Dr. O’Hanlan’s article was thought-provoking and informative, but I found the case vignette that opens the article to be slightly inflammatory. I am left wondering what details were left out.
Does the HMO provide reproductive endocrinology and fertility services to its members? Do the gynecologists who are mentioned offer insemination? Is there a clause in their contracts that exempts them from providing insemination to same-sex couples, or other procedures they may find morally reprehensible, such as elective termination of pregnancy?
I am comfortable with the current wording of the ACOG Code of Professional Ethics. I believe the right balance has been struck. I certainly do not think that the actions of the gynecologists described in Case #1 were discriminatory. My assumption is that they were acting in accordance with their religious and moral beliefs.
Every day, decisions are made in the practice of medicine that are based on what is good for a particular practice, for a particular patient, and for the physician who makes those decisions. For example, a practice may elect to limit the number of Medicaid or Medicare patients it manages because of financial stressors that imperil the survival of that practice. The care of a particular patient may be declined because of self-abuse tendencies that place her at higher-than-normal risk. Or a physician who wants to maintain his or her personal integrity may opt not to perform elective abortion or inseminate a lesbian.
In the aforementioned case, the patient found a physician who did not have the same moral or religious beliefs. A timely referral is all that was called for.
Last, the suggestion that “discipline” was necessary in this case is ludicrous. Any effort to legislate how physicians must behave will be met with great resistance when the rules require physicians to act contrary to their beliefs. In such cases, failure is the likely outcome.
E. David Autry, MD
Hereford, Tex