Baa-Baa Black Sheep

In my family medicine group, I always seem to have the dissenting voice. And as those of you who are loyal blog-followers know, that voice isn't a quiet one. Recently, one of my co-residents shared a story about a friend of hers in BC who was refused a prescription for the birth control pill. Apparently this physician (not her regular family doctor but a locum while her doctor was on vacation) is Catholic, and prescribing the pill went against his values. She was asking the group if we'd ever heard of this before, and if it was legal.

Well, yes. It's legal. And many of us had heard of it, but more in the case of Plan B (aka the Morning After Pill) than the birth control pill. Quite a few physicans (and pharmacists, for that matter) have been known to refuse to prescribe or dispense the morning after pill under the premise that it aborts a fetus. For those who believe that life begins the moment that sperm meets egg (like that Eliza-bitch on The View... uh, the secret is out. I read celebrity gossip magazines at the gym.) prescribing or dispensing Plan B would be like being accessory to murder. But that's not what I want to talk about.

I know of a woman who was recently faced with a horrible choice. After receiving a high risk result on her maternal serum screen, she was faced with the very real dilemma of whether or not to undergo a second-trimester termination or continue with the pregnancy, knowing that she had a very good chance of giving birth to a baby with a severe developmental delay. She opted to have an amniocentesis, in spite of the 1% risk of miscarriage, to confirm whether or not baby actually had the chromosomal abnormality. Baby was fine. But that's not what I want to talk about either.

When this woman was weighing her options, she learned that a second trimester termination, regardless of the indication for it, wasn't available in her hometown. She doesn't exactly live in a rural area-- her town has a population of over 100k people, but she would have had to travel 3 hours to another centre. The reason that this procedure isn't available is because too many nurses had opted out of it. They found it "wrong". Even in the case of a severely deformed or damaged fetus that would be unlikely to survive more than a few hours after birth, these nurses have decided that it is wrong to abort a fetus after 12 weeks gestation and have been given the option to absent themselves from this aspect of their work. Once a critical number of nurses decided not to assist in this procedure, the hospital eventually was forced to stop offering this service altogether. So now this incredibly difficult and emotionally devastating process has to be done while she stays in a hotel in a strange city, away from her support system.

No one uses second trimester abortions as birth control. They are difficult procedures, both emotionally and physically. And like any termination (in my opinion, anyway) it isn't easy to perform. I've never taken any termination I've attended lightly, even the ones done at 10 weeks where the fetus is barely distinguishable from the other products of conception. But is it really ethical to take the choice away from women simply because nurses don't want to participate?

The other family medicine residents believed that it was perfectly within any health professional's rights to refuse to participate in a treatment or procedure that they find morally objectionable. I was, once again, the outlier. I believe that if our refusal to participate in said treatment compromises a patient's access to it (such as the case of the woman in need of the termination, less so for the woman requesting the birth control pill) that it then becomes immoral to abstain from providing it.

As health care providers, sometimes we have to put our personal feelings and judgements aside for the benefit of our patients. Am I judging the 16-year-old who is pregnant with her second child? Sure I am. But I'll treat her threatened miscarriage the same as the 29-year-old married woman who had been trying to conceive for 5 years. And the alcoholic who cracked his head on the sidewalk outside of the pub? He'll get the same suture job as the child who fell off her bike. Because even if I'm secretly thinking that the person I'm treating is a waste of oxygen, no one will ever know I'm thinking it.

So to these nurses who refuse to participate in second trimester abortions? You became a nurse. You chose obsterics and gynecology. You don't get to pick and choose the parts of your job that you enjoy and refuse to do the ones you don't. If that were the case, I'd spend my time in emerg treating actual illness and not the drug-seekers, the addicts and the drunks. Sure, second trimester abortions aren't pleasent. Neither are the early abortions, for that matter. But for women to have a choice, someone has to do it. And if we as health care providers keep passing the buck on the grounds of moral objection, that freedom of choice is in real danger.