Conscience clause: moral compromise

Chris Thatcher

Canadian Pharmacists Journal
Canadian Pharmacists Journal

Extract
Ask your pharmacist: It’s the ubiquitous slogan of the past decade, underscoring the campaigns of most national and provincial pharmacy organizations as they promote the value of pharmacy services. But what if the question is about RU-486, the abortion drug, or Preven, the morning-after-pill? What if the question is from a physician seeking information on terminal sedation or assisted suicide?

Such questions push, and often breach, an ethical boundary for some pharmacists, who find their desire to help the patient in conflict with their moral convictions. And the ethical quagmire is likely to get deeper as advocacy groups press the federal government to allow physician-assisted suicide and various health organizations promote greater access to emergency postcoital contraception.

If these practices compromise your moral convictions, could you be fired by your employer for refusing to fill a prescription? More specifically, is there a point at which your personal beliefs supersede your obligation to the patient? That’s the difficult question posed by an Alberta-based group called Concerned Pharmacists for Conscience, which has suggested a conscience clause to protect pharmacists in such situations.


Thatcher C. Conscience clause: moral compromise. Can Pharm J. 1999;132(7):10-11

(News) Leak of abortion information creates turmoil at Foothills

Richard Cairney

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract

The Calgary Regional Health Authority (CRHA)has won a court judgement preserving the private, confidential nature of documents concerning genetic terminations of pregnancy that were leaked to Alberta Report by one or more angry pro-life nurses. . . .The controversy erupted after one or more members of the nursing staff at Foothills leaked confidential documents to the magazine. The resulting articles were filled with loaded language — “genetic terminations unquestionably constitute murder” and “the abortionist might well be guilty of culpable homicide” are 2 examples. . . ..


Cairney R. Leak of abortion information creates turmoil at Foothills. Can. Med. Assoc. J.. 1999;161(4):424-425.

Some ethical and legal issues in assisted reproductive technology

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients’ treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities..


Dickens BM, Cook RJ. Some ethical and legal issues in assisted reproductive technology. Int J Gynecol Obstet. 1999;66(1) 55-61.

Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights

Katherine A White

Stanford Law Review
Stanford Law Review

Abstract
In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.


White KA. Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights. Stanford Law Rev. 1999 Jul;51(6)1703-1749.

(News) Task force offers $547,000 to solve shootings (of abortion practitioners)

Barbara Sibbald

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
In all, 9 police forces on both sides of the border are investigating 5 incidents that are believed to be linked. All took place around Remembrance Day, all the physicians involved performed abortions and all were shot in their homes. The injured include Dr. Garson Romalis of Vancouver (1994), Dr. Hugh Short of An- caster, Ont. (1995), an unnamed Richmond, NY, physician (1996) and Dr. Jack Fainman of Winnipeg (1997). The first fatality occurred last Oct. 23 when Slepian was shot and killed at his home. An American murder warrant has been issued for Vermont antiabortion activist James Kopp, 44. Kopp, whose whereabouts are a mystery, is charged only in the slaying of Slepian. He remains a “person of interest” in connection with the other shootings.


Sibbald B. Task force offers $547,000 to solve shootings (of abortion practitioners). Can Med Assoc J. 1999 Jun 15;160(12).

Human rights and abortion laws

Rebecca J Cook, Bernard M Dickens

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.


Cook RJ, Dickens BM. Human rights and abortion laws. Int J Gynecol Obstet. 1999 Apr 22;65(81-87.

(News) US antiabortion pamphlet stirs anger north of the border

Patrick Sullivan

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
An American antiabortion publication that was mailed to Canadian physicians has angered many Ontario doctors and caused Queen’s University to contact police. The 32-page pamphlet, Quack the Ripper , was mailed by Life Dynamics Inc. of Denton, Texas, in March. . . the publication’s goal is to dissuade young physicians from providing abortions by insulting those who do perform them.


Sullivan P. US antiabortion pamphlet stirs anger north of the border. Can Med Assoc J. 1999;160(7):977.

International Developments in Abortion Law from 1988 to 1998

Rebecca J Cook, Bernard M Dickens, Laura E Bliss

American Journal of Public Health
American Journal of Public Health

Abstract
Objectives

In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women’s human rights has influenced legal reform.

Methods
A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences.

Results
Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third party authorizations, and blockades of abortion clinics.

Conclusions
Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women’s health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.


Cook RJ, Dickens BM, Bliss LE. International Developments in Abortion Law from 1988 to 1998. Am J Public Health. 1999;89(4):579-586.

(News) Police task force targets “terrorists” behind sniper-style attacks on MDs

Barbara Sibbald

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
Sniper-style attacks on 3 Canadian physicians are “terrorist acts,” police say,and the hunt for the attackers now involves a coordinated national effort. “This is terrorism against doctors as a whole,” says Inspector Keith McCaskill, a member of the national police task force investigating the attacks. “There may be a tendency to politicize this, but that’s not right. This is criminal activity.”


Sibbald B. Police task force targets “terrorists” behind sniper-style attacks on MDs. Can Med Assoc J. 1998 Nov 03;159(9):1153-1154.

(Correspondence) Abortion in proportion (The author responds)

Lynda Buske

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
Canada’s comparative ranking in terms of the proportion of therapeutic abortions involving married women should not have been described as a rate. The point being made in the paragraph in question is that the proportion of women receiving abortions in Canada who are either married or in common-law relationships, about 25%, is not unique in international terms.


Buske L. (Correspondence) Abortion in proportion (The author responds). Can Med Assoc J. 1998;159(4):318.