Roe v Wade is on deck

[Elixir]

Why did you omit the text above that which referred to the physician’s best judgment?

That wouldn’t fit with law enforcement having the final say over reproductive health decisions now, would it?
I’m sure the omission was not intentional, or part of a bad faith argument, right?

There’s also a bit about snitching on colleagues who are doing stuff that Emily fears. It’s required. The best interest of the patient is also in there, but the best interest of a 24+ week fetus is not. That has to rankle Ems something fierce.

Why do you feel the need to incessantly and repeatedly make shit up and lie about my view?

Apparently you haven’t even read the material you refer to. Sheesh.
If you’re gonna litter these pages with accusations of lying, you should probably identify the alleged lie, lest it appear that YOU are making shit up to avoid having to make a cogent argument to support your irrational “position”.
You have nothing but baseless ad hominem attacks, with which to defend your histrionic emotional rants about corrupt doctors and all the unevidenced atrocities they commit.
Get a life Emily.

 

[Toni]

Of course there are safeguards in place. They just are not what you agree with or understand

What safeguards are in place?

I’ve discussed them upthread.

Link, please?

You seem to believe that only laws will do.

I think regulations or laws are the only concrete safeguards we really have. Everything else ends up being someone's preference of personal beliefs - and personal beliefs are only safeguards if those personal beliefs completely align with yours.

Actual Safeguard: All firearm purchasers must undergo a background check
Meaningless 'Safeguard': Sellers will use their best judgment to decide whether or not to sell a firearm to someone who wishes to buy them

Actual Safeguard: Teachers and Caregivers working with children under age 13 without parental presence will be subjected to a background check and preliminary investigation which can include social media posts and shared video content
Meaningless 'Safeguard': Employers will use their personal beliefs and ethics to decide whether or not to hire someone who will be working with little kids.

The law doesn't have to be a step-by-step recipe, it doesn't have to be onerous. But without some regulatory or legal basis, it's not a safeguard at all, it's "trust me bro" and nothing more.

I disagree and in fact such laws have caused women to lose their lives.

Some laws have caused women to lose their lives. But not all laws are created equal. The fact that a bad and overly restrictive law has caused problems is NOT an effective argument for no laws at all.

How about you link for me the cases of women obtaining abortions at 35 weeks gestation ‘just because?’

 

[Emily Lake]

I'm revising my approach, based on the most generous policies in a fair bit of Europe.

Here's my original proposal:
Unrestricted abortions on request prior to the 27th week of gestation; at 27 weeks or later, abortions are restricted to medically indicated terminations when the life or health of the mother is at risk or when the fetus has severe deleterious conditions. For third trimester abortions, the doctor performing the procedure is required to document the conditions and risks involved, and their records may be subject to audit.

Here's my revised proposal:
Unrestricted abortions on request prior to the 27th week of gestation; at 27 weeks or later, abortions are restricted to medically indicated terminations when the life or health of the mother is at risk or when the fetus has severe deleterious conditions. For third trimester abortions, signatures indicating agreement from two doctors are required to be included along with documentation of the conditions and risks involved. REcords may be subject to audit.

ETA: Be aware that the latest period for unrestricted abortions in Europe is 24 weeks.

 

[Emily Lake]

Why did you omit the text above that which referred to the physician’s best judgment?

That wouldn’t fit with law enforcement having the final say over reproductive health decisions now, would it?
I’m sure the omission was not intentional, or part of a bad faith argument, right?

There’s also a bit about snitching on colleagues who are doing stuff that Emily fears. It’s required. The best interest of the patient is also in there, but the best interest of a 24+ week fetus is not. That has to rankle Ems something fierce.

Why do you feel the need to incessantly and repeatedly make shit up and lie about my view?

Apparently you haven’t even read the material you refer to. Sheesh.
If you’re gonna litter these pages with accusations of lying, you should probably identify the alleged lie, lest it appear that YOU are making shit up to avoid having to make a cogent argument to support your irrational “position”.
You have nothing but baseless ad hominem attacks, with which to defend your histrionic emotional rants about corrupt doctors and all the unevidenced atrocities they commit.
Get a life Emily.

1) YOU CLAIM that I want law enforcement to have the final say over reproductive health decisions, which is blatantly false, and it's something I have repeatedly corrected for you, repeatedly told you that you're wrong, and you just continue to lie about it.

2) YOU CLAIM that I require colleagues to snitch on each other, which I absolutely do not, this is another blatant and shameless lie on your part.

 

[Emily Lake]

Of course there are safeguards in place. They just are not what you agree with or understand

What safeguards are in place?

I’ve discussed them upthread.

Link, please?

You seem to believe that only laws will do.

I think regulations or laws are the only concrete safeguards we really have. Everything else ends up being someone's preference of personal beliefs - and personal beliefs are only safeguards if those personal beliefs completely align with yours.

Actual Safeguard: All firearm purchasers must undergo a background check
Meaningless 'Safeguard': Sellers will use their best judgment to decide whether or not to sell a firearm to someone who wishes to buy them

Actual Safeguard: Teachers and Caregivers working with children under age 13 without parental presence will be subjected to a background check and preliminary investigation which can include social media posts and shared video content
Meaningless 'Safeguard': Employers will use their personal beliefs and ethics to decide whether or not to hire someone who will be working with little kids.

The law doesn't have to be a step-by-step recipe, it doesn't have to be onerous. But without some regulatory or legal basis, it's not a safeguard at all, it's "trust me bro" and nothing more.

I disagree and in fact such laws have caused women to lose their lives.

Some laws have caused women to lose their lives. But not all laws are created equal. The fact that a bad and overly restrictive law has caused problems is NOT an effective argument for no laws at all.

How about you link for me the cases of women obtaining abortions at 35 weeks gestation ‘just because?’

I take it that this is your confession that you did NOT discuss any actual safeguards? Because realistically, all you did was to assert that safeguards must exist... simply because you believe they ought to.

 

[Elixir]

I think regulations or laws are the only concrete safeguards we really have.

Such an authoritarian.
Remind me not to trust you - EVER.
I’m sorry for whatever trauma you have endured that causes you to place trust in the Nanny State rather than in vetted medical professionals.

 

[Toni]

Why did you omit the text above that which referred to the physician’s best judgment?

In what way is "physician's best judgement" either materially different or more safeguarded than "physician's personal ethics"?

Because their license depends on it.

No, it doesn't.

How about you go find me the language that specifies that a physician's license depends on them employing safeguards to prevent the termination of health fetuses in healthy mothers in the later stage of gestation? Show me that language and I'll change my mind. Go on, I'll wait.

https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/guide-to-medical-regulation-in-the-united-states/about-physician-discipline#:~:text=Failing%20to%20meet%20the%20accepted,Conviction%20of%20a%20felony

• Alcohol and substance abuse
• Sexual misconduct
• Neglect of a patient
• Failing to meet the accepted standard of care in a state
• Prescribing drugs in excess or without legitimate reason
• Dishonesty during the license application process
• Conviction of a felony
• Fraud
• Inadequate record keeping
• Failing to meet continuing medical education requirements

You seem to insist that laws must specify specific parameters that meet your personal standards in order to be good enough for you.

The reality is that if specific circumstances are enumerated, anything that is not specifically described as prohibited is allowed .

Medicine is a profession where practitioners MUST rely on their expertise and ethics, gained through years of study and practice and experience. Physicians must operate within the bounds of state laws but also within the guidelines and regulations of the AMA and any other professional board providing guidance for their specific practice of medicine. In addition, they must follow the guidelines set by the hospital or clinic under which they practice.

One example of this would be my own personal experience of needing to change obstetricians for the birth of my 4th child because I wanted to have a tubal ligation during the c-section and my doctor had dropped one hospital and only delivered at a hospital which did not allow sterilizations.

 

[Toni]

Of course there are safeguards in place. They just are not what you agree with or understand

What safeguards are in place?

I’ve discussed them upthread.

Link, please?

You seem to believe that only laws will do.

I think regulations or laws are the only concrete safeguards we really have. Everything else ends up being someone's preference of personal beliefs - and personal beliefs are only safeguards if those personal beliefs completely align with yours.

Actual Safeguard: All firearm purchasers must undergo a background check
Meaningless 'Safeguard': Sellers will use their best judgment to decide whether or not to sell a firearm to someone who wishes to buy them

Actual Safeguard: Teachers and Caregivers working with children under age 13 without parental presence will be subjected to a background check and preliminary investigation which can include social media posts and shared video content
Meaningless 'Safeguard': Employers will use their personal beliefs and ethics to decide whether or not to hire someone who will be working with little kids.

The law doesn't have to be a step-by-step recipe, it doesn't have to be onerous. But without some regulatory or legal basis, it's not a safeguard at all, it's "trust me bro" and nothing more.

I disagree and in fact such laws have caused women to lose their lives.

Some laws have caused women to lose their lives. But not all laws are created equal. The fact that a bad and overly restrictive law has caused problems is NOT an effective argument for no laws at all.

How about you link for me the cases of women obtaining abortions at 35 weeks gestation ‘just because?’

I take it that this is your confession that you did NOT discuss any actual safeguards? Because realistically, all you did was to assert that safeguards must exist... simply because you believe they ought to.

Where is the link I requested?

You first, babe.

 

[Elixir]

1) YOU CLAIM that I want law enforcement to have the final say over reproductive health decisions, which is blatantly false

Who then, posted "I think regulations or laws are the only concrete safeguards we really have."?
If you don't mean it, DON'T SAY IT.

2) YOU CLAIM that I require colleagues to snitch on each other, which I absolutely do not, this is another blatant and shameless lie on your part.

Your incomprehension knows no bounds. DOCTORS ARE REQUIRED TO REPORT UNETHICAL BEHAVIOR BY THEIR COLLEAGUES.
Not everything is about YOU, Emily. I was identifying ONE of the MANY "safeguards" embodied in the AMA Principles, not accusing YOU of being reasonable.

A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

You really REALLY need to give your tactic of personal attacks a rest, and try to support your case with facts.
Start with the data that Toni just asked for again, after you refused my requests for the same thing.

 

[Emily Lake]

Why did you omit the text above that which referred to the physician’s best judgment?

In what way is "physician's best judgement" either materially different or more safeguarded than "physician's personal ethics"?

Because their license depends on it.

No, it doesn't.

How about you go find me the language that specifies that a physician's license depends on them employing safeguards to prevent the termination of health fetuses in healthy mothers in the later stage of gestation? Show me that language and I'll change my mind. Go on, I'll wait.

https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/guide-to-medical-regulation-in-the-united-states/about-physician-discipline#:~:text=Failing%20to%20meet%20the%20accepted,Conviction%20of%20a%20felony

• Alcohol and substance abuse
• Sexual misconduct
• Neglect of a patient
• Failing to meet the accepted standard of care in a state
• Prescribing drugs in excess or without legitimate reason
• Dishonesty during the license application process
• Conviction of a felony
• Fraud
• Inadequate record keeping
• Failing to meet continuing medical education requirements

Not a single one of those has any bearing on safeguards around late term abortions without reasonable medical justification, and they CLEARLY do not indicate that a physician might lose their license if they perform one.

You seem to insist that laws must specify specific parameters that meet your personal standards in order to be good enough for you.

The reality is that if specific circumstances are enumerated, anything that is not specifically described as prohibited is allowed .

No kidding? Oh wow. I guess I should revise my circumstances then.... seeing as "risk to life or health of the mother or deleterious condition in the fetus" is so broad and provides such an incredibly wide range of allowable circumstances just like I intended.

Medicine is a profession where practitioners MUST rely on their expertise and ethics, gained through years of study and practice and experience. Physicians must operate within the bounds of state laws but also within the guidelines and regulations of the AMA and any other professional board providing guidance for their specific practice of medicine. In addition, they must follow the guidelines set by the hospital or clinic under which they practice.

Again, AMA doesn't have any guidelines or regulations related to abortion, and only about 20% or so of doctors are members of AMA, and AMA doesn't actually govern a doctor's ability to practice in any way whatsoever. Guidelines set by hospitals or clinics vary widely and substantially based on the *personal beliefs* of the board or owner of those clinics.

So you're basing your assumption of safeguards being in place on 1) an association that has no actual oversight power and is not a governing body for the practice of medicine and 2) personal beliefs which vary wildly from person to person and facility to facility.

Look, I believe your heart is in the right place. But I think you're taking things on trust because you can't imagine that reasonable safeguards don't exist. You have assumed that safeguards exist because that makes sense. But the reality is that such safeguards don't actually exist in any meaningful way. That sucks, and it's hard to wrap your head around - but it's true.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Toni, can you provide a brief outline of the types of scenarios that you think would justify a 30 wk termination? It doesn't need to be exhaustive or overly specific, just a broad description of the types of circumstances you think should be considered appropriate.

 

[Emily Lake]

I think regulations or laws are the only concrete safeguards we really have.

Such an authoritarian.
Remind me not to trust you - EVER.
I’m sorry for whatever trauma you have endured that causes you to place trust in the Nanny State rather than in vetted medical professionals.

Glad to know you're a strong proponent of deregulation, I guess.

 

[Elixir]

Glad to know you're a strong proponent of deregulation, I guess.

Pleased that you finally realized that I am against laws that restrict reproductive health care treatment.
Maybe in another few years you'll come up with a cogent argument to support your emotional "position".

 

[Elixir]

But I think you're taking things on trust because you can't imagine that reasonable safeguards don't exist.

Why are you unable to read the links YOU YOURSELF POST?

What does "A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities"
mean to you?

I assume you also failed to read the repercussions and punishments incurred by violators...

 

[Emily Lake]

Of course there are safeguards in place. They just are not what you agree with or understand

What safeguards are in place?

I’ve discussed them upthread.

Link, please?

You seem to believe that only laws will do.

I think regulations or laws are the only concrete safeguards we really have. Everything else ends up being someone's preference of personal beliefs - and personal beliefs are only safeguards if those personal beliefs completely align with yours.

Actual Safeguard: All firearm purchasers must undergo a background check
Meaningless 'Safeguard': Sellers will use their best judgment to decide whether or not to sell a firearm to someone who wishes to buy them

Actual Safeguard: Teachers and Caregivers working with children under age 13 without parental presence will be subjected to a background check and preliminary investigation which can include social media posts and shared video content
Meaningless 'Safeguard': Employers will use their personal beliefs and ethics to decide whether or not to hire someone who will be working with little kids.

The law doesn't have to be a step-by-step recipe, it doesn't have to be onerous. But without some regulatory or legal basis, it's not a safeguard at all, it's "trust me bro" and nothing more.

I disagree and in fact such laws have caused women to lose their lives.

Some laws have caused women to lose their lives. But not all laws are created equal. The fact that a bad and overly restrictive law has caused problems is NOT an effective argument for no laws at all.

How about you link for me the cases of women obtaining abortions at 35 weeks gestation ‘just because?’

I take it that this is your confession that you did NOT discuss any actual safeguards? Because realistically, all you did was to assert that safeguards must exist... simply because you believe they ought to.

Where is the link I requested?

You first, babe.

This is dumb - I asked you first, and you're the one that made the assertion. You made the claim that safeguards exist and that you discussed those safeguards. All I'm asking you to do is provide a link to your own post.

But hey, let's take a moment to talk about claims, evidence, and burden of proof.

My claim is that without reasonable guidelines, it is possible for a healthy mother to abort a 35 week healthy fetus. I have repeatedly conceded that it would be extremely rare. But at the end of the day, it is possible provided the doctor is willing to do it. And given that several of the posters in this thread have taken the position that there should be no restrictions whatsoever, and that it is a woman's right to get an abortion at any point in her pregnancy if she decides she wants it... then I have to conclude that at least some doctors hold that same view. As a result of this, it logically follows that it is possible.

Your claim is that doctors will not perform abortions that late, because there are safeguards in place that prevent them from doing so.

If such safeguards exist, you should be able to provide them. You have not done so.

 

[Toni]

Why did you omit the text above that which referred to the physician’s best judgment?

In what way is "physician's best judgement" either materially different or more safeguarded than "physician's personal ethics"?

Because their license depends on it.

No, it doesn't.

How about you go find me the language that specifies that a physician's license depends on them employing safeguards to prevent the termination of health fetuses in healthy mothers in the later stage of gestation? Show me that language and I'll change my mind. Go on, I'll wait.

https://www.fsmb.org/u.s.-medical-regulatory-trends-and-actions/guide-to-medical-regulation-in-the-united-states/about-physician-discipline#:~:text=Failing%20to%20meet%20the%20accepted,Conviction%20of%20a%20felony

• Alcohol and substance abuse
• Sexual misconduct
• Neglect of a patient
• Failing to meet the accepted standard of care in a state
• Prescribing drugs in excess or without legitimate reason
• Dishonesty during the license application process
• Conviction of a felony
• Fraud
• Inadequate record keeping
• Failing to meet continuing medical education requirements

Not a single one of those has any bearing on safeguards around late term abortions without reasonable medical justification, and they CLEARLY do not indicate that a physician might lose their license if they perform one.

You seem to insist that laws must specify specific parameters that meet your personal standards in order to be good enough for you.

The reality is that if specific circumstances are enumerated, anything that is not specifically described as prohibited is allowed .

No kidding? Oh wow. I guess I should revise my circumstances then.... seeing as "risk to life or health of the mother or deleterious condition in the fetus" is so broad and provides such an incredibly wide range of allowable circumstances just like I intended.

Medicine is a profession where practitioners MUST rely on their expertise and ethics, gained through years of study and practice and experience. Physicians must operate within the bounds of state laws but also within the guidelines and regulations of the AMA and any other professional board providing guidance for their specific practice of medicine. In addition, they must follow the guidelines set by the hospital or clinic under which they practice.

Again, AMA doesn't have any guidelines or regulations related to abortion, and only about 20% or so of doctors are members of AMA, and AMA doesn't actually govern a doctor's ability to practice in any way whatsoever. Guidelines set by hospitals or clinics vary widely and substantially based on the *personal beliefs* of the board or owner of those clinics.

So you're basing your assumption of safeguards being in place on 1) an association that has no actual oversight power and is not a governing body for the practice of medicine and 2) personal beliefs which vary wildly from person to person and facility to facility.

Look, I believe your heart is in the right place. But I think you're taking things on trust because you can't imagine that reasonable safeguards don't exist. You have assumed that safeguards exist because that makes sense. But the reality is that such safeguards don't actually exist in any meaningful way. That sucks, and it's hard to wrap your head around - but it's true.

+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Toni, can you provide a brief outline of the types of scenarios that you think would justify a 30 wk termination? It doesn't need to be exhaustive or overly specific, just a broad description of the types of circumstances you think should be considered appropriate.E

Excuse me: Did you not read the line about failing to meet the accepted standards of care in the state in which the physician is practicing or do you not understand what that means?

Why on earth do you trust legislators who often have only a very vague understanding of female anatomy and pregnancy to write legislation safeguarding women's health over the expertise of actual trained medical professionals?

 

[Emily Lake]

1) YOU CLAIM that I want law enforcement to have the final say over reproductive health decisions, which is blatantly false

Who then, posted "I think regulations or laws are the only concrete safeguards we really have."?
If you don't mean it, DON'T SAY IT.

This is a failure of your cognition. There are a whole lot of regulations out there that provide the guidelines within which something may be done, but don't actually directly interfere with the doing of those things. There are many regulations that provide safe harbour rules, and which place limits on allowable actions, or which place requirements for documentation related to specific types of actions... but leave huge swathes of decisions up to the company or individual taking action.

For example... Do you think law enforcement has final say over your driving style? I think that would be a ridiculous extension of regulations around driving. The laws in place for driving provide basic expectations, specify some very specific unallowable actions, and provide guidelines for safety for everyone.

But within those guidelines, you have a huge amount of leeway about how you drive, what route you take, whether you hop in the fast lane or tarry in the slow lane, whether you're reticent or aggressive, etc. Additionally, there are a lot of reasonable exceptions to the guidelines that may occur, where judgment is employed with the understanding that your judgment may be challenged. For example, we have a law that says you have to come to a complete stop for three seconds at a stop sign... but there are also a lot of roads with totally unobstructed views, and it's not uncommon for people to slow down sufficiently to check for cross traffic but not actually stop entirely. In a lot of cases, even if you're observed by a cop, as long as it's clear that you slowed down and looked, they're not going to care - but you're also aware that if the cop decides to pull you over they could ticket you if you can't convince them that you were acting with care.

Some of those regulations prohibit driving under the influence of alcohol or other drugs. It's a pretty broad statement, and it's *technically true* that you shouldn't drive if you take a benadryl that could make you drowsy. Realistically, however, as long as your driving doesn't raise concerns, you're unlikely to get pulled over under suspicion of driving under the influence. It's a very strict regulation, with very severe penalties. But it's not 100% perfect, some people will get away with it when they shouldn't, and it certainly won't catch every stoner on a back road.

Do you think we should get rid of that regulation, because it gives law enforcement the final say in how you drive?

2) YOU CLAIM that I require colleagues to snitch on each other, which I absolutely do not, this is another blatant and shameless lie on your part.

Your incomprehension knows no bounds. DOCTORS ARE REQUIRED TO REPORT UNETHICAL BEHAVIOR BY THEIR COLLEAGUES.
Not everything is about YOU, Emily. I was identifying ONE of the MANY "safeguards" embodied in the AMA Principles, not accusing YOU of being reasonable.

It has nothing to do with me, Elixir.

Will you please actually answer this direct question?

Given that late term abortions are not considered unethical by any medical oversight body and assuming that the doctor performing the abortion does not believe it to be unethical... who would have a basis for reporting them? Who would they report them to, and for what reason?

A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

Which of those do you think applies to a doctor that performs a late term abortion where it's legal to do so, when the doctor firmly believes that it's a woman's right to have an abortion at her discretion at any point in gestation?

You really REALLY need to give your tactic of personal attacks a rest, and try to support your case with facts.
Start with the data that Toni just asked for again, after you refused my requests for the same thing.

What personal attacks?

 

[Emily Lake]

But I think you're taking things on trust because you can't imagine that reasonable safeguards don't exist.

Why are you unable to read the links YOU YOURSELF POST?

What does "A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities"
mean to you?

Do you believe that it's deficient in character for a doctor to perform a legal abortion late in gestation when the doctor believes it is a woman's right to have an abortion at any point in her pregnancy for any reason?

Do you think it's incompetent for them to do so? Do you think it's fraudulent? Do you think they've engaged in deception?

I assume you also failed to read the repercussions and punishments incurred by violators...

Does it apply to the 80%ish that aren't members of AMA?

 

[Emily Lake]

Excuse me: Did you not read the line about failing to meet the accepted standards of care in the state in which the physician is practicing or do you not understand what that means?

I read it.

Now, when the standard of care is "Oregon does not restrict abortions based on gestational stage", what standard of care is being failed? Can you provide an applicable standard of care for Oregon or DC that you think would preclude the abortion of a healthy 35 week fetus to a healthy mother?

 

[Jimmy Higgins]

Why did you omit the text above that which referred to the physician’s best judgment?

In what way is "physician's best judgement" either materially different or more safeguarded than "physician's personal ethics"?

Because their license depends on it.

No, it doesn't.

How about you go find me the language that specifies that a physician's license depends on them employing safeguards to prevent the termination of health fetuses in healthy mothers in the later stage of gestation? Show me that language and I'll change my mind. Go on, I'll wait.

Typically these standards aren't written out so descriptively, because otherwise, the document would be larger than library of congress.

 

[Jimmy Higgins]

I'm revising my approach, based on the most generous policies in a fair bit of Europe.

Here's my revised proposal:
Unrestricted abortions on request prior to the 27th week of gestation; at 27 weeks or later, abortions are restricted to medically indicated terminations when the life or health of the mother is at risk or when the fetus has severe deleterious conditions. For third trimester abortions, signatures indicating agreement from two doctors are required to be included along with documentation of the conditions and risks involved. REcords may be subject to audit.

I'm curious how this will stop a pair of doctors from wink wink, nudge nudge and terminate perfectly healthy fetus's at the very last moment. Also, who is the holder of the signed document of the two doctors?