Is it really ok that some GPs can refuse to prescribe the MAP

[msrisotto]

Or refer for abortions? They are legally protected due to their religious rights.
Just coming out of the thread where two gay chaps were refused a double room at a B&B due to the owners religious bigotry. B&B owners lost the legal battle as they are running a business and are not legally allowed to discriminate against who they provide a service to based on their sexuality.

But GPs are allowed to refuse a particular service to women on religious grounds? Is that ok? Really? Anyone?

Doctors are allowed to refuse to refer for abortion, but must refer to another doctor who is willing to consider it (if the woman meets the criteria, ofc, which most women will do by virtue of making an appointment to say that they don't want to continue with their pregnancy).

Midwives are allowed to exercise conscientious objection to the administration of abortive medications (e.g. misoprostol) but are not allowed to opt-out of any care that a woman undergoing termination of pregnancy requires.

So, for midwives, they can ask for another midwife to insert a pessary, say, but can not ask that another midwife is assigned to the woman.

Tea US newcaster Rachel Maddow calls it the "Amish Bus Driver" rule. If you're Amish, your religious beliefs prohibit you from driving (or even being in!) a car or bus. Fine - that's absolutely fine, you're free to believe and practice that belief. But if you, Amish person who cannot sit behind a wheel and drive because of your beliefs, apply for a job as a bus driver ... YABU! And YABVVU to then sue the company who, rightly, won't hire you because you can't/won't drive - for 'discriminating against my religious beliefs.'

If you're not prepared to give women the full range of reproductive health care, fine, but don't advertise that you're a medical professional who gives comprehensive care. At the very least I want some kind of plaque in your waiting room and notice on your website that says "I don't refer for abortions or prescribe the morning after pill" - that way I won't waste my time trying to see you, and I can find someone else.

This makes me cross.

My dh is a GP. He does not prescribe the MAP or refer for abortion because of conscience.

However, he provides immediate trauma care, first responder to emergencies in the community, home hospice for dying patients, evening appointments, early morning appointments, is a specialist in mental health issues, plus providing top quality care in all areas (I know, I know some of his patients and I've seen his appraisal reports).

If a patient asks for MAP or termination referral, he never lectures, just says sorry, I don't provide that service, please see Dr X who does.

Should he resign? In his health board area, it would be hard to replace someone with his set of skills. And he's never had a complainant about this part of his service or any other and that's damn rare for a GP!

If "the doctors" are causing unnecessary delays, then report them: they are breaking guidelines and doing wrong. What is the current estimate of the number of mishandled cases?

But the Amish bus driver example of course does not apply here. The current legal/contract arrangements means no one is doing anything forbidden, and it is not unreasonable to exercise this existing conscience clause.

weegiemum I'm not saying he should resign.

I would prefer it if he were clear about not providing the full range of reproductive health care, though - much quicker to get a direct appointment with Dr X, than get one with your husband, find out he can't help me, and have to make another one with Dr X (including getting another afternoon off work at a very stressful time, possibly costing me money if I do shift work, etc).

So wrong, it will always be issues that affect women that the religious will choose care about. All religions have so many edicts of what we should and shouldn't do.. how many are really followed? How many really concern people?

Agree with Blackcurrants, if a GP wishes to opt out of providing this sort of care it should be made very clear to all women patients at that surgery.

weegiemum if your husband performs first responder care..what happens when he meets a woman who has just been raped? He doesn't want to give her the MAP? That goes against his conscience?

Would it also be Ok for Jehova's Witnesses to not send a patient for a blood transfusion?

I think it's quite right that GPs shouldn't have to provide a particular service based on their conscience. But it should be made known the the practices patients.

If someone has been raped they need a specialist service, not a GP. He would offer help and reassurance and refer on to a specialist rape service (which is available) ASAP.

Blackcurrants - he would get them an immediate appointment with Dr X, no need for extra time off. Or, for map they can go direct to A&E.

Nah he's opting out of doing his job IMO.

weegie from my experience with doctors, though, immediate means 'next available with Dr X today' - or 'wait until Dr X's current appointment is done' or 'we'll catch Dr X in twenty minutes' - whereas if I knew that your husband (who I'm sure is a lovely man and great at other areas of care) didn't provide full reproductive health care, I could just go straight to Dr X. Which would save me at least half an hour, and incidentally free up your husband to be seeing a patient for whom he could/would offer care. So surely, if people like your husband are open and upfront about the areas of female healthcare they don't/won't do, it actually helps everyone?

I'm not suggesting all doctors who won't prescribe the MAP or refer for abortions be struck off, after all. I'm saying people who strongly believe that they shouldn't do these things, should be strongly open about it, so that patients can make an informed choice, do what's right for them, and save everyone time and money.

As for going straight to A&E - as if that were ever quick! If I could go straight to a doctor who'd prescribe it, wouldn't that be more straightforward and free up vital NHS emergency resources, etc?

It just strikes me as a good idea that doctors whose beliefs prevent them from providing all aspects of female reproductive healthcare share this information with their female patients before their female patients come to them in their time of need, and have to find others to help them. Surely it'd save everyone time, energy, pain, etc?

I agree. What about ectopic pregnancies weegie? Or does that come under abortion too? What about when a woman could genuinely die?

I think that's fine weegiemum, as long as he makes sure that patients at his surgery know about his opt out before they need that service.

The time to find out that your GP is against MAP/TOP is absolutely not in the middle of a consultation - no matter how nice he is about it.

I have a friend whose termination was delayed by almost 2 months by a less scrupulous GP unfortunately. He got away with it because he did a right number on a vulnerable 17 year old and made her feel like a dirty, shameful waste of space. She was hardly about to find the nerve to report him to the GMC. Shame his delicate feelings didn't run to basic human kindness.

What happens in a very small, rural area? Where there may only be one doctor for miles? What happens then?

It is not actually a religious clause, it is a moral one. It is part of the Abortion Act as part of the reason SOME doctors were opposing the act was because they felt it was against the principle of "first do no harm."

Very few opt out, but for those who do it is a right enshrined in law.

(But lecturing a woman against abortion is firmly against the rules).

Some people who are anti-abortion are not religious.

The time to find out that your GP is against MAP/TOP is absolutely not in the middle of a consultation - no matter how nice he is about it.

Absolutely.

Totoro that's an area of concern. There are some women (say, with DC under 5 who they have to bring to their appointments, or who do poorly paid work/ shift work that they can't easily leave to get to appointments) for whom it would be very tricky.

The time to find out that your GP is against MAP/TOP is absolutely not in the middle of a consultation - no matter how nice he is about it.

Agree. But I have no idea how I would find out my GP's views on this without said consultation.

Re. ectopic pregnancies - I had a bit of bleeding when about 9 weeks pregnant with DS, and my GP suspected an ectopic pregnancy. She got me an immediate appointment at the early pregnancy assessment so that they could do a scan to check it out. I would imagine that's normal practice for suspected ectopic pregnancies, regardless of the doctor's feelings on abortion. I can't imagine the GMC looking on it kindly if a patient died because a GP refused to refer a suspected ectopic pregnancy just in case it might result in an abortion.

this has made me think that i am going to check to see if any of my gps hold this view and if they do then i shall refuse to see them actually.

i think it is ok to opt out as long as they arrange for the woman to see another dr IMMEDIATELY, and i mean immediately, even if that means squeezing her in between other appointments, she should NOT be made to wait because a dr morally objects to her treatment. i mean it wouldnt happen for any other treatment ie can drs refuse to treat alchoholics or drug addicts, what male treatment is comparable? it does discriminate against women and makes an already fraught/stressful experience worse.

when you sign up at a gp surgery it should be made clear to you that certain drs will not refer you for treatment/give you the map. to turn up to an app (which was prob a pita to get and the woman is probably already feeling emotional) and be turned away is WRONG!!

and yes for me it would be a pita, for an app for the map or for abortion (which i have thankfully not needed, apart from the map once) i would have to arrange an app when i could get childcare, around school runs etc, its logistically a pita and for most app i take at least my toddler with me as its so hard to arrange them around dps shifts that i only do it if i REALLY need to.the map or for an abortion would be a situation where i would really need childcare in place, so to ahve arranged it and then be turned away i would be VERY cross.

*makes mental note to check with drs surgery if any of my gps object to map/abortion and if so to put them on my do not see list.