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NWR: ethical dilemma (long)

Okay, I don't usually like to talk about my non-wedding world, but I would like the opinion of you lovely Catholic ladies.

In "real life," I work as a geriatrician.  I see most of my patients in nursing homes.  As a geriatrician, I don't deal with abortion issues as the vast majority of my patients are beyond their reproductive years.  However, I have a new patient who just survived a traumatic car accident.  She is only in her thirties.  She was incidentally found to be pregnant when she was in the emergency room.

On meeting her, she started crying and told me that she doesn't want to be pregnant.  She wants an abortion.

Now, obviously, I don't perform abortions (in addition to trying to be a good Catholic, I also lack the training to perform them).  I have reached out to the woman's primary care doctor to tell him about the situation.  As a physician, I am allowed to decline to perform procedures or prescribe medications that go against my personal beliefs, but I am supposed to refer patients who want them to people who can help out.

As a Catholic, I feel a little funny even referring this woman to an abortion provider.  I know that a referral does not necessarily equate an abortion (she could change her mind or the doctor could decide that she's not appropriate for the procedure), but... 

Delaying the referral could make it so that she needs a more complicated procedure and would probably be medically ethically wrong.  But I also wonder if she is feeling overwhelmed by her recent surgery and accident and whatever else, and she's not thinking clearly through the pain and anguish.  And in my heart, I feel that if both she and the baby survived that horrendous accident, maybe that's a sign that this pregnancy was meant to be?

Any thoughts? 

Edited to remove personal information.

Re: NWR: ethical dilemma (long)

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    agapecarrieagapecarrie member
    First Anniversary 5 Love Its Combo Breaker First Comment
    edited December 2011
    Please please please do not refer her to an abortionist.

    "I don't kill people, but I know someone who does so I'll give you their number".


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    Calypso1977Calypso1977 member
    First Anniversary 5 Love Its First Answer Combo Breaker
    edited December 2011
    i agree with agape.

    this is really tough.

    can you excuse yourself from teh care of this patient?  if that's possible, i'd consider it.  explain to your supervisor your reasons for wanting to be excused - that you feel you cannot refer her to services that she's entitled to based on your beliefs.

    if you cant excuse yourself, is the responsibilty now on the PCP to help her wiht her decision since you informed them?  if not, can you explain your position to the PCP and ask them to take over?

    do you know how far along she is?  is it possible she could be out of the hospital before reaching the "too late for an abortion" stage and then be well enough to figure out what's best?

    have you ever had a similar situation that you could reflect on with an older patient who maybe inquired abotu assisted suicide?  is that even legal in your state?

    i really dont envy you working in the medical field.... there are so many procedures and concepts out there now that violate so much of what we believe.  good luck!!
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    Jasmine&RajahJasmine&Rajah member
    First Anniversary 5 Love Its First Comment
    edited December 2011
    Oh, mica, my heart breaks for you and for this woman (Jesus, protect this innocent child.)

    I agree with agape.  Please, please do not refer her to a doctor who will do this for her.  The resulting sin would also be on your head when you meet our Savior. 

    I imagine you may be restricted from sharing your faith with her and that you probably can't direct her to Birthright?  Sadly, the best option may be what Calypso suggested . . .
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    edited December 2011
    I agree with agape. This is such a tough issue, I am sorry you are going through this. Please don't refer her to an abortion clinic. I do think Calypso has some really good suggestions that way it is out of your hands and you won't have it weighing on your conscience.
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    mica178mica178 member
    5 Love Its First Anniversary First Comment
    edited December 2011
    Thank you ladies.

    I have contacted the other geriatrician with whom I work (although he does not usually come to this particular facility) to ask his advice.  I doubt I can sign off on her care as no one else from our group visits this nursing home, and the poor lady really needs a lot of medical attention for her other conditions.

    I also reached out to the patient's PCP hoping that perhaps he can give a recommendation or at least be the person to make the referral.

    I really don't have similar experiences.  Physician-assisted suicide is not legal in California.  Patients have hinted at it, but its illegality makes my answer easier: "I cannot kill you.  Let's talk about what I can do to reduce your pain and fears."

    I have contemplated just referring her to a normal OB/GYN so that person could make the referral.  I feel a little guilty "passing the buck," but even if I supported abortion rights, since I don't take care of young patients, I couldn't even make an informed referral choice!  This is out of my scope of expertise.

    This is a horrible situation!  I actually spoke with the social worker at the nursing home, and she's having a hard time too, since she's a practicing Muslim, and she is uncomfortable contemplating ordering transportation for this patient as that would be assisting her in obtaining an abortion.  My nurse is a Catholic, so I can't ask her to help either.  What a mess.
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    Bec20Bec20 member
    First Comment
    edited December 2011
    I think your best bet is to refer her to an OB or a midwife.  She can then make a more informed decision and get the pre-natal care she needs if she decides that she wishes to remain pregnant.  Like you have said, even if you did want to give her a referral you wouldn't know who to refer her too.
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    Calypso1977Calypso1977 member
    First Anniversary 5 Love Its First Answer Combo Breaker
    edited December 2011
    i wouldnt look at it as passing the buck... and God understands your dilemma.  He sees you giving this thought and trying to do the right thing.   

    is finding work in a catholic hospital a possibility?  or do catholic hospitals still have to offer services or referrals for abortions?  not that it would help you in this instance anyway, but i'm sure you may run into other issues like this in the future, although hopefully not too often.

    i would straight up ask the PCP to counsel her and make the referral.  technically, she's "his"  (or her!) patient anyway.  maybe doing this will generate a dialogue with you and the patient and you can explain why you had her PCP assist her.  this might lead to her asking for other resources that you CAN provide and maybe have a happy ending.
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    mica178mica178 member
    5 Love Its First Anniversary First Comment
    edited December 2011
    I spoke with my colleague, and he's going to talk with the patient's PCP and OB, and they will make any necessary arrangements.  Thank goodness he is so understanding.

    My understanding is that Catholic hospitals and groups do not perform procedures such as IVF or abortion, so if a woman comes to one and asks for one of those procedures, the provider recommends that she call her insurance company to find out which providers in the network can help her.  In that sense, the provide is not making a referral, he/she is teaching the woman how to get the information she requests.  That would be a good solution for me if my patient wasn't bedridden and wrapped in casts.  She needs a more active advocate for her health care, and I'm glad that my coworker is willing to fill in for me.
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    Calypso1977Calypso1977 member
    First Anniversary 5 Love Its First Answer Combo Breaker
    edited December 2011
    glad it worked out for you....i hope that it works out for this woman.  i cant imagine they'd perform an abortion while she's still recovering from what sounds like pretty bad injuries.  maybe this will give her some time to think.
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    edited December 2011
    Refer her to a psychologist/psychiatrist so she can discuss the emotional side of what is happening. She may not even have a full comprehension of everything yet. Also, refer her to a Ob/GYN as said so that she can recieve the appropriate medical care. As much as we have our views, others are still able to make other choices. Your obligation as a medical professional and as a person of faith is to get her the best assistance possible and leave the rest in God's hands.
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    mica178mica178 member
    5 Love Its First Anniversary First Comment
    edited December 2011
    Thank you ladies again!  The patient's family practitioner and OB/Gyn have stepped in to take over her obstetric care.  I will work on her medical side.  The poor lady is in shock, and I will let her know that she has time to make decisions, she needn't rush into any permanent decisions for a couple weeks at least.

    I appreciate that you all were my sounding board.  It made me feel a little less alone in my concerns and actions.  :)
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    edited December 2011
    Mica178, I see you're in Northern California (me too). I just heard about this place called First Choice - terrible name, but clever marketing, in reality...they are actually a pretty pro-life place. They don't do abortions and try to give good and accurate counsel about adoption and other support resources. I've also heard they do ultrasounds and have the moms-to-be see the ultrasound to show them the reality of the life inside them (most women who want an abortion don't go through with it when they see the ultrasound). Just throwing that out there as a possible option should the issue fall back into your court at some point. Peace, Lindsey
    Warning No formatter is installed for the format bbhtml
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    mica178mica178 member
    5 Love Its First Anniversary First Comment
    edited December 2011
    Thanks Lindsey.  I am praying that I am done with that particular issue.  But thank you for the resource.
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    edited December 2011
    I am in no way in support for abortions but what saddened me while reading the comments on here is that nobody thought of the child's life if a lady who requests an abortion ends up having a child.  What a horrible life to live for most kids who are in this situation - to constantly be reminded that they weren't wanted.  Have some adoption agencies cards' on you in case you run into this situation again. 
    Anniversary
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    Lisa50Lisa50 member
    5 Love Its Combo Breaker First Comment
    edited December 2011

    Your patient deserves a referral to an OB/GYN. 

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    edited December 2011
    Is she physically able to carry the baby to term? What kind of surgeries (and anesthesia/analgesics) has she been exposed to? 
    BabyFruit Ticker Anniversary
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    edited December 2011
    Taking my personal beliefs out of it. The decision about her body isn't your decision to make. If she wants a referral than give her one. You are both trying to make a decision that God should be making. Give her the referral and trust that God will show her the way.
    Anniversary
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    edited December 2011
    holy. crap.

    I will start out by saying I am against abortion.  But.

    You said yourself that you are 'supposed to refer' so do that.  It is not your position to make this decision for her.  If you are uncomfortable, don't perform the procedure.  If you honestly think it's a traumatic event clouding her judgement, can you direct her to a psychologist?  Either way, you have to provide her the resources she deserves.

    If you're not comfortable performing the necessary requirements of your job, find another career.  You are potentiality endangering the mother by delaying your assistance to her.
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    mica178mica178 member
    5 Love Its First Anniversary First Comment
    edited December 2011
    I honestly don't know why people post weeks after the fact without reading through the whole thread.  I found a way to get the patient the resources and care she needed and wanted without compromising my beliefs or her health within the business day.  Yeesh.
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