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Contraception, doctor-patient relations, Ethics, STDs, war on women

Contraception, medical care, and the cult of the individual

When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion.

So I spoke with her. I explained that over the course of her career she would undoubtedly see people from all walks of life with a myriad of religious and or personal practices. I explained that medical care is not about fulfilling any personal need beyond the need to help.

I gave the example of a doctor who is a Jehovah’s Witness. Refusing to order a blood transfusion would be both unethical and malpractice.

I had an OB/GYN who practiced the same religion discuss how he felt that he could prescribe contraception and still honor his Church.

None of this mattered. In her eyes prescribing contraception was an affront to her religion.

“What if you don’t council a patient about condoms and she gets HIV?” I asked.

No answer.

“Do you think it’s ethical for a woman to take time out of her day to come for a well-woman exam and not leave with the contraception that she wants and needs?”

Silence.

“What if that woman leaves your office without birth control, gets pregnant, and is then beaten to death by her partner as pregnancy puts her at increased risk for domestic violence related homicide?” I persisted.

“My patients will know I won’t prescribe birth control or discuss condoms. They will get the Creighton method,” she said.

“How? Will you have a sign? Will your receptionist tell every patient who calls?” I asked.

If the answer had been, I realize my personal belief system puts me at odds odds with the standard of care so I’m headed for pathology I would have commended her for her insight and given her a passing grade with a note about her contraception issues on her transcript.

But she responded that she was going to be a family doctor.

I spoke with the Chief of OB/GYN and the Dean of the Medical School. They agreed that refusing to be involved in any way with contraceptive or safe sex counseling should result in a failing grade on the clinical component of the rotation.

They agreed, that is until she lawyered up. A public fight about teaching contraception would just be too much, you know?

Shortly thereafter I resigned as the director of medical education for OB/GYN and left for a different state.

If a doctor can refuse to discuss contraception, essentially proselytizing to patients, then we should not be surprised that some pharmacists will refuse to dispense it AND be protected by the law

Ask yourself, do you want your own health care provider to consider their own religious or personal beliefs first before offering you medical care? If so, then everything is up for grabs. Everything. From blood transfusions and addiction medicine to fertility therapies and weight loss therapies because it all depends on how you interpret any given scripture.

The only religion that my patients see me practice is medicine. Anything else, in my opinion, is malpractice.

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Discussion

20 thoughts on “Contraception, medical care, and the cult of the individual

  1. Well said! Fabulous! Thank you

    Sent from my iPhone

    On Sep 28, 2012, at 4:54 PM, “Dr. Jen Gunter” wrote:

    WordPress.com Dr. Jen Gunter posted: “When I was the director of undergraduate medical education for OB/GYN at a Midwestern university (a state school), it came to my attention that a medical student was refusing to have anything to do with contraception as it was against her religion. So I”

    Posted by Sabine Munshi | September 28, 2012, 4:57 pm
  2. Dr. Jen,
    Aren’t medical students taught the Hippocratic Oath (excuse spelling errors, I am a theologian not a physician) where you promise to ‘first do no harm’? Denying a patient much needed care could lead to illness or injury; these misguided religious doctrines lead them to disregard the most important stance in medicine.
    AND this bizarre excuse for religious beliefs, in essence, imposes their beliefs on someone who probably has very different beliefs, and denies the patient their religious freedom, or freedom from religion.
    I dont’ know how we’ve come to this: people in helping professions should not be allowed to interfere with beliefs (or lack of them) of those who need their care.
    Caring for the greater good of the community supercedes an individual’s private beliefs; if you don’t believe in birth control, don’t use it, but don’t stand in my way if I need it .
    If you don’t want to practice medicine in its present width and breadth, then go into another profession.
    In the future, will there be physicians who deny patients antibiotics because the bacteria infecting the patient’s body are ‘life,’ and all life is precious?
    This ‘anti-science’ movement is terrifying; people have forgotten how to think rationally.

    Posted by Noel | September 28, 2012, 6:11 pm
    • So well said, and I couldn’t agree more. Our society is becoming one of, “Me first, everyone else second!” It makes me so sad and angry. I read a similar story recently about a student who wanted to go into counseling but refused to counsel gay people because her religion told her homosexuality was a sin. The only thing she would tell them was that they needed to stop being gay. Can you imagine being a bullied, gay teenager and getting her for your counselor? She got a lawyer, too, and I don’t know how it turned out, but if you can’t meet your patient where he/she is, then what are you doing in that profession? Be a pastor.

      Posted by Amy | October 5, 2012, 6:26 am
  3. I write this comment as a committed Christian and bible student, and also a healthcare professional (though not a clinician). As a provider of diagnostic services, I have to accept that I am here to provide care for people irrespective of whether they are unholy by somebody’s definition, even mine.

    But I think you are wrong that the only religion your patients see is medicine. At the edges, where the ethics cases arise, what is the religion of medicine? Save life at all costs? Do no harm? Do what the patient wants? Unless I have missed a significant piece of knowledge, the religion of medicine is incomplete, and something else has to come into play? My many clinical friends disagree strongly around these issues associated with the choice to end life, and think about them deeply- and talk about the regularly.

    Btw, We use contraception, and I can’t begin to understand why this would be considered against Bible teaching. Or why a church thinks it can make a superior ruling to what it’s own authority says.

    Posted by Gg | September 28, 2012, 6:12 pm
    • Having a religion does not make one immune or exempt from having moral dilemmas. While religion X may have a clear way to handle some types of situations. there will be dilemmas elsewhere.

      Posted by Anat | September 29, 2012, 4:08 pm
    • Do not confuse religion with ethics. They are completely separate. One need not have religion in order to be an ethical person, and your religion should not be a factor in the decisions you make in your job. If religion comes into play at all, it is the healthcare recipient whose religion matters, not yours. Ethics put forth by your professional association may still put you in conflict with that patient, but your religion drives only your choices for your own personal healthcare, not for the people you are serving.

      Posted by DF | October 1, 2012, 12:38 pm
  4. If a persons religion stands in the way , they should not be in the medical field .

    Posted by Jim ( aka@riiibbit ) | September 28, 2012, 11:44 pm
  5. Excellent post. I had a similar and stranger ongoing battle with a fellow student when I was in medical school. He said he would also not prescribe any contraceptives to women, unless it was for non contraceptive use. In that case, it was ethical due to “secondary intention.” He was very vocal about this.

    When we had an amazing presentation on Religion and Medicine, which focused on how honoring and connecting with the PATIENT’S religious and spiritual beliefs can enhance the practitioner – patient relationship, he proceeded to monologue about how he, as an observant Catholic, would impose his religious restrictions (that 80% or more of female Catholics choose to ignore).

    This story has a different twist, however. As VP of Med Students for Choice, one of the club activities I did was pass out condoms after the last exam in a block at the end of a semester. I knew there was going to be some heavy partying, and a lot of people would be traveling back home and hooking up with long lost flames. This anti-contraception med student started grabbing handfuls of them and stuffing them in his bag. His friend told me that the student regularly had sex with strippers at the nearby strip club, and he didn’t think using condoms violated his belief system, because he was using them to prevent disease, not as contraception. So, it was ethical due to “secondary intention”.

    No joke.

    Posted by MomTFH | September 29, 2012, 5:05 am
  6. I commend you for your strong sense if medical ethics and for doing your best to guide young doctors down an ethical path. Thanks for sharing this story – its quite powerful.

    Posted by GloPan | September 29, 2012, 12:06 pm
  7. So, Doc, since her religious convictions flew in the face of whatever your convictions are, she failed? Never occurred to you that a patient could see a different doctor who would sing the praises of condoms? Wow. I hope you are out of medical teaching now. Your ethics are scary.

    Posted by jaxsolo | September 29, 2012, 1:50 pm
    • The Doc’s questions regarding the student were about how the students stated refusal to discuss contraceptives flew in the face of established medical practice, not her own personal beliefs – even though those beliefs seem to mirror established protocol in this particular instance.

      Also, the students refusal to discuss HOW she would would advertise her refusal to discuss or provide birth control is a real sticking point. Unless you’re going to give every potential patient a heads up IMMEDIATELY, how is she going to prevent patients from wasting their time coming to a doctor who they subsequently need to leave because they find out at the bottom of some form, or told three visits in, or even worse, get told when they actually need such services, that the doctor doesn’t provide them?

      Posted by Jesse | September 30, 2012, 10:44 am
    • Religious convictions apply to the way an individual behaves. It does not apply to controlling others and forcing them to observe your interpretation of your religion. It definitely does not apply to intentionally entering a field in which one’s extreme religious convictions will force conflict and denial of services on an almost daily basis.

      And, these religious convictions are extreme. 98% of women in the United States use birth control at some point in their life, including the vast majority of Catholic women. This is not a fine point. This is basic health care.

      Birth control is a fundamental part of effective public health. There is no denying that controlling fertility and reproduction overwhelmingly saves lives and improves the quality of life of not just women, but their children, families, and community. This is not even considering the other medical uses of forms of contraception, such as controlling menorrhagia, etc.To deny this is unethical. Your definition of scary ethics are truly frightening.

      Posted by MomTFH | September 30, 2012, 12:11 pm
    • That means the woman has to book two appointments, likely a month or more apart, miss work twice, and probably receive two pelvic exams (what doctor says, “Oh, you just had one? Okay, here’s a prescription.”) This is an acceptable option for you? It’s not for me! I would be irate if I went for a script for the pill, only to be told after all was said and done that it was against HER religion! She isn’t the person taking them! Dr. Gunter’s ethics are spot on. A physician’s job is to provide healthcare. If I wanted someone to save my soul, I would go to church!

      Posted by DF | October 1, 2012, 12:53 pm
  8. This is actually not a new phenomenon. My parents decided to stop having children when my older sister was born, but the family doctor was Catholic and would not perform a vasectomy. By the time they found a doctor to do it, I had been conceived. That being said, I still find it outrageous that a healthcare provider basically forced my parents to raise a larger family than they had chosen for themselves. If your beliefs conflict with your duties stay out of the field altogether. I go to a doctor for healthcare, not to be judged by standards that I don’t believe in.

    Posted by DF | October 1, 2012, 12:45 pm
  9. As a pharmacist (RPh Pharm D), I have worked with a few who would not dispense routine or emergency contraceptives. (despite them being scientific people who understand that conception does not immediately occur at coitus) This is legally acceptable as along as someone is readily available who will. One may choose to opt out of the patient encounter as long as they do not choose to get in the way of the care the patient requires. That person will usually just take a walk for a moment while we take care of the patient. Silly, petty, whatever gets them through the night. I have always made it known that I would be available should the need arise so that our medical staff wouldn’t have to go “shopping” among the med staff at the last minute to take care of the patient.

    Posted by Combat Boot RPh | October 4, 2012, 8:03 am
  10. I once had a doctor tell me that I shouldn’t be on birth control because I was married. Then he made notes in my chart indicating that I had medical reasons not to be prescribed birth control (pills/Depo), so when I switched doctors, even though they didn’t have the same bias, they hesitated to do so.

    Posted by Denise | October 4, 2012, 10:29 am
  11. “My patients will know I won’t prescribe birth control or discuss condoms. They will get the Creighton method,” she said. She did not say she would not discuss birth control! She would not “prescribe” birth control. By discussing the “Creighton Method”, she would be discussing birth control. I think your suggestion of a sign or brochure, describing her beliefs on birth control for her patients is a good one. I would assume also, that she would be discussing “absentenance” – the safest form of birth control. There are lots of women that would appreciate a physician with the same moral values.

    Posted by Jan | November 5, 2012, 8:14 am
    • Jan, signs and brochures at the office or using the receptionist to inform people won’t cut it. I actually encountered this at a practice associated with a women’s medical center affiliated with a major teaching hospital in, of all places. California. The first physician I picked off a list of allowed providers turned out to be one who didn’t provide birth control. I called and made my first appointment and wasn’t told. When I confirmed just before the appointment, the receptionist finally remembered to inform me. At that point I was stuck, because I needed the appointment in order to get a referral for other necessary medication and I couldn’t afford to wait any longer.

      In that first appointment, the physician never discussed the issue with me all (and I was too scared to bring it up because I was afraid she wouldn’t give me the referral if I was immediately leaving her care). When I finally confronted her on this at a second appointment, all she said was that it was her receptionist’s job to inform me, not hers. Needless to say, we agreed to a parting of the ways and I found another provider.

      Posted by Amanda | November 16, 2012, 9:59 am

Trackbacks/Pingbacks

  1. Pingback: The Doctor Who…. « herlander-walking - October 2, 2012

  2. Pingback: Ectopic pregnancies, exploding gifts from God at some Catholic hospitals « Dr. Jen Gunter - November 5, 2012

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