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Delivering Obstetrics from Radical Islam
by R. John Matthies
Is a Muslim within his rights to insist a female physician examine his wife, or refuse male assistance in the birth of his child? And, are hospitals obliged to accommodate the Muslim's wish when this unfairly burdens staff, entails a delay that jeopardizes patient care, or if accommodations like these contravene the Hippocratic oath? Europe grapples with questions like these with increasing frequency; and Great Britain and the Netherlands appear well on their way to translating the discriminating tastes of their hospital guests into hospital policy.
The Dutch Telegraaf reports that the Dutch physicians' organization (KNMG), in reply to verified cases of doctor intimidation, has published guidelines that will allow Muslims to refuse a male physician. The organization asks that hospitals satisfy requests for a female physician in every case but those deemed "acutely emergent," and urges sensitivity. Without surprise, the article goes on to cite a Dutch National Broadcasting Foundation (NOS) report that acknowledges "some physicians" feel the professional organization is too quick to cater to "the wishes of Muslims."
The new physician selection guidelines are the fruit of questions posed in a policy progress document dated November 1, 2007. Section 5 of said document, which examines Medical Ethics, relates that one is unclear as to actions required when a Muslim, for reasons of faith – but occasionally at risk to the patient – refuses the attention of a male physician. And one reads, by way of reply, that a directive is in the offing. (This is followed by a paragraph, which, with no apparent irony, goes on to describe a study commissioned to explore "conscientious," or, physician-assisted, suicide.)
The Flemish Association for Obstetrics and Gynecology (VVOG), well aware of the problems posed by Muslim bias against male Obstetrician-Gynecologists, agrees with the physicians described by the NOS report, and demands a measure of inflexibility – if only for sake of efficiency. Johan Van Wiemeersch, head of Sint-Augustinus in Wilrijk, explains: "In my own hospital every patient who absolutely insists on a woman is dismissed from the hospital. As a gynecologist association we ask for the same strict rules in all maternity wards. In our own hospital we used to be more flexible, but female gynecologists had to be called out of bed to come in. That is not acceptable."
Grumbling over belligerent males in the obstetrics ward has also made news in Belgium, where two cases in particular made headlines recently. One concerns anesthetist Philippe Becx, who, on the night of August 23, 2007, was called to assist an emergency Caesarian. The doctor arrived to find his path obstructed by the patient's husband, who said in no case would a man be allowed to care for his wife. Two hours of debate ensued, in which time Dr. Becx explained he was the sole anesthetist on duty. At last an imam was called to broker an accord; this consisted of draping the expectant mother with cloth, and exposing her flesh to the doctor at the injection point alone.
The doctor reluctantly consented, and, after administering the epidural, waited outside the operating room, where he assessed his patient and conversed with the (female) gynecologist through a duty nurse and a door propped ajar. Dr. Becx went on to press charges against the man, for hindering a physician in the exercise of his function; but Belgium's professional association of anesthetists, while sure of the doctor's right, was unwilling to ascribe motive to the man's religious convictions, and reading instead a case of gender discrimination. All the same, the organization not only signed the complaint, but also filed civil charges of criminal negligence.
Similar, as reported by Brussels' De Morgen, is the case of Luc Gerguts, chief of gynecology at Geel Sint-Dimpna hospital, who described to a physician's journal how an angry Muslim prevented him from assisting his wife in a dangerous delivery. The woman had experienced two stillbirths already, he said, and her situation was critical. But when the husband refused to allow Dr. Gerguts to attend to his wife, the doctor yielded, and, following the example of Dr. Becx, dispatched for two experienced midwives, and stationed himself behind the door.
Examples like Becx's and Gergut's have become more visible in the Western European media, but this is not to say that this is everywhere the same. Across the border, in France, for example, violence against male physicians is neither unknown nor rare, but the tactics deployed to counter unreasonable demands for accommodation have evolved very differently.
To begin, accommodations like these are ridiculed in the press. France's most famous cartoonist and political satirist, Plantu, whose work appears on the front page of Le Monde, has, over time, produced several noteworthy panels on Islam in the obstetrics ward. One represents a quarrelsome Muslim, who demands to know the faith of his wife's physician. The doctor's answer? "Humanitarian." The second depicts a similarly threatening male, with pregnant wife in tow, who indicates his own prominent belly and bellows, "She hurts here."
French Ob-Gyn Gilles Dauptain says he's no stranger to belligerent comportment in the ward. But, he relates to Libération (Paris), "we've had far fewer incidents of this type" most recently; and this, he continues, for the "simple reason" that the French College of Gynecologists and Obstetricians (CNGOF) – with the unqualified endorsement of the French Medical Association (CNOM) – thought it best to publish a communiqué defense of women "against Muslim fanaticism."
This defense comprises a brief policy document (titled Information importante), which the College distributed to every Obstetrics-Gynecology service in France, with the recommendation that this be posted in plain view of hospital guests and those seeking care.
The Information states that, (1) the healthcare field is comprised of members of each sex; (2) it is impossible to guarantee a woman will be followed or examined by a female physician; (3) private conviction and the practice of faith must not be allowed to compromise patient care; (4) the service may not be disrupted for any reason; and (5) refusal to be seen by a man will be understood as refusal of service.
The attached communiqué (in French), titled "Obstetrician-Gynecologists Support Women Against Muslim Fanaticism," carries the names of the President and Secretary-General of the College of Gynecology; and reads: "We say, in no uncertain terms, that we will continue to administer services where physicians, male or female, will care for patients of either sex" (emphasis in original). And, to close:
Anecdotal evidence suggests that the problem of aggressive gender selection at the hospital is not so egregious in the United States; but this is not to say that incidents like these do not or cannot occur here. The United States would be wise to consider examples like the Netherlands's – and France's, of course – and think to fashion policy documents drafted to preclude unreasonable accommodation or special services, and, most important, consistent with the health, safety, and well-being of the patient population.
By way of reply to the questions posed at the beginning of this article, it should be observed that while the choice of physician is both private and a matter of taste, the demands occasioned by advanced medical practice often render consumer-oriented accommodations impracticable and/or unwise.
And, finally, on the subject of physician-selection and recalcitrant males, it was suggested to me by a nurse with experience in reproductive health that it's always best to abide by the phrase: "What's good for the goose is good for the gander."