Thursday, May 31, 2007

Sovereign Anatomy

Who makes decisions about your body? New laws give physicians and hospitals the right to deny the best care…even in emergencies. A recent poll conducted by resulted in nearly 1 in 20 respondents noting an incident in which their doctor had refused to treat them for moral, ethical, or religious reasons.

“Doctors swear an oath to serve their patients. But instead, they are allowing their religious beliefs to compromise patient care,” says Jamie D. Brooks, a former staff attorney for the National Health Law Program. At the forefront of this controversy is woman’s health care.

Lori Boyer was trembling after being sexually assaulted by an acquaintance. Bruised and shaken, she drove straight to Good Samaritan Hospital in Lebanon, Pennsylvania. After speaking to a rape counselor, she met with Martin Gish, M.D. for a pelvic exam and inquired to the doctor about the morning-after pill, which the counselor had mentioned earlier. She was mid-cycle, putting her in danger of getting pregnant. “No,” replied Dr. Gish. “It’s against my religion.” Emergency contraception is most effective within ideally 72 hours. She now had to look for another doctor who was willing to put religious beliefs aside in order to prevent a forced pregnancy. “I was so vulnerable,” laments Lori. “I felt victimized all over again. First the rape and then the doctor making me feel powerless.” Luckily Boyer was able to find a physician in enough time to prescribe her EC.

“What person who has been raped would really welcome a pregnancy from that?” asks James Trussell, Ph.D., director of the Office of Population Research at Princeton University. “Even if you oppose abortion, what could be better than preventing the pregnancy in the first place?”

In the absence of any local laws, it is up to individual hospitals to decide whether a rape victim will be given – or even told about – emergency contraception. (Glamour, May 2006) In The New England Journal of Medicine survey, 8 percent of physicians said they felt no obligation to present all options to their patients. Eight percent might not seem to be a high percentage but imagine you being one of the numerous patients to a doctor that falls in that 8%. “Especially in a crisis situation, like a rape, you often don’t think to question your care. But unfortunately, now we can’t even trust doctors to tell us what we need to know,” Jill Morrison, senior counsel for health and reproductive rights at the National Women’s Law Center points out.

There have been highly publicized articles and discussions about pharmacists who have refused to dispense birth control and emergency contraception. But more and more incidents like Lori Boyer’s are being noticed.

Cheryl Bray, a single 41-year-old, had decided to adopt a baby from Mexico. Where woman are dying because they are poor and having unsafe abortions since it is illegal. Those that do go through with a pregnancy often cannot afford to raise the child and put he/she up for adoption. Being a well-respected realtor in California, Cheryl decided to open her home and her heart to one of these children. She had already gone through a long and arduous application process along with various inspections, background checks, etc. One of the last requirements was to undergo a routine physical. “So, your husband is in agreement with your decision to adopt?” inquires Fred Salley, M.D. “I’m not married,” Bray told him. “You’re not?” He calmly put down his pen Bray recalls. “Then I’m not comfortable continuing this exam.” He later stated that his “decision to refer Ms. Bray was not because she was unmarried; rather, it was based on my moral belief that a child should have two parental units. Such religious beliefs are a fundamental right guaranteed by the Constitution of the United States.”

So by Dr. Salley’s statement and belief that a child should have two parental units, then widows should never be allowed to raise their own children unless they immediately get remarried. Interesting! As for the second part of his statement about religious rights, Bray has a right to her beliefs just as much as Salley. “Apparently it is ok to discriminate against somebody, as long as it’s for religious reasons,” Bray surmises.

Besides the doctor’s beliefs to content with, nearly one in five hospital beds is in a religiously owned institution, according to the nonprofit group MergerWatch. Often times, mergers take place at hospitals. As a result, the name of the hospital might not change but its philosophy does. Every Catholic hospital is bound by the ethical directives of the U.S. Conference of Catholic Bishops, which forbid abortion and sterilization (unless they are lifesaving), in vitro fertilization, surrogate motherhood, some prenatal genetic testing, all artificial forms of birth control and the use of condoms for HIV prevention. (“Is Your Doctor Playing Judge?” Self, June 2007)

At just 14 weeks pregnant, Kathleen Hutchins had her water break. Because there wasn’t enough amniotic fluid left and it was too early for the fetus to survive, the pregnancy was hopeless. Hutchins would miscarry in a matter of weeks but in the meanwhile, she stood at risk for serious infection, which could lead to infertility or death. Hutchins chose to go to local Elliot Hospital but Elliot had recently merged with nearby Catholic Medical Center – and as a result, the hospital forbade abortions. “I was told I could not admit her unless there was a risk to her life,” Dr. Goldner remembers. “They said, ‘Why don’t you wait until she has an infection, or she gets a fever?’ They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy.” (Self, June 2007)

South Dakota Governor Michael Rounds, signed into law the nation’s most sweeping state abortion ban in March 2006. The law makes it a felony to perform any abortion except in a case of a pregnant woman’s life being in jeopardy. (“South Dakota Bans Abortion, Setting Up A Battle”, The New York Times, 3/7/2006) But who decides when a woman’s life is in jeopardy? For Kathleen Hutchins, it was the local hospital. Isn’t it her body? Shouldn’t she ultimately make that decision? Not when doctors and hospitals are given the right to refuse care. They are making your decisions.

Since 2005, 27 states introduced bills to widen refusal clauses. Four states are considering granting carte blanche refusal rights – much like the law adopted by Mississippi in 2004, which allows any health care provider to refuse practically anything on moral grounds. (Self, June 2007) “It’s written so broadly, there’s virtually no protection for patients,” says Adam Sonfield, senior public policy associate for the Guttmacher Institute, a reproductive-health research group.

The relationship between patient and his/her doctor should be ‘sacrosanct’, and the moral condemnation of a doctor’s faith on a patient has caused patients to retreat from seeing and vocalizing their health in fear of being judged. As upsetting and discouraging as these changes might be, we must always be in control of our own body and health.

In 2002, I was diagnosed with Hashimoto’s Thyroiditis, a hereditary autoimmune disease. After years of arguing with doctor’s that I knew something was not right, it was a gastroenterologist that finally looked into it. Blood tests confirmed my assumptions and he referred me to an endocrinologist for further medical attention.

After being under the endocrinologist’s care for a year and taking the prescribed Levoxyl, I still did not feel any better. Being concerned about my health care, I read articles and studies on various medications and treatments. When I confronted my doctor, he responded “You shouldn’t read so much!” Needless to say, that was my last visit with him. I found a new endocrinologist who listened to my concerns and wound up changing the brand of medication. Although the main difference is just the fillers in the medication, sometimes it is even something that small that can make a difference. Luckily I had enough gumption to not accept substandard care but many people do not.

Doctor’s seem to forget that EVERYONE is different. We can all have a different reaction to the same treatment and as a doctor, you should always look to finding what is best for your patient.