Will Someone Please Pay for my Rubbers

[custosnox]

I think we have discussed in TNF whether a health care professional should be forced to perform procedures or otherwise act in contravention to their religious beliefs. If nothing else, I'm sure my position is known on that issue.

This might be a standing point if it was an ER and a rape victim.  If the doc wants to only treat for things that don't offend her religious sensibilities, then she should stay in her own office.

[guido911]

This might be a standing point if it was an ER and a rape victim.  If the doc wants to only treat for things that don't offend her religious sensibilities, then she should stay in her own office.

This is a tough issue, believe me. When I worked in an ER many years ago, I saw lots of sexual assault victims come through. This was before SANE and all these EC medications.

Still, I think what is confusing here is what is "treatment" for sexual assault? Is it just the direct treating of the medical and psychological injuries/complications of the victim or is it more? If it is more, what is it? Is terminating pregnancies or prophylactics part? And what about making treatment recommendations and questions posed by victims. Should all ER doctors as part of their informed consent process be required to discuss with the victim the pros and cons of carrying a baby to term or to terminate a pregnancy? Are ER docs now sexual assault and family planning counselors? Point is, ER docs are ER docs. Heaping on the very difficult decision of advising a woman who has just suffered perhaps the most dehumanizing injury her potential pregnancy options is simply unworkable and unfair to all.

I am not to the point where you throw the baby (the physician) out with the bathwater (the ER) over this one issue which statistically is a VERY small part of the emergency room experience. Now, if docs start objecting to numerous other procedures on religious grounds, we can revisit. This is largely about pro-life issue, though, so naturally it's going to be controversial. As I see it, in America, a woman presently has the right to choose whether to terminate her pregnancy with some limitations. There is nothing that I am aware of that requires anyone to assist a woman with following through with that choice to terminate her pregnancy. Again, this is a tough issue--but I will side with the legislature on this one.

And cust, instead of Integris where this took place it was St. Francis. Would you want that Catholic affiliated hospital to be required to write scrips or give EC?

[custosnox]

This is a tough issue, believe me. When I worked in an ER many years ago, I saw lots of sexual assault victims come through. This was before SANE and all these EC medications.

Still, I think what is confusing here is what is "treatment" for sexual assault? Is it just the direct treating of the medical and psychological injuries/complications of the victim or is it more? If it is more, what is it? Is terminating pregnancies or prophylactics part? And what about making treatment recommendations and questions posed by victims. Should all ER doctors as part of their informed consent process be required to discuss with the victim the pros and cons of carrying a baby to term or to terminate a pregnancy? Are ER docs now sexual assault and family planning counselors? Point is, ER docs are ER docs. Heaping on the very difficult decision of advising a woman who has just suffered perhaps the most dehumanizing injury her potential pregnancy options is simply unworkable and unfair to all.

I am not to the point where you throw the baby (the physician) out with the bathwater (the ER) over this one issue which statistically is a VERY small part of the emergency room experience. Now, if docs start objecting to numerous other procedures on religious grounds, we can revisit. This is largely about pro-life issue, though, so naturally it's going to be controversial. As I see it, in America, a woman presently has the right to choose whether to terminate her pregnancy with some limitations. There is nothing that I am aware of that requires anyone to assist a woman with following through with that choice to terminate her pregnancy. Again, this is a tough issue--but I will side with the legislature on this one.

And cust, instead of Integris where this took place it was St. Francis. Would you want that Catholic affiliated hospital to be required to write scrips or give EC?

It's an ER open to the public.  I think that religious biased should be set aside at this point.  But It is a valid argument as far as what does make for a sexual assault treatment.  I don't know if the contraceptive should be required if requested, since it, in my opinion, doesn't constitute an emergency, but it seems that the doc (according to the allegations) pretty much completely dismissed her based on her religious stance.  She should have at the very least medically treated her for the abuse, and recommended her to a GP for the prescription.

[nathanm]

She should have at the very least medically treated her for the abuse, and recommended her to a GP for the prescription.

Were EC not rather time sensitive, I might agree with that. It could be that the hospital is the only place to get it at a given hour. Not so much here in Tulsa, but there are still plenty of places in this state where there is no way to get EC at night or on weekends except at the hospital. The manufacturer of Plan B states that it is most effective when taken within 12 hours.

[custosnox]

Were EC not rather time sensitive, I might agree with that. It could be that the hospital is the only place to get it at a given hour. Not so much here in Tulsa, but there are still plenty of places in this state where there is no way to get EC at night or on weekends except at the hospital. The manufacturer of Plan B states that it is most effective when taken within 12 hours.

Didn't know that.  Why is it prescription only?

[guido911]

Were EC not rather time sensitive, I might agree with that. It could be that the hospital is the only place to get it at a given hour. Not so much here in Tulsa, but there are still plenty of places in this state where there is no way to get EC at night or on weekends except at the hospital. The manufacturer of Plan B states that it is most effective when taken within 12 hours.

What does any of that have to do with a physician's conscience-based decisions? You gonna force them to act in a manner inconsistent with their beliefs because of where they live? If so, good luck getting docs in those communities--although I'm sure there is a massive line of docs waiting to work in both south west/east Oklahoma...

[guido911]

She should have at the very least medically treated her for the abuse, and recommended her to a GP for the prescription.

No argument there. I cannot see what the objection would be to perform an examination or to treat injuries from the assault though. There may be more to the story, as it perhaps is given the abhorrent nature of the injury.

[dioscorides]

Didn't know that.  Why is it prescription only?

Plan B is available over the counter for anyone 17 years old or older.  It requires a prescription for anyone younger than 17.  The labeling states that it needs to be taken within 72 hours after unprotected sex, but is more effective the sooner it is taken.

[heironymouspasparagus]

And cust, instead of Integris where this took place it was St. Francis. Would you want that Catholic affiliated hospital to be required to write scrips or give EC?

They (and Integris - Baptist) put themselves in the secular world with their decision to go out amongst the masses to do good.  And get massive tax breaks from that secular world for doing the good they do.  So, they should conform to that part of the secular world view - going along with what the various legislatures say.  In Oklahoma, that should be no big deal, since we are so heavily oriented toward a state theocracy in our legislature.

[nathanm]

What does any of that have to do with a physician's conscience-based decisions? You gonna force them to act in a manner inconsistent with their beliefs because of where they live?

So if one of the crazy snake handler people decides to become a ER doc, it's OK with you if they refuse to administer antivenin? The patient can just mosey on over to another hospital? After all, the only thing delay will do in most cases is make your recovery slower and more painful. It probably won't kill you (or you'd have already died before reaching the hospital).

It has nothing to do with where they live and everything to do with the time sensitive nature of the medicine. Besides, I thought you were against abortions. You really want to add one more to the list because some jackass decided that their moral opprobrium was more important than someone else's need for medical care?

[guido911]

They (and Integris - Baptist) put themselves in the secular world with their decision to go out amongst the masses to do good.  And get massive tax breaks from that secular world for doing the good they do.  So, they should conform to that part of the secular world view - going along with what the various legislatures say.  In Oklahoma, that should be no big deal, since we are so heavily oriented toward a state theocracy in our legislature.

Medical practice/health care is not Burger King. You do not get to have it your way. You, as a patient, do not get to go to see a physician and decide what the physician prescribes you or your course of treatment. That's the doctor's job. Period. And that includes whether or not the physician decides he/she will not prescribe EC or even tell a patient where to go and get it. If you don't like it, go to another facility or get a medical degree. Problem solved. I am sorry to be blunt, but that is simply reality.

Furthermore, it is lunacy to impose on an emergency room physician the responsibility to provide family planning/counseling services to a patient--which is what that physician would be doing by explaining in detail what the physiological/philosophical effects associated with this sort of medication. Seriously, a traumatized woman comes in after being raped and leaves with a prescription for a medication she takes without knowing the emotional impact it may have 10 years down the road? Will she think she killed her baby? Will she think she acted impulsively? Women who know they are pregnant struggle with the decision for days/weeks/or even months before deciding on an abortion. This victim is having to decide in hours with folks like you expecting an ER physician already elbow deep in blood or working a code to drop those emergent situations and assist with that victim's decision.

Finally, as for those tax breaks which somehow means a physician is apparently legally prohibited from holding religious convictions , please tell me about the tax breaks this particular doctor got which led to her allegedly refusing to examine that rape victim. Because to me, that point is a massive:

[nathanm]

Furthermore, it is lunacy to impose on an emergency room physician the responsibility to provide family planning/counseling services to a patient--which is what that physician would be doing by explaining in detail what the physiological/philosophical effects associated with this sort of medication.

Prescribing medication is not the same thing as providing family planning services. For example, birth control is often dispensed without family planning advice to women who take it for reasons other than contraception. Moreover, if Plan B required that much counseling, it wouldn't be available OTC for most women.

You seem to think that everyone shares the Catholic view on contraception. The vast majority of us don't mourn the loss of our sperm or eggs and have no problem with contraception. (The same goes for Catholics, actually)

Lastly, SB1891 does not apply by the plain meaning of its words. I thought there was another law that allowed pharmacists to refuse to dispense contraceptives?

[Conan71]

Medical practice/health care is not Burger King. You do not get to have it your way. You, as a patient, do not get to go to see a physician and decide what the physician prescribes you or your course of treatment. That's the doctor's job. Period. And that includes whether or not the physician decides he/she will not prescribe EC or even tell a patient where to go and get it. If you don't like it, go to another facility or get a medical degree. Problem solved. I am sorry to be blunt, but that is simply reality.

Furthermore, it is lunacy to impose on an emergency room physician the responsibility to provide family planning/counseling services to a patient--which is what that physician would be doing by explaining in detail what the physiological/philosophical effects associated with this sort of medication. Seriously, a traumatized woman comes in after being raped and leaves with a prescription for a medication she takes without knowing the emotional impact it may have 10 years down the road? Will she think she killed her baby? Will she think she acted impulsively? Women who know they are pregnant struggle with the decision for days/weeks/or even months before deciding on an abortion. This victim is having to decide in hours with folks like you expecting an ER physician already elbow deep in blood or working a code to drop those emergent situations and assist with that victim's decision.

Finally, as for those tax breaks which somehow means a physician is apparently legally prohibited from holding religious convictions , please tell me about the tax breaks this particular doctor got which led to her allegedly refusing to examine that rape victim. Because to me, that point is a massive:

No need to bother Guido.  All the men in here have infinitely more experience in what it is to be a woman, especially one with a problem pregnancy than any woman does.

I mean we all know pregnancy is simply a binary problem.  On or off, no repercussions, no responsibility. 

[guido911]

Prescribing medication is not the same thing as providing family planning services. For example, birth control is often dispensed without family planning advice to women who take it for reasons other than contraception. Moreover, if Plan B required that much counseling, it wouldn't be available OTC for most women.

You seem to think that everyone shares the Catholic view on contraception. The vast majority of us don't mourn the loss of our sperm or eggs and have no problem with contraception. (The same goes for Catholics, actually)

Lastly, SB1891 does not apply by the plain meaning of its words. I thought there was another law that allowed pharmacists to refuse to dispense contraceptives?

Nate, you do not know what you are talking about. You have no idea what the process is for prescribing medication, the minimum amount of information which needs to be provided to a patient, or any other part of the physician-patient process other than your personal experience. You certainly have displayed ZERO awareness as to the standards of care for emergency (or any other ER personnel for that matter) in this thread but rather solely seek to suggest your own inexperienced and irrelevant opinions are correct.

This is an area of which I have very specific knowledge with almost limitless academic and personal/professional resources. Indeed, if I were in your shoes and was making an argument against facts within the sphere of water conservation, recycling, or jackassedness, I certainly would yield to waterboy, RM, and aox.

[Hoss]

No need to bother Guido.  All the men in here have infinitely more experience in what it is to be a woman, especially one with a problem pregnancy than any woman does.

I mean we all know pregnancy is simply a binary problem.  On or off, no repercussions, no responsibility. 

I'm not gonna come in here and be self righteous like some posters in here are (ahem), but until you've walked a mile in a woman's shoes who has been through the decision to terminate a pregnancy based on whether or not it would put harm to herself and/or the baby, I'd suggest you don't jump to conclusions.  I am very familiar with that decision process in that I had a former girlfriend have to face that decision.  It's one I wouldn't want to have to make.

Rolling eyes here as well.