Assisting/Observing Abortion.

[yazoo]

Originally Posted by Singh.Simran

And surely, if you cannot look at a clinical decision as such, you're ipso facto a bad clinician?

My case is rested.

I refer you to my comments above

(I think were it a pure quality of care evaluation as presented, it would make sense, but many doctors opt out not because they couldnt do it properly and to the best of their ability if they had to, just that they find the idea a little unsavoury.)

To dismiss others deeply held beliefs as " a little unsavourary" is somewhat ignorant, IMO. Sure you can voice you disagreement with their views, but you will find yourself appropriately ostracised if you treat your colleagues views so dismissively.

[Singh.Simran]

Your current line seems to boil down to look the GMC say it in their guidance so it must be right..

There's no scientific difference between this procedure and any other, certainly not in 99% of cases. Agreed? Were there actually any danger of "taking life", etc, it would be illegal. It's not. Simple.

So we're talking about a purely opinion/moral based problem. So my question is clear: Why should there be one exception to the generally simple rule that you have to do your job and all that is relevant to it to the best of your ability and to best help your patients?

We're not talking about what the status quo is, or what the GMC think - but what we think the best state of affairs is. It's a theoretical discussion.

Also, i don't think the GMC evaluation is good enough anyway - you say "when Drs views could influence a patients care, they should allow someone else to provide such care. " - but that is patently not the case! It is merely people who disagree with abortion don't have to do it. Or am i wrong? Could well be, so enlighten me, but as far as i know there is no provision anywhere else for anything like this. You could have views on anything, but only abortion seems to count when it involves opting out of doing one's job.


Also, last point. You might have answered this but the debate is getting very convoluted; do you think that there is a significant detriment to the patient in being referred, or not? Because if there is a risk of one, as i imagine there is, then the answer should be obvious.

[yazoo]

Originally Posted by Singh.Simran

Your current line seems to boil down to look the GMC say it in their guidance so it must be right..

You put words in my mouth that are not my own. Don't!

The GMC guidance, which YOU must agree to abide by in order to pratice medicine in the UK, sets the rules of the profession. Agree or not, the choice is yours. But, personally, I find them pretty reasoanble.

There's no scientific difference between this procedure and any other, certainly not in 99% of cases. Agreed? Were there actually any danger of "taking life", etc, it would be illegal. It's not. Simple.

An exceptionally naive view point that I hope you will have grown out of by the time you meet patients. Medicine cannot be distilled into a science only subject. Can you really see no difference in prescribing aspirin for someone with an MI and prescribing drugs for a ToP? Or a hysterectomy for medical reasons vs a surgical ToP?

We're not talking about what the status quo is, or what the GMC think - but what we think the best state of affairs is. It's a theoretical discussion.

I'm not having a freshers style theoretical discussion. I actually treat patients. I aim to act in their best interests.

Also, i don't think the GMC evaluation is good enough anyway - you say "when Drs views could influence a patients care, they should allow someone else to provide such care. " - but that is patently not the case!

In what sense is it not the case?

It is merely people who disagree with abortion don't have to do it. Or am i wrong?

Anyone can refuse to perform any procedure for any reason. whether or not it is deemed acceptable is another matter. But essentially, if you have someone who simply doesn't like doing X (forget any complex legal/moral/emotive topics) , then they don't have to do it. They can negotiate with their colleagues. It's what consultants call a job plan.

Also, last point. You might have answered this but the debate is getting very convoluted; do you think that there is a significant detriment to the patient in being referred, or not? Because if there is a risk of one, as i imagine there is, then the answer should be obvious.

I am sure you are intelligent enough to answer this for yourself, but I will answer. If done skillfully, the patient would often never know. A simple "my colleague Dr X deals with this - I can make an appointment for you now" would suffice. If they ask you outright, you can simply give your honest answer. That you prefer not to deal with ToP, which is why your colleague does it. You are under no obligation to discuss your personal views (and therefore underlying reaons for your choices) with your patients, and in this instance it would clearly be wrong. And you can point out, quite correctly, that your colleague is much better at talking through the pros and cons of ToP.

[BeanOfJelly]

I've skipped a few pages.. so maybe I've missed a relevant post.. but no-one has suggested the potential psychological harm of having an abortion you will regret later. Its not as simple as "you can always have another baby later". I think doctors should be very careful with abortion and how it is administered.. and sometimes this may mean not instantly giving an abortion to someone just when they want it. I understand the "you don't know a patient better than they know themselves" argument, but I also know people who have had abortions in a rush, or worse, because the doctor has told them its for the best, and have been very unhappy about their decision for the rest of their life.

[yazoo]

I agree entirely! Although I think the point has been alluded to already, I can quite see that this thread would be hard to read through from the start.

[Diya]

Suffice to say no one can make moral decisions for any body. We are all human and have moral rules we live by...there are many other ethical issues that bring up the same choices.
Euthanasia for e.g. I am sure the Drs in countries where it is legal are not forced to administer the drugs if they dont morally agree with the procedure (even if they can logically see how it could be the right choice for the patient).
Just as not all Drs would agree to administer the lethal injections used to execute sentenced criminals in some places (even if the Dr agrees they are guilty and should be punished)

[Singh.Simran]

I'm surprised that noone has said that both yazoo and (who was it? Dr Potato?) a right, to an extent. It's a clinical decision to be made by a clinician; you never just do as the patient wants. However, that doesn't mean you disregard what the patient wants, that being surely a major part of the decision making process. Furthermore if the patient doesn't agree they can't be forced into it, and if the Doctor doesn't agree they can't be forced into doing it.

It's a two way thing.





As for the practical side of things which we're now getting into; i suppose it is a workable system, as long as say under 10% of people opt out (such that you don't end up refferring someone 10 miles away or whatever), and while in theory you can "opt" out of doing anything by arranging for someone else to do it, i think there's a serious ethical difference between that an a get out clause enshrined in law.. also i think people who merely arrange timetables so they needn't do a procedure would do it if it came to them or nothing. Perhaps less so with the religion anti-abortionists?

[yazoo]

Originally Posted by Singh.Simran

It's a clinical decision to be made by a clinician; you never just do as the patient wants. However, that doesn't mean you disregard what the patient wants, that being surely a major part of the decision making process. Furthermore if the patient doesn't agree they can't be forced into it, and if the Doctor doesn't agree they can't be forced into doing it.

It's a two way thing.

Quite right. Unless the patient lacks capacity to make the decision for themselves.

As for the practical side of things which we're now getting into; i suppose it is a workable system, as long as say under 10% of people opt out (such that you don't end up refferring someone 10 miles away or whatever), and while in theory you can "opt" out of doing anything by arranging for someone else to do it, i think there's a serious ethical difference between that an a get out clause enshrined in law.. also i think people who merely arrange timetables so they needn't do a procedure would do it if it came to them or nothing. Perhaps less so with the religion anti-abortionists?

I suppose a sizeable minority of GPs won't get involved with abortion, but I have no idea of the figures. I simply know of a few who don't. I know no O&G consultants who refuse to be involved.

There isn't really a get out clause enshrined in law. The GMC guidance is based upon the views of many Drs. While a relatievly small number of Drs draft guidance, all such issues would be open to consensus evaluation prior to being deemed appropriate. So the majority of Drs would agree with the GMC guidance. I certainly have never heard anyone, either privately or publically, disagree with their good practice priciples. Putting them into practice 100% of the time is another matter - to err is human!

So basically, the vast majority of Drs think other Drs should be allowed to refuse to get involved in any case where their persoanl beliefs may influence practice. That makes total sense to me.

[CookieMonster07]

Originally Posted by Gizmo says -

you can always offer to elp clean up afterwards, mind.

LOL!! I'll bear it in mind!!

[CookieMonster07]

Originally Posted by Bambi

I think it's pretty harsh on the patient if you refuse as by doing so you are telling them you think they are doing something wrong. They are probably not exactly happy about having it done and people refusing to be there can only make them feel worse. Saying that I assume they don't know that you refuse.

But what if I do think they're doing something wrong? Must I ignore my own moral principles to prevent them from feeling worse? In refusing to participate I am not trying to make a point to the woman, I am merely maintaining my moral beliefs and refuse to make myself feel uncomfortable in light of the impending procedure. I would of course never inflict my views on my patients, if that is what I wanted, I'd become a preacher/pro-life campaigner!!