think you would try to argue that it is, or you'd be proving my point about slippery slopes.

volchitsa

crossman47 wrote: »

None of the above. They do not believe in ending the life of an unborn child. They are entitled to that belief even if the state says its ok.

Would it be okay for someone who voluntarily joins the army in peacetime, expecting all the advantages of being a soldier but not the downsides, and then after some years finds themselves being sent to war, to then declare themselves a conscientious objector?

AndrewJRenko

thomasdylan wrote: »

What I meant was that there's a cohort of doctors who don't want to be involved with providing abortion. They'd want to avoid referring for abortion so a list of places where it is provided makes sense. Having to go to a GP who doesn't provide abortion when all they're going to do is give you a list of places that do it doesn't make sense to me.

Most people have a good relationship with their GP and have a reasonable expectation that their GP will provide the medical services that they need. They're probably going to approach their GP in the first instance.

In the current environment, I'd have no difficulty with a clear statement on the GP website where the GP is not providing this service advising the patient where they should go instead, along with details of how they can get any referral information or records required.

I don't think many people are going to attend at the clinic of a non-participating GP just to make things difficult for the GP.

keano_afc wrote: »

This is why abortion was legal in these specific circumstances under the 8th.

Rewriting history indeed.

Abortion was legal after the passing of the Protection of Life During Pregnancy Act 2013, to be clear. There was no legal provision for abortion in any circumstances prior to this.

GPs are up the walls as it is with all the medical card holders clogging up the system with every sniffle they have. They are probably not keen taking on an additional difficult task.

One eyed Jack

volchitsa wrote: »

I asked for evidence of the bolded claim, it seems you don't have any. You don't need evidence because you already know - without evidence? That's called believing, not knowing.

I don't need evidence of JWs practicing medicine who provide blood transfusions because it has nothing to do with what I said. I said that that there is nothing in their beliefs which prohibits them from doing so. There is a prohibition in their beliefs on JWs receiving blood transfusions. That's what I know, and that's all I was referring to - your implication that JWs were prohibited from performing blood transfuions. It wouldn't matter if there were never any JWs practicing medicine (there are) - it's simply irrelevant.

volchitsa wrote: »

You seem determined to miss the real point here - the doctor who refused to operate was refusing to put you at increased risk because s/he did not have the skills to operate safely - not because they had a personal belief that it was wrong to operate without a blood transfusion.

The other anaesthetist did have those skills (often developed due to JWs refusing all blood transfusions even for essential operations - which yours apparently wasn't) and was therefore able to participate in the surgery.

Not because he was a player of medical Russian roulette. :rolleyes:

On the contrary, I'm not missing the point you're attempting to make at all. I know exactly what was on the doctors mind, I was there, you weren't, and they weren't the least bit shy about making their feelings known regarding my decision. Contrary to what you believe, they absolutely had the skills to operate safely (you think I'd let any jackass near me? :pac:) - they were honest with me and we were all acutely aware of what was at stake. It had nothing to do with them "not having the skills" (they do), and everything to do with the fact that they weren't comfortable with the risks of what I was asking because they viewed it as completely unnecessary risk. It also required the procedure being done in a public hospital because the private hospital didn't have an ICU in case things went tits up. I had already signed pages and pages of legal documentation so I wasn't sure myself what the ICU was required for, but it made them more comfortable to perform the procedure.

volchitsa wrote: »

God this is tedious. It's very different, for the reasons I explained. You're doing the same as when you repeatedly ignored studies that contradicted what you believed in favour of this non existent study that you were convinced was out there but wasn't: you are fitting the facts to your beliefs.

You're suggesting that every single case has to be decided in court? More nonsense.

It's incredibly tedious when you're continuing to misrepresent what I said. I never said every single case has to be decided in Court. This is what you asked me -

volchitsa wrote: »

Okay then, should someone who refuses to handle pork be taken on in an abattoir and then facilitated in his refusal to handle pork, or should he be told to get a different job?

Should a Jewish male midwife or obstetrician be allowed to avoid contact with menstruating or bleeding women?

At what point do we decide that if someone won't fulfill part of their job specs for religious reasons then they should just get a different job?

This was what I actually said -

One eyed Jack wrote: »

That can only be determined based upon the circumstances of each particular case. Jessica Yanniv for example recently tried to use anti-discrimination legislation to compel aestheticians to wax their genitalia, in violation of their religious beliefs. The Human Rights Tribunal decided their case had no merit. I wouldn’t suggest anyone should just get a different job as it’s not my place to do so. I would suggest that instead of expecting one should be able to compel another person to violate their conscience, it’s that person should find another medical professional who is willing to carry out any procedures they want in accordance with their wishes.

There are laws to protect people from being discriminated against. One of those grounds is religion. It doesn't mean every single case has to be decided in Court and if you actually read my post, I don't even suggest it. I said that it can only be determined based upon the circumstances in each particular case, rather like the way a physician refusing to provide a service to someone may face a disciplinary hearing or end up in Court, or they may take a risk and act in accordance with Irish law regarding a termination of a pregnancy, and still find themselves subject to a disciplinary hearing, or ending up in Court - it simply depends on which risk they're more comfortable with. You said it yourself that they don't guarantee outcomes. I was always acutely aware of that fact.

In the same way, you can't guarantee that a physician who refuses to assist, procure or provide the means to terminate a pregnancy will automatically be subject to a fitness to ppactice disciplinary hearing or be found guilty of discrimination in court, or any other number of outcomes, because it depends on the circumstances in each and every case. Irisj law allows for a termination of a pregnancy in accordance with the law; in no way does that suggest that a woman can compel a physician to provide them with the means to terminate their pregnancy. There's a distinction between the two ideas I think you're missing.

crossman47

volchitsa wrote: »

Would it be okay for someone who voluntarily joins the army in peacetime, expecting all the advantages of being a soldier but not the downsides, and then after some years finds themselves being sent to war, to then declare themselves a conscientious objector?

Thats such a stupid comparison it doesn't deserve a reply. A soldier joins the army to fight. A doctor joins his profession to save lives. no comparison.

volchitsa

crossman47 wrote: »

Thats such a stupid comparison it doesn't deserve a reply. A soldier joins the army to fight. A doctor joins his profession to save lives. no comparison.

Rubbish. People can join the army to protect their country, or because they want to fly a plane. But that isn't relevant to my point anyway, which is that conscientious objection should only apply to people who have not chosen to go into that particular profession. Conscripted soldiers are entitled to CO, volunteer soldiers would not be. And there is no such thing as conscripted doctors - though as I say, I would accept that doctors who joined under a regime of illegal abortions could argue that they had not signed up expecting to have to carry out abortions. Those doctors could potentially be compared to conscripts. Not those starting out now though.

crossman47

volchitsa wrote: »

Rubbish. People can join the army to protect their country, or because they want to fly a plane. But that isn't relevant to my point anyway, which is that conscientious objection should only apply to people who have not chosen to go into that particular profession. Conscripted soldiers are entitled to CO, volunteer soldiers would not be. And there is no such thing as conscripted doctors - though as I say, I would accept that doctors who joined under a regime of illegal abortions could argue that they had not signed up expecting to have to carry out abortions. Those doctors could potentially be compared to conscripts. Not those starting out now though.

We'll have to agree to differ. It will be a sad day if doctors have to carry out abortions against their will. I doubt it happens anywhere.

Rubberchikken

Maybe this is why abortions need to be taken out of doctors surgeries/ hospitals and dealt with by professionals in licenced clinics.

I accept that some doctors would find it difficult even impossible to carry out an abortion but if legally available in a country then a woman wishing to avail of one needs to be given professional, impartial information and professional care during and after the procedure.

I personally support the provision of legal abortion. A woman's right etc to end a pregnancy if she wishes for whatever reason.

Dav010

Rubberchikken wrote: »

Maybe this is why abortions need to be taken out of doctors surgeries/ hospitals and dealt with by professionals in licenced clinic.

The “professionals” are licensed by the State. Doctors. Who do you think the professionals are?

Beasty

I've just deleted a number of posts. There is a very clear mod warning in the OP - please observe it and do not re-hash the referendum debate. This thread is about GPs and the services they do or do not provide in connection with abortion

Any questions PM me - do not respond to this warning in-thread

volchitsa

One eyed Jack wrote: »

The people did vote for a law though? That’s what a referendum is - a proposal to change the constitutional laws which govern a society. We elect representatives to enact legislation, which we don’t get to vote on, it’s our elected political representatives who propose and vote on changes in legislation.

That’s not just technically correct or being disingenuous. It’s fact.

It's also exactly what I said. People claiming that they didn't expect the current legislation which was planned and announced in the case of a yes vote are either stupid or dishonest though.

I never said anything about people being for or against the proposed legislation,

I never said you did? The poster as was replying to said exactly that though.

because that’s not what people were being asked to vote on. Individual opinions regarding the proposed legislation are completely irrelevant because the people have no authority to change legislation - only their elected representatives have the authority to do that.

What you’re proposing is like me suggesting that if there was actually such a great amount of support for the legislation that you believe there was, then why are only a minority of physicians willing to provide the services? And why do you want to remove their right to choose not to provide those services?

It just seems incredibly undemocratic is all.

Lots of possible reasons why doctors might not rush to train to provide these new services. Several have been suggested. There doesn't seem to be an overall shortage of doctors able to provide the services, so it all seems fairly reasonable to me.

Amd of course doctors' support, or lack of it, would not be strong evidence of support in the general population, either way.

As for why they shouldn't have a right to pick and choose which medical services they wish to provide, IMO it is about medical professionals putting aside their personal opinions in their work. Doctors provide the care that is best indicated for the patient (as long as the patient has requested/agreed to it), whatever their own personal opinions. I mentioned a doctor who wants to refuse to treat a convicted paedophile for personal reasons - by your logic they could do that. They don't, and nor should they be allowed to cite religious reasons for this either.

One eyed Jack

volchitsa wrote: »

As for why they shouldn't have a right to pick and choose which medical services they wish to provide, IMO it is about medical professionals putting aside their personal opinions in their work. Doctors provide the care that is best indicated for the patient (as long as the patient has requested/agreed to it), whatever their own personal opinions. I mentioned a doctor who wants to refuse to treat a convicted paedophile for personal reasons - by your logic they could do that. They don't, and nor should they be allowed to cite religious reasons for this either.

I’m just going to address this part of your post as I’m going to adhere to the mod warning above.

Doctors refuse to treat people all the time for personal reasons. Even when doctors do treat people, how they treat them is informed by their personal beliefs and values. Your idealised scenario of a medical professional ignores the reality that medical professionals are first and foremost human beings, they aren’t mindless automatons.