Another question
SILENCE/AVOIDING THE QUESTION DOESN'T HELP ME FIGURE OUT THE RIGHT ANSWER. I'M NOT SURE WHAT TO MAKE OF THIS ONE, SO PLEASE HELP ME OUT HERE; I NEED TO KNOW WHAT OTHER PEOPLE ARE THINKING, EVEN IF IT IS DIFFICULT FOR YOU TO ANSWER.
If you are shy about answering this kind of question where everybody else can see your answer, then e-mail me privately at bubbsyte@yahoo.com, and indicate that you do not want your answer posted on the blog. I'll respect that, but I would really like to hear what other people think of this.
Another question has come to my attention lately. Call it philosophical, call it religious, or call it whatever you want. All I know is that it is a question that I probably never would have thought of or worried about if I would not be in school. It is this:
If you are (or if you would be) a healthcare provider, would you have any problems with prescribing and/or administering contraceptives to your patients? Why or why not? Maybe first, are you aware of precisely how different types of contraceptives work? On the physiologic level, there is more than one mechanism for prescription contraceptives work; some are hormonal and prevent ovulation, others destroy established zygotes, others inhibit fertilization of the oocyte.
Ok, so I'm sure somebody has to have an opinion on that, right? If you are reading this, I'm sure you have an opinion one way or another, so tell me about it - please. For those of you reading this who are religious, does your church or denomination have a written standard on this, either one way or another, for their members who are healthcare providers? I'm checking into mine. Can you tell me what yours say? What about those of you who do work in healthcare? What do you think of this question? Does your facility have a protocol or a standard of care that adresses this issue? Are you required by law or by your employer to administer contraceptives to patients who request them?
As with all questions I post on this blog, I'm looking for a variety of input from different perspectives, specifically: your opinion. It doesn't seem like all that many people have taken a huge interest in the past questions; or at least there was a minimal amount of response. I'm not asking this one just for the mere sake of asking questions in Soccratic method to get people all fired up and at odds or anything; this one is important because it could potentially make a difference on the future of my employment. As always, if you are not a blogger.com user, look at the instructions above to reply to this blog.
If you are shy about answering this kind of question where everybody else can see your answer, then e-mail me privately at bubbsyte@yahoo.com, and indicate that you do not want your answer posted on the blog. I'll respect that, but I would really like to hear what other people think of this.
Another question has come to my attention lately. Call it philosophical, call it religious, or call it whatever you want. All I know is that it is a question that I probably never would have thought of or worried about if I would not be in school. It is this:
If you are (or if you would be) a healthcare provider, would you have any problems with prescribing and/or administering contraceptives to your patients? Why or why not? Maybe first, are you aware of precisely how different types of contraceptives work? On the physiologic level, there is more than one mechanism for prescription contraceptives work; some are hormonal and prevent ovulation, others destroy established zygotes, others inhibit fertilization of the oocyte.
Ok, so I'm sure somebody has to have an opinion on that, right? If you are reading this, I'm sure you have an opinion one way or another, so tell me about it - please. For those of you reading this who are religious, does your church or denomination have a written standard on this, either one way or another, for their members who are healthcare providers? I'm checking into mine. Can you tell me what yours say? What about those of you who do work in healthcare? What do you think of this question? Does your facility have a protocol or a standard of care that adresses this issue? Are you required by law or by your employer to administer contraceptives to patients who request them?
As with all questions I post on this blog, I'm looking for a variety of input from different perspectives, specifically: your opinion. It doesn't seem like all that many people have taken a huge interest in the past questions; or at least there was a minimal amount of response. I'm not asking this one just for the mere sake of asking questions in Soccratic method to get people all fired up and at odds or anything; this one is important because it could potentially make a difference on the future of my employment. As always, if you are not a blogger.com user, look at the instructions above to reply to this blog.
posted by GKStauffer at 13:18
5 Comments:
I would want to know how the contraceptives work before I prescribed anything. Some contraceptives prevent pregnancy and others cause abortions. In my dictionary, prevention and destruction are two different words and therefore two different issues.
Gerald, I'm not in a field where I manage contraceptives.
However, it is a topic I have learned about. As a medical student at NYU, I was president of my campus chapter of the Christian Medical And Dental Society. At the same time, one of my good friends was president of the campus pro-choice club. She asked me specifically about the question you pose.
Commonly prescribed contraceptives can work through one of three mechanisms. 1. Preventing ovulation 2. Preventing implantation of the embryo.
3. Inducing loss of the implanted embryo.
Though they can work through all three mechanisms, the most common mechanism is through the first one. Therefore the loss of an embryo through failure of implantation or loss of an implanted embryo is a very uncommon event. That being said, it does happen and is a direct result of the contraceptive.
However, the exact same process occurs very frequently when contraceptives are not taken. A very large number of fertilized eggs are either lost due to failure to implant, or due to loss after implantation.
Here is my rational on the matter, though it is one that some may not accept. The primary mechanism of action of commonly prescribed contraceptives is inhibition of ovulation. This process is imperfect and a very, very small number of oocytes escape this inhibition, and an even smaller number become fertilized. The hormonal environment created by contraceptives is inhospitable to the survival of these fertilized eggs, and most of them fail to survive. However, the purpose of this contraceptive is NOT destruction of these embryos but is inhibition of their creation. Loss of embryos is something that will happen commonly whether or not a woman is on contraception, often times without her knowledge. In actuality, a woman not on contraception will lose more embryos due to miscarriages than will a woman who is on contraception. I therefore think that most of the commonly prescribed contraceptives are OK since their primary mechanism of action is prevention of ovulation, not prevention of implantation.
It is just like other things in life. We all know that lives are lost in cars. However, car wrecks are not the primary purpose of cars. Safe transportation is. Likewise, I prescribe a lot of different medications, each of which can take the life of a patient if they have the wrong sensitivity or allergy to it. Yet, I don't stop prescribing them just because they might take the life of such a patient. In the same vein, contraceptives have a very, very small chance of destroying an embryo. That however, is not their most common mechanism of action and their use should not be discontinued just because such a risk exists.
Thank you very much! That's the sort of input that I'm looking for; someone who gives an straightforward answer and supports it with a detailed explanation.
Anyone else have comments? I did recieve one other reply from a person who wanted to remain anonymous.
If I had prescribing powers, my philosophy would be not to prescribe anything that I have convictions against taking. In my opinion, it would be just as wrong to enable somebody as to do it yourself. I haven't done a lot of research on contraceptives, but I wouldn't have a problem taking the ones that prevent ovulation.
I was faced with a similar dilemma when I was in my OB rotation. One of my patients was on an abortive drip due to a prolapsed cord. I also had a patient whose baby had died because her placenta had abrupted. She was also on an abortive drip to pass the baby and placenta. I had a problem with the first one because the baby had not yet died, but I didn't with the second one because fetal death had already occurred.
The nurse I was assigned to was against abortion because of her own religious convictions. She told me that when you are hired to work in L&D, you have to sign papers about your level of participation in administering abortive drugs. You can (1) have no problem at all, (2)refuse to administer the drug, but agree to take care of the patient after somebody else administers the drug, or (3)refuse to administer or care for a patient taking abortive drugs.
So where do you think you would stand on that? By the way, I'm not posting on my blogger site any more. So if you care to reply, you can either go to http://www.xanga.com/sara5750 or e-mail me at sara42134@yahoo.com.
I agree with the differentiation that Sarah made between administering an abortive drip to a mother whose fetus had already died, and to one whose fetus had not died. Also, I would have to pick her option number 3, "refuse to administer or care for a patient taking abortive drugs." I can't think of any situation that would justify aborting a living fetus. Maybe some one who knows more than I do could pose some sort of situation where not aborting the infant will absolutely endanger the life of the mother. If there are any such situations, I would need to research those kinds of cases more closely before taking a stand on how I would proceed. However, any mother who is electively deciding to abort the life of a healthy or even viable fetus will not recieve any abortive meds from me.
This is one of the things that I enjoy about philosophical questions. When you discuss them, it's easy to go in all sorts of directions and get off of the original topic. :-)
In regards to the original question about the use of contraceptives, I did recieve another reply via e-mail, for which I'm grateful. Anita Showalter, D.O. from Oklahoma State University e-mailed this reply, and it is copy/pasted here with permission:
Dear Gerald,
You are asking good questions, and ones that need to be answered by Christians who find themselves in the health professions. I did some deep soul searching while I was in medical school about how I was going to respond to the issue of contraception. I also want to preface my comments with the understanding that dedicated Christians have come out on different sides of this issue. A very wise pastor friend of mine used to explain it this way - when ever there is an issue in the scripture where a certain action is identified as sin (murder, adultery) there is no compromise where we as Christians should stand on the issue. When ever interpretation is needed, because now "we see through a glass darkly" we need to have grace with each other in differing points of view.
If there is any gray area in the whole prolife philosophy, this is where it lies. One can make a great argument for natural family planning and leaving things in God's hands. The counter argument is that God does give us choices, and we need to be prepared to live with the consequences of those choices. For example, if you choose not to have sex, you won't have to deal with pregnancy at all. If you choose to have sex with great frequency, the chances of you having many pregnancies is good. Now, if it is God's desire for you to have children, he will not override your decision not to, so not having children could be against God's will. On the other hand, if you already have more children than you can provide for, emotionally and physically, but you decide to "leave it in God's hands", you will certainly get yourself in a pickle!
I was asked once by an Amish gentleman whose depressed wife with a large family was about to undergo a tubal ligation. He was reading his Bible and asked me what I thought. I told him that I thought God gave him a brain to figure out when having more children would be too much of a strain on their family. He said,"That's just what I think!" While there are many good Christians that would disagree with that statement, the majority would probably agree.
On the issue of types of contraception, or if we decide it is OK to exert our will into procreation, are there types of contraception that are morally wrong? While oral contraceptives suppress the ovary almost 100%, if an egg is released, it can become fertilized but pass through the unfavorable uterine environment. Many people are opposed to OC's for this reason. When I researched the subject, about 1/2 of eggs that become fertilized do not produce a successful pregnancy. That means that if you use the pill, you actually have fewer lost embryos than without anything! The copper IUD has been avoided by some because of its primary role to prevent implantation. Recent studies have suggested though, that the copper produces an inflammatory response that kills sperm on the way through, so even with that, you could potentially have fewer losses. The Mirena (progesterone IUD) essentially blocks sperm from entering the uterus. With that method of birth control the losses would be less. OC's have other health benefits, like decreased ovarian and breast cancer as well as being useful for PMS, acne, dysmenorrhea and other symptoms.
My bottom line is that I think each individual needs to decide for themselves what is morally right. I cannot make the decision for them because I don't think scripture is clear enough on this issue. I mean no disrespect to those who will not use or prescribe contraceptives that could prevent implantation, but in the normal course of life, this happens with great frequency anyway. God knows this because it was part of his design. Whenever I explain this to anyone, I always check my self because I pray that I don't mislead anyone with my advice. Therefore, as a practitioner, I will assist my patients in any method of contraception , but I make sure that they understand the mechanisms of action so they are making an informed, hopefully prayerful, decision.
I don't mind being quoted as long as it's not being raken out of context! I wish you well on your studies and your career in nursing. It is very important to have good nurses and that physicians learn to work with them in a team approach for the best outcomes.
Sincerely,
Anita Showalter, D.O.
Post a Comment
<< Home