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Mar 22 2012

It is our duty to refuse

A doctor on transvaginal ultrasounds: where is the physician outrage?

Fellow physicians, once again we are being used as tools to screw people over. This time, it’s the politicians who want to use us to implement their morally reprehensible legislation. They want to use our ultrasound machines to invade women’s bodies, and they want our hands to be at the controls. Coerced and invaded women, you have a problem with that? Blame us evil doctors. We are such deliciously silent scapegoats.

It is our responsibility, as always, to protect our patients from things that would harm them. Therefore, as physicians, it is our duty to refuse to perform a medical procedure that is not medically indicated. Any medical procedure. Whatever the pseudo-justification.

It’s time for a little old-fashioned civil disobedience.

Second that.

37 comments

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  1. 1
    ash bell

    Ophelia, looks like Amanda Marcotte over at pandagon has a different take. Not sure I buy it though…Your take?

  2. 2
    screechy monkey

    I’m not quite as critical of the anonymous doctor, because I think he or she is probably coming from the right place, but I think Marcotte is dead-on about why this “civil disobedience” would be a really dumb strategy.

    And Marcotte’s post mentions that anti-choice women do in fact seek abortions (and in some cases, go right back to the picket lines the next week), but she also alluded on Twitter to the fact that the Lila Rosa types will certainly attempt some outright Breitbartian “sting” operations with hidden cameras.

  3. 3
    Matt Penfold

    I’m not convinced that Amanda Marcotte is right on this.

    A quick check of the grounds for revoking a medical licence in a few US States suggests that not following such a law is not grounds for revocation. Indeed, it would seem following the law and carrying medical procedures that are not medically necessary would be grounds for revocation, since every state I checked allowed for revocation for performing unnecessary procedures, and for misleading a patient.

  4. 4
    Kevin

    Yes, I think that doctors should refuse to obey the law…while challenging the law in court.

    No, I don’t think any doctor found guilty of the law will be found in breach of professional ethics. Opposite, actually.

    You have no idea what kind of a incompetent monster you have to be in order to get your licensed revoked. State licensing boards are in the business of keeping physicians practicing.

  5. 5
    Godless Heathen

    Here’s Amanda Marcotte’s article:
    Why “civil disobedience” isn’t the answer in this case

  6. 6
    Dave

    Clearly, in any particular case, it depends what sort of legal trap has been set for individuals by the legislation itself, and how that plays out in the political and personal contexts of the people involved. But in general, it is the responsibility of any concerned citizen to object to bad laws by any means they see fit. If they choose to go beyond the bounds of law, even bad law, they should do so accepting, as all the great proponents of civil disobedience have accepted, that there will be consequences: arrests, criminal records, loss of income, and so on and so forth. Otherwise there is no law. At some point in the last 20 years, some people seem to have lost sight of this.

  7. 7
    Dianne

    I’m going to disagree with Marcotte on this one. I think civil disobedience is the only way to go on this one for one simple reason: following this law is unethical and the consequences of following it are worse than the consequences of not following it.

    If we let the “pro-life” movement get away with this–let the law stand, follow it, continue to do what we can to provide abortions under increasingly difficult circumstances–they WILL go further. The next round might involve more laws like the one proposed in Tennessee which publishes the name of every physician who performs abortions, under any circumstance, along with enough details about women who obtain abortions to identify them individually. This law will, inevitably, result in women and physicians being murdered. Indeed, that is the point and the purpose of the law, almost overtly. We simply can’t let this go and expect there to be any way to continue to survive.

    Also, hate to Godwin, but I think it’s justified in this case: Following this law would be like agreeing to work in a concentration camp because we’ll be nicer to the inmates than people who would normally volunteer for the job. The TV ultrasound bills are mandating rape. All the US bills are mandating psychological torture. There’s just no way to follow the law and still be acting in a manner that is in the patient’s best interest.

    I completely agree that challenging the law is good. But it is a bad enough law that following it in the mean time, until a challenge can be made, is too unethical to be reasonable.

  8. 8
    F [i'm not here, i'm gone]

    Doctor’s groups (AMA or whatever), and the professional organizations of any other medical personnel involved (nurses, technicians, whomever) should have spoken out right from the start. So should have medical colleges.

    They can still do this now.

  9. 9
    screechy monkey

    “You have no idea what kind of a incompetent monster you have to be in order to get your licensed revoked. State licensing boards are in the business of keeping physicians practicing.”

    Maybe. But a few aggressive “pro-life” board members could change that.

  10. 10
    Arain

    No, that is stupid Dave.

  11. 11
    Arain

    Okay, pandagon’s post is also stupid. I have learned a lot about civil disobedience and government in the last few months from real people who actually do it and know all the ins and outs.

    It is a tactic. This is also about being rational about how much other people can sacrifice. Demanding that doctors “start by providing abortions” is idiotic and will recieved rolling eyes, or worse, some very generous people will take a fall and have massive costs imposed on them unjustly because they were generous enough to do so.

    Attempting to tax the generous in that way is a completely losing strategy. Thank goodness we have people like the anonymous doctor instead of this pandagon person to come up with sensible ideas.

  12. 12
    Adela

    No matter how many times I read Marcotte’s piece it just comes across as insulting acquiescence.

  13. 13
    Godless Heathen

    I don’t know… I’m not convinced that the doctors jobs will necessarily be safe if they resist these laws. Fewer doctors performing abortions is not good.

    Also, is there the possibility of a legal challenge to these laws? If so, on what grounds? Who would have to do the challenging?

    Finally, if the doctors do engage in civil disobedience they’ll need an organized movement of some sort at their back. Individuals disobeying laws won’t have much impact if there aren’t a bunch of people backing them up.

  14. 14
    Dianne

    I’m not convinced that the doctors jobs will necessarily be safe if they resist these laws.

    They won’t be. Their lives won’t be either. But this has been true for many years now. The various new laws and regulations make it worse, but no physician who provides abortion has been able to delude him- or herself that it’s perfectly safe for years.

  15. 15
    AlphaCentauri

    Most doctors would refuse. This would be the tipping point that pushes a lot of them to stop performing abortions. That’s the point of the law. The ones like Kermit Gosnell, who flout both legal and ethical limitations, would continue, and would see their practices grow.

    The other thing that would happen is that pregnancy termination market would be taken over by people who have no licenses or malpractice insurance to lose. You can already buy everything necessary to perform a medical abortion from the same fraudulent pharmacies sending spam for Viagra. Unfortunately, the result of women using methotrexate of uncertain quality is likely to be a lot of brain damaged children whose mothers took too little and a lot of women with serious infections who took too much.

  16. 16
    Godless Heathen

    Right to both Dianne and Alpha Centauri. So, then why encourage doctors to risk even more? Especially when the risk to the public is fewer doctors performing safe abortions?

  17. 17
    Pteryxx

    I dunno, I’ve been gnawing this over and I think the mere fact that a call to disobey was made, might be more significant than whether it’s actually followed in sufficient numbers to accomplish anything that way.

    What I’m also thinking, is that many doctors who USED to perform abortions have been run out of business over the past few decades, like Mila Means. Most of them will still be in practice. Maybe someone will be brave enough to take up abortions again and overtly flout one of these ultrasound laws as a test case. The dissemination of Dr. Anonymous’s article shows just how much public support and attention there is.

  18. 18
    ema

    Thank goodness we have people like the anonymous doctor instead of this pandagon person to come up with sensible ideas.

    Yeah, about those sensible ideas, not so much. “Just don’t do it” is not an option. Both the TX and VA laws make performing a political U/S a mandatory part of *the informed consent to the abortion procedure*. If you perform an unconsented procedure, other than a political U/S that is, you are both medically (malpractice) and criminally (assault) liable. (That’s in addition to the penalties specified in the TX and VA laws for not performing the U/S — loss of license (TX) and a $2,500 fine (VA).)

    As to the “put a fake U/S image in the chart”, that’s a nice fantasy, but in the real world it’s falsifying medical records.

  19. 19
    Adela

    Ema, politicians may have written punishments into the laws for defiance but who gets to enforce them? If enough people say Fuck No Piss Off, then what. Politicians only have the power people let them have and without it they are just useless nobodies putting ink on paper. Police, prosecutors, judges and medical boards could also refuse to punish the doctors and the politicians can do diddly squat about it. So this civil disobedience message needs to spread far and wide otherwise the bullies win. Doctors outnumber politicians and politicians are expendable.

  20. 20
    Pteryxx

    Police, prosecutors, judges and medical boards could also refuse to punish the doctors and the politicians can do diddly squat about it.

    Um, sure, police prosecutors and judges IN TEXAS could choose to treat abortion providers like moral human beings instead of un-Christian slaughterers of the innocent…. but they’re not going to. They’re subject to all the same belief-system biases and good ol’ boy networking as the politicians are. Otherwise, clinics and health care workers wouldn’t have been facing harassment, intimidation and nuisance lawsuits for all these years; and CPCs wouldn’t still have free reign to lie to patients and mishandle their medical information. Just as one example, state health inspectors routinely go over everything Planned Parenthood does and slam them for the slightest violation, while CPCs in Texas have NEVER been investigated by the state in spite of investigations demonstrating CPCs’ violations. One source: (link)

  21. 21
    lordshipmayhem

    I have heard of this before, and I think that we need to get involved.

    Have your family physician, your OB/GYN, your cardiologist, whatever, put pressure on his/her professional organizations, preferably nationally, to come out with an official, publicly-pronounced policy that no legislature in the country can mandate either for or against any procedure or treatment, that the decision of whether or not to proceed with that procedure or treatment is an issue to be decided between the doctor and patient based on the best interest of the patient, backed up by the doctor’s training and experience – “first, do no harm”.

    That puts the line in the sand. Legislators in the western world are rarely doctors, and should not be trying to practice medicine.

  22. 22
    Dave

    I see I was called stupid above. I still have no idea why. Perhaps someone still thinks that politics is a nice game for nice people? If you resist the law by extralegal means – which is what ‘civil disobedience’ is – there will be unpleasant consequences. If you can’t handle them, don’t do it; that doesn’t mean you have give up working for change by legal means.

    Most of what I see here is people calling on other people to break the law in ways that the speakers will never have to contemplate. That is unreasonable. If you feel that strongly yourself, go chain yourself to the doors of the Texas legislature; if you don’t, stop telling other people to do things even more likely to land them in jail or out of work.

  23. 23
    Svlad Cjelli

    The alternatives to civil disobedience seem to include “quitting” and “being a bad doctor”. Is there a third option?

    Also, because my mind does things:

  24. 24
    Dianne

    So, then why encourage doctors to risk even more?

    Because we’ve reached the point where not disobeying the law is overtly immoral. It’s not ethical to perform a procedure on a patient who doesn’t need it. Or to lie to a patient.

    At some point, obeying the law so you can still practice gets to be like saying that you’ll go ahead and work at a concentration camp because you’ll be much more polite to the inmates than anyone else they might hire. I think we’ve gotten there with some of these laws.

    Probably not coincidentally, it’s really easy to get a job in medicine in Texas now. Even places like MD Anderson and Baylor are hiring. Almost like people don’t want to work in a state where the legislature is constantly harassing them.

  25. 25
    kenbo

    Playing a bit of the devil’s advocate here (since I do agree that this law is wrong)…

    What was the response to the town clerk in New York that refused to comply with the law regarding the issuing of same-sex marriage licenses? She was also caught in an ethical dilemma, and she surely felt as strongly about the wrongness of the same-sex marriage law as this doctor does about this law. I remember reading many comments that indicated if she wasn’t willing to follow the law, then she should resign. Would you say the same to the doctor?

    Now, I understand that this is not a perfect analogy, but it seems the attitudes and beliefs involved are similar enough to draw a comparison.

    Just something to think about.

    Kenbo

  26. 26
    kenbo

    Also, before I get pegged as a “concern troll”, I want to let you know that my post above is something I have actually been thinking about by examining my own thoughts and feelings.

    I also recognize that not all laws are created equal, and the ant-choice crowd is passing more and more misogynistic laws in order to limit women’s choices, plain and simple. Conversely, same-sex marriage laws actually enable MORE freedom and equality. Not everyone views the world the way I do, though.

    From my own perspective, if I cannot obey a law in good conscience, I am willing to lose my livelihood rather than adhere to said law (and I have). However, like a few of the posters above, I see these choices as two extremes and am looking for a compromise, if one even exists.

    Kenbo

  27. 27
    Dave

    Everyone can resist in their own way, according to their own consciences. Nobody should be playing the “Let’s you and him fight” game.

  28. 28
    Ophelia Benson

    That’s a fair point; “let’s you fight” is a good deal too reminiscent of WWI white feathers.

  29. 29
    kagerato

    I favor civil disobedience of injust laws generally, and would applaud any doctor who wants to make a clear public stand on the issue. However, because it means losing their job and all the work they’ve put into their career and education so far, I cannot recommend that any particular doctor actually do this. Many have families to provide for and are not in a reasonable position to be risking their livelihood to bring moral, political, or social judgement to the public eye.

    Ultimately, I don’t think it’s realistic to get a large enough segment of any professional class to protest in this manner to defeat the law directly. Instead, if there turns out to be an effective benefit to disobedience, it would likely be using protesting doctors as leaders or focal points for the movement to abolish these unconscionable laws.

  30. 30
    Godless Heathen

    What Dave @22 said.

    Also, Dave @27, what do you mean by “let’s you and him fight?” Is that a reference to telling other people to do something that the teller isn’t willing to do?

  31. 31
    Dianne

    @25: If the clerk in question feels it is so important that gays not be given marriage certificates that she is willing to risk her job and freedom in order to block the possibility then she should keep her job and refuse to hand out certificates. She shouldn’t be surprised if she gets fired, though. Similarly, I don’t think a doctor who refuses to rape a patient when the law requires should be all that surprised if his/her license gets pulled for that refusal. I just think it’s an important enough issue that the refusal should be given anyway. Of course, that’s easy enough for me to say, I’m a hematologist.

  32. 32
    Pteryxx

    Y’know, I think the doctors are knowledgeable enough that they won’t be surprised about getting punished if they refuse to comply. From the Texas Observer piece that kicked off all this discussion:

    “I’m so sorry that I have to do this,” the doctor told us, “but if I don’t, I can lose my license.”

    Source

    They could also be punished for malpractice FOR complying with the law.

  33. 33
    ema

    [W]ho gets to enforce them?

    The Utero-Vagina Inspectors from the Department of State-Mandated Rapes and Assaults, that’s who:

    (a)The [Health] department shall inspect an abortion facility at random, unannounced, and reasonable times as necessary to ensure compliance with this chapter and Subchapter B, Chapter 171.

    On a more serious note:

    If enough people say Fuck No Piss Off, then what.

    At a minimum, the following people would need to be involved: 1) the Ob/Gyn, 2) the clinic/hospital administrator and legal counsel (physician malpractice/assault liability extends to facility), 3) the Ob/Gyn’s insurance company (to avoid invalidating the policy), 4) assorted Health Department inspectors and their superiors, and 5) malpractice lawyers. And it wouldn’t be just x1 per patient. It would have to be x1 per patient x 7 years.

    I just don’t think it’s likely that that many people would be willing to break the law and face the consequences.

    That having been said, I agree with Dianne. As a physician, there is a line you do not cross. You don’t perform unnecessary tests, against the patient’s will, and you do not lie to patients.

    The problem is you can’t just not do the procedure, quit/lose your license, and abandon your patient. It is still your responsibility to provide the care your patient needs in a proper manner.

    How exactly you go about doing that when politicians are allowed to practice medicine without a license and interfere with your patient care I have yet to figure out.

  34. 34
    Echidna

    I think that the law is a trap for doctors who perform abortions. The ultrasound is clearly unethical, but if it’s not done they have you caught as as acting illegally. Easy way of running certain targeted doctors out of the business.
    The AMA is the one that needs to fight this, alongside the general population. The individual doctors have a metaphorical gun held to their heads, and are in a no-win position.

  35. 35
    Svlad Cjelli

    Options, revised:

    1. Harm patient.
    2. Abandon patient.
    3. Potentially be forced to abandon patient.

    Math favours the slim chances.

  36. 36
    peter g

    Nice.

  37. 37
    Infophile

    @34:

    The AMA is the one that needs to fight this, alongside the general population. The individual doctors have a metaphorical gun held to their heads, and are in a no-win position.

    I don’t think it has to be the AMA, but this has to be fought in court. The fact that it puts doctors in a no-win situation means that it’s effectively outlawing abortion, which Roe v. Wade doesn’t allow.

    Sad thing is, that’s what a lot of these legislators want. They’re convinced that if they make the requirements for abortion ridiculous enough, it will go to court, and they’ll be able to get Roe v. Wade overturned. I’m not sure of the outcome if a case does make the Supreme Court, but we’re far past the point where we can simply keep letting them make abortion closer and closer to impossible without making it 100% impossible. They will never stop until they’re forced to.

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