The Medical Multiverse

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Medical clinics are coalescing around religious principles and openly declaring doctors' aversion to birth control, reports The Washington Post:

Proponents say the practices allow doctors to avoid conflicts with patients who want services the practitioners find objectionable, as well as to provide care that conforms with many patients' own values. The approach, they say, provides an alternative to mainstream medicine's reliance on drugs and devices that, they argue, carry side effects and negatively affect couples' relationships.

You have to work pretty hard to see this as problematic. Provided doctors are open about the limits of the advice they're prepared to dispense, women on the pill can avoid a sermon and woman who object to birth control can avoid a condescending lecture about why they should be pill-popping. (And it'd be best if women could avoid conflict altogether and get the stuff over the counter.) But apparently we should worry:

"Welcome to the era of balkanized medicine," said R. Alta Charo, a bioethicist at the University of Wisconsin at Madison. "We've had this for years with religious hospitals. What's happening now is it's drifting down to the level of individual practitioners and small group practices. It essentially creates a parallel world of medicine."

Like, I dunno, alternative medicine? Even the most vocal proponents of a single-payer system don't hype the resultant lack of choice as a benefit. Anyone who has ever asked for a second opinion can understand that variation among individual practitioners is a good thing.

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  1. I agree with Howley 100% on this.

    …but I bet a bunch of you find this objectionable assuming the practitioner accepts Medicare or Medicaid.

    …just like you wouldn’t want anyone teaching Intelligent Design in a public school–am I right?

  2. Ken-

    The analogy between doctors who receive Medicare and public schools is a rather poor one. Public schools are generally local monopolies, while patients generally can choose from among several providers.

    That extra element of choice arguably makes a big difference. Or, at the very least, it complicates the analogy considerably.

  3. You’re right, there is a difference. …comparing this to school choice would be more appropriate. …not that I haven’t heard these kinds of arguments against school choice.

    …so you’re all okay with a doctor’s group that shuns doctors who give abortions? …and patients who want them? …on religious grounds? …and funds itself with your tax money?

  4. “while patients generally can choose from among several providers.”

    ‘generally’ being the key word. I’m sure there will be plenty of places in the country where there aren’t several providers, and if the only provider decides to make you live by his moral code, you’re stuck.

    I suspect these regions also happen to be regions where the doctors wil elect not to provide birth control.

    I also wonder if Outback Steakhouses will also have to employ vegans who refuse to serve meat.

  5. Not every job at Outback is a food-contact job, and not all vegans are against the right of paying customers to stuff their yaps with whatever garbage they want to, or against the right of Outback to make an honest dollar catering to their tastes. OK?

  6. Ok as an elective situation, but… what about cases where a clinic or practice in fact has a local monopoly and there isn’t choice? What if all OBGYNs in a town or region subscribe to this philosophy?

    “Implanting an IUD” is to me a part of the OBGYN repertoire, and as a response to this turn of events, the professional body of practicing OBGYNs should not sit on the sidelines: they should define what procedures they consider an integral part of their profession, and what is either elective or “vote your conscience”. If a doctor has a moral opposition to a mainstream procedure, then a) they should’ve self-selected a different specialization in medical school (are there Christian Scientist surgeons? Jehovah’s Witness blood-transfusion technicians?) and b) not identify as an OBGYN. Come up with a label that conveys a message like “80% OBGYN” or Alternative OBGYN.

    Actually, that medical-school self-selection is the opportunity cost these practitioners have deprived the consumers of medical care and the body of mainstream OBGYNs. A teacher-OBGYN spent hours teaching a set of procedures and pharmacopia to these folks with the expectation that this knowlege would be put to use. It would have been ideal for the slot to have been filled with someone who would have rather been there; it would probably have been better for all concerned if the slot was empty instead.

    Heh, RTFA shows me that The American College of Obstetricians and Gynecologists has a member who feels the same way though the organization doesn’t have an official position. The organization needs to have the internal discussions, fights and possibly schism on this issue. One group should keep the “brand” of OB/GYN and the other should define a new one.

  7. I agree the lack of viable alternatives in some places (perhaps the very places most likely to have a pack of religious nutjob doctors) is the problem here, particularly since doctors have been officially designated by our governmenr as gatekeepers over a host of drugs. And there does seem to be a real potential conflict between best medical practices and What Would Jesus Do medical practices. Doctors who don’t use best practices (whether because the doctors think the practices come from the devil or because the doctors are incompetent) should no longer be doctors.

  8. Hmmm…every problem is rife with possibility.
    I say we should most definately have “faith based” medical practices, clinics, hmos, etc.
    This bit of “intelligent design” will, overtime, see wack job christcreeps dwindle in number, as mortality takes its toll…..making the rest of us feel better.
    Yes: win/win. The not-so-invisible hand will spur the creation of actual medical practices. Got my vote.

  9. “Provided doctors are open about the limits of the advice they’re prepared to dispense…”

    not sure quite what you mean here, but I object to the idea that doctors don’t have to provide factual information in certain areas of medical practice. “I object to abortions, therefore I’m not going to discuss the facts or the existence of abortions with my patients.”

  10. A local paper (Seattle PI) had a bit about a pharmacist who won’t stock or dispense Plan B from his store on religious grounds. It generated about 400 posts.

    The arguement of “what if only doctor in town won’t do abortions” seems kind of silly. A number of towns have no doctor at all. Where do these people get abortions?

  11. Yes, Mutt, I’d noted the eugenic aspect myself.

    We’ll make a social darwinist of you yet.

  12. I note that if we applied the same model to the legal profession, we would have have criminal defense lawyers who take a dive when they think their client deserves to be punished.

  13. Let’s see…make sure the libertarian priorities are in order:

    1. Universal access to abortion and birth control
    2. Pirated copies of movies and music freely available online
    3. Freedom of association/speech/etc (does not apply to actions interfering with 1 or 2)

    Did I get that right?

  14. so you’re all okay with a doctor’s group that shuns doctors who give abortions? …and patients who want them? …on religious grounds? …and funds itself with your tax money?

    I’m not clear on why NOT giving an abortion needs funding from anybody at all — let alone from my tax money. Heck, Christian Scientist doctors are probably the most inexpensive Medicare practitioners there are. ­čÖé

    The problem with Intelligent Design is that it involves spending my tax money to teach bullshit. In contrast, the case of doctors refuse to provide certain treatments involves people finding bullshit reasons to NOT spend my money. It should be pretty obvious why the first bothers me more than the second.

  15. Speaking as a medical professional, here is my opinion on the subject: as a medical professional you are an advocate for your patient. Your responsibility is to ensure that they receive appropriate medical care. If your patient wants birth control and there is not a significant medical contraindication, you prescribe. Because it is not about you and what you are comfortable with, it is about the patient and the patient’s best interest. Of course, if you do not feel that prescribing birth control is appropriate because it poses an undue risk to the patient (as in the case of patients with history of significant hypercoagulable state resulting in DVT/PE, which even then is not an absolute contraindication by any means), that is a different matter. But failing to prescribe based on your religious biases in not acceptable professional behavior.

    If you are uncomfortable with abortion and the idea of performing abortions, there are many areas of medicine that do not put you in the position of performing abortions. If you are uncomfortable with prescribing birth control, there are areas of medicine that do not entail prescribing birth control. But if you enter a specialty like Ob/Gyn or Family Medicine, then you should be prepared to adhere to the standards of established medical practice, and prescribe appropriate drugs for the patient’s medical needs.

  16. The problem with Intelligent Design is that it involves spending my tax money to teach bullshit. In contrast, the case of doctors refuse to provide certain treatments involves people finding bullshit reasons to NOT spend my money. It should be pretty obvious why the first bothers me more than the second.

    The problem with Intelligent Design is that it involves spending tax money to teach theology. It should be pretty obvious why agnostics and others get peeved about the state using their tax money to teach their children about Intelligent Design.

    The problem with tax funded abortion services is that it involves spending tax money to do something that fundamentally violates the religious convictions of millions of taxpayers. It should be pretty obvious why fundamentalists and others get peeved about the state using their tax money to do something that violates their religious convictions.

    You see the connection, right? The state shouldn’t use taxpayer money to fund abortion procedures for the same reason it shouldn’t use taxpayer money to teach Intelligent Design. …and your personal opinion of other people’s religious convictions, as a matter of policy, should be beside the point. …just as their personal opinions on evolution…

    I like the arrangement Howley describes because, among other reasons, it seems to alleviate some of this. I also like school choice, again, for the same reason among others.

  17. The problem with Intelligent Design is that it involves spending tax money to teach theology. ….pretty obvious why agnostics and others get peeved about the state using their tax money to teach their children about Intelligent Design.

    The problem with tax funded abortion services is that it involves spending tax money to do something that fundamentally violates the religious convictions of millions of taxpayers. It should be pretty obvious why fundamentalists and others get peeved about the state using their tax money to do something that violates their religious convictions.

    And it should be obvious why using tax bucks to butcher peasants who object to our quislings , or to use the excuse of, say, “sandinista tanks are 3 days from Brownsville” or “a 5200 ft airstrip on Grenada will be used to refuel Libyan bombers on the way to Pleasantville” to launch murderous lunacy on a ……words fail me scale are fine, coz I cant come up with some crackpot “skygod” reason to object. Or to support?
    WILL you loons keep your murderous, crackpot desires in the pews, please?

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