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Wednesday, January 21, 2009

A horse of a different color.

A long time ago I wrote a post dealing with a detestable little tactic deployed to infringe on women's reproductive rights. Specifically, I wrote about the moves by some pharmacists to refuse to dispense birth control medication because it was against their own morality. My position at the time was that, while I disagreed with what these pharmacists were doing, I didn't believe it was criminal behavior. I instead considered it to be civil disobedience- a type of protest on a par with sit-ins at lunch counters- and argued that while it was reasonable and appropriate to remove these persons as unable to perform their job duties, the manner of their protest was a long honored part of American democracy. I was not, of course, insensitive to the hardships this would impose on women in the meantime, but I find it difficult to adjudicate between two people's legitimate claim on their own civil rights.

Since then, I have on several occasions written about various issues surrounding the birth control and abortion debates, mostly supporting women's free access to both. Indeed, I got rather a bit wound up about the South Dakota abortion ban- particularly their bogus and thoroughly insulting "exemption" from it. Likewise I got pretty annoyed when a rape victim, who was arrested for unrelated reasons, was denied the morning after pill because the jail worker had moral objections to it. And if you've been paying attention, you've probably figured out that I am both pro-choice and pro-birth control. I actually think that for the long-term survival and well-being of the human race, birth control rates up there with fire and vaccines as truly outstanding inventions.

Given this background, you will doubtless not be surprised to learn that I am rather irritated over news of a law suit being brought over an intrauterine device (IUD). Specifically, the user of the IUD is suing both a family health clinic (Presbyterian Health Services Rio Rancho Family Health Center) and a nurse practitioner (Sylvia Olona) employed therein for removing her IUD without permission. But, unfortunately, it doesn't stop there:

"As Defendant Olona began the procedure, (the plaintiff) felt Olona pull on the strings of the IUD. (The plaintiff) felt a distinct pulling on the strings followed by a sharp pain in her uterus similar to a very strong menstrual cramp.

"As that happened, Defendant Olona stated, 'Uh oh, I accidentally pulled out your IUD. I gently tugged and out it came.'


"Olona then stated, 'having the IUD come out was a good thing.' She asked (the plaintiff) if she wanted to hear her 'take' on the situation. Without receiving a response, Defendant Olona stated, 'I personally do not like IUDs. I feel they are a type of abortion. I don't know how you feel about abortion, but I am against them. What the IUD does is take the fertilized egg and pushes it out of the uterus.'

"Defendant Olona stated, 'Everyone in the office always laughs and tells me I pull these out on purpose because I am against them, but it's not true, they accidentally come out when I tug.'


"Defendant Olona told (the plaintiff) that is was better that she did not have the IUD because she could now use a "non-abortion" form of contraception. Defendant Olona suggested the deprovera (depo) [sic] shot or the pill, and made clear that she would not insert a new IUD."

So, we have a bit of a situation here. At a minimum this Olona appears to be incompetent to deal with IUDs and, thus, should have been kept away from cases involving them by her employers. In the event that her employers could not do this, she should have kept herself away from these cases. And, of course, this assumes that her repeated extraction of IUDs is accidental. If we assume that such is the case then we have an instance of clear medical negligence from both parties since, really, if someone were always transfusing the wrong type of blood into patients by accident, a hospital employing that person would be liable if they didn't, you know, keep that person away from blood transfusions.

But oddly I, and presumably the plaintiff, am more than a little skeptical about the "accident" explanation. There's an old saying that goes something like, "Once is an accident, twice is coincidence, three times is enemy action." I'm not labeling Olona an enemy, but the meaning of the saying can be summed up as: beyond a certain point a strong pattern suggests intention.* Plus, you know, the prepared speech about how IUDs are abortion kinda suggests intention as well. It really does strongly appear as though the defendant deliberately removed the plaintiff's IUD against her wishes because the IUD conflicted with the defendant's ethical beliefs. And this is a problem.

See, here's the thing, with the pharmacists I supported their right to refuse to dispense medication though I did not in any way argue that they should be immune to firing over their decision. In that case, I was saying that a professional shouldn't necessarily have to provide a good that they find morally objectionable. This, however, is not a comparable case. If Olona has a problem with IUDs, the responsible thing to do would be to refuse to assist the plaintiff in the first place. In the event that she decided to help the plaintiff, it was her duty to do so correctly. Her behavior is not civil disobedience, it is just plain malpractice.** Consider equivalent cases: a pharmacist agrees to dispense birth control but, because he or she disagrees with it, instead provides placebos. Is this civil disobedience? No, it is cowardice masquerading as an ethical decision. How would we react if a white supremacist administered abortifacient agents to pregnant black women because he or she believed that African Americans shouldn't reproduce? Why, then, would we ever tolerate this sort of behavior? If a woman chooses to use an IUD, that is her right and her decision. If you find IUDs morally objectionable, don't use one. If you're a nurse and you find them objectionable, recuse yourself or get a new job but do not make reproductive decisions for others.

You're not god and I doubt your god would approve of you acting like you are.

* For any intelligent design advocates in the audience, no, this is not an instance of design detection. Infering intention from an organism about which much is known under a very delimited set of circumstances is quite a bit different from that nonsense that Wild Bill peddles.

** Most likely the case whether this stems from deliberate action or negligence.

Hat-tip to feministe.

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