A Feminist Approach to the Opioid Epidemic - page 4

Nonmedical prescription opioid abuse (NPOA) is an ongoing problem in America, with data showing an increase in this phenomenon in every state (Paulozzi & Xi, 2008). This phenomenon found its genesis... Read More

  1. by   Julius Seizure
    Quote from JKL33
    4) Lastly, you have presented an idea that may be helpful, and because you see it as decidedly not "paternalistic" you have said that it is a feminist theory. But just being different than a negative manifestation of "paternal" doesn't make something feminist. The opposite of "paternalistic" is positive manifestations of 'paternal'; I certainly hope you agree that there are positives to paternal, just as there are to maternal. Now we are back to square one, where not all things that have to do with "this" are bad, and all things that have to do with "that" are good.
    Quote from Issaiah1332
    "Maternal/Paternal" is likely better wording.
    I agree, but I can understand who you used the terms that you did, since they seem to be what was used in existing literature.

    Example: Feminist Ethics (Stanford Encyclopedia of Philosophy)

    Quote from JKL33
    1) How does feminist theory reconcile the idea that "pain is whatever the patient says it is" (and we should treat it according to what patients say it is) with this: "the masculine approach is one that tends to generate blame, without empathy, and 'tough love' whether that is through the judicial system or evident in the care received?" I'm afraid it does matter, whether you wanted it to or not, because part of your opening statement was that the opioid crisis found it's "genesis and growth within the masculine context of care."

    2) My view, in part, is that the opioid crisis is a direct result of missteps in attempt to quash "paternalistic" control and judgment with regard to the assessment of pain and the prescribing of pain medication. In other words, if you want to talk about this in terms of paternalism, many of us believe this crisis is the result of a sort of paternalism back-lash, if you will. If we must talk in such terms, I would argue that the idea to label a subjective report as a vital sign did not evolve from a masculine or paternalistic mode of thinking.


    You want to say it doesn't matter how this got started but it certainly does, because if your theories are sloppy you risk doubling down on wrong ideas.
    Great points to think about.
    Last edit by Julius Seizure on Nov 25
  2. by   macawake
    Quote from Simonesays
    I have to conclude that it's your phrasing (masculine/paternalistic and feminine/maternalistic) that's been rubbing people the wrong way. Admittedly, I'm not sure if I love it myself. Although interesting in theory, I think it draws attention away from your actual thesis (which seems to be a holistic model of compassionate care, something that most people could probably support). Instead, the focus turns towards stereotypical gender roles and how we might fit in as male and female HCPs within a binary system (maybe why some of the responses have been defensive?).
    I agree 100 %



    OP, I read your post yesterday but I didn't have time to respond. I knew as soon as I started reading it that it would generate a lot of friction. But I think you made several good points, eventhough I personally would have avoided assigning gender stereotype labels to the different approaches to the healthcare provider-patient relationship. The reason for that is twofold. Many people as has been clearly evidenced in this thread, tend to get quite defensive so it's probably not a very effective strategy to convey your message. The other reason is that I'm not convinced that labeling the different approaches as feminine and masculine is accurate.

    That is to say, the masculine ethic of care is strongly concerned a more "hands off" approach to treatment. This duty of justice considers the patient as the sole, responsible party and, therefore, the fundamental agent of change and wellness. The way in which this is carried out is via a power dynamic in which the provider maintains an omniscient, fatherly role that emphasizes provider knowledge and patient obedience. Put another way, the masculine view stresses the notion that strong willpower and knowledge give rise to success. This method routinely omits empathy and patience from treatment and discounts the addiction research demonstrating impaired freedom of will (Vohs & Baumesiter, 2009). The result is a sense of failure and hopelessness felt by the patient.
    The feminist approach highlights the importance of the patient-provider relationship through the exercise of empathy. Central to this perspective is interdependence and the balance of power between the provider and the patient. By maintaining this symmetry, then the provider may foster open-communication, elicit change-talk, and identify barriers and strengths to recovery. Furthermore, the nurse and patient can work together to use those factors to tailor the treatment plan and evoke patient autonomy in a way that increases the chance of positive health outcomes.
    Just a minor point, but isn't it supposed to be either masculine vs feminine or masculinist vs feminist? To me the -ne describes someone's attributes but the -ist decsribes a person who subscribes to the related -ism. If you call a medical or nursing model feminist and state that feminism rocks, you'll likely lose half your audience and perhaps even send them into anaphylactic shock

    I understand the meaning of the word paternal and its male connotation but I never thought of the paternalistic physician-patient relationship in the olden days to be especially "masculine". Instead I've always interpreted paternalism as referring to a parent-child dynamic, rather than father-child. I take it to mean a medical model where the physician, the parent, has all the knowledge and knows what's best for the patient-child and will tell the child what's best for them and how to behave/act, and the patient is expected to obey.

    OP, I think your post was interesting and a lot of what you say has merit, but trying to gender-label the different models was a mistake.


    Quote from Emergent
    I argue that, perhaps my response may very well have a ring of truth. Society, in the last 50 years, has become emasculated. Strong male role models are increasingly rare, with the breakdown of families, feminization of the educational system, lack of discipline of our youth, loss of religious values and delineated moral codes.
    Wow, Emergent. I have about a zillion questions after reading this. You're not the first person that I've heard espouse similar views but I have never understood what it means. I've asked many times but I have never received an answer that I understand. I'm being dead serious here. I'm hoping that you can supply some enlightenment.

    Quote from Emergent
    Society, in the last 50 years, has become emasculated.
    emasculate | Definition of emasculate in English by Oxford Dictionaries

    1 (usually as adjective emasculated) Deprive (a man) of his male role or identity.

    2 Make (someone or something) weaker or less effective.
    What specifically does an emasculated society have or not have compared to society 50 years ago? (I'm not sure what to call that society... Omnipotent family jewels still firmly attached-society? Seriously, what's the appropriate name for a non-emasculated society? ) Patriarchal?

    Quote from Emergent
    Strong male role models are increasingly rare,
    What's your definition of a strong male role model? I guess that I know and see so many men that I like or love and admire, that I'm having a problem understanding why you believe they are becoming increasingly rare. Perhaps our definitions of a strong male differ, which is why I'm asking if you can describe the attributes, personality traits and values that you equate with a strong man.

    Quote from Emergent
    with the breakdown of families,
    What does this mean? What's a broken family? Is it every combination that isn't mother, father and child? As I said, I don't understand what the things you write mean and I don't know how you think/feel. So, I'm asking. Were the old days when a women had no source of income of her own and was forced to stay in an abusive marriage because of the stigma of divorce and the inability to fend for herself financially, better than what we have today in our part of the world? Are two loveless or abusive and/or dysfunctional parents better for a child than two loving and emotionally stable moms or dads as long as the dysfunctional pair is 1 male + 1 female? What is your definition of the breakdown of families?

    Quote from Emergent
    feminization of the educational system,
    What specifically characterizes a "feminized" school system? What does it have or not have that a "masculinized" school system has or doesn't have?

    Quote from Emergent
    lack of discipline of our youth,
    The older generations have been complaining about the terrible youths since the dawn of mankind I'm sure that the generations older than yours had plenty to say about your generation, when you were younger. So what is it that young people should or shouldn't be doing that they did or didn't do, 50 years ago?

    Quote from Emergent
    loss of religious values and delineated moral codes.
    Are societies with a strong religious presence in your opinion inherently better and more moral than a more secular society? Is it religious values that makes a person good? Is religion necessary in order to be good and moral? Or can you also be a good person by drawing your moral code from a humanist persuasion? And I have to ask, are religious values masculine? I'm trying to figure out if this purported emasculation of society is somehow connected to the perceived loss of religious values?

    What are religious values? The ten commandments? The golden rule? I'm a heathen but I'm completely onboard with treating people with respect and kindness and I don't think that murder and theft is acceptable behavior (along with a few other things).


    This is of course purely anecdotal... I've lived in a dozen countries, give or take. Some of them with basically no religious influence, like my own country and others whre religion seemed to be omni-present and most people would attend some kind of house of worship (depending on the dominant religion), on a very regular basis. And let me tell you, the U.S. and one country in the Middle East was were I was hit on more often than a stuck drawer by every married man within a 10-mile radius. Repeatedly. Persistent *****s. So, does religious values equal morality? Personally, I don't think it's religion that makes a person moral or ethical. Some people are religious and "good", some are religious and "bad". Some people are non-believers/atheists and "good", some are "bad".

    I fear that you might think I'm nitpicking with this barrage of questions, but I'm being genuine here. The things you wrote are just catchphrases to me and their true meanings are cloaked in a murky fog.

    What I'm basically asking is; what was so darn good about the 1950's?
    Last edit by macawake on Nov 25
  3. by   wondern
    Good thing we all have some of both masculine and feminine in varying unique and beautiful ways! Empathy has no 'assigned' sex. Does it???
    Every individual is so unique...
    Attached Images ron_empathy-gif
  4. by   wondern
    I do agree love and empathy are the best treatments to help addicts. I found this about dogs and empathy while researching what you said, Issaiah.

    Maybe they could help with opioid withdrawal treatment for dog lovers??? They probably already do, both boy and girl dogs alike, maybe some breeds more so than others too, like people maybe. Here's the link. Enjoy.Special abilities that show how smart dogs are - Business Insider

    PS-Anyone know how to unattach an image please???!
    Last edit by wondern on Nov 25
    Attached Thumbnails
    dog-1-jpg
  5. by   amoLucia
    This post confuses me, I admit. I never heard of NPOA. So I tried to google it. Didn't find anything although I only glanced at google. There is a snarky definition listed by Urban Dictionary. Not what OP meant, I think.

    As I tried to give some serious reading attention, almost immediately I was thinking women commit suicide by poison (feminine) and men commit suicide by gun (or something more violent, a masculine approach).

    Then I had the crazy association of Progressive Insurance's Flo, in that new TV commercial where some man shushes her with "a man is speaking".

    To OP - am seriously "clueless in Magnolia" re your post. I tried. But I will tell you it is one that is well written with background references. I'm thinking thesis/dissertation.

    I wish you well with your career and education program.
  6. by   Mavrick
    Quote from Emergent
    Seriously? Sorry, but this article seems like divisive, stereotyping nonsense generated by the woman's studies dept of academia.

    That bad, bad patriarchy doing everything wrong! Those uncaring men responsible for all our problems.

    Maybe a man will counter with an article claiming that female dominance of the regulatory system is what twisted the arms of the medical community to meet the pain goals of a generation of weaklings, who lacked strong male role models in their lives.
    OP's big goal is to be published. Ya know, the written equivalent of talking to hear yourself talk.
  7. by   CharleeFoxtrot
    Read it, and would like my 5 minutes back please and thank you.
  8. by   SummitRN
    Quote from Issaiah1332
    AThe medical problem, the domineering force in healthcare, largely is. There is a host of research into the paternal nature of the medical model.
    Medicine is still defined paternalism. It's the 80s/90s. Keep drinking that koolaid. How about you provide modern validated evidence based on modern medical education? Things have been changing!

    I cited a paper by Green who builds off of Gilligan, theoretically.
    1. You cited Green who published in a no-name OA journal, in their third-ever-issue. That is not a strong source. You drew on it to focus on this feminine-masculine care split, which the author based on Gilligan's work, citing her popular, but non-peer-reviewed (and often criticized) book from early 1980s... weak again. Your definitions are ill-defined.

    2. You quoted a 1996 paper by Miller who pioneered some pretty cool client-centered care methodologies in psychotherapy in the early 1980s... which is where nursing academia likes to pretend other health fields are stuck IME YOMV. You basically just declare this to be feminist without backing up your claim.

    3. You missed the relevance of the origin of the opioid epidemic. You don't demonstrate that paternalistic or "masculine care" is a progenitor of the epidemic vis-a-vis merely being a potential point of failure in the treatment of addiction (where Miller's work is applicable). Others have postulated that excesses in client-focused care (which you categorize as feminist) in pain treatment are contributory to the opioid crisis. To gloss over such an obvious point when you are making a claim about the positivity of feminism as defined by client centered care is hypocritical.

    Secondly, I'm not an undergrad student. I am, however, a graduate student.
    I was saying you wrote a bunch of supposition based on a weak source and nebulous philosophy. Those are the defining characteristic of a typical graduate (and undergraduate) paper in a nursing theory class. When otherwise well written, such "scholarship" usually receives an A grade, a sad commentary on nursing academia.
    Last edit by SummitRN on Nov 26
  9. by   Here.I.Stand
    I didn't read the articles as they're not linked (and I have about 6.022x10^23 better things to do than hunt for them)... but from the titles I can't tell if there's any causative link between paternalism and opioid abuse/addiction? I see a title about feminist ethics, one about statistics, one about addiction...and the 20+ yr old one about motivational interviewing?

    What has been your experience with paternalism? I'm curious because paternalism has been considered outdated for quite a long time. I attended nursing school in the early 2000s, and we were HEAVILY taught about advocacy and autonomy. The ONE physician who I have heard of chiding a family for questioning the surgeons (for merely pointing out a discrepancy among the POC as told by different team members) was FIRED.

    By contrast, the idea that pain is whatever the pt says it is seems like it would put pressure on the provider to do what the pt wants, even if that goes against his/her professional judgment. (Speaking of **unreasonable** demands.) Don't even get me started on HCAHPS nonsense!
  10. by   Issaiah1332
    Quote from wondern
    Good thing we all have some of both masculine and feminine in varying unique and beautiful ways! Empathy has no 'assigned' sex. Does it???
    Every individual is so unique...
    Empathy does not have an assigned sex, although many studies have concluded that women tend to experience empathy with more intensity.

    Of course we all have attributes regarded as feminine and masculine, but I wasn't describing people. I was describing a system of care. Mostly, the medical model that is still pervasive in which the patient is largely a passive receiver of care.

    This wasn't a personal attack on a sex, individual provider, etc. It was an observation/description of what I see as a systemic problem and a reason to advocate for a certain theory of care.
  11. by   Issaiah1332
    Quote from SummitRN
    Medicine is still defined paternalism. It's the 80s/90s. Keep drinking that koolaid. How about you provide modern validated evidence based on modern medical education? Things have been changing!


    1. You cited Green who published in a no-name OA journal, in their third-ever-issue. That is not a strong source. You drew on it to focus on this feminine-masculine care split, which the author based on Gilligan's work, citing her popular, but non-peer-reviewed (and often criticized) book from early 1980s... weak again. Your definitions are ill-defined.

    2. You quoted a 1996 paper by Miller who pioneered some pretty cool client-centered care methodologies in psychotherapy in the early 1980s... which is where nursing academia likes to pretend other health fields are stuck IME YOMV. You basically just declare this to be feminist without backing up your claim.

    3. You missed the relevance of the origin of the opioid epidemic. You don't demonstrate that paternalistic or "masculine care" is a progenitor of the epidemic vis-a-vis merely being a potential point of failure in the treatment of addiction (where Miller's work is applicable). Others have postulated that excesses in client-focused care (which you categorize as feminist) in pain treatment are contributory to the opioid crisis. To gloss over such an obvious point when you are making a claim about the positivity of feminism as defined by client centered care is hypocritical.


    I was saying you wrote a bunch of supposition based on a weak source and nebulous philosophy. Those are the defining characteristic of a typical graduate (and undergraduate) paper in a nursing theory class. When otherwise well written, such "scholarship" usually receives an A grade, a sad commentary on nursing academia.
    Once again, although the origins of the opioid epidemic may have taken place in the paternal system that I elaborate on, I do not posit that it is the causative agent BEHIND the opioid epidemic. That's simply a strawman.

    The entire point of the article was to advocate for an approach to the treatment of this epidemic, not to cast stones about how it occurred. If I gave an impression to the contrary, then, admittedly, that was my mistake and the consequence of a poor choice of words; but it was not my intent.

    As far as the "pain as the fifth vital sign, catering to patient satisfaction, etc" that has been mentioned and seems to be implied by some of your language- I agree. These are things that are absolutely problems and contributory to the genesis of the epidemic. I don't disagree. If one wants to label them as "feminist" then that's fine. I would say that no matter what theory or lens one chooses to base their practice off of or look through, every patient is an individual and their care may and should fall anywhere on this spectrum as appropriate for the best outcomes.

    That said, however, the patient's active participation in their care within a context that is not perceived as punitive, rigid, nor judgmental is absolutely going to be more effective. This is the basis of therapy and can be exercised with validation, while simultaneously advocating for certain values such as abstinence and wellness.

    This piece was something I see as a companion piece to the last article I wrote about choice, pathology, and the disease model of addiction. Which, I really wish I would've elaborated on because I think it may have illustrated my meaning a bit better. Specifically, the ways in which we value and view choice as a metric for the patient's willingness for recovery. We assign blame and moral claims, label things as "bad choices," and see addiction and relapse as the patient freely exercising the decision to use (IE: "They must NOT WANT to be clean, so what's the point" mentality). This is paternalistic, the sort of thing you see with "tough love." While those same people often demonize the disease model as "enabling" simply because the implication is that their freedom of will is not quite as "free" as people would like to believe.

    With regard to Miller, Yes...I see his approach as compatible with the feminist approach in a lot of ways. You ask that I backup this assertion. I'm not sure what it would even mean to do so. I reference an ethic of care, which the author terms "feminist," and elaborate on what that means. Specifically, I say that it is "in agreement with the feminist perspective." Whether you agree with philosophy in the Feminist paper or not, the paper outlines certain theoretical values. Those values ARE "in agreement" with Miller's work. This isn't an invalid or unsound argument, the premises linearly lead to the conclusion. If you wish to debate the value of those premises, then that is fine; but to claim that I did not backup my assertion is untrue. It's a categorical claim, falling out from the values of one theory and the approach of another. Does that mean Miller's work is "feminist"? Well, not necessarily; but that's mostly a semantic claim. What it does mean, however, is that the values it's based on are compatible in such a way that, given one agrees with what is labeled as a "feminist approach" (clearly, this doesn't mean everyone agrees nor must) is useful for putting the theory into practice.

    As far as your perception of Gilligan's work, that's fine and that is your opinion. It's a philosophical view that I believe would have positive outcomes when put into practice. Not only that, but I believe that the values this philosophy advocates have already been shown to be beneficial as various treatment modalities shown as effective frequently draws on the same premise/values.

    You're taking issue with an adjective, but it doesn't seem readily obvious that you're making a coherent objection to the content. As some have pointed out in criticism of my article, this isn't new. It's "patient-centered care." Which, I agree that it isn't new; but I also hold that there are still many areas that need improved. This is especially true in the case of substance abuse treatment. If you don't like the particular theory I chose to evaluate this problem through, then that is fine.

    Call it whatever you want, but the medical model is slow to adapt. We still stigmatize this population, many people (usually those who do not specialize in this area) refuse to accept the disease model or even acknowledge the neurobiological changes that take place in the context of addiction. So long as this stigma is present, then people will not seek care, those that do will perceive the provider-patient relationship as not therapeutic as a consequence and, thusly, outcomes will not be as positive as they otherwise could be.

    As far as your opinion on the scholarship of my writing, that's fine. You're free to your opinion, I will take your critiques and try to improve off of them. Of course, I generally see an opinion piece like this as a fundamentally different writing style than one may otherwise take in a scholarly journal. I was making an argument for something I believe in. You may see it as a weak one, it may need strengthened to be convincing, but it was never meant to be something that I intended to be on the caliber of being published in a scientific journal.
  12. by   No Stars In My Eyes
    Got several paragraphs into the article and thought one word:

    BUH?
  13. by   Issaiah1332
    Quote from Here.I.Stand
    I didn't read the articles as they're not linked (and I have about 6.022x10^23 better things to do than hunt for them)... but from the titles I can't tell if there's any causative link between paternalism and opioid abuse/addiction? I see a title about feminist ethics, one about statistics, one about addiction...and the 20+ yr old one about motivational interviewing?

    What has been your experience with paternalism? I'm curious because paternalism has been considered outdated for quite a long time. I attended nursing school in the early 2000s, and we were HEAVILY taught about advocacy and autonomy. The ONE physician who I have heard of chiding a family for questioning the surgeons (for merely pointing out a discrepancy among the POC as told by different team members) was FIRED.

    By contrast, the idea that pain is whatever the pt says it is seems like it would put pressure on the provider to do what the pt wants, even if that goes against his/her professional judgment. (Speaking of **unreasonable** demands.) Don't even get me started on HCAHPS nonsense!
    Hello HIS, thanks for your reply. I think you ask some fair questions and raise some good critiques, that I hope I can answer adequately for you. Well, at least I hope I can defend my position adequately. That doesn't mean I will convince you, but I honestly do appreciate criticisms. If I'm wrong, then I certainly don't want to be wrong a moment longer than I need to. Forgive me for not using the "quote" function as usefully as the others, but it isn't easy to do via iPhone.

    "from the titles I can't tell if there's any causative link between paternalism and opioid abuse/addiction? I see a title about feminist ethics, one about statistics, one about addiction...and the 20+ yr old one about motivational interviewing?"

    I elaborated on the first question a bit in a previous reply to another commenter. Evidently, I didn't choose my words wisely and gave the impression that I was blaming what I call the "paternal/masculine" approach for the cause of the epidemic. I definitely was not meaning that. My point was to say that this approach is likely maladaptive for treating substance abuse.

    Your second question: the reason I chose Miller's work is because I see it as foundational in MI (tricky abbreviation in healthcare, lol) and where the values of it were first really laid out. I should've also cited newer research on its efficacy, but I sort of saw it as a given (there is a lot of research out there showing MI as effective in addiction) and really wanted to draw on the parallels between Miller's practical approach and the feminist theoretical approach. Hopefully, that makes a little more sense. I think that is a very fair criticism and an error in my writing style/thought process. I've built my life around psych. and sometimes presume that my audience has to; but this is obviously not a virtue when you're making an argument.

    "What has been your experience with paternalism? I'm curious because paternalism has been considered outdated for quite a long time. I attended nursing school in the early 2000s, and we were HEAVILY taught about advocacy and autonomy. The ONE physician who I have heard of chiding a family for questioning the surgeons (for merely pointing out a discrepancy among the POC as told by different team members) was FIRED."

    When I mention "paternalism" or describe it as something that is can be perceived as "punitive," I am not necessarily meaning that as "rude." What I see as paternal in the medical model are some of the values, their effects on treatment approach, and the resulting provider-patient relationship. For example- we tend to see "choice" as one of the most important values, assign moral claims where they may not be applicable and/or beneficial, and allow this to shape interactions with patients. Keep in mind, my thoughts are specific to substance abuse populations. To be more specific, many see relapse as the patient actively deciding NOT to adhere to treatment, often perceive that patient as weak or not demonstrating a serious attempt for recovery. This impacts the relationship a provider has with this patient, where they may come across as punitive and assigning blame.

    The other side of this is the foundation the relationship is based on, generally, in which the provider is seen as unquestionable, all-knowing, and the domineering voice in treatment. Obviously, the provider does know more about medicine but the relationship often begins in a way that reduces the patient to a passive receiver of that care. There are even many providers that refuse to even accept or acknowledge the neurobiology of addiction, because they see it as "making excuses for and enabling" addicts rather than using these findings to gain insight into the patient's circumstances. Ultimately, the paternal model tends to view the patient as fundamentally an independent agent who is on his/her own after prescribing a treatment.

    Where as the "feminist approach" (admittedly, I hate this term too; but I wanted to remain consistent with the terms used by theorist) is less reductionist, seeing the patient as a cohesive unit of biopsychosocial factors. While it values health and wellbeing, it does so from a place that isn't judgmental and offputting. It values empathy, acknowledges the patient's hardship, and implores the patient's active participation not only in the prescribed care but in forging the treatment plan. The provider-patient relationship is more open, cultivating trust and allowing the patient to exercise their own honesty without fear of being judged or otherwise seen as not wanting treatment or not taking it seriously.

    As I said somewhere else, put another way: this is very similar to the medical vs nursing model. We don't just care FOR the patient, we care WITH the patient. Nursing isn't immune to bias or stigma, but it is holistic and can be very maternal.

    Here's what I am not saying: I am not saying that EVERY INDIVIDUAL operates this way or that we should blame men. These are just adjectives that are used because the exercise of care correlates with associated social norms. I am also not saying that there is no place for implementing some paternal characteristics; rather, we may and even should in certain patients who may be more responsive to this approach.

    "By contrast, the idea that pain is whatever the pt says it is seems like it would put pressure on the provider to do what the pt wants, even if that goes against his/her professional judgment. (Speaking of **unreasonable** demands.) Don't even get me started on HCAHPS nonsense"

    HAHA. Don't worry, I COMPLETELY understand what you are saying and agree. No experience in healthcare can be so easily quantified in a likert scale and just because one has subjective experiences doesn't mean this cannot be evaluated by another person in an objective way (Pain ISN'T always what the patient says or believes it is). We can listen and validate patient concerns. I think this is a good thing, because it fosters communication that may result in gaining additional data valuable for treatment. That said, we can validate but that doesn't mean we agree nor that we can be bullied into providing ANY care the patient wants.

    There's certainly a middle ground or more appropriate positions across this spectrum.
    Last edit by Issaiah1332 on Nov 26

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