Texas bans abortion.

[newyorkguy]

There is nothing in Texas law that prevents OB-Gyns from performing abortions in a hospital setting. Why don't more doctors do that? Even before this law, any doctor could have performed abortions in their offices. Why didn't they? The answer to both questions is the same: Mostly because doctors have a moral objection to it. Abortions have never been easily available in Texas.

I hate to sound like a broken record but do you have a cite for that? Now you're arguing the real problem here is that "doctors have a moral objection" to abortion. How do you know that? And doesn't that actually discredit your previous arguments that it would be easy for clinics to gain hospital admitting privileges if only they'd do a few "relatively minor" facility upgrades?

Hospital administrators have no say in the matter?

What I have seen is, the anti-abortion demonstrations and picketing have been very effective. What hospitals -- especially small community-based hospitals -- want to avoid is becoming embroiled in the abortion controversy. From the news article linked earlier, about the very clinic xjx388 has referred to:

Today, after weeks of failed negotiations with nearby hospitals, Hagstrom Miller announced that both clinics are closing their doors.

 

[xjx388]

Hospital administrators have no say in the matter?

Well, sure they do. But that has nothing to do with the law. And abortions already happen in hospitals and are paid for by insurance when they are medically necessary. The question revolves around elective abortions; that's where people draw moral lines -which they have every right to do. You can't force people to perform services they find morally objectionable.

 

[xjx388]

I hate to sound like a broken record but do you have a cite for that?

Sure. Why don't more OB-GYNS perform abortions as part of their services? Why is it limited to a handful of specialty clinics even where it's completely legal like New York State? Because most doctors don't want to do them.

Now you're arguing the real problem here is that "doctors have a moral objection" to abortion. How do you know that?

Because I know quite a few myself and have spoken with them. And I pay attention to polls like the one I linked to above. And I observe that, for such an easy and safe (other than the death of the fetus, natch) procedure, there sure aren't a lot of docs who provide the service.

And doesn't that actually discredit your previous arguments that it would be easy for clinics to gain hospital admitting privileges if only they'd do a few "relatively minor" facility upgrades?

There is nothing in law stopping hospitals from giving admitting privileges to abortion docs. My wife has admitting privileges right now. If she wanted to start doing abortions today in that clinic that faces closure, she easily could, as could any of the docs in our community. When you understand why none of them have done so, then maybe you'll start to truly understand my point. Since you can't force doctors to perform any procedure they find objectionable, abortion remains a service offered by a very few doctors.

What I have seen is, the anti-abortion demonstrations and picketing have been very effective. What hospitals -- especially small community-based hospitals -- want to avoid is becoming embroiled in the abortion controversy. From the news article linked earlier, about the very clinic xjx388 has referred to:

You are correct but I don't see the problem. Do you think that every community should be forced to have an abortion clinic in it's midst? How would you accomplish that without restricting free-speech, free-association, etc?

 

[cosmicaug]

What I have seen is, the anti-abortion demonstrations and picketing have been very effective. What hospitals -- especially small community-based hospitals -- want to avoid is becoming embroiled in the abortion controversy. From the news article linked earlier, about the very clinic xjx388 has referred to:

You are correct but I don't see the problem. Do you think that every community should be forced to have an abortion clinic in it's midst? How would you accomplish that without restricting free-speech, free-association, etc?

Are you trying to simultaneously say that he is correct (and that you do not see the problem) and that these abortion providers could get admission privileges if they really tried hard enough? If not, your writing might lack in clarity.

 

[Dr. Keith]

There is nothing in law stopping hospitals from giving admitting privileges to abortion docs. My wife has admitting privileges right now. If she wanted to start doing abortions today in that clinic that faces closure, she easily could, as could any of the docs in our community.

The problem here, in Texas, is that most hospitals are related to a church of some sort. You may have heard of out Presbyterian hospital in Dallas, known for its ebola expertise. Because of that your wife does not have such free choices. If she starts doing abortions her privileges will be revoked.

I don't care to delve into your wife's business, but I bet it would be a bit trickier to run her practice if her privileges were pulled.

 

[xjx388]

Are you trying to simultaneously say that he is correct (and that you do not see the problem) and that these abortion providers could get admission privileges if they really tried hard enough? If not, your writing might lack in clarity.

I may not be clear . . .

I am saying that yes, picketing and anti-abortion demonstrations have been very effective. If that stops hospitals in certain communities from giving out privileges to abortionists, then I don't see a problem with that -you can't force hospitals to privilege doctors they don't want to associate with.

 

[xjx388]

The problem here, in Texas, is that most hospitals are related to a church of some sort. You may have heard of out Presbyterian hospital in Dallas, known for its ebola expertise.

Lol, yeah. But Dallas has a few hospitals that are not religiously affiliated and further, there are still abortion clinics open there.

Because of that your wife does not have such free choices. If she starts doing abortions her privileges will be revoked.

There are 4 non-religiously affiliated hospitals within 10 miles of her. She is a partner at one of them and I don't see them revoking her privileges for that. I'd have to double-check the bylaws to be sure, but there's nothing in the partnership agreement that would bar her from having privileges while being an abortionist. A huge group of OB-GYNs are also partners (and a large contingent of FPs who do OB) and if they all decided to open an abortion clinic, I don't think the hospital would stop them. But I know most of them personally and the ones I know well would not perform abortions. One even refuses to refer out.

 

[newyorkguy]

<snip> Now you're arguing the real problem here is that "doctors have a moral objection" to abortion. How do you know that?

Sure. Why don't more OB-GYNS perform abortions as part of their services? Why is it limited to a handful of specialty clinics even where it's completely legal like New York State? Because most doctors don't want to do them.

From your link:

A new study released by the American College of Obstetrics and Gynecology, from main author Debra Stulberg, surveys 1,144 ob-gyns (1,800 were initially approached) to see how many provide abortion services. Though legal, abortion is much harder to come by than one might expect: while 97% of ob-gyns reported having encountered women seeking an abortion, only 14% said they were willing to perform the service.

It doesn't say why they are unwilling. It could be a good percentage of the doctors may refuse to perform them because they fear being targeted by anti-abortionists.

Do you think that every community should be forced to have an abortion clinic in it's midst? How would you accomplish that without restricting free-speech, free-association, etc?

Do I think every community should be forced to have an abortion clinic in it's midst? You make it sound like they're strip joints.

Don't Want To Be Pregnant?
Don't Be!!!!
C'mon In Y'all
Low Rates! No Waiting!
Five -- count' em -- Five doctors
On all call at all times
​

How does establishing an abortion clinic interfere with someone's right to free-speech, free-association or etc? I don't get that.

 

[tsig]

I'll ask again in another way . . . Why are philosophical differences not enough to base laws on? The only reason Texas has to have a "sham law" is because SCOTUS made it impossible for them to make a law based on the real rationale: valuing the human fetus as much as a human infant. You don't even need religion to have that rationale.

And valuing the woman as zero.

 

[tsig]

Sure. Why don't more OB-GYNS perform abortions as part of their services? Why is it limited to a handful of specialty clinics even where it's completely legal like New York State? Because most doctors don't want to do them.
Because I know quite a few myself and have spoken with them. And I pay attention to polls like the one I linked to above. And I observe that, for such an easy and safe (other than the death of the fetus, natch) procedure, there sure aren't a lot of docs who provide the service.There is nothing in law stopping hospitals from giving admitting privileges to abortion docs. My wife has admitting privileges right now. If she wanted to start doing abortions today in that clinic that faces closure, she easily could, as could any of the docs in our community. When you understand why none of them have done so, then maybe you'll start to truly understand my point. Since you can't force doctors to perform any procedure they find objectionable, abortion remains a service offered by a very few doctors.


You are correct but I don't see the problem. Do you think that every community should be forced to have an abortion clinic in it's midst? How would you accomplish that without restricting free-speech, free-association, etc?

True, but there is something in rabid mobs which make hospitals wish to avoid them.

 

[Cainkane1]

Mississippi only has one abortion clinic although it may be gone by now too.

 

[newyorkguy]

Instead of the Freakonomics cite addressing the question of doctors refusing to perform abortion, I think a better source is the Journal of Medical Ethics. The Journal doesn't agree with the notion doctors should have the right to pick and choose what procedures they're willing to perform. Specifically they address the California Conscience legislation which grants the legal right to any medical person -- doctors or nurses -- to opt-out of performing or assisting in an abortion procedure. The Journal sees three flaws in the reasoning behind this legislation.

The first is that the clause does not acknowledge physicians' obligations to provide abortion services. Rather, it appears to be grounded in the sort of "free agent" myth discussed in the previous section, ie, that physicians should be able to do whatever they wish.

The clause's second flaw is that it makes the process of declaring conscientious objection so simplistic as to trivialise moral decision-making. Recall the requirements of the law: If a health care worker wishes to declare conscientious objection she need only sign a form stating "a moral, ethical, or religious objection" to the procedure. She does not have to give reasons...

Third, in part because of the state licensing process, physicians have been granted a monopoly on most types of medical care. With such a monopoly comes an enhanced obligation to provide those services society has deemed valuable. In the case of abortion, as our example acutely reveals, women have no alternative source for treatment should physicians succeed in acquiring exemption.

 

[xjx388]

And valuing the woman as zero.

I don't want her to be killed either. I value them equally in that regard.

 

[xjx388]

Instead of the Freakonomics cite addressing the question of doctors refusing to perform abortion, I think a better source is the Journal of Medical Ethics. The Journal doesn't agree with the notion doctors should have the right to pick and choose what procedures they're willing to perform. Specifically they address the California Conscience legislation which grants the legal right to any medical person -- doctors or nurses -- to opt-out of performing or assisting in an abortion procedure. The Journal sees three flaws in the reasoning behind this legislation.

First, let's be precise, the Journal of Medical Ethics doesn't have a position. The authors of the paper in question have an opinion that they present for argument. That doesn't mean they are right or that JME is now advocating that position. The JME is a forum for these kinds of important medical ethics arguments, much like this forum is. It's not like the JREF ISF now advocates either of our positions as the official position.

Secondly: I wholeheartedly disagree with their argument that doctors have a prima facie obligation to provide services. The gist of their argument is fundamentally a logical fallacy -begging the question: they assume that abortion is a "vital and socially sanctioned," medical service. It is anything but.

But let's assume for a moment that abortion is "vital and socially sanctioned." Does this create an obligation for doctors to perform it? Does every doctor have an obligation to perform brain surgery, an obviously vital and relatively uncontroversial procedure? Of course not. A doctor can choose not to train in such a procedure. A surgeon can limit their practice to only GI surgery. Thus, if a general surgeon is the only surgeon in a small town, she would not have an ethical obligation to perform a brain surgery. The patient would be transferred whatever distance is necessary to find a qualified doctor.

Their whole idea about panels questioning doctors on the consistency of their beliefs is also highly problematic and I suspect would not pass Constitutional muster.

Sorry, not buying it.

 

[RandFan]

I don't want her to be killed either. I value them equally in that regard.

Do you value the quality of the pregnant woman's life? Are you willing to provide the woman resources to care for her child?

• A woman can feel pain.
• A woman can suffer stress and worry about her future.
• A fetus can do neither.

Saying you value her life is absolutely meaningless. Comparing the two is absurd and silly. One will know and appreciate the callousness of your impinging on their rights. The other hasn't the cognitive capabilities to hope for the future or fear for it's existence.

 

[newyorkguy]

<snip> Their whole idea about panels questioning doctors on the consistency of their beliefs is also highly problematic and I suspect would not pass Constitutional muster. Sorry, not buying it.

You're sticking with Freakonomics? Okay sure.

This is from page 118 of the Journal of Medical Ethics link.

The committee heard a variety of justifications given for why the physicians did not wish to perform abortions, none of which, in our minds, satisfy the intent of the law. For example, one physician viewed participation as creating a potential economic conflict for his private practice in fertility; he worried that his private patients would question his commitment to their goal of producing a child if he was at the same time willing to end the life of another. A second physician saw himself, and wished to be perceived, as a specialist in gynecology rather than obstetrics. A third candidly admitted that he did not not wish to be considered an abortion provider since such services are typically not lucrative. The only protest that came close to meeting the law's intent was the comment that second trimester abortions are "complex and frankly ugly. They are most unpleasant for everyone involved". Link

 

[xjx388]

You're sticking with Freakonomics? Okay sure.

I don't see how the quoted material indicates that I'm "sticking with Freakonomics." The Freakonomics article I linked to talked about the unwillingness of most doctors to perform abortions. Do you dispute the fact that doctors are unwilling?

The JME article you linked to acknowledges that docs don't want to do them and argues that they should be made to unless their reasons are vetted by a panel. I don't find that argument very persuasive.

This is from page 118 of the Journal of Medical Ethics link.

Exactly. Let's pretend that these authors get their way. A doctor's rationale doesn't meet the criteria to be able to refuse abortion. The doctor then actually physically refuses to perform an elective abortion that is referred to him. How are you going to actually make him perform the abortion? I don't think you can without violating his constitutional rights. You could take away his license, but I dont think such a move would hold up on appeal. And many docs would rather give up their license than perform an abortion. I don't see it.

Consider that in other rulings, the Court has already ruled that a person's beliefs don't have to make sense or be consistent in order to be Constitutionally protected. I think the very idea of vetting a person's belief and making a judgement if they are valid enough is a violation of a person's right to have whatever belief they want. I think it's enough to simply refuse without any need for a formal process. If no one desires to provide the service, then there is no service to provide. I cannot imagine a world where a U.S. citizen would be forced to provide a service they find objectionable. That sounds like some Orwellian nightmare to me.

Again, just because a person has a right to a certain service does not mean that the service has to be convenient or even offered at all.

 

[newyorkguy]

<snip> Let's pretend that these authors get their way. A doctor's rationale doesn't meet the criteria to be able to refuse abortion. The doctor then actually physically refuses to perform an elective abortion that is referred to him. How are you going to actually make him perform the abortion? <snip>

This isn't the really problem though -- doctors refusing to perform abortions -- nor is it the topic of the the thread. The thread is about Texas' restrictions on abortion that have led to most of the clinics closing. The problem I have seen involves doctors who ARE willing to perform abortions being unable to get admitting privileges at hospitals. The problem is the Texas law was proposed -- not to protect women's health as the authors stated -- but to close abortion clinics.

Anyway the authors of the report aren't proposing legislation to force doctors to perform abortions. They were trying to move the discussion along ethical grounds.

 

[thaiboxerken]

It's funny that conservatives want to convince us that the Texas laws aren't trap laws designed to make abortion hard to access.

 

[xjx388]

This isn't the really problem though -- doctors refusing to perform abortions -- nor is it the topic of the the thread. The thread is about Texas' restrictions on abortion that have led to most of the clinics closing. The problem I have seen involves doctors who ARE willing to perform abortions being unable to get admitting privileges at hospitals. The problem is the Texas law was proposed -- not to protect women's health as the authors stated -- but to close abortion clinics.

That's not in dispute. You say that's bad, I don't have a problem with it. I'm trying to explain why I don't have a problem with it. You obviously don't agree and that's fine.

Anyway the authors of the report aren't proposing legislation to force doctors to perform abortions. They were trying to move the discussion along ethical grounds.

They explicitly state that their scenario would obligate physicians to provide any and all services that are "vital and socially sanctioned," unless they appeared before a panel and were able to convince it that an exemption was justified by a true moral/religious objection. The whole purpose for the article was to propose an alternative to "conscience clauses," like the one in California that meets with their own ethical ideas. So, yeah, they were proposing legislation. Of course, I don't think they have any more chance of getting such changes made than the anti-abortionists have of completely banning abortion.