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Jill has been blogging for Feministe since 2005.
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99 Responses

  1. William
    William June 5, 2008 at 3:03 pm |

    After all, it’s my religion, motherfuckers. What are you gonna do?

    Turnabout is fair play, right? Just do what they do to abortion clinics. Picket, protest, lie, cheat, bomb, shoot, burn, vandalize, threaten, terrorize. I mean hey, if personal conviction is a justification to put it all out there on the table, we might as well get in on the game.

  2. felagund
    felagund June 5, 2008 at 3:07 pm |

    I think it’s CONSCIENCE clauses. That is, the RW fake Xian pharmacist would be kept awake at night by his conscience were he to prescribe mifeprestone for a white girl.

  3. Sara Anderson
    Sara Anderson June 5, 2008 at 3:12 pm |

    I’m no religious scholar, but I’m guessing that the Bible doesn’t actually forbid IVF for lesbians. I can only conclude that this guy is simply a meanie.

  4. MJN
    MJN June 5, 2008 at 3:43 pm |

    I actually have a problem with conscious clauses in general. Prescribing birth control is actually routine for a dermatologist; as a dependent, it was the only way my insurance covered it. And to base the argument that if it was something they learned in school, it’s something they should expect to do has huge potential flaws too – new, more controversial methods could come up that are better for the patient.
    I think the answer is less on approved medical practices that the doctor doesn’t want to do – there are, after all, restrictions on the kind of medicine you can perform based on your license – than on the informed consent of the patient regarding all of the possible outcomes of their treatment. I didn’t mean “informed consent” in the “misinformation” sense, however – more in the sense of choosing between medications based on a comprehensive understanding of their side effects, etc.

  5. ThickRedGlasses
    ThickRedGlasses June 5, 2008 at 3:56 pm |

    This seems to be unique to physical, as opposed to mental, healthcare professionals. If a counselor denies therapy to a lesbian couple for religious reasons, they are completely within their legal rights and ethical standards. In fact, one can argue that they’re ethically obligated not to practice therapy with the clients because doing so may harm them. Imagine having to remain just to people you find repulsive. It’s impossible to provide effective therapy to someone you have a serious issue with, and it’s impossible for a counselor to leave their values at the door once they walk into the therapy room. However, the counselor has an ethical responsibility to refer this couple to a competent counselor who is lesbian-friendly. Because counselors aren’t looking to lose their jobs, it’s doubtful that any of them would risk losing their license (and the public embarrassment that goes with that) or being sued for malpractice simply to appease their conscience (or should I say superego?). I would not be surprised if similar ethical guidelines exist for medical doctors, so addtional conscious clauses in legislation that are more about refusaing care than making sure people get fair and effective healthcare only exist to further disenfranchise certain groups of people.

  6. ThickRedGlasses
    ThickRedGlasses June 5, 2008 at 3:59 pm |

    Prescribing birth control is actually routine for a dermatologist; as a dependent, it was the only way my insurance covered it. And to base the argument that if it was something they learned in school, it’s something they should expect to do has huge potential flaws too – new, more controversial methods could come up that are better for the patient.

    True. Not only does birth control help improve mild acne, patients on Accutane are required to be on two forms of birth control, one primary and one secondary. It makes a lot of sense to get both prescriptions from the same doctor, especially if that’s the only way it’ll be covered.

  7. Daniel Martin
    Daniel Martin June 5, 2008 at 4:22 pm |

    how about if I refuse medical care to someone based on who they voted for in the last Presidential election

    Something similar to this has happened: back when malpractice insurance rates shot through the roof for no readily explained reason, some doctors did in fact decide to refuse treatment to malpractice attorneys and their dependents. The AMA even gave serious consideration to whether this practice should be adopted generally.

    (notice how that’s not a big political issue anymore? Maybe there was more going on behind insurance rates that simply rate-of-suit)

  8. anon
    anon June 5, 2008 at 4:33 pm |

    All the doctor had to say was that he refused to do it and not give a reason. You cant force a doctor to do something they dont want to do.

  9. Sarah
    Sarah June 5, 2008 at 4:36 pm |

    If the concern is truly over “forcing” people to perform job functions that violate their beliefs, why not make it a law that if you have certain beliefs you can’t get a license as a pharmacist or an MD? Afterall, that would prevent people from having to perform job functions that lie outside of their belief system AND it would make sure that when someone goes to see a doctor or pharmacist, that they can actually get the health care they need. Yes, people in the US are protected against job discrimination based on religion, but the anti-descrimination laws do have exemptions. I would wholeheartedly support the notion that it is a Bonafide Occupational Requirement that a health care provider not have religious beliefs that prohibit that person from providing health care. If you refuse medically-accepted health care to someone based on your beliefs, you lose should your license.

  10. Betsy
    Betsy June 5, 2008 at 4:39 pm |

    I’m a vegetarian. If I were to take a job as a chef or a waiter at a non-veg restaurant, and then refuse to prepare or serve meat, I would rightly be fired. I fail to see how this is any fucking different. Bastards.

  11. earlgreyrooibos
    earlgreyrooibos June 5, 2008 at 4:42 pm |

    I would wholeheartedly support the notion that it is a Bonafide Occupational Requirement that a health care provider not have religious beliefs that prohibit that person from providing health care. If you refuse medically-accepted health care to someone based on your beliefs, you lose should your license.

    I think that’s a great idea. Especially because for medicine, “conscience clauses” have the potential to violate the Hippocratic Oath. After all, a doctor who refuses to touch, and therefore treat, a woman because it violates his religious beliefs isn’t exactly “doing no harm.” If that person dies because nobody else was available to treat her, then he really did harm her.

  12. eastsidekate
    eastsidekate June 5, 2008 at 4:48 pm |

    I’m assuming a Christian Scientist that opposes medicine (as unnecessarily intervention against God’s will) wouldn’t be able to get a medical license, as he or she wouldn’t be able to do his or her job.

    However, this case is worse than that– it’s not simply about a fundamentalist refusing to ring up pork or provide birth control on religious grounds. If it were, it would be bad enough. This case is about denying treatment to specific groups of people, because of a practitioner’s belief that certain people aren’t entitled to certain treatments. This is messed up beyond belief. Sometimes, there’s nuance to be had, but I just don’t see it here. What’s the rational, ethical or legal argument for allowing this behavior? If I refuse to deal with straight people at my job, can I keep my job? What if I decide not to talk to Muslim people? This is discrimination, period.

  13. NamelessCity
    NamelessCity June 5, 2008 at 5:08 pm |

    Please please PLEASE use correct terms…it is not “conscious clause.” It is “conscience clause.” For an article as important as this, the term should be correct. The right wing fanatics might be loonies but the material they release, especially the antigay and misogynistic material from such organizations as Focus on the Family, is always well-edited and this gives the stuff legitimacy and credibility. If liberals continue to use terms like “conscious clause” and phrases like “the southern states succeeded from the Union,” we will appear illiterate! That will not help our causes.

  14. Melinda
    Melinda June 5, 2008 at 5:08 pm |

    Whoa, whoa, whoa. This is not IVF we’re talking about. This is interuterine insemination. They are NOT interchangeable terms. IUI can be done as simply as with semen and a turkey baster. Doctor does not have to be involved. All that is needed is a fertile woman and viable sperm. IVF, on the other hand, involves insemination in vitro; i.e., under a microscope, by an embryologist. The fertilized egg is then placed in the uterus of the woman desiring children, or the uterus of a surrogate who carries the embryo to term. Unfortunately, the blogsophere has interpreted this as IVF and the mistake has just carried from one blog to the next.

    Now while we’re talking about IVF, it’s notable that there are quite a few states in the U.S. that limit the procedure to married couples. So no single mothers, no same-sex couples, etc. So why is this recent case such a big issue? It’s nothing new, even if people have only realized it now.

    Furthermore, there ARE moral issues involved in IVF (again, that’s not this case). What IVF does is basically counteract evolution. It allow people who are not physically capable of reproduction (faulty sperm, etc.) to pass their genes onto future generations. This itself is morally questionable, and many other morally questionable cases come up. Is it acceptable to help a couple in which one or both partners are at the age or state of health at which death is imminent have children? Is it moral to counteract biology to let adults who want children for frivolous reasons and lack the (physical, mental, emotional, etc.) ability to raise them? These are the serious issues that come up in IVF, but they are rarely addressed in the media or blogosphere. As far as IVF is concerned, the issue is not limiting children (à la sterilization) from fertile adults. It is not about choice. It is about using technology to let people who would otherwise be incapable of it reproduce. (A single lesbian, for example, is not necessarily infertile; she only needs sperm to become pregnant. IVF is not relevant.)

    To be clear, I oppose limiting IUI or IVF to married, opposite-sex couples. Forbidding a single lesbian woman from a procedure (as in this case) for being single and lesbian is wrong and medically unjustifiable. Let us not, however, apply irrelevant issues to this case.

  15. little light
    little light June 5, 2008 at 5:14 pm |

    This does cross an interesting line because, as you said, it’s no longer about performing procedures the professional finds immoral–it’s no longer about actions they might be forced to perform, really. It’s about the patient/client being unacceptable. Really, it’s a hop skip and a jump from claiming that due to your religious convictions you can’t serve a particular class at all.
    And then it’s right at denying any medications to queer women, say, because keeping them alive supports their “lifestyle.” Or refusing to perform surgery on–or teach class at public school to–or count the votes of–other people who you believe to be immoral.
    I mean, you set the precedent of denying fertility treatment to people because you judge them–for belonging to a group you find immoral–to be an unfit parent, it’s in the same constellation as denying them adoption rights, taking away custody, or pushing toward sterilization for “undesirables.”
    Oh, wait. We’ve been there.

    (And Jill, I’m pretty sure it’s “conscience” clauses.)

  16. Hot Tramp
    Hot Tramp June 5, 2008 at 5:19 pm |

    I would wholeheartedly support the notion that it is a Bonafide Occupational Requirement that a health care provider not have religious beliefs that prohibit that person from providing health care.

    I doubt that something like this would fly, especially with the current U.S. Supreme Court. A compromise might be something like, “Health care facilities are required to employ at least one person who is willing and able to performing any FDA-approved procedure deemed medically necessary.” That would help solve the access issue, at least, by getting rid of rural pharmacies and doctors’ offices that are staffed entirely by those who would block people’s access to care.

  17. james
    james June 5, 2008 at 5:22 pm |

    But if the thing you object to is a part of the normal course of your job, and was a totally foreseeable consequences of you taking that job, I don’t have much sympathy.

    I can’t discuss this case, but some of these doctors do say that what they’re being asked to do is not part of the normal course of their job. Their argument would be that their job is to treat infertility, and that just because a woman is a lesbian doesn’t make her infertile.

    This kicks the whole question back to what condition these doctors are/should be treating. That’s an ongoing debate. On the one hand there are people that argue that infertility is a social condition, where you want a child but don’t have one. On the other hand, I think the traditional medical test for infertility is failure to conceive after having regular sex over the course of a year. I think some people also argue that infertility is something suffered by a couple, rather than something an individual can have.

    I don’t know the answer, but I don’t think it’s a simple as demanding he does his job. Becuase it is an open question as to what his job is.

    I think you make good points. Refusing to do something you’re hired for is a straight up breach of contract law, and you should be sacked. But in some cases – like fertility treatment – these aren’t tightly defined contracts.

  18. anon
    anon June 5, 2008 at 5:25 pm |

    IVF is a purely elective procedure. I dont think the same rules should apply for elective vs emergency treatment.

    For elective procedures, the doctor should have the right to tell you to go somewhere else.

    I mean really WTF are we talking about here? Is a police officer going to go into the doctor’s office and force him at the point of a gun to provide IVF?

  19. Melinda
    Melinda June 5, 2008 at 5:47 pm |

    Note: To be more accurate, the issue here is artificial semination. It can be interuterine (IUI) OR intercervical (ICI). Sorry about that.

  20. Liz
    Liz June 5, 2008 at 5:55 pm |

    It’s about making a decision for someone else because you think you know better than them and that you have the right to control their lives. It’s the #1 reason why I’m a liberal: I think people should be allowed to make their own decisions, no matter how stupid or intelligent they may be, as long as they aren’t harming others.

    A lesbian having a child won’t harm the child psychologically, nor will it grow up to be a lesbian or gay just because it has an LGBTQ mother. But, of course, the Christian right doesn’t believe that.

    Refusing to perform a medical procedure because you don’t like someone (which, let’s face it, the issue boils down to not liking a group of people for whatever reason – how very 5th grade of you), which does impact another person in a negative way.

  21. little light
    little light June 5, 2008 at 6:06 pm |

    OF course the doctor has the right to refuse to provide treatment to some patients, Anon. Similarly, I have every right not to go to work this week, or to show up and then not perform any tasks. And my boss has every right to choose not to pay or employ me if I do so.
    It’s not an issue of rights. The doctor has every right to do what they please. And we have every right to point out they’re not doing their job. It’s an issue of ethics much more than of rights.

  22. roses
    roses June 5, 2008 at 6:15 pm |

    I mean really WTF are we talking about here? Is a police officer going to go into the doctor’s office and force him at the point of a gun to provide IVF?

    No, we’re talking about his license to practice medicine being suspended, or him being fined. Or, if he works for someone else, fired. It may surprise you to learn that we live in a society with laws and rules and there are ways of getting people to fulfill their legal obligations that don’t involve putting a gun to their heads. I mean, really.

  23. roses
    roses June 5, 2008 at 6:16 pm |

    Oops, I screwed up the blockquotes, second paragraph is mine.

  24. preying mantis
    preying mantis June 5, 2008 at 6:28 pm |

    “I dont think the same rules should apply for elective vs emergency treatment.”

    So it’s totally kosher for doctors to refuse to provide birth control, pap smears, sterilization, etc., based on a patient’s marital status, racial group, religious beliefs, and so forth?

    Keep in mind, there’s a pretty big gulf between “emergency” treatments and purely elective things. Even with something like Plan B, where just jerking the patient around for a few hours can translate into the treatment being meaningless, you’re not talking about a life-or-death situation. Nobody’s going to bleed to death or suffer a fatal heart attack if the pharmacist decides that they’re so against abortion that they’ll precipitate one. An asshole provider can hose any number of patients very, very thoroughly while never crossing that “denial of emergency care” line, especially if those patients don’t have decent or better insurance.

  25. kate
    kate June 5, 2008 at 8:00 pm |

    Shit like this happened to my mother 30 years ago when she was trying to get pregnant with me. She didn’t even need IVF, just artificial insemination but since she wasn’t married doctors wouldn’t work with her. I never got the whole story from her as to whether or not the doctors knew she was a lesbian, but either way it was unacceptable and I can’t believe it’s still happening.

    As to the poster who insinuated that being a lesbian means you don’t qualify as infertile because you aren’t having heterosexual sex, that’s a load of crap. It’s highly likely that the woman in question had gone through multiple cycles of artificial insemination and had used other fertility treatments before trying IVF (it’s not exactly cheap). There’s nothing about the definition of being infertile that means you have to be having heterosexual sex, it just means you are trying to conceive (no matter how you are going about it) and having trouble.

  26. Abby
    Abby June 5, 2008 at 8:01 pm |

    “how about if I refuse medical care to someone based on who they voted for in the last Presidential election?”

    Such a good point! I don’t believe that God (or the American people) thinks Republicans are fit to be parents. Therefore, if I’m an IVF provider, I won’t help Republicans. Hey, they made that choice.

    Dude. The more I think about it, the more I like that idea. Off to med school!

  27. Craig R.
    Craig R. June 5, 2008 at 8:23 pm |

    Doctors who complain about trial lawyers are missing the target — there are actually a vary small number of big awards given out in medical malpractice suits — and those big awards are earned because of gross dereliction on the part of the medical professionals.

    The issue with the premium rates is an issue with the insurance companies. Most rises in malpractice rates are due to actuarial considerations (such as how many suits a doctor has had brought, or how risky a specialty is), but more to do with the current return on an insurance company’s investments in the stock market. When the markets are down the insurance companies raise premiums. They do it to doctors because if they tried to raise the insurance rates on the general public in something like auto or homeowners insurance, the people who get gored are many and they remind the legislators that they *vote* Witness the push in many states now to regulate the rates that insurers are trying to push through in homeowners laibaility coverage. The inasurance companies are guaranteed an exemption from anti-trust legislation, and they take full control of it.

    If insurance companies were really being so poor they would not be classed as suchsecure investments. Vultures.

  28. Alex, FCD
    Alex, FCD June 5, 2008 at 9:02 pm |

    For elective procedures, the doctor should have the right to tell you to go somewhere else.

    Doctors do have the right to do that, but if this particular procedure happens to be their specialty, they run the risk that they will soon not be doctors any more. This is not exactly a secret. You are informed, while in med school, that when you become a doctor you will occasionally be required to, you know, practice medicine.

  29. activistgradgal
    activistgradgal June 5, 2008 at 10:13 pm |

    As to the poster who insinuated that being a lesbian means you don’t qualify as infertile because you aren’t having heterosexual sex, that’s a load of crap. It’s highly likely that the woman in question had gone through multiple cycles of artificial insemination and had used other fertility treatments before trying IVF (it’s not exactly cheap). There’s nothing about the definition of being infertile that means you have to be having heterosexual sex, it just means you are trying to conceive (no matter how you are going about it) and having trouble.

    I was thinking the same thing. Does that poster really think that lesbians who want to birth a child jump right to IVF skipping over the much cheaper, easier, and less invasive turkey baster/semen routine? What lesbian in her right mind would do that?

    I don’t really understand the poster’s point that doctors could argue that helping a lesbian get pregnant wouldn’t be the normal course of their job. How so? Take two women using artificial insemination–one of whom has sex with her female partner and one who has sex with her male partner. Neither person A nor person B can get pregnant, although there is no problem with their ability ovulate or for a fertilized egg to implant. In both cases the problem is with the particular partner they choose to have sex with. Neither woman is herself infertile, it’s just that each chooses to only have sex with a particular partner, and it happens that that partner can’t get her pregnant.

    Now how can one of these women not count as infertile and therefore be refused treatment by a doctor who only treats infertility but not the other? In my eyes, I would say that both of the women are perfectly fertile (I can’t wrap my mind around the idea of a couple being infertile–how can two unattached people have share a medical problem?). Sure if they chose to have sex with someone other than their partner they could easily get pregnant, but they aren’t making that choice. Why is the straight woman’s choice not to have sex with someone other than her partner any different than the lesbian’s choice not to have sex with someone other than her partner?

  30. bushfire
    bushfire June 5, 2008 at 11:32 pm |

    Regarding lesbian’s use of IVF, I just want to add that some lesbian couples use IVF to put the egg of one woman into the other’s uterus and that way they are both mothers. I have no idea what this particular person was doing, but this is a possible reason why a lesbian might use IVF instead of a turkey baster.

  31. preying mantis
    preying mantis June 6, 2008 at 12:37 am |

    “I can’t wrap my mind around the idea of a couple being infertile–how can two unattached people have share a medical problem?”

    I think that’s usually reserved for couples where it’s a combination problem. Sometimes you get things where either partner could manage a viable pregnancy if paired with someone who was completely normal, reproductively speaking, but his sub-par sperm are compounding some minor problem on her end, and taken together they present as infertile. I think there’s also a type of recurrent pregnancy loss that’s been linked to couples being too genetically similar–the woman’s immune response never goes into pregnancy mode and instead attacks the embryo–so it winds up being a problem created between them rather than suffered by one of them.

    If I had to guess, though, I wouldn’t chalk too many fertility clinic patients up to the Wonder Twin version of infertility.

  32. Melinda
    Melinda June 6, 2008 at 2:16 am |

    Jill,

    Thanks for the reply. The condition does make add confusion, but every article I’ve seen described the procedure as insemination. IVF doctors do perform AI though.

  33. Mandolin
    Mandolin June 6, 2008 at 7:51 am |

    “But I do think that medical professionals should have to do the job they signed up for. That is, if you’re a dermatologist, I can see why it’s not reasonable to expect you to perform an abortion or write someone a birth control prescription.”

    Birth control pills can be an effective acne treatment. Many of the women I know first started the pill to eliminate skin problems, not to prevent pregnancy. So, I don’t think “I’m a dermatologist” is a good reason to avoid prescribing the pill.

    Maybe “I’m an ear, nose, and throat doctor.”

  34. Mandolin
    Mandolin June 6, 2008 at 8:01 am |

    “Furthermore, there ARE moral issues involved in IVF (again, that’s not this case). What IVF does is basically counteract evolution. It allow people who are not physically capable of reproduction (faulty sperm, etc.) to pass their genes onto future generations. This itself is morally questionable, and many other morally questionable cases come up. ”

    No, not really. Unless you’re a fucking eugenicist.

    God, that commenter’s a creep.

  35. Ismone
    Ismone June 6, 2008 at 11:42 am |

    Mandolin, I think the comment is a little questionable, but some forms of artificial reproduction (like the one where they inject a sperm cell directly into the egg) are a little questionable—if under normal circumstances, the egg would not “select” that sperm, there is a higher chance of genetic unfitness that could harm the child and its future offspring. And there is some indication that IVF may screw up imprinting and lead to poor health. Plus, if the infertility problems are genetic, they can be passed on to the offspring.

    So there are some ethical issues at play, and while I would personally adopt over using reproductive assistance (other than perhaps AI), this is not a view I would enforce on others. But they should be educated about the risks to their future offspring.

  36. Q Grrl
    Q Grrl June 6, 2008 at 12:36 pm |

    How would folks feel if lesbian doctors started to refuse to treat erectile dysfunction: “Sorry dude, your boner goes against my conscience.”

  37. amandaw
    amandaw June 6, 2008 at 1:12 pm |

    Sorry, but I have to call this out:

    What IVF does is basically counteract evolution. It allow people who are not physically capable of reproduction (faulty sperm, etc.) to pass their genes onto future generations. This itself is morally questionable

    for the ableist bullshit that it is.

  38. Hilary
    Hilary June 6, 2008 at 1:17 pm |

    I was also troubled by that poster’s comment.

    Who gets to decide who is a good parent? And how far do we get to go with that decision making? And who gets to decide when evolution is working to our advantage and when it isn’t? I plan to be an Ob/Gyn, and I cannot imagine predicting who is going to be a good parent and who isn’t, based on my personal set of standards, and then decide to offer different levels of care to different people based on that. The orthodox Jewish mother who just had her sixth kid by the age of thirty and can’t keep up with the ones she has…should I just let her hemorrhage or try not to save her uterus if she has a complicated birth? Hey, just keeping someone from reproducing again who I deem not worthy of further fertility.

    I am just trying to say religion and marriage doesn’t mean you can handle your next kid. Neither does money. And, being in your thirties or forties does not mean death is imminent. (What kind of a statement is that?!) Just like I would not want to be in the position of doling out parenting cards to the patients I like the most, I would not be pointing to my patients with fertility problems and tell them they are going to die soon anyway, so they may as well give up on parenting.

    It’s bad enough that fertility treatments are effectively rationed to those who can afford them or have procedures covered by their insurance, and then they have to fall within the laws of their state. Ethical rules on fertility treatments should focus on the health of the mom first and the potential babies, second. There is plenty of ground to cover there before we need to be telling people they are too old or too evolutionarily undesirable to parent.

  39. amandaw
    amandaw June 6, 2008 at 1:17 pm |

    Thanks Mandolin — I thought I was the only one who caught that.

    I thought pure social darwinism was the domain of assholes on the far right wing. Not people who claim to give a shit about social justice.

  40. Mandolin
    Mandolin June 6, 2008 at 1:18 pm |

    “Mandolin, I think the comment is a little questionable, but some forms of artificial reproduction (like the one where they inject a sperm cell directly into the egg) are a little questionable”

    What you said is not what the other commenter said. You’re talking about risk to fetus, via the actual method of the procedure itself. The other commenter said that certain people should not be allowed to reproduce because they are flawed, and that prevents evolution from working.

    Of course, it brings up the question of what is “flawed.” We all benefit from medical care; why is it more “morally questionable” for someone who is alive because of antibiotics, but has a healthy reproductive system, to reproduce than it is for someone who has never had a major surgery or medical intervention but who needs a pill to stimulate ovulation? Of course both these sentiments are monstrously ableist, as has been pointed out, but even within the ablist framing suggested by the initial commenter, the argument is still transparently bullshit.

    You’re discussing flaws inherent in a procedure. Sie’s talking about “flaws” in a population, with the implication that no matter what the procedure, such people should not have access to reproductive help. If you can’t see the difference, that’s a problem.

  41. Ashley
    Ashley June 6, 2008 at 5:13 pm |

    Hi! I’m an infertile!

    One thing I find disgusting is that there’s a fertility clinic in my town that mandates you see their religious counselor if you use donor gametes. So, if for whatever reason your eggs suck or you need donor sperm, you have to visit their pastor guy.

  42. med student
    med student June 6, 2008 at 8:46 pm |

    I just graduated from med school, and I never took any oath, nor was I instructed that if I choose a particular specialty that I must, under coercion of law, provide every “service”, elective or not, thats in the domain of that specialty.

    Its all about appropriate consequences. Your doc wont prescribe birth control? Tell him to shove it, protest outside his clinic, notify all your friends and family, etc. But lose his medical license, get fined, or go to jail? Thats BS and totally inappropriate. Just as women should have the option to seek out IVF or OCPs, the doctor should have the option to decline to provide the service and tell them to seek help elsewhere. If a referral is required for the insurance company, then the doc should supply it but they should NOT be coerced to provide it himself.

    If I have a problem with IVF or OCPs or whatever and I join a group clinic, then the bosses have every right to fire me. I dont have a problem with that. But if I start up MY OWN CLINIC then I should be able to choose which services I want to provide. I’m talking about outpatient clinics, not hospitals which is a totally different animal.

    Being fired from a company because you wont work under their guidelines is totally fine. But its a different thing for the government to get involved and use force of law to coerce people into providing services, whether its selling white walled tires, or providing IVF.

  43. Solitary
    Solitary June 6, 2008 at 11:19 pm |

    I saw an amusing bumper sticker the other day. “Keep your rosaries out of my ovaries.” It’s not enough that religious groups want to control what we think, learn and believe, they also want to control our bodies. (Sorry, organized religion makes me angry.)

    I actually had a fairly religious customer tell me that I was interfering with god’s plan by not having children. Since I had found out just weeks earlier that I could not have kids (happy joy!!) I answered that obviously god did not intend me to have kids. This fairly religious customer then proceeded to tell me to try fertility treatments. I am missing the connect between ‘god’s plan’ and ‘human intervention’ here. I have doubts and issues with IVF and other fertility issues, but at least I’m not hypocritical enough to dress them up in bible verses, picking and choosing in order to support my views.

  44. JenLovesPonies
    JenLovesPonies June 7, 2008 at 9:46 am |

    Hey Med Student,

    If I go to the gyno, and he or she refuses to provide me with birth control, that’s it. Do you know how many times a year I can go to the gyno? Once. My insurance only covers one visit a year. Do you really think Blue Cross/Blue Shield is going to let me go to another one, when they don’t even allow me to go to the gyno AND get a physical in the same year?

    So I hope when you open your own practice, you are open about what services you provide so that no one is in a mess with their insurance company.

  45. eastsidekate
    eastsidekate June 7, 2008 at 10:09 am |

    If I have a problem with IVF or OCPs or whatever and I join a group clinic, then the bosses have every right to fire me. I dont have a problem with that. But if I start up MY OWN CLINIC then I should be able to choose which services I want to provide. I’m talking about outpatient clinics, not hospitals which is a totally different animal.

    Sure. But do you have the right to hang a sign out front that says “No Lesbians”? Me thinks not.

  46. Rivka
    Rivka June 7, 2008 at 11:54 am |

    What IVF does is basically counteract evolution. It allow people who are not physically capable of reproduction (faulty sperm, etc.) to pass their genes onto future generations. This itself is morally questionable, and many other morally questionable cases come up.

    Any kind of lifesaving or reproductive-capacity-saving medical treatment prior to the end of the reproductive years “counteracts evolution,” then. Take the mumps vaccine: not only does it save lives, but the mumps render a certain percentage of males sterile. How dare we go against evolution by preventing mumps?

    No one has ever satisfactorily explained why no one wrings their hands and complains about “going against nature” when it comes to interfering with cancer cells. Infertility is the only illness you’re supposed to suck it up and not treat.

  47. Loosely Twisted
    Loosely Twisted June 7, 2008 at 11:58 am |

    If you spent an additional 12 yrs in school just to be able to deny a person care, you should have your license banned. In any state. I know a few power hungry doctors who enjoy doing just that. yes, they’re Male, why do you ask?

  48. med student
    med student June 7, 2008 at 2:21 pm |

    If you spent an additional 12 yrs in school just to be able to deny a person care, you should have your license banned. In any state. I know a few power hungry doctors who enjoy doing just that. yes, they’re Male, why do you ask?

    thats flawed thinking. Government should not be in the business of dictating what kind of service a company chooses to offer. Just as govt has no role in demanding that Walmart carry mifepristone, so too does it have no business demanding what individual clinics provide.

    If your clinic wont provide the services you need, then you have a number of options at your disposal:

    1) Protest the clinic
    2) Lobby the insurance company to drop them
    3) Tell all your friends and family to drop them
    4) Start a public information campaign about it

    99% of REI and ob/gyn clinics will provide any service under that specialty’s domain. What we are talking about is the 1% who refuse to offer 100% of the services under that domain. For those 1%, an appropriate consequence for them is that they go out of business due to market demands, NOT that the heavy hand of govt come down on them with fines, jail time, loss of license, etc.

    Can anybody give me a link to an ob/gyn practice that actually refuses to script OCPs? I’m sure they are out there, you guys make it sound like its a widespread practice.

  49. Mnemosyne
    Mnemosyne June 7, 2008 at 2:33 pm |

    thats flawed thinking. Government should not be in the business of dictating what kind of service a company chooses to offer. Just as govt has no role in demanding that Walmart carry mifepristone, so too does it have no business demanding what individual clinics provide.

    Huh? Your license to practice medicine comes from the government. They can put whatever restrictions on you that they like. Hopefully they told you in med school that practicing medicine without a license from the government is illegal.

  50. med student
    med student June 7, 2008 at 2:34 pm |

    If I go to the gyno, and he or she refuses to provide me with birth control, that’s it. Do you know how many times a year I can go to the gyno? Once. My insurance only covers one visit a year. Do you really think Blue Cross/Blue Shield is going to let me go to another one, when they don’t even allow me to go to the gyno AND get a physical in the same year?

    So I hope when you open your own practice, you are open about what services you provide so that no one is in a mess with their insurance company.

    Any ob/gyn that refuses to provide OCPs will go out of business within a few months. Thats a totally appropriate marketplace-based consequence of refusing to provide services.

    You still have other options. Change to a different ob practice. Go to a family practice instead. Lobby the insurance company to drop them. Organize a public relations campaign that will mobilize public support against them.

    When its a fact taht 99% of ob/gyn practices provide OCPs, when you have many other doctors who will provide OCPs, and when there are a myriad of marketplace-based consequences against ob/gyns who refuse OCPs, then I’m not willing to take the next step of FORCING all ob/gyns to provide it. Government-enforced coercion to provide services should be a last resort, not a first resort.

  51. Morningstar
    Morningstar June 7, 2008 at 3:15 pm |

    med student, what’s your take on the FDA?

    should the market be in charge of approving drugs?

    please unplug the virtual reality dream world you’re living in, and join us in real society.

  52. exholt
    exholt June 7, 2008 at 3:41 pm |

    thats flawed thinking. Government should not be in the business of dictating what kind of service a company chooses to offer. Just as govt has no role in demanding that Walmart carry mifepristone, so too does it have no business demanding what individual clinics provide.

    You’re arguments are flawed because the medical doctor’s very license to practice and the parameters for granting it are determined by the government. If the government determines you’re not doing your job and/or you’re incompetent based….the government can legally take away that license…so saying that it is undue interference in a doctor’s business is quite laughable when it is the very government with consultation from relevant experts in the field who determine whether you have the very license necessary to practice. In short, doctors and other similarly licensed professionals are beholden to the very institution which grants such professional licenses and the conditions for obtaining them…..the government.

    Don’t like that? Then don’t be a doctor, airline pilot, or any other profession which requires a government regulated professional license. You can always go to business school…

    It’s the same reason why I laugh at corporations and individuals who feel entitled to demand government assistance to protect their inventions and creative works under the rubric of intellectual property laws while hypocritically denouncing and doing whatever they can to undermine/gut the reciprocity clauses within those very laws: after a certain reasonable period has lapsed, those inventions and creative works should pass into the public domain for everyone’s benefit. These corporations and individuals forget that IP law was mainly intended by the government to encourage inventions and innovations of creative works to benefit the entire society…with only a secondary consideration towards providing a time-limited monopoly for the inventors/innovators to provide some economic incentive to do so. It was never intended to provide an effective life-long government sanctioned entitlement as it has currently become with the time limits being increased to a ridiculous life of author/inventor plus 95 or more years.

    Sounds like you want an effective government entitlement for not fulfilling your professional obligations….

  53. exholt
    exholt June 7, 2008 at 4:07 pm |

    And I find it kind of repulsive that you think medicine should be a purely market-based field.

    What’s funny is that the medical field, like law and other similar professions is essentially far from being market based due to the tight monopoly sanctioned by the government and inheritances from the days of medieval guilds. Though the exams and other licensing requirements are done in large part to ensure an acceptable baseline of professional competence among those who hold such licenses……those requirements also exist to minimize true market competition by severely limiting the numbers of people who can jump through all the hoops to get such licenses.*

    In short: by studying medicine to become a doctor, med student…you are already part of an institution that seriously discourages true market competition through such practices.

    * The degree of this practice does vary somewhat by country/society. For instance, the licensing of lawyers in Japan is so restrictive that up until recently…only about 3% of Japanese law school graduates** manage to pass the government regulated Japanese bar exam…an often overlooked fact when many people cite cultural reasons why the Japanese are not litigious…when it could also be that the resulting lawyer shortage and the difficulties in finding one in many areas may be a factor. Also, during the 1950′s, the poor economic conditions in Taiwan combined with some remaining cultural distaste for litigious behavior meant that studying law and being a lawyer was not as highly esteemed back then over there compared with the present….much less when compared compared with the US.

    ** Most from the prestigious universities like Tokyo U end up going into various prestigious departments within the government bureaucracy….the rest go into many other occupations within the private/low-level public sector.

  54. eastsidekate
    eastsidekate June 7, 2008 at 5:35 pm |

    I’m confused. While I agree with most of what’s been said about the dangers of conscience clauses and the false hope about “the market”, I think this discussion about freedom and choice is veering away from the story Pamela posted on RH reality check. A pair of doctors are claiming that they have the right to not treat a woman, because they don’t like people like her. I don’t care if you’re a doctor or a restauranteur… that sort of discrimination is illegal, and blathering on about “free markets” is only a convenient distraction from the real matters at hand.

  55. med student
    med student June 7, 2008 at 5:36 pm |

    Huh? Your license to practice medicine comes from the government. They can put whatever restrictions on you that they like. Hopefully they told you in med school that practicing medicine without a license from the government is illegal.

    Wrong. State laws dictate the practice of medicine, and my state (and no other that I know of) requires doctors to script OCPs, offer IVF, or even script for tylenol.

    Just as lawyers are not required by law to do wills/estates, neither are doctors required to offer particular services under their scope. Thats the way it should be.

  56. med student
    med student June 7, 2008 at 5:39 pm |

    And if you’re the only OB/GYN in the area, women are still forced to go to you because there are no other options.

    OB/GYNs arent the only option. Furthermore, I dont believe there is any area in the country in which a woman cant drive for 20 miles or so and find someone who will script OCPs.

    Give me your zip code and I can guarantee you that I’ll find either an FP, IM, or ob/gyn clinic which offers OCPs

  57. med student
    med student June 7, 2008 at 5:46 pm |

    Also: Anti-choicers are campaigning for things that would disable the market from solving the problem. Part of the way that the market operates is to give employers the option of terminating employees who won’t do their jobs. “Conscience clauses” make that impossible. Anti-choice groups have also opposed states mandating that insurance companies cover birth control, and they’ve opposed including birth control coverage in some employers’ insurance plans.

    I already stated several times that I have no problem if a group practice fires a doc who wont do IVF or script OCPs or whatever. Thats entirely their prerogative. But this should be the decision of the group practice management, not the government.

    And I find it kind of repulsive that you think medicine should be a purely market-based field. Perhaps that’s why the American health care system is so terrible — the market is not effective enough in providing equitable care for all people.

    Never once did I say that the entire medical field should be free market based. Thats an entirely separate discussion. What we are talking about here is government intervention to force docs to provide specific services. It would be the same thing as the FAA declaring that all pilots had to agree to fly planes on certain holidays. If the airline wants to fire pilots who dont agree to work holidays, then fine. But the government should not have the role of mandating that kind of stuff.

  58. med student
    med student June 7, 2008 at 5:48 pm |

    med student, what’s your take on the FDA?

    should the market be in charge of approving drugs?

    please unplug the virtual reality dream world you’re living in, and join us in real society.

    Your ad hominem logical fallacy notwithstanding, I’ll address this. I think all drug research should be taken out of the hands of the private pharma industry and run by the FDA. But that has absolutely nothing to do with the issue at hand (govt enforced mandates on particular services).

  59. exholt
    exholt June 7, 2008 at 5:53 pm |

    that sort of discrimination is illegal, and blathering on about “free markets” is only a convenient distraction from the real matters at hand.

    Agreed. Unfortunately, there are too many people like med student who use the phrase “free markets” to justify the “right” to discriminate while hypocritically overlooking the fact that s(he)’s operating in a profession that’s not only far removed from the “free market”…but one in which is completely beholden to the government as it regulates the granting of professional licenses.

    Thus, complaining of heavyhanded government regulation to ensure s(he)’s doing his/her job in the public interest does nothing but demonstrate hypocrisy and possible ignorance of how reliant s(he) actually is on government for his/her very livelihood.

  60. med student
    med student June 7, 2008 at 5:55 pm |

    In short: by studying medicine to become a doctor, med student…you are already part of an institution that seriously discourages true market competition through such practices.

    Healthcare will never be a pure free market, because people dont know what they need. Its not like buying a car. When the consumer doesnt know what they need, then its impossible for free market mechanisms to result in price-lowering competition.

    If you totally deregulated medicine, healthcare costs would skyrocket. You would have millions of charlatans trying to do CABG on people who didnt need it. Furthermore you would have to spend extra millions on fixing the mistakes created by the untrained charlatans. We’ve already seen this movie once, and its called the pre-Flexner era in american medicine up to the 1920s.

    As for the guild system, America is already in the top 10 in the world in number of doctors per capita. There’s no evidence of a massive doctor shortage. In fact, New York which has the highest number of doctors per capita in the US, also has the highest healthcare costs per capita, even after adjusted for cost of living indices. More doctors = more invasive procedures, more diagnoses, more tests, more hospitalizations, etc

    The Dartmouth Atlas has already done a lot of research showing that healthcare operates on a supply-induced demand model. As the number of doctors increases, per capita healthcare costs also increase, because doctors dont compete against each other, they just get more aggressive in their diagnositic/treatment management systems.

  61. med student
    med student June 7, 2008 at 6:04 pm |

    You’re arguments are flawed because the medical doctor’s very license to practice and the parameters for granting it are determined by the government. If the government determines you’re not doing your job and/or you’re incompetent based….the government can legally take away that license…so saying that it is undue interference in a doctor’s business is quite laughable when it is the very government with consultation from relevant experts in the field who determine whether you have the very license necessary to practice. In short, doctors and other similarly licensed professionals are beholden to the very institution which grants such professional licenses and the conditions for obtaining them…..the government.

    Don’t like that? Then don’t be a doctor, airline pilot, or any other profession which requires a government regulated professional license. You can always go to business school…

    The state medical codes say nothing about requiring docs to prescribe OCPs, or requiring them to provide an appendectomy for a ruptured appendix. That is left within the prerogative of the physician, and thats the way it should be. Like I said, there are other mechanisms that should be used to encourage good practice.

    You dont see the FAA requiring that pilots fly a certain kind of plane, do you? You dont see the govt forcing all lawyers to provide criminal defense services regardless of whether they want to or not. You dont see daycare owners (who are licensed by the govt too) being forced to offer certain toys or books for the kids under their custody.

    What you are attempting to put on medicine is not within the bounds of current law, and furthermore its not being applied to any other licensed professional field.

  62. med student
    med student June 7, 2008 at 7:32 pm |

    Agreed. Unfortunately, there are too many people like med student who use the phrase “free markets” to justify the “right” to discriminate while hypocritically overlooking the fact that s(he)’s operating in a profession that’s not only far removed from the “free market”…but one in which is completely beholden to the government as it regulates the granting of professional licenses.

    WTF? The healthcare market is not 100% free market, therefore it has to be 100% government controlled? I call BS on your premise. There’s a balance that should be found, and requiring doctors to write scripts for mifepristone, or OCPs, or provide IVF, or open heart surgery is beyond that threshold.

    Thus, complaining of heavyhanded government regulation to ensure s(he)’s doing his/her job in the public interest does nothing but demonstrate hypocrisy and possible ignorance of how reliant s(he) actually is on government for his/her very livelihood.

    The government provides a “base of operations” so to speak, not a comprehensive model by which all doctors must work. Thats true for every “government controlled” field. You dont see lawyers being forced to take clients do you? You dont see CPA accountants being forced to use certain accounting models by the government do you? All of htose professionals are “beholden” to the government also.

  63. med student
    med student June 7, 2008 at 8:00 pm |

    Court appointed lawyers either choose to work at public defender’s offices OR they choose to work at firms in which there is an established contract with the county to provide legal support. It is NOT the case that random lawyers are appointed by the courts–in all cases the lawyer knows before signing the employment contract whether or not they will be called as public defenders. The bottom line is that lawyers CHOOSE whether or not they will be public defenders, its not the case that its a requirement to practice law.

  64. med student
    med student June 7, 2008 at 8:03 pm |

    And once a lawyer starts representing someone, they must continue to do so to the best of their ability. The analogous example would be the ob/gyn who sees a patient for an appointment, thereby establishing himself as her doctor, but then refuses to adequately meet her medical needs (won’t give her birth control, etc). If a lawyer takes on a client, he has to do his job as effectively as possible, even if he dislikes the client’s identity.

    I’m not sure thats true for lawyers, and I’m SURE its not true for OB/GYNS. There is no requirement by law that states that once an OB/GYN takes on a new patient they are committed to them in perpetuity NOR is there any law which states that the OB/GYN has to provide specific services such as OCPs.

    The law does say that you cant dump a patient unless you arrange referral to another doc, but it does not get into specifics of exactly what you have to do for them in a professional capacity.

  65. exholt
    exholt June 7, 2008 at 8:07 pm |

    You dont see the FAA requiring that pilots fly a certain kind of plane, do you?

    Actually they do…by certifying/decertifying the airworthiness of a plane/class of planes. There are many cases in the aviation world where certain types of planes and/or the institutions which fly them like Southwest Airlines* or the USAF** had some/all of their fleets decertified and grounded due to suspicions of technical faults and/or poor inadequate maintenance.

    * 44 planes grounded for inspection problems.

    ** Grounding of the USAF and USANG F-15 fleet after one F-15 was destroyed in a nosecone separation incident during air combat training.

  66. Peter
    Peter June 7, 2008 at 8:22 pm |

    We’ve all heard the stories about the nutbag pharmacists, nurses and doctors who refuse to provide women with adequate health care because of their “religion.” Women are refused emergency contraception, and even standard birth control pills and devices, with alarming regularity. Anti-choice groups have pushed for “conscience clauses” in state law, allowing medical professionals to refuse to do their jobs.

    Rightwing nuttery. If a pharmacist or doctor doesn’t want to prescribe a legal drug or provide a neccessary and legal healthcare service, they need to find another profession.

    Healthcare is not like “requiring” certain kinds of toys in a day care, or requiring private attorneys to take divorce cases.

    Healthcare is a fundamental human right, and need. It’s not a toy, or a divorce case.

    And I’ve seen the rightwing fall back on the why don’t they drive 20 miles to another town canard. First, not everyone has a car. There’s a lot of poor people who don’t. Second, rightwingers who makes this case have clearly never been to alaska, or parts of the rural west.

  67. med student
    med student June 7, 2008 at 8:48 pm |

    I was saying that it is true for lawyers as an ethical obligation. My point was to counter your contention that no other profession is required to serve people they don’t like. Lawyers are. Doctors should be, too.

    Your lawyer analogy doesnt work though. Like I said, there is NO legal requirement that says if you practice law you must agree to take court-appointed cases. If you choose to do court-appointed work, you either sign on with a firm that has a contract with the courts, OR you work in a public defenders office. But if I want to do private practice criminal law, I am under no obligation to take court-appointed cases.

  68. med student
    med student June 7, 2008 at 8:57 pm |

    Actually they do…by certifying/decertifying the airworthiness of a plane/class of planes. There are many cases in the aviation world where certain types of planes and/or the institutions which fly them like Southwest Airlines* or the USAF** had some/all of their fleets decertified and grounded due to suspicions of technical faults and/or poor inadequate maintenance.

    * 44 planes grounded for inspection problems.

    ** Grounding of the USAF and USANG F-15 fleet after one F-15 was destroyed in a nosecone separation incident during air combat training.

    Two points:

    1) The obligation under law falls to the airlines, not the pilots. Likewise, in medicine the EMTALA regulations apply to hospitals, NOT individual doctors. Thats a huge fundamental difference.

    2) FAA does NOT require them to fly a specific kind of plane, it just gives the minimum safety thresholds that must be met IF YOU CHOOSE TO OPERATE that particular type of aircraft. Its the difference between a law that says “all pilots must operate 747-style aircraft” vs a law that says “if you CHOOSE to operate 747 aircraft, then you must meet safety requirements A-Z.” The onus for choosing which kind of aircraft to fly rests with the airlines and hte pilots, NOT with the government.

    A law coming out stating that “if you provide OCPs, you must do so in the following manner” is a lot different than the law stating “all OB/GYNS MUST offer OCPs”

  69. med student
    med student June 7, 2008 at 9:08 pm |

    Rightwing nuttery. If a pharmacist or doctor doesn’t want to prescribe a legal drug or provide a neccessary and legal healthcare service, they need to find another profession.

    Agreed, but being forced out by government mandate is not the answer.

    Healthcare is not like “requiring” certain kinds of toys in a day care, or requiring private attorneys to take divorce cases.

    Yes it is. Healthcare is a commodity just like anything else. You can argue its a more valuable commodity than others, but

    Healthcare is a fundamental human right, and need. It’s not a toy, or a divorce case.

    Lets talk about other “fundamental human rights” then. Take food for example. There is no legal requirement that grocery stores stock bread, or milk, or orange juice. There are regulations in place IF THEY CHOOSE TO OFFER THOSE ITEMS, but thats different than requiring them to stock it in the first place.

    And I’ve seen the rightwing fall back on the why don’t they drive 20 miles to another town canard. First, not everyone has a car. There’s a lot of poor people who don’t. Second, rightwingers who makes this case have clearly never been to alaska, or parts of the rural west.

    My challenge still stands. Give me any zip code in the USA, and I’ll find an IM, FP, or ob/gyn practice that scripts OCPs.

    Not everyone has a car to drive 5 miles to the grocery store either, yet you dont see government mandates about what foods they are required to carry.

    Isnt food a “fundamental human right” just like healthcare?

  70. exholt
    exholt June 7, 2008 at 10:03 pm |

    The FAA does determine whether a particular aircraft/class of aircraft meets their airworthiness. No matter how much a given individual or institution and its pilots want to fly a particular aircraft/class of aircraft….if the FAA determines at any point that that aircraft/class of aircraft are not airworthy….they will be grounded and no one can fly them…no matter how much they may want to.

    Though the FAA does not directly mandate airlines/pilots fly certain types of aircraft in the sense you are thinking of….that’s mainly because any aircraft deemed unworthy at the design/prototype stage won’t be put into production until the defects are corrected. If they cannot be corrected, they are effectively banned. In a sense, the variety of aircraft available to pilots and institutions to fly are ones the FAA has “mandated” as they are the models deemed airworthy to be put into service.

    Agreed, but being forced out by government mandate is not the answer.

    If government mandate through licensing procedures and granting of a license is ok….why not being forced out for failure to fulfill one’s professional obligations?? The last thing our society needs are doctors who are incompetent and/or unwilling to perform the professional duties for which they are licensed.

    If you do not want to fulfill your professional obligations as determined by government regulated licensing…..you can always choose alternative professional occupations which do not have government mandated licensing…….as i said before…you can always go to business school….

  71. Ben
    Ben June 7, 2008 at 10:12 pm |

    Give me any zip code in the USA, and I’ll find an IM, FP, or ob/gyn practice that scripts OCPs.

    Just a wild guess: 57755.

  72. med student
    med student June 7, 2008 at 11:34 pm |

    Just a wild guess: 57755.

    AMA and physician search gave back 2 hits. One ob/gyn practice is in Bowman, ND (about 15 miles north of ludlow). Another is Dr. Mack, who primarily practices in Buffalo, SD but holds clinic 2 days a week in Ludlow. His office is closed today but I’ll verify that he actually provides OCPs tomorrow.

  73. med student
    med student June 7, 2008 at 11:35 pm |

    Also, there are several nurse practitioner clinics specializing in ob/gyn care within a 20 mile radius, and some of them also hold clinics one day per week in Ludlow.

  74. bushfire
    bushfire June 8, 2008 at 12:30 am |

    There is no comparison to be made between grocery stores being forced to sell orange juice and doctors being forced to prescribe birth control. People can ingest calories from any food, it doesn’t matter which. If a doctor decided which company’s birth control pill they prefered and only prescribed that one, that would fit your “particular foods” analogy. Refusing to provide any birth control for “religion/consciousness” would be like me walking into a grocery store and being refused any food that is there because the grocery store owner thinks I’m immoral or unworthy for some reason. Sure, the government can’t make that grocer sell me food, but if he became a grocer he should allow anyone to make a legal purchase in his store, regardless of whether he thinks they’re icky.

    As for “fundamental human rights”, there are many commenters here who do think these should be human rights and provided to everybody. Its the right wing who likes it when only the privileged can have these things. You’re repeating that this stuff is based on market, which is it, but this system keeps the unprivileged down, and that is a system feminists want to improve.

  75. Bridgetka
    Bridgetka June 8, 2008 at 3:20 am |

    Hey Med Student,

    I just did a doctor search on WebMD for OB/GYNs, FPs, and IM practitioners for Nuiqsut, Alaska (99789), and there ain’t one within one hundred miles. I think I just proved you wrong.

  76. little light
    little light June 8, 2008 at 3:33 am |

    Lets talk about other “fundamental human rights” then. Take food for example. There is no legal requirement that grocery stores stock bread, or milk, or orange juice. There are regulations in place IF THEY CHOOSE TO OFFER THOSE ITEMS, but thats different than requiring them to stock it in the first place.

    You’re not getting it, med student, old bean.
    This is a clinic that does choose to offer the particular medical services we’re talking about. They offer these procedures. They have agreed to do so and abide by the attendant regulations.
    They are choosing not to offer the medical services that they normally provide to particular people.
    It’s not a matter of “You’re a doctor, therefore you MUST perform IVF!” It’s “You’re a doctor who, no gun to your head at all, has chosen to offer IVF, and are denying it to a particular woman because she’s a lesbian.” The objection isn’t to their not offering a given procedure; if we had a problem with that there would be no specialists. It’s that they, providers of a particular procedure, are refusing to treat a particular patient, out of dislike for what that patient is.

    You’re obscuring the issue. I think you know that.

  77. med student
    med student June 8, 2008 at 8:43 am |

    I just did a doctor search on WebMD for OB/GYNs, FPs, and IM practitioners for Nuiqsut, Alaska (99789), and there ain’t one within one hundred miles. I think I just proved you wrong.

    According to AMA physiciansearch, the university of alaska has a set of rotating clinics that go thru northern alaska thru barrow and go to alpine alaska (10 miles north of nuiqsut) once per week.

  78. med student
    med student June 8, 2008 at 8:51 am |

    Update: Turns out there is a federal Indian Health Service Clinic in Nuiqsuit too.

    http://www.ihs.gov/GeneralWeb/WebApps/Locator/index.cfm?module=facilitySearchDetail&num=259

  79. Mnemosyne
    Mnemosyne June 8, 2008 at 12:40 pm |

    You dont see the FAA requiring that pilots fly a certain kind of plane, do you?

    What? Pilots have to be certified and licensed by the government for particular planes before they’re allowed to fly them. You don’t get to show up at the airfield and climb into a 747 when all you’ve flown is Cessnas. Same thing with drivers’ licenses — there are different classes of licenses, and if they catch you driving a motorcycle or a semi truck without the proper license, you’ll be arrested and fined.

    Seriously, the more you chatter, the less you seem to understand about how the world actually works. You’re going to get yourself into deep trouble with a licensing board someday if you don’t educate yourself about this stuff.

  80. Entomologista
    Entomologista June 8, 2008 at 1:18 pm |

    No, religious people should not get any special accommodations in the work place. AT ALL. You shouldn’t get to go home early or get extra days off or any other special privileges just because you’re religious. You want religious people to be privileged over non-religious people, which is wrong. Your desire to attend to your woo Friday afternoon is not any more or less important than my desire to play video games Friday afternoon.

  81. eastsidekate
    eastsidekate June 8, 2008 at 3:05 pm |

    It’s that they, providers of a particular procedure, are refusing to treat a particular patient, out of dislike for what that patient is.

    You’re obscuring the issue. I think you know that.

    Agreed. It’s an ancient tactic. Nobody is taking away any of your rights by insurance that those doctors that provide IVF to straight women also provide IVF to lesbian women.

    Also, I don’t know what’s up with all the crazy analogies. Let me try to make my point by rescuing the grocery store one:

    You’re free to open a Halal market. You would be making a religious, cultural and economic decision to only carry certain foods. People actually do this. It’s akin to deciding to open a clinic that provides IVF. However, you couldn’t decide to not allow lesbian women in your market. Likewise, the argument is that you’re not allowed to deny your IVF services to lesbian women.

    There are tons and tons of decision that are being made in both analogies. Elements of the market play into many of those decision. The only one most of us are arguing about is the decision to deny service to an individual based on their identity.

  82. eastsidekate
    eastsidekate June 8, 2008 at 3:07 pm |

    It’s that they, providers of a particular procedure, are refusing to treat a particular patient, out of dislike for what that patient is.

    You’re obscuring the issue. I think you know that.

    Agreed. It’s an ancient tactic. Nobody is taking away any of your rights by ensuring that those doctors that provide IVF to straight women also provide IVF to lesbian women.

    Also, I don’t know what’s up with all the crazy analogies. Let me try to make my point by rescuing the grocery store one:

    You’re free to open a Halal market. You would be making a religious, cultural and economic decision to only carry certain foods. People actually do this. It’s akin to deciding to open a clinic that provides IVF. However, you couldn’t decide to not allow lesbian women in your market. Likewise, the argument is that you’re not allowed to deny your IVF services to lesbian women.

    There are tons and tons of decision that are being made in both analogies. Elements of the market play into many of those decision. The only one most of us are arguing about is the decision to deny service to an individual based on their identity.

  83. med student
    med student June 8, 2008 at 3:25 pm |

    What? Pilots have to be certified and licensed by the government for particular planes before they’re allowed to fly them. You don’t get to show up at the airfield and climb into a 747 when all you’ve flown is Cessnas. Same thing with drivers’ licenses — there are different classes of licenses, and if they catch you driving a motorcycle or a semi truck without the proper license, you’ll be arrested and fined.

    You obviously dont understand what I posted. Go back and read it again. The FAA says IF you choose to fly a certain plane, you have to meet certain requirements. It does NOT say that every pilot must operate a certain kind of aircraft. Requiring all doctors, or all OB/GYNs, to script a particular class of drug is analogous to the FAA declaring that ALL pilots must fly a certain type of plane. Lets use drivers licenses for example. If you want to be a truck driver, then you are required by law to get a CDL. But it does NOT require you to get a regular DL, motorcycle DL, etc. In other words, you have the choice to decide which kind of service you are going to offer. Forcing ob/gyns to prescribe is in no way analogous to the regulations guiding other professions.

    Seriously, the more you chatter, the less you seem to understand about how the world actually works. You’re going to get yourself into deep trouble with a licensing board someday if you don’t educate yourself about this stuff.

    WTF do you know about medical licensing boards? Did you pass the medico-legal jurisprudence exams? Did you successfully apply for state licensure? I have, and I’ll put my knowledge and experience of medical licensing boards up against yours any day of the week.

    Have you read the medical licensing statutes? I have and I was tested on them. There is NOTHING in those statutes requiring doctors to script certain classes of drugs, or offer particular procedures. Thats left to the discretion of the individual physician. Thats the way pilots, accountants, lawyers, social workers, truck drivers, and every other licensed professional operates and thats the way it should be. What some of you are describing is a fantastical fascist state where the government dictates all facets of practice. Thank god we dont live in that world.

  84. Mnemosyne
    Mnemosyne June 8, 2008 at 6:08 pm |

    Forcing ob/gyns to prescribe is in no way analogous to the regulations guiding other professions.

    So by your rationale:

    Psychiatrists do not have to prescribe anti-depressants or anti-psychotics to mentally ill patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Cardiologists do not have to prescribe anti-clotting drugs to heart patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Internists do not have to prescribe antibiotics to infection patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Surgeons do not have to remove the burst appendixes of patients whose lifestyles they disapprove of, even if removing that appendix is medically indicated.

    Wow. You really are headed for a major malpractice suit someday, aren’t you?

    Have you read the medical licensing statutes? I have and I was tested on them. There is NOTHING in those statutes requiring doctors to script certain classes of drugs, or offer particular procedures.

    So my orthopedic surgeon could spend his days doing pelvic exams rather than knee surgery because nothing in his license requires him to practice the area of medicine that he’s trained and skilled in? That’s pretty scary. I guess that’s why you’re only supposed to go to board-certified physicians, because doctors like you are convinced that they not only don’t have to fulfill the basic requirements of their jobs, they can do any other doctor’s job without having to have the actual training or certification to do it.

    Or are you under the impression that the Basic Certification of Obstetricians and Gynecologists exam includes a section about family planning and contraception on the assumption that it’s a topic that will never come up in the course of a doctor’s normal practice?

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  86. Dianne
    Dianne June 9, 2008 at 4:24 am |

    med student: All doctors are required to provide medical care that meets or exceeds the standard of care set by the medical community. An OB/GYN who refused to prescribe birth control pills or, especially, refused to provide OCP to certain groups based on any grounds except medical contraindications, would be failing to meet standard of care. He or she would be open to a malpractice suit and have little or no defense. If you don’t want to deal with that, get out of med school NOW. Seriously. Or plan to go into pathology or radiology or some other specialty where you won’t have to deal with this problem.

  87. Dianne
    Dianne June 9, 2008 at 4:33 am |

    Did you successfully apply for state licensure? I have…

    Unless things have changed drastically since I was a medical student, med students are not required to pass state licensure. Indeed, they generally can’t be licensed until they’ve graduated and passed the USMLE. Methinks that there’s something odd about “med student”…

  88. med student
    med student June 9, 2008 at 1:50 pm |

    med student: All doctors are required to provide medical care that meets or exceeds the standard of care set by the medical community. An OB/GYN who refused to prescribe birth control pills or, especially, refused to provide OCP to certain groups based on any grounds except medical contraindications, would be failing to meet standard of care. He or she would be open to a malpractice suit and have little or no defense. If you don’t want to deal with that, get out of med school NOW. Seriously. Or plan to go into pathology or radiology or some other specialty where you won’t have to deal with this problem.

    You obviously didnt read this thread. I never said anything about medical malpractice suits. Thats an ENTIRELY DIFFERENT ANIMAL than government regulations FORCING docs to script certain drugs or do certain procedures. Its the difference between a doc getting sued for medical malpractice for failing to intubate a patient in respiratory failure VS state law which says all doctors must do intubations. Surely you can see the distinction. Medical malpractice suits are a fine instrument which teases out the particulars of individual patient scenarios. Laws forcing docs to provide OCPs, or IVF, or intubations are extremely blunt instruments with no place in society.

  89. med student
    med student June 9, 2008 at 1:53 pm |

    Unless things have changed drastically since I was a medical student, med students are not required to pass state licensure. Indeed, they generally can’t be licensed until they’ve graduated and passed the USMLE. Methinks that there’s something odd about “med student”…

    You are obviously out of the loop. It works on a state by state basis, but there are several states where you apply for medical licensure immediately out of med school.

  90. med student
    med student June 9, 2008 at 2:22 pm |

    So by your rationale:

    Psychiatrists do not have to prescribe anti-depressants or anti-psychotics to mentally ill patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Cardiologists do not have to prescribe anti-clotting drugs to heart patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Internists do not have to prescribe antibiotics to infection patients whose lifestyles they disapprove of, even if those drugs are medically indicated.

    Surgeons do not have to remove the burst appendixes of patients whose lifestyles they disapprove of, even if removing that appendix is medically indicated.

    Wow. You really are headed for a major malpractice suit someday, aren’t you?

    Your examples have nothing to do with what I’m talking about. I’m responding to the argument that doctors should be forced BY LAW to provide OCPs, or coumadin, or appendectomies, or any specific service. As I’ve already stated many times, there is NOTHING in the state medical codes that require this, and there is no parallel for this precedent in any other licensed profession.

    So my orthopedic surgeon could spend his days doing pelvic exams rather than knee surgery because nothing in his license requires him to practice the area of medicine that he’s trained and skilled in? That’s pretty scary.

    Yes, he could. State medical licenses give you an unrestricted scope of practice. Theoretically, a FP could start doing brain surgery. There’s nothing in the state medical codes that prohibits that. However, a myriad of other protections keep it from happening. One, a FP could never get operating privileges at a hospital to do brain surgery. Two, his insurance company would drop him if they found him working outside his scope. Three, every neurosurgeon in the state would raise a ruckus and he would be publicly shunned/humiliated. Four, the obvious medical malpractice case would rise against him.

    BTW, every person who graduates med school is well qualified to do pelvic exams. Its a pretty simple procedure. Hell, even associates degree nurses do them nowadays and they do a fine job. If your example of the orthopedic surgeon is supposed to show that he’s not qualified to do pelvics, you are mistaken. If your example was supposed to show that the ortho doing pelvics means he’s sexually assaulting women for no medical reason, then thats where medical malpractice and criminal law come into play. But its ridiculous to write a law stating that orthopods cant do pelvics, or REQUIRE them to do knee replacements.

    I guess that’s why you’re only supposed to go to board-certified physicians, because doctors like you are convinced that they not only don’t have to fulfill the basic requirements of their jobs, they can do any other doctor’s job without having to have the actual training or certification to do it.

    WTF are you talking about? You obviously dont understand what “board certified” means. It regulates intra-disciplinary, not inter-disciplinary competencies. You’re just making up BS now. I never said I was qualified to do whatever I wanted with no training/certs.

    Or are you under the impression that the Basic Certification of Obstetricians and Gynecologists exam includes a section about family planning and contraception on the assumption that it’s a topic that will never come up in the course of a doctor’s normal practice?

    Again, its the difference between requiring basic competency in a subject vs FORCING you to provide a particular service, two entirely different things. I’ve got no problem with the oral boards failing an ob/gyn who doesnt know enough about OCPs to script them properly. If the oral boards cover the subject of IVF and an applicant cant pass that subject, then by all means fail them. But board certification in any field DOES NOT require you to offer all of the services under that umbrella.

  91. Dianne
    Dianne June 10, 2008 at 4:19 am |

    It works on a state by state basis, but there are several states where you apply for medical licensure immediately out of med school.

    Which ones? And are you talking about a permanent license or a resident’s license? I’m prepared to believe that there are states that don’t require the USMLE, but I find the idea that some states don’t require an MD (or DO) highly unlikely. Hence, a med student would not have applied for his or her license yet.

  92. Dianne
    Dianne June 10, 2008 at 4:38 am |

    I’m responding to the argument that doctors should be forced BY LAW to provide OCPs, or coumadin, or appendectomies, or any specific service. As I’ve already stated many times, there is NOTHING in the state medical codes that require this,

    Technically, you are correct. However, if you set yourself up as an OB/GYN and then refuse to provide one of the basic services for which women go to OB/GYNs you will find yourself in difficulty very quickly. First, you’ll lose patients very quickly. I wouldn’t go to an OB who wouldn’t provide OCP even though I don’t use them for birth control. There are other indications for the use of OCP such as…well, can you name a few? If you’re past the first year you should be able to. Second, you’re going to get sued for failing to provide care that meets the standard of care for gynecology in the US. Unless you can justify your decisions through citations in the peer reviewed literature that indicate that, for example, condoms are a better choice of birth control for, again as an example, a 20 year old woman in a monogomous relationship with a family history of ovarian cancer seeking highly effective birth control. Technically, you could send her to another OB who is willing to prescribe OCP, but then you’re losing patients again. Finally, you’re betraying your patients and your profession by refusing to do what is right for your patients. In the end, if you’re any kind of decent doctor at all, the good of your patients must come first. Not your religion, not your social conscience, not your profit margin, not your paper count. If you can’t put your patients’ interests before all that, then go into another field.

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