I can't get NO....satisfaction....

[kyburg]

Let's see.

You don't need to take Jim's word for it anymore. Even down to the names...which he was a good boy about and didn't tell anyone about either.

Hooray! (And so much for Tiajuana Taxi Fertility Hookups.) Note the words 'there is no law against...' - this is a evaluation by peers, and I hope we find out what they decide. But keep in mind - there is no law, and this won't create one. (Consider what the enforcement of one might look like, BTW. Just think about it for a moment, it'll come to you.)

Let me get this straight. When the McCaughey septuplets were born in 1997, President Clinton called to congratulate the parents, who were given a free 12-passenger van, Pampers for life, furniture, food, and a custom built house. Last spring, when Michelle and Jim Bob Duggar got pregnant with their 18th child, they announced it on the Today Show and their reality TV show launched that fall. When Nadya Suleman, 33, gave birth to octuplets on January 26th, she got revulsion, ridicule and death threats. A talk radio host who called her a freak said his listeners were prepared to boycott any company that helped out mother or babies. Jimmy Kimmel declared that "Golden retrievers do not have that many kids."

Uh, yawp. Single, POC and oh mi ghad IRAQI. SPICY.

(You know, I'd almost expect some people to have a little empathy for people who have somewhat toxic parents....but noooooo. Guess not.) And before you hit that comment button - keep in mind. The lady had choices. Since we see more of the grandfather doing childcare publically than the grandmother, you figure it out. Watch the grandkids leave that house Real Soon. As soon as enough money shows up - and it will show up. (Just keep making those death threats on all those sponsored websites, kids!)

Quick quiz.

Who administers 'food stamp' programs?

- Department of the Treasury
- Department of Homeland Security
- The Internal Revenue Service
- Department of Agriculture (*dingdingding*)

Also, the going term is Supplemental Nutrition Assistance Program - not food stamps. Note the key word - there is no intention for this ever to be the sole support for anyone. (I love the fact they've moved it off paper and to electronic ATM card. No, you can't pool the change from buying a candy bar with a coupon until you can buy liquor anymore. Too bad. *snickers*)

Oh yeah, $490 a month is a REAL GOOD incentive to have a kid. (...where do people get this crap...) And of course you top out, regardless of the number of people in the household.

Defend her? Not so much. What I find amazing is the vitriol where in just about every other case I know of, there was nothing but cooes and praise for being 'so absolutely PERFECTLY FEMALE' for being, well - successful at being female. That's it, isn't it? The pastel pinks and blues, the heft of the rewards thrown, the fairy tale twittering. The strokes - oh yes - THE STROKES.

(I'm catching echoes of it adopting right now, and I know it when I see it. It's perceived sainthood and I'm hip. I got much the same when I was the wife of a terminal patient. It's not helpful, except as a signal that they're not going to bitchslap you.)

I'm glad information is getting out. It's making our lives easier not having to keep our mouths shut. (How many times does WE CAN'TALK make sense?)

What I'm watching for? Terminations at the hospital of people who were peeking into health records when they had no reason to. Yeah, it's all electronic, all tagged with who was doing the peeking and we've had plenty of evidence there's a zero tolerance policy for fraud - though I think Kaiser might handle these a bit differently after a whole family died when both parents were fired for it. Remember - same hospital system.

Whatta parade. Can we talk about Sully instead?

Comments

[eyelid.livejournal.com]

so, if this is determined to be within the "standard of care", then that's ok?

also, say the standard of care outlawed abortion. Should a physician's group be able to make that kind of personal reproductive decision and enforce it amongst its members?

[betnoir.livejournal.com]

1. *with proof that the doctor performed OUTSIDE the standard of care*.

2. Abortion is regulated by federal law. If Roe v. Wade goes off the books, it then reverts to a states' rights issue. At least here in California, that still makes it legal. It's been *mumblerumph* years since I worked for ACOG, but the last time I checked, abortion was not outside the standard of care.

Why should sanctions against a doctor (if the charges can be proven) be any different for OB/GYN than for any other doctor?

If a psychologist does not breach confidentiality in a case where a patient has made specific harm threats against an identifiable individual, that's failure of duty to warn. And that could potentially mean suspension of license.

As it should be.

I'm really failing to understand why it should be any different for IVF doctors if there is sufficient evidence to prove that they performed outside standards of care.

[eyelid.livejournal.com]

I'm really failing to understand why it should be any different for IVF doctors if there is sufficient evidence to prove that they performed outside standards of care.

Because you're not talking about professional, technical errors. You're talking about barring a doctor from practice because he followed his patient's wishes and helped her have a child.

He didn't stim her wrong. He didn't perform negligently. He allowed his patient to make her own medical decisions.

This is a misuse of the standard of care. The standard of care is there to define malpractice - to say what the appropriate medical treatment is in any given situation, where medicine is of course partly an art and practitioners disagree. It's not there to enforce society's judgment about how many kids a person should be allowed to have!

It is a lot like when a doctor's license could be pulled for performing an abortion.



but the last time I checked, abortion was not outside the standard of care.

But if it were, you would support having the doctor's license pulled for performing it?

[(Anonymous)]

Patients make stupid-ass and uninformed decisions all the time.

Patients walk into their doctors' offices and demand drugs by brand name because they saw the commercial that says that the Purple Pill will cure what ails them. Or that the Happy Egg pill will cure their depression.

Because no drug company throughout the annals of history has ever buried negative findings six feet under. Nope. Never happens.

Should the doctor just roll over and prescribe Happy Egg pill because that was the patient's choice? Even if the doctor knows that Happy Egg is not the right call (and you wanna talk medicine as an art, let's talk about finding the right brain drugs).

As for your question regarding abortion -- the day Roe V Wade goes off the books is the day that question becomes relevant.

[betnoir.livejournal.com]

Whup -- that was me above.

[eyelid.livejournal.com]

Should the doctor just roll over and prescribe Happy Egg pill because that was the patient's choice?

Again, that's a different situation - it's one where the patient has a condition they think the Happy Pill will cure, but the doctor knows that's not true.

Here, we're talking about a person making a decision regarding how many kids she wants to have. You're saying the doctor should decide, as a "medical" opinion, whether it's appropriate for her to have more children.

Doctors are neither trained nor morally positioned to make another person's reproductive choices.

You're trying to say a doctor should be de-licensed because the doctor allowed a woman to decide whether she wanted to reproduce or not. Not because the doctor fucked up a medical procedure or prescribed the wrong pill or cut off the wrong leg. Totally different from a doctor dictating another person's repro decisions.


As for your question regarding abortion -- the day Roe V Wade goes off the books is the day that question becomes relevant.

you're refusing to answer it because you don't like the answer you'd logically have to give. That's cowardly.

[betnoir.livejournal.com]

Who said anything about morals?

If the standard of care says "Do X" and the doctor does not do X -- regardless of what the patient does or does not want, that's a problem.

This is not about reproductive rights specifically. This is about the standard of care that ANY doctor should be held to.

As for any discussion of cowardly -- you've set up a strawman. You are asking me to posit a situation that is not relevant. A 'what if.' Talk to me the day ACOG changes its position. As an aside, the day that happens is the day I call up my first boss and have a "Dude, WTF???" discussion.

Talk to me the day Roe v Wade goes away (and so that you do not misunderstand my stance on that -- I do NOT want it to go away). Until either of those two things happen, the point is moot.

Not moo as in COWardly.

[eyelid.livejournal.com]

If the standard of care says "Do X" and the doctor does not do X --

So what would your standard of care say? An infertility specialist should cut off a person at 2 children? Maybe if they're married (produce marriage certificate!) they should get an extra child allowance?

Similarly, shouldn't we be pushing into people's homes and removing the kids if, in your opinion, they have too many?

bottom line, THIS ISN'T A MEDICAL PROFESSIONAL JUDGMENT. These questions are entirely unsuited to be decided by medical professionals. Being a doctor doesn't mean you magically have insight into what the Right Family Size Is. You're trying to make this a "standard of care issue" but it ISN'T APPROPRIATE TO BE DECIDED BY A STANDARD OF CARE.


Talk to me the day Roe v Wade goes away (and so that you do not misunderstand my stance on that -- I do NOT want it to go away). Until either of those two things happen, the point is moot.

It's not moot, because the point is that if you think the "standard of care" should dictate medical decisions PERIOD, you should be willing to say that if abortion is outlawed, and therefore automatically outside the standard of care, a doctor should be de-licensed for performing it.

The point is that the "standard of care" should NOT be used to make another person's repro choices for them.

You don't want to admit this because you don't want doctors to be de-licensed for performing abortions. But you do want them to be de-licensed for performing fertility treatments. So you don't want to consider that it's the same thing.

[betnoir.livejournal.com]

*deep breath* What we have here is a failure to communicate.

I think you are talking specifics (repro endocrinologists) and I am talking generalities (all doctors, regardless of specialty, if they have one).

If there is *substantiated proof* against *any* doctor, regardless of specialty, then yes, their board should pull their license.

Repro endocrinolgists. Surgeons. Psychiatrists. Same rule applies.

*IF* there is *substantiated proof*. Not just because the board is morally outraged, but only if there is proof.

Did her repro endocrinologist perform irresponsibly? Dunno. And really, don't really want or need to know. That's a decision for their licensing board to make.

My point -- and my hand to ghod I really did have one -- was only that if any doctor, regardless of specialization, has performed their duties irresponsibly *and their licensing board can prove that*, then yes, they should be de-licensed.

If the repro endocrinol in question has been found by their licensing board to have have performed appropriately, then everyone can just siddown and shut their pieholes on the matter. End of story, nothing to see, move along now, and thank you for playing. Because baseless witch hunts just piss me right the hell off.

If the repro endocrinol has been found to have performed irresponsibly, then the board should take whatever appropriate action it has been charged to take.

*whew* that was a whole lotta qualifiers.

[eyelid.livejournal.com]

My point -- and my hand to ghod I really did have one -- was only that if any doctor, regardless of specialization, has performed their duties irresponsibly *and their licensing board can prove that*, then yes, they should be de-licensed.

ok, well, I can agree with that. with this caveat:

If it's concluded that putting so many embryos back was a violation of the standard of care because, e.g., the risk of high order multiples was too high, then ok.

But if the issue is that he "violated a standard of care" because he performed fertility services PERIOD on a woman who was "too poor" or "had too many kids already," I think that's an inappropriate question to be included in a "standard of care." Doctors are not qualified to make family size judgments, nor should they be de-licensed for it.

[betnoir.livejournal.com]

I don't know if that is the standard the board is using. Not my bidness to know. If that is indeed the standard, I'd be right there with you squinting sideways at the whole thing.

From my standpoint, despite the hoops I had to jump through to get fixed before I had children, I don't think the OB who did the deed should have been de-licensed just for that. < wry >I has my my own rant from the other end of the spectrum about a 30-day wait period before I could have the surgery done. < /wry >

As to your abortion question -- I did clinic escort when I was in college 20-plus years ago.

Until I finally did get fixed, I lived in fear of getting pregnant because I knew the odds of my for-shite DNA being passed along (and don't think for a minute that deciding to end the family line because you are an only child doesn't have its own ramifications).

Finally, I know what a uterus that has been torn apart by a coathanger that was left in looks like. I have that photograph seared onto my brainpain for the rest of my life. There is very little any more about human wetware that freaks me out -- I've seen everything from picture of unborn fetuses with gross deformaties that would earn them a spot in the circus freakshow to cancerous tumors the size of a bowling ball growing off an ovary. Make no mistake that when girlbits go wrong, they go horridly horridly wrong.

But that picture...oh that picture will stay with me until the day I die. The whole "no more wire hangers" thing took on a whole new meaning after that.

[eyelid.livejournal.com]

I'm a pro-choice activist, so abortion rights are next to my heart. To disclose my own biases, I have gone through abortion, childbirth, miscarriage and infertility (through IVF), so I am touchy about doctors being cut off from doing ANY repro-related things just because Society Disapproves.

[kyburg.livejournal.com]

I'm waiting to see what the board says. I sure hope they show some backbone. (And we get some history - some of the reports are saying the prior pregnancies (ending in singletons, mostly) were also 6 eggs implanted. If that's the case? *shrug* I'm not the titled professional and any opinion I have about the whole thing is just hot air, nothing more.)

Who can and can't have kids? Not on the table.

I'm trying to remember what the criteria was for Dr. Whiz-bang. I do recall he wouldn't do additional work for people with three or more children at home - vaugely.

[betnoir.livejournal.com]

Some of those six eggs went down to one due to 'selective reduction.'

Now that, right there, is a euphamism for ya.

[anahata56.livejournal.com]

Did she do a reduction in the first six pregnancies?

When asked about it for this one, she said that she absolutely wouldn't even consider a reduction.

I wonder what happened to make her change her mind between those pregnancies and this one?

[(Anonymous)]

Dunno. Don't need/want to know. Not my bidness.

That's HIPAA at work. And if folk want it to work in their favor, they'd best siddown, shuddup and let it work for her.

(sorry, not schnarky at you, but at people who demand her personal info, yet would howl to the moon if their medical info suddenly became public fodder).

[anahata56.livejournal.com]

Oh, I didn't take it as snarky. And yeah, that was my curiosity getting the better of me, because as time goes by, the muddier it gets, and, in my mind, it's becoming less and less about children.

Thing is, though--that little data point might be significant when it comes to what to do with the fertility doc. If he did six embryo transfers in the past, all with upwards of five embryos, and she's had singletons every time, then there would be no reason for him to believe that this outcome would be any different. And when it comes right down to it, a reduction isn't usually in the hands of the fertility doc--it's in the hands of the perinatologist/maternal-fetal medicine. So the fertility doc may not be as responsible for this as is being insinuated in the press, and there may be even more doctors held liable in this situation as are readily evident.

[betnoir.livejournal.com]

Which, really, was my point, despite what others may have thought.

IF the board can PROVE megligence on the part of the fertility doc? Have at.

Note the emphasized words.

[anahata56.livejournal.com]

Exactly.

And to be honest, just one more issue that makes me suspicious of this woman.

I mean, she talks about him like he's the most wonderful man in the world, but she's ready to throw him under the bus by divulging the information that suits her, and withholding the information that doesn't. And of course, he can't defend himself, because telling what really happened would definitely be a HIPPAA violation.

I just hope that the right people get the right information, and that a just decision can be made where his licensure (and no doubt his board certification) is concerned.