Doctor refusing to make prescription

padser

I found this in PI and was just wondering about whether a doctor can legally refuse to prescribe the morning after pill on religious beliefs. Iv included the entire original post, its not really needed but it does illustrate the point that both parties here are well over the consentual age and entitled to make their own decisions.

My reason for thinking in this case that it may not be legal is as follows. Since doctors are the ones given the legal power to dispense these drugs can they choose not to excerise it for personal reasons (ie religious grounds) and in doing so deprive someone of their lawful right to have the pill?


Also what if a pregency was dangerous to a given woman? Could the doctor still refuse to prescribe it?

Imagine you went into the doctor needed an injection for something. However the doctor told you that due to his religious beliefs he would not perform any 'invasive' proceedure. (similar to the North eastern Health board PKU test case - only in this case the doctor refusing to perform it) Would this be acceptable?

Finally I have had some problems myself with a Pharmacy (there is one within 10 mins walk of UCD that does not stock them) refusing to stock condoms. Pretty much the same issue although I think this is slightly different since they are now stocked in pubs, shops and petrol stations meaning most people have an option to go elsewhere.

*Edit
I have been asked to remove the quote from PI. The gist of it is that two consenting adults (26+) had a brust condom. They went to local doctor (were away on holiday within Ireland) and he lectured them on morals and refused to prescribe the pill.

link: http://www.boards.ie/vbulletin/showthread.php?t=2054925700

Rev Hellfire

You have a lawful right to have the pill ? You might have one to purchse the pill where available, but that does mean places must stock said items.

How does a chemist not stocking condoms differ from the local sweet shop not stocking lion bars ? If they don't have it you go else where.

The same is true of the doctor, you don't like the service you're getting go somewhere else. Mountain out of mole hill it seems to me.

RE*AC*TOR

Au contraire - its not a doctor's job to preach morals. He should be reported to the relevant authority (IMB?).

Nevyn

I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgement, the following Oath.

To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.

I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

To please no one will I prescribe a deadly drug nor give advice which may cause his death.

Nor will I give a woman a pessary to procure abortion.

But I will preserve the purity of my life and my art.

I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."

The dr could be of the belief (religiously biases) that the morning after pill be doing harm to the person.
There is still a huge ammount of conflict in reguards to reporductive health in this country.

Sleipnir

RE*AC*TOR wrote:

Au contraire - its not a doctor's job to preach morals. He should be reported to the relevant authority (IMB?).

The doctor wasn't preaching his moral beliefs, he simply stated his own and that is not against any code.
With regards the shop which refuses to stock condoms;

"Hey, it's my f*cking shop. Open your own shop and sell them if you don't like it. I also don't stock large oddly shaped dildos and while you have a right to buy them, I also have the right not to sell them"

RE*AC*TOR

Sleipnir wrote:

The doctor wasn't preaching his moral beliefs, he simply stated his own and that is not against any code.

The OP stated he gave the girl a lecture on his beliefs - that sounds like preaching to me.

hullaballoo

Sleipnir wrote:

The doctor wasn't preaching his moral beliefs, he simply stated his own and that is not against any code.
With regards the shop which refuses to stock condoms;

"Hey, it's my f*cking shop. Open your own shop and sell them if you don't like it. I also don't stock large oddly shaped dildos and while you have a right to buy them, I also have the right not to sell them"

That's not a realistic argument. The relationship you have with your local corner shop is extremely different to the relationship you have with your doctor.

That said, I'm not sure that a doctor can be legally compelled to write prescriptions for anything at all. If I went to my doctor with ADHD, he is under no duty to prescribe me Ritalin. He could offer me information on how to deal with it otherwise, even without any medication at all.

It may not be standard practise to refuse a prescription for the morning after pill, but it's his prescription book, and it's his prerogative.

BC

This issue came up around the time of the last abortion referendum. As far as I remember there is legislation or a code of conduct or something protecting the doctors. In the same way that a patient can refuse treatment based on his/her religious beliefs, a doctor can refuse to perform certain things based on his/her beliefs. A doctor can refuse to prescribe the pill in the same way that he can refuse to do an abortion. The patient has to go elsewhere.

Someone else may have more info on where the details of the legistlation are.

Rev Hellfire

Still hardly a reportable offence.

RE*AC*TOR

anyway - The Medical Council is the place to complain about a GP.

http://www.medicalcouncil.ie/default.asp

If the doctor is going to base his scientific/medical decisions on religious mumbo-jumbo - then he should have a plaque outside his practice stating

"Dr. X - Christian General Practitioner".

RE*AC*TOR

As for the condoms - the pharmacy is under no obligation to stock them - however, not stocking them - is irresponsible.

Rev Hellfire

RE*AC*TOR wrote:

As for the condoms - the pharmacy is under no obligation to stock them - however, not stocking them - is irresponsible.

Hardly. The pharmacy is not responsible for the stupidity of people should they wish to have unprotected sex.

padser

No one seems to have addressed the issue of whether the situation would be different if a woman had been told that a pregnency would be dangerous to her (similar to the McGee case).

So now a woman is stranded in a remote part of Ireland with one doctor within the area. Her only way to get the pill and prevent a pregnency is to get the pill.
The doctor in that situation surely could not refuse to write the prescription? In the same way as the state could not refuse Mrs Mcgee her contraception surely a doctor here, since he has set up to serve the medical needs of the surrounding committee, and in doing so prevented (in practice - in a small rural committee) anyone else from doing so can not refuse to fulfil his obligation.

RE*AC*TOR

Rev Hellfire wrote:

Hardly. The pharmacy is not responsible for the stupidity of people should they wish to have unprotected sex.

I disagree. Its largely a public health issue. People do have sex. (maybe not so much the nerds who come here ) Its in the interest of public health that condoms are easily available. Just in the same way that there are road-signs telling people to slow down. I guess the road authority isn't responsible for the stupidity of people who drive too fast.

Thirdfox

Padser: I thought McGee was mostly decided on the fact that she was married? - protection of family unit and all that... if she was single then I doubt the court would have decided in her favour back then.

REACTOR: So says the person with 3,571 posts to their name
Condoms are free in Trinity College

tabatha

you wont get anywhere with the medical council. i know this for a fact, previous experience. best bet is to try paitent focus. they are a free service and well worth it. http://www.patientfocus.ie/

The_Minister

RE*AC*TOR wrote:

Au contraire - its not a doctor's job to preach morals. He should be reported to the relevant authority (IMB?).

Doctors have a right to conciensious objection and that should be respected.

RE*AC*TOR

Firespinner wrote:

Doctors have a right to conciensious objection and that should be respected.

Does he have a right to preach to someone who doesn't share his beliefs?

Should the public not be aware that a certain "doctor" is praciticing faith-based quackery?

padser

Thirdfox wrote:

Padser: I thought McGee was mostly decided on the fact that she was married? - protection of family unit and all that... if she was single then I doubt the court would have decided in her favour back then.

No almost cetainly not, but today the case would probably not need to be decided on 'marital privacy' it could be decided purely on 'privacy'.

Thirdfox wrote:

Condoms are free in Trinity College

Thats probably due to the lack of demand for them........:D (1 nil UCD)
.
.
.

The_Minister

RE*AC*TOR wrote:

Does he have a right to preach to someone who doesn't share his beliefs?

Should the public not be aware that a certain "doctor" is praciticing faith-based quackery?

How is it "faith-based quackery"? He will not do something that goes against his conscience but is still a qualified and competant doctor, who (as far as I can tell) follows regular treatment courses for all illnesses (pregnancy is not an illness).
He has a right to explain to her about his beliefs, so that she knows why he is refusing to give her the pill as opposed to merely saying no and kicking her out.

RE*AC*TOR

Well the OP didn't say "explain" - he said "lecture".

So, once more, does he have a right to preach to someone who doesn't share his beliefs?

The_Minister

We don't know what or how it was said. Thus, neither of us can answer that. He had a right to explain himself.

RE*AC*TOR

Firespinner wrote:

We don't know what or how it was said. Thus, neither of us can answer that. He had a right to explain himself.

So you're saying the OP lied when he said "lecture"?

aniascor

Unfortunately, I don't think this situation is a one-off - I know two girls who had similar experiences with two different doctors. One of the girls wanted to go on the pill in the hopes that it would relieve extremely painful PMS - but the doctor just saw her request as an opportunity to rant at her about low morals and mortal sin... Disgraceful!

The_Minister

RE*AC*TOR wrote:

So you're saying the OP lied when he said "lecture"?

I'm saying that he may have misinterpreted the doctor. There is little tangable difference between lecture and explain - both would involve the espousal of his beliefs.

RE*AC*TOR

I think it rather presumptious of you to doubt the OP. If you can't take what he said at face value, then I don't see what kind of rational arguement can take place.

Our man in Havana

If the doctor won't perscribe ask him/her for the name of a doctor that will.

padser

aniascor wrote:

Unfortunately, I don't think this situation is a one-off - I know two girls who had similar experiences with two different doctors. One of the girls wanted to go on the pill in the hopes that it would relieve extremely painful PMS - but the doctor just saw her request as an opportunity to rant at her about low morals and mortal sin... Disgraceful!

I think we were talking about a slightly different pill however the principle is exactly the same. Anyway the thread seems to have completely run its course.


Reactor and firespinner I really dont think it was ever a question of whether the OP was 'lectured' about morals or simply refused prescription and informed it was on moral grounds.

RainyDay

Is it OK for the docs to lecture us about giving up smoking & losing weight?

Star*

the Mc gee case is slightly different as was said above at it was privacy within marriage, although i think it could form the basis of case here too.

However, look at this in accordance with abortion, our doctors have the right to give us the information on abortion if necessary and can give our medical records to the clinic also. however, this does not mean that every doctor has to do so - as it is in accordance with their own personal views on occasion not necessarily medically based.

However, on a personal level i feel it is terrible for any doctor to refuse to give a medicine that may be of necessity to an individual, if you are a doctor it is surely your right to give the best medical care possible and the best drugs that you have available to you. So, if the morning after pill is necessary for your patients then it is up to you the doctor to be responsible and give the person what they so desire to help them overcome a sitution. If you put this in the context of the cases recently in the uk for the cancer drug herecptin, all be it that this drugs helps and beats cancer if it is available on a drugs market surely it should be available to all, not just those privelged enough to get it and privelged enough for their health authority to pay for it.

So both cases in a sense are similar, as a patient you are entitled to the best medical care that is available to you and suits your needs. If this is the morning after pill or a cancer beating drug either way. it is for you to chose not a doctor.

Personally i think the doctor in this case should be outed, he does not deserve to have practice in this country if he feels his moral views are more important. Will he be the same doctor who would think that post natal depression is just in a womans mind?

Eru

RainyDay wrote:

Is it OK for the docs to lecture us about giving up smoking & losing weight?

Yes, he took an oath and is acting for your health, thats his job.

As for the morning after, I didnt think this still happened but I think they can refuse to presribe anything they dont want to prescribe. (personal opinion)

Thirdfox

taken from http://www.medword.com/hippocrates.html:

THE OATH OF HIPPOCRATES

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

Of course one could argue that the Oath is irrelevant nowadays but I think doctors still do take it seriously (an oath is an oath!)

Easygainer

Thirdfox wrote:

taken from http://www.medword.com/hippocrates.html:

THE OATH OF HIPPOCRATES

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

Of course one could argue that the Oath is irrelevant nowadays but I think doctors still do take it seriously (an oath is an oath!)

It isn't akin to an abortion, that's why it is legal. It prevents fertilisation which is, in effect, no different than using a condom, which harps back to the "sperm being sacred" bull. There is no problem, from the oath stance, in a doctor prescribing the morning after pill, as it is not harming any life. It is, in effect, an application of the law of unintended consequences which was approved in the Ward of Court case.

It is clearly a moral decision by the doctor. I never came across this as being a crime or tort in Medical law but it is feasible that the doctor could be liable for costs in tort if the woman subsequently became pregnant. England has a spate of wrongful birth cases and it is the necessary aspects of proximity, foreseeability etc would be present in refusing to grant the pill on subjective grounds.

Thirdfox

I may be mistaken but I thought the pill "flushed" out the egg (which may have combined with sperm to create an embryo)? Isn't that a life then? Of course this thread isn't about the legality/morality of abortion per se.

England could probably be differentiated from Ireland as abortion itself is legal there...

Anyway I put the oath here primarily to show that doctors try to keep people healthy (in relation to why the sermonising about smoking, obesity etc.)

hullaballoo

The pill controls the period. It fools the body into thinking that it's pregnant by releasing the relevant hormones. I'm not sure about the flushing out of the egg.

Thirdfox

But this girl just had sex... I'm sure they're talking about the morning after pill (and not The Pill).

One's contraception and the other is similar to pre-abortion abortion (I think).

The_Minister

Star* wrote:

However, on a personal level i feel it is terrible for any doctor to refuse to give a medicine that may be of necessity to an individual, if you are a doctor it is surely your right to give the best medical care possible and the best drugs that you have available to you. So, if the morning after pill is necessary for your patients then it is up to you the doctor to be responsible and give the person what they so desire to help them overcome a sitution.

But its not nessacery. The mother will live without it and could easily get it from another source. Its not like he walked away from a car crash

hullaballoo

Thirdfox wrote:

But this girl just had sex... I'm sure they're talking about the morning after pill (and not The Pill).

One's contraception and the other is similar to pre-abortion abortion (I think).

My bad!

Easygainer

Thirdfox wrote:

But this girl just had sex... I'm sure they're talking about the morning after pill (and not The Pill).

One's contraception and the other is similar to pre-abortion abortion (I think).

No, morning after pill prevents them fertilising, if it were going to happen. It takes around 3 days for this to happen hence the 48 hour window for getting the "morning after" pill.

Nevyn

The morning after pill does not prevent conception,
it prevents the implantation of the zygote or dividing ball of cells.
Up intil implation in the womb walls occur a woman is not pregnant
so it is not terminating a pregnacy so it is not an abortion.

The 3 days is the length of time it takes the ovum or zygote to travel from
the fallopian tubes to the centre of the womb where it will implant.

Yes it is meddling making the womb a hostile enviroment for the zygote but
in the same was as other froms of contraception do from the contraceptive pill to the coil, but it is not abortion.

RainyDay

Karlitosway1978 wrote:

Yes, he took an oath and is acting for your health, thats his job.

And if in his professional opinion, unprotected sex is dangerous for your health, is he expected to keep his mouth shut? [Yes, I'm aware that OP stated that the condom broke, but I guess most people looking for the MAP say that the condom broke]

Thaedydal wrote:

The morning after pill does not prevent conception,
it prevents the implantation of the zygote or dividing ball of cells.
Up intil implation in the womb walls occur a woman is not pregnant
so it is not terminating a pregnacy so it is not an abortion.

The 3 days is the length of time it takes the ovum or zygote to travel from
the fallopian tubes to the centre of the womb where it will implant.

Yes it is meddling making the womb a hostile enviroment for the zygote but
in the same was as other froms of contraception do from the contraceptive pill to the coil, but it is not abortion.

Whoa - hold your horses there. The MAP has a fundamentally different effect than the normal pill. The normal pill prevents ovulation, so no egg is released. The MAP prevents implantation of the zygote (aka fertilised egg, aka foetus, aka tiny baby - choose your own terminology). Where do you get your definition of pregnancy starting after implantation from?

Easygainer

RainyDay wrote:

And if in his professional opinion, unprotected sex is dangerous for your health, is he expected to keep his mouth shut? [Yes, I'm aware that OP stated that the condom broke, but I guess most people looking for the MAP say that the condom broke]


Whoa - hold your horses there. The MAP has a fundamentally different effect than the normal pill. The normal pill prevents ovulation, so no egg is released. The MAP prevents implantation of the zygote (aka fertilised egg, aka foetus, aka tiny baby - choose your own terminology). Where do you get your definition of pregnancy starting after implantation from?

Wow, strong ignorance.

IrishHealth.com wrote:

Emergency contraception is also known as post coital contraception and can prevent pregnancy after unprotected intercourse. It is not quite true to say 'the morning after the night before' as it can actually work up to 72 hours of unprotected sex.

There are two forms of emergency contraception - one is by way of hormonal contraceptive tablets and the other is by insertion of a copper coil or intrauterine device (IUD).

The emergency contraceptive pills are high dose oestrogen pills and are taken in two separate doses. The first dose must be taken within 72 hours of unprotected intercourse followed by the second dose 12 hours later. It is important to make sure that there were no previous bouts of unprotected intercourse prior to this 72-hour window. If this was the case the woman could already be pregnant and the pills would be contraindicated. The IUD can be inserted up to five days after unprotected intercourse in the hope of preventing pregnancy.

There is no fertilisation until the egg and sperm fuse to form a zygote. This is prevention, same as using regular pill in that you are preventing the fertilisation by hormonal manipulation.

Also it is not a zygote aka foetus aka little baby. Go back to the right if you're going to try and spread that SPUC propaganda.

RainyDay

Wrong again - Why the selective quotes from irishhealth.com. You omited the more interesting bits;

These high dose hormones act by delaying or inhibiting ovulation and/or by altering the transport of sperm along the tubes. They may also alter the lining of the endometrium so preventing implantation.

The VHI site gives more emphasis to the implantation effect;

It is unclear exactly how emergency contraception pills work. The pills contain the hormone progesterone, which is believed to:
• Cause changes in the lining of the womb that prevent implantation of a fertilised egg;
• Prevent or delay ovulation (release of an egg from the ovary);
• Interfere with movement of the egg or sperm through the fallopian tube to the uterus.

And please do explain the difference between a zygote and a foetus. When does a zygote become a foetus?

Easygainer wrote:

Go back to the right if you're going to try and spread that SPUC propaganda.

Thanks for your suggestions. It is unfortunate that you seem to feel threatened by the facts. But they are the facts. And I'll be staying exactly where I am.

GilGrissom

Go back to askaboutmoney.com where you boss about everyone about. Your SPUC views are not welcome here.

Nevyn

Rainyday wrote:

And please do explain the difference between a zygote and a foetus. When does a zygote become a foetus?

http://dictionary.reference.com/search?q=fetus

In humans, the unborn young from the end of the eighth week after conception to the moment of birth, as distinguished from the earlier embryo.

The zygote divides and becomes an embryo and when it implants then it developes with in the lining of the womb until it becomes a fetus.

maidhc

Must every thread on this sort of topic descend to this?

Our man in Havana

More suited to Humanities tbh.

RainyDay

GilGrissom wrote:

Go back to askaboutmoney.com where you boss about everyone about. Your SPUC views are not welcome here.

And your 16 posts qualify you to choose what views are welcome or not? As it happens, I'm not really bothered whether they are welcome or not. For the record, I'd suggest you reread my posts carefully before you fling around labels.

But I agree that we should get back on topic - Let's get back to understand exactly how the MAP works.

GilGrissom

---

maidhc

RainyDay wrote:

But I agree that we should get back on topic - Let's get back to understand exactly how the MAP works.

No No No. Topic was the the legalities of a "Doctor refusing to make prescription".

Nevyn

RainyDay wrote:

But I agree that we should get back on topic - Let's get back to understand exactly how the MAP works.

If you want that disscussion I suggest you try the biology forum.

Must every thread on this sort of topic descend to this?

Because there are people who fail to see that thier world view and/or personal moralities is not the only way and they get frustrated.

Back on topic

Healing and harming many of the things perscribed by drs have the potential
to do both, tis one of the reasons perscriptions have metred doses.
What heals one person or eases thier condition may be detremental to another.
If a dr was to take the priciple of first do no harm then really that limits far
to many options.
Which would be considered more 'harmful' the morning after pill with in the
window of 72 hours, a 6 to 12 weeks termination, having to endure an unwanted pregnacy
and the effect of that both mentally, emotionally and physically.

Yes the dr could refuse on the grounds of his/her own morals and ethics to perscribe the morning after pill
but it should be done will still respecting the patient. Dr are bound to 'treat' the patient in front of them,
the dr accepted the appointment and saw the patient and does have a duty of care,
I would said that he would be in breach of the 'first do no harm' by
aggrevating the worries, fears and anxieties of the patient by lack of understanding
and lecturing to the patient.

A simple I don't perscibe this treatment there are other options would have been enough
or really if there was a practice receptionist who would have asked what the appointment was for they could have explained.