Category: Procedures & Services

Freedom from conscience

The Interim

Editorial

On June 24, Joan Chand’oiseau saw a sign at the front desk of the Westglen Medical Centre in Calgary: “The physician on duty today will not prescribe the birth control pill.” The sign, put up only when Dr. Chantal Barry is the sole physician at the clinic, so offended the would-be birth-controller that she has since made the good doctor’s principled objection her casus belli for a modern-day, social-media crusade. The apparent slight against Chand’oiseau has now garnered national attention, with political candidates dutifully – if pitifully – conforming to the conventional wisdom: that some wrong has been done, and some remedy must be made. – [Full Text]

I was told to approve a lethal injection, but it violates my basic medical ethics

We risk botched executions so long as they are conducted in a scientific vacuum and medical professionals operate devoid of any moral compass

The Guardian

Marc Stern

I peered through the small window of an otherwise solid steel door of the isolation wing of the prison, and saw a small man on his knees in front of his steel framed bed. He had committed many murders and was sentenced to life without the possibility of parole. Perhaps he was praying. Perhaps he was looking for a pencil. But that’s when it struck me: There might be a punishment worse than execution.

Other than a maximum of one hour per day when he could be escorted to a recreational cage outdoors, he would spend the next 10, 20, perhaps 30 years of his life in this very room – eight feet by 10 feet. He would have little contact with other human beings aside from officers and medical professionals. Forging a new friendship or hugging a loved one, if possible at all, would be rare, supervised and not likely spontaneous. His life would be restricted to the same 80 square feet – forever. . . [Full Text]

 

Ethics should colour doctor’s decisions

Wrong to ask MDs to leave their values at their exam room doors

Hamilton Spectator

Reproduced with permission

Lea Singh

In a recent column, Martin Regg Cohn throws spears in all directions as he attacks doctors who refuse to prescribe or refer for birth control pills. Cohn wants the College of Physicians and Surgeons of Ontario, which is reviewing its human rights guidelines, to clamp down on these doctors and force them to participate in treatments they consider unethical or risk losing their jobs.

First off, Cohn rejects the possibility that there could be sound medical judgment behind the decision not to prescribe birth control pills. He is wrong; birth control is not Tylenol. Popular pain relievers are very safe when used according to directions; their main danger comes from accidental overdose.

In contrast, a regular “safe” daily dose of birth control pills will nearly triple a woman’s risk of deadly blood clots, and newer pills like Yasmin further double or triple that risk. Last year, Yasmin was linked to the deaths of 23 Canadian women. This year, a major French report revealed that blood clots caused by birth control pills have killed about 20 French women per year since 2000. Many women who survived their blood clots have been left paralyzed, blind and otherwise disabled.

Yes, pregnancy also increases blood clot risks. Blood clots kill more pregnant women than any other cause in the developed world. But pregnancy only lasts nine months, while many women are on the pill for years or even decades, often with little monitoring.

And what about the fact that the World Health Organization has classified birth control pills as “carcinogenic to humans?” The WHO is hardly trying to promote a religious agenda, but in a 500-page report it found “sufficient evidence” that birth control pills increased the risk of breast cancer and cancers of the cervix and liver.

But medical judgment aside, should doctors have the right to opt out of treatments they believe to be deeply unethical? Cohn argues that doctors should leave their religious values and personal ethics out of their workplace.

This is a new and dangerously totalitarian way of thinking. In the past, we have always respected every person’s right to live according to their own moral and religious precepts. This is why our Charter says that “Everyone has the following fundamental freedoms: (a) freedom of conscience and religion.”

Living out our values is the essence of true freedom. In dictatorships, everyone is still free to think, but they cannot act on their beliefs. In democracies like Canada, citizens have the right to conform their actions to their deepest values.

Cohn would take away this Charter protection from doctors, to save patients from the inconvenience and annoyance of having to go elsewhere. But is minor inconvenience really too high a price to pay for the fundamental freedom of our doctors, or any citizens? Ontario patients have plenty of alternative venues from which to get their prescriptions, such as public health clinics and emergency rooms. Abortions don’t even need a referral in Ontario.

If the medical profession is different from other professions, it is because ethics are so much more important in the field of medicine. Doctors hold our health and our lives in their hands. For centuries, we have insisted that doctors promise to do no harm, because we know that internal ethical limits make doctors far more responsible in the use of their medical powers. If doctors become mere machines that take orders without question, patients will ultimately be far less safe.

How can we trust doctors who leave their personal ethical limits at the door of their workplace? To really undermine confidence in our health care system, populate it with morally schizophrenic doctors who won’t mind performing procedures they admit are deeply unethical.

The law is too rough, corruptible and imperfect to prevent doctors from playing God. What will hold back doctors if the law permits any unethical procedures? Is it wise to place all our faith in regulations as our only safeguard when the scalpel looms over us?

We will reap what we sow. Perhaps we have truly become so dogmatic that we can no longer tolerate any dissent from the mantra of reproductive and sexual rights, and freedom is the next casualty. But freedom is a mighty tree that should not be cut down lightly. Our pluralist, democratic society lives in its branches, and the aftershocks of such a fall will be felt by all of us.

Lea Singh is a blogger, writer and lawyer who resides in Ottawa. Her blog is at http://leazsingh.blogspot.ca/.

Submission to the College of Physicians and Surgeons of Ontario

Gift of Life Fertility Care Centre

Dear CPSO Members,

I teach women and couples how to understand and track their fertility using the Creighton Model FertilityCare™ System. I am writing in response to the review of your policy about Physicians and the Ontario Human Rights Code.

Several articles by major news outlets have documented the inconvenience experienced by a woman who wanted to get the birth-control pill only to find that the doctor on staff did not prescribe it. Despite attempts by these outlets to make it more than this, ultimately “inconvenience” is the right word for what this woman experienced. She lost, maybe, 30 minutes of her time going to another clinic.

What has been played up by these news outlets as an inconceivable travesty is common fare for the women who are my clients. I work with women who, in contrast to women who use the Pill, believe their fertility to be health, not disease, and therefore use methods of family planning based on their natural cycle. These women want to work with doctors who will treat their reproductive and gynaecological issues in accord with this mindset. Many of the women I have worked with would be glad if the worst thing that happened to them in their attempt to find such a doctor was a 30 minute detour to a different clinic. A significant number of my clients make regular 3 to 6 hour trips, each way, to see a doctor who will respect their decision to work with their fertility versus seeing it as a disease. Some have even travelled from other provinces, paying not only for travel but also hotel rooms and lost days of work.

To my knowledge, the woman in the above mentioned news articles never even interacted with a doctor. She was never judged for wanting the Pill, never pressured to get off of it, or never told she should be doing something else. In contrast, here are some of the things that women using natural methods have dealt with:

  1. More than once, a woman’s physician has pressured her to go on the Pill, despite her clearly telling her physician that she does not want that, after she has chosen to get pregnant and given birth. [Please note: “chosen” is the best word, as my experience in practice matches with the published method effectiveness for the Creighton Model of 99.5% to avoid pregnancy.)
  2. In one instance, an OBGYN was so insistent that a women use non-natural methods of family planning that she felt the need to get a letter from her lawyer before her scheduled C-section as she feared the OBGYN would tie her tubes.

In addition, clients have experienced ignorance, scorn, and downright rudeness from physicians who, horribly informed about modern methods of Natural Family Planning, chastise them for using the “Rhythm” method or no method at all.

This lack of respect for my clients’ desires is seen not only with their choice for family planning but also with their approach to pregnancy:

  1. A woman struggling from multiple miscarriages shared with me how callous her physician was in response to her distress regarding her most recent miscarriage; for him, loosing multiple unborn children was no big deal and he felt it should also be for her.
  2. A couple, given a potential negative prenatal diagnosis was repeatedly pressured by their physician to abort despite the couple telling the physician that they were morally opposed to abortion.

Finally women who are looking for real answers to their reproductive and gynaecological health issues, as opposed to suppressive/destructive approaches like the Pill, have sometimes found Pill-prescribing physicians more “dogmatic” than any of the physicians the media decided to highlight who do not prescribe the Pill. A number of my clients have been told by these Pill-prescribing physicians that the Pill was the only option to their problems. In case you were wondering, the Pill was not the only medical answer, as all of them have subsequently found out.

I find it ironic that, given the ubiquitous presence of the Pill and the ease at which hormonal contraception can be found – not only in private medical practice, but at any Public Health Unit or Family Planning Clinic – that the story of one woman’s inconvenience became national news. Meanwhile, the women that I work with continue to quietly accept the difficult and costly efforts they go to to find physicians who will work with them. These women are equally deserving of having physicians, such as those who only prescribe natural methods for family planning. Any attempt by the CPSO to change its referral policy and thus force such physicians out of practice is a clear statement by the CPSO that some women – particularly those who take the Pill – are more equal than others.

Gift of Life FertilityCare TM Centre,
Ottawa, Ontario

Anti-abortion doctor fired

The Warsaw Voice

Prof. Bogdan Chazan, a gynecologist who recently became the central figure in a heated pro-life vs. pro-choice dispute, was dismissed as the director of the Holy Family Hospital in Warsaw June 21.

Warsaw Mayor Hanna Gronkiewicz-Waltz fired Chazan after the media revealed that, citing a “conflict of conscience,” Chazan had refused to perform an abortion on a patient despite clear medical indications.

The patient had requested an abortion after the child she was carrying was diagnosed with severe health problems, including deformities of the head and face.

Under Polish law, a doctor who refuses to perform an abortion in such cases must refer the patient to another doctor or a medical establishment where she can have the pregnancy terminated.

Chazan did not do that. He said that doing so would have made him an “accessory to an abortion.” [Full text]