You are the general internist in a large, multi specialty physician group. The office based pregnancy test on your patient has just become positive and you estimate the gestational age of the fetus at eight weeks. You are a very deeply religious person in a conservative, mid western city and you are opposed to abortion because you believe life begins at conception. After extensive discussion about the options, your patient asks to be referred for an abortion.
Which of the following is the most appropriate action?
a. Inform the patient that you are morally opposed to abortion and you cannot make the referral.
b. Terminate your relationship with the patient as her physician.
c, Propose social work/psychological evaluation of the patient.
d. Tell her you will make the referral after a 30 day consideration period in which she may change her mind.
e. Refer the patient for the abortion.
Explanation:
(e) Refer the patient for the abortion,
Patients have the legal right to safe and effective abortions. This right is universal within the first trimester and no hrrther evaluation or rsaiting period is required. The right to abortion after the first trimester (12 weeks) is less cleat and extenuating cir cumstances such as a risk to the life ofthe mother from the pregnancy or whether the conceptiolr is a product of sexual assault are also considered. The criteria for ready access to abortion becomes less clear after the first trimester as the fetus progresses in iL. development loward bccoming a viahle inlant Although you may object to abortion, the patient still has a legal right to obtain one. You are not under an obligation to perform the abortion yourself. your objection can cover your refusal to do the procedure personally but you do not have the right to refuse to refer her to the care she neecls as your patient. Although a physician has the right to refuse to enter into the physician/patient relationship before it has begun, once you have entered into the relationship you are obligated to provide the care the patient needs. Hence, you cannot just terminate the physician/patient relationship at the moment the patient needs a form of care you disagree with. you cannot ask for a four-week waiting period especially when the patient presents at eight weeks of pregnancy and this wait will bring her past the first trimester
Ifthe patient has clear decision_making capacity, there is no need to obtain a psycho logical evalualion