Continuing the discussion about respecting choices... Betsy referred to a situation in which a practitioner 'fired' a patient. This seems to me an odd turning of the tables, as I have never thought of a practitioner as 'hiring' their patients. I see my doctor as a consultant whom I have engaged to provide me with her views on what to do when I consider myself in need of medical care. I am of course under no obligation to follow my doctor's advice if I feel it is inappropriate or just doesn't suit me, and my doctor is likewise under no obligation to compromise her standards in order to tell me what I want to hear, if she feels that is wrong from a medical standpoint. That is pretty much the way our relationship functions and if it didn't, I would fire her and hire myself a different consultant because I prefer an adult-adult relationship with my doctor (and indeed with anyone providing a personal service for me). If she were to tell me that my behavior was compromising my health and she therefore was firing me as her patient, I think I would be most inclined to laugh in disbelief. After the laughter died down, I might consider reporting her to her governing body as unfit to practice, for being delusional about a relationship between us that simply doesn't exist. I was even more concerned at the mention of turning away 'non-vaccinators' as though this were somehow reason to deny a child all pediatric care. Since vaccination has prevented a tiny fraction of the deaths that breastfeeding has, one could follow the same line of reasoning and decide that caring for children of mothers who don't breastfeed would be compromising one's practice. Surely no one would argue that a child's access to care should be determined by whether or not the doctor agrees with the parent on immunizations, or even on breastfeeding? I am struggling to see how such a conflict illustrates respect for the mother's choice in any way, at least in the language in which it is couched in your post. Let me add that I can easily imagine situations in which it would be entirely appropriate to tell a patient or a client 'I am not the practitioner for you. You don't want what I have to offer, you want something else.' And I don't have to fantasize about the situations in which a child's safety is so jeopardized that I am forced to notify child protective services. That is still not the same as firing someone. I have on one occasion declined to plan to attend a home birth because I felt that I would not be able to give the baby the care it deserved outside a hospital. Facts came to light after I had agreed to attend the mother at home which led me to break my agreement with her. Fortunately the terms of the contract I make with pregnant women who want home birth gives both of us the option of withdrawing from the contract unilaterally in such cases. I know the woman felt angry, she accused me of denying her a home birth, she disagreed with my assessment, and she even argued that her doctor felt it was safe for her baby to be followed at home. It was very uncomfortable but I was convinced that the best interests of the baby would not be served if I were to take it on myself to care for her. My response was, 'fine, then perhaps your doctor will be happy to attend you and follow your baby at home, but I don't feel competent to do so myself'. At no time did I feel that I had 'fired' her. I resigned as her midwife. Not the same thing, in my book. Rachel Myr Kristiansand, Norway *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(R) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html