Discrimination and Choice

The case of the Michigan pediatrician who declined to take as a patient the newborn child of two lesbians moms, instead referring the family to another doctor in her practice, is being raised as a picture perfect example of why anti-discrimination laws are needed. As Dr. Vesna Roi explained in her letter to Jami and Krista Contreras, “After much prayer following your prenatal, I felt that I would not be able to develop the personal patient doctor relationship that I normally do with my patients. I felt that was not fair to the two of you or to Bay [the baby]. I felt that you deserved that type of relationship and I know you could get that with Dr. Karam.”

This is a grayer area than forcing bakers, caterers and photographers to provide expressive/artistic services in celebration of same-sex weddings. Access to medical care strikes deep chords. In a better world, Dr. Roi wouldn’t have felt this way. But with an anti-discrimination statute, would the Conteras and their baby be better off with a surly and resentful pediatrician? But what about families who don’t have medical options?

More. In the end, medical care should not be denied on the basis of minority status. Whether this requires government intervention is quite another matter, and there is a convincing case that the better response is censure by the American Medical Association, which holds that:

“A physician may decline to undertake the care of a patient whose medical condition is not within the physician’s current competence. However, physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, gender identity or any other basis that would constitute invidious discrimination.”

That said, in a non-emergency situation where there are choices, why would you want the doctor who doesn’t want you?

Added: Censure by a licensing organization brings social stigma and can limit practice opportunities. To some, apparently, that’s insufficient and the power of the state must be brought in through anti-discrimination statutes to impose confiscatory financial penalties (which if unpaid lead to the threat of incarceration). Sorry, I don’t feel that the iron fist of the state is necessary in this and similar situations.

Added: For the record, the health practitioners’ credentials at Eastlake Pediatrics include Vesna L. Roi, D.O, and Melinda E. Karam, M.D. So Dr. Roi is not a medical doctor but Dr. Karam is. This makes the demand that Dr. Roi be the primary pediatrician—in lieu of an actual M.D.—seem even more strained.

(And if that is not the objective of the lesbian moms, as some responded indignantly, then what is—that Dr. Roi not be able not to take their child as a patient, which is somehow different from insisting that Dr. Roi be their child’s doctor?)

A further note: The American Osteopathic Association covers sexual orientation in its anti-discrimination provisions, but Dr. Roi does not list the AOA among her associations. She does list the American Academy of Pediatrics, which also prohibits sexual orientation discrimination in its ethics code. I’m betting Dr. Roi wishes she had just said she was too busy to take on new patients.

45 Comments for “Discrimination and Choice”

  1. posted by Houndentenor on

    I agree that the family is better off with a doctor who isn’t a bigot. And I have to wonder what other prejudices cloud this doctor’s judgment in less obvious ways. Fortunately there were other doctors available, but what if this were a rural community with just one doctor? I find this behavior highly unethical and frankly bizarre. Does she really think that it’s a violation of her religious beliefs to treat a child raised by two moms? Is that what anti-gay bigotry has come to in America?

  2. posted by Tom Jefferson III on

    This particular family had (assuming that this particular narrative is entirely truthful) no problem finding and getting into another — more professional — PEDIATRICIAN. It sounds like that their was not much of a doctor-patient relationship to begin with.

    Their are two main problems here;

    1. Medical ethics generally frown on allowing one’s personal biases or prejudices to meddle in the doctor providing professional care. A system whereby professionally trained doctors or nurses or social workers can decide to only treat “saints” with professional care, treatment and respect, should raise all sorts of red flags.

    2. If we say that their should be some sort of exemption — in a civil right code that may or may not cover LGBT people — how does that work? Can surgeons refuse to treat gay people? Can Jewish doctors refuse to treat Muslims? Can Republicans refuse to treat Democrats?

  3. posted by Tom Jefferson III on

    Again — the narrative — suggests that the doctor referred them to another less-bigoted doctor and did so because the bigoted doctor was sooo deeply concerned about the need to have a good doctor-patient relationship.

    Is Dr. Karam in the same hospital or is the family now going to have to make a long drive?
    What happens if Dr. Karam has her own set of religious or political objections to the parents or their baby?

  4. posted by Doug on

    When brought up in previous discussions, as I recall, doctors not treating LGBT patients was pretty much labeled ridiculous. Now according to Stephen it’s a ‘grayer’ area. Pretty easy to see where the evangelical right wants to take this.

  5. posted by mark j on

    I deeply question Dr. Roi’s morality, her humanity, her Christianity and her medical ethics.

    Still, I am glad she realized she is a total c*nt and shouldn’t be taking care of the children of gay parents.

    One of the problems is that she felt the need to proselytize to these parents and tell them that she couldn’t provide medical care to their child because they are lesbians.

    Instead, she could have simply made up a reason (balancing workload) for the change in primary care physician. But no, she had to preach. And luckily, in this case, there was another doctor who wasn’t a bigot who could care for this child.

    That isn’t always the case. And I worry about the GOP’s push for laws that allow religious exemptions to helping gay people because there often isn’t an option.

  6. posted by Tom Scharbach on

    My view is that Dr. Roi acted correctly in removing herself. No doctor can ethically take on a patient if his/her personal biases would so cloud his/er profressional judgment as to make it impossible to render a standard level of care and medical judgment. Dr. Roi found that her personal prejudices would prevent her from providing a standard level of care for the child, and that undertaking the child’s treatment could have endangered the child. In those circumstances, Dr. Roi would have breached every principle of her profession had she agreed to treat the child under those circumstances.

    Dr. Roi’s letter to the parents, however heartfelt, indicates a level of self-importance and self-abosorbtion that gives me pause, leading me to wonder whether she should find a way to practice that does not involve direct, sustained contact with patients/parents. If the letter is any indication, her “bedside manner” skills are sorely lacking.

    The difficulties of gays and lesbians in finding doctors who can/will provide standard levels of care is well documented. Although the issue is less pronounced than it was a few decades ago, the problem persists.

    But most of the problems surrounding provision of adequate medical care to gays and lesbians are created by medical ignorance — an insufficient level of knowledge to know what to ask, what to look for, and how to recognize what is being seen. Those problems are different than the case presented by Dr. Roi.

    Non-discrimination laws are not going to help in this situation; adequate medical/psychological training (both in the medical school and in ongoing professional education) might help.

    Medical care is different than baking a cake, taking a wedding photograph or putting together flower arrangements. For all the argle bargle we’ve been treated to about “creative expression” and whatnot, cake decorating, wedding photography and flower arranging do not involve anywhere close to the level of professional training/judgement that is involved in practicing medicine. The tasks demand, at best, skilled craftsmanship, akin to the skilled craftsmanship of a tool and die maker.

    I have much more sympathy with a doctor who recognizes his/her own inability to live up to the standards of his/her profession, and is unwilling to endanger patients as a result, than I do with a self-aggrandizing baker, wedding photographer or florist.

    • posted by Mark Peterson on

      I’d agree that this case is different than a public accommodations case: a doctor as bigoted as Dr. Roi likely would–if only at an unconscious level–provide substandard treatment to a child of gay or lesbian parents, with potentially life-altering effects. But I’d be a lot more comfortable with this case if Dr. Roi’s office currently had some sort of public notification that she refuses to treat the children of gay or lesbian parents. The secret, unwritten policy–doubtless unwritten because otherwise Dr. Roi’s practice would lose patients–is unfortunate.

      As to Stephen’s bizarre “creative expression” argument–the logical corollary is that public accommodation laws can never apply to married gay or lesbian couples. Surely by these standards a restaurant could refuse service to a gay or lesbian couple for an anniversary dinner, since to do otherwise would compel the chef’s “expressive/artistic services in celebration of same-sex weddings” as the chef prepared the meal. And a hotel could refuse service to a married gay or lesbian couple for a weekend getaway, since to do otherwise would compel the maid’s “expressive/artistic services in celebration of same-sex weddings” as the maid prepared the room for the couple’s use. There’s a reason why anti-discrimination laws never were given the kind of exceptions for which Stephen yearns–the exemptions would nullify the laws.

    • posted by Mike in Houston on

      I think that the AMA would probably disagree.

      The AMA’s principle VI states that a physician may choose whom he or she wishes to treat…. but there’s a caveat:

      Opinion 9.12 of the Ethical Code, however, states that “physicians who offer their services to the public may not decline to accept patients because of race, color, religion, national origin, sexual orientation, or any other basis that would constitute invidious discrimination”

      This is not a case of having a conflict of interest (treating a relative), but one where the physician in question, in my view, acting unethically and unprofessionally. She admitted that she could not follow the Hippocratic Oath or Ethical Code. Her error was not just the lack of treatment that was already contracted for, but that she did not let her patients’ know before taking them on that her “religious beliefs” precluded her personal treatment of anyone who was LGBT.

      To quote from the AMA Journal of Ethics, “Professional Demands and Religious Observance”:

      By taking the Hippocratic Oath, a physician pledges to always do the best he can for his patients. The physician must decide what is best, based on medical knowledge and current practice standards in conjunction with the patients’ understanding of their own best interests. Religious beliefs or teachings of the organized religion to which a physician belongs should not enter into his or her clinical judgment of what is best for a patient. To let religious beliefs influence clinical judgment would be a disservice to the patient and a breach of the Oath.

      Further discussion in the Journal’s, “Unethical Protection of Conscience: Defending the Powerful against the Weak”:

      Health care professionals who place their own religious or moral interests above their patients’ health care interests experience an especially unethical conflict of interest because physicians enjoy the power of a legal monopoly over the provision of medical services.

      • posted by Mark Peterson on

        My apologies: I hadn’t realized the AMA’s ethical guidelines carried the same force as public accommodations laws passed by a state legislature.

      • posted by Tom Scharbach on

        I think that the AMA would probably disagree.

        Given the information you provided, Mike, I think that is probably right.

        However, I suspect that there is an underlying assumption in Opinion 9.12, the assumption that a doctor refusing to treat a patient on those grounds could provide a standard of care to the patient who is refused.

        Dr. Roi’s letter, it seems to me, made it clear that her biases were so strong that she could not provide the same standard of care to the child of a same-sex couple that she could and would provide to the child of a straight couple.

        I suspect that would influence an AMA ethics decision in this case, but I don’t know.

        Thanks for providing such detailed information. Reading the information you provided, I wonder if Dr. Roi should be practicing medicine at all, except, perhaps, in a situation in which she is not involved with patient care.

        • posted by Fritz Keppler on

          I understand that Dr Roi is a Doctor of Osteopathy rather than an MD and probably not under the jurisdiction of the AMA. Do DO’s have a similar organization providing ethical guidance? I don’t know, but I presume they would.

          • posted by Fritz Keppler on

            (My understanding comes from a post on Facebook with her name and DO after it, rather than MD)

          • posted by Tom Scharbach on

            I assume that they do, but I don’t know, either. Doctor Roi does not seem to be a member of any medical associations, although she is Board Certified as a pediatrician, and affiliated with a number of hospitals, which, presumably, have policies that might bear on the situation.

  7. posted by Doug on

    Do any of these so called right wing evangelical christians actually think Jesus would have turned his back and/or discriminated against anyone? History says no.

    • posted by Francis on

      Funnily enough, you and Pope Francis are in agreement on the matter.

    • posted by clayton on

      In point of fact, Jesus healed the sick, thereby providing a model for Dr. Roi. She should get a Bible and a sheet of paper, and go through the gospels, very carefully noting all the people Jesus refused to heal because of their sin. Then she should hang this blank sheet of paper on the wall as a constant reminder.

  8. posted by Houndentenor on

    Here’s the part I don’t understand. Why would she ever tell the parents why she didn’t want to be their child’s doctor? Why disclose this information at all? People take a pass on clients they don’t want to deal with all the time and they do so without being assholes about it. Why is it just the fundamentalist Christians who have to make sure that you know that the reason they won’t cater your wedding or treat your child or whatever is because you are gay. It’s not enough for them not to do it. They have to make sure that they tell you that they think you’re an unworthy human being as well.

    • posted by mark j on

      Houndentenor, what is the fun of being Christian if you don’t get to openly judge and belittle others?

      You are right, of course, that Dr. Roi could have easily passed this patient along to a colleague. Doctors do it all the time. But of course, none of this is about protecting an individuals right to religious freedom. It is about forcing a militant brand of Christian theocracy on the entire country.

  9. posted by Thom on

    What I don’t understand is why anyone would want to give their business to someone who despises them. In a market economy, my greatest power is how I choose to spend my money. Certainly in an age where online reviews and social media can immediately spread the word on which proprietors welcome our business and which ones do not, we should do a little research to see where our dollars are valued and focus our energy on allowing the market to do it’s job. I realize on principal businesses shouldn’t be able to discriminate, but there are other ways to win the war without wasting time on incessant lawsuits and constantly playing the victim card.

    Of course I’ve never understood why people live in parts of the country that treat them so badly. I moved away 26 days after I graduated high school and never looked back. But that’s just me…..

    • posted by Tom Scharbach on

      Of course I’ve never understood why people live in parts of the country that treat them so badly. I moved away 26 days after I graduated high school and never looked back. But that’s just me …

      I can’t speak for anyone else, but I live in a small rural town because I prefer living in a community where people know each other, rub up against each other every day, and find ways to live with each other, to the anonymity and indifference of urban life. I live on land settled by my great-great-great grandfather, have deep roots in this place, and that is part of it, too, but my decision to live where I live is largely driven by quality of life issues.

      I’ve lived in both rural and urban environments, having spent 25 years in a “Lakefront Liberal” neighborhood of Chicago. I didn’t experience much difference in terms of being “treated badly” (by which I assume you mean putting up with the annoyance of anti-gay remarks and incidents of one sort or another) between the two. If anything, I encounter less visible antipathy living where I now do than I did in Chicago.

      Granted, I could have largely avoided any unpleasantness in Chicago had I chosen to confine myself to the “gay ghettos” Hyde Park, Lincoln Park and Andersonville, but I never placed much value on living in a comfortable bubble, isolated from the world around me. And once you get out of the “gay ghettos” in Chicago, you are definitely outside the bubble. I suspect that is true in most supposedly “gay-friendly” urban areas, as is evidenced by the fact that almost all of the “public accommodations” cases that have become a cause celebre of late come out of urban areas.

      I wonder, Thom, if you aren’t looking up the wrong end of the horse. It seems to me that the question should not be why gays and lesbians choose to live where they choose to live, but instead why gays and lesbians can’t choose to live wherever they want to live, free of discrimination, violence, and harassment.

      Whatever you may think about that observation, the days of the “gay ghetto” are gone, anyway. Many (if not most) gays and lesbians have long since moved out of the “safe areas” and into the real world.

      It is there that the battle is playing out, and the end game will take place.

      • posted by Thom on

        For the record, I have never lived in a gay ghetto and never would. I merely meant living in a state that affords me some sense of equality and/or recourse – I was not speaking to how my neighbors treated me. With marriage equality a few months away, it’s clear that right-wing controlled states are going to start rolling back any sort of protection they can. In a perfect world, yes, we’d all be treated equally without fear of harassment and violence. But that utopia in many parts of the world (and sadly this country) are a long way off. Maybe I’m a wimp, but I have neither the time nor the energy to try and convince people in Mississippi (or Uganda) that I deserve equal rights. I’ve been fighting for decades and frankly I’m exhausted. The younger generation can fight the next round – I’m all tuckered out.

        • posted by Tom Scharbach on

          I’ve been fighting for decades and frankly I’m exhausted. The younger generation can fight the next round – I’m all tuckered out.

          You and me both. I’m 68 now, and I’ve been at this a long, long time. I’m getting more and more crotchety. I’ve lost all patience with the “we have to win over the social conservatives” crowd, and it shows, I guess.

          I don’t think getting out of the way is a bad thing. The next phase will require more political finesse than the earlier phases. I’m glad to see younger, more politically adept, people taking up the fight.

  10. posted by Tom Jefferson III on

    “My apologies: I hadn’t realized the AMA’s ethical guidelines carried the same force as public accommodations laws passed by a state legislature.”

    I must confess to be a tad ignorant about this matter. However, I believe that every licensed doctor has to belong to the American Medical Association (or is strongly encouraged to do so). It may be different based on the State; i.e. In a some States require lawyers to belong to their State bar association, while and others just really, really encouraged it.

    If pediatricians in Michigan have to belong to the AMA, it possible that this particular pediatrician violated the ‘membership rules’ of t he organization. Although, I would have to see more about what when AMA membership is required and what sort of process is involved within the AMA in terms of membership discipline.

    Lawyers are generally expected to operate (as part of the bar association membership rules) under a similar type of non-discrimination policy, but are also — generally — told (by the State and National bar) not to accept a client if they are really unable to robustly/ethically defend the client. Although, examples of this are typically the decision of a firm as to whether or not it takes cases dealing with abortion or other hot topics.

    I have had a few occasions were a medical service provider has suddenly found it impossible to continue to treat me/offer services after they discover that I am gay (I am not really that out locally, so my public support for gay rights was probably what did it, if anything)

    For example, I saw a dentist for several years now (not often, mind you) and then I got a letter saying that they were sorry but that they could no longer take me on as a patient because — on paper — they had changed which insurances they accepted/too many clients

    Yes, it is entirely possible that I the stated reasons were all that was behind the letter (and I did find another dental clinic in town) but it is also possible that — in a fairly rural and conservative community — word got out that I was (at least) supportive of gay rights (this was when the debate in Minnesota over gay marriage was very public).

    Medical care or dental care is a wee bit more important then finding a wedding caterer or photographer. In a large, urbane city maybe this would not be a big deal or much of a problem, especially if you live in the ‘right’ side of the tracks.

    • posted by Dale of the Desert on

      Membership in the American Medical Association or in individual state medical associations is not required of any physician, and neither is membership in the national boards that certify physicians in various specialties. However, most hospitals require board certification in whatever specialty as a prerequisite for hospital staff appointment and practice privileges. It is the formal policy and standard of the AMA and of the American Academy of Pediatrics (as well as most other medical professional organizations) that physicians may not refuse care to patients on the basis of sexual or gender orientation. Like most other helping professions, physicians are taught throughout their training that a basic element of excellent medical care is the practice of setting aside one’s personal ethical, moral, social, or political opinions in order to focus solely on the needs of the patient (or in the caase of children, the patients’ parents).

      While either a physician or a patient may terminate their relationship, a physician may not abandon a patient, and it is generally preferable that the patient do the terminating. Thus, Dr. Roi would have been on firmer ethical and professional footing if she had told the parents that she had personal of religious problems with homosexuality but promised to do her best to provide good care for their child, regardless of her opinions. It then would become the privilege of the parents to decide whether they wanted to continue their child’s care by Dr. Roi or to seek another, less biased physician.

  11. posted by Dale of the Desert on

    “there is a convincing case that American Medical Association censure is the better response.”

    If there is a convincing case for such, please make us aware of that case convincingly, Stephen.

    In fact, the framework for governmental intervention probably already exists in the State of Michigan, although I’m not familiar with the details of their standards for professional conduct. Were a complaint filed with the Michigan State Board of Medicine, through the Department of Licensing and Regulatory Affairs, Dr. Roi’s license could potentially be subjected to disciplinary action, even revocation. Similarly, investigation by the American Academy of Pediatrics (although not a governmental agency), based upon a formal complaint, could lead to disciplinary measures or even revocation of membership of certification.

  12. posted by Dale McGhee on

    Continuation of my prior post:

    However, in the absence of LGBT anti-discrimination laws at the state or federal levels, someone such as Dr. Roi could argue that she had broken no laws, however reprehensible her conduct might be ethically, and the reality is that state licensing boards or professional organizations such as the American Academy of Pediatrics would be unlikely to impose more than a slap on the wrist, such as a letter of reprimand or a requirement to take a course on professional ethics.

  13. posted by Tom Scharbach on

    Whether this requires government intervention is quite another matter, and there is a convincing case that the better response is censure by the American Medical Association …

    In what way?

    Doctor. Roi (an OD rather than an MD) may not be a member of either the American Medical Association or the American Academy of Pediatrics, but whatever her memberships and affiliations might me, voluntary associations have no control over physician licensing or health care providers in Michigan. That’s handled by the Department of Licensing and Regulatory Affairs, Bureau of Health Care Services, which enforces the Public Health Code.

    That does not mean that government sanction is the only sanction that might be meaningful.

    Doctor Roi is Board Certified by the American Board of Pediatrics, which may have its own standards for patient care, and is affiliated with seven hospitals, which might have standards for affiliation, as well. For that matter, her clinic, East Lake Pediatrics PC Group, might have something to say about her conduct.

    But to argue that “there is a convincing case” that voluntary associations can better handle the matter than the government regulatory agencies charged with ensuring standards of medical care, without actually making an argument supporting the “convincing case”, is just breaking wind and should be treated as such.

  14. posted by Tom Jefferson III on

    The libertarian/Objectivist argument — which seems to be what Stephen is pulling for — is that it is unjust for the government to regulate a private citizen, business, club, or service provider in any way, short of good-old fashion murder, assault, rape or theft and (even then some libertarians are a bit fuzzy on that point).

    Basically they hold that ALL civil right laws that apply to the private sector are unjust and should be gotten rid of (although the Libertarian Party platform is no longer quite as explicit on this point).

    If the libertarian dictatorship (and the Objectivist/right-libertarian movement would almost certainly result in one) arose tomorrow, well, you would have two options to try and deal with this situation; (a) hope that lots of people in the community are willing to boycott the clinic or (b) hope that the clinic itself (or some private professional association) has an policy on the matter that it wants to enforce.

  15. posted by Tom Jefferson III on

    I do not know if the State of Michigan has a civil right law that covers sex-orientation/marital status in terms of providing medical care to patients or the patients children. Even then, I do not know what exemptions may or may not exist. I am pretty sure that this is not covered by the federal law — even ENDA only deals with employment law –.

    I think that situation could have been handled better, but the situation could have turned out a lot worse for the parents/children (and oftentimes does).

  16. posted by Mike in Houston on

    Just one more thought on the whole “discrimination against LGBT people is okay, because Jesus” theme that Stephen keeps bringing up…

    We just got word that a bill has been filed in Texas (like other similar ones in Georgia, Tennessee, etc.) that would criminalize transgender people from using a public bathroom or other single-sex facilities if their “biological sex” doesn’t match the designation of that facility. Violators would be subject to a fine and a year in jail… and, get this… it would also make it a state jail felony — punishable by up to two years in prison and a maximum $10,000 fine — for a building manager to “repeatedly allow” a transgender person to use such a facility according to their gender identity.

    It goes further to enshrine what is already Texas judicial precedent by defining gender identity as XX and XY (never mind that there are variants all over the place on this) — regardless of whether or not a transgender person has gone through reassignment procedures, changed their birth certificate and other legal markers.

    This is where those advocating carve outs eventually get us.

    • posted by Tom Scharbach on

      Just one more thought on the whole “discrimination against LGBT people is okay, because Jesus” theme that Stephen keeps bringing up …

      A gentle reminder, if any is needed, that we are entering the “massive resistance” stage of the struggle for equality. We can expect to see a gazillion of bills chipping away at “equal means equal”, one way and another, for the next decade.

      We will see frontal assaults at the federal level like the Federal Marriage Amendment (introduced by Tim Huelskamp and a couple dozen other Republican representatives) and the State Marriage Defense Act (which Ted Cruz promises to introduce and is backed by several other serious contendors for the Republican nomination), and we will see a wide variety of flank attacks at both state and federal level — rolling back local/county non-discrimination ordinances, “Don’t Say Gay” laws covering the schools, roadblocks tossed into the marriage licensing path, laws making the transgender transistion as difficult as possible, and, of course, any number of variations of so-called “religious freedom” laws and initiatives. We’ll see action in the legislatures and at the ballot boxes in the form of citizen’s referendums.

      I don’t know whether Stephen will back all, most, or some of the efforts to chip away at “equal means equal”, but I think that we can bet that almost all of the political/legislative backing for bills, referenda and amendments will come from Republicans. What effect any and all of this will have on the Republican Party’s “turnabout” on LGBT issues, I cannot predict.

      The thing we have to keep in mind is this: We have been at the fight to end legal discrimination against gays and lesbians for about fifty years now, and we have to stay the course for another ten years, fighting back for “equal means equal”. If we do, we will eventually prevail. If we do not, we will see our gains turned into losses, sooner or later.

      Stephen likes to characterize all this as “the last gasp” of conservative Christians. I don’t think that … I think that it is going to go on for a lot longer than most of us think.

      • posted by Mike in Houston on

        You’re correct — it’s the substitute “gay marriage” for “abortion” strategy… don’t make it “illegal”, just unobtainable.

        In Oklahoma, they are looking to bring back mandatory STD (including HIV) testing before granting licenses… which, of course, takes extra time in process and makes your health information a public record that can be used against you…

    • posted by clayton on

      So the party of small government wants a guard stationed at every public restroom to examine your birth certificate and your genitals before you are allowed to pee.

  17. posted by Tom Scharbach on

    That said, in a non-emergency situation where there are choices, why would you want the doctor who doesn’t want you?

    Nobody wants to deal with a doctor who doesn’t want to deal with them.

    But that isn’t the issue in this case.

    Dr. Roi’s letter clearly states that she believed that, given her belief-set about same-sex parents, that “I would not be able to develop the personal patient doctor relationship that I normally do with my patients. I felt that was not fair to the two of you or to Bay [the baby]”. At other points in her letter, she indicates that she believes that the “personal patient doctor relationship” is critical to providing the standard of care she considers adequate.

    She did not remove herself from the case because she didn’t want to deal with the parents. She removed herself because she knew that, given her biases, she could not provide adequate medical care to the child because of her biases.

    Again, let me say that I believe that Dr. Roi “acted correctly in removing herself”, and that I believe that it was the only thing that she could ethically do.

    She may, or may not, be in violation of other ethical standards and/or medical association guidelines or hospital affiliation requirements — that is for others to decide — but I believe that she did the right thing by removing herself from the doctor-patient relationship in order to avoid risking harm to the child by providing substandard care.

  18. posted by Jorge on

    1. Medical ethics generally frown on allowing one’s personal biases or prejudices to meddle in the doctor providing professional care. A system whereby professionally trained doctors or nurses or social workers can decide to only treat “saints” with professional care, treatment and respect, should raise all sorts of red flags.

    Well said.

    My view is that Dr. Roi acted correctly in removing herself. No doctor can ethically take on a patient if his/her personal biases would so cloud his/er profressional judgment as to make it impossible to render a standard level of care and medical judgment. Dr. Roi found that her personal prejudices would prevent her from providing a standard level of care for the child, and that undertaking the child’s treatment could have endangered the child. In those circumstances, Dr. Roi would have breached every principle of her profession had she agreed to treat the child under those circumstances.

    Also well said.

    My position is that the ethical thing to do is try to the best of one’s ability. I am concerned about the physician’s lack of realization that negative feelings and biases about one’s patients are a condition of her profession–that’s called countertransference in the social services field. I have the same thing in my agency. Things like really conservative religion, abortion, extreme patriarchy, and of course homosexuality come up. I don’t agree with most of my colleages on these matters (which frightens me because I’m supposed to be in a liberal city), and certainly there are bound to be disagreements between social service profesionals and families. But that is not the question. The question is can you provide the service?

    A profesional working relationship involves many things that are personal, and it takes a certain amount of skill to navigate the discomfort well. But I happen to believe that it is more ethical to trip and fall on your face than to try to refuse to work with a family. If you work for the government, you are obligated to provide your mediocre level of service. If you work privately, you provide your mediocre service and grant the family the right to choose a better service.

    • posted by Jorge on

      I suppose I should consider, Tom, that I have had encounters with agencies that demand a very, very, very close and supportive relationship with their clients and patients.

      “We follow them.” “They’re like family to us.” “The continuity of care and support is important.”

      Those agencies are going to ensure the quality of the match, damn the rotation or the letter of the ethics board if they have to. Or else, they’ll provide the doctor with very good supervision or case consultation. And they’ll switch doctors without telling the client the reason–you mustn’t harm the continuity of care and support… oops! See, as I think you point out, that was the doctor’s mistake.

      Oh, I forgot to add race and nationality to my list above. Now, that kind of discrimination is outright illegal, but what if your client is straight out of neo-naziland and wants to work only with a dead fish? There is a way around the problem–assign only your finest employees to the case. Your best employee (or senior caseworker, etc.) will be able to tackle the transference/countertransference obstacles no matter what the demographics.

  19. posted by tom Jefferson 3rd on

    Some people – more then certain folk here may want to think about – do not have many choices when it comes to their health care or that of their children.

    Income and geography are two relevant factors, and it would seem that some people would prefer to force every gay person in America to drive to San Francisco every time they have a health care need or a medical problem….

    • posted by Tom Scharbach on

      Many of us lived through the days when gays (and probably lesbians, too) had to be very careful about picking a doctor, often traveling a long ways to find a doctor who could and would provide a standard level of care unless the gay patient stayed in the closet with the doctor.

      That isn’t much of a problem anymore. Almost all doctors are professional enough to put aside their personal attitudes about sexual orientation to treat a gay patient according to the same standard of care that he/she would accord to a straight, but not all doctors are that professional.

      Nobody wants to return to the days when gays had to carefully search to find a doctor, often a distance away, who would provide adequate medical care, but when a doctor comes right out and flatly says that he/she cannot provide a standard level of care to a patient because of the doctor’s prejudices about the patient’s sexual orientation, what the hell do you do? Let them treat you, knowing that the care you’ll get won’t be up to par? Not me.

      • posted by JohnInCA on

        Maybe “[n]obody wants to return to the days when gays had to carefully search to find a doctor”, but there sure seems to be people arguing that it’s okay if that happens anyway.

        • posted by Tom Scharbach on

          I should probably have said “nobody gay wants to return to the days …”. Religious/cultural conservatives would be all too happy to see it happen.

  20. posted by Dale of the Desert on

    “This makes the demand that Dr. Roi be the primary pediatrician—in lieu of an actual M.D.—seem even more strained.”

    Oh good lord, Stephen, when you’ve dug yourself into a hole, you’re supposed to stop digging. But you just dig yourself in deeper and deeper, and farther and farther from reality. Come over here in the corner where I can whisper in your ear and save you from further embarassing yourself: Dr. Roi IS a medical doctor. DOs (Doctors of Osteopathic Medicine) have the equivalent education and the same licensing privileges as MDs (Doctors of Medicine), in all 50 states.They may graduate from different medical schools, but they have equal professional standing, and they work side by side as equal partners. Just like gay marriages and straight marriages are equal under the law. Equal means equal, whether we’re talking about pediatricians or bakers.

    • posted by Tom Scharbach on

      Dead on. I would add only that no “demand that Dr. Roi be the primary pediatrician” is involved. The couple is working with Dr. Karam now, and has given no indication that they want to work with Dr. Roi ever again. Certainly they would be nuts to do so, but not because Dr. Roi, as an OD, is not fully accredited and competent to practice medicine. She is.

      • posted by Dale of the Desert on

        I think the story of Dr. Roi and this rejected child is not over yet. There are three female pediatricians(*) in the Eastside Pediatrics office, and the overwhelming likelihood is that they rotate nighttime and weekend emergency call for the entire office, as well as covering for one another when one is on vacation. When this child gets sick during those times when Dr. Roi is on call, is she going to refuse to treat this acutely ill child? Send him/her to a hospital emergency room or urgent illness clinic? Or what options will the mothers have when noone from that office is available other than Dr. Roi?

        (*) As a side issue, and although it’s a purely conjectural one, one may reasonably wonder about why every pediatrician in that Eastside Pediatrics office is female. Have there been no male pediatricians looking for a group practice opportunuity in southeastern Michigan? Or might it be that the women in this practice have systematically discriminated against and exluded males?

        • posted by a.j. on

          might it be that the women in this practice have systematically discriminated against and excluded males?

          If they are a medical partnership and the 3 female doctors are partners, then they are co-owners and the lack of male doctors would not be an employer/employee situation covered by Title VII.

  21. posted by RD on

    As a physician, I’m a surprised that the Medical Board of Michigan is not formally investigating. Physicians should be and are held to a higher standard than a business. For a physician to embrace a practice of discrimination based on personal or religious beliefs is an admission that she is unfit ethically. The principal of providing the optimal care that one can do professionally is part of the core of being a physician. She appears to be stating that if she were to provide care for this family, her religion and beliefs will cause her to provide sub-standard care. This concept should be repugnant to both her religion and to her profession. Medical Boards control and enforce this standard.

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