We’re pleased to introduce our latest guest blogger, Dr. Joseph Stanford. Dr. Stanford is a professor at the University of Utah Medical School where his research focuses on fertility care. This year he’s on sabbatical at the National Institutes of Health to do epidemiologic research related to human reproduction. He recently finished a three year appointment on the FDA Advisory Committee for Reproductive Health Drugs. Brother Stanford is an advocate of natural family planning and published an article on the topic for the religious journal First Things in November 1999. (The article caused some controversy about whether a Mormon “should” publish in a journal that publishes articles by Catholic, Protestant, and Jewish scholars.) Joe and his wife Kathleen have seven boys, all of whom, minus their eldest son who’s serving a mission in Toronto, are spending the year in my Maryland ward. Welcome, Brother Stanford.
Um, if First Things is good enough for the president of BYU to plagiarize from, it ought to be fine to publish original work there, I would think.
I am looking forward to Dr. Stanford’s posts.
Hehehe, Kristine! Feeling a wee bit snarky this morning, are we?
But is it plagiarism if you don’t apologize, or blame it on your overworked research assistants?
Welcome, Dr. Stanford! It’s great to hear from you. I found the linked article fascinating. I’m interested to hear more.
“But is it plagiarism if you donâ€™t apologize, or blame it on your overworked research assistants?”
That worked for Doris Kearns Goodwin. (Sorry Kristine–I figured since you brought it up, I might as well hit the Harvard angle…)
Welcome, Dr. Stanford! I’m looking forward to your posts; in reading your article linked above, I found a lot to applaud and a lot to challenge. Speaking as someone who conceived her first child while intending to avoid pregnancy using NFP—I understood my cycle just fine, it was how long-lived my husband’s contribution could be that tripped us up—I have a very personal interest in the topic. (And let me be clear—the result of that unplanned pregnancy is my exquisite and utterly delightful four-year-old daughter, whom I emphatically do not regret in any way!)
Well, you do know the old joke:
Q. What’s the technical term for people who use timing / natural family planning?
Welcome, Dr. Stanford.
During her recent med school years my wife heard a lecture given by Dr. Stanford on his views about natural planning. If I recall correctly, she came home saying that he took the stance that as a physican he would refuse to prescribe birth control to patients. (If I’m wrong, I’m sure someone will tell me.) I think my response was that it was fine for him to have his unique perspective as long as he didn’t claim to represent the official LDS stance on the matter.
I do think that self restraint is a virtue that should be practiced in marriage but I don’t think that it is morally superior as a form of birth control. LDS are commanded to multiply and replenish the earth. Withholding seed by abstinence isn’t much different from any other method when it comes to obeying this commandment.
I’m looking forward to your contributions, Brother Stanford.
I’ll go further than that, Danithew. I don’t think it’s right for a physician to refuse to make categorical decisions such as not to give birth control prescriptions to patients. At the very least, such a decision should only be made with absolute, informed consent by the patients.
I wouldn’t want to go to a physician who would categorically refuse to prescribe ibuprofen to any patient. If I need ibuprofen, and that’s what’s best for me, then that’s what s/he should prescribe for me. The same applies to birth control. The physician who deliberately handicaps herself in her ability to best treat me isn’t doing her job fully.
Yes, there are some things that are off limits. (I would happily go to a physician who categorically excludes phrenology). I don’t think birth control falls within this camp. It’s widely accepted, it has benefits for its users, and NFP is not an acceptable alternative. (Cf. Rosalynde’s comment).
“That worked for Doris Kearns Goodwin.”
If research assistants get to determine the text of your book, Doris, then they ought to be co-authors.
I agree with Kaimi about prescribing birth control. If you don’t want to treat your patients properly then you ought to find another job.
Kaimi and Hellmut, I understand your perspectives but I have mixed feelings on the question of whether a doctor is justified in refusing to prescribe birth control. Though I think it is an odd decision to make, I think a doctor ultimately has the right to make that decision. Laying that issue aside, on a more practical basis, I’m not at all concerned about patients having difficulty finding available means of contraception or a doctor who is willing to prescribe birth control.
My concern is more with a feeling that to a great degree Dr. Stanford relies on his LDS identity and LDS sources to explain/justify the unique stance he has taken. He may in fact leave some with the impression that a practicing LDS person is forbidden to use birth control or that LDS doctors are forbidden to prescribe birth control. I once heard an anecdote about a man who had decided he would not leave the area of his bed on the Sabbath day. A rabbi responded to this by saying: “That’s fine if that’s what you want to do, but please don’t call what you are doing Judaism.” My response to Dr. Stanford is similar: “That’s fine if that’s what you want to do, but please don’t call it Mormonism.”
Perhaps Dr. Stanford will treat us to a post on the professional ethics of declining to prescribe a treatment that is legal, indicated, and endorsed by the mainstream of the medical profession.
Great post, Danithew. I like your point about choice and theology.
There is a difference, however, between Sabbath observance and practicing medicine. Choosing a health care profession implies the obligation to properly treat you patients. You have the freedom to choose the obligation that comes with the job, but not to hold the job without the obligation it entails.
It seems to me that the ethics of Dr. Stanford’s refusal to prescribe birth control (if this is indeed his position) hinge entirely on the consent of patients. I have no problem with doctors who exercise idiosyncratic moral judgments with regard to how they practice their profession. Indeed, I think that it is healthy for the profession to have people who are willing to make independent moral decisions about its practice. It seems to me that it would only be unethical in a case where the exercise of independent moral judgment was being done in such a way that patients were unaware of what was happening. Otherwise, I see the professional ethics of Dr. Stanford’s refusal as being analogous to an attorney who refuses to represent Big Tobacco or engage in nominally legal and ethical scortched earth litigation tactics. I know many attorneys who are pressed by their clients to do certain things that are legal and would not result in any professional sanctions, but which the attorneys nevertheless refuse to do.
I am also uncomfortable with the notion that we can comfortably divide the world into that which is “Mormonism” and that which is purely personal opinions. It seems to me that we want members of the Church to engage in independent thinking about the possible implications of their religious beliefs. Furthermore, I think that we benefit when they articulate and publish their thinking. If the test for what counts as Mormon thinking becomes “what every Mormon thinks” and if anything that doesn’t meet this criteria must be shorn of any Mormon content so as to prevent misperception about what other Mormons believe, Mormon intellectual discussion will come to a screeching halt.
Look, Dr. Stanford may be mistaken with regard to natural family planning. I am not a fan of it myself. But I don’t see any reason for people to start hyper-vennillating about the ethics of his conduct, or somehow insist that his thinking is some sort of illegitimate use of Mormon sources or theology. One can be wrong without being unethical, outrageous, or threatening to the faithful.
It seems to me that this discussion might be best put on hold until Brother Stanford actually puts up his own, more detailed views on NFP, of which his post on sexuality and procreation is obviously only a first step.
I’m simply wondering if these posts will be enough to wake Snarkernacle from its holiday hibernation.
One hopes not…
Resting, no doubt, between frenzied bouts of holiday sex.
Kingsley, I was just laughing so hard my co-worker started laughing too. And she had no idea why …
It seems to me that the ethics of Dr. Stanfordâ€™s refusal to prescribe birth control (if this is indeed his position) hinge entirely on the consent of patients.
While that is a factor, it is not the only factor. I am chary of a medical professional taking a position that is entirely self-serving — it appears from his public statements that Dr. Stanford prescribes the treatment that makes him feel good, not necessarily the treatment that is best for the patient. This is more than a little troubling.
While some of the damage from this postition could be ameliorated if he gives his patients an opt-out disclaimer — say, along the lines of “I do not prescribe birth control medications because I find them morally offensive. I also believe there may be medical benefits to the patient in avoiding such medication. Neither my moral position nor my medical position are those held or adopted by the mainstream of the medical profession, and if you prefer more conventional treatment, here is a list of licensed and competent physicians to whom you can go for a prescription.” — that still does not explain why his moral qualms should trump the best interests of his patients.
And while I understand that the legal profession has its own set of professional ethics, they are not the same as those of the medical profession. There is a very big difference between witholding treatment from a patient and deciding not to litigate on behalf of Phillip Morris.
What is your view of a physician who declines to perform nontherapeutic abortions because he or she believes them to be morally wrong?
What is your view of a physician who declines to perform nontherapeutic abortions because he or she believes them to be morally wrong?
DavidH, first why don’t you tell my why you think your question is relevant, given that you are now talking about a surgical procedure rather than a pharmaceutical prescription, and given that you have specified “nontherapeutic.” In fact, why don’t you define what you mean by that term while you are at it — my guess is that your definition would not be my definition.
While you’re thinking about that, I’ll give you my bottom line again: a physician who puts his own moral comfort ahead of his patients’ welfare should find a different profession.
diogenes: I find it interesting that you reframe the issue of moral scruples in terms of “feeling good.” I would agree with you if I thought that moral judgment was purely a matter of pyschology, but I don’t. It seems to me that what is at issue here is whether a physician should be allowed to refuse to be complicit in what he regards as immoral behavior. We would be in a different situation if the physician’s refusal place a patient in the situation of not having access to some otherwise available form of care. I take it that this is not the situation here, since as far as I know Dr. Stanford does not have a monopoly on medical care. Rather the doctor is in effect saying, “This stuff is available, but if you want it you will have to go elsewhere.” I don’t see that this undermines the patient’s welfare.
I actually think that the analogy to doctors and lawyers in this case is fairly good. Both are professionals who are charged with looking out for the best interests of their clients/patients. Both are retained because they have special expertise that the client/patient lacks, and hence in both cases the client/patient is in some sense in a dependent relationship. One might argue that medical care is more important than legal representation. In many situations this is not doubt true, but is far from clear that this is always the case. For example, life or death medical care is clearly more important suing an insurance company over a fender bender. On the other hand, I think that representation in a matter than may result in years of incarceration or complete financial ruin may be more important than many kinds of minor or elective medicine.
“I take it that this is not the situation here, since as far as I know Dr. Stanford does not have a monopoly on medical care. Rather the doctor is in effect saying, â€œThis stuff is available, but if you want it you will have to go elsewhere.â€? I donâ€™t see that this undermines the patientâ€™s welfare.”
Where do you draw the line, Nate? What if Dr. Stanford was the only OB/GYN in a rural area? How far would his patients have to drive before you change your position?
” first why donâ€™t you tell my why you think your question is relevant, given that you are now talking about a surgical procedure rather than a pharmaceutical prescription, and given that you have specified ‘nontherapeutic.’ In fact, why donâ€™t you define what you mean by that term while you are at it â€” my guess is that your definition would not be my definition.
“While youâ€™re thinking about that, Iâ€™ll give you my bottom line again: a physician who puts his own moral comfort ahead of his patientsâ€™ welfare should find a different profession.”
I apologize if I offended you. I was trying to understand if your view that a physician should perform all legal procedures that are endorsed by the mainstream of the medical profession (comment 13) had any limitation.
If, in fact, you mean that there should be no personal moral or religious limitations on a physician’s obligation to perform procedures that are mainstream and legal, I do not agree with you, as you correctly inferred from my question.
Nate seems to think I’m not being inclusive enough when I say that Dr. Stanford’s stance isn’t representative of Mormonism. I hope we can say that to a great extent Mormonism embraces a broad spectrum of people with a wide variety of opinions and ideas. I can understand that Mormonism has room for Dr. Stanford. I didn’t mean to say he can’t be a good Mormon and have his own unique views on reproduction and birth control. Of course that is possible and is in fact the case.
The perspective I was taking in making my comment was a little different. I was trying to think of an analogy and here goes. Imagine you have a Mormon who draws an unusually strict interpretation of the Word of Wisdom — that is, he or she thinks that based on D&C 89, it would be better if people wouldn’t eat meat at all. That isn’t completely illogical. No doubt, despite the fact that Mormons in general are permitted to eat meat, this person could still use scriptures and quotes from general conference talks to support vegetarianism. Now let’s imagine that person owns a deli and refuses to serve sandwiches with meat. If you ask that person why he won’t serve a roast beef sandwich and he starts out his explanation by saying “Well, I am a Mormon …”
That’s the part of the question I have a problem with. Do I think Mormonism has room for vegetarians? Of course. Do I think the Mormon church has room for a doctor who thinks birth control is bad and refuses to prescribe it? Yes. But I think in explaining their vantage-points the LDS vegetarian or the LDS doctor opposed to the use of birth control should concede that they are taking a unique vantage-point and not teaching a strict mainstream Mormon doctrine.
Good point, danithew, that should apply to most of the things we discuss.
Do you think that Dr. Stanford crossed the line you describe? It’s been awhile now since I read his article, but I don’t remember any statements about how Mormons must adher to this or that view of birth control. Is your complaint that he did not write a disclaimer into his article?
More broadly, I think Nate is exactly right when he says that “[o]ne can be wrong without being unethical, outrageous, or threatening to the faithful.” Frankly, I think it would be a great improvement if that point of view were more widely accepted (not that I come close to being a perfect model of this, as my reaction to Adam’s previous post on IVF demonstrates).
Randy, it’s an overall impression of what I read in the linked article. He writes quite a bit about LDS beliefs and doctrines — but my feeling is that he’s trying to hard to connect all the doctrinal dots in order to arrive at his approach to things. Maybe I’m missing something.
Show me a line where he concedes that (worthy) LDS couples are permitted by Church leadership to use birth control.
I pointed to these lines when the issue came up before:
â€œI do not presume in any way to judge others (particularly my patients) when they choose to use contraceptives. Their choices about their reproductive potential are between themselves and God, and it is their right and responsibility to determine for themselves what they will do about their fertility.â€?
Does that help or should I go back and look for something different?
I would also point to this line, which comes after a listing of several related positions taken by church leaders (all of which seem basically correct to me, at least in their abbreviated and necessary vague form):
“To me, all of these doctrines in their fullness completely support the appropriateness of using NFP within marriage.”
Key words there being “[t]o me.”
What is interesting is that trials in India (where human experimentation appears to have fewer limits) resulted in NFP being more successful than oral contraceptives in preventing pregnancy. That was a shock to me, when I read the studies about ten-twelve years ago.
On the other hand, combined methods, such as NFP and barriers, etc., are more effective than any of the methods alone.
I once heard an anecdote about a man who had decided he would not leave the area of his bed on the Sabbath day. A rabbi responded to this by saying: â€œThatâ€™s fine if thatâ€™s what you want to do, but please donâ€™t call what you are doing Judaism.â€? My response to Dr. Stanford is similar: â€œThatâ€™s fine if thatâ€™s what you want to do, but please donâ€™t call it Mormonism.â€?
I’ll have to remember that one ;)
One final point, danithew, and then it’s back to work. I agree entirely with you that Stanford is “trying hard” to connect all the doctrinal dots in order to arrive at his approach to things, an approach that I’m frankly not sold on. (I am eagerly awaiting for Stanford to check in and respond to the questions posed by RAF and others. Should be interesting.) But his article doesn’t strike me as going overboard on predicting official Mormon doctrine. He is making an argument that goes beyond current doctrine based on what has been said before. As Nate points out, that can be an enlightening and productive exercise, provided that those who make such arguments are willing to concede that they are, at the end of the day, only arguments and not official pronouncements.
My only hope is that Nate’s approach is applied so as to allow argument in more than one direction. I think all of us, myself included, are a bit guilty of holding arguments we reject to a higher standard than those we accept.
Randy B., I appreciate you drawing my attention to those lines. Somehow I missed it when you pointed them out earlier. And I like the other thoughts you’ve offered as well. I didn’t respond much for a little while because I was leaving for home. I hope my brief silence there wasn’t interpreted as stubborness.
Danithew, you are too nice.
On the issue of (not) prescribing birth control:
I appreciate the effort that posters on this thread have taken to understand and not overstate what I have already written. Frankly, that is something I haven’t experienced much of before in public discourse that I have been involved with in the past.
As stated in my article in First Things, I do not prescribe artificial birth control in clinical practice. What I actually say to patients is pretty close to what is described in response #22 and #25. I do not tell people they are wrong to choose a birth control method or that birth control is morally wrong or that I don’t prescribe birth control because I am Mormon. (In fact, quite a few of my patients have assumed that I am Catholic until eventually learning otherwise.) I will discuss all methods and issues around any and all birth control methods as objectively as possible- stating as clearly as possible what is the “mainstream medical” position and where and how mine differs. But when it comes to the actual writing of a prescription, I simply say that because of my personal moral stance, I can not prescribe certain things.
It is rare that this comes as a surprise to any of my patients, and I make every effort to let patients know as soon as possible, up front, if this might be an issue for them. My office staff are well aware of my stance and usually alert patients up front if they are calling in as a new patient. My partners in practice respect my stance and are happy to see patients that are looking for birth control that I don’t prescribe. Actually, my practice now consists largely of patients who seek me out because they are looking for something along the lines of NFP or NaProTechnology (to be discussed later). Most of these patients have been unable to find what they are looking for with other doctors, or have been referred to me by other doctors.
I believe that physicians and other health professionals are not obligated to provide every treatment just because it is legal or considered a mainstream medical option. Induced abortion (surgical or medical) is an obvious example, and the question that was raised about whether providers should be required to provide abortion when requested is morally analagous to the question of whether providers should be required to prescribe any particular birth control method when requested.
As another example, consider newborn male circumcision. Some years ago, a female colleague of mine came to the conclusion that this was a totally unjustified procedure and that she could not perform it (she had been trained to do so), even if it was the parents’ informed choice. I don’t agree with her assessment that it is completely immoral: my own position on newborn male circumcision is that I will encourage parents to consider the reasons not to do it, but if requested with full informed consent, I will still perform the procedure. But I defend the right of my colleague to not perform the procedure.
Actually, physicians don’t provide various treatment that they were trained to do for all kinds of reasons, most of them not moral in nature. Physicians stop doing deliveries or certain surgeries because of malpractice costs. Or they don’t provide vaccinations simply because they are too expensive to keep in the office. Or they simply choose to specialize in their scope of practice.
I believe health professionals can and should follow their own ethical and responsible professional choices in the services that they provide, and that physicians are equally obligated to respect their patients’ choices. In my experience, this can be accomplished with nonjudgmental dialogue and letting patients match up with the health professionals that provide what they are seeking.
Religious freedom requires that, to at least some extent, religious people can think through how religion should influence their public action and can then act accordingly. I applaud Dr. Stanford for having the courage of his convictions.
The contrary view–that one’s beliefs should be stay private–seems to me the product of a kind of dhimmitude of believers.
Kudos to you for standing firm in what you believe. We all would do better to stand for our own morals as we too often give in to pressure from those around us.
Any ways, is your son in the East or West mission?
West Toronto mission
That’s too bad. The East Mission was better. ;)
I thought Dr. Stanford’s comment #39 was well-stated.