Yes, very well said - and I still completely disagree. Who do doctors think they are? Gods? Why is it any of their business to try to protect the hypotheticals emotions of people who are not their patients. They do not get to play judge and jury on the morality or wisdom of patients’ decisions. We’ve been fighting for 100 years for the right for patients to make their own decisions. Informed decisions, of course. If the doctor said, “in my reading of the literature, there are well documented trends that many people experience this or that from the course of action you’re selecting, so you should think carefully about your particular situation before YOU make the final decision, and then I, as a service provider, will do my part so long as the law and regulations allow it.” But the that’s not what happened.
The doctor is saying, “I don’t think you’re making the decision that I would in this case, so I’m overruling you.” F that.
Could a doctor refuse life-saving treatment to a female smoker so she doesn’t become pregnant someday and end up giving that hypothetical kid a birth defect?
I get this sentiment... and I don't. This isn't' about protecting the hypothetical emotions of people or playing judge and jury regarding morality or overruling a decision 'I would 't make'.
Some of these meds (category X) almost always cause fetal demise or significant abnormalities. There are 2 risks here.
There is a very real potential for serious physical sequelae occurring in the person who gets pregnant. Pregnancies with fetal anomalies are often higher risk for complications that affect the woman. The complications can be serious and may result in the death of the mother. The risk for complications increases as the pregnancy progresses and may become acute well after the time pregnancy can be terminated. The result can be the death of both mother and fetus. This was an issue BEFORE Roe was overturned.
The pregnancy may result in fetal demise before birth or if live birth occurs there may be significant fetal anomalies that require highly complex care- that may still result in death- often shortly after birth. Yes, I get that you may consider this a personal choice of the parent(s) but is it ethical to put them in the position to almost guarantee this will occur?
This is one of those things where the libertarian concept is great in theory but not great in practice in a number of ways.
-The oath is 'Do no harm'. Is it ethical or moral on a Provider's part to do something that almost surely guarantees harm on some level because the person wishes to take risk?
-Is it ethical to require a Provider to do something that almost surely will result in harm because someone wants to do it? The drugs that are Category X are not just a chance, they are pretty much guaranteed to have a bad outcome.
- If we think that is OK then why have rules that don't allow unlimited use of substances?
- People have a right to make choices where they are the ones who deal with the consequences and do not affect others.
-who pays for the care of the person who will almost certainly have serious medical complications? The bills are
massive- extremely likely the person will end up being unable to cover the expense. Permanent disability of mother, child (if it survives) or both means society pays. I have no problem paying for people who need care. I do have a problem with people who think they have a right to take a course of action that almost certainly will result in society dealing with the result.
>>Could a doctor refuse life-saving treatment to a female smoker so she doesn't become pregnant someday and end up giving that hypothetical kid a birth defect?
This is an excellent example that makes my point.
First- the lack of expertise means the person is not aware of the risks or underestimates them.
Second- it sounds as though you think the potential risk is like playing the lottery- possible but unlikely.
So, the real answer to this is the problem with prescribing birth control pills to female smokers is not birth defects or even increased pregnancy risk. The risk is a significantly higher risk of blood clots forming in the woman. These clots can result in severe medical conditions including but not limited to problems with blood flow in the limbs, lungs, heart and brain and in extreme cases- death.
True story- when I was working I had a patient land in the ICU with a pulmonary embolism. Another provider thought it was OK to roll the dice and ignore the risk of prescribing the pill to a 2 pack a day smoker. The woman took months to recover, lost her job, was overwhelmed with medical bills, her family suffered significant financial setbacks and disruption because she was unable to contribute either financially or in the care of her other children. Was that OK to do?
It isn't judgement re someone's morality or playing holier than thou. It is being responsible for do no harm.
Edit- also adding it is also possible with complications in pregnancy or a late termination that you could put the woman's future fertility at risk. Part of the discussion with any of these meds is to provide the woman enough info to make decisions that allow for the best possible outcome for her needs without causing her harm
