Thought I'd forward along an article that I and my classmate Olivia Campa published in this month's edition of the Sacramento and Sierra Valley Medicine Journal. The piece is a response to a previous commentary (whose author happens to be one of our Faculty) regarding the ever-contentious and hot-button topics of abortion services and physician-assisted suicide. Many thanks to Dr. Nate Hitzeman for his input and assurance that such a response would not torpedo our academic futures with said Faculty.
An Assault on Physician Conscience or Patient Access?
The article “Assault on Conscience” published in the January/February 2011 edition of Sierra Sacramento Valley Medicine describes an impending attack on physicians who do not wish to participate in procedures contrary to their conscience.
Most notably, the author is concerned with potential legislation that would force physicians to participate in controversial services such as abortion or physician-assisted suicide. While the author gives an example of language removed from the recent Assembly Bill 2747, the argument can be made that there are far more real and existing threats to the physician-patient relationship.
We believe that bills have already been passed that threaten a physician’s ability to practice within a “shared moral integrity” and “in a manner that best serves the patient.”
For example, many states have passed a variety of laws to limit the access of patients to abortion services. In Oklahoma, the law requires abortion providers to read a script providing details of the fetus’ development and suggesting the fetus may feel pain during an abortion.1 We students see these punitive state statutes as a far greater threat to physician conscience.
As first year medical students, we are taught to prioritize the safety of our patients, despite gender, race, or age. It is difficult to justify concerns about a near attack on physician conscience when a more unjust attack is already occurring on women’s rights and access to safe and timely care.
A human society does not exist where a significant proportion of women will not, at some point in their lives, seek out abortion services.2 In this country, 1.37 million abortions are performed annually and 52 percent of these abortions are performed in women younger than 25.3
An estimated 43 percent of all women will have at least one abortion by the time they are 45 years old. Black females are three times more likely than white females to receive abortion services, and Hispanic females are two times more likely.
This racial disparity is very much thought to be due to lack of access to preventative care and contraception services — the very services threatened by cutting federal funds to Planned Parenthood.1 Hence, rhetoric cloaked in the guise of physician conscience that serves to limit access to patients seeking reproductive services disproportionately affects minority women living in low-income areas. This is a dangerous step backwards in terms of social consciousness and women’s rights.
Regarding concerns about physician-assisted suicide, shortsighted rhetoric among politicians like “death panels” and “rationing” detracts from a much-needed honest discussion on end-of-life care.
It does not seem likely that a bureaucrat will force a lethal dose of pentobarbital into a physician’s hand anytime soon, while it does seem highly likely that skyrocketing health care costs and inappropriate heroic care will break the back of our aging populace and tech-driven economy in this very decade!
The hijacking of legitimate strategies such as reimbursing for advanced directive conversations, improving access to hospice, and promoting patient centered comparative effectiveness research by politically-driven agendas not only limits our society’s ability to move the conversation forward in how to get the most of our health care dollars, but severely threatens the physician’s ability to best serve the patient.
As first year medical students, we learn to put our own judgment aside in the interest of our patients. We learn to actively listen to patients’ concerns and help guide them through their medical crises. We worry far less about patients dictating their own care than them being afraid to openly discuss their concerns out of fear of judgment. Over four years, we learn history-taking, then physical examination skills, and finally the art of diagnosis. The ability for a provider to connect to a patient in a way that solicits the patient’s trust is endearingly termed “the art of medicine.”
Before we enter into discussions about “poking a vengeful finger in the eye of those whom we disagree” perhaps we should discuss how we as a community of physicians can maintain patient safety while enjoying our work and chosen specialties, how medical educators can increase medical student interest in areas where there is a high need for services, and how best to protect a patient-centered focus in medicine.
— Olivia Campa, MS I
— Adam Dougherty, MPH, MS I
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