Institutions (Hospitals, etc) Archives - Page 5 of 6 - Protection of Conscience Project Library

Institutional identity, integrity, and conscience

Keven Wm Wildes

Abstract
Bioethics has focused on the areas of individual ethical choices — patient care — or public policy and law. There are however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.

Wildes KW. Institutional identity, integrity, and conscience. Kennedy Inst Ethics J. 1997 Dec;7(4):413-419.

The Hospital Ethics Committee: Health Care’s Moral Conscience or White Elephant?

David C Blake

Abstract
In a morally fragmented society there is no good reason for ethics committees to assume any particular point of view, yet failure to do so compromises their ability to function in either a case-review or an educational capacity. A casuist methodology might enable committees to fulfill both roles.

Blake DC. The Hospital Ethics Committee: Health Care’s Moral Conscience or White Elephant?. Hastings Cent Rep. 1992;22(1):6-11.

Abortion (Policy Statement)

Canadian Medical Association

Abstract
The Canadian Medical Association (CMA) recognizes that there is justification for abortion on medical and nonmedical socioeconomic grounds and that such an elective surgical procedure should be decided upon by the patient and the physician(s) concerned. Ideally, the service should be available to all women on an equitable basis across Canada. CMA has recommended the removal of all references to hospital therapeutic abortion committees as outlined in the Criminal Code of Canada. The Criminal Code would then apply only to the performance of abortion by persons other than qualified physicians or in facilities other than approved or accredited hospitals. The Canadian Medical Association is opposed to abortion on demand or its use as a birth control method, emphasizing the importance of counselling services, family planning facilities and services, and access to contraceptive information. . . the association also supports the position that no hospital, physician or other health care worker should be compelled to participate in the provision of abortion services if it is contrary to their beliefs or wishes. CMA also recommended that a patient should be informed of physicians’ moral or religious views restricting their recommendation for a particular form of therapy.

Canadian_Medical_Association. Abortion (Policy Statement). Can Med Assoc J. 1985 Aug 15;133(4):318.

(Correspondence) Abortion

Wendell W Watters, May Cohen

Extract
The statement on abortion sponsored by the Canadian Physicians for Life and Les Medecins du Quebec pour le Respect de la Vie (Can Med Assoc J 1981; 125: 922) is an insult to all physicians who support the position of the Canadian Medical Association (CMA) on abortion, including physicians who are members of the Canadian Abortions Rights Action League (CARAL). We categorically reject the charge that we “promote the destruction of the unborn”. The use of the epithet proabortion in reference to either the CMA or the prochoice position is one of many examples of deliberate misrepresentation of the facts surrounding abortion. “Proabortion” applies to those who promote abortion, who favour it as a population control measure; such people live chiefly in India and China. Antichoicers do not recognize this crucial distinction between proabortion and prochoice . . .Are antichoicers now prepared to guarantee that the emotional and physical needs of all unwanted children will be met; to ensure that each one is able to make a life out of the existence that antichoicers would force on it? Hardly. They are interested only in “protecting” the fetus until it is too late for an abortion. They feel no responsibility for the aftermath of compulsory pregnancy for either the mother or the offspring. Their interest is in quantity, not quality of life. . . .These prolife physicians endorse the “moral rights of hospital boards” to protect the “unborn” by depriving women of their legal right to terminate an unwanted pregnancy. History teaches us that whenever the rights of institutions are allowed to ride roughshod over the rights of individuals, humanity as a whole suffers. No publicly funded hospital in this country has any moral right to deprive the women it serves of their legal right to an induced abortion. . . .As long as our laws make it possible for antichoice groups to impose their notions of reproductive morality on other Canadians in this arbitrary fashion, we should all blush in referring to Canada as a democracy.

Watters WW, Cohen M. (Correspondence) Abortion. Can Med Assoc J. 1982 Mar 01;126(5):465. Available from:

Statement on abortion (Canadian Physicians for Life, Médecins du Québec pour le respect de la vie)

Walter J Kazun, Rene Jutras

(Published in response to CMA policy that abortion can be justified on medical or non-medical social grounds)

Extract
Be it resolved that we as members of the CMA as well as members of the Canadian Physicians for Life and Les Medecins du Quebec for le Respect de la Vie:

* Reject the pro-abortion stand of the CMA . . .

* Support fully the strong stand of some of the hospital boards . . .

* Deplore the pressure being brought to bear on the democratic as well as moral rights of hospital boards by some of our colleagues . . .

* Assert that any future statements made by CMA should reflect the views of the great number of doctors who respect human life . . .

Kazun WJ, Jutras R. Statement on abortion (Canadian Physicians for Life, Médecins du Québec pour le respect de la vie). Can Med Assoc J. 1981 Oct 15;125(8):922.

(News) Inequities in abortion law found result of attitudes in people and institutions

JS Bennett

Extract
[Outline of the findings of the Badgley Committee studying the operation of the abortion law.] A trend seen since 1970 is the reduction in the number of “back street abortions” and the sharp decrease in morbidity and mortality stemming from such procedures. Perhaps the most telling sentence in the 474-page report is this: “The procedure in the Criminal Code for obtaining abortion is in practice illusory for many Canadian women.

Bennett JS. Inequities in abortion law found result of attitudes in people and institutions. Can Med Assoc J. 1977;116(5):553-554.

(Correspondence) The Canadian abortion law

MM Sereda

Extract
In the intensive care unit at the University of Alberta Hospital in Edmonton a fetus weighing 720 g has survived and thrived. By definition, any fetus of that size or larger should be considered potentially viable. . . . . In Alberta in 1975 there were two abortions induced by saline infusion; the fetuses weighed 800 and 1250 g, respectively. These weights were discovered by accident because hospitals allowing abortions prohibit the weighing of aborted fetuses. In fact, one of the fetuses was rushed to an intensive care unit in Edmonton, so it must still have been alive. . . . There is no question that the Criminal Code needs amendment to accomplish two things: (a) to make recording of weights of aborted fetuses mandatory and (b) to make it possible to take criminal action against any doctor who kills a potentially viable fetus by abortion.

Sereda MM. (Correspondence) The Canadian abortion law. Can Med Assoc J. 1977 Feb 05;116(3):247.

Hill-Burton Hospitals After Roe and Doe: Can Federally Funded Hospitals Refuse to Perform Abortions?

Eugene L Berl

Extract
Conclusion
Public hospitals, by reason of the mandate of Roe and Doe, cannot categorically refuse to perform abortions. Similarly, under the state action doctrine, hospitals receiving federal funds pursuant to the Hill-Burton Act cannot refuse to perform abortions, notwithstanding the Health Programs Extension Act of 1973. The inter-relationsip of state and the hospital in the Hill-Burton program, with all the rights, duties and obligations incidental thereto, and the fact that the state and the hospital are joint participants in a state project undertaken for the benefit of the public, support the finding of state action. The Roe prohibition against state interference in a woman’s abortion decision, to be more than a mere cipher, must extend beyond state abortion statutes to the unwarranted refusal to perform abortions by hospitals with which the state is intimately involved.

Berl EL. Hill-Burton Hospitals After Roe and Doe: Can Federally Funded Hospitals Refuse to Perform Abortions? New York U Rev Law & Social Change. 1974;4(1):83-97.

Constitutional Law: Private Hospital May Refuse to Perform Abortion

Betty Berger

Extract
Conclusion
It is evident that the abortion question in relation to private hospitals is being fought on two grounds. One ground is state action. The other is freedom of religion and moral conviction. Decisions are beginning to indicate that public hospitals may have to perform abortions if they have the facilities. On the other hand, decisions such as Bellin, indicate that courts may not find sufficient state action when a private hospital is involved even if that hospital has received public funds. Even if they do, Bellin indicates that the right of conscience may protect the private hospital which is also sectarian and opposed to abortion on religious and moral grounds.’ Furthermore, the United States Congress has established a policy that receipt of funds from Hill-Burton or any other programs covered by the Health Services Extension Act of 1973 should not force a hospital to provide personnel and facilities for abortions. In addition, the first amendment protects the rights of individuals and groups to refuse to do what their religion prohibits. Abortions are generally a convenience and not a matter of life and death if not performed in the private hospital. In the balance of convenience versus first amendment freedoms, courts are unlikely to let convenience prevail. Private hospitals have sold neither their rights nor their private status..

Berger B. Constitutional Law: Private Hospital May Refuse to Perform Abortion. Saint Louis U Law J. 1974;18(3): 440-460.

Outpatient management of first trimester therapeutic abortions with and without tubal ligation

JA Collins, HH Allen, AA Yuzpe

Abstract
In busy hospitals the increasing numbers of abortions must be performed without disturbing other hospital functions. Local anesthesia, vaginal tubal ligation and the use of outpatient beds are the operative and administrative adaptations described. Of 1545 abortions performed in Victoria Hospital, London, in 1971, 428 (32%) were done under local anesthesia; 14 of these patients also had vaginal tubal ligation under local anesthesia. There were 405 sterilizations (26.2%) among this group of patients, of which 390 (96.3%) were vaginal tubal ligations. Of the total number, 891 (57.7%) were dealt with as outpatients and these comprised 62.0% of patients having therapeutic abortion only, and 46.7% of patients having tubal sterilization as well as abortion.

Collins JA, Allen H, Yuzpe A. Outpatient management of first trimester therapeutic abortions with and without tubal ligation. Can Med Assoc J. 1972 May 20;106():1077-1080.