Dear ProLife Medical Student or Resident , This is a collection collection of unedited comments from your peers in answer to the question: “What do I do if my assignment includes time spent on an abortion service or Planned Parenthood clinic, or similar assignment?” AAPLOG points out that you do have conscience rights–(they come from God)– and you do have conscience protection, which comes from U.S. law: The Church Amendment from the 1970’s and the Hoekstra-Coats Medical Training Nondiscrimination Act of 1995 (which declares that an entity that forced individuals or programs to participate in abortions would be discriminatory, and on that basis that entity would lose federal funding.) Don’t forfeit your conscience rights. (And if push comes to shove, the Alliance Defense Fund and other similar legal organizations would be glad to take your case.) For practical advice, we feel much wisdom resides with those who have faced the situation. We asked for and received the following notes from prolife doctors and students. Advice from your peers: male I was a med student and a GYN resident at the cities “Abortion hospital” including Saline, Intracardiac Potassium, etc…for no reason other than convenience. The Chair, vice chair, and many private abortionists hated me. They were unable to touch me however based on the grace of God. The way I survived the harassment was to be very careful to do the following: 1. Have an honorable life stance. No room for controversy such as vulgarity, disrespect of women and patients, disrespect to professors (that is what they do to us thus they expect we will do the same to them…don’t do it) 2. Read…Study…Be smarter and medically better than your peers. 3. Work longer hours to be sure you know the patients and their issues and Differential diagnoses etc. THEN you have their respect Now you need to know the facts 4. Learn the facts. That is…The EVIDENCE BASED MEDICINE that medical school so loves to hold as the standard of intelligent medical decision making. Excellent sources include: aaplog.org web site where peer reviewed journal articles give you great medical info to “share” with others…including the patients! AUL.org gives accurate info regarding the laws that govern…or don’t…the abortion industry. When people see that the abortion industry fights Informed Consent (the great standard for patient autonomy and “choice”), but actually give woefully inadequate information in their consent process, it opens some eyes (except for those who choose to be willfully blind). I had great pleasure in reading and quoting from the writings of Planned Parenthoods research arm..The Guttmacher Institute..Back in the late 80’s they published their own study that showed that 30% of their own patients, after being aborted, stated that they came to pp to KEEP their pregnancies and felt THEY were coerced !!! This was great! Pro-choice? Whose choice when 30% are forced against their will to abort. 5. At that time…everyone was wearing prochoice pins etc…So, I wore the little feet pins !!! great to start conversation. To be successful, remember, you are on the front lines of this war. Know your enemy. Know how to persuade those around you. Be courageous, trust God for the rest. (from the New York theater of war). Xxxxxxxxxxxxxxx male They would not consider a crisis pregnancy center a valid medical rotation, I would volunteer to go to a community health center, STD clinic, etc. I agree with the Community Health Center or STD Clinic as an acceptable alternatives to present. If the school insists that (the student) spend a day at Planned Parenthood, and they won’t allow an alternative, tell him to go. He can see for himself what an abortion mill looks like, and if he gets a chance, he can discretely suggest to a patient that she might want to consider a second opinion at a crisis pregnancy center, or at least request an ultrasound. He should ask to sit in on a counseling session and learn firsthand what is not covered and how few options are discussed. Send him our list (at www.aaplog.org, see “abortion complications”) of abortion complications so he can ask intelligent and probing questions of the staff, preferably in front of a patient. When he gets home, he may want to scrub with Lava soap under very hot water for about 2 hours. xxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxx I would contact the dean of the medical school and request a meeting to voice my objection. xxxxxxxxxxxxxxxxxxxx Female I was a resident in a top 10 OB/GYN residency program. As an intern, I was asked to hold the U/S for one first trimester abortion and after that told them that I would not attend or perform abortions or go to abortion lectures. The harassment was brutal. I was discriminated against in assignments to surgical cases, in a deliberate attempt to restrict my surgical experience and ostracized by my fellow residents. Attendings gave me the cold shoulder. I was threatened by the chair but told him that he could fire me, but that I would not perform abortions or stop praying with patients. The advice about being stronger academically is very good. I got extra surgical experience by moonlighting. An attending at a Catholic hospital took me under his wing as well. Ironically, in my chief year, four junior residents stood up to the department and said that they also would not perform abortions. All power is in Jesus’ hands, and He will not abandon you. I ALWAYS found that it was better to be bold and stand for truth rather than being silent and/or hiding, (it would be nice to say that I always did the right thing, but I didn’t.). God honors holy boldness but only forgives cowardice (Prov. 25:26, Matt. 5:13). He won’t honor obnoxious behavior that disgraces His name. Another key is to have a group of people praying for you. In that hospital, people in Radiology, Environmental Services, the OR and elsewhere were praying and supporting me. In the end, the fire I went through made me a stronger Christian. Remember that God is on your side, and if you have to suffer for Him, it is well. Also remember that few chairs will openly try to fire you or damage your career, since they are afraid of legal challenges (important to remember, and to tell them if need be). xxxxxxxxxxxxxxxxxxxx Female I am a medical student from a prestigious med school and I just finished my ob/gyn rotation as a med student. I did end up talking to the course director prior to the rotation, but before I met with him, I talked with other medical students who I knew had the rotation and had gone before me. I would recommend talking with students at your school who share your opinion and have had the rotation (your local CMDA or Catholic group would know those students) and what they did. I would recommend talking with the course director if others have said he or she is reasonable. But, when you talk to him/her don’t site faith or other reasons other than specific legal language of it is “against your conscience rights.” That is still the law (even if it’s not reinforced) and most schools don’t want to get entangled in a legal battle with students. Usually they will work with you. Asking for an alternative usually works as well because they want you to learn and be productive. Another thing you can do is talk to other students about whether or not such experience is truly required in terms of a sign-in sheet. In my experience, even though a go to a great university, most extras don’t have a sign in sheet and they don’t know who is supposed to show up when or if anyone is coming. Often times I find myself arriving at rotations or extras and they didn’t know I was suppose to come and didn’t have any plans for me being there. So, for example my school had a “required” lecture on abortion, but there was no sign in sheet, so I just didn’t show and it didn’t make a difference, no one knew and no one cared. I just read the required chapter for the exam and was fine. In my opinion, you are spending a quarter of a million on your education and you are the consumer, so you should make the education the best for you. But, if you do go, I agree, work hard, know your facts, and be better (more cordial, better fund of knowledge, know the evidence based medicine, etc) than your med student peers. But, I would recommend requesting at the pp site to not observe the actual abortion procedure – your conscience and soul is more important than anything on this earth xxxxxxxxxxxxxxxxxxx As a former abortion provider, now pro-lifer whose ministry has operated a charity full pre-natal clinic, I would add Federally Qualified Health Clinics. FQHC’s are normally conservative and in great need of physicians. Family Planning is standard care in most FQHC’s. Some charity clinics offer family planning as well as pre-natal care. Check your area for non-profit clinics that may even offer a broader range of OB-GYN care than Planned Parenthood. Please join me in praying that the Lord will open a door for these young physicians for life-affirming service in their rotation. Carol Everet xxxxxxxxxxxxxxxxxx I am a health care provider and have recently resigned from Planned Parenthood due to religious conflict. I suggest that if the student is forced to rotate there, he or she, can ask the preceptor to not work on the surgical or med ab services, instead work on the gyn, male services, or, if available at that branch, the prenatal service. xxxxxxxxxxxxxxxxxx Female Wow. Thankfully I did not have such an issue at Vanderbilt. My heart goes out to those students. I think a lot of it depends on how receptive their faculty is. If this is a regular event that they have students in the rotation complete, they might consider forming a petition to show that they are not alone in their pro-life stance. If the Planned Parenthood experience is a lecture/ clinic environment (in other words, no exposure to actual procedures), they could attend regardless, as this would be a good learning opportunity to hear some of the so called “facts” and “counseling” that patients receive there. I just hope that even if they feel they feel they cannot speak out for fear of grades/ evaluations, that they realize that there are many pro-life individuals in medicine! They are not alone! xxxxxxxxxxxxxxxxxxx Male Have him and his colleague hold the line and do an alternative. If the school refuses, then they will need to seek legal counsel. They must not be intimidated at this stage. They tried this with me and I held fast. They cannot require you, under the federal statutes (Church amendment, etc) to do anything against your conscience. xxxxxxxxxxxxxxxxx Female 1. They may have the students doing something entirely separate from the abortions. When I was a student we rotated through a county “family planning” clinic where abortions were done, but on our family planning clinic day, we mainly wrote for birth control pills and checked BP’s. It was a place like Planned Parenthood, but we were not involved in any abortions there. And our role was pretty minimal as students, since we could not actually prescribe the birth control. I didn’t feel I was put in the position of compromising on any principles. 2. Find out IF there will be any involvement with abortions, ahead of time. Once, on my 3rd year OB/GYN rotation, I was assigned for part of the time with a doc in private practice. He said, “I’m doing an abortion tomorrow, you can come and watch if you want.” He sounded like he was allowing it to be optional, and from what he said I would be watching. Not assisting. And he was in private practice, so usually the guys in private practice didn’t necessarily want students to do much more than watch. Still, I phoned my pastor and asked him about it. We both agreed that if I only watched, that would not be wrong, and I should pray for the woman, silently of course. I did consider “what if he ends up wanting me to hold something or assist in some way,” and I was aware that things can come up suddenly in a surgical situation where people just say, “Here, hold this,” or “Do that,” so I had that in mind also… if I would have gone in to watch the abortion, I would have been very clear with the attending that I was not agreeable to assisting. But then she changed her mind, and that was the only abortion case. So, if it is not entirely clear, find out in advance IF one will be in on abortions, and if one will be watching vs. assisting, because that makes a difference. If a student could be present ONLY to watch and not assist, then that would be quite an opportunity to learn, to see how the women are really treated etc. What are they told about the procedure etc. Might even be an opportunity to find out if state informed consent laws are being followed etc. if it is an informed consent state, etc. But good to find out what is expected, set boundaries and see if it looks workable. 3. At the family planning clinic, we did do STD screenings and pelvic exams, and that was really our main reason for being there, I think, to just get practice doing the pelvic exams. If it was just that, I personally would have no problem just doing the pelvic exams even if it is Planned Parenthood, and I could do a rotation there. However, if that is a problem, there ought to be some community STD clinic or an STD clinic at the Medical School that would be an acceptable alternative. The pro-life pregnancy center would not be comparable because many aren’t medical, and even if medical such as providing ultrasound, you don’t get the experience in doing pelvic exams and treating STD’s. 4. Be informed. In addition to the AAPLOG website, go also to www.standapart.org and look at some of the research there on women’s mental health in relation to abortion. Possibly there will be some moment when you have an opportunity to educate another student, a resident, or even an attending, or perhaps there will be an opportunity to offer assistance to someone who does not really want an abortion. I have one other suggestion but I have to look up the link, so will follow up further later. Once I was involved in an abortion case while on a psychiatry rotation during residency. Because it was a second or third trimester, and too late to do at our medical center, the lady was going to go out of state to have the abortion. I was supposed to be involved in certifying “medical necessity” for a late abortion. Had it gotten to that point, I would have made someone else take over the case, but initially, I was just doing a pscyh evaluation, getting the information, and it had not reached a point where someone was going to expect me to sign something for her to have an abortion. Because it was so late, the states involved had a couple of standards, but just a couple signatures on a paper, and the abortion moves forward. Anyway, while she was in psychiatry, when the right opportunity presented itself, I offered her the opportunity to view the ultrasound of her baby, which nobody else would have done, and later in the process she and her husband decided they were going to proceed with the pregnancy and not have the abortion. She changed her mind. I think probably seeing the print of the ultrasound probably made the difference. There may be opportunities to make a difference even for some of the abortion patients, but one would want to be certain that one was not going to be in a position of potentially being forced into contributing to the actual abortion process. Xxxxxxxxxxxxxxxxxxxxxx Female http://downloads.frc.org/EF/EF10B09.pdf As an additional suggestion, I would suggest that residents take a look at this brochure– not sure if this is at the AAPLOG website or not– and become familiar with the info as well as following the links that are given. Might possibly give some ideas for discussion with patients or preceptors. xxxxxxxxxxxxxxxxxxxxxx Female (I think, from email address) I am from Winston-Salem, NC. You should be able to determine the School of Medicine in that city. I was taking a course of study at the school shortly after I moved to W-S. I recall hearing an OBG faculty member say to another, “No resident is going to do a residency here without have done abortions.” The statement shocked me, and being new in the community I did not speak up, but should have. About 2 years later a new group of house officers began their 1st yr. rotation. An MD who will go nameless, when faced with being forced to perform abortions, told the OBG faculty absolutely not. Further he stated that if dismissed from the program he would bring suit against them and the school. The OBG department buckled. and he was excused from the performance of abortions. When other house officers saw this, several likewise told the faculty that they were no longer going to perform abortions. The actions of this young physician, while not stopping the performance of abor tions at this medical school at least brought to end the coercion of house officers to perform them. A 2nd result was the complaint by the remaining OBG residents of having to do all the abortions, so the pro-choice faculty had to get involved to reduce the work load and get their hands involved in that dirty business. Many years later it was while discussing pro-Life issues with another resident that I learned of AAPLOG and joined. Xxxxxxxxxxxxxxxxxxxxxxxxxx Male In my residency, I was required to provide post-care and complication care to women undergoing mid-trimester saline abortions, of which there were very many. Every night on call during my first two years I was called to assist at least 2 or 3 of these ladies that had made such a terrible choice. It was quite depressing. However, my refusal to learn technique or to perform the procedures was respected by all of my superiors, and there was no retaliation. In my opinion, the students must abide by their principles, which, as a ProLife Practitioner-to-be should be to not provide or assist in abortion procedures, and, if Catholic, to not do the same with contraceptive or most infertility procedures. Observation of a procedure that they are powerless to directly prevent (other than prayer) is another matter. It is important that the preceptor be provided feedback that some of their students do object, and why there are objections. It should be obligatory. That would be an opportunity to minister to that preceptor, and, if they are merely ignorant and not truly evil, they might potentially be open to a change of heart. Failing this, that care should be observed. If the student has the proper conviction, seeing these things will strengthen that conviction. Having direct observatory experience will allow them to speak with greater knowledge, confidence, authority and conviction against these practices. That was great advice , especially the part about being prepared with facts. My advice for medical students: PRAY PRAY PRAY. Also remember that we are put in the body of Christ for a reason. Lean on others. Make sure your church is praying for you. Join the Christian Medical and Dental Association, or the Catholic Medical Association, and find a prolife attending who knows the area and what is available. None of us can win this battle alone. Male As a medical student who just finished an OB rotation, here’s a few points from my perspective: 1) I felt led to attend a clinic session at PP. It originally wasn’t on my schedule and I had to ask for it to be added, but I wanted to know exactly what goes on there. As tough of an experience as it was to be there, I did it and I’m glad I now know first hand how PP operates. The staff was quite hospitable and was more than willing to let medical students observe counselling sessions, ultrasounds, “procedures”, etc. 2) PP offers many services, including prescribing birth control and a number of GYN procedures unrelated to abortion (i.e. PAPs, colpo, etc.) The student addressed in the email you sent could ask to see that portion of services — it’s much less objectionable. If his/her program director insists she be trained in / exposed to D&Cs or D&Es, there’s another option. With the GYN surg team at my hospital, I participated in a number of D&Cs for other indications — removal of a fetus after IUFD, for collection of tissue for evaluation of post-menopausal bleeding, to go after an IUD with a broken string. As sad as it was to watch the vacuum aspiration of an 18 w fetus that had passed away before the patient presented, the same life issues are not there. Perhaps participating in procedures like this could be an acceptable compromise. (even so, I made sure to find out the exact indication for the D&C before entering the OR). 3) I’d echo the sentiment for knowing the facts, for knowing your patients forwards and backwards, and maintaining a respectful demeanor at all times. With that, there is no justification for the repercussions against the student. 4) Remember that currently there is no legal requirement for the student to participate in procedures contrary to their conscience. I pray this may be of some help to other students out there facing these issues head-on. My advice is have the student call 1-800-TELL-ADF (AAPLOG NOTE: This advice comes from Alliance Defense Fund, who will be glad to advise you and even defend you legally, if necessary.)