Same sex fertility treatment, ethical, legal or discrimination matter?

BlueDevil,DNP, DNP, RN · Nov 25, 2012

As usual, I agree with Ruby, with one caveat. I do think a fertility specialist should, have the right to decline to impregnate an obese woman due to the obvious health risks. Once a woman is already pregnant, one deals with the health issues at hand. However, I do see the wisdom in choosing not to assist a obese, or diabetic, or (fill-in-the-blank with co-morbid complication of choice) female become pregnant, thereby putting herself, the fetus, and the professional's license and Liability Insurance on the line.

mappers · Nov 25, 2012

Know this is an old thread but didn't see any mention of it so here goes.
A year or more ago the WH reversed/repealed a set of religious conscience executive orders issued by GWBII. These EOs allowed healthcare workers to opt out of performing certain treatments/proceedures etc... on religious grounds including many that pertained to gays, lesbians and transgendered persons. IIRC the WH gave as it's reasons that there were enough legal protections in federal statue that provided such workers with protection, and that the current EO served mainly as way for some providers to discriminate against LGBT. For what it is worth reproductive services was one of the issues cited.

This brings up an interesting point. Even though my first reaction to the OP is Yes it is discrimination and no they shouldn't do that, do we as individuals have a right to refuse to do something we find morally wrong? Being devil's advocate here, do I have to provide abortion services if I think it is wrong? Do I have to do blood transfusion if I think it is wrong? (This issue comes up on this board a lot with JW nurses.)

I think it is one thing for the government or another institution to discriminate based on race, sex, orientation, etc. However, an individual? Does a practitioner have the right to refuse to treat people except in an instance of life and death?

If an MD refused to do some elective procedure on me for whatever reason, I have the right to find another MD who will. And, my gut is telling me (as much as I might despise the reason the MD refuses) has the right to refuse to do it.

DoGoodThenGo · Nov 25, 2012

This brings up an interesting point. Even though my first reaction to the OP is Yes it is discrimination and no they shouldn't do that, do we as individuals have a right to refuse to do something we find morally wrong? Being devil's advocate here, do I have to provide abortion services if I think it is wrong? Do I have to do blood transfusion if I think it is wrong? (This issue comes up on this board a lot with JW nurses.)
I think it is one thing for the government or another institution to discriminate based on race, sex, orientation, etc. However, an individual? Does a practitioner have the right to refuse to treat people except in an instance of life and death?
If an MD refused to do some elective procedure on me for whatever reason, I have the right to find another MD who will. And, my gut is telling me (as much as I might despise the reason the MD refuses) has the right to refuse to do it.

Abortion is covered via federal and some state statues that bar facilities getting federal funding or other (local usually) reasons from forcing nursing and or other healthcare workers to participate in that proceedure.

There have been several high profile court cases in the past year or so on the matter including one in both New Jersey and New York City (NYP hospital) where this played out.

Nurses Don't Have To Assist In Abortions, Hospital Agrees

Usually one is asked upon hire and or told of a hospital's policy on abortions and such. You can then inform the facility if you wish to decline participation in such matters based upon moral objections. Most often this is put into writing and remains part of one's employment file.

Being as all this may a hospital does have the right (IIRC upheld via the courts) to staff and or schedule nursing staff based upon patient care needs, not their own personal/moral requirements. Thus a nurse who does not wish to participate in abortions may find herself removed from say OB/GYN and offered a position elsewhere. Facilities claim this is a balance between staffing and patient safety. That is should something happen to say a woman in labour or who is expecting and an emergency proceedure must be done to terminate the pregnancy there isn't time to go hunting down a nurse who has no moral qualms. That is you aren't going to find an OB/GYN or L&D floor staffed totally each shift with nurses who will not perform abortions under any circumstances.

The exception to the above might be Catholic hospitals who adhere to a strict no abortion policy, but even then things *happen* and something has to be done for the patient's health.

As for the rest of other "moral objections" where does one draw the line? Sex change surgery? Reproductive proceedures? Reproductive proceedures only involving gays or lesbians? What about a straight woman being a surrogate for a gay man and or *married* couple?

FutureCRNA?, BSN, RN · Nov 25, 2012

However, I do see the wisdom in choosing not to assist a obese, or diabetic, or (fill-in-the-blank with co-morbid complication of choice) female become pregnant, thereby putting herself, the fetus, and the professional's license and liability insurance on the line.

I've had diabetes for almost 20 years now and had trouble getting pregnant with #2 and ended up using IUI with injectables. That comment made me sad because I sincerely love my kids and I tend to be obsessive, so my blood sugars were in excellent control, during both my pregnancies. In fact, my A1c was at the low end of normal and my babies were 6 lb 13 oz and 7 lb 2 oz. But of course, that isn't always the case.....

DoGoodThenGo · Nov 25, 2012

I've had diabetes for almost 20 years now and had trouble getting pregnant with #2 and ended up using IUI with injectables. That comment made me sad because I sincerely love my kids and I tend to be obsessive, so my blood sugars were in excellent control, during both my pregnancies. In fact, my A1c was at the low end of normal and my babies were 6 lb 13 oz and 7 lb 2 oz. But of course, that isn't always the case.....

For some reason the film "Steel Magnolias" just shot into my mind.

Poor Shelby, but a woman's desire to have an infant of her own often does mean then and now she will risk her life in the process.

As Shelby says: "I'd rather have thirty minutes of wonderful than a lifetime of nothing special."

FutureCRNA?, BSN, RN · Nov 26, 2012

Thankfully, diabetes care is drastically different than it was back then. With tight control (which is the key), complications can be mostly avoided, or at least deferred for years.

Ntheboat2 · Nov 26, 2012

I don't know why anyone would WANT a doctor who obviously judges them for their lifestyle performing any kind of anything on them!

At the same time, I don't see why a nurse would put herself in a position to work somewhere where blood transfusions or abortions are going to be on the agenda.

I personally think it's fine for same sex couples to have a baby, and don't know why a doctor would refuse, but I would suggest simply finding another doctor. It's kind of crazy that anyone can sue a person for something like that. If there was only one doctor in the world who could do the procedure then that would be another story.

I went to the dentist for a consult on having my wisdom teeth pulled one time and had to list my medications prior to the consult. When the dentist came in, he started asking me why I was taking the medication, who prescribed it, and basically just made it clear to me with his expressions that he didn't approve.

I made an appointment that same day with a different dentist. He didn't refuse to do my procedure or anything. I'm sure he would've GLADLY taken my money, but I wasn't about to have to deal with that man again. If it would've been something as huge as getting pregnant...that's a little more intimate..and I DEFINITELY wouldn't want to deal with anyone who I know doesn't approve.

BlueDevil,DNP, DNP, RN · Dec 5, 2012

I've had diabetes for almost 20 years now and had trouble getting pregnant with #2 and ended up using IUI with injectables. That comment made me sad because I sincerely love my kids and I tend to be obsessive, so my blood sugars were in excellent control, during both my pregnancies. In fact, my A1c was at the low end of normal and my babies were 6 lb 13 oz and 7 lb 2 oz. But of course, that isn't always the case.....

I do think there is a stark difference between a judgement that one is unworthy of children, as implied in the OP, and a clinical judgement that a pregnancy is inherently risky and opting not to accept the professional liability therein. By the same token, there is a difference between providing fertility treatment for the 200lb female with a A1c of 6.5 and the 300lb female with a A1c of 13. Savvy?

DoGoodThenGo · Dec 7, 2012

I don't know why anyone would WANT a doctor who obviously judges them for their lifestyle performing any kind of anything on them!
At the same time, I don't see why a nurse would put herself in a position to work somewhere where blood transfusions or abortions are going to be on the agenda.
I personally think it's fine for same sex couples to have a baby, and don't know why a doctor would refuse, but I would suggest simply finding another doctor. It's kind of crazy that anyone can sue a person for something like that. If there was only one doctor in the world who could do the procedure then that would be another story.
I went to the dentist for a consult on having my wisdom teeth pulled one time and had to list my medications prior to the consult. When the dentist came in, he started asking me why I was taking the medication, who prescribed it, and basically just made it clear to me with his expressions that he didn't approve.
I made an appointment that same day with a different dentist. He didn't refuse to do my procedure or anything. I'm sure he would've GLADLY taken my money, but I wasn't about to have to deal with that man again. If it would've been something as huge as getting pregnant...that's a little more intimate..and I DEFINITELY wouldn't want to deal with anyone who I know doesn't approve.

Methinks the larger issue and IIRC this weighed in on the WH decision was what happens when entire groups of physicans, hospitals, pharmacies and other healthcare providers/services in a community opt out on religous grounds from providing services they have objections to. This is becoming an increasing worry as healthcare/hospital networks in many areas of the country are becoming owned by one or a few large systems.

Say within an local area a Catholic hospital system controls >80% of the market including physican groups, pharmacies and so forth. What would happen then to abortion and family planning services for women in the area? Would they be forced to travel in order to have access to IVF? Abortion?

Ruby Vee, BSN · Dec 8, 2012

Methinks the larger issue and IIRC this weighed in on the WH decision was what happens when entire groups of physicans, hospitals, pharmacies and other healthcare providers/services in a community opt out on religous grounds from providing services they have objections to. This is becoming an increasing worry as healthcare/hospital networks in many areas of the country are becoming owned by one or a few large systems.
Say within an local area a Catholic hospital system controls >80% of the market including physican groups, pharmacies and so forth. What would happen then to abortion and family planning services for women in the area? Would they be forced to travel in order to have access to IVF? Abortion?

I have to say this is something that has worried me for a long time. I'm long past the stage of needing family planning, but it's not just the Catholic hospital systems who are opting out of providing this sort of care. I believe that they hospitals who control the majority of a market still have a responsibility to provide care to the women within the market. If you don't believe in abortions, just don't have one. But don't try to control other people's options!

edmia, BSN, RN · Dec 8, 2012

Given the ever increasing world population (doubled since 1960), increasing pollution, and scarcity of resources, fertility treaments are unethical for ANYONE.

Obviously not a popular opinion, but I agree with you. In fact, the only way to fix some of the environmental problems we have created as a human race, we would need to all agree to only 1 child per family for about 20 years. Never gonna happen, I know, but that would be the responsible human response to our current crisis.

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