Ectopic Pregnancy Surgery / Abortion

[Wanna_B_Scutty]

If you made the choice to practice in a system of medicine where this was part of the code of conduct then you would be obliged to practice within this code of conduct. I don't think he was saying he would actually do this, because like me he would probably never agree to practice in such a system. You have a choice, no one forces you to join a proffession, but by joining you effectively agree to operating within that proffession's code of conduct. If the code of conduct changes at some point you are always free to leave that proffession. If you disobey the code of conduct then they are free to kick you out too (i.e. take away your license).

But now we're back to where we started. You are defining "ethics" as the rules set out by the professional socitey. I, however, would call that a "professional code." I do not accept that as the definition of ethics.

Rather, I accept the definition of ethics helpfully cited by OncoCaP: that "medical ethics is the study of moral values as they apply to ethics. In many cases, moral values can be in conflict, and ethical crises can result."
http://en.wikipedia.org/wiki/Medical_ethics
Thus, if the professional code has unethical content, it is possible to act unethically while following the code. Likewise, it is possible to act ethically in opposition to the code.

Regarding the necessity of following the code... it is just that. A code. A code may hold sway within the given organization, but Federal Law > Code. Thus, by choosing to take advantage of the laws designed to protect objectors to certain sections within that code, I violate the code but cannot be punished for its violation. And since I reject your premise that code = ethics, I can safely say that choosing to violate the code is not inherently unethical.

Ultimately, we can probably never agree on this, so it's all academic. However, I find the premise that ethics = code of rules particularly suspect, given that this premise is being set out by the very people who would gain the most power through universal acceptance of such a premise.

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[kylek044]

Ethics does not equal morals and therefore does not equal the mandate of god. Ethics is the code of conduct that humans operate under. These codes of conduct can be based on morals and values, but they are not equivalent. As people's beliefs have changed throughout history, the codes of conduct that reflect these beliefs have also changed. Also new ethical dilemmas come constantly for which we have to decide what is the ethical response thereby adding to our code of conduct. An example is the number of issues having to deal with HIV patients that never existed before the 80s. A person has a personal code of conduct that is based on their own personal beliefs, and for you this might in fact equal the word of your god. For me it reflects my beliefs based in western science and the teachings of the buddah, so my personal code of ethics probably looks really different from yours. But both of us, as practicing physicians in the US allopathic system, agree to operate within a code of ethics that has been standardized for all physicians, decided by physicians, reflecting the beliefs of the majority in our proffession. This is to standardize what a patient can expect within the doctor patient relationship to try and strengthen their trust in that realationship. Occassionaly we add to and change this code to try and improve this relationship and to reflect the ever changing beliefs of humanity.

For any theist, the code of conduct that they operate under should be a DIRECT influence of their religous beliefs. And, as you mentioned, we should ADD to the code. I don't think we should ever chip away at the professional code of medicine and sacrifice beliefs because some nut-job decided to do something stupid that changes popular opinion.

 

[OncoCaP]

I also agree that we should not blindly follow a professional code. Basically no one does so anyway when you get right down to it. Professional codes are very helpful, but they have their limits and can be manipulated for improper reasons. In those areas where a professional code follows generally accepted ethics and morals, it should certainly be obeyed; any deviation should be a very unusual situation. Where the professional code has been manipulated by leaders past or present for their own personal benefit or unjustified agenda, the professional code is in poor standing.

We all have minds, education, experience, and, I dare say, values, whereby we can judge when the code is wrong and should not be followed. Such deviations must be made with great care and in some cases the best approach is for the physician with the objection to simply not get involved in a case.

As a counterexample to simply bowing out of a case, if the professional code, by some unfortunate turn of political events, advocated discrimination based on some other unjust criterion (race, age, etc.), I'm convinced that not only does it make sense not to follow the professional code, but I would consider it a physicians duty to follow a higher ethical or moral law than what the professional code represents. I'm not suggesting that a physician think of himself or herself "above the law." Some physicians think they are part of an elite group that can make up rules about life or death as they go along; I question such a perspective. In my opinion, physicians must answer at least to the same higher laws of justice and fairness that everyone else does as well as stricter and more demanding requirements.

We should not use the excuse of losing our license to allow the weak, mute, or very young from being treated unfairly or inappropriately in medicine or any other field. The idea that we should not join a profession because aspects of it are corrupt or unethical is not the right approach either; that would just make matters worse by increasing the corruption and damage. There are physicians who do things that are unethical and they may try to justify their actions or even codify their reprehensible actions as proper conduct. If anything, we need more physicians who are concerned about and able to help patients and want to conduct themselves ethically, even if they can't always agree on what exactly is ethical in a particular situation and need to work out difficult cases from time to time.

 

[snoozer]

Are you actually saying that you'd refer for an organ transplant cut from a political prisoner just because the standard of care told you to?!?!

Oh my god. That is most horrifying thing I've ever heard.

May I suggest that you have a look at the wiki article referenced by OncoCaP? Despite the thoughtless gruel you may have been fed that simply says "following the rules we give you is ethical and failing to follow those rules is unethical," we are not mindless automatons doing whatever the rules say and always without questioning. At least... I'm not. There are, after all, medical crises in ethics. And all sides will agree that abortion constitutes an ethical crisis.

This is particularly true since, as stiffany pointed out, ethical standards change over tme. I'm sure you recall that in the beginning of this century, the distribution of birth control was unethical. Would you have refused to give someone the Pill if you'd been an MD at that time? Even more importantly, the birth contol example is revelatory in that it shows us that professional codes are often more informed by politics thatn they are by ethics- two related but distinct entities. Thus, professional codes, however much they might like to set themselves up as defining ethics, are always suspect.

And yes, this is relevant to the thread. The issue at hand is basically: what is ethics? Is "ethics" simply synonymous with a professional code? If so, you are quite right that ethics would be doing whatever the code says. However, as OncoCaP's most recent posting points out, it can sometimes be ethical to not follow the code just like it can be unethical to follow it. This is revelant because it reveals that anyone failing to follow the "refer" code is not automatically rendered unethical.

Nice attempt to make my response into something it isn't Wanna be scutty. Then again, I truly don't expect any better from you.
As psipsina pointed out, if I had AGREED to work within that system, that means that I had AGREED with the ethics code enough to go ahead and actually abide by the set rules and standards of care set forth by the country in which I am practicing. However, under no circumstance, as you attempted to twist it into, did I say that I was willing to work in China. Did I say I advocate referrals to a kidney transplant program? I did not, but thanks for attempting to make a giant assumption. Ahem.

I appreciate your attempts to try to turn this into a personal and emotional debate, but that's really not my goal here. Now back to the topic at hand, at the bottom line "ethics" is now in large part defined as a code set up by the board that gives you your license. As you mentioned, you think it's a sneaky thing and you dont agree. However, you are not the board that hands down my license or even yours, so though your personal opinion is against defining ethics in that way, it may stand to be this way for some period of time before techno jargon and whatever is hip, (we used to be called doctors, now we are "physicians") changes that.

And finally, I am not operating on thoughtless gruel. You follow the standards, that doesn't mean you aren't aware of what you are doing. If you agree to practice within the system, then you should at least be able to operate somewhat within the guidelines. I think this is the bottom line, don't sign up for something that you couldn't even agree to in the first place.

 

[psipsina]

I also agree that we should not blindly follow a professional code. Basically no one does so anyway when you get right down to it. Professional codes are very helpful, but they have their limits and can be manipulated for improper reasons. In those areas where a professional code follows generally accepted ethics and morals, it should certainly be obeyed; any deviation should be a very unusual situation. Where the professional code has been manipulated by leaders past or present for their own personal benefit or unjustified agenda, the professional code is in poor standing.

We all have minds, education, experience, and, I dare say, values, whereby we can judge when the code is wrong and should not be followed. Such deviations must be made with great care and in some cases the best approach is for the physician with the objection to simply not get involved in a case.

As a counterexample to simply bowing out of a case, if the professional code, by some unfortunate turn of political events, advocated discrimination based on some other unjust criterion (race, age, etc.), I'm convinced that not only does it make sense not to follow the professional code, but I would consider it a physicians duty to follow a higher ethical or moral law than what the professional code represents. I'm not suggesting that a physician think of himself or herself "above the law." Some physicians think they are part of an elite group that can make up rules about life or death as they go along; I question such a perspective. In my opinion, physicians must answer at least to the same higher laws of justice and fairness that everyone else does as well as stricter and more demanding requirements.

We should not use the excuse of losing our license to allow the weak, mute, or very young from being treated unfairly or inappropriately in medicine or any other field. The idea that we should not join a profession because aspects of it are corrupt or unethical is not the right approach either; that would just make matters worse by increasing the corruption and damage. There are physicians who do things that are unethical and they may try to justify their actions or even codify their reprehensible actions as proper conduct. If anything, we need more physicians who are concerned about and able to help patients and want to conduct themselves ethically, even if they can't always agree on what exactly is ethical in a particular situation and need to work out difficult cases from time to time.

I agree that you shouldn't blindly follow. If you see something within the medical code of conduct that you believe is not ethical, you have the right to try and gather like minded physicians to change it. If you see a group whose interests are not being adequately protected you can rally for change. As a member of the proffession you have a voice that will be listened to, especially if there are enough of your collegues who feel the same way. However if you violate the code of ethics before change has occurred you risk losing your license to practice. I never said that you shouldn't join a proffession if your personal values don't jive with that proffession's code of ethics, but only pointed out that joining is your choice. If you don't feel like you can endure some opposition between your personal values and the code of conduct of your proffession, you don't have to join. You can also chose to avoid specific specialties that would make that opposition more likely to occur. If you feel like there is something that needs to change and want to work for that change, thats great too.

 

[Wanna_B_Scutty]

Now back to the topic at hand, at the bottom line "ethics" is now in large part defined as a code set up by the board that gives you your license. As you mentioned, you think it's a sneaky thing and you dont agree. However, you are not the board that hands down my license or even yours, so though your personal opinion is against defining ethics in that way, it may stand to be this way for some period of time before techno jargon and whatever is hip, (we used to be called doctors, now we are "physicians") changes that.

And finally, I am not operating on thoughtless gruel. You follow the standards, that doesn't mean you aren't aware of what you are doing. If you agree to practice within the system, then you should at least be able to operate somewhat within the guidelines. I think this is the bottom line, don't sign up for something that you couldn't even agree to in the first place.

Please refer to my post at the top of this page, which addresses all of these issues.

 

[kelaskov]

Sometimes the reality of the situation gets lost in the search for the truth. My truth is that, nearly 48% of pregnancies in the US are unplanned and almost half of these end in induced abortion. Before the legalization of abortion (and since the beginning of time) women sought unsafe abortions and often became severely injured, infertile or died. Women will always have unplanned pregnancies and, at times, they will always seek abortion. I firmly believe that physicians who refuse to provide birth control for their patients increase the likelihood of unintended pregnacy. I will do everything within my professional means to help my patients avoid unintended pregnancy. I will also become trained to provide safe abortion and offer services to those in need- if only because there are no other practioners who will help them. I'm content that, at the moment, my own ethical code falls within my professional code.

 

[snoozer]

Please refer to my post at the top of this page, which addresses all of these issues.

What I am saying does not refer to your top page post other than to say: your personal opinion differs from that of the board which will hand your down your license and ask you to follow a set code which they will term, despite your objections, "ethics".
So even if you think you are being perfectly "ethical", if the board disagrees with you, you don't win. a duh!

 

[psipsina]

For any theist, the code of conduct that they operate under should be a DIRECT influence of their religous beliefs.

Yes, their personal ethical code of conduct should be directly influenced by their religious beliefs. But not their proffessional code of ethics. The proffessional code of ethics is a balance of everyone's personal ethical beliefs. Look at the difference between your and my personal codes . . . if there is to be a standardization of medical ethics it has to be a compromise between these two extremes. This standardization is necessary so the patient can know what to expect of their doctor and the doctor can know whats expected of them.
Its like laws of a civilization that is not based in religion, the laws of the US are standardized as a social contract that all citizens, with their many different value systems, can agree to participate in together. If every american followed their own value system then it wouldn't be illegal to for someone who believes that god told them to sacrifice their son to do so (extreme I know but I'm trying to pick something that most people wouldn't want to happen) . . since the majority agree that this is wrong, we have made it illegal to sacrifice children. So in order to be a part of this community the citizen has to abide by our code of conduct which may be contrary to his individual values.
A physicians code of conduct is a similar standardized compromized social contract that reflects the beliefs and values of the majority of those within the proffession. There will be times that it doesn't line up with an individual physicians individual values (which if that physician is a theist may in fact be the word of their god) because it is a compromise between all these individual values. But that doesn't mean that physician can decide to not follow the code of conduct in that instance, just like the citizen can't follow the word of his god who said to kill the kid, without breaching that contract and therefore being subject to punishment or expulsion. That physician can try to change the code of conduct and if enough of his collegues agree the code will shift to reflect the view of the majority. Just like the citizen can fight to change the law. But until that code is changed they are bound by the contract. Just like the citizen chooses to be an american citizen and thereby accepts the social contract of the laws of our civilization, the physician chooses to be a part of this proffession and thereby agrees to follow the current code of conduct to remain a part of that proffession.

 

[OncoCaP]

Sometimes the reality of the situation get lost in the search for the truth. My truth is that, nearly 48% of pregnancies in the US are unplanned and almost half of these end in induced abortion. Before the legalization of abortion (and since the beginning of time) women sought unsafe abortions and often became severely injured, infertile or died. Women will always have unplanned pregnancies and, at times, they will always seek abortion. I firmly believe that physicians who refuse to provide birth control for their patients increase the likelihood of unintended pregnacy. I will do everything within my professional means to help my patients avoid unintended pregnancy. I will also become trained to provide safe abortion and offer services to those in need- if only because there are no other practioners who will can help them. I'm content that, at the moment, my own ethical code falls within my professional code.

Yes, this is a concern. I wouldn't want women to be subjected to unsafe abortions. Given a choice between unsafe and safe abortions, I would advocate safe abortions every time.

Maybe I'm just too sappy when it comes to kids, but I wonder what would happen if many of the women who have elective abortions now carried them to term and either made some accommodation in their lives to raise the child or gave the child up for adoption. I realize this is a personal decision, but perhaps advocating adoptions or raising the kids could be a good thing? Wouldn't adoption or raising the child be a preferred alternative that could allow both the unborn child and mother to live? Aren't there thousands of couples out there who want to adopt a child but must travel to another country because they cannot adopt one in the U.S.? I have some kids, and they are quite enjoyable! I also know people who have gone through the adoption process, which can be long and difficult because there often not enough babies available for adoption. I also agree that dads should be held responsible for the care of their children, at least financially at a minimum.

(And, yes, deviations from the Professional Code should be handled in a professional way to the extent possible -- there is a value in working together in a professional way, difficult as that may be at times.)

 

[Wanna_B_Scutty]

Just like the citizen chooses to be an american citizen and thereby accepts the social contract of the laws of our civilization, the physician chooses to be a part of this proffession and thereby agrees to follow the current code of conduct to remain a part of that proffession.

The other issue, though, is: precisely what code are we talking about here? I've been posting all this time assuming that all states' ethics codes say approximately the same thing. However a little web research over the past hour has shown me otherwise. To be honest, it's not clear to me that any universal "physician's code" actually exists!

Also, when you say "code," I trust that you're not referring to the AMA, right? The AMA, after all, does not license, discipline, or otherwise have any authority over physicians. It is a lobbying organization with its own agenda. It does indeed have its own codes, but it is certainly not true that all doctors are expected to follow its codes, any more than physicians must follow the dictates of any other lobbying organization. A physician could theoretically reject every single one of the AMA's dictates (not that I'm recommending this... but in theory), so long as federal and/or state law did not also contain the dictate. The worst thing the AMA could do to such a physician would be to revoke his/her AMA membership- and many docs choose never to join the AMA in the first place (though I probably will).

So, in reality, this whole argument may been a kind of "theoretcial thought experiment." That is to say, there does not even appear to be any universal code... is there? As far as I can tell, the codes all vary by state.

 

[stiffany]

I realize this is a personal decision, but perhaps advocating adoptions or raising the kids could be a good thing? Wouldn't adoption or raising the child be a preferred alternative that could allow both the unborn child and mother to live? Aren't there thousands of couples out there who want to adopt a child but must travel to another country because they cannot adopt one in the U.S.? I also agree that dads should be held responsible for the care of their children, at least financially at a minimum.

There are plenty of kids stuck in the horror that is foster care in this country. This shows a graph verifying the fact that there are many more kids in foster care than those adopted every year: http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm Unfortunately, a lot of the people who want adopted children want young children/babies of a specific ethnicity without health problems or a history of mental issues. Sadly, if you spend the first several years of your life with a mother who is unfit to raise you either due to substance abuse problems or mental problems or someone who lacks time to spend any time with you at all due to working three jobs to make ends meet, you're bound to have some issues. Many people simply don't want these broken children. Personally, as I've said many times, I think anyone who thinks abortion is wrong needs to also consider and be morally outraged by the lack of support for the children of mothers who cannot support them. I don't care if you (not you in particular, but a general you) think that the mothers shouldn't have been having sex and are awful people for that, the fact is the child that's created still has to deal with the consequences at the end of the day if it's not aborted and is allowed to live a life of neglect and in poverty. I also think that "pro lifers" - which is a stupid term anyway - after all, pro choice people are also interested in what they consider life - also need to consider why so many women are stuck with the problem of raising children. Sex is not (usually) a solo sport. I agree with you that fathers should also be held responsible as well with mandatory (and enforceable!) child support instead of just scapegoating women since they're the ones who noticeably create the "problem" of abortion.

Finally, why do we have so many abortions in this country? I find it hard to believe that as a population we have an excessive amt of sex relative to many other populations with low birth rates. Why don't we have better access to and education about contraception? Certainly if you want to solve the abortion problem, that's a good place to start. After all, we've seen abstinence education does not work and, no matter what people against contraception think, others will still decide to have sex and subsequently have to deal with the consequences. Okay, rant complete.

 

[psipsina]

The other issue, though, is: precisely what code are we talking about here? I've been posting all this time assuming that all states' ethics codes say approximately the same thing. However a little web research over the past hour has shown me otherwise. To be honest, it's not clear to me that any universal "physician's code" actually exists!

Also, when you say "code," I trust that you're not referring to the AMA, right? The AMA, after all, does not license, discipline, or otherwise have any authority over physicians. It is a lobbying organization with its own agenda. It does indeed have its own codes, but it is certainly not true that all doctors are expected to follow its codes, any more than physicians must follow the dictates of any other lobbying organization. A physician could theoretically reject every single one of the AMA's dictates (not that I'm recommending this... but in theory), so long as federal and/or state law provided for the rejection.

So, in reality, this whole argument may been a kind of "theoretcial thought experiment." That is to say, there does not even appear to be any universal code... is there? As far as I can tell, the codes all vary by state.

There certainly is not a universal physicians code. The nitty gritty is that you are required to follow the code of conduct of whoever controls your license to practice medicine. They have the right to take that license away if you don't follow their code. You have the right to chose which state/country/etc that you practice in. You also have the right to be active in local physicians organizations that determine these things. There is however alot of consistency across the board as can be seen by the similarity of the ethics discussions in every medical school. When you get licensed for a particular state you need to know how that state may deviate from this common thread and you are responsible for changing your practice if necessary to go along with it. The AMA does hold some sway in these matters but certainly isn't the final end all be all determinant of individual states. For instance we have a physician in New Orleans who is currently on murder charges when her actions fell within AMA guidelines . . . so even beyond licensing you are still accountable to state and federal laws too. And then there is your specific institution who's ethics boards will help you when you are in the more foggy regions of ethics and the answer doesn't seem clear to you, you are requried to follow your employers guidelines too. What we've basically been trying to get across is that as a physician you sometimes have to set aside personal values if you want to keep your job, your license to practice or your butt out of jail. That by becoming a licensed physician and taking a specific job you are basically agreeing to follow the codes of conduct put forth by your employer and your licensing board in addition to the laws you have already agreed to abide by as a citizen.

 

[psipsina]

There are plenty of kids stuck in the horror that is foster care in this country. This shows a graph verifying the fact that there are many more kids in foster care than those adopted every year: http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm Unfortunately, a lot of the people who want adopted children want young children/babies of a specific ethnicity without health problems or a history of mental issues. Sadly, if you spend the first several years of your life with a mother who is unfit to raise you either due to substance abuse problems or mental problems or someone who lacks time to spend any time with you at all due to working three jobs to make ends meet, you're bound to have some issues. Many people simply don't want these broken children. Personally, as I've said many times, I think anyone who thinks abortion is wrong needs to also consider and be morally outraged by the lack of support for the children of mothers who cannot support them. I don't care if you (not you in particular, but a general you) think that the mothers shouldn't have been having sex and are awful people for that, the fact is the child that's created still has to deal with the consequences at the end of the day if it's not aborted and is allowed to live a life of neglect and in poverty. I also think that "pro lifers" - which is a stupid term anyway - after all, pro choice people are also interested in what they consider life - also need to consider why so many women are stuck with the problem of raising children. Sex is not (usually) a solo sport. I agree with you that fathers should also be held responsible as well with mandatory (and enforceable!) child support instead of just scapegoating women since they're the ones who noticeably create the "problem" of abortion.

Finally, why do we have so many abortions in this country? I find it hard to believe that as a population we have an excessive amt of sex relative to many other populations with low birth rates. Why don't we have better access to and education about contraception? Certainly if you want to solve the abortion problem, that's a good place to start. After all, we've seen abstinence education does not work and, no matter what people against contraception think, others will still decide to have sex and subsequently have to deal with the consequences. Okay, rant complete.

 

[OncoCaP]

There are plenty of kids stuck in the horror that is foster care in this country. This shows a graph verifying the fact that there are many more kids in foster care than those adopted every year: http://www.acf.hhs.gov/programs/cb/stats_research/afcars/trends.htm

Yes, true. There is a big difference though between the adoption of 13-year-olds and newborns (don't you agree?). After all, we have security in the maternity wards because people steal babies ... they are valuable. We could use many more. Here is some general information about adoptions:

http://adopting.adoption.com/child/how-many-people-choose-adoption.html
"The federal government tracks the numbers of adoptions from the U.S. foster care system, and international adoptions; however, since 1992, numbers of private agency and independent adoptions have not been formally reported. The 2000 Census, for the first time in history, included questions about adopted children in the household.

"How Many Children Are Adopted Each Year?

"It is estimated that around 120,000 children are adopted by U.S. citizens each year. Approximately half of these children are adopted by individuals not related to them (called "stranger adoptions") and about half are adopted by relatives such as grandparents or stepparents. Anecdotal evidence indicates that stepparents are the largest single group of adopters.

"In fiscal year 2003, approximately 21,616 children were adopted through international adoption (source: U.S. Department of State).
In fiscal year 2002, approximately 51,000 children were adopted from the U.S. foster care system (source: U.S. Department of Health & Human Services).

Unfortunately, a lot of the people who want adopted children want young children/babies of a specific ethnicity without health problems or a history of mental issues.

The good thing is that most abortions are for children of an ethnicity that people want (arrg -- I don't like that this is such an issue) and for children with parents without a history of mental issues. So, most mothers/ children would qualify. Also, newborns of any ethnicity are more desired for adoption than 13-year-olds for adoption.

Sadly, if you spend the first several years of your life with a mother who is unfit to raise you either due to substance abuse problems or mental problems or someone who lacks time to spend any time with you at all due to working three jobs to make ends meet, you're bound to have some issues.

Well, we all have issues, and, when it comes to abuse and neglect, that's what the foster care system is there for. I lived next to a family with ~8 foster kids (biological parents were in jail or had drug habits). It was really sad, but the kids did get excellent care.

Many people simply don't want these broken children.

Yes, but most abortions are for children that are "desirable" (ugh ...).

Personally, as I've said many times, I think anyone who thinks abortion is wrong needs to also consider and be morally outraged by the lack of support for the children of mothers who cannot support them.

I'm with you on that.

I don't care if you (not you in particular, but a general you) think that the mothers shouldn't have been having sex and are awful people for that, ...

Nope, sex is good thing. I'm all for that. I personally think that sex should be in a marriage relationship, but I can understand why people choose to have sex outside such a relationship.

... the fact is the child that's created still has to deal with the consequences at the end of the day if it's not aborted and is allowed to live a life of neglect and in poverty.

Again, most abortions are for the "desired" newborns that are in short supply ... they would be adopted by parents who would love them and care for them properly to the extent that any one of us would. Somehow I think we can come up with a solution for the "undesired" babies as well. We're capable people; we can do this.

I also think that "pro lifers" - which is a stupid term anyway - after all, pro choice people are also interested in what they consider life - also need to consider why so many women are stuck with the problem of raising children.

Well, it's the breakup of the family. Not a good thing. I guess it's not valued like it used to be.... Do you think we should promote families with both parents present or do you have another idea?

Sex is not (usually) a solo sport. I agree with you that fathers should also be held responsible as well with mandatory (and enforceable!) child support instead of just scapegoating women since they're the ones who noticeably create the "problem" of abortion.

Agreed.

Finally, why do we have so many abortions in this country? I find it hard to believe that as a population we have an excessive amt of sex relative to many other populations with low birth rates. Why don't we have better access to and education about contraception? Certainly if you want to solve the abortion problem, that's a good place to start. After all, we've seen abstinence education does not work and, no matter what people against contraception think, others will still decide to have sex and subsequently have to deal with the consequences. Okay, rant complete.

I don't think that people are wondering about contraception these days. People are using abortion as a method of contraception. I agree that there are better ways, and I plan to educate my children about contraceptives.

 

[pillowhead]

Yes, this is a concern. I wouldn't want women to be subjected to unsafe abortions. Given a choice between unsafe and safe abortions, I would advocate safe abortions every time.

Maybe I'm just too sappy when it comes to kids, but I wonder what would happen if many of the women who have elective abortions now carried them to term and either made some accommodation in their lives to raise the child or gave the child up for adoption. I realize this is a personal decision, but perhaps advocating adoptions or raising the kids could be a good thing? Wouldn't adoption or raising the child be a preferred alternative that could allow both the unborn child and mother to live? Aren't there thousands of couples out there who want to adopt a child but must travel to another country because they cannot adopt one in the U.S.? I have some kids, and they are quite enjoyable! I also know people who have gone through the adoption process, which can be long and difficult because there often not enough babies available for adoption. I also agree that dads should be held responsible for the care of their children, at least financially at a minimum.

(And, yes, deviations from the Professional Code should be handled in a professional way to the extent possible -- there is a value in working together in a professional way, difficult as that may be at times.)

There are plenty of children available for adoption in the US. They're just not the right age, color, IQ, etc. In general, we as Americans are obsessed with only having the best and brightest rather than something older and potentially damaged (just look at how many cats and dogs are euthanized in this country annually when there are so many people willing to pay hundreds of dollars for some designer dog with papers!)

 

[OncoCaP]

There are plenty of children available for adoption in the US. They're just not the right age, color, IQ, etc. In general, we as Americans are obsessed with only having the best and brightest rather than something older and potentially damaged (just look at how many cats and dogs are euthanized in this country annually when there are so many people willing to pay hundreds of dollars for some designer dog with papers!)

Well, let's start with putting up the "desired" newborns up for adoption (most abortions are of these unborn children). Many mothers after they see their newborn can't give them up anyway and decide to raise them ... and love the experience (wouldn't give it up for the world). That would make a lot of families very happy. As far as the "undesired" newborns, I'm sure we can do something loving there as well. Let's give it a shot; if we fail, at least we tried to save them. It greatly disappoints me is that newborns of a certain ethnicity are "undesired." To me this is not something we should just accept. Anything we could do to encourage people to love newborns without regard to their ethnicity, etc. would be a good thing and a step forward for our country.

I have met a number of people whose mothers considered aborting them in difficult circumstances, including one rather successful pastor. His name is Reggie Dabbs:

http://reggiedabbsonline.com/story.php
http://myspace.com/rdabbs
http://www.sjya.com/OLD%20Stuff/Clip0005.jpg

(He plays the sax VERY well -- see http://youtube.com/watch?v=NCA6lIXwDUw&mode=related&search=)
"Born to an unwed teenager who at one time considered abortion as a viable option for solving her "problem," Reggie Dabbs considers himself fortunate to be alive. With no place to go, the pregnant teenager ended up living in a chicken coop in Louisiana. It was there she remembered a former school teacher, Mrs. Dabbs, who had said to her students, "If you ever need anything, call me," and gave the students her home phone number. The girl called.

"Mrs. Dabbs went to Louisiana, picked up the girl, and took her back to Tennessee where she and her husband, whose six children were adults by this time, took the girl into their home and cared for her until after the baby was born. They continued to care for little Reggie as foster parents until he was in the fourth grade, and then they officially adopted him and gave him the Dabbs name.
...

People just love the man ... and there is a lot of him to love (he's a big guy). He tours the country and also serves at his own church of course. Most of the ones who have publicly stated this this were either pastors, presidents of seminaries, etc. because, let's face it, having a mom who wanted to abort you isn't an easy thing to talk about.

Here are some people who were born in difficult circumstances, but made a big contribution. There isn't enough storage space to tell all their stories, of course. These are a few famous people who might have been candidates for abortion because they had a disability, were born in difficult circumstances (financially or otherwise). These and many other lives prove that you don't need to be born to a "desireable" upper middle class family to make a big contribution. Children of the poor or children with disabilities should not be preferentially aborted, in my opinion.

http://answers.google.com/answers/threadview?id=516179
Oprah Winfrey

"Oprah Winfrey was born poor and black in Mississippi in 1954, when
poor and black meant no flush toilets, no shoes, and no real chance to
get ahead in the world."
http://www.nndb.com/people/466/000022400/
"Oprah Gail Winfrey was born to Vernita Lee on 29 January 1954 in
Kosciuscko, Mississippi. Initially raised by her grandmother. (&#8230 As a
young adolescent, Oprah often acted out and misbehaved; once she
attempted to run away. After initially trying to place her in a
juvenile detention center, Lee sent Oprah to live with her father,
Vernon Winfrey, in Nashville, Tennessee."

According to Oprah, "There really is nothing more important to me than
striving to be a good human being" (Academy of Television Arts and
Science 2003).

Learning to Give
http://www.learningtogive.org/papers/index.asp?bpid=136

Business Quotes by Opray Winfrey

"I knew there was a way out. I knew there was another kind of life
because I had read about it. I knew there were other places, and there
was another way of being."

"What I know is, is that if you do work that you love, and the work
fulfills you, the rest will come."

"You know you are on the road to success if you would do your job, and
not be paid for it."

"What material success does is provide you with the ability to
concentrate on other things that really matter. And that is being able
to make a difference, not only in your own life, but in other people's
lives."

Walker, Madame C. J.: (1867-1919)

"A St. Louis laundress who grew up in Mississippi as the impoverished
daughter of slaves, she developed the first commercially successful
hair-straightening process, known as the "Walker System." ...
Jim Crow History
http://www.jimcrowhistory.org/scripts/jimcrow/glossary.cgi?term=w&letter=yes

Quotation:

"Don't sit down and wait for the opportunities to come; you have to
get up and make them."
http://www.cybernation.com/quotationcenter/quoteshow.php?type=author&id=9249

Helen Keller

"She altered our perception of the disabled and remapped the
boundaries of sight and sense"

"She proved how language could liberate the blind and the deaf. She
wrote, "Literature is my utopia. Here I am not disenfranchised." But
how she struggled to master language. In her book "Midstream," she
wrote about how she was frustrated by the alphabet, by the language of
the deaf, even with the speed with which her teacher spelled things
out for her on her palm. She was impatient and hungry for words, and
her teacher's scribbling on her hand would never be as fast, she
thought, as the people who could read the words with their eyes.W

Time Magazine: Heroes and Icons
http://www.time.com/time/time100/heroes/profile/keller01.html

Helen Keller overcame blindness and deafness to become a symbol of the
indomitable human spirit.

For the first 18 months of her life, Helen Keller was a normal infant.

"Then," as she recalled later, "came the illness which closed my eyes
and ears and plunged me into the unconsciousness of a newborn baby."

...
Her life thereafter, as a girl and as a woman, became a triumph over
crushing adversity and shattering affliction. In time, Miss Keller
learned to circumvent her blindness, deafness and mutness; she could
"see" and "hear" with exceptional acuity; she even learned to talk
passably and to dance in time to a fox trot or a waltz. Her remarkable
mind unfolded, and she was in and of the world, a full and happy
participant in life.

What set Miss Keller apart was that no similarly afflicted person
before had done more than acquire the simplest skills.

Yousuf Karsh

"Yousuf Karsh was born in Madin, Armenia and became one of the world's
most renowned portrait photographers."
http://www.brainyencyclopedia.com/encyclopedia/y/yo/yousuf_karsh.html


A classic rags-to-riches immigrant story, Karsh was born in Turkish
Armenia, growing up as a Christian in predominantly Muslim Turkey.
Karsh was just 14 when the family fled the horror of genocide in
Armenia for freedom in Syria, with nothing but the belongings on their
backs. At the tender age of 16, Karsh's parents sent him to
Sherbrooke, Quebec, to live and work with his uncle, George Nakash, a
portrait photographer. Recognizing his nephew's talent, Nakash sent
20-year-old Karsh to Boston in 1928 to study with John H. Garo, one of
the top portrait photographers in America. His exposure to the
powerful and famous in Boston would leave an indelible impression on
the young man and determine the course of his life."

"Young, talented and hungry, Karsh returned to Canada and set up a
humble studio on Sparks Street in Ottawa. Eventually, he caught the
eye of Prime Minister Mackenzie King, who took a liking to the
relatively unknown photographer and helped him snag visiting
dignitaries for portraits."

CBC
http://www.cbc.ca/lifeandtimes/karsh.html

Napoleon Hill

"Napoleon Hill (1883-1970) was born in poverty in rural Virginia, and
rose to become one of the world's premier motivational authors and
speakers. An advisor to Franklin Roosevelt and a confidant of Andrew
Carnegie, Hill's philosophy of success has inspired thousands of men
and women to aquire untold personal and financial riches."

Amazon
http://www.amazon.com/exec/obidos/tg/detail/-/1932429166/104-1251916-2251128?v=glance


"Napoleon Hill was born into poverty in 1883 in a one-room cabin on
the Pound River in Wise County, Virginia. At the age of 10 his mother
died, and two years later his father remarried. He became a very
rebellious boy, but grew up to be an incredible man. He began his
writing career at age 13 as a "mountain reporter" for small town
newspapers and went on to become America's most beloved motivational
author. Fighting against all class of great disadvantages and
pressures, he dedicated more than 25 years of his life to define the
reasons by which so many people fail to achieve true financial success
and happiness in their life."

Napoleon Hill
http://napoleonhill.wwwhubs.com/

Quotations

"Before success comes in any man's life, he's sure to meet with much
temporary defeat and, perhaps some failures. When defeat overtakes a
man, the easiest and the most logical thing to do is to quit. That's
exactly what the majority of men do."

"All the breaks you need in life wait within your imagination,
Imagination is the workshop of your mind, capable of turning mind
energy into accomplishment and wealth."

"Every adversity, every failure, every heartache carries with it the
seed on an equal or greater benefit."

"Through some strange and powerful principle of "mental chemistry"
which she has never divulged, nature wraps up in the impulse of strong
desire, "that something" which recognizes no such word as
"impossible," and accepts no such reality as failure."

"When defeat comes, accept it as a signal that your plans are not
sound, rebuild those plans, and set sail once more toward your coveted
goal."

Brainy Quote
http://www.brainyquote.com/quotes/authors/n/napoleon_hill.html

 

[snoozer]

There certainly is not a universal physicians code. The nitty gritty is that you are required to follow the code of conduct of whoever controls your license to practice medicine. They have the right to take that license away if you don't follow their code. You have the right to chose which state/country/etc that you practice in. You also have the right to be active in local physicians organizations that determine these things. There is however alot of consistency across the board as can be seen by the similarity of the ethics discussions in every medical school. When you get licensed for a particular state you need to know how that state may deviate from this common thread and you are responsible for changing your practice if necessary to go along with it. The AMA does hold some sway in these matters but certainly isn't the final end all be all determinant of individual states. For instance we have a physician in New Orleans who is currently on murder charges when her actions fell within AMA guidelines . . . so even beyond licensing you are still accountable to state and federal laws too. And then there is your specific institution who's ethics boards will help you when you are in the more foggy regions of ethics and the answer doesn't seem clear to you, you are requried to follow your employers guidelines too. What we've basically been trying to get across is that as a physician you sometimes have to set aside personal values if you want to keep your job, your license to practice or your butt out of jail. That by becoming a licensed physician and taking a specific job you are basically agreeing to follow the codes of conduct put forth by your employer and your licensing board in addition to the laws you have already agreed to abide by as a citizen.

Exactly. Thanks for putting it so elegantly.

 

[snoozer]

Yes, true. There is a big difference though between the adoption of 13-year-olds and newborns (don't you agree?). After all, we have security in the maternity wards because people steal babies ... they are valuable. We could use many more. Here is some general information about adoptions:

http://adopting.adoption.com/child/how-many-people-choose-adoption.html
"The federal government tracks the numbers of adoptions from the U.S. foster care system, and international adoptions; however, since 1992, numbers of private agency and independent adoptions have not been formally reported. The 2000 Census, for the first time in history, included questions about adopted children in the household.

"How Many Children Are Adopted Each Year?

"It is estimated that around 120,000 children are adopted by U.S. citizens each year. Approximately half of these children are adopted by individuals not related to them (called "stranger adoptions") and about half are adopted by relatives such as grandparents or stepparents. Anecdotal evidence indicates that stepparents are the largest single group of adopters.

"In fiscal year 2003, approximately 21,616 children were adopted through international adoption (source: U.S. Department of State).
In fiscal year 2002, approximately 51,000 children were adopted from the U.S. foster care system (source: U.S. Department of Health & Human Services).



The good thing is that most abortions are for children of an ethnicity that people want (arrg -- I don't like that this is such an issue) and for children with parents without a history of mental issues. So, most mothers/ children would qualify. Also, newborns of any ethnicity are more desired for adoption than 13-year-olds for adoption.



Well, we all have issues, and, when it comes to abuse and neglect, that's what the foster care system is there for. I lived next to a family with ~8 foster kids (biological parents were in jail or had drug habits). It was really sad, but the kids did get excellent care.



Yes, but most abortions are for children that are "desirable" (ugh ...).



I'm with you on that.



Nope, sex is good thing. I'm all for that. I personally think that sex should be in a marriage relationship, but I can understand why people choose to have sex outside such a relationship.



Again, most abortions are for the "desired" newborns that are in short supply ... they would be adopted by parents who would love them and care for them properly to the extent that any one of us would. Somehow I think we can come up with a solution for the "undesired" babies as well. We're capable people; we can do this.



Well, it's the breakup of the family. Not a good thing. I guess it's not valued like it used to be.... Do you think we should promote families with both parents present or do you have another idea?



Agreed.



I don't think that people are wondering about contraception these days. People are using abortion as a method of contraception. I agree that there are better ways, and I plan to educate my children about contraceptives.

I would disagree with that statement, I have never come across a woman, friend, patient or otherwise who said to me, well I figured I'd probably get pregnant but then I figured I'd just get rid of it. It's not that simple. I don't think they plan in their daily lives:
1. Have lots of unprotected sex
2. Get pregnant, freak out for a bit
3. call planned parenthood and voila!

I think the issue is obviously a lack of contraception or planning because let's face facts, abortions and pregnancies both expose the mother to SOME risk and I'd guess the general population should be aware of that. I won't even argue which one puts the mother at more risk, but all that hormonal flux isn't good for the mother period. I don't think the average woman takes her own body or the potential life of another so lightheartedly the way your statement implies.

 

[OncoCaP]

I would disagree with that statement, ... I don't think the average woman takes her own body or the potential life of another so lightheartedly the way your statement implies.

You're right, that wasn't a well worded statement. Maybe a better way of putting it is that many women have sex without contraceptives but without the intention of getting pregnant. In other cases, contraceptives fail. Because abortion is available as a backup plan, contraceptives are not as critical to some women as they would be otherwise (but they are still extremely important -- billions of dollars spent on these items, after all). It's probably fair to say that if every viable pregnancy was carried to term, men and women would put more emphasis on contraceptives ... how much more is hard to say.

 

[evade]

I'm sorry if I'm taking this thread on a tangent, but I feel that this whole discussion is about the relative value of lives: fetus vs. the woman carrying it. OncoCaP, Wanna_B, your arguments seem to be based on the idea that the lives of the woman and her fetus are 100% equal. If you would, please indulge me by considering the following scenario:

You are in an IVF clinic that is burning to the ground. To your left is a freezer filled with 1,000 frozen embryos, waiting to be implanted. To your right is a squalling infant. You can only carry one with you.

Which do you choose?

 

[OncoCaP]

I'm sorry if I'm taking this thread on a tangent, but I feel that this whole discussion is about the relative value of lives: fetus vs. the woman carrying it. OncoCaP, Wanna_B, your arguments seem to be based on the idea that the lives of the woman and her fetus are 100% equal. If you would, please indulge me by considering the following scenario:

You are in an IVF clinic that is burning to the ground. To your left is a freezer filled with 1,000 frozen embryos, waiting to be implanted. To your right is a squalling infant. You can only carry one with you.

Which do you choose?

Apparently to most of America it matters what the ethnicity, mental issues, professional background of the parents are ... maybe the infant or embryos are offspring of a royal family and the infant has HIV, fetal alcohol syndrome, genotype for a severe mental illness that would make the offspring unable to develop normally ...

However, the sad state of affairs in the U.S. aside, I would probably try to save both the infant first and then go back for the embryos. Since the embryos are in a freezer, they have more protection and could survive longer in a fire, theoretically.

Maybe a better way to ask the question is as follows (especially in light of American preferences and to put both an equal "frozen" footing but biased in another way): You have 1000 frozen embryos (with suitable surrogate mothers who all want a child (they cannot have one naturally) and are willing to pay you $50,000 per embryo) or one infant frozen in liquid nitrogen (but with new technology that gives odds of thawing survival/growth similar to each of the embryos becoming an infant). The embryos were from an affluent royal family with genes for a typical IQ of ~200, looks to die for, excellent health, no known genetic diseases, great compassion and people skills. You would be rewarded in a huge ceremony for saving them and you would be able to enjoy a very posh Derm or Rad residency with bankers hours. On the other hand, nobody but you knows the infant is there; the infant was abandoned decades ago. The infant is an illegal immigrant, the offspring of two very ugly and morbidly obese career criminals with long family histories of mental illness an IQ of less than 80. The infant is physically deformed in a grotesque way, has full-blown AIDS, failed kidneys (requires dialysis), diabetes, down syndrome, fetal alcohol syndrome, brain damage (will never walk, talk, etc.) and you would need to take care of the child 24/7 by yourself for at least 10 years until the child dies a painful death and raise money by basically begging (you have no money are in medical school, which you would need to drop out as an MS4 with $200K in loans). Needless to say, you have no medical insurance and will never qualify with that infant (who doesn't qualify since he's an illegal) ... nor would you have money to pay for it anyway. You can't adopt because you also don't have money for that. The infant will only be able to smile, hug, and cry. If you save the infant, people would ridicule you for the rest of your life for not making the "obvious" correct choice and hate you for saving the life of an infant who is the child of two criminals that killed a popular U.S. President. Which would you save then?

I would try to save both and try to use the money from the embryos to help pay for the care of the infant. If I could not save both, I would save whichever one and however many I could. I wouldn't use their age or IQ to discriminate against them.

(This may come as huge shocker, but I would expect most people to save the embryos in the alternate question, even with less bias ... some simply based on race or the fact that the embryos were "theirs" whereas the infant was someone else's ... some just based on the money they could make off the embryos).

 

[evade]

Apparently to most of America it matters what the ethnicity, mental issues, professional background of the parents are ... maybe the infant or embryos are offspring of a royal family and the infant has HIV, fetal alcohol syndrome, genotype for a severe mental illness that would make the offspring unable to develop normally ...

However, the sad state of affairs in the U.S. aside, I would probably try to save both the infant first and then go back for the embryos. Since the embryos are in a freezer, they have more protection and could survive longer in a fire, theoretically.

Maybe a better way to ask the question is as follows (especially in light of American preferences and to put both an equal "frozen" footing but biased in another way): You have 1000 frozen embryos (with suitable surrogate mothers who all want a child (they cannot have one naturally) and are willing to pay you $50,000 per embryo) or one infant frozen in liquid nitrogen (but with new technology that gives odds of thawing survival/growth similar to each of the embryos becoming an infant). The embryos were from an affluent royal family with genes for a typical IQ of ~200, looks to die for, excellent health, no known genetic diseases, great compassion and people skills. You would be rewarded in a huge ceremony for saving them and you would be able to enjoy a very posh Derm or Rad residency with bankers hours. On the other hand, nobody but you knows the infant is there; the infant was abandoned decades ago. The infant is an illegal immigrant, the offspring of two very ugly and morbidly obese career criminals with long family histories of mental illness an IQ of less than 80. The infant is physically deformed in a grotesque way, has full-blown AIDS, failed kidneys (requires dialysis), diabetes, down syndrome, fetal alcohol syndrome, brain damage (will never walk, talk, etc.) and you would need to take care of the child 24/7 by yourself for at least 10 years until the child dies a painful death and raise money by basically begging (you have no money are in medical school, which you would need to drop out as an MS4 with $200K in loans). Needless to say, you have no medical insurance and will never qualify with that infant (who doesn't qualify since he's an illegal) ... nor would you have money to pay for it anyway. You can't adopt because you also don't have money for that. The infant will only be able to smile, hug, and cry. If you save the infant, people would ridicule you for the rest of your life for not making the "obvious" correct choice and hate you for saving the life of an infant who is the child of two criminals that killed a popular U.S. President. Which would you save then?

I would try to save both and try to use the money from the embryos to help pay for the care of the infant. If I could not save both, I would save whichever one and however many I could. I wouldn't use their age or IQ to discriminate against them.

You didn't answer my question. Assume you can only remove one from the building: the infant or the embryos. You don't know anything about their social status, IQ potential, etc. We're ignoring money: you have nothing invested in either the infant or embryos. Whichever you do not remove WILL burn in the fire.

You know what I'm getting at: is an eight-cell embryo really equal, in your eyes, to a fully formed and living infant? Is it equal to you? Is it equal to me?

The last piece of your post indicates that perhaps you would choose the embryos, as that would be 1,000 lives (in your estimation) compared to the one life that is the infant. But I might be totally off-base.

 

[Frank l]

i'd take the squalling baby no question. i consider a frozen embryo to be human life, and therefore equal to any other human life. in that case there would be no correct choice. i don't think there is a lesser of two evils there either. there are just two wrong choices and you get to choose which one you want to live with. in most cases it would be easier for me to live with taking the baby. of course, there are exceptions. you can always come up with senarios like OncoCaP. there are too many variables that come into play when you try to decided between lives. whether it is 1000 saved versus one lost, or 500 saved versus 500 lost where you just choose which half you save. there isn't a right decision, nor is there a "better" decision.
same thing with pregnancies that endanger the woman's life. the life of the baby and the mother are equal, but i would almost always choose to save the mother. i think most of us would, and that is why people like to believe that the life of a fetus is not worth as much as the mother. it is easier that way. that way you don't have to take responsibility for such a horrible thing. in a perfect world, abortion would never happen. we obviously don't live in a perfect world, and sometimes we have to make horrible choices, but just because the choice HAS to be made doesn't excuse you from judgement concerning your choice.

 

[OncoCaP]

You didn't answer my question. Assume you can only remove one from the building: the infant or the embryos. You don't know anything about their social status, IQ potential, etc. We're ignoring money: you have nothing invested in either the infant or embryos. Whichever you do not remove WILL burn in the fire.

You know what I'm getting at: is an eight-cell embryo really equal, in your eyes, to a fully formed and living infant? Is it equal to you? Is it equal to me?

The last piece of your post indicates that perhaps you would choose the embryos, as that would be 1,000 lives (in your estimation) compared to the one life that is the infant. But I might be totally off-base.

You're right, I didn't answer your question; let me try this again:

Part of the problem here is that if the 1000 embryos are just going to remain frozen, I would consider them to be essentially dead -- I don't think anyone would claim they were alive in the frozen state. If they are all going to be implanted, then I would probably still save the infant because I can relate to infants more than embryos that I can't even see easily. I could see myself more or less reacting to the crying infant than the silent embryos (I wouldn't ponder the question, most likely).

If we are talking about saving one infant or 1000 embryos in the wombs of expectant mothers ... well, that would be even tougher. Either way, I would lose. If I saved the infant, I would have 1000 angry mothers and 1000 dead unborn children. If I saved the 1000 unborn children, I would still be troubled by not being able to save the one infant. Given such a horrendous dilemma, I would save the 1000 unborn children because there are just more of them. Simply and crudely put: 1000 lives > 1 life.

More to the point of this discussion, I have said previously that if a mother had a very high risk pregnancy and had to choose between her own life and the life of her unborn child (her child was viable and expected to make it), I would ask her to make that difficult decision. No matter what she would decide, it would be a tragedy, and I wouldn't be upset at her if she chose to save her own life (although I wouldn't like the situation overall). For what it's worth, I would give my life for my children without any hesitation (say I had to shove one of them out of the way of an oncoming truck but risk getting killed myself), but that's my own set of values. If my wife died so that one of our children could be born and live on, I would be traumatized, no doubt about it. I would raise that child with special care, in honor of her mother's sacrifice, and if it was a girl, I would name the baby after her mother.

 

[Wanna_B_Scutty]

What we've basically been trying to get across is that as a physician you sometimes have to set aside personal values if you want to keep your job, your license to practice or your butt out of jail. That by becoming a licensed physician and taking a specific job you are basically agreeing to follow the codes of conduct put forth by your employer and your licensing board in addition to the laws you have already agreed to abide by as a citizen.

But there simply is no such code that requires a physician to refer for an abortion- at least not as far as I can tell. I have already posted the federal laws which give a physician the right to refuse to refer. Some states also have their own laws which support refusal to refer. But when other states don't have such laws, Federal Law > State Law, to the very best of my knowledge. If you have alternate information, though, then I would like to hear it.

No one has said that there will not exist a code of rules that each physican will be generally be required to follow or else face potential disciplinary action from her licensing board. It is simply a truth, though, that referral for an abortion is not a part of any such required code. Again, if I am wrong about this, please post the revelant laws to correct me. Referral may be part of the AMA's recommended code, but the AMA is simply a lobbying and political organization. It cannot discipline, license or otherwise alter the behavior of physicians. Any physician who wishes to disagree with the AMA on this issue may freely do so.

In addtion, as per the ethics discussion above (see my post at the top of the page), I reject the premise that code=ethics. I submit that following a given code can be unethical and that defying a code can be ethical. In a case where a physician believes that a code is unethical, that physician must determine what is more important to her: to behave unethically and escape punishment or to defy the code and risk punishment. For example, I hope that every person here would defy a professional code that told us, say, we must perform infanticide if the mother asked us to do so. I know I would. Some punishments are worth it. Sometimes behaving ethically means behaving in defiance.

 

[Wanna_B_Scutty]

I'm sorry if I'm taking this thread on a tangent, but I feel that this whole discussion is about the relative value of lives: fetus vs. the woman carrying it. OncoCaP, Wanna_B, your arguments seem to be based on the idea that the lives of the woman and her fetus are 100% equal. If you would, please indulge me by considering the following scenario:

You are in an IVF clinic that is burning to the ground. To your left is a freezer filled with 1,000 frozen embryos, waiting to be implanted. To your right is a squalling infant. You can only carry one with you.

Which do you choose?

Certainly I would take the squalling infant, just like OncoCap would. However, your premise that I am setting fetus = woman is faulty. At no time have I said that absolutely fetus = woman. In fact, I am on record as saying that I would perform an abortion if it were necessary to save a woman's life, though I would experience profound cognitive dissonance at the physical act of doing such a thing.

I also, however, reject the premise that either a fetus must have precisely the same moral status as its mother. Rather, I hold that a fetus, as a unique and living human entity, has some moral status. And, as such, I will not harm such a living human entity except in the most dire circumstace: such as the impending death of that fetus's mother.

But you are not even asking about a fetus- you are asking about an embryo. And, while I am also inclined to attribute at least some moral status to a human embryo, since it also is a unique human organism, a frozen embryo will never continue to develop unless its environmental circumstances are altered. Thus, I would easily choose to rescue the baby over 1,000 frozen embryos. However, I would also feel sadness at the death of those embryos. If the fire let up and I could see a clear and safe path toward the frozen embryos, I would go back to save them, as well.

 

[psipsina]

But there simply is no such code that requires a physician to refer for an abortion- at least not as far as I can tell. I have already posted the federal laws which give a physician the right to refuse to refer. Some states also have their own laws which support refusal to refer. But when other states don't have such laws, Federal Law > State Law, to the very best of my knowledge. If you have alternate information, though, then I would like to hear it.

No one has said that there will not exist a code of rules that each physican will be generally be required to follow or else face potential disciplinary action from her licensing board. It is simply a truth, though, that referral for an abortion is not a part of any such required code. Again, if I am wrong about this, please post the revelant laws to correct me. Referral may be part of the AMA's recommended code, but the AMA is simply a lobbying and political organization. It cannot discipline, license or otherwise alter the behavior of physicians. Any physician who wishes to disagree with the AMA on this issue may freely do so.

In addition, as per the ethics discussion above (see my post at the top of the page), I reject the premise that code=ethics. I submit that following a given code can be unethical and that defying a code can be ethical. In a case where a physician believes that a code is unethical, that physician must determine what is more important to her: to behave unethically and escape punishment or to defy the code and risk punishment. For example, I hope that every person here would defy a professional code that told us, say, we must perform infanticide if the mother asked us to do so. I know I would. Some punishments are worth it. Sometimes behaving ethically means behaving in defiance.

No one ever said that you have to refer for elective abortions, . . . the original discussion was about the procedure to save a mother with tubal pregnancy that couldn't go to full term and this is what most of us have been discussing. The point was that if you want to keep your license you have to follow the code of conduct of whomever licensed you and the code of conduct says you have to provide standard of care (or if there is time get the patient to someone who will), and in the case of the ectopic pregnancy a procedure that the OP equated with abortion is standard of care. You certainly have the right to refuse to follow the code of conduct, but you risk a lawsuit if the patient dies because of your actions and you risk the loss of your license. You have the right to determine if your action is worth these consequences.

Finally, in the world of medicine the term "medical ethics" is currently equated with the values that physicians have agreed upon that we use to guide our proffessional actions aka a code of conduct. You can argue semantics with me all you like but this is the meaning that has been assigned to the term "medical ethics" by the medical community, and neither you nor I can change that meaning by our conversation on this forum. The purpose of language is to communicate with others, if you decide that you don't like the currently agreed upon definition of a term thats fine, but you can't change the meaning in general conversation for everyone else simply by stomping your foot and saying I disagree.

 

[snoozer]

No one ever said that you have to refer for elective abortions, . . . the original discussion was about the procedure to save a mother with tubal pregnancy that couldn't go to full term and this is what most of us have been discussing. The point was that if you want to keep your license you have to follow the code of conduct of whomever licensed you and the code of conduct says you have to provide standard of care (or if there is time get the patient to someone who will), and in the case of the ectopic pregnancy a procedure that the OP equated with abortion is standard of care. You certainly have the right to refuse to follow the code of conduct, but you risk a lawsuit if the patient dies because of your actions and you risk the loss of your license. You have the right to determine if your action is worth these consequences.

Finally, in the world of medicine the term "medical ethics" is currently equated with the values that physicians have agreed upon that we use to guide our proffessional actions aka a code of conduct. You can argue semantics with me all you like but this is the meaning that has been assigned to the term "medical ethics" by the medical community, and neither you nor I can change that meaning by our conversation on this forum. The purpose of language is to communicate with others, if you decide that you don't like the currently agreed upon definition of a term thats fine, but you can't change the meaning in general conversation for everyone else simply by stomping your foot and saying I disagree.

I think her attitude is exactly that. How convenient that when something doesn't suit her, she just says well I'm against that definition. As if that will even mean anything when standing in front of a disciplinary board. If she's uncomfortable being termed "unethical", maybe she's just having an overly emotional reaction to the term and needs to check her baggage at the door before entering medicine. Hahahaha.

Btw, as psipsina very well pointed out, part of being in this profession is that physicians can band together to try to change things they see as unethical and thus alter the code of conduct/ ethics code that is currently set forth and then follow the new code that they agree with. But of course, if you'd like to just cross the guidelines and codes in the name of some cause and risk your own license, I'd ordinairily say it was fine except that you affect those patients that you cross that line with. If it really were each person to their own, I don't think I'd care at all what my next-door doctor thought or did.

 

[OncoCaP]

I think her attitude is exactly that. How convenient that when something doesn't suit her, she just says well I'm against that definition. As if that will even mean anything when standing in front of a disciplinary board. If she's uncomfortable being termed "unethical", maybe she's just having an overly emotional reaction to the term and needs to check her baggage at the door before entering medicine. Hahahaha.

I'm not sure I understand the point of conflict exactly. I would wager that psipsina and scutty probably agree on most aspects of medical ethics, no matter how you define it. I can't see either of them violating patient confidentiality or intentionally injuring or taking advantage of a patient.

Btw, as psipsina very well pointed out, part of being in this profession is that physicians can band together to try to change things they see as unethical and thus alter the code of conduct/ ethics code that is currently set forth and then follow the new code that they agree with. ...

This is really the key point in my opinion. There must be an effort to work together to resolve problems and work out differences in a fair and practical way. Having no ethical standard or simply ignoring all ethical standards is not a solution because it creates a huge risk for patients -- what is my physician going to do? On the other hand, if a physician has a problem with an ethical standard (whatever the place of work seems to be following), that physician should make an effort to resolve that issue in the most professional way possible. For a pro-life physician that may mean not taking a case. The details of the situation should be carefully considered. It's going to be tough to provide excellent care when the physicians at a hospital or clinic can't get along due to the distractions and stress that such conflicts inevitably create.

 

[Wanna_B_Scutty]

Finally, in the world of medicine the term "medical ethics" is currently equated with the values that physicians have agreed upon that we use to guide our proffessional actions aka a code of conduct.

But this is simply not true! As I have pointed out, there IS no set of "values that physicians have agreed upon that we use to guide out professional actions aka a code of conduct." Or if there is, please post it for me. As I've already noted, the AMA's Code does not qualify because the AMA is a lobbying and politcal organization- nothing more. Plenty of physicians choose not to join the AMA, and plenty more disagree freely with a few of its dictates.

 

[OncoCaP]

But this is simply not true! As I have ponted out, there IS no set of values that "physicians have agreed upon that we use to guide out professional actions aka a code of conduct." Or if there is, please post it for me. As I've already noted, the AMA's Code does not qualify because the AMA is a lobbying and politcal organization- nothing more. Plenty of physicians choose not to join the AMA, and plenty more disagree freely with a few of its dictates.

What about if a hospital or clinic has a particular set of ethics (put forth by the management of that organization)? If a physician didn't agree with it, how would you suggest that the conflict be resolved (what might be a typical approach)?

 

[evade]

Certainly I would take the squalling infant, just like OncoCap would. However, your premise that I am setting fetus = woman is faulty. At no time have I said that absolutely fetus = woman. In fact, I am on record as saying that I would perform an abortion if it were necessary to save a woman's life, though I would experience profound cognitive dissonance at the physical act of doing such a thing.

I also, however, reject the premise that either a fetus must have precisely the same moral status as its mother. Rather, I hold that a fetus, as a unique and living human entity, has some moral status. And, as such, I will not harm such a living human entity except in the most dire circumstace: such as the impending death of that fetus's mother.

But you are not even asking about a fetus- you are asking about an embryo. And, while I am also inclined to attribute at least some moral status to a human embryo, since it also is a unique human organism, a frozen embryo will never continue to develop unless its environmental circumstances are altered. Thus, I would easily choose to rescue the baby over 1,000 frozen embryos. However, I would also feel sadness at the death of those embryos. If the fire let up and I could see a clear and safe path toward the frozen embryos, I would go back to save them, as well.

This is my point exactly. People place different moral status on zygotes, embryos, fetuses, and fully independent people (babies through adults), even within groups of people with similar views on abortion. You seem a lot more definite about your decision to prioritize saving the infant over saving the embryos than OnoCaP does. I, like you, would grab the baby and run like the wind. Unlike you, I would probably not look back for the embryos. The infant is a living, breathing, independent being with wants and needs. The embryo lacks everything that makes me consider it human. I would risk a lot to save a baby in trouble, regardless of whose baby it was. I would be very unlikely to take any risks whatsoever to save an eight-cell embryo, even if it were my own. You would likely see it differently.

When it comes to whole choice thing really comes down to how much risk women are willing to take versus the moral status they confer on their pregnancy.

A woman who very deeply wants her child will go to incredible lengths and take astounding risks to ensure the pregnancy comes to completion. I'm always awed by the women with pre-eclampsia or preterm labor who will stay on magnesium sulfate for days and days, even though it makes them feel AWFUL. They place high value on their pregnancy, they want it badly, and they'll take a lot of risk for it. This is true whether or not she sees her fetus as a complete person, in the moral sense. Even if she doesn't think an 8-week fetus has the same moral status as an 8-week-old baby, it doesn't matter, because that fetus is deeply wanted, and it will continue along that developmental path. And more power to those women.

A woman who has an unwanted pregnancy, but places high moral status on her fetus, will likely take a good number of risks to ensure her pregnancy comes to completion. Remember that risks are not medical alone: if she's young, she risks difficulties with finishing school, with her family and friends if they are not supportive. She may risk physical abuse from her parents, or from the father of the child. If she is older, she risks difficulties with her work. A woman who views her fetus as having the same moral status as any other person will take these risks. She may place her child for adoption at the end of it all, but still she will complete her pregnancy.

A woman, however, who has an unwanted pregnancy and who does not see her fetus as holding full status as a person, is unlikely to risk her health, her schooling, her job, her financial security, or her relationships with others for that pregnancy. These are the pregnancies that are terminated. This doesn't mean that they don't consider the fetus to have any personhood, it just means that in the balance of things, the woman feels she can't take on the risks in order to continue the pregnancy.

I think just about everyone has a different concept of whether (or to what degree) a fetus posesses personhood. I think everyone also has a different line they'll draw as to what level of risk they will accept in order to bring that fetus into the world. These things end at both extremes: women who willingly die to bring their babies into the world, and women who terminate their pregnancies so that they may continue on their paths. I would never tell a woman she should take risks she's not comfortable with to continue her pregnancy, and I would never tell a woman she should NOT take risks she's comfortable with in order to ensure her baby is born. In the end, it's not about my morals. It's about hers.

 

[Wanna_B_Scutty]

What about if a hospital or clinic has a particular set of ethics? If a physician didn't agree with it, how would you suggest that the conflict be resolved (what might be a typical approach)?

The decision tree would be:

Federal Provisions > State Provisions > Hospital Provisions

Ultimately, if a physician could not find support in Federal or State provisions (inlcuding laws that prevent discrimination against religious beliefs, etc.), the physician might ask for an exemption from the hospital. Failing that, I suppose the physician would have to choose whether to take the risk of defying the hospital or to simply seek employment elsewhere.

 

[OncoCaP]

This is my point exactly. People place different moral status on zygotes, embryos, fetuses, and fully independent people (babies through adults), even within groups of people with similar views on abortion. ...
I would never tell a woman she should take risks she's not comfortable with to continue her pregnancy, and I would never tell a woman she should NOT take risks she's comfortable with in order to ensure her baby is born. In the end, it's not about my morals. It's about hers.

I'm going to assume that you do not think it is ok to terminate a (healthy) infant's life. How about an unborn child's life? If the mother had been pregnant very close to the end of the third trimester and now decided to have an abortion (let's say at 38 weeks). For the point of this question, let's assume that the baby could survive outside the womb if removed by C-section or induced vaginal birth. Would you think that such an abortion was ethical simply on the basis of the mother's decision? Would the mother's morals govern in this situation?

 

[snoozer]

But this is simply not true! As I have pointed out, there IS no set of "values that physicians have agreed upon that we use to guide out professional actions aka a code of conduct." Or if there is, please post it for me. As I've already noted, the AMA's Code does not qualify because the AMA is a lobbying and politcal organization- nothing more. Plenty of physicians choose not to join the AMA, and plenty more disagree freely with a few of its dictates.

Are you really going to say that you've NEVER heard of a physician coming before the DISCIPLINARY board of their state? RI has one, it's one of the 1st things that pops up when you type it into a simple google search. Others that followed in my google search include NY, Massachusetts etc.

Do you think disciplinary actions are based on whims? Or violations of a SET CODE? It wouldn't be a disciplinary action if it were just a violation of a law, that would go to federal or state court and that'd have charges pressed. These doctors are going in front of a disciplinary board that assesses their actions as a physician.

http://www.health.state.ny.us/nysdoh/opmc/faq.htm

And here's something from Mississipi about conduct codes and certification:
http://www.msbml.state.ms.us/regulations/UR Regs Effective Dec 1.pdf

seems to go hand in hand.

 

[psipsina]

But this is simply not true! As I have pointed out, there IS no set of values that "physicians have agreed upon that we use to guide out professional actions aka a code of conduct." Or if there is, please post it for me. As I've already noted, the AMA's Code does not qualify because the AMA is a lobbying and politcal organization- nothing more. Plenty of physicians choose not to join the AMA, and plenty more disagree freely with a few of its dictates.

In the broadest sense there is the code of conduct that you will be taught during medical school in ethics coursework and in practice on rotations. There is a strong continuity in what is taught in all US allo schools. Ethics can be tested on boards so there has to be a cohesiveness. The AMA guidelines generally reflect this unified concept of medical ethics. You ultimately answer to your licensing board that has a group of physicians that will meet and evaluate individual cases based on the same ideas that were taught in medical school. If they decide that you acted against the code of conduct they can take away your license. If you work in a hospital there will also be an ethics comittee that you can seek out for help or that can judge your behavior if a patient or collegue lodges a complaint against you. Also, unethical behavior tends to make you more vulnerable to successful litigation. I though we had discussed this previously but here it is again.

 

[OncoCaP]

Are you really going to say that you've NEVER heard of a physician coming before the DISCIPLINARY board of their state? RI has one, it's one of the 1st things that pops up when you type it into a simple google search. Others that followed in my google search include NY, Massachusetts etc.

Do you think disciplinary actions are based on whims? Or violations of a SET CODE? It wouldn't be a disciplinary action if it were just a violation of a law, that would go to federal or state court and that'd have charges pressed. These doctors are going in front of a disciplinary board that assesses their actions as a physician.

http://www.health.state.ny.us/nysdoh/opmc/faq.htm

And here's something from Mississipi about conduct codes and certification:
http://www.msbml.state.ms.us/regulations/UR Regs Effective Dec 1.pdf

seems to go hand in hand.

Looks like it covers things like misconduct:

"Examples of medical misconduct include (but are not limited to): practicing fraudulently, practicing with gross incompetence or gross negligence; practicing while impaired by alcohol, drugs, physical disability or mental disability; being convicted of a crime; filing a false report; guaranteeing that treatment will result in a cure; refusing to provide services because of race, creed, color or ethnicity; performing services not authorized by the patient; harassing, abusing or intimidating a patient; ordering excessive tests; and abandoning or neglecting a patient in need of immediate care.

"Certain types of complaints are not considered misconduct and therefore are not under the jurisdiction of OPMC. These include complaints regarding fees (unless they represent fraud), and complaints about a physician’s attitude, communication skills or rude behavior. OPMC does not condone uncaring behavior but such actions do not, by themselves, constitute misconduct.

I would be willing to guess we could all agree that such misconduct would be wrong.

 

[Wanna_B_Scutty]

This is my point exactly ... In the end, it's not about my morals. It's about hers.

I quite agree with you that different people place different moral values on developing humans. If it were not so, the abortion wars would not exist.

However, I profoundly disagree with you that the moral worth of a fetus is contingent only upon the value that a woman gives it. Why should this be so? Why should the value of one unique human life be contingent upon the value conferred upon it by another?

Last I checked, in the USA, we do not support discrimination on the basis of age, appearance, or location. A human fetus- while young, tiny, and inconveniently located within the womb- is still human. So why should you or I support a "woman's right" to discriminate against him or her? Particularly when the discrimination is both permanent and unrectifiable?

 

[snoozer]

I'm not sure I understand the point of conflict exactly. I would wager that psipsina and scutty probably agree on most aspects of medical ethics, no matter how you define it. I can't see either of them violating patient confidentiality or intentionally injuring or taking advantage of a patient.

My issue is that Wanna Be is taking personal issue with the term "ethics" as though she can change what it means in our medical profession because she WILLS it so. It reflects in her, a thinking that medicine is about the doctor 1st and what her values are and that's just plain wrong.

 

[Wanna_B_Scutty]

Are you really going to say that you've NEVER heard of a physician coming before the DISCIPLINARY board of their state? RI has one, it's one of the 1st things that pops up when you type it into a simple google search. Others that followed in my google search include NY, Massachusetts etc.

Do you think disciplinary actions are based on whims? Or violations of a SET CODE? It wouldn't be a disciplinary action if it were just a violation of a law, that would go to federal or state court and that'd have charges pressed. These doctors are going in front of a disciplinary board that assesses their actions as a physician.

http://www.health.state.ny.us/nysdoh/opmc/faq.htm

And here's something from Mississipi about conduct codes and certification:
http://www.msbml.state.ms.us/regulations/UR%20Regs Effective Dec 1.pdf

seems to go hand in hand.

Of course I was aware that there were state boards, disciplinary actions, etc. I was simply pointing out, however, that there is no ONE, UNIFYING code.

You will note that the cases you present come from different states. Do a bit of research as I did, and you'll see that state laws do differ somewhat- praticularly with regards to the controversial issues such as abortion.

 

[snoozer]

Looks like it covers things like misconduct:

"Examples of medical misconduct include (but are not limited to): practicing fraudulently, practicing with gross incompetence or gross negligence; practicing while impaired by alcohol, drugs, physical disability or mental disability; being convicted of a crime; filing a false report; guaranteeing that treatment will result in a cure; refusing to provide services because of race, creed, color or ethnicity; performing services not authorized by the patient; harassing, abusing or intimidating a patient; ordering excessive tests; and abandoning or neglecting a patient in need of immediate care.

"Certain types of complaints are not considered misconduct and therefore are not under the jurisdiction of OPMC. These include complaints regarding fees (unless they represent fraud), and complaints about a physician’s attitude, communication skills or rude behavior. OPMC does not condone uncaring behavior but such actions do not, by themselves, constitute misconduct.

I would be willing to guess we could all agree that such misconduct would be wrong.

Right but misconduct can only be deemed on the basis that there are set rules that can be misconducted/broken. So there ARE rules, unlike Wanna be scutty insists, and there ARE governing boards that discipline you for falling out of line. And although these listed are rather egregious violations, there are and have been incidences where phyisicans were disciplined for smaller things.

 

[OncoCaP]

My issue is that Wanna Be is taking personal issue with the term "ethics" as though she can change what it means in our medical profession because she WILLS it so. It reflects in her, a thinking that medicine is about the doctor 1st and what her values are and that's just plain wrong.

It seems to me that she is emphasizing that there is a lot of variation in the "ethics codes." One place may be operating under one code, whereas another has a different code, particularly when it comes to something like abortion. I could see the ethics code (with respect to abortion) at a Planned Parenthood clinic being totally different from the ethics code at a hospital run by Catholic nuns, for example. This argument is going in circles as far as I can tell.

 

[OncoCaP]

Right but misconduct can only be deemed on the basis that there are set rules that can be misconducted/broken. So there ARE rules, unlike Wanna be scutty insists, and there ARE governing boards that discipline you for falling out of line. And although these listed are rather egregious violations, there are and have been incidences where phyisicans were disciplined for smaller things.

So with respect to abortion (or the refusal to refer/perform), what kind of ethical disciplinary actions are you aware of? (let's say against a pro-life physician, for example, who didn't want to refer a patient)

 

[snoozer]

Of course I was aware that there were state boards, disciplinary actions, etc. I was simply pointing out, however, that there is no ONE, UNIFYING code.

You will note that the cases you present come from different states. Do a bit of research as I did, and you'll see that state laws do differ somewhat- praticularly with regards to the controversial issues such as abortion.

If there were ONE unifying code, and I didn't say there was one, another good misinterpret on your part, then after South Dakota passed that law outlawing all abortions, we'd either have all flipped to the same position or Dakota would have been forced to change its decision immediately. So obviously it differs by state, but if you're going to suggest that codes differ very radically, I'd suggest you did more research.

As to the topic of abortion, you're right, states make different rules although the Federal government/Supremem court also has the right to intervene and POTENTIALLY unify the regulations. It doesn't always or effectively do so, but the potential is there. As psipsina is saying, you have to answer to SOMEONE.

 

[Wanna_B_Scutty]

My issue is that Wanna Be is taking personal issue with the term "ethics" as though she can change what it means in our medical profession because she WILLS it so. It reflects in her, a thinking that medicine is about the doctor 1st and what her values are and that's just plain wrong.

No indeed, I do not believe that medicine is about the doctor first. Nor do I believe that it is about the patient first. Rather, I believe that medicine is about what is ETHICAL first.

This, of course, brings us back around to our previous discussion about "what is ethics." According to every definition I've found online (do a search yourself, if you like), ethics is constitues both a professional code AND a system of morals and values. The only souce that would say otherwise is the AMA, which apparently wishes to reduce ethics to code. The AMA is one politcal organization in one moment in time. What is more, the AMA has a lot to gain by circumscribing the definition of ethics in order to gain more power for itself. Why on earth should we ignore thousands of years of ethical philosophy and writing to instead buy into the claims of a singular organizatin that none of us are required to join, anyway?

 

[Wanna_B_Scutty]

Right but misconduct can only be deemed on the basis that there are set rules that can be misconducted/broken. So there ARE rules, unlike Wanna be scutty insists, and there ARE governing boards that discipline you for falling out of line. And although these listed are rather egregious violations, there are and have been incidences where phyisicans were disciplined for smaller things.

I never said that there weren't rules that vary by state, etc. I was simply pointing out that there is no one code. Please don't put words in my mouth that I didn't say.

 

[OncoCaP]

Here is an interesting article about ethics in the medical profession:

http://pmj.bmj.com/cgi/content/full/82/966/233
Postgraduate Medical Journal 2006;82:233-238; doi:10.1136/pgmj.2005.037754
© 2006 by Fellowship of Postgraduate Medicine

Dismembering the ethical physician
S J Genuis

Correspondence to:
Dr S Genuis
2935-66 Street, Edmonton, Alberta, Canada T6K 4C1; [email protected]

ABSTRACT
"Physicians may experience ethical distress when they are caught in difficult clinical situations that demand ethical decision making, particularly when their preferred action may contravene the expectations of patients and established authorities. When principled and competent doctors succumb to patient wishes or establishment guidelines and participate in actions they perceive to be ethically inappropriate, or agree to refrain from interventions they believe to be in the best interests of patients, individual professional integrity may be diminished, and ethical reliability is potentially compromised. In a climate of ever-proliferating ethical quandaries, it is essential for the medical community, health institutions, and governing bodies to pursue a judicious tension between the indispensable regulation of physicians necessary to maintain professional standards and preserve public safety, and the support for "freedom of conscience" that principled physicians require to practise medicine in keeping with their personal ethical orientation.
...

"Personal and corporate ethical standards and behaviour are at the very heart of the medical profession's implicit contract with society.1–3 The dual functions of physicians, to be healers and to be professionals, is an integral mixture of science and ethics4 and MD, according to some, should represent both a medical degree and a moral degree.5 ...
...

"Through the centuries, there have been various guidelines that influence ethical standards that govern the conduct of the medical profession, the most well known of these is the Hippocratic Oath. This covenantal pledge, previously considered to be "the immutable bedrock of medical ethics,"6 embodies the philosophy that physicians are accountable to transcendent forces and authority, that human life is inviolable at any stage from in-utero existence to natural death, and that primum non nocere (first, do no harm) is a critical premise of medical practice. With the dislocation of spirituality from medical practice and widespread utilisation of abortifacient procedures, the Hippocratic Oath is now considered morally and culturally irrelevant by many, and embraced by others "as a symbol of professional cohesion [rather] than for its content."7

...

"With the complex and divisive scenarios that routinely present to contemporary practitioners in varied medical specialties,20 it is not enough for doctors to simply be well mannered, technically competent, and compassionate.21 In modern day medical practice, physicians often experience ethical angst in the workplace as they encounter situations that demand difficult decisions and necessitate the choosing of sides. A few examples from a range of medical disciplines illustrate the concern. ...

"Recent findings show that many medical students perceive that the current medical environment is abusive toward their personal, moral and spiritual growth.27 Many health professionals feel a threat to their "freedom of conscience" (a basic human right according to the UN Universal Declaration of Human Rights28) and report a type of moral or ethical distress29 when placed in a position of subordination to authorities who exert power to elicit choices that contravene personal values. Most health providers wish to maintain ethical standards, but it is unrealistic to expect that all individuals will act according to their principles if the cost or consequences are considered too high.30 Many practitioners are afraid to challenge authority or to seem defiant and out of step with prevailing professional wisdom. The risk of serious disciplinary action, including the inability to graduate from medical school or the loss of licence to practise medicine, has pushed health providers into reluctantly acquiescing. The prospect of facing such difficulty has also prompted many trainees to shun areas of medicine that may infringe on their ethics because they prefer to avoid the aggravation and possible consequences of dealing with issues likely to engender moral turmoil and ethical distress.

...

 

[psipsina]

No indeed, I do not believe that medicine is about the doctor first. Nor do I believe that it is about the patient first. Rather, I believe that medicine is about what is ETHICAL first.

This, of course, brings us back around to our previous discussion about "what is ethics." According to every definition I've found online (do a search yourself, if you like), ethics is constitues both a professional code AND a system of morals and values. The only souce that would say otherwise is the AMA, which apparently wishes to reduce ethics to code. The AMA is one politcal organization in one moment in time. What is more, the AMA has a lot to gain by circumscribing the definition of ethics in order to gain more power for itself. Why on earth should we ignore thousands of years of ethical philosophy and writing to instead buy into the claims of a singular organizatin that none of us are required to join, anyway?

My personal system of morals and values is very different from your personal system of morals and values. Because the code of conduct for the medical proffession could never represent both my personal system of morals and values and your personal system of morals and values and all the personal systems of morals and values of each physician practicing we as a proffession tried to build a more unified code of behavior (that we call "medical ethics") that every physician, regardless of his or her personal system of morals and values, can be asked to follow. This in necessary so that the social contract between patients and physicians can remain in tact. Because we can't place more value on any one persons individual system of morals and values we try to have that code of ethics reflect those morals and values shared by the majority of physicians.

If we go micro with this concept we get the individual hospital ethics comittee who make decisions based on the morals and values shared by the majority of those on the comittee. In between we have the state licensing board who has a disciplinary comittee that does the same. On the macro end of things we have the AMA who have tried to unify the proffession by proposing a code of ethics that reflect the morals and values of the majority of its members. This is usually in sync with what is taught in medical schools to medical students who are future physicians who each have their own personal systems of morals and values but are asked to learn the code of conduct of their new proffession and expected to behave within it when acting in a proffessional role. When they are practicing physicians they can join the AMA and their state licensing and specialty boards and even individual ethics comittees and then their individual system of morals and values will contribue to the balance of the whole.

I'm sorry that medical ethics isn't more black and white than this, it would really make things much much simpler. But the entire issue is that none of us have the same background and beliefs so we can't possible invent a code that each of us will be 100% on board with. . . but we can't let everyone just go with their gut because the patients have to have an idea of what they can expect when the come into an exam room, strip to their skivvies, alow you to do a rectal exam, tell you their secrets and then put their lives into your hands. And you have to have an idea of what is expected of you. And so the system that we've been trying to explain exists. We're not making this up for fun, we're just telling it like it is. Because if you are about to join this proffession you have a right to know what you are signing up for. It is what it is.

 

[snoozer]

I never said that there weren't rules that vary by state, etc. I was simply pointing out that there is no one code. Please don't put words in my mouth that I didn't say.

Oh right, LOL, cause you never do that in a debate... (transplant/China thing anyone??).

And in either case, I think you miss the point. The point is that you're joining a profession, as psipsina said, and there is a general homogeneity in a large amount of the ethics codes even including their variations by state. If you take such heated issue w/ the AMA terming ethics as code, fine but in most cases, ethics and code just go together or they say "ethical code" as a nice lump sum because it's not law, it's within just the medical profession and it is something that others hold you to.

I don't think its just the AMA, I'm not in the AMA and I define ethics that way too (n = 1 studies are not always the best but that's not my point). Just because you're not in a lobbying group, doesn't mean you cant have similar ideas. And besides, that whole thing about the thousands of years... um that was a completely different time for doctors AND patients. Do you think doctors were investigated back then? Sued? Asked to perform recertification for the boards every 3-10 years?

And what I mean by saying that you think medicine is about the doctor first is exactly this:
You say that ethics are a professional code + morals and values, and the problem is inherently that. By adding your PERSONAL morals + values in, it's really about you then your patient. That I find to be very distasteful.