Medicine is an area of study that is bursting with countless gut-wrenching ethical debates. Throughout our medical training, even in some medical school interviews, we are asked and tested on how we would personally navigate the delicate tightrope of right and wrong.
Trying to maintain equilibrium between our personal beliefs and those that are best for our patients can often be difficult. On one side of our acrobatic act, we are bound by the Hippocratic Oath where, above all else, we shall do what is best for our patient and do no harm. On the other side, we have our personal beliefs including our possible religious and cultural upbringings; creating potential bias on how we see and treat patients.
Historically, I am a medical student who tries my best to avoid conflict and confrontation. However, two recent events have led me to speak out as a medical student, future physician, Christian, and fellow human being.
Abortion is a sensitive topic that often can spark emotionally-driven arguments. Whether abortion is right or wrong will not be directly discussed, as this article is only meant to create a healthy dialogue about how health care providers can be caught between the Hippocratic Oath and one’s personal beliefs.
This past month, while walking a few blocks from the hospital to attend a didactic lecture in obstetrics and gynecology, I happened to walk by an abortion clinic. Many could tell that this was an abortion clinic not by the small free-standing building with dated architecture, or the small sign reading, “women’s clinic” in the front lawn, but by the daily presence of a half-dozen individuals protesting with large pro-life banners. The small crowd would scream out at the women entering the building, calling them “murderers” and stated they were “going to hell.” As I walked by I saw a woman, in her mid-teens, break down into tears, lowering her head and entering the small building as quickly as she could as she was harassed by the group. It was hard for me to watch such hate-driven and judgmental dialogue from a collection of people identifying themselves within the same religion as myself.
Two weeks later I was participating in sign out in the women’s hospital when a resident was telling me about a patient who presented the night before. The patient came to the emergency room in pain after receiving progesterone injections. A few days prior she was at the same women’s clinic I had been walking by, and received an elective abortion using the manual technique of dilation and curettage. When walking out of the clinic she was told by the group that she was going to go to hell and that they could save the baby and help her go to heaven if she took medication- progesterone pills and injections.
The group drove the woman to a physician to prescribe the medication, and she received injections of progesterone in the office. Days later, the woman was now in the emergency room, in pain, with the progesterone pills in one hand and operative report of her abortion in the other. The patient was confused, coerced by a group, and prescribed medicine by a doctor that was not medically indicated, and seemed to be driven by personal bias. No medication was going to return her fetus or decide where she was going in her afterlife.
Hearing and seeing stories like these as a medical student is disheartening. This is not to say that there might have been a miscommunication between patient and physician on what happened with the original abortion, but this reiterates the delicate tightrope metaphor we all walk as medical providers.
Religion and medicine are two beautiful things in their own right. Many times there are cases where the two intertwine and patients and physicians can benefit. However, medical providers must realize that they have a very important responsibility. No matter what one may believe about abortion, or any other ethical issue, there are three primary principles that I believe health care providers should practice.
First, try your best to remove personal bias when providing patients with possible treatments. There are not many fields outside medicine where within minutes of meeting an individual they are entrusted with vulnerable information that has a direct impact on a person’s health. People confide in their physician, and in many times rely solely on their recommendations about life decisions.
Second, recognize and respect the power and impact of the patient-physician relationship. A couple of years ago I met Dr. Ben Carson, a well-known neurosurgeon, author, and Christian. I asked his opinion on offering prayer with patients. He explained that he wouldn’t recommend a physician offering prayer to a patient, as a physician is a person of power. Patients may agree to pray after they are asked even though they feel uncomfortable, trying only to please the authority figure within their health care environment. In the same way, it is easy for our personal beliefs to create bias when presenting patients with treatment options. From termination of a pregnancy to options for adoption- each possibility should be addressed in a straightforward and unbiased manner.
Third, perform and advocate what is in the best interest of the patient, not necessarily what you would do personally in that situation. It is easy to become judgemental and place oneself into a situation, but as a health care provider, you are walking alongside a patient helping them navigate through their health care decision — not making the decision for them.
Everyone in health care has chosen to enter a field where ethical and moral debate can be found in almost every decision. It is our responsibility to uphold the Hippocratic Oath and do what is best for our patients. Instead of being condemnatory, we must walk alongside our patients as they make some of the most difficult decisions in their lives.
In the same way, although easier said than done, those outside of the health care environment should realize that no matter what their own beliefs, physicians have the obligation to do what is best for their patients. In regards to abortion, physicians are often ostracized, criticized, and in rare cases killed because they perform elective abortions. We should, as a society, reflect on the results of such actions. As I told the protesters in front of the abortion clinic that sunny afternoon: None of us are in the position to cast the first stone.
The author is an anonymous medical student.