Alberta physician refuses to prescibe birth control

[jfdes]

Saw this story on the news today, what do people think about this?

 

http://calgary.ctvnews.ca/calgary-doctor-s-refusal-to-prescribe-birth-control-triggers-outrage-1.1890211

 

http://globalnews.ca/news/1421470/debate-sparked-after-calgary-doctor-refuses-to-prescribe-birth-control/

 

(the comments in the second link are especially interesting)

 

On the one hand, the physician's primary role is to look after the patient's best interest, which isn't happening if they refuse to prescribe medication that the patient needs. On the other, it isn't fair to physicians to force them to perform medical services that go against their religion (this is supported by law, and as long as they refer to another physician they're legally entitled to uphold their beliefs).

 

Most of the news stories I've read seem to be slanted against the physician, and the one I saw on TV even had representatives from the PC Party of Alberta and the Sexual Health Centre speaking out against it and saying they would look into this issue.

[ellorie]

Some of the people seem especially affronted by her sign - I actually think it's a good thing that she has a sign up in the waiting room - one of the issues for me is would be if a physician WASN'T up front about her views and took on patients without their knowing. That would be unfair, because they would have a therapeutic relationship with her and it might be hard for them to go elsewhere when they finally did realize. As long as she does not take those patients on in the first place, and there is somewhere else to send them.

 

It's not an optimal situation, but perhaps if she knows she absolutely cannot be nun-judgmental - it's ultimately healthier for her patients for her to not even try.

[Birdy]

I don't like it one bit and I think the woman should have pursued something other than family medicine if that's her feeling about it, but as a physician she has the right not to offer services that go against her morals provided doing so is not bringing immediate harm to the patient. Even if I think it is despicable of her. If she were a surgeon on call at a rural hospital and refused to operate on a ruptured ectopic pregnancy, that would be a different story.

 

I'm curious WHY she doesn't prescribe them. Is it because she doesn't think women should be having non-procreative sex (the Catholic approach) or is it that she feels that the possibility the pills may reduce the likelihood of implantation is the problem (the pro-life argument.) If it's the former, I wonder whether she would still prescribe them to someone like me, who does not take them for he purpose of contraception, I would welcome any additional children, but because I have PCOS and BCPs are the only way to keep the cysts from getting huge and rupturing, causing so much sudden, intense pain I have actually passed out from it.

[rmorelan]

this stuff always makes me uncomfortable - I feel as a professional my person beliefs aren't as important as the needs of my patients and the broader interests of society related to me role. I should be respecting my patients beliefs and following purely evidence based medicine. To me that is part of my personal beliefs revolving around being a professional.

 

Moreover I get a bit confused when people cherry pick parts of fields and do only those things they want to - there are dozens of types of specialties and the doctor chose one where she cannot perform an entirely expected basic aspect of the job. You can believe what ever you want as long as it doesn't hurt others but those beliefs have consequences and may restrict your personal freedoms.

 

Any it is always good to have a back up in the sense that if you cannot do something you can refer to someone else but look at practical side of this - I mean it often takes a long time to get to see a doctor, and now you are simply extending that until yet another appointment can be done - does that person now have two doctors? Do they have to go to doctor one to refill half their medications and the other for the rest? What if the birth control pill now interfers with the therapy of the other doctor? Who is managing this? Or does the original doctor simply transfer care completely every time someone asks for birth control? As a doctor you are not suppose to subtly impose restrictions or judgment - and saying you have to go somewhere is exactly that.

 

How far should this go? Should a doctor be able to refuse to treat homosexuals? Women? Should a doctor be able to refuse a surgery to the unbaptized because they are worried if the operation goes wrong there are spiritual consequences? What puts religious beliefs higher then a personal philosophy (one that can be shared by even more people than practice a religion). This can go in a lot of very strange places.

 

Anyway to a point all this is allowed under our current rules but I still think that it is somewhat unprofessional and should be done only very carefully.

[Birdy]

Something that popped into my mind; this woman should re-specialize as a geriatrician. Absolutely guaranteed she will not need to prescribe birth control pills.

[DarkGhost]

All I could think while reading these articles was, did nothing else more important happen in the world this week?

[Renoir]

but as a physician she has the right not to offer services that go against her morals provided doing so is not bringing immediate harm to the patient.

 

Yeah, they did seem to suggest there were moralistic reasons, but I was hoping against hope that there was some other 'good' reason why she doesn't prescribe. I'd be interested to hear her side of it, but she's probably quite wary of how the media would cut her sound bytes if she gave an interview.

 

I really hope this is overblown and there' s some therapeutic reason why she doesn't prescribe.

[Birdy]

Yeah, they did seem to suggest there were moralistic reasons, but I was hoping against hope that there was some other 'good' reason why she doesn't prescribe. I'd be interested to hear her side of it, but she's probably quite wary of how the media would cut her sound bytes if she gave an interview.

 

I really hope this is overblown and there' s some therapeutic reason why she doesn't prescribe.

 

Which would make some sense. I hate taking them because I become ridiculously emotional to the point I have burst out crying in class and I loathe myself for it because I have put so much effort into treating my studies professionally and crying in public is embarrassing. I go back and forth between caving in from the pain and taking them to going off them because of the emotional side effects. It would make more sense to me for her to have medical reasons she chooses not to prescribe them, like maybe having been sued after a patient died from a DVT breaking free while taking them or something.

[rmorelan]

Which would make some sense. I hate taking them because I become ridiculously emotional to the point I have burst out crying in class and I loathe myself for it because I have put so much effort into treating my studies professionally and crying in public is embarrassing. I go back and forth between caving in from the pain and taking them to going off them because of the emotional side effects. It would make more sense to me for her to have medical reasons she chooses not to prescribe them, like maybe having been sued after a patient died from a DVT breaking free while taking them or something.

 

well that would be a completely different matter of course - ha, one would hope the reporters would at least get that level of information etc

[larva]

This Dr has no business practising medicine. Imagine the state of the profession if every patient whose behaviour went against our own personal moral code was denied care. Unacceptable. She needs to check her own beliefs at the door and do her job.

 

I am also extremely disappointed by the response from the College here in Alberta, which reaffirmed her right to refuse to provide service, and then had the gall to say that people shouldn't be going to walk-in clinics for birth control anyway, they should be going to their family doctor. Ha! What idealistic BS. Wilfully ignoring that many are without a family doc, and that for some youth who only see their family doc with their parents, they aren't able to address sex/contraception at those visits.

 

A bigger issue brought up by some medical ethicists is that beyond just refusing to prescribe BCP, she is sending a message that sexual health isn't a safe topic to bring up in her clinic, which is an unacceptable barrier to those seeking care.

 

It's examples like this that make me excited for the day when medicine loses the "privilege" to self-regulate.

[Renin]

Maybe she feels that she can't follow you up or has time to get a good medical history, so she doesn't feel comfortable giving you a one off rx of 30 days or something?

[rmorelan]

Maybe she feels that she can't follow you up or has time to get a good medical history, so she doesn't feel comfortable giving you a one off rx of 30 days or something?

 

the article states it is for a religious reason.

[Renoir]

the article states it is for a religious reason.

 

It didn't from what I could see. The NatPo article found a religious statement from her from years ago, but there was no firm link made and she did not give a statement, so it is not a certainty that it's for religious reasons.

 

Edit: Just saw the Global News statement that the receptionist confirms it was due to the Dr's 'beliefs'. Frustrating.

[jfdes]

I'm not entirely sure how I feel about this, but I suppose I'll pick the less popular side to try and make an argument for

 

 

This Dr has no business practising medicine. Imagine the state of the profession if every patient whose behaviour went against our own personal moral code was denied care. Unacceptable. She needs to check her own beliefs at the door and do her job.

 

The Charter of Rights and Freedoms specifically protects the "fundamental freedom of conscience and religion" - she has a right to refuse to perform action that goes against her religion, not only because the College of Physicians say so, but because it is one of the foundational rights of freedom and justice for all Canadians. These are very basic rights, and they are respected in any other job. Why not for physicians as well?

 

I am also extremely disappointed by the response from the College here in Alberta, which reaffirmed her right to refuse to provide service, and then had the gall to say that people shouldn't be going to walk-in clinics for birth control anyway, they should be going to their family doctor.

 

Can you provide the link to this response? I've tried searching for it, but couldn't find it on their website and Google keeps returning more stories about the actual incident itself. I agree that it does sound a bit presumptuous, although I'd like to see the official statement itself.

 

A bigger issue brought up by some medical ethicists is that beyond just refusing to prescribe BCP, she is sending a message that sexual health isn't a safe topic to bring up in her clinic, which is an unacceptable barrier to those seeking care.

 

This is a good point

 

It's examples like this that make me excited for the day when medicine loses the "privilege" to self-regulate.

 

Is this likely to happen anytime soon?

[hexonu]

I don't have a problem with it. Actually, it reminds me of staff who refuse the flu vax due to personal/religious reasons that have to wear a mask for an entire season. A more diplomatic approach would suggest that they could have another physician available immediately to prescribe.

[lokiki]

 

How far should this go? Should a doctor be able to refuse to treat homosexuals? Women? Should a doctor be able to refuse a surgery to the unbaptized because they are worried if the operation goes wrong there are spiritual consequences? What puts religious beliefs higher then a personal philosophy (one that can be shared by even more people than practice a religion). This can go in a lot of very strange places.

 

Anyway to a point all this is allowed under our current rules but I still think that it is somewhat unprofessional and should be done only very carefully.

 

And thought of in another way- this is just one thing that a professional may choose not to do based on their beliefs. How many future doctors here would say that this doctor should be prescribing BCP, but balk if they were asked to assist with a terminally ill patient's request to die? It still comes down to personal belief systems, it's just on a more extreme and less socially acceptable level.

 

Please note I'm not meaning to make a false equivalency here, I just want people to think about the line being drawn and where it is, and where it is for them. Realize the line is in different places for different people.

 

I think Larva's point about accessibilty of sexual health services is great, too. That is probably the major issue in this whole story, and it seems to be overlooked.

[larva]

Here is the link to the article with the statement from the college, as well as the remarks from Dr Mitchell. (who teaches us ethics here at U of C)

 

http://www.calgaryherald.com/news/calgary/Doctor+refusal+prescribe+birth+control+creates+barrier/9982533/story.html

 

I know that her rights are protected by the charter, but in my ideal world I imagine that it means no one would ever force her to take birth control, or to work in a job that required her to deal with it. However, she chose to become a doctor, then chose family medicine, and is now unable to do her job properly. Given that, I don't think she should get to cherry pick what parts of her job she "doesn't believe in", then fall back on the charter to protect her.

[rmorelan]

Here is the link to the article with the statement from the college, as well as the remarks from Dr Mitchell. (who teaches us ethics here at U of C)

 

http://www.calgaryherald.com/news/calgary/Doctor+refusal+prescribe+birth+control+creates+barrier/9982533/story.html

 

I know that her rights are protected by the charter, but in my ideal world I imagine that it means no one would ever force her to take birth control, or to work in a job that required her to deal with it. However, she chose to become a doctor, then chose family medicine, and is now unable to do her job properly. Given that, I don't think she should get to cherry pick what parts of her job she "doesn't believe in", then fall back on the charter to protect her.

 

that was kind of my point - rights have associated responsibilities. If you are a vegetarian you cannot exercise your right to demand equal consideration for a job involving butchering animals and then say your beliefs don't allow you to be a butcher. As a doctor you have the right to practice within your beliefs - but then a responsibility to structure your practice so that you aren't putting your personal beliefs in conflict with the patient's right to good medicine, access to what is considered the standard of care and respectful of their choices. If the two come into conflict I think in general we should side with the patient. It is actually not that hard to do exactly that sort of structuring in medicine.

 

It would be one thing if sudden birth control pills showed up on the market for the first time and you newly had to confront an aspect of the job that you didn't know was coming or going to be there (the arguments of euthanasia would likely fall into this category) but this is a standard medical practise going back a long time now. You go into family medicine for all general patients you know you are going to have to manage standard reproductive health issues.

[uwopremed]

this stuff always makes me uncomfortable - I feel as a professional my person beliefs aren't as important as the needs of my patients and the broader interests of society related to me role. I should be respecting my patients beliefs and following purely evidence based medicine. To me that is part of my personal beliefs revolving around being a professional.

 

Moreover I get a bit confused when people cherry pick parts of fields and do only those things they want to - there are dozens of types of specialties and the doctor chose one where she cannot perform an entirely expected basic aspect of the job. You can believe what ever you want as long as it doesn't hurt others but those beliefs have consequences and may restrict your personal freedoms.

 

Any it is always good to have a back up in the sense that if you cannot do something you can refer to someone else but look at practical side of this - I mean it often takes a long time to get to see a doctor, and now you are simply extending that until yet another appointment can be done - does that person now have two doctors? Do they have to go to doctor one to refill half their medications and the other for the rest? What if the birth control pill now interfers with the therapy of the other doctor? Who is managing this? Or does the original doctor simply transfer care completely every time someone asks for birth control? As a doctor you are not suppose to subtly impose restrictions or judgment - and saying you have to go somewhere is exactly that.

 

How far should this go? Should a doctor be able to refuse to treat homosexuals? Women? Should a doctor be able to refuse a surgery to the unbaptized because they are worried if the operation goes wrong there are spiritual consequences? What puts religious beliefs higher then a personal philosophy (one that can be shared by even more people than practice a religion). This can go in a lot of very strange places.

 

Anyway to a point all this is allowed under our current rules but I still think that it is somewhat unprofessional and should be done only very carefully.

 

I completely agree with this statement. What the doctor is doing is kosher by the letter of the law, BUT she is being somewhat intolerant and brining her personal views into a very public job paid for by he public taxpayer.

 

I suppose we would all agree that obs/gyns can't be forced to give abortions (even many atheist people aren't keen on abortions), so there is probably some things where 'religion' or 'personal beliefs' can be evoked. But birth control?!? Especially when birth control pills sometimes aren't used literally for birth control, but can be used to manage PMS symptoms or severe menstrual issues? Mind boggling.

[rmorelan]

It didn't from what I could see. The NatPo article found a religious statement from her from years ago, but there was no firm link made and she did not give a statement, so it is not a certainty that it's for religious reasons.

 

Edit: Just saw the Global News statement that the receptionist confirms it was due to the Dr's 'beliefs'. Frustrating.

 

yeah that is what I was pulling it from - I mean there is a chance that their was a mistake there but that is unlikely.

[lokiki]

Just playing devil's advocate here: the CTV article states "Dr. Chantelle Barry is an internist/geriatrician"- so no, it looks like she didn't choose family med.

 

I wonder if there's more to the story here, maybe all the doctors are required to do clinic duty and so she is too. It's not an active decision on her part to be in situations where she may be required to write these BCP prescriptions.

[ellorie]

I think that article made a mistake. She is a GP.

 

http://www.cpsa.ab.ca/PhysicianSearch/PhysicianProfile.aspx?PhysicianId=000012208326

[Renoir]

I think that article made a mistake. She is a GP.

 

Out of interest, why would it have taken 4 years to do her postgrad training? Is it common for GPs? I thought 2 years was kind of standard unless doing an frcp or something...

[ellorie]

Probably having kids, since she doesn't believe in birth control

[jfdes]

Hmm, so there seems to be general agreement that what she is doing is wrong professionally (by either refusing to leave her personal beliefs at the door, or going into a specialty of medicine that she should have been aware would clash with her religion), although legally she's in the clear.

 

What, if anything, should be done in this specific scenario then?