Professionalism Archives - Page 5 of 11 - Protection of Conscience Project Library

Conscientious Objection: Resisting Ethical Aggression in Medicine

Sean Murphy

Responding to Cantor, Julie D., Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine. N Eng J Med 360;15, 9 April, 2009

Extract
Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong.

She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant. At least, that is the inference to be drawn from her warning that health care “could grind to a halt” if a federal protection of conscience regulation were “[t]aken to its logical extreme.”

Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. If anything, this demonstrates that health care is provided to many Americans – and many of the poorest Americans – because of the commitment of health care workers to their moral convictions, not in spite of them.

Murphy S. Conscientious Objection: Resisting Ethical Aggression in Medicine [Internet]. Protection of Conscience Project (2009 Apr 17).

Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine

Julie D Cantor

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. . . .Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.

Cantor JD. Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine. N Engl J Med. 2009 Apr 09;360(15):1484-1485.

Negative and positive claims of conscience

MR Wicclair

Cambridge Quarterly of Healthcare Ethics

Journal’s Extract
Discussions of appeals to conscience by healthcare professionals typically focus on situations in which they object to providing a legal and professionally permitted service, such as abortion, sterilization, prescribing or dispensing emergency contraception, and organ retrieval pursuant to donation after cardiac death. “Negative claims of conscience” will designate such appeals to conscience. When healthcare professionals advance a negative claim of conscience, they do so to secure an exemption from ethical, professional, institutional, and/or legal obligations or requirements to provide a healthcare service.

Wicclair MR. Negative and positive claims of conscience. Camb Q Healthc Ethics. 2009;18(1):14-22.

Is conscientious objection incompatible with a physician’s professional obligations?

Mark R Wicclair

Abstract
In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician’s professional obligations (the “incompatibility thesis”). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician’s professional obligations unequivocally supports the incompatibility thesis.

Wicclair MR. Is conscientious objection incompatible with a physician’s professional obligations? Theor Med Bioeth. 2008;29(3):171-185.

(Thesis) Hospital Ethics Committees in the USA and in Germany Bioethics qua Practice, Nurses’ Participation and the Issues of Care

Helen Kohlen

Extract
In this work the institutionalisation of Hospital Ethics Committees in the USA and in Germany will be analysed by focussing on nurses’ participation and the representation of caring issues. Therefore, questions about the design of Hospital Ethics Committees and how their practices really look like, will be raised. The central question is, how the traditional care ethos of the helping professions in medicine and nursing can find its place in discussions of these committees while hospitals have increasingly been organised along economic criteria.

. . . .My observations and interviews in the field work show that care practices in the tradition of Hippocratic Medicine are no longer self-evident for the helping professions. Physicians and nurses do rather struggle for a care ethos especially with regard to end-of- life questions and regulations of tube-feeding. The “cases” for ethics consultation brought into the committees by physicians and nurses did not rarely emerge as social problems and as a lack of professional competence. The problems appeared to be solvable by translating them into a language of principles and making the process manageable. These principle-based discussions in the practical arena of the hospital resemble discourse practices embedded within the larger bioethical debates in the political arena. Technical procedures given by management and administration do fit into the use of abstract principles and contribute to a language that limits the possibilities to think – what is at stake for patients – in terms of caring relations rather than thinking in terms of rules, regulations and control.

Kohlen H. (Thesis) Hospital Ethics Committees in the USA and in Germany Bioethics qua Practice, Nurses’ Participation and the Issues of Care. Gotfried Wilhelm Leibniz University, Hanover, Germany. 2008 Apr 02.

Physicians and Execution

Gregory D Curfman, Stephen Morrissey, Jeffrey M Drazen

Extract
Physicians and other health care providers should not be involved in capital punishment, even in an advisory capacity. A profession dedicated to healing the sick has no place in the process of execution.

Curfman GD, Morrissey S, Drazen JM. Physicians and Execution. N Engl J Med. 2008 Jan 24;358(4):403-404.

The Proper Place of Values in the Delivery of Medicine (Conscience in Medicine)

Julian Savulescu

Extract
Physicians who fail to act in their patient’s interests breach the fundamental duty of care of a physician. It is negligent to deny a person who would benefit a blood transfusion, a vaccination, an abortion, intensive care or sedation at the end of their life. Physicians should not play God. If they morally disagree with some medical treatment, they can give their reasons to their patients and they can take that debate to the level of law and professional bodies. But in a liberal society they should not inflict their judgments on their patients. Physicians can disagree, but they should not dictate.

Savulescu J. The Proper Place of Values in the Delivery of Medicine (Conscience in Medicine). Am J Bioeth. 2007 Dec 19;21-22.

Negotiating the Tension Between Two Integrities: A Richer Perspective on Conscience (Conscience in Medicine)

Susan S Night

Extract
I think most would agree that to progress the debate over the role of conscience in medicine we must continue the conversation about the means and ends of medicine as suggested by Lawrence and Curlin (2007, 10). This must be done because the tensions that exist between negotiating one’s personal integrity and one’s professional integrity will never go away. These tensions are not exclusive to the profession of medicine, but are enhanced by potential conflicts between physician integrity and patient autonomy. The objective of the conversation should neither be to eliminate these tensions nor to narrowly compartmentalize them as having religious or secular origins. Rather, the objective of the conversation should be to first encourage each physician to engage in moral reflection upon what they believe is right or wrong and the source that informs these values. Only then will physicians be able to appropriately negotiate the tensions that exist between the moral duties of personal and professional integrity and engage in meaningful dialogue rather than disagreement with their peers and their patients.

Night SS. Negotiating the Tension Between Two Integrities: A Richer Perspective on Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12):24-26.

Professionalism and the Medical Association

Jeff Blackmer

Extract
In many respects, medical professionalism is currently at a crossroads. The nature of the physician-patient relationship continues to evolve, as physicians struggle to redefine their role in an ever-changing society that is in the midst of a technological revolution. Threats to medical self-regulation and evolving physician scopes of practice have caused many practicing doctors to question whether the profession itself will ever be the same. . . . The objective of this paper has been to examine medical professionalism through the lens of the representative medical association rather than the individual clinician. Through providing both general and specific, concrete suggestions and examples of current and future potential activities which might be undertaken, it is hoped that it will add in a positive and constructive way to the preservation of what most doctors consider to be at the core of medicine: the role of the physician as healer and professional.

Blackmer J. Professionalism and the Medical Association. World Med Ass J. 2007;53(3):58-74.

Pharmacists and the Social Contract (Conscientious Objection and Emergency Contraception)

Kenneth A Richman

Extract
. . .pharmacists in the news who claim that emergency contraception causes abortion are acting impermissibly by basing their conscientious objection on false claims. . . My main point here, however, is drawn from a familiar concept of political philosophy — the idea of a social contract. . . Pharmacists benefit from a monopoly on the right to dispense prescription medications. This monopoly, like those offered to public utilities, comes with responsibilities that go beyond the usual duties of professionalism. Pharmacists have a duty to conform to the system which has invested in them and in which they have a vested interest. . .Card (2007) argues that the prima facie right to conscientious objection is defeated by the facts of this particular case. Applying the argument of the Crito to the role of pharmacists in the United States leads us to conclude that this prima facie right is defeated for the pharmacist in the professional role in all cases. What remains are the right to work for change and the right to opt out of the professional role entirely.

Richman KA. Pharmacists and the Social Contract. Am J Bioethics 2007 Jun 01, 7:6,15-16,DOI: 10.1080/15265160701347247