I have commented on two issues relating to the recent publication of the American College of Physicians Ethics Manual. Generally, I have been pleased, with some exceptions noted, e.g. its failure to sanction doctors who assist suicides despite that lethal procedure being opposed by the College. But in reviewing the section on reproductive rights, usurprisngly, I was struck at how things have changed–and not for the better–in medical ethics over the last fifty years.
First, doctors who oppose abortion receive a conscience exemption. From the Manual (no link):
The ethical duty to disclose relevant information about human reproduction to the patient may conflict with the physician’s personal moral standards on abortion, sterilization, contraception, or other reproductive services. A physician who objects to these services is not obligated to recommend, perform, or prescribe them.
So far, so good. But this seems problematic to me:
As in any other medical situation, however, the physician has a duty to inform the patient about care options and alternatives, or refer the patient for such information, so that the patient’s rights are not constrained. Physicians unable to provide such information should transfer care as long as the health of the patient is not compromised.
Is a healthy pregnancy that a woman wishes to terminate a “medical situation?” Only in the sense that she is creating the circumstance that would not exist but for her lifestyle desires. In such cases–as opposed to what used to be called therapeutic abortion circumstances–I don’t see why a doctor who wishes not to be in any way complicit in the taking of a human life should be forced to provide the patient with information to help find someone to terminate the pregnancy. If a doctor has those heterodox moral views, however, he/she should be unequivocally clear about that with prospective patients so there are no misunderstandings after they create a doctor/patient relationship.
Doctors are also not allowed to tell parents about minors’ sexual diseases or abortions:
If a patient who is a minor requests termination of pregnancy, advice on contraception, or treatment of sexually transmitted diseases without a parent’s knowledge or permission, the physician may wish to attempt to persuade the patient of the benefits of having parents involved, but should be aware that a conflict may exist between the legal duty to maintain confidentiality and the obligation towardparents or guardians. Information should not be disclosed to others without the patient’s permission. In such cases, the physician should be guided by the minor’s best interest in light of the physician’s conscience and responsibilities under the law.
Hello? If the minor asked the doctor not to tell a parent that she had, say, appendicitis, would that stand? No. If a child told a doctor not to tell his parents that he was overweight or that he was close to becoming diabetic, would the doctor have to keep her mouth shut? I think not. How about if the child had a bad case of food poisoning? Would a doctor have to tell parents and get consent before treatment? Except in a life threatening emergency, yes. So, why should the doctor’s conscience about a minor’s sexual issues or pregnancy trump those of the parents or, for that matter, the minor?
Before some of you start screaming, I know that most state laws exclude parents from having a right to know about their children’s health and well being when it comes to sexual issues–and that’s really too bad. I believe that certain cultural advocates successfully worked to effectively emancipate children from parental control in these areas (particularly from religious and cultural conservative parents) to the very real detriment of minors and our culture. The shame of it is that some medical organizations have promoted these policies that have dragged medical ethics into the mud because doctors have no choice but to obey the law.