Abortion Discussion, Part the Fourth

I don't think anybody really gains by forcing a doctor to carry out an abortion when they have a strong objection to it.

The majority of current Consultant Obstetricians would have also been contracted long before 2018. There may be grounds to include clauses in new employment contracts but given that conscientious objection is enshrined in law now its not clear whether a contract of employment could supersede it.

And that's why Dr. Katherine Astbury, whose malfeasance killed Savita Halanappavar, is still practicing obstetrics in Galway. In the US she'd have been stricken off. Not in Ireland - HSE protects their own first and foremost.

ratemds.com has some reviews, Boards having trouble with the link.

Here's one review from 2021:

"Literally let’s people die. She also treats mothers as incubators, reserving no care for them. Please choose someone else, I literally do not want any more kids after the experience I had with her."

and another from 2018:

"Received medical misinformation from her team, decision made not to provide appropriate care before we actually arrived in hospital, and lied to about call from our referring doctor. We actually had to leave and race to another hospital where we fortunately received very good care (portiuncula)"

So, she's not learned from past experience.

I won't go into how the review of Savita's case absolutely trashed the performance of the physicians and the hospital. You can read the report yourself.

HSE's not fit for purpose. Unfortunately we're stuck with it, and it works well for the Government to not seriously change it. Highest administrative load in the EU, for middling/low health outcomes with some serious failures (like hiding the results from Cervical Check too.)

So for the women of places like Kilkenny, where all the ob-gyn consultants are either conservative catholics or muslims, it's tough luck, is it?

Well this is the thing. It's hard to pin down exactly who is pulling whose strings here but I'm convinced something as momentous and disruptive as the repeal of Roe doesn't happen unless somebody somewhere in the chain really wants it as the status quo ante suited so many parties just fine. I don't think it can be merely the outcome of various factions manipulating the issue for political advantage as if that is all the 'pro-life' movement is I'm pretty sure a way would have been found to keep Roe or something equivalent to it in place. Is the ultimate puppet master here the Catholic Church working through its minions on the Supreme Court?

I'm not sure what that has to do with recruitment. In any event I am not familiar with what, if any, complaint or regulatory proceedings were initiated in any of those situations.

I'm also not sure of the relevance of cervical check to the subject matter. In any event the failure to pass on audit results was a matter for treating clinicians as opposed to the HSE as an entity.

both are healthcare. Do doctors get to choose what healthcare procedures they are willing to carry out?

If these people are really so concerned about what "God's will" supposedly is, how do they know that practising medicine at all is in accordance with it? Shouldn't they be performing an exorcism or saying another mass or something?

As usual, it's only sex and women's reproductive issues in particular that they have problems with... quelle surprise.

You'd have to ask those doctors those questions. I would say also that it isn't always purely religious grounds upon which CO is based.

I'd also say that women's health certainly isn't the only issue in this space and you should look beyond the narrow focus you have. This winter and I'm sure into next year the public debate on assisted dying is about to be reignited (through a new Oireachtas Committee) and conscientious objection is entangled in that debate in every way that it is with regard to abortion.

Ah, I stand corrected. Your point is that you think there is an assumption on the part of some person/s that doctors might be forced against their will to perform abortions that you had in mind. I understood doctors with conscientious objections merely had a legal obligation to refer female patients seeking abortions on to another doctor. I wasn't aware that it might be future Govt policy to force doctors with anti-abortion beliefs to perform abortions. Would you have any person/s, body or group in mind which you believe would be likely to try and force doctors to do so?

They have a right to object, not obstruct. If they are unable to perform the duties their position requires then they need to step aside.

For those doctors, whether on religious or other grounds, feel termination a fetus is ending a life, assisted suicide often is one and the same, at least from a principle/moral perspective...

Most terminations don't fall under emergency medicine either and if you truly understood the nuances of conscientious objection you'd know that in the case of emergency situations affecting the life or health of the pregnant woman there is sever limitation on conscientious objection both legally and ethically

As for your last paragraph, all I'd say is let's not confuse a discussion on conscientious objection with the wider anti abortion perspective

Just as an example, there is no consultant in Kilkenny hospital who will perform an elective abortion

So the effect is to obstruct.

No it's not. The effect is a lack of service. But one shouldn't conflate action and effect in such a way.

I haven't mixed up anything, you have a right to object not obstruct, your deflection won't work.

Only the referral? So you accept the obstruction in hospitals?

Unless instructed by the Dail (and even then) the HSE would never prioritize hiring OB/GYN who would, at their interview, agree to provide abortion. If this all about difficulty in hiring, make it a job requirement and heck, pay more. Fire a few percent of the administrators (plenty hired at high salaries during Covid) to balance the salary need.

This isn't difficult, just a matter of will. If you can't get Irish OB/GYN to provide the service, hire from overseas.

But it is difficult. Recruitment challenges generally in the health sector are well documented. Obstetrics has been a traditionally difficult specialism to recruit into for a long time nationally and internationally. In the US alone projections show a gigantic shortfall in obstetricians in the coming years.

Firing "administrators" to pay for more obstetricians is an immature response and shows a complete lack of genuine understanding of healthcare systems management

Resignation is of course an option...

Hospitals can't refuse to provide a service.

What?

So Ireland is insulated against the challenges of recruitment? Is that what u are saying?

Is this a legal, moral, ethical, hypothetical, [insert] question?

What I would say is this, irrespective of the basis for your question, it's an entirely flawed question coming from, as far as I can tell, an ideological position and not a rationale position (no surprises there)

But let's deal with your question and use the aforementioned Kilkenny hospital example. Let's sack our consultant obstetrician who conscientiously objects to carrying out an abortion, even though her contract of employment does not require her to carry them out, even though there's both a legal and medical code of ethics acknowledgment of her right to maintain such a position.

And then let's replace her with...

What exactly?

Congratulations, women of Kilkenny now have a long list of Health care services not available to them because they don't have ready access to a consultant obstetrician.

The question I asked you was if the doctor should remain on in the job when he/she has conscientious objections to providing abortion services the job requires him/her to perform or leave and give the job to another doctor who doesn't have the same objections to providing abortion services. No flaws: Go or stay?

Where did I say that? 🙄

Albeit not for the patient, There's a world of difference between refusing to and not being able to provide a service. The reasons behind not being able to provide a service are nuanced but important if you want to find a solution. You've a simplistic view of Healthcare challenges and even more simplistic view of how to solve them.

So, how long do we wait? 4 years+ since the referendum and counting. 5 years? 10? 30? 50?

Wait for what?