Question: I have an excellent primary care physician. She is superb and works very long hours - 7 a.m. or earlier until 6 p.m. - then she makes rounds. She is on call on weekends whenever her turn comes up. She also is her kid's mom, and she does a superb job of it.
I go to another doctor, a dermatologist, who is excellent in her field. My problem is this: She works only three mornings a week from 8 a.m. until noon. Period. She has a husband (also a doctor) and two sons, both teenagers. She has a very large caseload of patients. She does not make rounds nor is she on call. Her specialty is such that it does not require this. If one of her patients has a skin cancer or some other problem requiring surgery, she sends that patient to a specialist.In this city dermatologists are in very short supply so having this very capable dermatologist demonstrate her total lack of commitment to her profession and to her patients is, for me, a large aggravation.
If this is an acceptable way of doing medicine, then I'll try not to be offended by it and accept her terms. Otherwise, I think she is a disgrace to her profession and she should either quit or work full time. Am I off base or what?
- Urbana, Ill.
Dr. Laura: I would rather be the child of the part-time dermatologist than of your primary car physician - wouldn't you? She is not unprofessional (she refers out the cases which require special attention), and how dare you call her that simply because your time is inconvenienced.
I do realize that in this day and age there is an aggressive resentment toward those who value family more than income. Clearly, she is devoted to both her profession and her family - and she has chosen not to sacrifice the latter for the former. I respect her - and you should, too!
Question: Recently I hear you tell a caller it is neither ethical nor moral to set aside your religious faith in pursuit of something that seems very important at the moment. The issue was a Catholic caller and artificial insemination.
I work with Arizonans who are living with kidney failure. I would like to know your opinion about organ donation as it relates to some American Indians whose religious beliefs forbid such activity - specifically those who believe they will need all their organs in the next life.
As a group, American Indians have a disproportionately high incidence of diabetes and kidney failure. The people who support transplantation as the treatment of choice for kidney failure want to educate them into acceptance of this treatment option, even though there is another option - dialysis. Both treatments come with their own set of challenges.
Do you think that it is either ethical or moral to try to persuade American Indians who are able to accept dialysis to set aside their religious beliefs for the other medical treatment, transplantation?
- Scottsdale, Ariz.
Dr. Laura: Yours is a fascinating and difficult quesiton to answer in a few words, but here goes: There were religions that called for human sacrifice, those that command a widow to throw herself onto the funeral pyre of her husband, those that would castigate women for baring their heads, those that demand suicide as the ultimate response to the evil on this earth and some that would allow children to die rather than receive lifesaving medical treatment (like blood transfusions). Surely you do not see these values as legitimate, universal, just or compassionate.
The Catholic woman who called was struggling with her church's prohibition of artificial means of bringing life into the world. While this might seem a prohibition that lacks compassion, she admitted to the ego-investment of procreation, which conflicted with altruistic opportunities to adopt children already here, children without parents and hope for a loving, bonded life.
Biblically centered Judeo-Christian ethics on this subject generally agree that the preservation of life (God's divine gift) takes precedence over many other concerns, excluding immoral acts like taking the heart from someone still alive. However, where there is a legitimate alternative (dialysis), the patient has the choice. Therefore, the purpose of education is to increase the opportunity for the exercise of choice and free will within the context of the patients' personalities and religion.
There is an obvious difference between education and enforced conversion, And, as you said, not all tribes or nations agree on this issue - even within their communities it is not an absolute.