Do We Need A Pro-Choice Litmus Test for Obstetricians?
Defenders of abortion rights in the United States have faced a demographic paradox over the past decade: although a majority of Americans continue to favor a woman's right to choose, and strong support for this right among young people suggest that public attitudes toward abortion will continue to liberalize, the number of physicians actually performing abortions has steadily ticked downward. The reasons that newly-minted doctors refuse to replace their retiring colleagues in this enterprise include fear of violent reprisal (as evidenced in the high-profile murders of providers David Gunn and Barnett Slepian) and of chronic harassment from groups who believe abortion should be criminalized. While tighter law enforcement, increased training opportunities, and higher reimbursement rates might ameliorate this crisis to some degree, they do not address one of the rarely-mentioned causes of this dire shortage: the underlying problem may be that the pool of potential abortion providers is too small. During my medical training and career as a bioethicist, I have encountered many obstetricians who could never be convinced to terminate pregnancies because they were personally opposed to doing so--often for private religious or philosophical reasons. In short, while part of the shortage may be a result of how our nation treats its providers, another cause of the shortage is how our healthcare system selects who we will train to become future gynecologists and obstetricians. One solution to rectify this "selection effect" is a litmus test for new OBGYNs, requiring that only pro-choice obstetricians be trained until the ongoing shortage of abortion providers is resolved.
Residency positions in obstetrics are a highly-limited resource. The federal government determines the quantity of such training appointments it will finance, effectively creating an artificial shortage of jobs for junior OBGYNs. So while the number of plumbers or bioethics professors is determined largely by the laws of supply and demand, the market place has little to do with the number of obstetricians learning their craft. OBGYN residencies, for all meaningful purposes a prerequisite to practice obstetrics in the United States, are doled out in the context of artificial scarcity--like liquor licenses. As a result, becoming an obstetrician is a privilege, a great public trust held on behalf of the American people. In contrast, the United States Supreme Court has repeatedly made clear that abortion is a fundamental right. One might logically conclude that when the two come into conflict--the right to an abortion and the privilege to practice obstetrics--that our society would uphold the former. So far, alas, this has not been the case.
Almost immediately after the Supreme Court's decision in Roe v. Wade, Idaho Senator Frank Church sponsored a rider to the Health Programs Expansion Act of 1973--now known as the Church Amendment--that guaranteed health care professionals who were opposed to abortion the right to opt out of the procedure. (The Church Amendment technically applied only to institutions receiving federal funds, but today that means nearly all hospitals). A complex web of additional "conscience" laws, at both the federal and state level, have followed. In principle, such freedom of conscience seems highly desirable in a liberal society. As I have written elsewhere, when patients have easy access to alternate providers, there is no reason to force objecting health care practitioners from their jobs. For example, if Wal-Mart has two pharmacists on duty, one who holds religious objections to emergency contraception and the other who does not, it does not seem unreasonable to ask the non-objector to fill such a prescription. Of course, the situation is entirely different when there is only one pharmacist on duty. In the case of abortion, the current shortage of providers justifies a limited waiver of conscience exemptions as applied to the training of new OBGYNs. If we do not act, women may find themselves in a position similar to that of the criminal defendant who in theory has the legal right to counsel, but cannot find any lawyer willing to take her case.
Obviously, it is not realistic to force currently-practicing OBGYNs either to perform abortions or to hang up their forceps. Unless we wish to create a nationwide shortage of all obstetricians, we will have to grandfather in abortion opponents like Tom Coburn and Ron Paul. But that is very different from requiring future OBGYNs to take part in elective terminations during their training--at least as long as the shortage of providers continues. By analogy, we might permit a lone Scientologist to enter a psychiatriac residency program, despite his religious opposition to the pharmacological treatment of mental illness, but we would not allow thousands of Scientologists do so, if the result were a national shortage of prescribers. Otherwise--and I am reluctant to put ideas into the minds of abortion opponents--the most effective way to curtail reproductive freedom in the United States would be to have anti-choice activists enter medical school en masse and later crowd pro-choice physicians out of obstetrics training programs.
I feel strongly that individuals who believe that life begins at conception and individuals who believe that life begins at birth--as well as individuals who believe that life begins before conception or after birth--should have an opportunity to express their ideas in the marketplace. Our society will only achieve meaningful enlightenment through civil discourse. Those individuals who believe I am wrong about these issues should have every right to convince me that my views are mistaken or my values are misguided. However, philosophical disagreement does not give one the right to generate a public health crisis. The courts are a good place to battle over constitutional rights; the wombs of often desperate women are not. So while one has every right to oppose abortion, one should not necessarily have a right to do so while occupying the scarce and precious position of an obstetrics resident that instead could be allocated to a potential provider. We hear much talk in progressive circles about a pro-choice litmus test for future Supreme Court justices. Yet without a pro-choice litmus test for future obstetricians, who serves on the federal bench may no longer matter.
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I am a former attorney and currently in medical school. As a second year student, I just went through a class that was supposedly intended to be a discussion on professionalism in medicine. Unfortunately, it turned out to be a terrifying lesson on how narrow-minded most of the 24 year old men in my class are. The vast majority of them are not only anti-choice, but actually believe that it is mostly a woman's promiscuity that leads to pregnancy. The physician teaching the class (male) was also clearly anti-choice, and stated his belief that abortion is now a form of birth control. Bioethicists were referred to during the class (but only tangentially) and the women in the class were too intimidated to speak up in any way (I still have no idea what any of them think). If my class is representative at all of the way future doctors are being trained in this country, there is zero effort being made in the area of reproductive freedom and choice. In fact, there is an effort being made to steer doctors from participating in providing termination services to women. It actually made me start considering ob/gyn as a result.
Absurd. Would you prevent someone from specializing in geriatric medicine because they are opposed to euthanasia of the elderly on ethical grounds? Apparently so.
Strawman
This would theoretically work if there was an overwhelming number of people getting in to OB/GYN. Of course, there isn't, so this would likely have the effect of just less OB/GYNs in the future.
Of course, there is also the almost guaranteed fallout from such a proposal. Endless lawsuits are practically guaranteed. I'm fairly certain this would end up at the Supreme court, and with the justices right now it's a fair bet that this will be seen as unconstitutional on the basis of religious discrimination (catholics, etc).
i agree that it seems a slippery slope to require prospective obgyns to pass a politicized litmus test. why not just allow for and encourage more residencies? but personal experience has now led me to wonder if even that is enough when you live in an area like i do.
i'm staunchly pro-choice, but because of geographical logistics, both my children were birthed by staunchly pro-life nurse mid-wives and doctors. i felt completely positive about these medical professionals and they did wonderfully with both pregnancies and births.
but nobody would perform a tubal on me when i asked. not only are the majority of the doctors in my area pro-life, the catholics have a racket on the hospitals here. i have to go across state lines and its a hassle and added expense. and i'm not even asking for an abortion. just the opportunity, after two children and ample discussion with my husband, to retire my uterus for our the sake of our family's finances and what i believe to be responsible consideration of global overpopulation. not only was i refused, but given many tsk tsks and lectures. they'll begrudgingly give me birth control (which i can't take) but damn it all if they'll tie MY tubes. really, in my humble opinion, there's a point at which the obstetrics community has to honor the decisions of the women they chose to serve and the oaths they took to get their licenses.
Awesome point, and well stated. Lectures from doctors and nurses about the percieved morality of your decisions as an adult are unwelcome, belittling and ineffective. There's nothing in their oaths that gives them the right to judge. I hope you articulated your feelings to the medical professionals in question before you were forced to take your business elsewhere.
The idea of discourse is good, but do you really think there hasn't been thousands of hours of discourse on the subject since RoeVWade?!? Too many people have too much emotion and religion tied up in the idea that abortion is wrong to listen. It scares me that it is so, but it is. A woman's right to freedom of conscience over her own body is a constant battle to protect.
Likewise a doctor's right to freedom of conscience is also a constant battle to protect.
"Too many people have too much emotion and religion tied up in the idea that abortion is wrong to listen."
I think both sides suffer from insensitivity and lack of tolerance to the others point of view.
Only liberals would propose to limit the right of an individual to his concience and freedom to chose.
So true! Ref: The Soviet Union.
Um... FAIL! I'm not denying that liberals come out sometimes with some REALLY stupid ideas that would limit your rights, but to claim that ONLY liberals do so shows that you aren't intelligent enough to look at your own party to see its flaws!
Most who enter the field do so for the purpose of creating life, not destroying it.
Even if a litmus test was in place, that doesn't mean the OB would perform the procedure. Being in favor of legal abortion is nowhere near actually performing one.
Such a requirement would be discriminatory and ill conceived. Most OBGYNs don't perform abortions nor are their offices set up to do so. Wht not take the high road and expand the financial aid to those who would like to become a OBGYN that special ize in abortion? This article demonstrates a lack of understanding of the medical field and doesn't consider the negative ramifications of forcing politics into it.
It would appear the solution is to stop limiting the number of residencies so severely.
If a potential health care provider objects to ANY kind of medical procedure, whether it's abortion, drugs for psychiatric illnesses, organ donation, IVF, genetic counseling, etc., they should consider another line of work.
The medical field is no place for people who are going to limit the care options patients have access to due to their own "moral and/or philosophical objections
blood letting , voodoo, potions, herbology, are all considered medical procedures ... Abortion is considered murder in many instances by millions if not billions ,,,,,
Voodoo is not medical in nature, it's religious. All the rest are all valid procedures in some circumstances, and any doctor that won't perform them in those circumstances needs to find another line of work.
So, there are a lot of doctors who would like to go into obstetrics but the government limits the number of residencies that are available. The result is that there are few obstetricians but they get to make a lot of money because of supply and demand.
Why don't we just attack the real problem and get government to finance more obstetric residencies. More doctors. More doctors willing to do abortions. More doctors to deliver babies. More affordable obstetric care for lower income mothers. Better care for mothers. Healthier babies. Maybe fewer unwanted pregnancies in the next generation.
Good luck with that. Really. Here's another idea. Make sure at least half of all recidencies are filled by female doctors. There's a real struggle to get into these programs, as you say, because the potential money making is so great. Women doctors are so very much braver about this issue than are men. The bravest doctor i ever met regarding the availability of abortions was a man, but in general women are more willing to put themselves out there.
We shouldn't need a litmus test. I think the hippocratic oath should cover us.
The hippocratic oath is very clear in this regard:
--I will follow that system of regimen which, according to my ability and judgment, 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.-
In the above editorial, the author states that ob/gynes don't perform abortions out of fear of "violent reprisals" and "harassmen
No. GIve it a bit more thought and get back to us.
What would happen if we ended this program of creating artificial scarcity and allowed the market to dictate how many OGBYNs there are?
if you are too stupid to tell the difference between a person and a 8-week fetus, you are probably should be considered too dumb to go into medicine
I have seen many residents come and go through obgyn, and it's generally the young men who hold the prim views. It's all about controlling women. It's that simple. There is a deep fear that if given the actual, carefree choice, women will not have "my" baby. Or.. worse... maybe mommy wouldn't have had me.
Women are largely above this question. They are the mommy if they want to be. This is why women should handle this kind of medicene..
an interesting perspective
The law and its definition of when a fetus is a person is not clearly defined either.
Sure Roe v Wade defines the transformation is at birth but other laws rule differently. If a pregnant woman is murdered, defendant is charged with two murders. The mother and the baby.
If a woman is beaten and the fetus is killed it is not treated as an abortion where the fetus is insignificant. It brings additional charges that can include manslaughter.
Brilliant lawyers know a fetus is a life and deserves protection.
In those cases the law recognizes that the fetus is not just a thing that was discarded but it is a life that requires protection as a human. Many talented students go into OBGNY because they understand life the same way.
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