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Questions from Medical Students / Residents & Answers From Practicing Physicians

Americans United for Life is working on model Rights of Conscience legislation – www.unitedforlife.org

Q. How can pro-life medical students avoid being harassed for our views?

Response from a top pro-life OBG:

If you are harassed by your professors for your pro-life views, write a detailed description of the harassment for legal purposes. Federal Civil Rights Laws protect you. 

Being harrassed for your pro life views is a given.  Expect it now and for the rest of your career. Know your position, and be able to articulate it, be sure it is conscience based.  

Being penalized is what we need protection from.  And we have protection from the Medical Training Nondiscrimination Act of l995, which states:  The federal govt and any state that receives federal financial assistance (and that would be all of them!!) may not subject any health care entity to discrimination on the basis that the entity refuses to undergo training in the performance of induced abortions, to provide such training, to perform such abortions, or to provide referrals for such abortions.

So programs may insist that students/residends must do abortions, but if they so insist, they stand to lose all their government money—and no program could stand that.  So, every pro-life student/resident should be very conversant with that bill, by name, and be able to quote it in your sleep. 

Some suggest writing a statement to have placed in your file. As far as being sure a statement stating you will not do abortions is in your folder, I don't have an opinion on that. 

Should you put such statement in your file before hand, or wait until the issue comes up?  I don't know.  It would only be relevant in your ob/gyn training (whether student or resident), and as long as you know the law, you might just wait to see if the issue comes up.  Or there may be an appropriate time to declare your stand, going into that section of training.  I just don't know .  Having it in there from the first would be good if there was a way to do it that didn't look like you were trying to start an issue.  Might vary with the circumstance. 

As for a lawyer,  I would urge you, if challenged, to contact Alliance Defense Fund, or American Center for Law and Justice, or Rutherford Institute, or Southeast Law Institute.

Q. Is there any information about Residency Programs that may accept those who do not want to participate in abortion training? 

Residency Programs that might Welcome Those who Possess a Respect for the Human Life Ethic:  

I did my training in the military, which is really ideal as an  OB doctor.  Abortion is strictly forbidden in federal hospitals.  Most programs that I know of will provide a way of getting training in performing abortions if the resident requests it, but never in any circumstances was I forced to be part of an (elective) abortion procedure.  I can't speak for the all of the programs necessarily (though the law is the law), but I did my training at Keesler AFB in Biloxi, MS and was very happy with the "protection" from abortion
procedures.  I know that the military is not an option for everyone, but for those to whom it applies, it's nice to know you'll have one less ethical dilemma to deal with.

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OB-GYN Residency
Genesys Regional Medical Center
Grand Blanc, Mi  48439-8066

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St. Louis University residency program 

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University of Kentucky in Lexington. 
We do not do abortions in our hospital and have no abortion training.   

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Concerning the residency question.  Walter Reed Army Medical Center in DC. Military residencies – all of them – are not allowed to do abortions.  It doesn't matter what your personal vantage point is, one can't do them in a federally supported facility.  Not to be too self-serving, but we have a great program as well.

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The Mercy General Health Partners Osteopathic OBGYN Residency. We take two residents per year.  (Mercy General Hospital, Muskegon, MI; affilliated with Michigan State University)
 
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SUNY Buffalo. In fact most residents did NOT perform abortions. (80-90%)

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The Ohio State University OB/GYN residency. Even though it has people in it who do abortions, residents are never required to do abortions, only know how to deal with the complications of induced abortions.

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Lehigh Valley Hospital in Allentown, PA. 4 residents at each level.

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The GRAMEC OB/GYN residency program in Grand Rapids, MI. 

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Milwaukee Ob/Gyn Residency.  

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There were no requirements to perform or experience abortion.
Carilion Health Systems OB/Gyn in Roanoke, VA.

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Good Samaritan Hospital, Cincinnati Ohio

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Mercer University, Memorial Health University Medical Center, Savannah,
GA

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Residency program at Univ. of TN – Knoxville 

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Medical Student Program for Elective Rotations
http://www.choicesmc.org/pages/help/medicalstudent.php 

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Residency Program Review
This is a list of available Family Practice and Obstetrics/Gynecology Residency Programs with comments from applicants describing how much the sponsoring organization is willing to accomodate NFP-oriented residents.
The comments can be read by clicking your cursor over the cell where a comment has started. The full comment will then appear along with the name and contact information for the commentator; move to other cells to view more comments.
    

 

[Below are some suggestions from physicians for a particular medical student which may or may not be of help to others.  They are simply offered as food for thought and as a starting place…]

Dear Physicians For Life,

I am a 3rd year medical student and was wondering if anyone could give me advice on how I could avoid having to give contraception to patients during my clinicals. My classmates tell me that they are instructed to give prescriptions for the pill to patients. I believe contraception is immoral and unhealthy.

RESPONSES:

Tell this student that…slavery ended with the Civil War. He MUST be well aware of ALL the contraceptives and their actions, but he can defer prescribing them to someone else. He is never solo as a student. Tell him to know the contraceptives so well that he can answer any questions, but also know…the evils of artificial contraception. It comes up in my Emergency Practice and I just say NO, I don't write the pill. You cannot right a wrong with another wrong. This is my religious belief and it is protected. Charles H, MD FAAEM

Contraception is a difficult issue…For me I don't prescribe OCPs to unmarried women unless it is for a medical problem. OCPs are a license to get pregnant for most teens.
Scott L, MD

I would advise this individual to make his/her moral beliefs known to the preceptor of the rotation ASAP. They can help to keep this person out of this situation….also, it may be necessary that this person share this information with patients on an "as needed" basis. If this is the way this person believes, then it is important to get comfortable in being able to convey this in a tactful manner to patients for not only the present, but throughout a career.

I know of no easy answer to that 3rd year medical student's dilemma. But I would encourage him/ her to stand by his/her beliefs and just say no! There are certain situations where hormonal replacement may benefit the patient such as a woman with polycystic ovary syndrome or a young anorexic woman who doesn't ovulate and doesn't have menstrual periods. Unfortunately, most of the prescriptions for birth control pills are for contraception.

It has been reported in the medical literature(and indeed is listed in the PDR) that hormonal contraception can increase a woman's risk for stroke, deep venous thrombosis, myocardial infarction, and in a diabetic, can decrease glucose tolerance and increase insulin resistance. Therefore diabetes, hypertension, clotting disorders, smoking, and age >35years are considered contraindications to birth control pills. There was an article in JAMA last year which suggested that birth control pills may increase the risk of breast cancer in women who have 1st degree relatives with breast cancer.

Furthermore, when hormonal contraception fails to block ovulation, it is an abortifacient (aborting drug) because it changes (thins) the endometrium so that the embryo is unable to secure a good implant and is thus aborted/killed.  I believe this is how the morning after pill Preven [and Plan B] works.

Birth control pills also fail to prevent pregnancy 18% of the time according to a study. I would recommend that the 3rd year student read NEJM article "Timing of sexual intercourse in relation to ovulation" December 7,1995 Volume 333 No. 23 pp 1517-1521. For most people, I believe NFP is the safest method of "family planning". I would encourage that 3rd year medical student to learn about Natural Family Planning (NFP) so that he/ she can recommend this for his/her future patients (The Couple to Couple League,#513-471-2000, P.O. Box 111184 , Cincinnati, Ohio 45211; www.ccli.org).

I would remind the 3rd year student that hormonal contraception does not protect against sexually transmitted disease (STDs) and that he/she should counsel his/her patients against premarital or extramarital sex and not be a party to it. I would recommend that this 3rd year medical student try to garnish as much support as possible. He/she should expect to face some ridicule from recalcitrant colleagues. Enlist the help of his/her local pastor and other physicians in his/her community. 
Anne B, MD

Dear 3rd year medical student,

My best advice is to be up-front with the physician who is in charge of that rotation for the month, even at the risk of getting a lower grade. Pray before you speak to that person and then tell him/her how you feel that you can't prescribe them because of moral and ethical reasons. Be prepared to offer an explanation b/c that may happen and you may have to speak to more than one director. From my own experience, don't just wait and try to get around it every time the issue comes up by making another student write the rx., etc. Just be up-front from the start- you may be persecuted; but Christ is with you, take comfort.
Best wishes, Maria M, M.D.  [Consider contacting (262-523-6201) www.cathmed.org

Americans United for Life is working on model Rights of Conscience legislation – www.unitedforlife.org