Abortion Archives - Page 14 of 49 - Protection of Conscience Project Library

Ethical misconduct by abuse of conscientious objection laws

Bernard M Dickens

Abstract
This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women’s health depends. Religious institutions that historically served a mission to provide healthcare are now perverting this commitment in order to deny care. Physicians who followed their calling honourably in a spirit of self-sacrifice are being urged to sacrifice patients’ interests to promote their own, compromising their professional ethics by conflict of interest. The shield tolerant societies allowed to protect religious conscience is abused by religiously-influenced agencies that beat it into a sword to compel patients, particularly women, to comply with religious values they do not share. This is unethical unless accompanied by objectors’ duty of referral to non-objecting practitioners, and governmental responsibility to ensure supply of and patients’ access to such practitioners.

Dickens BM. Ethical misconduct by abuse of conscientious objection laws. Med Law. 2006 Sep;25(3):513-522.

The Oral Contraceptive as Abortifacient: An Analysis of the Evidence

Dennis M Sullivan

Abstract
Pro-life Christian ethicists and medical practitioners have been united in their opposition to abortion, but have sometimes been divided in their ethical approach to hormonal contraception. Even though many Christians believe that birth control may be a moral option, some claim that the “Pill” acts, at least some of the time, as an abortifacient. If true, Christians who hold that human personhood begins at conception would be morally opposed to the use of combined oral contraceptives. This article examines the scientific evidence for an abortifacient effect of such contraceptive agents, and concludes that such an effect is yet unproven. Some of the ethical arguments are also examined, and the author suggests that further research on early pregnancy factor (EPF) may help to resolve this controversial issue.

Sullivan DM. The Oral Contraceptive as Abortifacient: An Analysis of the Evidence. Perspectives on Science and Christian Faith. 2006;58(3):189-195. Available from:

Does Mission Matter?

Lawrence E Singer

Extract
It is apparent that Catholic health care is suffused with a religious purpose. Its creation is based upon Church interpretation of a duty to Jesus, and its facilities are required to adhere to formal prescriptions of appropriate canonical, ethical and moral behavior. As recently as twenty years ago, questions regarding a facility’s Catholicity and the implications of this calling would rarely have been asked. In part this was because of the highly visible presence of Sisters or Brothers in the facility, making the religious nature of the institution readily apparent to even the casual observer. Too, few Catholic institutions were part of health care systems, and those systems that existed were of a local or regional nature, likely well- known by the communities served.

Today, many Catholic health care facilities have joined together into larger (often multi-state) health care systems with less visible Sister presence and the development of sophisticated corporate management teams distant from day-to-day operations and local community involvement. Many of these systems enjoy significant market power. As discussed below, the heightened visibility of these organizations has led to very public questioning of institutional adherence to religious teaching (especially in the area of sterilizations and, to a lesser extent, abortion), posing a significant challenge to the Catholic mission. Other significant challenges to the mission have also arisen, as the law, the competitive environment, and even changes within the Church present their own hurdles to Catholic facilities. Section III discusses these issues, setting the stage in Part IV for a discussion of whether a religious mission is sustainable in a pluralistic society.

Singer LE. Does Mission Matter? Houston J Health Law Pol. 2006 Sep;6(2):347-377.

Foreword: The Role of Religion in Health Law and Policy

William J Winslade, Ronald A Carson

Extract
This symposium issue explores several continuing controversies at the intersection of Law, Ethics, Healthcare, Politics, Health Policy and Religion: abortion, contraception, the status of embryos, stem cell research, IVF, personal and professional autonomy, end- of-life decisions, and religiously based health care systems. The multiple values associated with each of these topics strain and threaten to usurp the effectiveness of our legal system to regulate them.

Winslade WJ, Carson RA. Foreword: The Role of Religion in Health Law and Policy. Houston Journal of Health Law & Policy. 2006 Sep;6(2):245-248.

“Conscience Clauses” or “Unconscionable Clauses”: Personal Beliefs Versus Professional Responsibilities

Martha S Swartz

Yale Journal of Health Policy, Law and Ethics

Abstract
Conclusion
Ultimately, this Article proposes a new model for such “conscientious objections,” one that presumes the general obligation ‘of health care professionals, who hold monopolistic state licenses, to participate in requested medical care that is not contraindicated or illegal, notwithstanding their personal moral objections. This model is based on “the· premise that it “is the patient’s best interest (as determined by -the patient, but mediated by the health care professional’s medical judgment), not the health care professional’s personal interests, that should govern the professional relationship. This should be the standard taught in professional schools and promoted by professional associations. “Conscientious objections” should be permissible based on prevailing medical ethics; however, to the extent that they are based on the personal morals of the· health care professional, they should be actively discouraged.

Swartz MS. “Conscience Clauses” or “Unconscionable Clauses”: Personal Beliefs Versus Professional Responsibilities. Yale J Health Pol Law Ethics. 2006;6(2):269-359.

What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist?

Dorothy Shaw, Anibal Faúndes

Best Practice and Research Clinical Obstetrics & Gynaecology

Abstract
Women’s sexual and reproductive rights are an integral part of daily practice for obstetricians/gynaecologists and the key to the survival and health of women around the world. Women’s sexual and reproductive health is often compromised because of infringements of their basic human rights, not the lack of medical knowledge. Understanding the relevance of respecting and promoting sexual and reproductive rights is critical for providing current standards of care, and includes access to information and care, confidentiality, informed consent and evidence-based practice. The violation of women’s rights in their daily lives through common problems such as gender-based violence and discrimination results in serious consequences for their health. Obstetricians/gynaecologists are natural advocates for women’s health, yet may be lacking in their understanding of relevant laws or the limits of conscientious objection. This chapter outlines the framework for sexual and reproductive rights, and explores its relevance to the practising clinician.

Shaw D, Faúndes A. What is the relevance of women’s sexual and reproductive rights to the practising obstetrician/gynaecologist? Best Practice and Research Clinical Obstetrics and Gynaecology. 2006 Jun;20(3):299-309.

Initiating Abortion Training in Residency Programs: Issues and Obstacles

Ian Bennett, Abigail Calkins Aguirre, Jean Burg, Madelon L Finkel, Elizabeth Wolff, Katherine Bowman, Joan Fleischman

Abstract
Objectives: Early abortion is a common outpatient procedure, but few family medicine residencies provide abortion training. We wished to assess experiences and obstacles among residency programs that have worked to establish early abortion services.
Methods: From 2001–2004, 14 faculty participated in a collaborative program to initiate abortion training at seven family medicine residencies. Ten focus groups with all trainees were followed by individual semi-structured interviews with a smaller group (n=9) that explored the progress and obstacles they experienced. Individual interviews were recorded and analyzed to identify major themes and sub-themes related to initiating abortion training.
Results: Five of seven sites established abortion training. Five major themes were identified: (1) establishing support, (2) administration, (3) finance, (4) legal matters,and (5) security/demonstrators. Faculty from sites where training was ultimately established rated the sub-themes of billing/reimbursement, obtaining staff support, and state/hospital regulations as most difficult. Gaining support from within the department and institution was most difficult for the two sites that could not establish training. None experienced difficulty with security/demonstrators.
Conclusions: Developing the clinical and administrative capacity to provide early abortion services in family medicine residency programs is feasible. Support from leadership within departments and from the wider institution is important for implementation.

Bennett I, Aguirre AC, Burg J, Finkel ML, Wolff E, Bowman K et al. Initiating Abortion Training in Residency Programs: Issues and Obstacles. Fam Med. 2006;38(5):330-335.

The Growing Abuse of Conscientious Objection

Rebecca J Cook, Bernard M Dickens

American Medical Association Journal of Ethics

Extract
Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with society.

Cook RJ, Dickens BM. The Growing Abuse of Conscientious Objection. Am Med Ass J Ethics. 2006 May;8(5):337-340.

(Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics

Frank A Chervenak, Laurence B McCullough

British Medical Journal, BMJ — British Medical Journal

Extract
Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.

Chervenak FA, McCullough LB. (Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics. Br Med J. 2006 Feb 18;332(7538):425.

(Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience

Vaughn P Smith

Extract
Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded — for example, respectively, eugenic “research” and psychiatric “treatment” of dissidents. . . . My chances of behaving honourably would have been
greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day. They would have been least if Savulescu’s opinions had prevailed . . .After 30 years of reading the BMJ, Sava-
lescu’s article was the first one to make me feel physically sick.

Smith VP. (Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience. Br Med J. 2006 Feb 18;332(425)