Joyce Cappiello, Margaret W Beal, Kim Gallogly-Hudson
Journal of Obstetric, Gynecologic & Neonatal Nursing
Abstract Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals’ right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.
Grace S Chung, Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
American Journal of Obstetrics & Gynecology
Abstract Objective: The purpose of this study was to assess obstetrician- gynecologists’ regarding their beliefs about when pregnancy begins and to measure characteristics that are associated with believing that pregnancy begins at implantation rather than at conception.
Study Design: We mailed a questionnaire to a stratified, random sample of 1800 practicing obstetrician-gynecologists in the United States. The outcome of interest was obstetrician-gynecologists’ views of when pregnancy begins. Response options were (1) at conception, (2) at implantation of the embryo, and (3) not sure. Primary predictors were religious affiliation, the importance of religion, and a moral objection to abortion.
Results: The response rate was 66% (1154/1760 physicians). One-half of US obstetrician-gynecologists (57%) believe pregnancy begins at conception. Fewer (28%) believe it begins at implantation, and 16% are not sure. In multivariable analysis, the consideration that religion is the most important thing in one’s life (odds ratio, 0.5; 95% confidence interval, 0.20.9) and an objection to abortion (odds ratio, 0.4; 95% confidence interval, 0.20.9) were associated independently and inversely with believing that pregnancy begins at implantation.
Conclusion: Obstetrician-gynecologists’ beliefs about when pregnancy begins appear to be shaped significantly by whether they object to abortion and by the importance of religion in their lives.
Lisa H Harris, Alexandra Cooper, Kenneth A Rasinski, Farr A Curlin, Anne Drapkin Lyerly
Obstetrics & Gynecology
Abstract Objective: To describe obstetrician-gynecologists’ (ob-gyns’) views and willingness to help women seeking abortion in a variety of clinical scenarios.
Methods: We conducted a mailed survey of 1,800 U.S. ob-gyns. We presented seven scenarios in which patients sought abortions. For each, respondents indicated if they morally objected to abortion and if they would help patients obtain an abortion. We analyzed predictors of objection and assistance.
Results: The response rate was 66%. Objection to abortion ranged from 16% (cardiopulmonary disease) to 82% (sex selection); willingness to assist ranged from 64% (sex selection) to 93% (cardiopulmonary disease). Excluding sex selection, objection was less likely among ob-gyns who were female (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.8), urban (OR 0.3, 95% CI 0.1-0.7), or Jewish (OR 0.3, 95% CI 0.1-0.7) compared with male, rural, or religiously unaffiliated ob-gyns. Objection was more likely among ob-gyns from the South (OR 1.9, 95% CI 1.2-3.0) or Midwest (OR 1.9, 95% CI 1.2-3.1), and among Catholic, Evangelical Protestant, or Muslim ob-gyns, or those for whom religion was most important, compared with reference. Among ob-gyns who objected to abortion in a given case, approximately two-thirds would help patients obtain an abortion. Excluding sex selection, assistance despite objection was more likely among female (OR 1.8, 95% CI 1.1-2.9) and United States-born ob-gyns (OR 2.2, 95% CI 1.1-4.7) and less likely among southern ob-gyns (OR 0.3, 95% CI 0.2-0.6) or those for whom religion was most important (OR 0.3, 95% CI 0.1-0.7).
Conclusion: Most ob-gyns help patients obtain an abortion even when they morally object to abortion in that case. Willingness to assist varies by clinical context and physician characteristics.
Abstract This paper reports on a national study that explored the complexity surrounding ethical conflicts related to conscientious objection in social work. Specific focus was on the extent to which practitioners have a right to remove themselves from professional services and situations that conflict with a religious or moral worldview.
Abstract In much contemporary constitutional thought the exercise of state power unbounded by or contrary to the law is nothing other than the failure of justice in the constitutional order. Yet it has not always been so. For a substantial period of common- law legal history the exercise of judgment despite the law was viewed as essential to seeing that justice was done. This article argues that attention to the imaginative architecture of our criminal justice system discloses the continued presence of the concept of the positive conscience-based exception as a dimension of modern constitutionalism. This article looks at jury nullification, the royal prerogative of mercy, and prosecutorial discretion as abiding expressions of the idea that law and reason alone are insufficient to give full expression to our sense of state justice. The persistence of these sites for conscience-based decisions unbounded by the law ought to trouble prevailing theories of modern constitutionalism based on the preeminence of a reason- driven proportionality in which all decisions must be contained and regulated by the reason of law. Without denying the dangers of the exception, this article suggests that the conscientious decision made against or in spite of the law remains an important component of the way in which we imagine criminal justice.
David Isaacs, Bernadette Tobin, Julie Hamblin, Emma Slaytor, Kim C Donaghue, Craig Munns, Henry A Kilham
Journal of Paediatrics and Child Health
Abstract Doctors sometimes struggle with ethically challenging requests for treatment from children’s parents. For instance, we have recently had two requests by parents of children, a girl and a boy, each with a severe developmental disability, for hormonal therapy to suppress growth and puberty: the girl’s parents requested, in addition, hysterectomy and mastectomy. We propose a reliable approach to assessing the ethical and legal aspects of these and other requests for ‘non-therapeutic’ treatment of a minor who lacks the capacity to give informed consent. We argue that a doctor should first assess whether the request is one that he or she can, in conscience, accede to, and then, if it is, seek the authorisation of a court. We outline considerations relevant to the doctor’s assessment of both the ethical issues and to the need for court authorisation.
RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
Contraception
Abstract Background Given recent legislative efforts to require parental notification for the provision of reproductive health care to minors, we sought to assess how ob/gyns respond to requests for confidential contraceptive services.
Study Design Mailed survey of 1800 U.S. Obstetrician-Gynecologists, utilizing a vignette where a 17-year-old college freshman requests birth control pills and does not want her parents to know. Criterion variables were the likelihood of: encouraging her to abstain from sexual activity until she is older; persuading her to involve her parents in this decision; and prescribing contraceptives without notifying her parents. Covariates included physicians’ religious, demographic, and clinical characteristics.
Results Response rate 66%. Most (94%) would provide contraceptives without notifying her parents. Half (47%) would encourage her to involve a parent, and half (54%) would advise abstinence until she is older. Physicians who frequently attend religious services were more likely to encourage her to involve her parents (OR 1.9), and to abstain from sex until she is older (OR 4.4), but equally likely to provide the contraceptives.
Conclusions Most obstetrician-gynecologists will provide adolescents with contraceptives without notifying their parents.
Abstract Objective: To explore attitudes towards conscientious objections among medical students in the UK.
Methods: Medical students at St George’s University of London, Cardiff University, King’s College London and Leeds University were emailed a link to an anonymous online questionnaire, hosted by an online survey company. The questionnaire contained nine questions. A total of 733 medical students responded.
Results: Nearly half of the students in this survey stated that they believed in the right of doctors to conscientiously object to any procedure. Demand for the right to conscientiously object is greater in Muslim medical students when compared with other groups of religious medical students.
Discussion: Abortion continues to be a contentious issue among medical students and this may contribute to the looming crisis in abortion services over the coming years. This project sheds some light on how future doctors view some of their ethical rights and obligations. Using empirical evidence, it reveals that conscientious objection is an issue in the UK medical student body today. These data could help anticipate problems that may arise when these medical students qualify and practise medicine in the community.
Conclusion: Clearer guidance is needed for medical students about the issue of conscientious objection at medical school.
Abstract Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous selfdetermination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion.
Resolution adopted by the Council of Europe’s Parliamentary Assembly
Mark Campbell
Medical Law Review
Journal Extract The Council of Europe’s Parliamentary Assembly has adopted a resolution on conscientious objection in medicine, ‘The Right to Conscientious Objection in Lawful Medical Care’.1 In general terms, this resolution (‘the Resolution’) affirms the place of conscientious objection in the medical context while inviting member states to provide appropriate regulation of the practice of conscientious objection. In particular, it provides the following: first, there is a recognition that ‘[n]o person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason’.2 Secondly, the right of conscientious objection is affirmed together with the state’s responsibility ‘to ensure that patients are able to access lawful medical care in a timely manner’.3 Thirdly, it is acknowledged that ‘[i]n the vast majority of Council of Europe member states, the practice of conscientious objection is adequately regulated’.4 Fourthly, the Resolution invites member states ‘to develop comprehensive and clear regulations that define and regulate conscientious objection with regard to health and medical services’.5 Given that the Resolution sets out broad principles in this area and is not binding on member states—the Parliamentary Assembly has the role of a consultative body within the Council of Europe that seeks through its adopted texts to influence legislation and practice at a domestic level—the purpose of this short article is not to provide a line-by-line analysis of the text. It is rather to ‘read between the lines’ of the Resolution by examining its background and significance.
