Journal Articles Archives - Page 33 of 67 - Protection of Conscience Project Library

Obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

International Journal of Gynecology & Obstetrics

Abstract
Objective
To examine obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling.

Methods
Between October 2008 and January 2009, a survey was mailed to a national randomized sample of 1800 practicing US obstetrician–gynecologists. Study variables were agreement with 2 statements. (1) “If physicians counsel patients about safe-sex practices, the patients will be less likely to engage in risky sexual behaviors”. (2) “If physicians counsel patients about abstinence, the patients will be much less likely to engage in sexual activity”. Covariates included demographic, clinical, and religious characteristics of the physician.

Results
The response rate was 66% (1154/1760 eligible physicians). Most respondents somewhat (62%) or strongly (25%) agreed that counseling patients about safe-sex practices makes patients less likely to engage in risky sexual behaviors. Fewer agreed strongly (3%) or somewhat (28%) that counseling patients about abstinence makes patients less likely to engage in sexual activity. The belief that safe-sex counseling reduces risky behaviors was less common among males (odds ratio [OR] 0.6) and more common among immigrants (OR 2.0). Religious physicians were more likely to believe that abstinence counseling reduces sexual activity (OR 2.2–5.3).

Conclusions
Most obstetrician–gynecologists believed that counseling about safe sex is effective, and a significant minority endorsed abstinence counseling.

Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling. Int J Gyn Obst 2011; 114(3):281-285.

Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act

Carolyn Wendel

Notre Dame Journal of Law, Ethics & Public Policy

Extract
Conclusion
It is undeniable that Catholic hospitals play a pivotal role in the administration of health care in America. The requirement that they follow both federal law and canon law can, however, create conflicting obligations. If FOCA were to pass, Catholic hospitals would be required under federal law to provide abortions and other reproductive services in direct conflict with Catholic teachings. At the same time, because the Catholic Church would view FOCA as an unjust law operating against human good and divine good, Catholic hospitals would also have a moral obligation under church teachings to disobey the provisions of FOCA.

Unable to sell because of their inability to cooperate in an evil act, Catholic hospitals would likely engage in civil disobedi ence. And yet, such tactics would only work for so long. Suits would be brought and courts would almost certainly uphold FOCA as a valid and neutral law that is generally applicable. Despite what many would like to believe, FOCA poses a very real and imminent threat to the existence of Catholic hospitals. And the effect least talked about and yet most important is not what effect such closing would have on the Church itself, but what effect it would have on the 92 million patients that Catholic hospitals treat annually. The effects of FOCA passing and Catholic hospitals closing would be much more than a victory for the pro- choice advocates; it would be a loss to every person who has ever received treatment at a Catholic hospital and to all those who would be denied such services in the future. Perhaps we should take a cue from the medical profession itself and remember above all else: first, do no harm

Wendel C. Just how much do medicine and morals mix: catholic hospitals and the potential effects of the Freedom of Choice Act. Notre Dame J Law Ethics Pub Pol. 2011;25(2):663-688.

Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment

Kenneth A Rasinski, John D Yoon, Youssef G Kalad, Farr A Curlin

Abstract
Background and objectives: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners’ opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists’ (OB/GYN) support for the recommendations.

Design: A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee–whether the doctor referred and whether the doctor disclosed their objection to the abortion.

Participants and setting: 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.

Measurement: Physicians indicated their approval for the vignette doctor’s decision.

Main results: Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.

Conclusion: OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.

Rasinski KA, Yoon JD, Kalad YG, Curlin FA. Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment. J Med Ethics. 2011;37(12):711-714.

Triangular reflective equilibrium: A conscience-based method for bioethical deliberation

Y Michael Barilan, Margherita Brusa

Abstract
Following a discussion of some historical roots of conscience, we offer a systematized version of reflective equilibrium. Aiming at a comprehensive methodology for bioethical deliberation, we develop an expanded variant of reflective equilibrium, which we call ‘triangular reflective equilibrium’ and which incorporates insights from hermeneutics, critical theory and narrative ethics. We focus on a few distinctions, mainly between methods of justification in ethics and the social practice of bioethical deliberation, between coherence in ethical reasoning, personal integrity and consensus formation, and between political and moral deliberation. The ideal of deliberation is explicated as a sharing of conscience within a special commitment to sincerity and openness to persuasion. Personal growth in wisdom is an indirect by-product of the continuous practice of moral deliberation. This is explicated in the light of Sternberg’s balance theory of wisdom and in the context of medicine as a profession embodying altruistic responsibilities of care in democratic and pluralistic societies.

Barilan YM, Brusa M. Triangular reflective equilibrium: A conscience-based method for bioethical deliberation. Bioethics. 2011;25(6):304-319.

Process and Outcomes of Euthanasia Requests Under the Belgian Act on Euthanasia: A Nationwide Survey

Yanna Van Wesemael, Joachim Cohen, Johan Bilsen, Tinne Smets, Bregje D Onwuteaka-Philipsen, Luc Deliens

Abstract
Context: Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated.

Objectives: To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician.

Methods: A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request.

Results: The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians’ characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted.

Conclusion: Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not.

Wesemael YV, Cohen J, Bilsen J, Smets T, Onwuteaka-Philipsen BD, Deliens L. Process and outcomes of Euthanasia Requests Under the Belgian Act on Euthanasia: A Nationwide Survey. J Pain Symptom Manage. 2011 May 16;42(5):721-733.

A matter of conscience: do conflicting beliefs and workplace demands constitute religious discrimination?

CW Von BergeN, Martin S Bressler

Journal of Behavioral Studies in Business

Abstract
Increasingly, employees maintain they should be provided an unqualified legal right to refuse work activities that violate their ethical, moral, personal, or religious convictions or beliefs-in short, their conscience. This assertion has become one of the more controversial issues confronting employers. This paper presents a brief review of conscientious objection with special attention to objection in medical related areas, followed by new discussion of freedom of conscience in the workplace.

Bergen CV, Bressler MS. A matter of conscience: do conflicting beliefs and workplace demands constitute religious discrimination? J Behavioral Studies in Business. 2011;3:1-14. Available from:

Conscientious commitment to women’s health

Bernard M Dickens, Rebecca J Cook

Abstract
Conscientious commitment, the reverse of conscientious objection, inspires healthcare providers to overcome barriers to delivery of reproductive services to protect and advance women’s health. History shows social reformers experiencing religious condemnation and imprisonment for promoting means of birth control, until access became popularly accepted. Voluntary sterilization generally followed this pattern to acceptance, but overcoming resistance to voluntary abortion calls for courage and remains challenging. The challenge is aggravated by religious doctrines that view treatment of ectopic pregnancy, spontaneous abortion, and emergency contraception not by reference to women’s healthcare needs, but through the lens of abortion. However, modern legal systems increasingly reject this myopic approach. Providers’ conscientious commitment is to deliver treatments directed to women’s healthcare needs, giving priority to patient care over adherence to conservative religious doctrines or religious self-interest. The development of in vitro fertilization to address childlessness further illustrates the inspiration of conscientious commitment over conservative objections.

Dickens BM, Cook RJ. Conscientious commitment to women’s health. Int J Gyn Ob. 2011;113(2):163-166.

Dishonest deed, clear conscience: when cheating leads to moral disengagement and motivated forgetting

Lisa L. Shu, Francesca Gino, Max H. Bazerman

Personality and Social Psychology Bulletin

Abstract
People routinely engage in dishonest acts without feeling guilty about their behavior. When and why does this occur? Across four studies, people justified their dishonest deeds through moral disengagement and exhibited motivated forgetting of information that might otherwise limit their dishonesty. Using hypothetical scenarios (Studies 1 and 2) and real tasks involving the opportunity to cheat (Studies 3 and 4), the authors find that one’s own dishonest behavior increased moral disengagement and motivated forgetting of moral rules. Such changes did not occur in the case of honest behavior or consideration of the dishonest behavior of others. In addition, increasing moral saliency by having participants read or sign an honor code significantly reduced unethical behavior and prevented subsequent moral disengagement. Although dishonest behavior motivated moral leniency and led to forgetting of moral rules, honest behavior motivated moral stringency and diligent recollection of moral rules.

Shu LL, Gino F, Bazerman MH. Dishonest deed, clear conscience: when cheating leads to moral disengagement and motivated forgetting. Pers Soc Psychol Bull. 2011 Mar;37(3):330-49. PubMed PMID: 2130717

Conscientious refusals to refer: Findings from a national physician survey

Michael P Combs, Ryan M Antiel, Jon C Tilburt, Paul S Mueller, Farr A Curlin

Abstract
Background: Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral.

Method: The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral.

Results: Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one’s practice (multivariable ORs, 1.6-2.4).

Conclusions: Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide..

Combs MP, Antiel RM, Tilburt JC, Mueller PS, Curlin FA. Conscientious refusals to refer: Findings from a national physician survey. J Med Ethics. 2011;37(7):397-401. Available from:

A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants

Dominic Wilkinson

Abstract
When is it permissible to allow a newborn infant to die on the basis of their future quality of life? The prevailing official view is that treatment may be withdrawn only if the burdens in an infant’s future life outweigh the benefits. In this paper I outline and defend an alternative view. On the Threshold View, treatment may be withdrawn from infants if their future well-being is below a threshold that is close to, but above the zero-point of well-being. I present four arguments in favor of the Threshold View, and identify and respond to several counterarguments. I conclude that it is justifiable in some circumstances for parents and doctors to decide to allow an infant to die even though the infant’s life would be worth living. The Threshold View provides a justification for treatment decisions that is more consistent, more robust, and potentially more practical than the standard view.

Wilkinson D. A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants. Am J Bioeth. 2011 Feb;11(2):20-32.