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

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