Journal Articles Archives - Page 23 of 67 - Protection of Conscience Project Library

Conscientious objection to harmful animal use within veterinary and other biomedical education

Andrew Knight

Abstract
Laboratory classes in which animals are seriously harmed or killed, or which use cadavers or body parts from ethically debatable sources, are controversial within veterinary and other biomedical curricula. Along with the development of more humane teaching methods, this has increasingly led to objections to participation in harmful animal use. Such cases raise a host of issues of importance to universities, including those pertaining to curricular design and course accreditation, and compliance with applicable animal welfare and antidiscrimination legislation. Accordingly, after detailed investigation, some universities have implemented formal policies to guide faculty responses to such cases, and to ensure that decisions are consistent and defensible from legal and other policy perspectives. However, many other institutions have not yet done so, instead dealing with such cases on an ad hoc basis as they arise. Among other undesirable outcomes this can lead to insufficient student and faculty preparation, suboptimal and inconsistent responses, and greater likelihood of legal challenge. Accordingly, this paper provides pertinent information about the evolution of conscientious objection policies within Australian veterinary schools, and about the jurisprudential bases for conscientious objection within Australia and the USA. It concludes with recommendations for the development and implementation of policy within this arena.

Knight A. Conscientious objection to harmful animal use within veterinary and other biomedical education. Animals. 2014 Jan 21;4(1):16-34.

Reproductive Justice Begins with Contraceptive Access in the Philippines

Elisabeth S Smith

Abstract
Reproductive justice will exist in the Philippines when the lowest-income Filipino women have access to contraception. As long as women express a desire to use modern contraception but cannot access it, the Philippine government has not met its obligations. As the right to health is self-executing, Filipinos do not depend on the interest or goodwill of their government, but rather have enforceable claims to health care, including contraception. The government of Philippines should adhere to the Constitution, national laws, and ratified international agreements and fulfill the RH Act’s objectives to advance reproductive justice for all Filipinos.

Smith ES. Reproductive Justice Begins with Contraceptive Access in the Philippines. Pacific Rim Law Pol J. 2014;23(1):203-249.

Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death

Courtney S Campbell, Margaret A Black

Abstract
The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient’s death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.

Campbell CS, Black MA. Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. J Pain Symptom Manage. 2014 Jan;47(1):137-153.

Conscientious Objection and Professionalism

Bernard M Dickens

Expert Review of Obstetrics & Gynecology

Abstract
The duty of referral that objecting physicians owe their patients, and that hospitals owe members of the communities they serve, requires identification of and patients’ reasonable access to physicians (or other qualified health service providers) able and willing to undertake the lawful procedures that objectors find offensive. Referral must be made in good faith, since objecting physicians cannot ethically or lawfully practise deception or evasion to compel their patients’ involuntary compliance with objectors’ own religious or moral beliefs.

Dickens BM. Conscientious Objection and Professionalism. Expert Rev Obstet Gynec. 2009;4(2):97-100.

Conscientious objection to provision of legal abortion care

Brooke R. Johnson Jr., Eszter Kismödi, Monica V. Dragomana, Marleen Temmermana

International Journal of Gynecology & Obstetrics

Abstract
Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion,a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when referral is not possible. In addition, states should take all necessary measures to ensure that all women and adolescents have the means to prevent unintended pregnancies and to obtain safe abortion.

Johnson BR, Kismödi E, Dragomana MV, Temmermana M. Conscientious objection to provision of legal abortion care. Int J Gynaecol Obstet. 2013 Dec;123 Suppl 3:S60-2. doi: 10.1016/S0020-7292(13)60004-1.

In Defense of Religious Bioethics

Judah Goldberg, Alan Jotkowitz

Extract
In the first year of a celebrated graduate program in bioethics, one of us wrote a short essay about physician-assisted suicide that claimed that murder is not only a breach of rights, but also a “grave affront to all human existence as well as to He who grants life.” Well, that last part earned me a predictable scribble on the margins of my returned paper, something to the effect of, “What if someone does not believe in a Giver of life?”

Goldberg J, Jotkowitz A. In Defense of Religious Bioethics. Am J Bioethics, December, Vol. 12, No. 12, 2012

Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings

Christina Zampas

Abstract
The practice of conscientious objection by healthcare workers is growing across the globe. It is most common in reproductive healthcare settings because of the religious or moral values placed on beliefs as to when life begins. It is often invoked in the context of abortion and contraceptive services, including the provision of information related to such services. Few states adequately regulate the practice, leading to denial of access to lawful reproductive healthcare services and violations of fundamental human rights. International ethical, health, and human rights standards have recently attempted to address these challenges by harmonizing the practice of conscientious objection with women’s right to sexual and reproductive health services. FIGO ethical standards have had an important role in influencing human rights development in this area. They consider regulation of the unfettered use of conscientious objection essential to the realization of sexual and reproductive rights. Under international human rights law, states have a positive obligation to act in this regard. While ethical and human rights standards regarding this issue are growing, they do not yet exhaustively cover all the situations in which women’s health and human rights are in jeopardy because of the practice. The present article sets forth existing ethical and human rights standards on the issue and illustrates the need for further development and clarity on balancing these rights and interests.

Zampas C. Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings. Int J Gyn Ob. 2013 Dec 10;123:S63-S65.

Conscientious objection to the provision of legal abortion care

Brooke R Johnson, Eszter Kismödi, Monica V Dragoman, Marleen Temmerman

Abstract
Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when referral is not possible. In addition, states should take all necessary measures to ensure that all women and adolescents have the means to prevent unintended pregnancies and to obtain safe abortion..

Johnson BR, Kismödi E, Dragoman MV, Temmerman M. Conscientious objection to the provision of legal abortion care. Int J Gyn Obstet. 2013;123(S60-S62).

Conscientious objection by Muslim students startling

Michelle McLean

Extract
I read Robert Card’s recent paper entitled ‘Is there no alternative? Conscientious objection by medical students’ with great interest.1 That Muslim students in America are able to conscientiously object (and this was entertained) to the cross-gender consultation is somewhat startling. I have just left the Middle East, where I worked as a medical educator for five-and-a-half years (2006–2011), and, to the best of my knowledge, even in the conservative, gender-segregated traditional Muslim culture of the United Arab Emirates, not once did a male or female student refuse to examine a patient of the opposite sex.

Mclean M. Conscientious objection by Muslim students startling. J Med Ethics November 2013 Vol. 39 No. 11

Rethinking Voluntary Euthanasia

Byron J. Stoyles, Sorin Costreie

Abstract
Our goal in this article is to explicate the way, and the extent to which, euthanasia can be voluntary from both the perspective of the patient and the perspective of the health care providers involved in the patient’s care. More significantly, we aim to challenge the way in which those engaged in ongoing philosophical debates regarding the morality of euthanasia draw distinctions between voluntary, involuntary, and nonvoluntary euthanasia on the grounds that drawing the distinctions in the traditional manner (1) fails to reflect what is important from the patient’s perspective and (2) fails to reflect the significance of health care providers’ interests, including their autonomy and integrity.

Stoyles BJ, Costreie S. Rethinking Voluntary Euthanasia. J Med Philos (2013) 38 (6): 674-695. doi: 10.1093/jmp/jht045