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proginoskes 31-Aug-06, 13:04	Elective Medical Services Should a physician be able to refuse elective medical procedures. What immediately comes to mind is boob-jobs or liposuction. Here's the scenario, and this was a real scenario, a lesbian couple want to get pregnant and they have a male donor, but the doctor refuses to do the service because he doesn't approve of the lifestyle. Should he be compelled to provide this elective service? (*throws the bone to the dogs and waits for it . . .*)
eldude 31-Aug-06, 13:05	Good question I dont know
mozz 31-Aug-06, 14:23	Yes a doctor should be able to refuse but not on the grounds mentioned above. There is a growing trend for teenage girls in Australia to be having boob jobs and the like because they don't like the way they look. As I see it, they should be waiting until they have finished growing until they can make those decisions. I do not believe that they are mature enough to make the decision. The doctors should be saying this to them rather than just collecting the cash. I think Mrs Lowenstein (aka Cat Woman) is another example. It is clear that she has some form of body dismorphic disorder. To keep operating is ridiculous, I doubt that she is mentally competent enough to judge what she is doing in this case. It almost equates to drug abuse. Maybe we should have a rehab centre for serial plastic surgery patients. As for the lesbian couple. Well they can legally adopt so I see no reason why they can not legally get pregnant. This one can be a bit of a slippery slope though. If doctors are allowed to refuse to treat elective patients based on their lifestyle, how far is it till they start to refuse to perform legitemate procedures for the same reasons? I suspect that this may already be happening. A doctor's decision should be made based on what is in the best interest of the patient, not their own sensibilities.
pawntificator 31-Aug-06, 15:15	I disagree A doctor should be able to refuse to preform any procedure based on their own belief system. There are always doctors willing to do it for the money, so don't make the doctor with principles go against his nature. Also, mozz, did you just say that artificial insemination for lesbians is an illegitemate procedure? Gasp! Next you will say dwarf-chucking is inhumane. Speaking of boob jobs, does anyone know anything about penis enlargement surgery? Or...are we not allowed to talk about penis size in here? Just boobs? Ok, gotcha.
tugger 31-Aug-06, 15:23	funny you should ask that, there was an interview with a doctor, who refuses ivf to lesbians as he does not believe it is nature's way. i do not believe a man should be forced to do something that is against his prinicples. he is not being prejudiced, he has based his decision on a personal moral.
mozz 31-Aug-06, 15:29	pawn How on earth did you read that I was claiming artificial insemination was illegitemate for lesbians? I will grant though, that whilst dwarf chucking may not be completely inhumane, I do find it incredibly distasteful. I try not to think about penis enlargment surgery, the thugh of someone mucking around with my old fella with a knife makes me feel very uncomfortable. As for the belief system, I can't really agree with you. A doctor needs to put the patient first, that was the intent of the hippocratic oath. I will admit though that if a doctor does not believe in what they are doing then the patient may be well advised to seek help elsewhere. Theory and practice rarely coincide in the real world.
kingofpawns 31-Aug-06, 17:19	Hippocratic Oath—Modern Version I think that according to the Hippocratic Oath, the doctor must help the lesbian couple, but apply his/her judgement for other cosmetic surgeries and treatments. Hippocratic Oath—Modern Version: I swear to fulfill, to the best of my ability and judgment, this covenant: I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
proginoskes 31-Aug-06, 20:16	Interesting points, however, mozz: it seems to me that you are arguing that people are traying to make it illegal, and that doctors need to always put the patients health in mind and should not discriminate. You just midunderstand medical ethics - in an emergent situation for any persos all doctors will treat that patient the same as any other because it is about life/death, and health. kop: the health deals with the practice of treating disease, elective procedures like this are not treating any disease A physicians should not be forced to do something to you that is not directly involved with treating disease.
zorroloco 31-Aug-06, 20:42	Deleted by zorroloco on 31-Aug-06, 20:45.
zorroloco 31-Aug-06, 20:46	yes a physician must be allowed to refuse an elective, cosmetic surgery but, only on reasonable basis. for example, being a minor, valid health concerns, or if their professional opinion advises against it for whatever reason. they, of course, should not deny people in any discriminatory manner.
mozz 31-Aug-06, 21:11	jdh71 Poor choice of words on my part with the statement you are referring to. I was not trying to imply any basis in law. Legitimately would have been a better choice in the context that artificial insemination I would consider a legitimate procedure whereas a boob job or a penile enlargement (not on the same person) would not be without some important medical reason.
proginoskes 01-Sep-06, 05:28	jeff Here's some things to think about. Why is the refusal to provide IVF to a lesbian couple, because one does not approve of their lifestyle, an "unreasonable" basis for refusal of said service? What is wrong with making discriminatory decisions? How is IVF any less "elective" than a boob job?
proginoskes 01-Sep-06, 05:29	mozz I'm a little unclear. You think that a boob job and IVF are not the same type of "elective" procedure?
mozz 01-Sep-06, 06:02	JDH No I don't. Due to the eggs inability to make it to the uterus through whatever reason, my brother and his wife underwent IVF to have their daughter. This wasn't a whimsical decision. I consider this very different to a boob job. These women, though are not after IVF (invasive and painful), they are after artificial insemination, a very different procedure. I would also consider reconstructive breast surgery for a cancer sufferer or a breast reduction to be different from a boob job as well. There is no sound medical reason for a boob job. If someone has BDD then they need psychiatric counselling, not surgery.
proginoskes 01-Sep-06, 06:20	what is the "medical" reason for artificial insemination and/or IVF? what disease are we treating?
mozz 01-Sep-06, 06:30	Well For IVF it was endometriosis which rendered the fallopian tubes unpassable. There are a number of others. Artificial ensemination can be for a number of reasons. Possibly sperm was stored before chemo. In the case of the lesbian couple, they were creating a child that would be theirs. Unfortunately for them, this requires donor sperm. Artificial insemination is the only way for this to happen. A medical reason does not have to be a disease. These women are not asking for a medical procedure that is a result of an underlying psychological condition.
proginoskes 01-Sep-06, 06:36	Ok, the medical proedure in question treats no disease. I think we are in agreement there. IVF and artificial insemination do not treat" endometriosis. The endometriosis may be the reason that any female cannot get pregnant, but IVF and AI (artificial insemination) are not treating the endometriosis. By witholding IVF and AI to *anyone* is not witholding medical care because it does not treat disease any more than a boob-job treats disease.
mozz 01-Sep-06, 06:45	I'm not sure I understand your stance here. Are you saying that withholding treatment is OK if the treatment does not treat the underlying disease or condition? That argument could also be used to withhold treatment that treats symptoms and not the condition.
proginoskes 01-Sep-06, 06:55	treating *symptoms* is treating the disease - not being able to not have children is not a symptom of the disease we are talking about, it's a consequence. thre's a difference. let me see if I can make the distinction by analogy: asthma is a common condition that most of us are familiar with because we all know someone who has this condition. Simply it is a disease of the airways that makes the airways over- reactive, causing constriction of said airways, air trapping, a difficulty breathing. Now medicine treats this condition in two ways generally (depending on severety), 1)treats the underlying infamatory process itself, the disease, with steroids, and 2) treats the symptoms, such wheezing, cough, and sortness of breath with direct bronchodialators. Now if one of these folks want to run a marathon and they cannot, is this now a "symptom" of their disease? No it's just a conequence. There may be things that medicine can do to help the asthmatic run a marathon, but it is not withholding treatment of a medical condtion to refuse to try to help an asthmatic run a marathon. Maybe this is more clear?
mozz 01-Sep-06, 07:19	OK, I think we may have our terminology in hand. I still consider IVF and artificicial ensemination as different to boob jobs and the like. With this in mind, I still believe that the doctor should perform the procedure. What they are asking for is legal and not as a result of a psychological disorder.
proginoskes 01-Sep-06, 07:32	On what basis should a doctor be forced to perform such a medical procedure?
zorroloco 20-Sep-06, 11:18	revisited another interesting thread that should be revisited...
softaire 20-Sep-06, 12:32	is there someone out there that would like to have surgery performed on themselves by a doctor who has stated that he would prefer not to do the surgery but is now being forced to perform that surgery because of legislation?
soulcrates 20-Sep-06, 12:35	Yes, I'll volunteer! For someone that wants compulsive medical care. I want to see their faces when I say, "I told you so."

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