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Forcing Doctors to Perform Abortions

 

There’s an interesting piece from Wesley Smith at NR today:

The medical and bioethics establishments and the international abortion lobby want to drive pro-life and Hippocratic Oath–believing doctors, midwives, and nurses out of medicine. One authoritarian tactic is to obliterate “medical conscience,” e.g., the civil right to refuse participation in legal medical procedures to which one has a religious or moral objection.

This assault on religious freedom has already commenced. Increasingly strident calls have been published in medical and bioethics journals urging that MDs be forced to perform abortions when asked, or if unwilling, to procure an abortionist for the patient — already the law in Victoria, Australia.

The only doctors qualified to perform abortions are Ob/Gyns, a specialty that has become overwhelmingly female during my career.

(Not surprisingly, the NPR piece considers racial diversity more important than sexual diversity, but I wander.)

This is not a new issue. In 1982 I chose my residency, not at a Catholic hospital, with the proviso that I would not be obligated to do abortions. Two years later when a chief resident objected, I took extra time in the clinic to make up for other residents doing the cases. While on residency, faculties in two large New England cities in 1989-94, we allowed potential residents to choose to do or not do abortions; most chose not, with zero repercussions.

Not everyone can choose “no.” There are some abortions that need to be done, I can recall eight such cases in a thirty-year career. Invasive cancer, sepsis, leukemia, that sort of thing. So someone in every community needs to have experience in doing abortions. It’s not pretty, but true. Abortions past nine weeks are surprisingly fraught with hazard to the pregnant woman as well as lethal to the fetus and require technical expertise. Your local primary care doctor can’t do them safely.

I don’t see how you could force a doctor to do abortions by any means other than as a prerequisite of licensure or of institutional credentialing. The last thing you would want in the OR is a doctor who was coerced or held at gunpoint to do a procedure to which he objects and with which he is uncomfortable.

In my work, I now and then encounter patients who request services that I cannot in good conscience provide. When this happens I do not get on a soapbox, I don’t always tell patients of my conscientious objection. I quietly and politely demur and suggest another doctor for them. I believe it is my job to serve the patient, not the patient’s job to meet the needs of my soul.

Published in Healthcare
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There are 13 comments.

  1. Contributor

    It sounds like you handled the situation admirably, Doc Robert. My question is: if a doctor needs to have that experience to do abortions for licensure (I think you’ve said that), and the doctor objects to doing them on principle, how does the doctor or his supervisor decide which ones to do? Can a doctor wait until a “legitimate” case appears? How many abortions does one need to do for adequate experience? Since legitimate reasons are rare (based on your experience), how would that decision be made? I’m not challenging you at all–but it seems like it would be awkward to decide. Good post!

    • #1
    • August 8, 2018 at 1:57 pm
    • 5 likes
  2. Member

    Thanks Doc. I just read the NRO story on this topic and was wondering how such a law could be enforced. It’s nice to hear what someone who works in the field thinks about the subject.

    • #2
    • August 8, 2018 at 2:05 pm
    • 3 likes
  3. Member
    Doctor Robert Post author

    Susan Quinn (View Comment):

    It sounds like you handled the situation admirably, Doc Robert. My question is: if a doctor needs to have that experience to do abortions for licensure (I think you’ve said that), …

    This is not now the case, but is the only way I think you could make it work.

    That is to say, if my license in California required that I perform abortions to perform ObGyn, or if my privileges at X hospital required that I do so, I would be forced to do abortions as a matter of staying in business. In fact, I would go to a different state or to a Catholic hospital, but not everyone has that choice.

    I don’t think any other penalties would be reasonable and enforceable. You gonna hold a gun to my head?

    Sue, the topic rarely comes up in my reproductive endocrinology practice but when it does, it does so in an overwhelming way. My last such case was in October 2001, this was a woman who conceived unknowingly while taking methotrexate for arthritis, an unintended and unexpected pregnancy. When I scanned her fetus there were severe congenital malformations incompatible with life after birth. Abortion was performed to permit further methotrexate therapy and to avoid sepsis in the event of a likely fetal demise in a woman who was immunocompromised.

    This is why someone in every city has to have this nasty skill. I don’t, but I know several Docs who do.

    There is no reason to FORCE a Doc to do abortions, or to perform euthanasia, or to perform transgender surgery, but Wesley Smith’s cite article is very provocative.

     

    • #3
    • August 8, 2018 at 3:30 pm
    • 5 likes
  4. Coolidge

    Doctor Robert: I don’t see how you could force a Doc to do abortions by any means other than as a prerequisite of licensure or of institutional credentialing.

    It has been a while since I paid close attention to this sort of thing, but I vaguely remember that requiring all medical students specializing in ob/gyn to do abortions was something that was suggested by those who support legalized abortion in the U.S. They will support anything that promotes abortion.

    • #4
    • August 8, 2018 at 4:04 pm
    • 2 likes
  5. Member

    Doctor Robert (View Comment):

    Susan Quinn (View Comment):

    It sounds like you handled the situation admirably, Doc Robert. My question is: if a doctor needs to have that experience to do abortions for licensure (I think you’ve said that), …

    This is not now the case, but is the only way I think you could make it work.

    That is to say, if my license in California required that I perform abortions to perform ObGyn, or if my privileges at X hospital required that I do so, I would be forced to do abortions as a matter of staying in business. In fact, I would go to a different state or to a Catholic hospital, but not everyone has that choice.

    I don’t think any other penalties would be reasonable and enforceable. You gonna hold a gun to my head?

    Sue, the topic rarely comes up in my reproductive endocrinology practice but when it does, it does so in an overwhelming way. My last such case was in October 2001, this was a woman who conceived unknowingly while taking methotrexate for arthritis, an unintended and unexpected pregnancy. When I scanned her fetus there were severe congenital malformations incompatible with life after birth. Abortion was performed to permit further methotrexate therapy and to avoid sepsis in the event of a likely fetal demise in a woman who was immunocompromised.

    This is why someone in every city has to have this nasty skill. I don’t, but I know several Docs who do.

    There is no reason to FORCE a Doc to do abortions, or to perform euthanasia, or to perform transgender surgery, but Wesley Smith’s cite article is very provocative.

     

    Dr. Robert, this is a really interesting thing: It argues that there are very rare circumstances under which abortion should be legal. From your account, it isn’t obvious that the danger to the woman’s life is imminent, but the danger to her health (not being able to take methotrexate and thus suffering from her arthritis symptoms which, by the way, I know from the painful experiences of several friends is not a mere “inconvenience.” So how could a law be structured so as to account for a case like this one?

     

     

     

    • #5
    • August 9, 2018 at 5:27 am
    • 3 likes
  6. Member

    For me, the story conjures up the sad, serious, thoughtful, scientific-and-yet-loving hospital-room conversations I’ve been part of, either with my own family or those I’ve served as a chaplain when something catastrophic has taken place, and medical decisions must be made. In either case, I’ve always found these conversations to be serious, prolonged, thoughtful and imbued with an implicit humility. Faced with uncertainty in a matter of transcendent importance, we earnestly strive do the best we can… and yield the rest to God. 

    A doctor serving as “medical control” for the paramedics at the scene of my late-husband’s accident had to make the decision to call off (futile) attempts at CPR: without knowing it, he was making this call on behalf of a family friend. When I talked to him about it afterward, I was impressed with the humane spirit as well as the expertise and acumen he brought to his decision. And I was deeply moved and so grateful for the obvious tenderness in the hands of the doctors and nurses as they removed the life-support apparatus from my own little grandson, so that when his inevitable death came, he could be in his mother’s arms. 

    Now, I’m part of a long, long version of the same conversation in which the patient—Mom—gets to play a big part as she attempts (with our imperfect help) to navigate a terminal disease. 

    Doctors, nurses and families do this sort of thing all the time. The mantra about how the decision on abortion should be left “to a woman, her family and her doctor ” is well-chosen; it resonates. It seems so reasonable. 

    And yet, as we all know, that’s not w hat’s happening. That isn’t what abortion is. But it is what abortion should be.

    • #6
    • August 9, 2018 at 5:34 am
    • 4 likes
  7. Member
    Doctor Robert Post author

    GrannyDude (View Comment):
    Dr. Robert, this is a really interesting thing: It argues that there are very rare circumstances under which abortion should be legal…how could a law be structured so as to account for a case like this one?

    Granny, thank you for your thoughtful, poetic post #6.

    Responding to your #5 now. There are uncommon (sadly, not “very rare”) circumstances under which abortion MUST be legal. Of the 8 cases I encountered from 1981-2001, 7 required pregnancy termination to save the mother’s life, the current case being the exception, but this case also involved agenesis of the brain due to methotrexate toxicity, so fetal or neonatal death was inevitable. Perhaps some day I shall post them here on Ricochet, maybe when we have another big kerfluffle over something a candidate says.

    If 5% of the 19,000 ObGyns in America had this skill (https://www.bls.gov/oes/current/oes291064.htm), that would be plenty.

    How to structure such a law? I think it’s easy. Ban abortions outright. No exceptions. When there is legitimate maternal need, do what is medically necessary to protect the mother and damn the consequences. This would be a private matter, HIPPA rules would apply and the police would have no way of knowing that anything untoward had occurred. If word leaks and some ass of a DA then files charges, the hospital’s attorneys take over and their defense is preservation of maternal life. No jury would convict.

    But that’s not going to happen in modern America.

    My thoughts for an abortion prohibition that would actually get through state legislatures would be to ban all abortions after 12 weeks except as needed for preserving the life of the mother, or in cases of anomalies incompatible with life. The dating would have to be established by an ultrasound performed at a second facility, to avoid cheating. Pro-abortion folks would have their bone for rape etc up to 12 weeks. Pro-lifers of good faith and with a little experience in dealing with the real world, like you Granny, will appreciate the need to have options for hard cases such as the 8 that I have seen.

    • #7
    • August 9, 2018 at 8:02 am
    • 7 likes
  8. Member

    Doctor Robert (View Comment):

    GrannyDude (View Comment):
    Dr. Robert, this is a really interesting thing: It argues that there are very rare circumstances under which abortion should be legal…how could a law be structured so as to account for a case like this one?

    Granny, thank you for your thoughtful, poetic post #6.

    Responding to your #5 now. There are uncommon (sadly, not “very rare”) circumstances under which abortion MUST be legal. Of the 8 cases I encountered from 1981-2001, 7 required pregnancy termination to save the mother’s life, the current case being the exception, but this case also involved agenesis of the brain due to methotrexate toxicity, so fetal or neonatal death was inevitable. Perhaps some day I shall post them here on Ricochet, maybe when we have another big kerfluffle over something a candidate says.

    If 5% of the 19,000 ObGyns in America had this skill (https://www.bls.gov/oes/current/oes291064.htm), that would be plenty.

    How to structure such a law? I think it’s easy. Ban abortions outright. No exceptions. When there is legitimate maternal need, do what is medically necessary to protect the mother and damn the consequences. This would be a private matter, HIPPA rules would apply and the police would have no way of knowing that anything untoward had occurred. If word leaks and some ass of a DA then files charges, the hospital’s attorneys take over and their defense is preservation of maternal life. No jury would convict.

    But that’s not going to happen in modern America.

    My thoughts for an abortion prohibition that would actually get through state legislatures would be to ban all abortions after 12 weeks except as needed for preserving the life of the mother, or in cases of anomalies incompatible with life. The dating would have to be established by an ultrasound performed at a second facility, to avoid cheating. Pro-abortion folks would have their bone for rape etc up to 12 weeks. Pro-lifers of good faith and with a little experience in dealing with the real world, like you Granny, will appreciate the need to have options for hard cases such as the 8 that I have seen.

    Works for me. 

    • #8
    • August 9, 2018 at 9:54 am
    • 3 likes
  9. Coolidge

    Another reason why the term “pro-choice” should only be used ironically.

    • #9
    • August 9, 2018 at 10:47 am
    • 1 like
  10. Inactive

    I thought slavery is abolished, and professionals can’t be forced to work for anybody. 

    • #10
    • August 9, 2018 at 11:23 am
    • 4 likes
  11. Member
    Doctor Robert Post author

    Hypatia (View Comment):

    I thought slavery is abolished, and professionals can’t be forced to work for anybody.

    Hypatia, you say the funniest things…

    • #11
    • August 9, 2018 at 12:04 pm
    • 3 likes
  12. Member

    These type of actions (forcing doctors to perform abortions) seem like it would make a future SCOTUS more likely to overturn Roe v Wade. I would have said a decade ago, it would be ok to leave it alone, but I don’t believe that today. 

    • #12
    • August 9, 2018 at 7:21 pm
    • 2 likes
  13. Member
    Doctor Robert Post author

    A correction to #7, by coincidence I came across the American Congress’ of Ob/Gyn count of practicing members today, this is about twice as many as estimated by the Bureau of Labor Statistics. You might expect the BLS to just ask ACOG, but hey, this is government work.

    “The number of ACOG Fellows in practice in 2017 was 35,586, including 31,163 Fellows and 4,235 Junior Fellows in active practice. This number is slightly greater than that reported in 2010. When considering workforce supply, the customary reporting involves the density of physicians per unit population. Using U.S. Census estimates, the number of ACOG Fellows per 10,000 women aged 16 years or older was 2.7 in 2016 (down from 3.1 in 2008) and per 10,000 women of reproductive age (15–44 years) was 5.5 in 2016 (down from 6.2 in 2008).”

    Source, William Rayburn, “The Obstetrician–Gynecologist Workforce in the United States”. ACOG, 2017

    • #13
    • August 13, 2018 at 8:28 am
    • Like