Category: Contraception

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

Doctors Should Not Be Forced to Prescribe the Pill

Huffington Post

There’s a Toronto-based business called the Red Tent Sisters, which gives sex advice to women. They are advocates for women’s health, offering classes in everything from contraception to fertility and sexuality. They encourage women to leave hormonal contraception behind. “Ditch the Pill,” says their website, “and reclaim your health, happiness and future fertility.” Ditch the pill? To reclaim health? Happiness? What? The founders of the Red Tent Sisters teach that fertility awareness, also known as natural family planning, provides reliable contraception and is better for women’s health and the environment. There are many methods, but the commonality between them is that they eschew daily hormones and put women themselves in charge of their own sexual health without relying on Big Pharma. In short, fertility awareness is healthy and empowering. It could also soon be forbidden to advise or explain it for Ontario’s doctors. . . [Full Text]

Ontario conscience debate is about forcing out Catholic doctors

Lifesite News

Lea Singh

Let’s be honest: The current pressure on the College of Physicians and Surgeons of Ontario to change their human rights guidelines is all about forcing faithful Catholics out of the public square.

The media debate has focused on three Ottawa doctors who refuse to prescribe birth control pills, and guess what? All three of these doctors happen to be Catholic. The media hasn’t mentioned this fact, but there it is. Is it really surprising? Who else other than Catholics would refuse these days, on grounds of conscience or religious freedom, to prescribe birth control pills?

The Catholic Church consistently teaches that birth control pills (and other artificial birth control methods, including vasectomies) are morally wrong. Still, just a very small minority of Catholic doctors follow their faith to the extent of limiting their medical practice. For instance in Ottawa, a city with 870,000 inhabitants and hundreds of doctors, the media has reported only three such needles in the haystack. . . [Full Text]

Access to Birth Control Isn’t Just About Doctors

Ottawa Citizen

Kelly Grindrod , Sherilyn Houle

Earlier this summer, a debate was sparked by the experience of Kate Desjardins, an Ottawa woman who went to a walk-in clinic to renew her birth control prescription. She was handed a letter informing her that three of the clinic physicians were not prescribing birth control because of their “religious values.”

At the time, most media outlets noted that this meant she was forced to find another physician. But she had a choice that almost no one is talking about.

Her pharmacist could have also written the renewal prescription for her. . . [Full text]