Conscience Clause

[glamqueen]

I'm a soon-to-be M1, so I know I will have lots of time to decide a specialty; however, OB/GYN is something I have an interest in. I was curious what the perspective is from residents/attendings on the conscience clause law that Bush put into practice that the new administration is discussing revamping/repealing?

Are there any OB's opposed to performing abortions who are worried that a revamp may occur that may force all practitioners to perform upon demand according to the law?

I was just curious if this is an irrational fear as I am not a physician yet and may not understand etc., or if physicians themselves are worried also. Could anyone shed some light on this?

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[Ironspy]

The problem with the conscience clause is that is allows any healthcare worker to refuse to partake in any procedure, medication prescription etc that they object to. As it stands, no OB/Gyn has ever been forced to perform abortions, and that's unlikely to happen in the future.

I should remind you that the average woman spends approximately 30 years being both fertile and sexually active and desires 2 children (on average). Anyone who claims to be responsible for womens' reproductive health is responsible for caring for women for their entire reproductive life cycle (and beyond). This includes health maintenance, contraceptives, prenatal/perinatal care and termination of pregnancy. If you are unwilling or unable to perform terminations yourself, you are still cannot abandon your patient and must refer them in a timely manner to someone who can since your patients will come to you in need of timely and compassionate care. There are plenty of physicians who are morally opposed to OCPs. Personally, I believe that if your morals prohibit you from prescribing OCPs and performing terminations, then you're really only willing to treat women during a small window of their reproductive lives-in which case you should consider another field of medicine.

Just my .02

 

[glamqueen]

Thank you for your reply - I appreciate it. I have plenty of time to consider my stance on everything and pick a specialty, but I do appreciate the feedback from those ahead of me in this game.

 

[EastWestN2grt]

The problem with the conscience clause is that is allows any healthcare worker to refuse to partake in any procedure, medication prescription etc that they object to. As it stands, no OB/Gyn has ever been forced to perform abortions, and that's unlikely to happen in the future.

I should remind you that the average woman spends approximately 30 years being both fertile and sexually active and desires 2 children (on average). Anyone who claims to be responsible for womens' reproductive health is responsible for caring for women for their entire reproductive life cycle (and beyond). This includes health maintenance, contraceptives, prenatal/perinatal care and termination of pregnancy. If you are unwilling or unable to perform terminations yourself, you are still cannot abandon your patient and must refer them in a timely manner to someone who can since your patients will come to you in need of timely and compassionate care. There are plenty of physicians who are morally opposed to OCPs. Personally, I believe that if your morals prohibit you from prescribing OCPs and performing terminations, then you're really only willing to treat women during a small window of their reproductive lives-in which case you should consider another field of medicine.

Just my .02

Excellent Post!!!

 

[achiever]

I don't think there is anything wrong with having a moral basis to not wanting to perform abortions and that should not deter anyone into going into OBG. There are plenty of good OBG who don't perform abortions.

 

[kelaskov]

The problem with the conscience clause is that is allows any healthcare worker to refuse to partake in any procedure, medication prescription etc that they object to. As it stands, no OB/Gyn has ever been forced to perform abortions, and that's unlikely to happen in the future.

I should remind you that the average woman spends approximately 30 years being both fertile and sexually active and desires 2 children (on average). Anyone who claims to be responsible for womens' reproductive health is responsible for caring for women for their entire reproductive life cycle (and beyond). This includes health maintenance, contraceptives, prenatal/perinatal care and termination of pregnancy. If you are unwilling or unable to perform terminations yourself, you are still cannot abandon your patient and must refer them in a timely manner to someone who can since your patients will come to you in need of timely and compassionate care. There are plenty of physicians who are morally opposed to OCPs. Personally, I believe that if your morals prohibit you from prescribing OCPs and performing terminations, then you're really only willing to treat women during a small window of their reproductive lives-in which case you should consider another field of medicine.

Just my .02

Excellent post, I agree

 

[glamqueen]

I do like all the feedback - thanks. So just to be clear -you guys think (the majority of you) that all OB/GYN's should be required to perform abortions or should perform abortions ? Even if that is the only thing they are not ok with? Even if they ARE willing to prescribe the full OCP's even the abortofacient IUD's and the Plan B pill? The fact that I am willing to do all of that but draw the line at prescribing Mif or performing an elective termination makes me unfit for OB/GYN?

I am also interested in EM and in surgery, but I really do want to seriously consider OB/GYN also. I know there is a huge sector of society that believes as I do, so would there not be a market for an OB/GYN who will care/do everything but elective abortions?

 

[amy2003uva]

I do like all the feedback - thanks. So just to be clear -you guys think (the majority of you) that all OB/GYN's should be required to perform abortions or should perform abortions ? Even if that is the only thing they are not ok with? Even if they ARE willing to prescribe the full OCP's even the abortofacient IUD's and the Plan B pill? The fact that I am willing to do all of that but draw the line at prescribing Mif or performing an elective termination makes me unfit for OB/GYN?

I am also interested in EM and in surgery, but I really do want to seriously consider OB/GYN also. I know there is a huge sector of society that believes as I do, so would there not be a market for an OB/GYN who will care/do everything but elective abortions?

I would not take this microcosm that is SDN to be representative of the field of Ob/Gyn as a whole. I respectfully disagree with Ironspy and do NOT think one should "consider another field of medicine" if they will not perform terminations (which is a grossly blanket statement in and of itself). I absolutely do not think I have a professional and moral obligation to perform elective, late term abortions. For that matter, I do not think I have a professional obligation to perform elective abortions, period. Does that mean I will not objectively counsel my patients on all of her options with regards to birth control and pregnancy management? No. Does that mean I will refer patients to the appropriate venue for pregnancy termination if that is what she desires? Yes. Will I perform medically-necessary pregnancy terminations? Of course.

I do not think the issue is as clear-cut as some may think. This issue should not deter you from pursuing Ob/Gyn.

 

[Cologist]

I would not take this microcosm that is SDN to be representative of the field of Ob/Gyn as a whole. I respectfully disagree with Ironspy and do NOT think one should "consider another field of medicine" if they will not perform terminations (which is a grossly blanket statement in and of itself). I absolutely do not think I have a professional and moral obligation to perform elective, late term abortions. For that matter, I do not think I have a professional obligation to perform elective abortions, period. Does that mean I will not objectively counsel my patients on all of her options with regards to birth control and pregnancy management? No. Does that mean I will refer patients to the appropriate venue for pregnancy termination if that is what she desires? Yes. Will I perform medically-necessary pregnancy terminations? Of course.

I do not think the issue is as clear-cut as some may think. This issue should not deter you from pursuing Ob/Gyn.

If you read Ironspy's post correctly, it is clearly stated that one should consider another field of medicine if you oppose BOTH abortion and contraception and I couldn't agree more with this.

 

[glamqueen]

I don't oppose contraception at all. In fact, it appears my views align with amy2003uva's views. Thanks for both of your posts. I'm sure that when I rotate, I'll get a better perspective. I'm just trying to wrap my head around the possibilities right now.

 

[THP]

If you are unwilling or unable to perform terminations yourself, you are still cannot abandon your patient and must refer them in a timely manner to someone who can since your patients will come to you in need of timely and compassionate care.

I completely disagree. I am not willing to perform terminations or refer for them. There is a large population of women who will come see me just for this reason and will avoid providers who do perform terminations. In fact most of the OB/GYNs I have come across in the community feel the same way.

 

[Bluemirage]

Performing abortions can be a dangerous line of work these days and I don't mean for the patients. Here is an article of an OBGYN that was assassinated by a sniper in Buffalo NY. A sniper followed the doc to his home and shot him through the window while he was eating. See link below:

http://www.cnn.com/US/9810/24/doctor.killed.02/

So besides the morality/beliefs issue, OBGYNs performing abortions also have to worry about the their personal and family's safety. Can anyone honestly expect or mandate all OBGYNs to perform abortions under these circumstances? There are alot of OBGYNS in the upstate NY area who are not morally against performing abortions but choose not to do them because of they fear for their safety and want to avoid having crowds of demonstrators in front of their offices. I think one can only realistically expect physicians who are not willing to perform terminations to make referrals to OBGYNs that will.

 

[Ironspy]

I know its unreasonable to say every OB/Gyn should perform terminations. The point I was making is that one really needs to examine their beliefs before choosing OB/Gyn since many people are opposed to abortions AND birth control for religious reasons. I believe that putting your own personal beliefs before the health of your patients is a slippery slope. I'm not sure where you can draw a line between the pharmacist who won't fill scripts for OCPs or Plan B and the Christian Scientist who doesn't believe in ANY medication wants to heal only via the power of the bible.

I happen to think it's reprehensible to refuse to refer your patients for a procedure that you're not willing/able to perform if that procedure is legal---especially if it is safest when done early.

Performing abortions can be a dangerous line of work these days and I don't mean for the patients. Here is an article of an OBGYN that was assassinated by a sniper in Buffalo NY. A sniper followed the doc to his home and shot him through the window while he was eating. See link below:

http://www.cnn.com/US/9810/24/doctor.killed.02/

So besides the morality/beliefs issue, OBGYNs performing abortions also have to worry about the their personal and family's safety. Can anyone honestly expect or mandate all OBGYNs to perform abortions under these circumstances? There are alot of OBGYNS in the upstate NY area who are not morally against performing abortions but choose not to do them because of they fear for their safety and want to avoid having crowds of demonstrators in front of their offices. I think one can only realistically expect physicians who are not willing to perform terminations to make referrals to OBGYNs that will.

 

[peppy]

I completely disagree. I am not willing to perform terminations or refer for them. There is a large population of women who will come see me just for this reason and will avoid providers who do perform terminations. In fact most of the OB/GYNs I have come across in the community feel the same way.

I'm not going into ob/gyn but I've noticed that in my rotations as well. Some women will ask around to find the ob/gyns who don't perform elective abortions, so I don't think a pro-life ob/gyn would have a shortage of business. Women are not a monolithic group who all share the same values, so I think it is probably beneficial to women to have doctors from a diverse range of viewpoints. Then women can find the doctors who understand them best.

To address the OP, you may be able to get answers by contacting the American Association of Pro-life Obstetricians/Gynecologists with your concerns. They seem to have a good-sized membership, so I definitely don't think pro-life people should give up on the idea of going into ob/gyn.

 

[glamqueen]

Peppy - thank you for your post. My underlying major concern - maybe you guys might have an opinion to share with this- is that I will have a military obligation to fulfill. I'm HPSP. So I don't want to go into OB/GYN, have the laws change, and then be FORCED to do things I feel morally against. Does this make sense? I've been told it is unlikely since the military is so right of center, but still...it definitely makes a difference when you can't just "quit" a job. I mean, I'll have to do what I'm ordered.

 

[AnotherOBGYNapp]

A few thoughts:

1. There is a spectrum here, ranging from providing terminations yourself to being a complete roadblock to your patients and their medical care. It is possible to fall somewhere in the middle; not providing terminations but still making certain that your patients have timely access to various services.

2. Consider that there are some institutions that do not allow certain types of reproductive services within their walls. Consider training at and practicing at one of these institutions, but remember that the same place that doesn't "allow" elective terminations might also have prohibitions on certain types of contraception. In these cases, it is important to remember my previous point (#1).

 

[Ziehl-Neelsen]

Peppy - thank you for your post. My underlying major concern - maybe you guys might have an opinion to share with this- is that I will have a military obligation to fulfill. I'm HPSP. So I don't want to go into OB/GYN, have the laws change, and then be FORCED to do things I feel morally against. Does this make sense? I've been told it is unlikely since the military is so right of center, but still...it definitely makes a difference when you can't just "quit" a job. I mean, I'll have to do what I'm ordered.

The military does not provide elective abortions due to the restrictions of the Hyde Amendment, which bars the use of federal funds used for elective abortions. This amendment is not affected by the recent change in the Mexico City policy and must be legislated out of existence before military physicians would even have the option of performing an elective termination. Currently, women who desire elective abortions must seek them outside of the military medical system and pay for them out of pocket.

This was one of the deciding factors for me to join the military. As a pathologist, I absolutely refuse to perform a pathologic evaluation of an electively terminated baby; numerous civilian residencies at which I interviewed had no policy protecting residents from performing procedures which they found morally abhorrent. There is a significant cohort of military obsetricians that remains in the military for these reasons.

 

[Cologist]

This was one of the deciding factors for me to join the military. As a pathologist, I absolutely refuse to perform a pathologic evaluation of an electively terminated baby; numerous civilian residencies at which I interviewed had no policy protecting residents from performing procedures which they found morally abhorrent. There is a significant cohort of military obsetricians that remains in the military for these reasons.

Talk about putting yourself in the way of women having access to healthcare! A pathologic evaluation of an electively terminated fetus is usually done when there is something wrong with the fetus in the first place (trisomy, anencephaly and so on). So instead of providing potentially clinically important information to your patients, you keep them in the dark. Nice.

 

[Ziehl-Neelsen]

Perhaps you should do a rotation in pathology. Every surgical specimen requires pathologic evaluation by a pathologist. Elective abortion is a surgical procedure. QED. (furthermore, as I'm sure you are aware, the vast majority of elective abortions are performed on genetically "normal" babies).

I have performed numerous post-mortem exams on IUFDs and stillbirths for suspected genetic abnormalities. I do not relish these procedures, but I am able to take some solace that I provide useful information for the family. I, however, refuse to have any part in the murder of babies. I consider this analgous to the plastic and reconstructive surgeons who refuse to perform procedures on some patients...

Furthermore, I responded to a post that asked a specific question and tried to provide knowledge that I am uniquely qualified to give. I didn't expect to be harangued for doing so.

 

[rayofdiana]

For what it's worth, state laws requiring examination of products of conception by a pathologist varies from state to state. In many, it is not the norm before certain gestational ages. This might be where the confusion between the two of you is coming from. (Besides the disagreement on some ethical concepts; I'm with Cologist for that one.)

 

[grayce79]

Peppy - thank you for your post. My underlying major concern - maybe you guys might have an opinion to share with this- is that I will have a military obligation to fulfill. I'm HPSP. So I don't want to go into OB/GYN, have the laws change, and then be FORCED to do things I feel morally against. Does this make sense? I've been told it is unlikely since the military is so right of center, but still...it definitely makes a difference when you can't just "quit" a job. I mean, I'll have to do what I'm ordered.

I am an ob/gyn resident in the military. I would fall over shocked if for some reason the law changed and elective terminations were allowed in the military. However, should this ever be changed, you will never be forced to do a procedure that you do not feel comfortable with. For example, several military ob/gyns at my military facility are strict Catholics and do not give contraception or do tubals. They are not forced to give contraception or do tubals since that is against their personal beliefs.
If you plan to do a military residency in ob/gyn and want abortion training, they will let you do an elective at a civilian institution to get training for it.

 

[glamqueen]

grayce79 - great response. Thank you so much - I really feel better about considering OB/GYN.

Other posters - thank you for your input. This was a really helpful thread.

 

[McGillGrad]

If this is true, then you are setting yourself up for losing your license.

You cannot refuse to refer a patient for elective abortion. It goes against all ethical and legal guidelines for practising competent medicine.

I completely disagree. I am not willing to perform terminations or refer for them. There is a large population of women who will come see me just for this reason and will avoid providers who do perform terminations. In fact most of the OB/GYNs I have come across in the community feel the same way.

 

[McGillGrad]

It is a fetus, not a baby. You have a right to be biased, but you could at least try to be rational. I know it is difficult for religious people, but at least try.

P I, however, refuse to have any part in the murder of babies. I consider this analgous to the plastic and reconstructive surgeons who refuse to perform procedures on some patients...

 

[THP]

If this is true, then you are setting yourself up for losing your license.

You cannot refuse to refer a patient for elective abortion. It goes against all ethical and legal guidelines for practising competent medicine.

Show me the specific law forcing me to do this. In fact I can fire or refuse to see any patient I want as long as its not an emergency.

 

[McGillGrad]

Show me the specific law forcing me to do this. In fact I can fire or refuse to see any patient I want as long as its not an emergency.

That is not what you originally said. You said that you would refuse to refer a patient. That assumes that the patient is already in your care.

I am not willing to perform terminations or refer for them.

 

[THP]

That is not what you originally said. You said that you would refuse to refer a patient. That assumes that the patient is already in your care.

I meant the same thing. Show me where it says I have to refer or risk losing my license (as I'm sure you know licenses are issued by individual states).

 

[Regnvejr]

I meant the same thing. Show me where it says I have to refer or risk losing my license (as I'm sure you know licenses are issued by individual states).

Many states consider it malpractice if you do not. And the license boards take a dim look at physicians who do not refer patients so they can form a full, informed decision.

Refusing to refer goes against laws, license board rules and the ethics of most medical diciplines.

Feel free to challenge it