kate_nepveu: sleeping cat carved in brown wood (Default)
Kate ([personal profile] kate_nepveu) wrote2012-03-22 06:08 pm
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Upsetting but important things

You know, I was going to make a post about how the intersection of the news lately (particularly Trayvon Martin's murder) and the bridge of a Decemberists song nearly had my crying in my car yesterday evening, but the point would just be what the subject line says, and this gives you more time to read the links.

[*] Yes, I saw the doctor guest post over at Scalzi's. I actually found it more depressing than anything because of the comments, and not even the predictable derailing ones, the "for the first time I feel some hope!" remarks. Seriously? One anonymous doctor arguing for civil disobedience after one of these horrible laws has passed—the efficacy of which I have considerable doubts regarding—and suddenly everything's sunshine and roses? What-fucking-ever. (Especially given the entirely unjustified assumption by many commenters that the anonymous doctor in question was male. Yeah, we've never seen that pattern before.)

turnberryknkn: (activism / politics)

[personal profile] turnberryknkn 2012-03-23 07:47 am (UTC)(link)
I'm not sure I agree with where Amanda Marcotte is coming from. Let me posit a different theoretical example:

Until 1973, LGBT sexual orientation was officially a mental illness, and classified as such in the DSM, the central manual of psychiatric illness. There are many who continue to insist that LGBT orientation is a mental illness, and so advocate for "treatment".

So suppose they passed a law that said doctors like me should be required to report and refer LGBT patients for "counseling" to "treat" their LGBT orientation, before we provide them with other necessary mental health care services, like intervention for suicidal depression. The law's backers would argue that it if I had a patient who was schizophrenic and suicidally depressed, failure to treat the schizophrenia would be malpractice; so having a LGBT patient who was suicidally depressed and failing to "treat" the LGBT orientation would be equally inappropriate.

Borrowing Amanda Marcotte's logic, she would probably agree with me that required involuntary referral of LGBT patients to "treatment" for their LGBT orientation as the price of getting other necessary mental health care was an outrage. But Amanda would, if I follow her logic, then argue that, ultimately, regrettably, compliance with the law would be the most "practical" solution. Because if I don't comply with the law requiring me to refer LGBT patients for "corrective" therapy, if they catch my doctored records and failure to report, I could have my license stripped and my ability to provide further care denied. That the greater good of continued access to potentially life-saving mental health care for LGBT individuals willing to submit, is worth the regrettable cost of partial violation an LGBT patient's right to choice and privacy and imposition of "treatment" for their LGBT orientation. That the act of civil disobedience of failing to force LGBT patients to get "treatment" for their orientation isn't the answer.

I would counter that Amanda confuses the point of the civil disobedience in this case. She's right that some forms of civil disobedience are specifically to provoke a public reaction -- the civil rights lunch counter sit-ins are a classic case. But in the hypothetical example above, the civil disobedience I would be engaging *isn't* about garnering public attention. It *isn't* about flipping the government the bird. It's entirely about not demanding my patients submit to something ethically unacceptable, as the price of the care they need.

The civil disobedience in question -- the lying in medical records to say I made the referral for LGBT therapy, when I really didn't -- is about providing necessary mental health care -- the intervention for suicidal depression, for example -- *without* also forcing my patient to undergo invasive, demeaning, and illegitimate "therapy" for his/her sexual orientation. Yes, if I do that, I open myself to the possibility of prosecution and being shut down for failing to obey the law. But the law is morally wrong. And demanding my patients submit to it -- submit to invasive, illegitimate "therapy" as the price of receiving the services they need, or turning them away if they can't accept that price, is IMO, ethically unacceptable. In such a situation, my duty as a physician is to do my best to help my patients *evade* the law as long as I can, and help as many depressed LGBT individuals as I can, before I get caught.

Amanda's equivalent suggestion -- that I refuse to see those patients who will not allow me to involuntarily refer them for LGBT therapy, so that I can avoid non-compliance with the law and thus remain legally available to those who will swallow the invasion and degradation as the price of getting the other care they need; I don't think that's ethically acceptable, or the proper response. Forcing my patients to choose between unjust submission to an invasive therapy, or not getting care, just so I as a physician can stay on the right side of the law, is not the answer. My duty is to provide necessary care, without demanding ethically unacceptable submissions in return. Outside of the law, if I have to. If the price of delivering necessary medical care legally, is to do ethically unacceptable things; then it's time for me as a physician to stop giving a shit about being on the right side of a wrong law.

(I used the LGBT depression example because I personally can't use the abortion case directly. I won't argue that physicians have an moral obligation to perform requested abortions, because I personally *can't* in my own mind as a physician define an ethically clear distinction between actively terminating an implanted pregnancy outside of cases where continued pregnancy would threaten the mother's life, and killing a born baby (although other colleagues of mine can). It is for that reason that (again, outside of threat to the mother's life) I would not participate in the performance of an elective termination of a sustainable pregnancy.

My opposition to the legislative agenda of the so-called pro-life movement stems from my conviction that banning abortion doesn't actually save babies. There were countless abortions before Roe v. Wade; there will be afterwards. I believe that the only way to actually reduce the number of abortions is to provide enough support that fewer pregnant women will feel like terminating a pregnancy is their best option. Otherwise, you're just driving the problem underground; and worse yet, creating an enviroment where women considering abortion will hide from physicians, rather than engage with us to explore alternative options. Babies will still die when abortion is banned. It'll just become nearly impossible to have the kinds of discussions and interactions with our patients that might enable us to help find alternatives. And if a policy change doesn't advance the goal of reducing the number of abortions, then it is not a policy which I support.)
turnberryknkn: (life on wards)

[personal profile] turnberryknkn 2012-03-23 03:33 pm (UTC)(link)
Both absolutely true.

The larger question -- which, as you point out, different people can come to different conclusions about -- is whether there is some limit to what they can make one do.

To throw out another example, what if legislators proposed that doctors who provide abortions should be required to brand women who recieve them? Doctors would be "allowed" to use anesthesia, so the branding would be painless; and women would be "allowed" to choose the location of the pencil-head sized brand, such that it could be somewhere -- under the armpit, between the buttocks, the roof of the mouth -- where even sexual partners might not see it. The (insane) theory that having a tangible, permanent reminder of the prior decision to have an abortion, would "encourage" women to make different choices. With enough lidocaine and nerve blocks, one *could* apply the brand without pain; a small enough brand would not cause functional morbidity, and with the right choice of location, it would be overlooked by everyone except the patient themselves. Would Amanda Marcotte also believe doctors should obey that law? Because, really, is a small brand placed under anesthesia any "worse" than a awake forced pelvic ultrasound? Where is the line?

Hard questions. But deeply relevant ones.