Can't care for youWhat does it mean when a provider of healthcare can't work with anyone who disagrees?
Can you imagine a doctor or nurse saying:
I choose to work only with women who believe in Jesus, because that’s where my passion and training lies. I’m a firm believer in Christianity and in my idealism as a provider, I see spreading the Word through birth care as my contribution to helping change the world.or
I choose to work only with with white women because that’s where my passion and training lies. I’m a firm believer in the superiority of the white race, and I see this as my contribution to helping change the world by improving the racial stock.That would be unethical, obnoxious, racist, and illegal.
Evidently these rules of ethical medical care have not reached doulas. According to an article in the NYTimes, And the Doula Makes Four:
"I choose to work with women who are striving for a natural birth because that’s where my passion and training lies," said Ms. Harris, whose training was as a Bradley-method childbirth instructor, which emphasizes natural birth with intensive support from the husband.What does it mean when a doula or direct entry midwife refuses to care for women who don't share the same philosophy on pain management or breastfeeding? I think we can draw several conclusions, besides the obvious one that it is completely obnoxious:
"I’m a firm believer in the natural process," she said, "and in my idealism as a birth worker, I see this as my contribution to helping change the world." In both cases, Ms. Harris referred the women to another doula.
1. The doula or midwife is not a provider of health care, but a friend.
Providing healthcare ethically mandates putting aside your own thoughts and feelings. You can't refuse to care for people simply because you don't agree with them. The classic medical example is caring for the injured drunk driver after he has killed an innocent victim. You cannot refuse to care for him, even though you despise what he did, and have just viewed the remains of the person he just killed.
2. It is culturally and ethnically insensitive.
"Natural" childbirth and homebirth reflects the views and beliefs of a small subgroup of white, Western, relatively well educated and relatively well off women. It is not your job as a provider, to proclaim the superiority of your worldview. You must respect, and adjust to the worldview of the patient.
3. It reflects minimal knowledge.
To a certain extent, it reflects the minimal training and minimal knowledge of doulas and direct entry midwives. They don't plan to do much because they don't know much. A patient who doesn't share their birth philosophy might ask for something that they literally know nothing about.
4. It is unethical.
If you represent yourself as a provider of healthcare, you cannot decide whom you will treat based on a philosophic litmus test. You are entitled to point out that the fit between you and the patient might not be the best, but you are not entitled to refuse to care for someone.
5. It's all about YOU, not about women.
In essence, it is determining whom you will treat based on whether they meet YOUR needs, not based on whether you meet their needs. While you may choose to become a healthcare provider because you think, in general, it will fulfill personal needs, you can not extend or refuse care based on whether an individual patient is likely to meet those needs.
Of course, a healthcare provider is never required to provide care that she believes to be medically unsafe, or illegal, or prohibited by medical standards. The actual care provided should be determined by the scientific evidence. However, a healthcare provider cannot refuse to care for someone because she disagrees with a patient on philosophical (or any other) issues.