What Can We Do About Medicine?
Reproduced from Abortion is a Blessing by Anne Nicol Gaylor.
WOMEN, THOSE SECOND-CLASS CITIZENS, have suffered long and silently from an elitist medical profession dominated by males. When a general practitioner or a gynecologist goes out to a small community and will not, as many in Wisconsin still do not, offer birth control, sterilization, or abortions to his patients, the state is allowing the medical profession to place individual religious views above the health and welfare of its citizens. When women with four and five Caesarean sections are denied tubal ligations by their physicians, a familiar story in Wisconsin, we might as well be licensing Jack the Ripper or Richard Speck. Because women are going to suffer and women are going to die.
From 1969 to 1971 in Wisconsin forty-eight women died in pregnancy, thirty-two of whom had serious and compelling medical reasons not to be pregnant at all. (Herbert Sandmire, M.D., "Family Planning Comes of Age?" Wisconsin Medical journal, April, 1972, pp. 71-72.) Unbelievably these victims included a woman whose scar from a classical Caesarean section had ruptured in her last pregnancy. What did these medical boobs think would happen, allowing her to become and remain pregnant again? One woman who had had seven pregnancies, and suffered from hypertension of several years duration, requested an abortion, which was denied. One day prior to her own death, she delivered a stillborn, macerated fetus. No doubt her doctor still is allowed to practice his lethal brand of medicine and her hospital still is receiving public funds!
Other women in this Wisconsin study, who died from pregnancy, had diabetes, breast cancer, heart disease or disorders, histories of toxemia and hypertension, four and five previous Caesarean sections. They might as well have lived in remotest Upper Slobovia, for in far too many communities in Wisconsin a woman's life and health still do not matter--what matters is the religion of her physician and of those who control the local hospital.
In Wisconsin there are 145 hospitals for short-term patient care in the state. Of these 133 are classed as "private." In many communities the only obstetrical services available are from Catholic-owned or dominated hospitals. What are women to do under this sort of medical dictatorship? And is there such a thing any more as a "private" hospital? All hospitals receive huge infusions of the public's money, and they should be operated by medical, not religious standards. A state government does not license doctors or hospitals for their benefit, but for the public's benefit. When will the idea of service penetrate that armor of insensitivity surrounding the medical community?
A new wrinkle in hospital practice in cities having two or three hospitals is the channeling of maternity patients to one facility. All too often the facility chosen is a Catholic hospital, and women needing sterilizations at the time of delivery find their medical needs ignored because of religious prejudice. Neonatal units (for high risk newborns), serving wide geographic areas, are occasionally located in Catholic hospitals, and the pregnant woman again is in a captive situation. Sterilizations are sought more often by women after high-risk pregnancies, and these patients' serious medical needs again are shunted aside. Catholic hospitals delight in proclaiming their moral objections to abortion, yet every time they deny a woman a sterilization they have created a candidate for abortion.
In the backlash of the United States Supreme Court decision on abortion, Congress and many states have passed laws specifying that any hospital, public or private, may turn away any woman for sterilization or abortion, no matter what her physical condition, even if she has a doctor willing to help her. These laws have been challenged successfully insofar as public hospitals are concerned, but, unbelievably, the private hospital exemption has been allowed to stand. While such laws have limited effect in large, urban communities with a choice of hospitals for women and doctors, they seriously jeopardize freedom of choice and humane health care for women who have one local hospital.
These laws, of course, discriminate against women, since men do not need abortions and can have their sterilizations performed in doctor's offices. Women need a hospital for a second trimester abortion and for a sterilization. Such laws discriminate against the poor. If a well-to-do woman is denied an abortion or tubal ligation in her own community, she has the money and resources to seek these services elsewhere. But if the poor woman is not served by her local community, she is rarely served at all.
No hospital should be allowed to deny emergency treatment to women. When a woman is having a fourth or fifth Caesarean section, she needs a tubal ligation; this is an emergency situation. When a woman becomes pregnant, who has diabetes or hypertension or a heart disorder or any of a dozen other serious conditions, she needs an abortion; these are emergency situations. Too many women suffer and die because hospital policy ranks higher with male physicians, male legislators, and male judges than women's lives and health.
In 1974, 5,000 applicants, many of them women, applied for 121 medical school openings at the Wisconsin Medical College in Milwaukee.(Milwaukee Journal, Sept. 8,1974) While some of these applicants were accepted at other schools, and many did not have the necessary academic qualifications, there were still large numbers of qualified would-be physicians who were turned away. Here we are, the richest country in the world, and qualified women and men who wish to become doctors may not do so because we do not have the capacity to train them. The most important single thing we can do to improve health care in our country is to train more doctors, and to be sure that at least half of them are 'women, and that blacks and other minorities are represented fairly. Who knows--with enough doctors to help, maybe house calls might be fashionable again? (In 1955 I had had twin babies via Caesarean section, my third Caesarean, with my medical history further embellished by a ruptured appendix earlier in that pregnancy. I was nursing the babies, having an abundance of milk, but developed a breast infection when they were about a month old. I was really very sick, with chills and raging fever. The doctor diagnosed and prescribed over the phone. When a couple of days passed and my fever still raged, the doctor suggested that I come in for an office visit. I explained what he must have known--that I was too weak to do that, that my fever edged up a notch or two just getting up to go to the bathroom. When I recovered and went in a week or so later to be checked, he said, "Well, we got through that one all right, didn't we?" I would agree that the patient going to the doctor makes sense most of the time, but there are occasions when house calls are warranted, even for obstetricians.)
In addition to training more doctors we must check the screening procedures used in acceptance of applicants. Medical schools must not look just for academic excellence, but for social concern, some evidence of social commitment, some awareness in the applicant of the dignity and worth of all people. Too often a physician comes across not as a patient advocate, but as a patient adversary. The qualities of consideration and warmth are ignored. One cannot avoid the impression that most medical schools in the past have screened for political conservatives.
Since a medical education is the most expensive education we offer, and since the medical student pays for only a small portion of that education (15 percent at the University of Wisconsin, Madison), it is fair and proper that we expect certain things of these privileged persons. If a student wishes to become a gynecologist or obstetrician, the student should understand that she/he will be expected to help women with birth control and do tubal ligations and abortions. Medical students must be screened, and if they possess convictions that prevent their delivering certain medical care, then they should either specialize in an area where they cannot damage their patients with their personal beliefs, or perhaps they should consider the church, not medicine.
In addition, since this is such an expensive education that we provide, there is no reason why we should not ask these women and men, who have been chosen for this coveted training, to serve in areas without doctors for two years, or perhaps a period equivalent to their academic training? Who knows-they might like the communities that need them, and when they wished to leave, new graduates would be coming along. This is a practical, feasible answer to the distribution problem.
If we had a shortage of persons wanting and qualified to be physicians, we would have some excuse for being in the bind we are in. We do not have that shortage. Our problem is one of priorities, and our priorities can be changed!
The letter that follows is just an "every day" letter that illustrates the problems caused by doctors imposing religious views on their patients. This young couple had decided to opt for permanent birth control but could find no doctor to help them.
Dear ZPG: I wrote to you about eight months ago. My husband wanted a vasectomy and you were very good to give us a list of doctors from this area who perform this surgery. We contacted the doctors but no one would do it because my husband is only twenty-four. At that time I had tried the pill and had very bad reactions, and the doctor did not want to give it to me. So they put in an IUD that worked for one year, and now I am pregnant. We have prepared ourselves for a baby, knowing we will try to make good parents. But the point is that after four years of marriage and two years of going together, we had definitely decided we did not want children. Now with one baby coming we are already worrying about what method of birth control we can use next. We can't understand why this decision should not be ours. We are old enough to vote and pay taxes and run a business of our own, but we aren't old enough to decide if we want a family or not. We have discussed all the angles many times and this is still our choice. So if there is anything you can do to help us now we would appreciate it. Thank you. R.S.
The medical community could do so many painless things to improve its image and its services. Boards of Medical Examiners, for instance, should not all be physicians; they should have consumer representation. Medical societies should offer referrals. There should be a place to call and find out where one can get, for example, a safe tonsillectomy at the lowest cost. There should be simple procedures for registering complaints about treatment and charges.
Recently I referred a woman for abortion, who had a three-year-old child and an eleven-week-old baby. She said her doctor, a specialist, had told her as long as she was nursing and used foam, she would not get pregnant. She believed him, and she got pregnant. Now, you could forgive a doctor like that if he were some old, overworked, country GP, but a specialist! Doesn't he read the literature? She could have got advice as sound from any occult. And here she is-she doesn't want to have an abortion, but what is she to do?
Besides giving out a great deal of misinformation and incomplete information on contraception, many doctors will not tell women of the risks involved in closely spaced pregnancies, or the risks of childbirth. Some of them love to represent abortion as involving risk, but they will not tell women that delivery involves greater risk. A careful specialist will see that his patient goes off the pill every two to three years for a few months time, to let her ovaries work on their own, but there are specialists who will never let on to their patients that four, five or even seven straight years on the pill is a risk they should not take.
Personal action is certainly in order for every woman in this country concerned with women's medical care. First of all, quiz your doctor. If he is opposed to contraception, sterilization, or abortion, dump him. Even if it means the inconvenience of going to another community, don't patronize him. If you are lucky and he is not a sexist, that is still no reason to be in awe of him. If he goofs, let him know. If his charges are excessive, complain. He has had a privileged education, tax-supported for the most part. He should be serving patients, not running his own private dictatorship.
Over the past few years my own attitude toward the medical profession has undergone a rather painful metamorphosis. I summed it up in a speech before a medical group in the spring of 1971, the chapter that follows.
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