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

(News) Matters of principle; AMA favors reproductive rights access but says providers can’t be forced to violate conscience

Deanna Bellandi,Elizabeth Thompson

Extract
After Roman Catholic leaders issued strong criticism about its trampling of religious freedom, the American Medical Association approved a watered-down measure supporting continued community access to a full range of reproductive services following hospital consolidations. The AMA’s amended resolution stopped short of saying Catholic hospitals should have to perform all reproductive health procedures. . . The AMA instead upheld its policy that physicians and hospitals not be forced to perform services that violate their moral principles. . .

Bellandi D, Thompson E. Matters of principle; AMA favors reproductive rights access but says providers can’t be forced to violate conscience. Mod Healthcare 2000 Jun 19; 30(25): 6,14.

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

Katherine A White

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.

The Moral Reasoning of HEC* Members (*Hospital Ethics Committee)

Donnie J Self, Joy D Skeel

Extract
It appears that on many characteristics there are significant differences among members and non-members of HECs. Whether it be a self-selection bias or some other factor, whatever is at work on the composition of HECs seems to have a profound effect pulling toward homogeneity of the membership. This is not necessarily bad if it leads to the best ethical thinking in the institution. It does, however, give pause for thought considering the current widespread emphasis on cultural diversity in society. If diversity is thought to be desirable, is such homogeneity within HECs appropriate?

Self DJ, Skeel JD. The Moral Reasoning of HEC* Members (*Hospital Ethics Committee). HEC Forum. 1998 Mar;10(1):43-54.

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.

Will the “Conscience of an Institution” Become Society’s Servant?

Joan Mclver Gibson, Thomasine Kimbrough Kushner

Extract
(Overview of accomplishments and future direction of hospital ethics committees) Overall, there is a modest sense of satisfaction with present mechanisms for dealing with ethical dimensions of patient care decisions, and a cautious optimism about the future. This is tempered by a growing, though as yet unfocused concern that emerging issues of cost, access, and quality of care will press ethics committees, now the “consciences” of institutions, into service on behalf of the community at large. . .

Gibson JM, Kushner TK. Will the “Conscience of an Institution” Become Society’s Servant? Hastings Cent. Rep. 1986 Jun;9-11.

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.