1. Doctors' beliefs can hinder patient care

Comment #52016 by kamisama on June 26, 2007 at 12:27 am

Although it may not be a good idea to tell a doctor about your (lack of) religion, I think it's appropriate to discuss the doctor's religion because it might affect the quality of the care you receive someday. You don't necessarily need to ask about it directly; bring it up while asking about hospital affiliations. "I understand this hospital is catholic; I heard that catholic hospitals do not provide these services. How do you provide those services for your patients? What do you think about the church's influence on hospital policies?" Then depending on the response, you may find out about options that may be more to your liking or that this doctor is not the right one for you.

Sometimes healthcare workers are unclear about hospital policies. I asked several employees of a catholic hospital about hospital policies regarding birth control and got a different answer from each one. I'm not picking on catholics; they just happen to own a very big hospital near me. I would also beware SDA-owned hospitals and Loma Linda graduates. There are some good SDA/LLU-grads, but many of the least moral/ethical people I've met are SDA and LLU-grads. Medical training at LLU includes mandatory religion classes, and I'm told by some of their graduates that LLU does receive government funding.

2. Doctors' beliefs can hinder patient care

Comment #51761 by kamisama on June 24, 2007 at 6:06 pm

Following are some clarifications:

Regarding vaccination in other countries, I did not mean that people should be sent off to other countries to get vaccines that are not generally available in the US. The point was that telling patients of ALL options is not necessarily a good idea.

The purpose of vaccines is prevention. Vaccines are given to healthy people. Once someone has a disease, vaccines are useless. Anyone who got infected with TB would be quarantined and drugged. Quarantine ends when the drugs take hold; then drugging continues for about a year. The long treatment course for TB has resulted in poor compliance that has led to outbreaks in families and communities. Countries where TB is a greater problem vaccinate against it. The CDC does not recommend against BCG, it simply does not recommend for it (except for certain high-risk populations). If TB became a major problem in the US, vaccination with BCG would probably become more common. Here's a CDC webpage about BCG; feel free to click around: http://www.cdc.gov/tb/pubs/tbfactsheets/bcg.htm

As for BIID affected people, I did mention psychiatric care and stated that the analysis assumed failure of the psychiatrists to alleviate the problem. Of course if psychiatric care worked, the person would no longer need amputation. Maybe I misunderstood the autonomy principle. I don't really care to find a better argument in that category in favor of people with BIID because I do not sympathize with them. (I read an article a while back about someone with the problem who had gotten a doctor to agree to amputate her legs. The article implied that the way BIID people are treated is somehow the same as how homosexuals and other minorities have been treated. In a way it made sense, but -- it just doesn't seem right.)

Part of a doctor's duties is to help patients understand the risks and consequences of the decisions they are making. So the doctor is supposed to serve the role a statistician might serve. I suppose I made an assumption that the woman with the cancer genes was being stubborn, unreasonable, and demanding about wanting the mastectomies that the doctor no longer felt further discussion would be productive.

A woman with a breast cancer gene might feel victimized by her disposition and feel that having double mastectomies would allow her to seize control. Psychologists are not just about mental illnesses. They also help people cope with situations and generally feel better about themselves. In the end though, it would be up to such a woman to decide what she wants done and to convince a doctor to agree with her.

3. Doctors' beliefs can hinder patient care

Comment #51760 by kamisama on June 24, 2007 at 6:05 pm

None of what I write is meant to imply that anyone holds any particular beliefs.

The overall theme of my comments seems to have been understood and taken: Denial of care by medical practitioners is a complicated issue with no simple solution.

There are probably better examples I could have used, if only I knew about them. My experiences are limited.

Some of the examples I use are purposefully strange. The reader is meant to think they are strange, that doctors should not be required to act in accord with them, and thus that forcing doctors to meet particular criteria about beliefs and behavior is probably not such a good idea. Further, do you trust that the lists of required beliefs and actions will only include beliefs and actions that we would agree with?

The realm within which a doctor operates is quite broad. Is it within a physician's responsibility to attempt to ensure that expectant parents are properly prepared to raise their child? How parents treat children affects the health of those children. There are shaken baby syndrome, SIDS, car seat safety, stroller safety, and other child-care issues that can lead to a child's injury or death. These are concerns for the physician.

The religion of the parents may be a concern of the physician's because parents' religions affect how they treat and raise children. FGM occurs primarily within the context of religion. Patients' religions may also affect how they treat themselves. It definitely affects how they feel about themselves. A person's mental well-being is at least within the realm of psychology.

Should physicians force their own religion on others? Just as parents should not force their religions on their children, physicians should not force their religion on patients. But patients also should not force their religions on physicians. There's a line to draw regarding what patients and doctors are willing to do. Ideally, it should be drawn before doctors and patients begin a professional relationship; often it is not. In some cases, such as emergency rooms, it cannot be.

As for the remark about the well-being of the patient's soul, that was written in jest. I have heard similar remarks made seriously so I understand that it might not have been well-received

Another common problem is the denial of care caused by the refusal of insurance companies to pay for treatments that physicians, patients, and just about everyone else agrees are necessary. Solving the insurance problem may lead to solutions to religious issues as a side-effect.

4. Doctors' beliefs can hinder patient care

Comment #51643 by kamisama on June 23, 2007 at 11:34 pm

Corylus:

Parents request and coerce their kids into getting unnecessary cosmetic surgeries all the time. Doctors perform them. I wouldn't. Some are good candidates for a list of required treatments if ever one were made.

Amputating healthy tissue happens all the time too.

As for body integrity identity disorder (BIID), people with BIID have successfully convinced doctors to amputate them. I would make sure the patient visited a psychologist or psychiatrist then insist that the mental health professional help the patient find another doctor if they think the BIID afflicted person could be helped only by amputation. I don't actually think like this, but here are some arguments in favor of amputation of people with BIID:

• A beneficence argument: People with BIID suffer psychologically. If they cannot be helped by a psychologist or psychiatrist, their suffering can be alleviated by physical amputation.
  

• A non-malefience argument: By not amputating the person with BIID, we cause that person to suffer further mental anguish. In effect, we are torturing that person by refusing to amputate.
  

• An autonomy argument: People with BIID feel that possessing certain limbs prevents them from being the people they should be. They feel incomplete. By amputating them, we allow them to become the people they were meant to be.
  

• A justice/resource argument: People with BIID will go to great lengths to lose limbs. They will injure themselves and risk the loss of their lives to lose limbs. The doctors will do everything possible to save those limbs. When the doctor is "successful" and the patients have completed lengthy recoveries, the cycle begins again. The BIID affected people again seek injuries that may result in the loss life or limb. Thus tremendous resources are expended over time trying to save unwanted limbs -- preventing physicians from helping people who want to keep their limbs. Thus, if a person with BIID cannot be psychiatrically treated, removing unwanted limbs prevents the loss of resources that might be needed to help someone else.
  

• The four principles are in agreement, therefore BIID people deserve to have what they want -- amputation.

5. Doctors' beliefs can hinder patient care

Comment #51638 by kamisama on June 23, 2007 at 11:02 pm

Treatment should not have been denied to the patients described in the article. However, requiring physicians to hold particular beliefs or perform particular treatments is a poor solution to the problem. Religious preferences would inevitably sneak onto the list of required treatments.

Requiring doctors to advise patients of all options isn't a particularly great idea either. Facing a particular direction while praying and eating dust gathered from some holy place might be an option instead of having an abortion, but being required to advise patients of that option seems silly. How about a real example: Doctors in the US do not advise patients about BCG vaccine. The CDC does not recommend BCG vaccine, nor can patients easily obtain it without leaving the country. People who become infected are screened, quarantined, and drugged. Does it make sense to advise patients to leave the country to get BCG vaccine because it might help them avoid ever having to go through a lengthy quarantine and drugging process someday?

Corylus mentioned a number of principles. I do like them, and I have collected a similar set of principles. A big problem, though, is principles tend to have many exceptions that complicate their use so that they may be applied in ways originally unintended. Some parents choose to not vaccinate their children because they wish to avoid doing harm to already healthy children. Many extend "do no harm" to "prevent future harm". On the one hand, vaccines. On the other, women who possess a number of breast cancer genes might wish to avoid going through the ordeal of having breast cancer by having double mastectomies. (Such women should see a psychologist; right now.)

Some doctors who decide not to treat patients on religious grounds may be abusing principles. They may have the well-being of their patients' eternal souls in mind.

6. Doctors' beliefs can hinder patient care

Comment #51436 by kamisama on June 22, 2007 at 11:54 pm

Many readers' responses to the problems described in this article seem to be that the physicians should not refuse treatment. But what if religious demands were made of non-religious physicians? Consider the various forms of genital mutilations that religions have been espousing. I wouldn't want to hash up some kid's genitals simply because the parents weren't happy with how their child was born; I probably wouldn't even refer them to a doctor who would do it. I'd want to send them away and tell them to not come back (but due to laws regarding patient abandonment, that's probably not an option). Now consider what should happen if a religious ritual could be non-religiously justified. What if research done in Africa (to get around human-research ethics committees) "proved" that FGM could reduce rates of HIV infection? Should physicians be forced to participate in religious rituals simply because they have been recast in a medical setting?

What about "unnecessary" treatments? Cosmetic surgeries on kids who have been coerced by their parents to agree? Drugs known to be ineffective against a particular ailment (antibiotics for viral infections)? Tests unlikely to reveal anything not already known or suspected by the doctor? Etc.

The proposal made in another comment that doctors should keep lists of procedures they will not perform seems like a good idea. The only problem I see is the lists may interfere with physicians' abilities to treat patients. It could open up a new industry: software designed specifically to manage the lists in a manner that complies with regulations.

The accompanying idea that doctors should provide transportation for services they do not provide is less reasonable. Here are a couple examples of patients "restricted, by any circumstances" of "an "otherwise typical treatment for ideological reasons":

* Some physicians decide to treat only people under a certain age. So this doctor will give a Td shot to that kid, but won't give it to the 80-year-old -- age discrimination.

* Many surgeons probably refuse (or should refuse) to amputate off people with body integrity identity disorder. They'll amputate the guy who doesn't want to lose his leg, but not the guy who doesn't want the leg. Lifestyle discrimination?

Maybe we'll sort this out in a few hundred years.