Advice on choosing not to perform an abortion

[Hillary]

Hi,

 

Thanks everyone, I've resolved this issue.

[Satsuma]

Hmm...honestly I am not sure how to approach refusing to do a procedure once you've already agreed to it. As you are well aware, it is likely a pretty emotional time for the pt, so having the procedure cancelled on short notice certainly will be hard.

 

You mentionned your preceptor was on board. Is it possible for your preceptor to complete the procedure without you? Can you get in touch with your preceptor to discuss your concerns sooner rather than later?

 

About your fear of rejection from either the community or colleagues if you were to go ahead with such procedures...I don't particularly think that is a good reason to not perform procedures if you are morally ok with them yourself. There are certainly other members of the community and doctors who are not against abortions...perhaps they just aren`t as vocal. Are you worried that by refusing to do abortions you would be rejected by them?

 

It's a controversial issue. But either way you risk offending someone.

 

I think the main concern though is your patient. If you cannot provide this procedure, then you need to help her get access to someone who will provide her with the care she needs. And in this case you need to be prepared to also handle her reaction to having this procedure cancelled.

[Hillary]

Re:

 

Just to clarify: The preceptor I am working with has done these procedures many times before. There are surgical abortions that require more training as well as medically-induced procedures that are less invasive. My patient requested the medically-induced type, which will involve a simple IM injection followed by self-administered vaginal suppositories. There will be close monitoring and follow up. Of course I had an understanding of the procedure beforehand. Like other residents, I always read up on the details before I assist. The problem is that I had never seen myself actually injecting the medicine needed to kill the fetus.

 

My first concern is of course the patient. I have seen her many times already, so I am hoping that she will understand when I tell her that my preceptor will be doing the procedure alone. I am planning to tell her that my preceptor has much more experience than I do, and that she will be doing and following up the procedure. After this, I will make it clear to my patients that I do not do abortions for my own personal beliefs and moral reasons. My other preceptor is very much against them, and will not even refer pts to doctors who will do them.

[The Law]

Does your patient know your preceptor is going to be assisting in the procedure? If so, would you have a problem carrying out the second part of the procedure (following the injection)? That way, your patient will have the comfort of knowing her doctor is there and partcipating.

 

Otherwise, your patient is probably going to feel upset that you are not going to be doing the procedure. Maybe if you tell her you are going to be there with her for the entire procedure, then that may calm her down and give her some reassurance.

[Satsuma]

Re:

 

My other preceptor is very much against them, and will not even refer pts to doctors who will do them.

 

 

I'm pretty sure he/she is obliged to refer to someone who will do them. Or at the very least be informed of her right to consult another physician.

[peachy]

I'm pretty sure he/she is obliged to refer to someone who will do them. Or at the very least be informed of her right to consult another physician.

We just had a seminar about this the other day. In Canada, there is no obligation to refer. The only obligation is to state that you will not perform the procedure and to emphasize to the patient that this is your own personal choice and has nothing to do with them, their own medical situation, or your judgment of them and their choices.

[The Bunny]

I heard that in Canada the ethics code does include an obligtion to refer. It is not the law though.

[peachy]

I heard that in Canada the ethics code does include an obligation to refer. It is not the law though.

The CMA's policy does not include the obligation to refer, as in the following CMAJ letter:

http://www.cmaj.ca/cgi/content/full/176/9/1310

 

But I think it gets a bit sticky because the CMA does require that the physician not stand in the way of the woman's access to an abortion and not cause delays in accessing the service. There are a whole bunch of letters about this in the CMAJ (eg http://www.cmaj.ca/cgi/content/full/176/4/494) and there doesn't seem to be a consensus about what this means.

 

In any case, there are definitely practicing doctors in Canada who will not refer.

[Satsuma]

I just wanted to add to this, for anyone who may read this post in future, as we discussed this yesterday in class.

 

So...I cannot speak to all of Canada, just Ontario since this is where I am, and the only province we discusssed.

 

There is no "legal" responsibility to refer your pt to someone who will perform an abortion. HOWEVER, the college states that if you cannot/will not be able to then it is your responsibility to refer to someone who wil in a TIMELY manner. (not sure what colleges in other provinces state).

 

SO...if the pt were to make a complaint to the college, it would be taken up with the college and there could be consequences, if you did not refer. It seems though that most patients would be unaware that they are able to make a complaint with the college and as such, some physicians may be refusing to perform and abortion AND refusing to refer without consequence. But if they are practicing in Ontario....then they SHOULD be referring.

[quickdraw_mcgraw]

The media and patients like to remind us about our oath, well, in the true oath, abortion is not allowed.

________________________________________

THE OATH OF HIPPOCRATES

 

I SWEAR by Apollo the physician and Æsculapius, and Health, and All-heal, and all the gods and goddesses, that, according to my ability and judgment,

 

I will keep this Oath and this stipulation — to reckon him who taught me this Art equally dear to me as my parents, to share my substance with him, and relieve his necessities if required; to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction,

 

I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others.

 

I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.

 

I will give no deadly medicine to any one if asked, nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion. With purity and with holiness I will pass my life and practice my Art.

 

I will not cut persons labouring under the stone, but will leave this to be done by men who are practitioners of this work. Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further, from the seduction of females or males, of freemen and slaves. Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad,

 

I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times. But should I trespass and violate this Oath, may the reverse be my lot.