Sterilization Archives - Page 2 of 5 - Protection of Conscience Project Library

Managing ethically questionable parental requests: growth suppression and manipulation of puberty

David Isaacs, Bernadette Tobin, Julie Hamblin, Emma Slaytor, Kim C Donaghue, Craig Munns, Henry A Kilham

Abstract
Doctors sometimes struggle with ethically challenging requests for treatment from children’s parents. For instance, we have recently had two requests by parents of children, a girl and a boy, each with a severe developmental disability, for hormonal therapy to suppress growth and puberty: the girl’s parents requested, in addition, hysterectomy and mastectomy. We propose a reliable approach to assessing the ethical and legal aspects of these and other requests for ‘non-therapeutic’ treatment of a minor who lacks the capacity to give informed consent. We argue that a doctor should first assess whether the request is one that he or she can, in conscience, accede to, and then, if it is, seek the authorisation of a court. We outline considerations relevant to the doctor’s assessment of both the ethical issues and to the need for court authorisation.

Isaacs D, Tobin B, Hamblin J, Slaytor E, Donaghue KC, Munns C, Kilham HA. Managing ethically questionable parental requests: growth suppression and manipulation of puberty. J Paed Child Health. 2011 Sep 27;47(9):581-584.

Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act

Carolyn Wendel

Notre Dame Journal of Law, Ethics & Public Policy

Extract
Conclusion
It is undeniable that Catholic hospitals play a pivotal role in the administration of health care in America. The requirement that they follow both federal law and canon law can, however, create conflicting obligations. If FOCA were to pass, Catholic hospitals would be required under federal law to provide abortions and other reproductive services in direct conflict with Catholic teachings. At the same time, because the Catholic Church would view FOCA as an unjust law operating against human good and divine good, Catholic hospitals would also have a moral obligation under church teachings to disobey the provisions of FOCA.

Unable to sell because of their inability to cooperate in an evil act, Catholic hospitals would likely engage in civil disobedi ence. And yet, such tactics would only work for so long. Suits would be brought and courts would almost certainly uphold FOCA as a valid and neutral law that is generally applicable. Despite what many would like to believe, FOCA poses a very real and imminent threat to the existence of Catholic hospitals. And the effect least talked about and yet most important is not what effect such closing would have on the Church itself, but what effect it would have on the 92 million patients that Catholic hospitals treat annually. The effects of FOCA passing and Catholic hospitals closing would be much more than a victory for the pro- choice advocates; it would be a loss to every person who has ever received treatment at a Catholic hospital and to all those who would be denied such services in the future. Perhaps we should take a cue from the medical profession itself and remember above all else: first, do no harm

Wendel C. Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act. Notre Dame J Law Ethics Pub Pol. 2011;25(2):663-688.

Conscientious commitment to women’s health

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

Abstract
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.

Dickens BM, Cook RJ. Conscientious commitment to women’s health. Int J Gyn Ob. 2011;113(2):163-166.

Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

American Journal of Obstetrics & Gynecology

Abstract
Objective
To characterize beliefs about contraception among obstetrician-gynecologists (Ob/Gyns).

Study design
National mailed survey of 1800 U.S. Ob/Gyns. Criterion variables were whether physicians have a moral or ethical objection to – and whether they would offer – six common contraceptive methods. Covariates included physician demographic and religious characteristics.

Results
1154 of 1760 eligible Ob/Gyns responded (66%). Some Ob/Gyns object to intrauterine devices (4.4% object, 3.6% would not offer), progesterone implants and/or injections (1.7% object, 2.1% would not offer), tubal ligations (1.5% object, 1.5% would not offer), oral contraceptive pills (1.3% object, 1.1% would not offer), condoms (1.3% object, 1.8% would not offer), and the diaphragm or cervical cap with spermicide (1.3% object, 3.3% would not offer). Religious physicians were more likely to object (OR 7.4) and to refuse to provide a contraceptive (OR 1.9).

Conclusion
Controversies about contraception are ongoing, but among Ob/Gyns objections and refusals to provide contraceptives are infrequent.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician-gynecologists’ views on contraception and natural family planning: a national survey. Am J Obstet Gynecol. 2011;204(2):124e1-124e7.

Factors influencing physicians’ advice about female sterilization in USA: a national survey

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

Abstract
Background
Tubal ligation can be a controversial method of birth control, depending on the patient’s circumstances and the physician’s beliefs.

Methods
In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients’ and physicians’ characteristics influence Ob/Gyns’ advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient’s age, gravida/parity and her husband’s agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery.

Results
The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9–70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians’ sex had no significant effect on advice about tubal ligation.

Conclusions
Regarding patients who seek surgical sterilization, physicians’ advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Factors influencing physicians’ advice about female sterilization in USA: a national survey. Hum Reprod. 2011;26(1):106-111.

Making Rules and Unmaking Choice: Federal Conscience Clauses, the Provider Conscience Regulation, and the War on Reproductive Freedom

Rachel White-Domain

Extract
Conclusion
This Comment analyzes the PCR, which is currently under review by the Obama Administration. As currently written, the PCR promises to have devastating effects on the healthcare system. . .

Commenters have predicted that the PCR will be used to discriminate against patients based on their sexual orientation. 196 And because reproductive healthcare remains so controversial in this country, women will be disproportionately disadvantaged by the PCR, which now allows almost all employees-not only the doctor, but potentially the nurse, the pharmacist, the pharmacist’s assistant, the receptionist, the ambulance driver, and the janitor-to have a say in whether she can access her chosen healthcare without interference.

The PCR brought the ongoing debate over conscience clauses into the national spotlight. . . .this Comment argues that any analysis of conscience clauses must recognize that what is at stake is access to healthcare services, and that reduction of healthcare access can be accomplished not only explicitly, for example through the explicit redefining of the term “abortion,” but also through “strategic ambiguity.” . . .

White-Domain R. Making Rules and Unmaking Choice: Federal Conscience Clauses, the Provider Conscience Regulation, and the War on Reproductive Freedom. DePaul Law Rev. 2010 Summer;59(4):1249-1281.

From reproductive choice to reproductive justice

Rebecca J Cook, Bernard M Dickens

Abstract
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.

Cook RJ, Dickens BM. From reproductive choice to reproductive justice. Int J Gyn Ob. 2009 Aug;106(2):106-109.

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.

Moral Courage Through a Collective Voice

(Ethics and Rural Healthcare)

Julie Aultman

Extract
In posing the question of whether it is morally right for the only pharmacist in town to refuse healthcare services based on his or the community’s religious convictions, I could not help but think of “the conscience clause.” While many states across the United States support the conscience clause, which protects healthcare professionals from discrimination when refusing to dispense birth control pills or performing abortions and sterilizations, such clauses have different implications in the rural setting.When a physician or pharmacist refuses to prescribe or dispense birth control pills, the urban patient is able to acquire birth control from another healthcare provider with less difficulty than the rural patient. The rural patient may have to drive a great distance to acquire birth control even if it is needed for a medical condition rather than to prevent pregnancy.

Aultman J. Moral Courage Through a Collective Voice (Ethics and Rural Healthcare). Am J Bioeth. 2008;8(4):67-69.

Conscientious commitment

Bernard M. Dickens

Extract
In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?

Dickens BM. Conscientious commitment. Lancet [Internet]. 2008 Apr 12; 371(9620): 1240 – 1241