Journal Articles Archives - Page 30 of 67 - Protection of Conscience Project Library

When Doctors Break the Rules: On the Ethics of Physician Noncompliance

Jeffrey Blustein

Cambridge Quarterly of Healthcare Ethics

Abstract
Avoiding complicity in injustice is not limited to engaging in acts of noncompliance on behalf of one’s patients. The injustices from which one’s patients suffer may be rooted in morally suspect norms to which the profession of medicine, or some influential part of it, has lent its support or that it has not opposed and from which it and its practitioners have benefited. There may also be injustices that the profession has condemned but that remain. In general, avoiding complicity in wrongdoing involves, as a base- line, understanding that the norms and practices responsible for it have contributed to making noncompliance an option that at least deserves serious moral consideration, if not endorsement. A physician may then decide to engage in some form of rule breaking in order to act on this understanding and express her refusal to be complicit.. . .Complicity threatens the moral and professional integrity of the physician, and noncompliance may be warranted in part because it is the only way that a physician can meet the threat.

Blustein J. When Doctors Break the Rules: On the Ethics of Physician Noncompliance. Camb Q Healthc Ethics. 2012;21(02):249-259.

After-birth abortion: Why should the baby live?

Alberto Giubilini, Francesca Minerva

Abstract
Abortion is largely accepted even for reasons that do not have anything to do with the fetus’ health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.

Giubilini A, Minerva F. After-birth abortion: Why should the baby live?. J Med Ethics. 2013;39(5):261-263.

Pediatricians’ experience with and response to parental vaccine safety concerns and vaccine refusals: a survey of Connecticut pediatricians

Susan Leib, Penny Liberatos, Karen Edwards

Abstract
Objectives. Physicians are seeing increasing numbers of parents who question the safety of vaccines or refuse to vaccinate their children. This study examined how frequently pediatricians in one New England state encounter parental vaccine safety concerns and vaccine refusals, how often physicians dismiss families from their practices for vaccine refusal, and how parental vaccine refusal impacts pediatricians personally.

Methods. The study consisted of a quantitative survey of primary care pediatri-cians in one New England state; 133 pediatricians completed the questionnaire. Variables examined included number of parental vaccine concerns and refusals seen by each physician, physicians’ response to parental vaccine concerns and refusals, the personal impact of parental vaccine safety refusals on pediatricians, and respondent estimates of socioeconomic characteristics of families seen in their practices.

Results. The majority of responding pediatricians reported an increase in parental vaccine safety concerns and refusals. More than 30% of responding pediatricians have dismissed families because of their refusal to immunize. Suburban physicians caring for wealthier, better educated families experience more vaccine concerns and/or refusals and are more likely to dismiss families for vaccine refusal. Vaccine refusals have a negative personal impact on one-third of physician respondents.

Conclusions. Pediatricians in Connecticut are reporting increased levels of parental vaccine safety concerns and refusals. Physicians who report more parental vaccine safety concerns and refusals and who care for wealthier, better educated families are more likely to dismiss families who refuse vaccines and to be negatively affected by parental vaccine refusals, which may adversely impact childhood vaccination rates.

Leib S, Liberatos P, Edwards K. Pediatricians’ experience with and response to parental vaccine safety concerns and vaccine refusals: a survey of Connecticut pediatricians. Public Health Rep. 2011 Jul-Aug;126 Suppl 2:13-23

Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ)

Johan Ahlin, Eva Ericson-Lidman, Astrid Norberg, Gunilla Strandberg

Abstract
The Perceptions of Conscience Questionnaire (PCQ) and the Stress of Conscience Questionnaire (SCQ) have previously been developed and validated within the ‘Stress of Conscience Study’. The aim was to revalidate these two questionnaires, including two additional, theoretically and empirically significant items, on a sample of healthcare personnel working in direct contact with patients.The sample consisted of 503 healthcare personnel.To test variation and distribution among the answers, descriptive statistics, item analysis and principal component analysis (PCA) were used to examine the underlying factor structure of the questionnaires.Support for adding the new item to the PCQ was found.No support was found for adding the new item to the SCQ. Both questionnaires can be regarded as valid for Swedish settings but can be improved by rephrasing some of the PCQ items and by adding items about private life to the SCQ.

Ahlin J, Ericson-Lidman E, Norberg A, Strandberg G. Revalidation of the perceptions of conscience questionnaire (PCQ) and the stress of conscience questionnaire (SCQ). Nurs Ethics. 2012;19(2):220-232.

What makes killing wrong?

Walter Sinnott-Armstrong, Franklin G Miller

Abstract
What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Sinnott-Armstrong W, Miller FG. What makes killing wrong? J Medical Ethics 2013;39:3-7.

The Harmony Between Professional Conscience Rights and Patients’ Right of Access

Matthew S Bowman, Christopher P Schandevel

Abstract
“Access” is the new catchphrase for expanding privacy rights. This shift moves from seeking merely legalization, to demanding government assistance and the participation of private citizens. . . . This article will begin by examining the chief access arguments being used against conscience protections today: that the health professionals hold a monopoly so they are bound to offer abortion, that health professionals must defer their pro-life consciences to abortion’s legal status, and that health professionals must not impose their pro-life views. The article will conclude that, if access principles really flowed from a neutral concern for patient choices, they would require rather than strike down conscience protections. In many cases patients desire in their physicians the traditional Hippocratic values that unequivocally support human life and therefore oppose participating in activities such as abortion. The right of patients to access such physicians can only exist by guaranteeing the right of physicians to practice according to those values.

Bowman MS, Schandevel CP. The Harmony Between Professional Conscience Rights and Patients’ Right of Access. Social Science Research Network. 2012;1-39.

Best evidence in critical care medicine. Early versus late parenteral nutrition in the adult ICU: feeding the patient or our conscience?

Jeff P Kerrie, Sean M Bagshaw, Peter G Brindley

Abstract
Background: Critical illness increases the risk of malnutrition, which can increase infections, prolong mechanical ventilation, delay recovery, and increase mortality. While enteral nutrition (EN) is considered optimal, this is not always an option. Furthermore, algorithms for parenteral nutrition (PN) vary significantly, and it is unclear whether early initiation or delay of parenteral feeding is preferable.

Objective: This study compares intensive care unit (ICU) duration of stay in adults randomized to early initiation of PN (within 48 hr of ICU admission) vs delayed (at eight days or later after ICU admission), as consistent with European and North American guidelines, respectively. . . .

Conclusions: While ICU and 90-day survival were not significantly different, patients in the late PN group were discharged earlier from both the ICU and the hospital. Late PN initiation was also associated with fewer infections, shorter mechanical ventilation time, shorter RRT time, and lower overall healthcare costs. While there were more episodes of hypoglycemia and more inflammation in the late PN group, there was no apparent clinical consequence. No primary or secondary end points showed that early PN was superior.

Kerrie JP, Bagshaw SM, Brindley PG. Best evidence in critical care medicine. Early versus late parenteral nutrition in the adult ICU: feeding the patient or our conscience? Can J Anesthesia. 2012 Feb 03;59(5):494-498.

Stress of conscience among staff caring for older persons in Finland

Reetta Saarnio, Anneli Sarvimäki, Helena Laukkala, Arja Isola

Abstract
Caring for older persons is both rewarding and consuming. Work with older people in Finland has been shown to be more burdensome than in the other Nordic countries. The aim of this study was to try out a Finnish version of the Stress of Conscience Questionnaire (SCQ) and explore stress of conscience in staff caring for older persons in Finland. The data were collected from the nursing staff (n = 350) working with older people in health centre wards, municipal and private nursing homes, and municipal and private dementia care units in Finland. It emerged clearly from the results that Finnish nursing staff mostly felt that they did not have enough time to provide good care to patients, and this gave them a troubled conscience. They also felt that the demanding work taxed their energy, a consequence being that they could not give their own families and loved ones the attention they would have liked.

Saarnio R, Sarvimäki A, Laukkala H, Isola A. Stress of conscience among staff caring for older persons in Finland. Nurs Ethics. 2012 Feb 01;19(1):104-115.

In Defense of Ectogenesis

Anna Smajdor

Extract
In his article ‘‘Research Priorities and the Future of Pregnancy’’ in this issue of CQ, Timothy Murphy evaluates some of the arguments I advanced in an earlier publication, ‘‘The Moral Imperative for Ectogenesis.’’ In this reply to Murphy’s article, I acknowledge some of his points and seek to show why some of his objections are not as powerful as he thinks. I start here by summarizing the argument put forward in my original article.

Smajdor A. In Defense of Ectogenesis. Camb Q Healthc Ethics (2012) 21 , pp 90-103

“It’s a girl!” could be a death sentence.

Rajenda Kale

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
When Asians migrated to Western countries they brought welcome recipes for curries and dim sum. Sadly, a few of them also imported their preference for having sons and aborting daughters. Female feticide happens in India and China by the millions, but it also happens in North America in numbers large enough to distort the male to female ratio in some ethnic groups.1^–4 Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups?

Kale R. “It’s a girl!” could be a death sentence. CMAJ January 16, 2012, doi: 10.1503/cmaj.120021