Ema at The Well Timed Period has this fantastic post up detailing just how easy it is for doctors to refuse reproductive health care to women. Go read it. She’s responding to this article, which discusses all the different ways that women’s health is compromised by ideologues in white coats. And it is disturbing as all hell.
It begins with the story of a rape survivor who was denied emergency contraception in the ER:
Lori Boyer couldn’t stop trembling as she sat on the examining table, hugging her hospital gown around her. Her mind was reeling. She’d been raped hours earlier by a man she knew—a man who had assured Boyer, 35, that he only wanted to hang out at his place and talk. Instead, he had thrown her onto his bed and assaulted her. “I’m done with you,” he’d tonelessly told her afterward. Boyer had grabbed her clothes and dashed for her car in the freezing predawn darkness. Yet she’d had the clarity to drive straight to the nearest emergency room—Good Samaritan Hospital in Lebanon, Pennsylvania—to ask for a rape kit and talk to a sexual assault counselor. Bruised and in pain, she grimaced through the pelvic exam. Now, as Boyer watched Martin Gish, M.D., jot some final notes into her chart, she thought of something the rape counselor had mentioned earlier.
“I’ll need the morning-after pill,” she told him.
Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. “No,” Boyer says he replied abruptly. “I can’t do that.” He turned back to his writing.
Boyer stared in disbelief. No? She tried vainly to hold back tears as she reasoned with the doctor: She was midcycle, putting her in danger of getting pregnant. Emergency contraception is most effective within a short time frame, ideally 72 hours. If he wasn’t willing to write an EC prescription, she’d be glad to see a different doctor. Dr. Gish simply shook his head. “It’s against my religion,” he said, according to Boyer. (When contacted, the doctor declined to comment for this article.)
Boyer left the emergency room empty-handed. “I was so vulnerable,” she says. “I felt victimized all over again. First the rape, and then the doctor making me feel powerless.” Later that day, her rape counselor found Boyer a physician who would prescribe her EC. But Boyer remained haunted by the ER doctor’s refusal—so profoundly, she hasn’t been to see a gynecologist in the two and a half years since. “I haven’t gotten the nerve up to go, for fear of being judged again,” she says.
We tend to forget the long-lasting effects of these kinds of judgments. Not only was this woman denied the health care she requested — health care that could prevent her from being impregnated by her rapist — she was further psychologically traumatized. Rape is a crime of violence and control, and it’s crucial for rape survivors to feel that they are able to regain control over their bodies. This doctor took that away from her, because he believes that a potentially fertilized egg is more important than his patient. That is shameful.
The stakes were high for Realtor Cheryl Bray when she visited a physician in Encinitas, California, two and a half years ago. Though she was there for a routine physical, the reason for the exam was anything but routine: Then a single 41-year-old, Bray had decided to adopt a baby in Mexico and needed to prove to authorities there that she was healthy. “I was under a tight deadline,” Bray remembers; she had been matched with a birth mother who was less than two months from delivering. Bray had already passed a daunting number of tests—having her taxes certified, multiple background checks, home inspections by a social worker, psychological evaluations. When she showed up at the office of Fred Salley, M.D., a new doctor a friend had recommended, she was looking forward to crossing another task off her list. Instead, 10 minutes into the appointment, Dr. Salley asked, “So, your husband is in agreement with your decision to adopt?”
“I’m not married,” Bray told him.
“You’re not?” He calmly put down his pen. “Then I’m not comfortable continuing this exam.”
Bray says she tried to reason with Dr. Salley but received only an offer for a referral at some future date. Dr. Salley disputes this, telling SELF that he offered to send Bray to another doctor in his group that day. “My decision to refer Ms. Bray was not because she was unmarried; rather, it was based on my moral belief that a child should have two parental units,” he adds. “Such religious beliefs are a fundamental right guaranteed by the Constitution of the United States.”
Yes, religious freedom is guaranteed by the Constitution — and it’s a crucial right that I don’t want to see taken away. But it’s long been established that religious freedom has to be balanced with workplace obligations. I think it’s fair to require workplaces to make reasonable accomodations for religious people. I’m not so sure it’s fair for an employee to refuse to do their job because of their religion. If you follow Jainism and feel it is utterly morally wrong to consume animal products, you probably should not apply to be a cook in a non-vegetarian restaurant.
Allowing a person to wear unobtrusive religious clothing items is a fair accomodation. Allowing someone to take Saturday off instead of Sunday is a fair accomodation. Allowing an employee a break to pray is a fair accomodation.
Allowing an employee to compromise someone’s health when their job is to provide health care is not a fair accomodation. Case in point:
If there’s one thing both sides can agree on, it’s this: In an emergency, doctors need to put aside personal beliefs to do what’s best for the patient. But in a world guided by religious directives, even this can be a slippery proposition.
Ob/gyn Wayne Goldner, M.D., learned this lesson a few years back when a patient named Kathleen Hutchins came to his office in Manchester, New Hampshire. She was only 14 weeks pregnant, but her water had broken. Dr. Goldner delivered the bad news: Because there wasn’t enough amniotic fluid left and it was too early for the fetus to survive on its own, the pregnancy was hopeless. Hutchins would likely miscarry in a matter of weeks. But in the meanwhile, she stood at risk for serious infection, which could lead to infertility or death. Dr. Goldner says his devastated patient chose to get an abortion at local Elliot Hospital. But there was a problem. Elliot had recently merged with nearby Catholic Medical Center—and as a result, the hospital forbade abortions.
“I was told I could not admit her unless there was a risk to her life,” Dr. Goldner remembers. “They said, ‘Why don’t you wait until she has an infection or she gets a fever?’ They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy.” He tried admitting Hutchins elsewhere, only to discover that the nearest abortion provider was nearly 80 miles away in Lebanon, New Hampshire—and that she had no car. Ultimately, Dr. Goldner paid a taxi to drive her the hour and a half to the procedure.
That’s right: She had to come in with an infection before she could get the health care she needed. Keep in mind that her fetus was going to die, but it could take weeks for her to miscarry. Carrying a dead body inside of your own body is incredibly dangerous. It can be psychologically devastating. It could have killed her.
But “morality” demands that she get an infection before she can receive care.
And in emergency scenarios, Dr. Stulberg says, the newly merged hospital did not offer standard-of-care treatments. In one case that made the local paper, a patient came in with an ectopic pregnancy: an embryo had implanted in her fallopian tube. Such an embryo has zero chance of survival and is a serious threat to the mother, as its growth can rupture the tube. The more invasive way to treat an ectopic is to surgically remove the tube. An alternative, generally less risky way is to administer methotrexate, a drug also used for cancer. It dissolves the pregnancy but spares the tube, preserving the women’s fertility. “The doctor thought the noninvasive treatment was best,” Dr. Stulberg recounts. But Catholic directives specify that even in an ectopic pregnancy, doctors cannot perform “a direct abortion”—which, the on-call ob/gyn reasoned, would nix the drug option. (Surgery, on the other hand, could be considered a lifesaving measure that indirectly kills the embryo, and may be permitted.) The doctor didn’t wait to take it up with the hospital’s ethical committee; she told the patient to check out and head to another ER. (Citing patient confidentiality, West Suburban declined to comment, confirming only that as a Catholic hospital, it adheres to religious directives “in every instance.”)
In other words, the embryo matters more than you, even if it’s doomed. Under Catholic doctrine, you apparently cannot simply dissolve an embryo implanted in the fallopian tube; you have to remove the whole tube. The justification is that removing just the embryo is tantamount to abortion; removing the tube, though, terminates the “life” of the embryo as a side-effect. So we can pretend that — oops! — we didn’t mean to kill the embryo, it just kind of happened while we were taking away a woman’s ability to have children in the future. Can’t beat the logic there.
Oh, and your doctor doesn’t have to tell you that they may simply refuse to provide you with basic health care:
Sonfield notes that many refusal clauses do not require providers to warn women about restrictions on services or to refer them elsewhere. “You have to balance doctors’ rights with their responsibilities to patients, employers and communities,” he adds. “Doctors shouldn’t be forced to provide services, but they can’t just abandon patients.”
I agree that doctors should not be forced to provide a service just because a patient asks for it — there are ethical lines that they have to follow, and those lines can be blurry. But there are the fuzzy, outlier ethical issues, and then there are all the issues involved in reproduction. Ob-Gyns or ER doctors cannot possibly claim that they had no idea they would ever have to face medical issues that involved reproduction and women’s sexual health. I don’t see how they can possibly claim that they had no idea they would have to provide care for someone who lived according to a different set of beliefs.
And I wonder how this would all be received if it were members of minority religious groups who were refusing care. Ema gives one example:
Asks for some pain relief during labor. That’s when I inform her that I’m a Scientologist and that pain relief for pregnant women is against my religion. Five minutes of verbal sparring later [’cause what would providing medical care be without the patient having to beg and plead for it just a tad], I relent with an order for pain meds—but only after the patient tells me she needs pain control for a toothache, not to ease labor.
Now, this is just a woman we’re talking about here, so it might not be that big of a deal. But let’s say a young man goes to a school counselor. He says he’s depressed. He’s says he’s thinking of hurting himself or other people. He says he wants help, and he asks if the counselor knows a psychiatrist or mental health professional she could refer him to.
The counselor tells him that she would love to assist him, but psychiatry is the root of all evil. She tells him that it cased WWI, the rise of Hitler and Stalin, the wars in Bosnia and Kosovo, and the September 11th attacks. She tells him that she can, however, serve as his “auditor,” wherein she will use an E-meter and ask him a series of questions. Auditing, she says, will “help the practitioner (referred to as a preclear or PC) to unburden himself or herself of specific traumatic incidents, prior ethical transgressions and bad decisions, which are said to collectively restrict the preclear from achieving his or her goals and lead to the development of a “reactive mind”. ”
Is she doing her job? If this kid does end up hurting himself or someone else, should she be considered negligent? Or can she just say that she was following her religious beliefs, maintain her job, and continue refusing to refer troubled students to psychiatrists — indeed, encouraging them not to see psychiatrists?
Even if nothing dramatic happens, should the school maintain her employment?
Religious freedom is crucial. But if one is in a care-giving profession, it is not obscene to require that person to provide health and life-saving care.
Now, really, go read Ema’s post.
Thanks to Sailorman for the link.
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