Doctors and freedom of conscience

Ethics media Social Issues

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VICTIMS OR BULLIES? Mel Pont, pictured with her fiancé, is upset that doctors have the freedom to do what they think is right rather than what she wants them to do.

In my part of the world, the most commented on new story at the moment is that a bigoted, moralistic, judgemental doctor has refused to prescribe the contraceptive pill for a young engaged woman, and she is making sure the media knows his name.

Blenheim woman Melissa Pont thought her doctor was “joking” when he refused to give the contraceptive pill.

Pont, 23, had recently moved to Blenheim with her fiance, Callum Alexander, and went to see Dr Joseph Lee at the Wairau Community Clinic to renew her prescription of the contraceptive pill.

“I went in and all I needed was a repeat of the pill and he said he would not give me a prescription because he was ‘pro-life’,” Pont told The Press today.

“I thought he was joking. It didn’t seem real that he would not give it to me. I started getting quite annoyed, especially as I had just waited an hour in reception.”

Pont said Lee questioned her on why she would not have children. “I said I’d just bought a house and was not ready to have children but that I was in a committed relationship. It’s my choice when to have children. He looked disgusted by my response.”

Pont had visited another doctor for her prescription, but said she was “concerned” that Lee would be acting in this way.

I don’t know everything Dr Lee said to his patient or how he acted towards her and spoke to her. The truth is that we only have one side of the story from a person who is clearly offended by the stance that Dr Lee took towards her. It’s important to bear in mind that the principle of “we don’t have all the facts, we only have one side of the story so we shouldn’t rush to judgement about how pleasant / unpleasant he was” is a principle that should afford conservatives the same protection from unwarranted speculation and/or condemnation that it ought to afford anybody else. We should therefore overlook the emotive descriptions of Dr Lee’s “disgusted” facial expressions and the manner in which he allegedly addressed the complainant. It is evident that she is unhappy with him and wants to shame him. We weren’t there, so we should presume to know only the facts: A patient requested that a Doctor prescribe a contraceptive pill for her. He declined, and he is being publicly named and shamed for it as though he is in the wrong and she in the right.

The issue is an important one and is bigger than this one encounter between doctor and patient – and it’s bigger than the issue of birth control. The question is whether or not a doctor should be compelled to do what they think is morally wrong, and whether or not it’s appropriate or even acceptable to morally condemn a doctor who refuses to provide a medication or perform a procedure on conscientious grounds.

Firstly, you might be tempted to think that if it’s legal then the question of morality should never arise. The doctor is required to do what the patient wants within the law and that is that. But this is obviously false. Doctors are routinely required to make judgement calls based on a whole range of factors beyond what is permitted by law. There are various codes of conduct to which they must adhere that are not legal requirements, and they are always required to act in a manner that they consider to be ethical. It would be a sorry state of affairs if we took the view that the law could supplant a person’s conscience so that everything that was legal was also moral. If this were the case, the very concept of disobeying an unjust law would make no sense.

If Dr Lee takes a standard Catholic view of birth control, he does not view it as being on par with murder – not by a long shot. But suppose for a moment that he did. Are we really willing to say that a person should be compelled to do that which they consider to be tantamount to murder? That it’s acceptable to cultivate a mindset that if we are told by the government to carry out murder, we should simply comply? Clearly not, so we should reject outright the view that we are all morally justified in doing (or worse, required to do) whatever the law requires or permits.

Secondly, you might be tempted to say that actually Dr Lee isn’t required to prescribe birth control, because he’s not required to prescribe anything. He chose to be a doctor, and he can simply find a new job if he doesn’t want to do what his patient asks for. This too is an unacceptable stance to take. It implies that doctors – all those who choose to be doctors – are the agents of the government whose conscience must agree with the law. In a world where doctors were legally required to euthanize the newborn children of an unwanted subsection of the population, any who refused, a proponent of this view would say, are just in the wrong profession. They should quit, and allow doctors who are prepared to do their job to get on with it.

There is a good reason why neither the law nor medical standards of practice endorse either of these two options. Any free society must make provision for conscientious objections on at least some level. The idea that what you believe about this thing called “ethics” aka “morality” is something you think about when you’re reading, blogging or going to church, but they’re a curiosity that you must set aside when you return to the real world and go to work, simply fails to grasp what morality is all about. It’s incredible that so many are actually prepared to utter glib comments like “As a doctor you really have to leave your personal beliefs at the door and treat each patient without prejudice.” This is what one of the commenters on this story had to say, and it’s a sad indictment on the skill of moral thinking that exists among those who digest news stories. On the one hand we crusade for ethical business practice: We demand that big corporations like Nike, Apple and a host of cosmetics companies change the way that they do business because we judge that what they are doing is fundamentally immoral; they should adopt standards that we think are morally right, and yet on the other we (some of us at least) decry those medical practitioners who dare to bring their moral beliefs to bear on the services that they provide. They should shut up and do what we think is right. Unfortunately, you cannot have it both ways. Make up your mind what sort of society you want to live in.

Thirdly, you might be tempted to say that you grant all of the above, but that what’s wrong with Dr Lee’s actions – and why doctors should not be permitted to refuse to provide the prescription or procedure requested – is that he is interfering with a woman’s choice. One of the commenters on the news story summed up the view of many on this by dismissing the thoughts of somebody who took Dr lee’s side of the story by saying “Not your uterus, not your choice.” The doctor doesn’t have to take the pill (!), but who is he to tell a woman that she can’t? However, it is precisely scenarios like this one that show that the issue is not simply a matter of a woman’s choice. If it was purely a matter of her choice, then there would be no possibility of complaint about what this man is willing to do. The fact is, this complaint is not about women choosing, but about a doctor choosing. Nobody has told this woman what she can and cannot do. It is the other way around: She (along with those who whose comments fill the comments section on news stories) is telling the doctor what he should and should not do. Another person’s private choice surely cannot compel me to take part in it. Clearly this is not a woman’s private choice about how she conducts her own affairs and uses her own body (setting aside for now concerns over the possible destruction of embryos). This is a woman’s demand on how a doctor ought to conduct his affairs. If our concern is to preserve the right to choose, then very clearly the doctor is the one to whose side we should be rallying.

In the end, I think the only real avenue for condemnation, or at least feisty disagreement, is about whether or not the doctor’s stance on birth control is the right one to take. Maybe you deny that the contraceptive pill (very) occasionally destroys an embryo. To the best of my knowledge, you’d be wrong, but fine, have that dispute if you like. Or maybe that’s not the real issue for you. Maybe you think that the objection to contraceptives in general is mistaken. OK, make that case (I may even agree with some of what you say). But don’t try to strong-arm doctors into accepting your beliefs about such matters by shaming them and implying that they have some sort of duty to shut up, stop thinking and obey you. Defend your stance on a contentious issue. Have backbone to do that, rather than try to get your way on the issue by bullying people into feeling bad for not fulfilling your desires.

Glenn Peoples

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{ 46 comments… add one }
  • Immanuel Kant July 15, 2013, 9:41 pm

    I wrote about this all the way back in 1784 in my short essay titled “Answering the Question: What is Enlightenment?”. As one of the greatest moral philosophers in history I expect gumbies like yourself to refer to me.

  • Glenn July 15, 2013, 9:53 pm

    Soz Kant. Mebbe if u had a blog I’d follow your stuff.

  • Blair Donkin July 15, 2013, 9:57 pm

    You have hit the mark Glenn in that it is not about her choice at all but the Drs. choice not to prescribe. As you say there is so much we don’t know. In asking why she didn’t want children, which as a question has been presented in a negative light, under the Health Practioners Competency Assurance Act the Dr is required, by this Act, to satisfy him or herself that the patient is making an informed choice. For all we know this one aspect of the conversation could well have been in that context, rather than the way it has been presented – as an inappropriate line of questioning.

    It is a health practioners professional responsibility to question. The practioner cannot adequately perform their duty of care without doing so.

    What’s more is that we don’t know if the Dr referred the young woman to another practioner who would be willing to Rx what she wanted. If after the conversation about options / pros and cons, which must be had, the young woman still wished to exercise her choice to take the OC pill then the Dr does have a professional obligation to refer her to a colleague; to not do so would be obstructing her ability to make and exercise an informed choice. This issue doesn’t appear to be at the heart of the complaint though so much as this particular Dr, “would not do what I wanted.” I hope that the medical fraternity speak out on this as there is too much at stake for it to be decided by ill informed opinion.

  • Harry Johnston July 16, 2013, 2:09 pm

    This is ridiculous. If your religion prohibits the use of nails, you don’t get a job as a carpenter! Contraception is basic health care, and should be available to everyone without being made to jump through hoops.

    There’s a basic conflict of interest here; as a doctor, Dr. Lee is supposed to serve the needs of his patient and of society. As a devout Catholic, he is forbidden to do either. I have to wonder how he treats patients with VD, do they also get a lecture on his idea of morality?

  • Glenn July 16, 2013, 3:42 pm

    Harry, you appear to be depending on the second and third arguments that I cover here, and to which I have responded already. Moreover, your nails analogy, along with your comments about contraception being a core health service, reveal that you think, or so it seems, that healthcare can’t exist without birth control. But evidently this doctor disagrees. So the question is whether or not the doctor must be compelled to agree with you or give up his job. I have provided reasons for denying this.

    Also, ” As a devout Catholic, he is forbidden to do either” is mere rhetorical flourish.

    If you choose to interact with the arguments given, I’m all ears / eyes.

  • Harry Johnston July 16, 2013, 6:26 pm

    I don’t believe being asked to choose your career to accord with your conscientious objections is unreasonable. By way of comparison, the provision for conscientious objection against military service during WWII was to go to jail.

    I don’t think you thought your analogy with euthanasia all the way through, because it requires that you accept that the ethical response in that scenario would be for the doctor to continue other business as normal but refer the newborn children in question to another doctor to be murdered, rather than, say, attempting to rescue them, fleeing the country, or taking up arms.

    As to the idea that naming the doctor in question was in some way unethical, if you hired a carpenter and then found that (for conscientious reasons) he won’t use nails, would you really feel obliged as a result to keep secret the fact that his service was inadequate?

    As a slightly less contrived analogy, consider an Jewish person taking a job at a supermarket and then insisting that as a matter of conscience he has a right not to serve anyone who is buying pork products. Is it unreasonable for an employer to insist that he do his job? (Of course, both analogies depends on the premise that contraception is a basic health service rather than being something specialized, unusual, or controversial; for now, at least, I’m going to simply assert that without justification.)

    As for your third argument, you’re completely ignoring the power disparity between the doctor and the patient. The doctor is in a position of responsibility and needs to handle it … well, responsibly. Note that if he had just said, “I am unable to deal with your case for personal reasons; please wait for a moment while I arrange for another doctor for you” there would not have been a problem. It was the lecture, and the fact that he tried to dissuade the patient from seeing another doctor, that set matters off. Another patient might have been intimidated into giving up seeking contraception; perhaps one or more already were, we simply don’t know.

    The point here is that the GP’s behaviour created the real possibility that his patient would go without proper health care, and I don’t think that’s acceptable. His PHO apparently agrees.

    As for your mention of bullying, Ken White wrote a very good post about exactly this a while back, so I’ll just refer to it: http://www.popehat.com/2013/02/13/bully-means-just-what-i-choose-it-to-mean-neither-more-nor-less/

  • Harry Johnston July 16, 2013, 6:42 pm

    [I’m sorry, my reading comprehension seems to be on the fritz today. If you’ll excuse the double-comment, which I hope doesn’t bring me over the 4000 character limit, I’ll try to address your point about whether contraception is a core health service.]

    The question is not whether the GP must agree with me [on what constitutes adequate healthcare] or give up his job. The questions are, firstly, whether he must agree with his employer or give up his job (or reach a reasonable compromise, where possible) and, secondly, whether or not the public are entitled to try to influence said employer’s position on the matter. (And, I suppose, thirdly, whether said public’s opinion is reasonable.)

    I’ve already addressed the first two questions [although I didn’t put them in this specific context] and am willing to discuss the third if you like, though I’m not sure it is a discussion that is likely to be productive.

  • Glenn July 16, 2013, 7:58 pm

    I don’t think you thought your analogy with euthanasia all the way through, because it requires that you accept that the ethical response in that scenario would be for the doctor to continue other business as normal but refer the newborn children in question to another doctor to be murdered, rather than, say, attempting to rescue them, fleeing the country, or taking up arms.

    Not at all. The point of the analogy was only to deny that a person can be obligated to do something or else leave their job because it’s just what people in their profession are being asked to do, and that’s all. Nothing about this commits me to the view that such a doctor would be obligated to refer the baby to be killed by somebody else. So rather than me not thinking this through, it’s likely that you assumed something that wasn’t there.

    Your comeback about naming the doctor by again using the nail analogy is unacceptable, for using nails is virtually inseparable from being a builder. However, one can be a very fine doctor who performs core health services every day without ever prescribing the contraceptive pill. So the analogy is not successful.

    As for the response to my third argument by claiming that I am “completely ignoring” a power disparity here, this line of reasoning seems, if you’ll pardon my saying so, a bit jumbled. My third argument was about the in-principle objection to a doctor who refuses to prescribe something that a patient asks him to prescribe on the grounds that this violates somebody’s choice. I quoted a real world example of this argument: “Not your uterus, not your choice.” Your reply, however, where you purport to show a power imbalance, is to point out that this particular doctor (allegedly) gave her a lecture. But this doesn’t connect with my third argument at all. That has nothing to do with the complaint that he was taking away her choice, that’s just about whether or not he was nice about it. Recall that I started with this specific encounter, but then said:

    The issue is an important one and is bigger than this one encounter between doctor and patient – and it’s bigger than the issue of birth control. The question is whether or not a doctor should be compelled to do what they think is morally wrong, and whether or not it’s appropriate or even acceptable to morally condemn a doctor who refuses to provide a medication or perform a procedure on conscientious grounds.

    I thin gave my first, second and third responses to three possible arguments about this. Now I don’t know how the doctor handled this at the time. All we have is the account of someone who is angry with him and wants to make him look bad. Bad it’s not really the point. The point is quoted above.

    Lastly, “The question is not whether the GP must agree with me [on what constitutes adequate healthcare] or give up his job. The questions are, firstly, whether he must agree with his employer or give up his job (or reach a reasonable compromise, where possible) and, secondly, whether or not the public are entitled to try to influence said employer’s position on the matter.”

    The first is not an issue, since the doctor is already permitted, as far as law and employment is concerned, to refuse to prescribe the pill, which he did. And yes of course the public are permitted to express their opinion on whether those rules are good ones. I have supplied reasons here for supporting them.

    But in fact the issue really is whether or not the doctor should either violate his conscience or not work as a doctor. You appear to take the latter view, as evidenced by these comments:
    ” If your religion prohibits the use of nails, you don’t get a job as a carpenter!”
    and
    “as a doctor, Dr. Lee is supposed to serve the needs of his patient and of society. As a devout Catholic, he is forbidden to do either.”

  • Glenn July 16, 2013, 8:31 pm

    Although I will say, Harry, that I agree here: “I’m not sure it is a discussion that is likely to be productive.”

    I say this because I suspect that actually you’d grant that in general, people should be allowed to exercise conscience even on matters that arise in their employment where the vast majority of their work does not involve doing the thing that they object to. I suspect that really the issue here is that you’re zooming in on this particular instance because you reject the doctor’s stance on birth control. Sound right?

  • Harry Johnston July 17, 2013, 4:02 pm

    The point of the [euthanasia] analogy was only to deny that a person can be obligated to do something or else leave their job because it’s just what people in their profession are being asked to do, and that’s all.

    But the analogy depends on the over-the-top scenario, so it falls down unless you’re willing to follow the consequences of that scenario all the way through. My no-nails-carpenter analogy is also exaggerated, but it can be toned down without losing significance, hence its replacement with the won’t-serve-supermarket-customers-pork analogy – which I note you haven’t responded to.

    However, one can be a very fine doctor who performs core health services every day without ever prescribing the contraceptive pill.

    A fine specialist, certainly. As a GP most female patients are going to need contraceptive advice sooner or later, so being unwilling to provide it is at the very least a handicap. Not necessarily a fatal one, mind you, provided you cope with the situation properly.

    But in fact the issue really is whether or not the doctor should either violate his conscience or not work as a doctor.

    Strawman. None of the primary articles I’ve seen take that position to that extent, and I doubt many of those commenting do either. The mainstream commentary is about the GP’s alleged (and, to the best of my understanding, admitted) attempts to dissuade the patient from seeking contraception, not to the bare fact that he wasn’t willing to write the script himself.

    Your interpretation of my original comments is overly literal. I was simply being concise. I would not personally interpret “Not your uterus, not your choice” that literally either.

    I suspect that actually you’d grant that in general, people should be allowed to exercise conscience even on matters that arise in their employment where the vast majority of their work does not involve doing the thing that they object to.

    So far, I haven’t been able to think of any reasonable examples where I would agree to this. If you want to propose some specific examples I could comment on them individually. In some cases (including this one, but not I think the pork-in-the-supermarket scenario) a compromise may be possible and if you are valuable enough to your employer to justify the inconvenience then that’s fine – provided that neither customers nor society is harmed as a result.

    The fact that this particular case is about birth control certainly pushes my buttons; if it was about something less socially important I’d probably never have found your post or bothered to reply. But as far as I can judge at this point it doesn’t change my logic.

  • Glenn July 17, 2013, 5:37 pm

    “But the analogy depends on the over-the-top scenario, so it falls down unless you’re willing to follow the consequences of that scenario all the way through.”
    “That scenario” was the analogy in which doctors are called on to euthanise. I made it up. It is what I say it is and no more. I do not need to create extra points of analogy within that scenario. It exactly fulfills its purpose. The purpose of the analogy was to get the reader to see that some extraordinary scenarios show us that really we don’t think that people are morally obliged to always do what they are told or quite. And it does that nicely.

    “A fine specialist, certainly.”

    No. Take everything that you imagine all GPs should be able to be required to do. Now subtract birth control. The result is not a specialist, but a generalist.

    “None of the primary articles I’ve seen take that position to that extent”

    There is no straw man here. This is exactly what people have been saying. Of course the news article itself will not make that claim. But the commenters have been saying just that. You yourself, via your analogy to a builder, have said that this man should not be a doctor.

    “So far, I haven’t been able to think of any reasonable examples”

    And naturally, any example where you’d think that a person should just refuse to do what they are told would count as so extreme as to not be a “reasonable” example. 🙂 But if you were able to empathise with the doctor’s committment to his conscientiously held views, I suspect you’d be a little more flexible.

    “The fact that this particular case is about birth control certainly pushes my buttons.” Yes, I guessed as much!

  • Harry Johnston July 17, 2013, 10:10 pm

    “The purpose of the analogy was to get the reader to see that some extraordinary scenarios show us that really we don’t think that people are morally obliged to always do what they are told or quit. And it does that nicely.”

    Surely you admit that in your scenario, the doctor is in fact morally obliged to quit? His employers are monsters. So while the scenario certainly shows that we think people are not morally obliged to do what they are told, it does not show that we think people are not morally obliged to quit if they are not willing to do what they are told. (I don’t in fact agree with the premise you are arguing against, but your analogy does not address it.)

    “No. Take everything that you imagine all GPs should be able to be required to do. Now subtract birth control. The result is not a specialist, but a generalist.”

    A generalist who depends on his colleagues to make up for an important gap in the services he provides, i.e., not likely to be a “very fine” generalist at all, but at best an adequate one.

    “But the commenters have been saying just that.”

    Citations, please. Also keep in mind that a doctor refusing to personally fill a prescription for contraception is not all that unusual an event, so that’s not the reason this particular occasion became a story. Context is important, and it is beginning to seem that you’re deliberately trying to strip it away in order to promote an agenda that is tangential to the facts of the case.

    “You yourself, via your analogy to a builder, have said that this man should not be a doctor.”

    I really do think you’re pushing a passing remark somewhat too far, particularly since I already acknowledged that it was an overstatement. But, yes, OK; hypothetically speaking, if there was no shortage of doctors, and assuming the doctor in question was not otherwise unusually skilled, it would make more sense to give preference to doctors who don’t refuse to perform a particular part of their job, just as it would be more sensible for a supermarket to hire a checkout person who will not refuse to handle particular products. In either case, the reasons for the refusal, however well founded or however silly, are pretty much irrelevant.

    “if you were able to empathise with the doctor’s committment to his conscientiously held views”

    Well, then, present me with a conscientiously held view I can empathize with! Given your doubts as to my sincerity, I’ll drop the requirement that it be a “reasonable” example.

    I’m not insensitive to moral dilemmas in general; I face a potential one every time I’m called for jury duty, since as a matter of conscience, I am forced to refuse to convict on drugs charges. The difference is that I have no choice about serving on a jury, the most I could do is to present my concerns to the judge and hope I’m not jailed or fined for contempt. A medical career, on the other hand, is very much a voluntary and hopefully well-thought-out choice.

    “Yes, I guessed as much!”

    Ditto. 🙂

  • Glenn July 17, 2013, 10:35 pm

    Re: the Euthanasia analogy, “Surely you admit that in your scenario, the doctor is in fact morally obliged to quit?” No. That is exactly what the analogy showed to be unacceptable. If a rule came to pass so that doctors were expected to do the terrible thing I described, we would not say that they are all morally obliged to quit if they won’t take part.

    “Citations, please.”

    Gladly. From the comment thread of the news story:
    “The thing is that a doctor or any health professional in fact, is not at all entitled to their opinion when it comes to treating a patient.”
    “I am astonished that Joseph Lee was allowed to become a doctor whilst holding such bizarre beliefs!”
    “As a doctor you really have to leave your personal beliefs at the door and treat each patient without prejudice.”
    “Any doctor who doesn’t believe in medical science shouldn’t become a doctor. End of story.” [In context, what the Dr did here is clearly being labelled not believing in science.]
    “To me this person should stop being a doctor and be come one of those religious nutters.”
    “He can have his own beliefs. He just shouldn’t force them onto his patients. If he does, he is in breach of the HDC and should be struck off.”
    “What sort of b/s is this? That doctor should be struck off.”
    “But if you’re denying [the prescription] because of a “moral” reason (e.g. you know they cheated on their partner, and you don’t want to help) then you’re being unethical and need to be struck off. This guy is acting AGAINST the patient’s medical interests, and only acting for religious reasons.”

    I could quote many more, but I hope these will do. People – many, many people – are indeed publicly saying that this doctor should either have violated his conscience, or else he should not be a doctor.

    “In either case, the reasons for the refusal, however well founded or however silly, are pretty much irrelevant.”

    Can you give a reason for thinking that?

    “Well, then, present me with a conscientiously held view I can empathize with!”

    I don’t need to.

    As for you saying that I am trying to strip the issue of the context of this particular encounter and how the doctor acted – as I have already said – Yes that is exactly what I am doing. Remember what I said in the original post: “I don’t know everything Dr Lee said to his patient or how he acted towards her and spoke to her…. The issue is an important one and is bigger than this one encounter between doctor and patient – and it’s bigger than the issue of birth control. The question is whether or not a doctor should be compelled to do what they think is morally wrong, and whether or not it’s appropriate or even acceptable to morally condemn a doctor who refuses to provide a medication or perform a procedure on conscientious grounds.”

    Maybe you’d prefer that I had written about etiquette when making such a refusal and whether or not Dr Lee on this instance met those standards, but I didn’t write about that. I wrote about the principled question of whether or not Drs should have the right to refuse, and whether or not various objections to that view are plausible.

  • Harry Johnston July 18, 2013, 9:02 am

    “If a rule came to pass so that doctors were expected to do the terrible thing I described, we would not say that they are all morally obliged to quit if they won’t take part.” You might not. I certainly would, although I’d elide the “if” clause – they should quit, full stop. Voluntarily collaborating with crimes against humanity is unethical, whether you take part directly or not.

    “From the comment thread of the news story” Taken in context, I don’t interpret any of the quotes you provided as addressing the issue you’re wanting to discuss. (Some address the separate issue of whether religious belief is, in itself, evidence of irrationality or incompetence, and others are talking about the incident as a whole, not the specific aspect you’re focusing on.)

    “Can you give a reason for thinking that?” IMO, all that should matter to an employer is how well or how poorly the candidate can do the job he or she is being hired for. It follows from that that a person’s reason for not being able to do a job well is (usually) irrelevant.

    “I don’t need to.” Fair enough. Since you insist you aren’t debating the same issue I was, it’s a moot point anyway.

    “I didn’t write about that. I wrote about the principled question of whether or not Drs should have the right to refuse” OK. Not a very interesting or relevant question, in my opinion, but it’s your blog.

  • Glenn July 18, 2013, 9:55 am

    “they should quit, full stop.”
    This is unreasonable in the extreme. All doctors should quit if doctors become required by some rule to do something unethical? So under such circumstances, we should have no doctors? Compared to such an extraordinary solution, my proposal that they simply refuse to take part rather than quit is downright moderate.

    “Taken in context, I don’t interpret any of the quotes you provided as addressing the issue you’re wanting to discuss.”
    They plainly do.

    “Not a very interesting or relevant question”
    You may not think so, but it was made explicit in the blog entry. I happen to think it’s important.

  • Harry Johnston July 18, 2013, 10:28 am

    “So under such circumstances, we should have no doctors?” That would be a good first step, yes. It would certain raise awareness, might well lead to a general strike and, if necessary, armed insurrection. Your suggestion is certainly more moderate, but the scenario you describe is not one where moderation is justifiable.

    “They plainly do.” I disagree. Not much more we can discuss on that question.

  • Glenn July 18, 2013, 6:59 pm

    OK, so your position, after all, really is that doctors should do what they are asked, or if they have a problem with it – quit.

    You may think that “moderation” isn’t acceptable as a principle, but I fail to see the issue. Refuse to do what you think is wrong, but continue to serve people as you see best. Seems like a praiseworthy attitude – as opposed to saying that you aren’t even willing to provide what you regard as core health services anymore.

    (By the way, it’s no good pointing out that conscientious objectors went to jail, so doctors should quit, as some sort of parallel. Conscientious objectors never chose to go to jail. They were sent there and had no choice. It is not good that they were sent to jail. The equivalent would be firing doctors. Again, not good or fair.)

  • Harry Johnston July 19, 2013, 9:42 am

    “OK, so your position, after all, really is that doctors should do what they are asked, or if they have a problem with it – quit.” No, that’s not my position.

    You seem to be asking for a single answer that fits all situations. I don’t have one. The answer depends on the context.

  • Glenn July 19, 2013, 2:29 pm

    OK, I was hoping for principles that could abstracted and applied across a range of scenarios. Hopefully this isn’t a case of you applying some principles only in cases that push your buttons, and not really having a principled approach to the issue of freedom of conscience. There’s nothing I can glean about an overall guiding principle here.

  • Givemhell July 23, 2013, 5:39 pm

    If I were a doctor and someone came into my clinic and asked me to amputate their arms because they simply didn’t want them … well, I just wouldn’t do it. I might also recommend a psychologist since it is really a psychological issue and not a physical issue. The real problem is not with their arms but with their thinking. The same goes for abortion. As far as I know, doctors aren’t required to perform these operations and a woman has more right to cut off her arms then cut off her child’s life.

    This does happen by the way. It is known as Apotemnophilia and many of these people do not receive psychological help and will go so far into their own sickness as to begin to remove their own limbs so as to force a hospital to finish the operation. The connection to certain transgender issues and abortion are obvious. Just because there are people who are “sick” enough to cut off their own limbs or genitalia or kill their own children does not mean that doctors should be forced to perform these operations in the same way that a slaughterhouse for chickens shouldn’t be forced to slaughter humans just because some people really, really want them to.

    In fact, I believe that in the United States most of our physicians take an oath called the Osteopathic Oath in which they swear: ” I will give no drugs for deadly purposes to any person, though it be asked of me.”

    In the more ancient form of this oath, called the Hippocratic Oath the physician would swear ”

    I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

    I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.”

  • Tucker July 24, 2013, 9:04 am

    Great thread, Glenn; I really like to see the Christian philosophical community taking on these topics, considering that we’re up against people who make the sorts of statements you quoted earlier. When I was in medical school, I was told point-blank by a classmate by that if I wouldn’t refer for abortion, that I shouldn’t be a doctor. It was an experience that quite upset me at the time.

    You may be happy to hear that the few physicians I know who will not prescribe artificial contraception are generally left alone about it, as long as their belief is clearly explained to the patient and the doctor-patient interaction is carried out professionally. Most doctors are at least mildly supportive of the right to conscientious objection, in my experience, even if they personally are not pro-life, because they grasp what you’re saying here: it’s not just about abortion, or contraception, or whatever; it’s the principle that medicine is fraught with ethical decisions without one-size-fits-all solutions.

    In fact, I believe that in the United States most of our physicians take an oath called the Osteopathic Oath in which they swear: ” I will give no drugs for deadly purposes to any person, though it be asked of me.”

    I don’t know about the United States (I expect it is the same) but here in Canada there is this common misperception by the public that physicians all take the Hippocratic Oath. When I graduated, our class was allowed to make up its own oath, which, as you can imagine, ended up being fairly generic and inoffensive.

  • Tucker July 24, 2013, 9:09 am

    Though not Catholic, I am a big fan of Humanae Vitae, and I find it a continual source of interest and amazement that people continue to claim that artificial contraception is a “basic part of healthcare”, even though the world’s biggest religion teaches otherwise. We really do live in a culture dominated by the “contraceptive mentality”.

  • Tucker July 24, 2013, 2:23 pm

    A striking quote from the young woman in the article:

    “If I was an impressionable young 16-year-old and had been too timid I might have just left and never got proper contraception,” she said. “It’s worrying that he can tell people this.”

    The 16-year-old fails to receive “proper” contraception – and then what? Is she responsible to govern her own behaviour accordingly? Or if something “happens” to her (during the recreational sex that everyone is entitled to), is it the nasty doctor’s fault? I say the former. The 21st-century contraceptive mentality says the latter.

  • Harry Johnston July 24, 2013, 2:46 pm

    @Givemhell: I think the problem is that anybody can compare contraception to radical amputation with a straight face.

    @Tucker: see http://en.wikipedia.org/wiki/Argumentum_ad_populum ; also, are you really suggesting that sexually active young women should be denied birth control because they deserve to get pregnant?

  • Givemhell July 25, 2013, 3:36 am

    @ Harry Johnston – Your sexually explicit “joke” username shows an underlying immaturity when it comes to things of a sexual nature which may be part of the cause of your confusion concerning the moral issues surrounding contraception. The parallel between unnecessary surgery, abortion and prescribing contraceptives is that these are all elective surgeries/prescriptions which a doctor is not obligated to administer and should not administer if he feels that they violate his religious beliefs or cause harm to his patient. I “say” this with a straight face because what I said is true.

  • Harry Johnston July 25, 2013, 9:24 am

    @Givemhell: what joke username? I use my real name online. See http://www.cms.waikato.ac.nz/genquery.php?linklevel=3&linklist=SCMS&linkname=All_Staff_in_the_Deans_Office&linktype=report&listby=Name&lwhere=unique_record_id=38&children=

    Contraception is technically elective but is an essential part of a normal, healthy, and socially responsible lifestyle. Arguably it isn’t essentially part of healthcare, in that it could be provided separately, but it is not sensible to do so because many contraceptive techniques may present health risks for some people, particularly in combination with other prescription medication.

    A doctor, like anybody else, is obligated to do his job. In the US, if I understand correctly, a GPs job is defined by private entities, some of which are religious in nature or heavily influenced by religious factions, so prescribing contraception may not be part of the job description. In New Zealand the job is defined by the public health boards, which are governed in a secular manner by elected officials. AFAIK all the PHBs in New Zealand require general healthcare providers to include contraception, although (as already discussed) there is an “out” for individual GPs who have religious issues with this, provided they treat their patients with respect and do not unreasonably inconvenience them. (The particular fuss that launched this blog post was about a GP who did not treat his patient with respect.)

  • Glenn July 25, 2013, 9:30 am

    “Arguably it isn’t essentially part of healthcare, in that it could be provided separately, but it is not sensible to do so because many contraceptive techniques may present health risks for some people, particularly in combination with other prescription medication.”

    So something should be treated as part of healthcare if it presents health risks – especially in combination with prescribed medication?

    So drag racing should be treated part of healthcare? This may not be a very good line of reasoning to depend on.

  • Harry Johnston July 25, 2013, 9:36 am

    I’m not aware that drag racing presents health risks. Do you mean from the G-forces, or are you confusing health risks with the risk of accident?

  • Glenn July 25, 2013, 9:44 am

    Harry, I am referring to risks to one’s health. Drag racing presents such a risk, since being in an accident is generally not good for one’s health. I hope that clarifies things for you.

    Bottom line: It is implausible to say that something is a healthcare service on the grounds that it presents health risks.

    How about another counter example: Providing high-calorie fast food is a healthcare service.

    Do we really need a long list here Harry? I think you see the point. You really don’t want to use that line of reasoning.

  • Harry Johnston July 25, 2013, 10:12 am

    You’re still trying to conflate fundamentally different scenarios. The obvious difference in this case is that you don’t need a prescription to go drag racing or to buy fast food. We could solve your problem by removing the requirement for a prescription for contraceptives, but I believe that would be unacceptably risky.

    Your GP can tell you, “While you’re on this medication, don’t do extreme sports.” or “While you’re on this medication, you must avoid fatty foods.” and any normal person can keep track of that. If your GP tells you, “While you’re on this medication, you must avoid Oxybutynin-based contraceptives, unless you also take Fexofenadine at least once a day.” how many people are going to be able to keep track of that?

    We could also make contraception a specialty, have dedicated birth control centers. There are several reasons why this isn’t a great idea: for example, they’d have to have access to your medical history, which introduces complications and has privacy implications. They probably still wouldn’t be able to do as good a job as your GP, because they wouldn’t be personally familiar with your case history. Finally, it would be more expensive. It might all be worth it if a lot of doctors had religious objections to contraception. Since in fact there’s only a handful, it’s far more sensible to ask their colleagues to take care of it.

  • Glenn July 25, 2013, 1:08 pm

    “You’re still trying to conflate fundamentally different scenarios.”
    Harry that’s clearly not the case. I am not conflating these scenarios with that of birth control. When you conflate things, you treat them as being the same. And of course driving a drag car and eating fast food is not the same as taking the pill. But the point, Harry, is that you claimed that we should treat birth control as though it were a core health service (even though you could separate it from genuine health services) because (and here is the point) is presented a potential medical risk. For that reason, it should be treated as a health service.

    Rather than conflating different actions with taking the pill, Harry, what I have done is to demonstrate that this is not a sufficient ground on which to treat provision of the pill as being on par with core health services – because there are other activities that meet this condition (drag racing, eating fast food), and clearly these things are not health service related. Ergo, this condition is not sufficient at all. If you want to claim that providing the pill to people is like a core health service, you will need a new reason for saying so.

    “We could solve your problem” – Whose problem?

    Your GP can tell you, “While you’re on this medication, don’t do extreme sports.” or “While you’re on this medication, you must avoid fatty foods.” and any normal person can keep track of that.

    You’re missing the point and now changing tack. You claimed that being prescribed the pill is a health service because it presents a risk.

    But even if you want to modify your argument and say (in effect): “OK, forget medical risks in general, let’s focus only on the risk of the pill if a woman is already on other medications,” the response is just as simple:
    1) It’s easy for a doc to say “Now when you’re taking this medication, you should not take the contraceptive pill.” Done. It’s exactly as easy as saying “don’t use heavy machinery when taking this medicine.” Point is, it’s the medicine that is the healthcare, and not the use of heavy machinery, taking the pill, drag racing etc.
    2) Your concern is now solely about the fact that taking the pill is risky when a woman is already taking certain types of medication. But this does not make it the role of the health profession to provide the pill, on pain of being told that they chose the wrong job! This is a case of people having the ability to consult health professionals for information about the risks they are choosing to take, and the burden of responsibility falls to those who provide the pill, namely drug companies, and of course to the women taking the pill. In most cases this is a lifestyle choice (definitely not a medical or healthcare issue), and how they manage the risks associated with that lifestyle is up to them. If some doctors elect to provide a service of supporting this lifestyle choice then that is their call, and if women seek advice from such doctors than that is prudent. But this has absolutely nothing to do with the obligations of doctors in general.

    If the concern is no more and no less than that the pill is potentially harmful under some circumstances, this puts it in the category of substances to which many have allergies, substances that causes reactions in some people, etc. It is often the case that the cause of these reactions is complex and the subject of scientific analysis. But this is not an adequate reason to decide that the substance therefore is something that we should expect doctors to supply – otherwise they’re not really doing their job.

  • Harry Johnston July 25, 2013, 1:55 pm

    I originally said “but it is not sensible to do so because many contraceptive techniques may present health risks for some people, particularly in combination with other prescription medication.” The missing part from that sentence, which I had expected readers to fill in on their own, was “health risks [that we address by requiring doctor’s prescriptions]”.

    “Whose problem?” The “problem” that GPs are being asked to prescribe contraceptives.

    1) There is more than one contraceptive pill, so such a blanket statement would rarely be true.

    2) Conflicting medications is not the only issue. Family and medical history are also relevant; for example, a particular pill might not be suitable for someone who has had certain conditions in the past. There may be other reasons I’m not aware of. The bottom line is that you require a prescription to obtain the pill, and I’m sure the Government has good reason for doing so.

    If you do think that the Government’s reasons for requiring a prescription for contraceptive medication are inadequate, by all means, make that case. It’s not something I’ve researched, I simply assume they wouldn’t have done it without reason.

  • Glenn July 25, 2013, 3:40 pm

    The missing part from that sentence, which I had expected readers to fill in on their own, was “health risks [that we address by requiring doctor’s prescriptions]“.

    Yes, I realise that this is what you meant: The pill presents risks, therefore those risks should be managed by requiring that the pill only be given via prescription. My response took for granted that this is what you meant.

    “The “problem” that GPs are being asked to prescribe contraceptives”

    OK…. it’s a bit odd then that you called it “your problem” (speaking to me). It’s not my problem at all, it’s a problem for those who think that the pill ought to be treated as a core health service, hence assuming (wrongly, I say) that GPs who choose not to prescribe the pill are in the wrong job (which is your position).

    “Conflicting medications is not the only issue. Family and medical history are also relevant…” [etc]
    Granted, and obviously this is all compatible with my previous comments. Are you agreeing with me? There may be a variety of factors that make any given substance, taken as a lifestyle choice, more of a risk to specific people. And whose job is it to manage such risks? Again, manufacturer’s and customers. These are lifestyle products. And as I already said,

    If some doctors elect to provide a service of supporting this lifestyle choice then that is their call, and if women seek advice from such doctors than that is prudent. But this has absolutely nothing to do with the obligations of doctors in general.

    If the concern is no more and no less than that the pill is potentially harmful under some circumstances, this puts it in the category of substances to which many have allergies, substances that causes reactions in some people, etc. It is often the case that the cause of these reactions is complex and the subject of scientific analysis. But this is not an adequate reason to decide that the substance therefore is something that we should expect doctors to supply – otherwise they’re not really doing their job.

    What you are now saying is compatible with this. May I assume that your last comment is not meant as a disagreement?

  • Harry Johnston July 25, 2013, 4:04 pm

    I think it’s your problem, because you’re the one objecting to the status quo. Society has long since decided that contraception shall be prescribed by GPs. (Actually it was Givemhell that was objecting to the status quo, but by arguing against my response I took it that you were implicitly agreeing with his stance that asking a doctor to administer contraceptives is comparable to asking him to perform an unnecessary radical amputation.)

    “Yes, I realise that this is what you meant: The pill presents risks, therefore those risks should be managed by requiring that the pill only be given via prescription.” No, that’s not what I meant. I meant: “The pill presents risks, and it was decided long ago that those risks are best addressed by making it a prescription medication.”

    As a direct consequence of that decision, and because having a separate set of doctors just for contraception would be both less effective and less efficient, contraception was made a part of a GPs job. These are decisions that were made long ago, along with the decision to provide a conditional “out” for conscientious objectors. I see no compelling reason to reconsider them.

  • Glenn July 25, 2013, 8:22 pm

    “you’re the one objecting to the status quo”

    Given that the status quo is that Doctors can refuse to prescribe the pill and I have defended that right, and now we have both agreed that providing the pill is not a core healthcare service….

    I don’t see the problem.

    You now appear to be saying that the “out” makes things OK, which is an about face from the stance your first took. Perhaps I have won you over, Harry. Your approach summed up in your very first comment seems to be long gone. Go back and read it – quite the contrast now! A change for the better. 🙂

  • TW July 25, 2013, 9:31 pm

    Insulin injections are technically elective as well, because a diabetic can balance their blood sugar with a very strict diet and without artificial insulin. My grandmother did this exclusively. Does a physician who refuses to prescribe insulin a fine doctor make? Should a diabetic who does not receive insulin be shamed for eating a piece of candy? Since about 99% of fertile women in the United States have used some form of birth control, it would seem that contraceptive use is in fact much more common than insulin. You seem to assume that the doctor in question is being asked to change his beliefs, when in fact none of the commentators you mentioned have suggested that the doctor change his beliefs. The doctor is being asked to separate his beliefs about contraception from his professional practice and prescribe medication according to medical standards. Licensed counselors are asked to do the same thing; they may morally disagree with drug use or extramarital sex, but they must learn how to counsel people using drugs and having extramarital sex and if they are employed by a public institution, they will likely be required to counsel these people professionally or lose their jobs. You forget that doctors are gatekeepers to contraceptive medication, meaning it is THEIR responsibility to provide accurate information about it to patients and write scripts for it. A woman can’t simply go to the pharmacy and buy it herself. If she lives in a rural town, there may not be another doctor for miles to write the script and give her medically-accurate information. Unfortunately, many doctors take advantage of their position as health care providers and choose to make it very difficult for women to access birth control. This particular doctor also went against nationally-established protocols by lecturing the patient about her “reproductive duty.” He also recommended the rhythm method, which he then admitted to the press “is not very effective.” Imagine a doctor giving you medical advice that he knew was not effective. Would you trust this doctor? Would his employer fear legal action if a patient became pregnant? If this doctor feels confident that his conduct is appropriate and legal, he shouldn’t mind others finding out about it in the news. As you can see, there are many aspects of this encounter that are simply wrongheaded. Much of your support for this doctor is clearly rooted in your shared aversion to birth control. Would you continue to support him if the medication in question was insulin?

  • Glenn July 25, 2013, 9:47 pm

    “Insulin injections are technically elective as well, because a diabetic can balance their blood sugar with a very strict diet and without artificial insulin.”

    TW, it’s not clear that this reasonably draws the line between what is elective and what is not. I suspect that it does not, otherwise many forms of treatment that we reasonably take to be non-elective would be seen as elective. You can recover from many diseases, repair broken bones, even (if you had the abilities as a chemist) make your own remedies. But doctors, when providing care under these situations, are meeting a need that is difficult for non-specialists to meet for themselves and must be met in order for the recipient to enjoy what many of us would call normal health from a medical standpoint. This seems like what most people are talking about when they say that a treatment is not elective.

    This commonsense understanding of what it means for something to be elective or not also shows why birth control is (usually) elective. There may be rare cases when, for particular individuals in particular medical circumstances may require birth control and it is plausibly seen as not elective (for example, a woman who would likely die if she got pregnant). But since reproduction is part of normal function in healthy people, preventing birth seems rather obviously to be elective under normal circumstances.

    But contrary to what you say, I am not averse to birth control. My wife and I have used birth control and I have no moral reservations about this. This appears to be an assumption that you have made simply because I have defended freedom of conscience for those who are opposed to the use of birth control. The point is only that the doctor in this case was averse to birth control on moral grounds, and I have argued that he should have a right to choose not to prescribe it for that reason.

    The discussion later developed into whether or not birth control is (usually) elective, and it is quite clearly so in most cases – the counter example of insulin not successfully overturning this, as just explained.

  • Harry Johnston July 26, 2013, 8:51 am

    My position hasn’t changed. As I’ve explained repeatedly, you’re misinterpreting my original statement. I don’t object to GPs having an “out” provided they use it responsibly. The incident that launched this entire conversation was about a GP who did not behave responsibly. You’ve clarified that you’re not really talking about that particular GP, but just GPs in general, and subject to that proviso I have no objections to your position, though I think you chose an inappropriate example.

    Under my interpretation of the phrase “core healthcare service” contraception is definitely such a service. The fact that society has given the job to GPs makes it one. You seem to interpret the phrase differently, and that’s OK. So long as you’re happy for GPs to be generally expected to prescribe contraceptives I don’t care whether you call it “core” or not. It appears that Givemhell does not want GPs to be generally expected to prescribe contraceptives, even if they’re given an “out” and that is what triggered this subthread.

    I don’t see how you can say that birth control is elective and insulin isn’t. They’re both intended to improve a person’s lifestyle. Is it the fact that almost everybody needs birth control and only some people need insulin?

  • Glenn July 26, 2013, 9:46 am

    “As I’ve explained repeatedly, you’re misinterpreting my original statement”
    I don’t think there’s any merit to this. With respect, your comments have been a bit “all over the place” and you may at times have wished that you did not make your original comments. It looks as though you burst in, not really getting the point of the OP, and now you have come around to agree with it as you’ve seen what the issue really was, and instead of accepting that you misunderstood the OP, you are saying that I am misrepresenting you.

    The blog claimed that a Doctor should have the right to refuse. Your first comment very obviously objected to this:
    “This is ridiculous. If your religion prohibits the use of nails, you don’t get a job as a carpenter!” [Emphasis added]

    You were clear – this man is in the wrong job. You added that there was a basic conflict between his values and his job.

    It’s no good claiming that you were misrepresented. You were not. Much more likely is that you made a comment much stronger than anything you could justify, you now see that, you wish you hadn’t made the original comment, and so you now claim that you didn’t mean it and I’ve misrepresented you. Not true.

    “You’ve clarified that you’re not really talking about that particular GP, but just GPs in general,”

    Now you are misrepresenting me, and obviously so. I explicitly stated in the original blog article that the issue is not this GP in particular, but GPs in general. I have already reminded you of this, but since you seem to still be claiming that this was a later clarification, let me quote again from the original article:

    The issue is an important one and is bigger than this one encounter between doctor and patient – and it’s bigger than the issue of birth control. The question is whether or not a doctor should be compelled to do what they think is morally wrong, and whether or not it’s appropriate or even acceptable to morally condemn a doctor who refuses to provide a medication or perform a procedure on conscientious grounds.

    Obviously you didn’t see this right away (I’ve had to remind you of it a couple of times now), so you reacted to a different issue than this one. You acknowledged that this was the case, but rather than a simple “oops,” you claimed that the subject of the blog article, in that case, wasn’t very interesting.

    Your position in this thread has clearly mellowed from “this is ridiculous,” and the claim that he shouldn’t have chosen this job, given his reservations about this particular prescription, to the idea – once you realised what this is about – that it’s totally fine for doctors to have an out, and even though this is the status quot – which I defended in the article, you’ve tried to turn things around to their opposite and claim that “you’re the one objecting to the status quo.”

    This is an extraordinary reversal. I am the one who wrote a blog article to defend the status quo, and you called it ridiculous. So as I said, I am still maintaining that position, and you have changed your tune. If this is not the case, then you entirely misunderstood the blog article, objected to your misunderstanding, and now that you see what the blog is actually saying, you realise that you did agree after all because it defends the status quo, but in an effort to somehow (?) maintain that I’m wrong anyway, you’re attempting to say that I’m opposing the status quo.

    With respect, it would have been much more dignified to say: “Oops, my mistake, Glenn. I misunderstood you. After all this, I actually agree with you that there should be an out, doctors absolutely should have the right to freedom of conscience, just as you have claimed in this blog article.” Clarity is much more desirable than saving face.

  • Harry Johnston July 26, 2013, 11:11 am

    Yes, I concede that I misunderstood your original post. In my defense, this is largely because it was presented as being in the context of the behaviour of this particular GP. It would perhaps have been a lot clearer if you hadn’t kept mentioning Dr. Lee as if you were defending him. It also didn’t occur to me that you were likely to be seeking to defend the status quo, for the obvious reason that it doesn’t need defending. However, had I read it more slowly and carefully I might have noticed your provisos and confined my comments to asking for clarification. That was my fault and I apologize for commenting without making certain I understood what you were saying.

    I also apologize that my original meaning wasn’t clear to you. I would have expected it to be clear that I was talking about Dr. Lee, rather than about GPs in general, although of course this is at least partly because of my misinterpretation of your post. It should however be noted that none of the news coverage or commentary that I have seen objected to anyone other than Dr. Lee, so at the time I really had no reason to expect to be misinterpreted in this way.

    So, to be clear: do you disagree with Givemhell’s position that doctors shouldn’t even be expected to provide contraception? If so, then yes, it seems we’re in agreement as far as that goes, although I don’t understand why you chose to nitpick over the details of my response to him if you actually agreed with me.

    Again, to be clear: are you in fact proposing that contraceptives should be available without prescription? Or was that just a rhetorical argument?

    We still, if I haven’t gotten totally confused, disagree on whether the news coverage and popular commentary was in effect objecting to the status quo. I don’t think it was. The general public and I object to Dr. Lee’s alleged misbehaviour (which he has not, to the best of my knowledge, denied) but not to the bare fact of GPs being allowed to refer patients to other members of the practice. As evidence I put forward the fact that a number of GPs have been doing that for decades without any widespread complaint.

  • Glenn July 26, 2013, 12:44 pm

    Thanks for that Harry.

    On the issue that Givemhell raised – which is effectively the question of whether or not contraception is a core health service at all (and hence, whether or not doctors should be expected, as part of their duty as doctors, to prescribe them at all), I am inclined to agree with him. They aren’t a core health service (something you’ve said as well), and reasons for lumping them in with core health services aren’t very persuasive, for reasons I’ve suggested.

    Whether or not this means that they should simply be available for purchase over the counter is another matter. I haven’t made this argument. It depends on the risks that would prevent. There are other substances that are lifestyle choices but which present risks (narcotics being the obvious example). The solution in these cases has not been to simply make them available without restriction, but rather to impose restrictions, or to ban them altogether.

    I’ve said that it makes sense for doctors who support the use of these substances to choose to provide the service of offering a medical assessment of how safe the pill would be on a case by case basis. This is already the case with a variety of health supplements, which feature warnings to seek medical advice before choosing to use them, along with explanations of scenarios in which people should not use them at all. Whether such a consultation should be required is a matter that doesn’t have an obvious answer.

    Regarding the last comments you made, I have provided some examples of people who think that the doctor in this case was actually wrong, as a doctor, to refuse to prescribe the pill. These people commented that when it comes to providing prescriptions, doctors are “not at all entitled to their opinion.” People complained that he was “allowed to become a doctor” while he held this view of the pill. It was said that if you’re a doctor with such reservations, you have to “have to leave your personal beliefs at the door” – and so on. So they really were objecting to the status quo.

    I think part of your reluctance to see that this really, truly is what people are saying is that what they are saying genuinely is unreasonable – It’s so unreasonable, in fact, that a fair minded assessment of what they are saying is that it’s incredible. The doctors (alleged) manner of expressing his views has been criticised, to be sure, but his stance on the pill while practicing as a doctor is undeniably being condemned as simply inappropriate. Doctors should provide this because it’s part of their job, and their beliefs should just stay out of it.

  • Harry Johnston July 26, 2013, 1:42 pm

    It still seems that you are not entirely satisfied with the status quo, in that doctors are currently expected (not an absolute requirement but an expectation) to advise on and prescribe contraceptives. There are only a few options that I see here: (A) outlaw contraceptives; that’s a non-starter. (B) Remove the requirement for a prescription; I don’t think either of us has enough specialist knowledge to discuss this sensibly, but I assert that the Government would not have mandated prescriptions without good reason. (C) Create separate birth control centers; this would be, in my opinion, an unnecessary waste of money. (D) The status quo, give the job to GPs; I have no problem with this, and I don’t believe you’ve presented any convincing reasons why it should be changed.

    As far as the public comment goes, I think we’ve pretty much driven this subject into the ground already. There’s no way for either of us to prove what an anonymous third party meant by a short comment, so we’ll have to agree to differ. 🙂

    I will give you my interpretation, FWIW, of two of the comments you requoted: the first I would take as “not at all entitled to [use their position to attempt to convert patients to] their opinion” and the second I would take as “[should not be] allowed to become a doctor [while believing in Christianity/Catholicism]”. I don’t agree with the latter, BTW, but I see it as a different complaint to the one you’re talking about.

  • Glenn July 26, 2013, 5:12 pm

    Harry, the status quo in question earlier was the status quo in regard to doctors can refuse to prescribe the pill. They can, and I support that for reasons suggested here.

    On the new issue of whether or not we should expect this service, as a rule, from doctors – you’re right, I haven’t yet encountered good reasons for an affirmative answer as to why this stats quo should be endorsed as ideal or even desirable. I’m not sure.

    “I have no problem with this, and I don’t believe you’ve presented any convincing reasons why it should be changed.”

    I do not take the stance that we should all assume that the status quo is correct until someone shows why it is not. I am not aware of good reasons for saying that this is something that, as a rule, we should expect of doctors. My comparisons between the pill and other lifestyle choices seem fine to me. There are other lifestyle substances that are dangerous when used by some people and when taking other substances – although in the majority of cases they are safe. This seems like a suitable analogy to the contraceptive pill, and medical advice is wise. As I’ve said, I have no problem with the pill in all contexts anyway, but I just don’t see a compelling reason for the status quo on this new issue (and I certainly don’t buy the line that the government says we should do it, so it’s OK – it’s quite likely that this is a political issue, as requiring a prescription ensures taxpayer subsidies, and many people have a strong interest in keeping birth control subsidised).

    Moreover, there does seem to be something inherently unjust about taxpayer subsidies for a service that is morally contested by a large minority and which is not required for any health reason. But that’s another issue.

    “an anonymous third party” Actually, many, many, many third parties of whom I provided s very small selection. Their meaning was really clear, but evidently you don’t see that. You even show that you’d have to substantially alter what they said in order to find a different meaning in their words. In their original wording, they say precisely what I said. Effectively you’re saying “Sure, they said that. But that’s extreme, so they can’t have meant that. Here, I’ll fix it for them.” As for the second of the two quotes – it’s not simply against Catholicism, it’s against a Catholic view on contraception, saying that a doctor who held that view should not have become a doctor (clearly his belief in the resurrection of Jesus, for example, was not part of the concern).

  • Glenn July 26, 2013, 5:56 pm

    For what it’s worth, and to clarify that this sentiment is definitely being expressed:

    “The thing is that a doctor or any health professional in fact, is not at all entitled to their opinion when it comes to treating a patient. This was one of the first things I learnt when studying to become a nurse. Personal values, attitudes and beliefs are not to interfere with your practice.”

    “As a professional it is your responsibility to leave your personal business at the door and collect it on the way out. This woman went in looking for a medical prescription because this is the form of contraception she choses, he is a doctor and should do his job.”

    “The problem is that it is a simple request and he failed to do his job.”

    “No one should be denied medical treatment or a prescription because a doctor has moral objections!”

    “I expect every REGISTERED medical professional to check their beliefs at the door when it comes to my personal decisions about my reproductive health.”

    Reviewing the list of comments that I first gave along with these, I see no sensible way to deny what is being said here: Doctors have no right to their personal moral objections when they are serving as doctors.

    This was also confirmed via comments in social media at the time – but I didn’t record those. But we do, at least, Harry, agree that this common outlook is wrong. That was the substantive point here.

  • Harry Johnston July 27, 2013, 11:38 am

    “I just don’t see a compelling reason for [GPs to be expected to prescribe the pill.]” My belief is that efficiency is always preferable to inefficiency, unless there is a compelling reason why the efficient solution is undesirable.

    Is contraception really opposed by a large minority? I’d have thought quite a small minority.

    FWIW, I don’t think I changed the meaning, simply clarified the ambiguity. You’re still trying to read this commentary out of context and expecting way more precision in writing than most people (including me, most of the time) can be bothered with. If they mean what you suggest, why did they wait until now to say it, and why has the issue died down without any change in the rules? I do also believe that many people think religion (e.g., belief in the resurrection of Jesus) indicates some level of mental incapability, which makes that the more likely rationale for those particular comments. It’s an understandable belief, after all, though the evidence says that it’s wrong.

    However, I’ll try not to answer back from now on, as far as that particular issue goes.

  • Glenn July 27, 2013, 12:42 pm

    “why did they wait until now to say it”

    You mean… immediately? I don’t get it.

    But I think we understand each other. 🙂

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