Journal Articles Archives - Page 24 of 67 - Protection of Conscience Project Library

Conscientious refusal and health professionals: Does religion make a difference?

Daniel Weinstock

Abstract
Freedom of Conscience and Freedom of Religion should be taken to protect two distinct sets of moral considerations. The former protects the ability of the agent to reflect critically upon the moral and political issues that arise in her society generally, and in her professional life more specifically. The latter protects the individual’s ability to achieve secure membership in a set of practices and rituals that have as a moral function to inscribe her life in a temporally extended narrative. Once these grounds are distinguished, it becomes more difficult to grant healthcare professionals’ claims to religious exemptions on the basis of the latter than it is on the basis of the former. While both sets of considerations generate ‘internal reasons’ for rights to accommodation, the relevant ‘external’ reasons present in the case of claims of moral conscience do not possess analogues in the case of claims of religious conscience. However, the argument applies only to ‘irreducibly religious’ claims, that is to claims that cannot be translated into moral vocabulary. What’s more, there may be reasons to grant the claims of religious persons to exemptions that have to do not with the nature of the claims, but with the beneficial effects that the presence of religious persons may have in the context of the healthcare institutions of multi-faith societies.

Weinstock D. Conscientious refusal and health professionals: Does religion make a difference? Bioethics. doi: 10.1111/bioe.12059

Welcome to the wild, wild north

Conscientious Objection Policies Governing Canada’s Medical, Nursing, Pharmacy, and Dental Professions

Jacquelyn Shaw, Jocelyn Downie

Abstract
In Canada, as in many developed countries, healthcare conscientious objection is growing in visibility, if not in incidence. Yet the country’s health professional policies on conscientious objection are in disarray. The article reports the results of a comprehensive review of policies relevant to conscientious objection for four Canadian health professions: medicine, nursing, pharmacy and dentistry. Where relevant policies exist in many Canadian provinces, there is much controversy and potential for confusion, due to policy inconsistencies and terminological vagueness. Meanwhile, in Canada’s three most northerly territories with significant Aboriginal populations, whose already precarious health is influenced by funding and practitioner shortages, there are major policy gaps applicable to conscientious objection. In many parts of the country, as a result of health professionals’ conscientious refusals, access to some legal health services – including but not limited to reproductive health services such as abortion – has been seriously impeded. Although policy reform on conscientious conflicts may be difficult, and may generate strenuous opposition from some professional groups, for the sake of both patients and providers, such policy change must become an urgent priority.

Shaw J, Downie J. Welcome to the wild, wild north: Conscientious Objection Policies Governing Canada’s Medical, Nursing, Pharmacy, and Dental Professions. Bioethics. doi: 10.1111/bioe.12057

Am I my profession’s keeper?

Avery Kolers

Abstract
Conscientious refusal is distinguished by its peculiar attitude towards the obligations that the objector refuses: the objector accepts the authority of the institution in general, but claims a right of conscience to refuse some particular directive. An adequate ethics of conscientious objection will, then, require an account of the institutional obligations that the objector claims a right to refuse. Yet such an account must avoid two extremes: ‘anarchism,’ where obligations apply only insofar as they match individual conscience; and ‘totalitarianism,’ where even immoral obligations bind us. The challenge is to explain institutional obligations in such a way that an agent can be obligated to act against conscience, yet can object if the institution’s orders go too far. Standard accounts of institutional obligations rely on individual autonomy, expressed through consent. This paper rejects the Consent model; a better understanding of institutional obligations emerges from reflecting on the intersecting goods produced by institutions and the intersecting autonomy of numerous distinct agents rather than only one. The paper defends ‘Professionalism‘ as a grounding of professional obligations. The professional context can justify acting against conscience but more often that context partly shapes the professional conscience. Yet Professionalism avoids totalitarianism by distinguishing between (mere) injustice and abuse. When institutions are – or we conscientiously believe them to be – merely unjust, their directives still obligate us; when they are abusive, however, they do not. Finally, the paper applies these results to the problem of conscientious refusal in general and specifically to controversial reproduction cases.

Kolers A. Am I my profession’s keeper? Bioethics. doi: 10.1111/bioe.12056

Justification for conscience exemptions in health care

Lori Kantymir, Carolyn McLeod

Abstract
Some bioethicists argue that conscientious objectors in health care should have to justify themselves, just as objectors in the military do. They should have to provide reasons that explain why they should be exempt from offering the services that they find offensive. There are two versions of this view in the literature, each giving different standards of justification. We show these views are each either too permissive (i.e. would result in problematic exemptions based on conscience) or too restrictive (i.e. would produce problematic denials of exemption). We then develop a middle ground position that we believe better combines respect for the conscience of healthcare professionals with concern for the duties that they owe to patients. Our claim, in short, is that insofar as objectors should have to justify themselves, they should have to do it according to the standard that we defend rather than according to the standards that others have developed.

Kantymir L, McLeod C. Justification for conscience exemptions in health care. Bioethics. doi: 10.1111/bioe.12055

Moral distress and moral conflict in clinical ethics

C. Fourie

Abstract
Much research is currently being conducted on health care practitioners’ experiences of moral distress, especially the experience of nurses. What moral distress is, however, is not always clearly delineated and there is some debate as to how it should be defined. This article aims to help to clarify moral distress. My methodology consists primarily of a conceptual analysis, with especial focus on Andrew Jameton’s influential description of moral distress.

I will identify and aim to resolve two sources of confusion about moral distress: (1) the compound nature of a narrow definition of distress which stipulates a particular cause, i.e. moral constraint, and (2) the distinction drawn between moral dilemma (or, more accurately, moral conflict) and moral distress, which implies that the two are mutually exclusive.

In light of these concerns, I argue that the definition of moral distress should be revised so that moral constraint should not be a necessary condition of moral distress, and that moral conflict should be included as a potential cause of distress. Ultimately, I claim that moral distress should be understood as a specific psychological response to morally challenging situations such as those of moral constraint or moral conflict, or both.

Fourie C. Moral distress and moral conflict in clinical ethics. Bioethics. doi: 10.1111/bioe.12064

A neglected aspect of conscience: awareness of implicit attitudes

Chloë Fitzgerald

Abstract
The conception of conscience that dominates discussions in bioethics focuses narrowly on private regulation of behaviour resulting from explicit attitudes. It neglects to mention implicit attitudes and the role of social feedback in becoming aware of one’s implicit attitudes. But if conscience is a way of ensuring that a person’s behaviour is in line with her moral values, it must be responsive to all aspects of the mind that influence behaviour. There is a wealth of recent psychological work demonstrating the influence of implicit attitudes on behaviour. A necessary part of having a well-functioning conscience must thus be awareness and regulation of one’s implicit attitudes in addition to one’s explicit attitudes; this cannot be done by an individual in isolation. On my revised conception of conscience, heeding social feedback, being emotionally self-aware and engaging in self-monitoring are important for the possession of a well-functioning conscience. Health professionals may need specific training to help them develop and maintain a well-functioning conscience, which should involve cultivation of awareness of implicit attitudes, emphasis on social feedback and techniques to enable better control over them.

Fitztgerald C. A neglected aspect of conscience: awareness of implicit attitudes. Bioethics. doi: 10.1111/bioe.12058

Conscientious objection and induced abortion in Europe

Anna Heino, Mika Gissler, Dan Apter, Christian Fiala

The European Journal of Contraception & Reproductive Health Care

Abstract
The issue of conscientious objection (CO) arises in healthcare when doctors and nurses refuse to have any involvement in the provision of treatment of certain patients due to their religious or moral beliefs. Most commonly CO is invoked when it comes to induced abortion. Of the EU member states where induced abortion is legal, invoking CO is granted by law in 21 countries. The same applies to the non-EU countries Norway and Switzerland. CO is not legally granted in the EU member states Sweden, Finland, Bulgaria and the Czech Republic. The Icelandic legislation provides no right to CO either. European examples prove that the recommendation that CO should not prevent women from accessing services fails in a number of cases. CO puts women in an unequal position depending on their place of residence, socio-economic status and income. CO should not be presented as a question that relates only to health professionals and their rights. CO mainly concerns women as it has very real consequences for their reproductive health and rights. European countries should assess the laws governing CO and its effects on women ’ s rights. CO should not be used as a subtle method for limiting the legal right to healthcare.

Heino A, Gissler M, Apter D, Fiala C. Conscientious objection and induced abortion in Europe. European J Contraception and Reproductive Health Care, 2013; 18: 231–233

Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women

An analysis of the death of Savita Halappanavar in Ireland and similar cases

Marge Berer

Abstract
Issues arising from the death of Savita Halappanavar in Ireland in October 2012 include the question of whether it is unethical to refuse to terminate a non-viable pregnancy when the woman’s life may be at risk. In Catholic maternity services, this decision intersects with health professionals’ interpretation of Catholic health policy on treatment of miscarriage as well as the law on abortion. This paper explores how these issues came together around Savita’s death and the consequences for pregnant women and maternity services worldwide. It discusses cases not only in Ireland but also the Americas. Many of the events presented are recent, and most of the sources are media and individual reports. However, there is a very worrying common thread across countries and continents. If further research unearths more cases like Savita’s, any Catholic health professionals and/or hospitals refusing to terminate a pregnancy as emergency obstetric care should be stripped of their right to provide maternity services. In some countries these are the main or only existing maternity services. Even so, governments should refuse to fund these services, and either replace them with non-religious services or require that non-religious staff are available at all times specifically to take charge of such cases to prevent unnecessary deaths. At issue is whether a woman’s life comes first or not at all.

Berer M. Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women: An analysis of the death of Savita Halappanavar in Ireland and similar cases. Reproductive Health Matters 2013;21(41):9–17

Seeing through the secular illusion

Iain T Benson

Dutch Reformed Theological Journal (NGTT)

Abstract
Only when it is recognized that not all ‘faiths’ are religious and that all citizens operate out of some sort of faith commitments can we be properly in a position to evaluate nonreligious faiths alongside religiously informed ones. This re-adjustment of the usual way of examining matters then should lead, Professor Benson argues, to a more accurate way of viewing current education and politics (and their areas of avoidance) as well as such things as fair access to the public square by religious believers and their communities. The long dominance of atheistic and agnostic forms of social ordering (including funding for such things as education and health care) is based, in part, on a belief that stripping religious frameworks from public sector projects is ‘neutral’ when it is not.

In addition, the focus on a rights based jurisprudence has a tendency to view rights such as the freedom of religion in individualist ways that ignore the communal importance of religion. The paper will suggest that moves to put pressure on the associational dimension of religions ignore the communal nature of certain forms of belief to the detriment of a more co-operative society and far from encouraging human freedom, actually reduce it.

In the long run, the importance of religions and their communities to the public sphere – which has been recognized by the Constitutional Court of South Africa – will be encouraged by this fresh and more accurate way of viewing belief systems and the communities that form around them. The more accurate way of understanding both the reality of and the need for more articulate public beliefs, will, Benson argues, provide a richer ground for such things as public school curriculum which often drift in the face of fears of moral imperialism and metaphobia (fear of metaphysics).

Benson IT. Seeing through the secular illusion. Nederduitse Gereformeerde Teologiese Tydskrif. 2013;54(Supplement 4)

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. 2013 Jul 3. pii: S0885-3924(13)00270-4. doi: 10.1016/j.jpainsymman.2013.02.024. [Epub ahead of print]