Obamacare: From the Patient to a Population Part 1

Her Health or Women’s Health?

Her boyfriend’s condom broke and now the pregnancy test is positive—again. She ran the second one in her friend’s dorm bathroom just to be sure. She felt trapped. Her life as she knew it, as she planned it came to a screeching halt. She never thought something as benign as a pink plus symbol could be so horrifying. She needed her life back, needed answers, and needed medical intervention. Her boyfriend was pushing her to get an abortion. She couldn’t bear to embarrass her parents their little girl getting pregnant. But then she had always believed abortion was wrong, that it ended the life of a baby. Looking online she found a list of abortionists and several other websites. All of them offered many services including abortion. But she wanted information about all her options before making a decision. One website said that her pregnancy may not continue naturally anyway and that she needed to have the pregnancy confirmed by a doctor. She thought that made a lot of sense. So she called and scheduled an appointment with an abortion doctor that same day thinking she could help. She had never experienced an unplanned pregnancy and felt alone and in need of someone who could help her get back in control. Upon arriving at the abortionist’s office the RN asked her to sign a piece of paper with the title “Informed Consent” with a lot of words she did not understand.  After asking how she will be paying for her services the RN ushered her back to a procedure room and paused before leaving saying, “If you have any questions the doctor will be in shortly.” Oddly she felt a cold sense of anxiety growing in her throat. With a quick knock the exam room door opened revealing a stout woman gowned in sterile medical garb. Opening the chart on the counter with a furtive glance the doctor shot, “Do you have any questions?” Haltingly the patient opened her tormented mind to this trusted figure, “I think there may be some mistake. I don’t know what I want to do yet. How far along am I? Will this hurt? Will I be able to have kids in the future if I wanted to? My parents would kill me if they found out. My boyfriend doesn’t even know I’m here.” Watching her from over her reading glasses the doctor simply said, “I am here to give women access to pregnancy termination. If you don’t know if that is what you want then I can’t help you.” Feeling even more isolated glancing up at the doctor’s steely gaze she leaned back on the exam table hearing only echoes dropping from the doctor’s mouth as she went to work, “You may experience some pain during the procedure, and afterward some bleeding is normal . . . .”

Obamacare relocates the focus of medical care from the patient to the ‘population.’ This is a problem because it

Clinical Medicine: The Population’s ONLY medicine

forces the violation of traditional medical ethics. When medical clinicians are asked to consider the health of a ‘group of individuals’ or of a population rather than a particular patient it ignores the primary basis for the medical profession and assumes something about the role of medicine in society that is basically inhumane. It assumes that the needs of the population as perceived by legislators and economic actuaries trump the needs of the person as experienced by doctors and patients.

A classic example of the politicizing of medicine is in the area of women’s access to ‘reproductive health services.’ The population group being addressed is ‘women of child bearing age.’ The medical access referred to is usually abortion, sterilization, and abortion-causing contraception. Providing a population with access to these ‘services’ is not the same as treating a woman whose autonomy has been arrested by the crisis of an unplanned pregnancy and is in need of medical care. Access to abortion services is not the same as treating a woman facing unplanned pregnancy. The above story illustrates the point.

Become a signatory on the Commission for Reproductive Health Service Standard’s Physician Code of Conduct.