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Friday, November 9, 2007

Session 7: Public Comments

Cynthia Merrill

CHAIRMAN PELLEGRINO: We're at that portion which is the public part of the meeting.  We have two people who have signed up to comment, and I would like to ask if there are others who have not signed up, the first opportunity for comment would be to Cynthia Merrill and Jonathan Imbody. 

Now, as they get up to the microphone, let me say that we have limited time for public commentary.  So as always, brevity and clarity and raising the question as concisely as possible is the best way to advance whatever it is you want to say before the Council.  Sometimes people use the commentary to make another speech, but we've heard a lot of speeches today. 

So let me first ask Cynthia Merrill from the University of Richmond to come to the microphone and make her presentation, repetitively, with brevity and clarity.

DR. MERRILL:  Thank you.  I just wanted to go back to Dr. Hardt's talk yesterday about conscience and the doctor/patient relationship.  I'm a family practitioner, and I have been for my lifetime in the trenches of primary care, and I see the conscience problem differently.  The first ethical priority should be the well-being of the patient, and I don't mean by that that the doctor is a slot machine, the patient brings in his money, and the doctor spits out a prescription.

In the case he presented of a man who had had a distant relationship with his wife, no intimacy for more than a year, and had gotten involved in an extra-marital affair and wanted Viagra, we heard about his misgivings, but we did not hear about the patient's needs. 

Erectile dysfunction is a symptom, not a diagnosis, and there's several questions that should have been raised in this interview.  One is unless this was the first time this patient had been to this doctor, he knew what the doctor's feelings about this were because one cannot hide the feelings about this sort of thing.  It radiates from your pores.  So why did he bring it up?  Why did he divulge this potentially risky behavior which could involve disease, a divorce, or other destructions in his life? 

I would put it to you that he expects a consultation and not a judgment, and I think that this doctor was being judgmental in his presentation of the case.  There's multiple causes for erectile dysfunction.  He said the man had a physical, but many of the causes may or may not be elucidated on a physical. 

For example, vascular disease and some subclinical diabetes can cause it.  He could be a closet alcoholic.  That will do it.  A heavy smoker can have problems like this.  He could be chronically depressed.  All of these things need to be addressed, if only to be ruled out. 

And, secondly, he needs to deal with the emotional aspects of it.  What caused the coldness between him and his wife?  Has he been impotent for a long time and that's the basic problem?  And, secondly, could his impotence in this relationship be a consequence of guilt?  He needs to have all these things talked about and not a knee-jerk reaction to give or not give a pill.           

And the last thing I wanted to bring up is, would the ethical doctor treat his erectile dysfunction given it was some physical or psychological cause, knowing that the man might go out and use it for what he would consider to be immoral purposes?

CHAIRMAN PELLEGRINO:  Thank you very much.  Next?

MR. IMBODY: Thank you, Dr. Pellegrino.  I appreciate it very much the discussion and excellent points made yesterday on the issue of conscience, which I'd also like to address and have a practical application. 

The way things are going, some would actually force out of the profession those physicians who have moral objections to procedures like abortion, and that loss of physicians, especially obstetricians and gynecologists who, as you know, are already leaving a practice because of malpractice insurance costs, would have a severe impact on the delivery of healthcare. 

The committee on ethics of the American College of Obstetricians and Gynecologists, known as ACOG, an organization that is officially and politically pro-choice or pro-abortion, depending on which term you prefer, has just issued a paper laying down the rules for when and how and why pro-life physicians may or may not exercise the rights of conscience and mostly about how they may not exercise the rights of conscience.  And a few excerpts from this paper illustrate what I see as a war that's being waged against conscience rights, and, also, how far apart are the world views of those who do have conscientious objections to abortion and those who do not?

ACOG says in its position paper, for example, that physicians may not exercise the right of conscience if that might "constitute an imposition of religious or moral beliefs on patients."  Well, that would seem to mean that any physician who has religiously-based objections to procedure or prescription would be forced to ignore his or her conscience and simply fulfill the patient's demand like a vending machine. 

The ACOG paper also says, "All healthcare providers must provide accurate and unbiased information so that patients can make informed decisions."  Well, that sounds great until you realize that ACOG will only apply this rule to make pro-life doctors offer abortion as an option.  ACOG has actually gone to court to fight laws requiring abortion doctors to offer informed consent information to patients on the risks and alternatives to abortion. 

ACOG also says, "Physicians have the duty to refer patients in a timely manner to other providers if they do not feel they can, in conscience, provide the standard reproductive service that patients request."  So according to ACOG, physicians who see abortion as killing a developing baby have a duty to refer patients to a doctor who will do the deed.

And, finally, ACOG suggests that "Providers with moral or religious objections should practice in proximity to individuals who do not share their views."  So ACOG rules would actually require a pro-life physician to relocate his or her practice to be close to an abortion facility.  And besides the fact that this drastic requirement would only be imposed on pro-life doctors, it would also have the practical impact of removing desperately needed doctors from underserved areas. 

These statements from ACOG would seem to illustrate why the issue of the conscience rights of those who provide healthcare should not and cannot be separated from the issue of healthcare delivery.  Thank you.

CHAIRMAN PELLEGRINO:  Thank you very much.  Any other members of the audience?  If not, let me declare this 31st meeting closed and express my gratitude once more to the Council members for their participation and to the audience for their attentiveness.  Thank you.

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