Journal Articles Archives - Page 12 of 67 - Protection of Conscience Project Library

Navigating the new era of assisted suicide and execution drugs

Sean Riley

Extract
I. Introduction
Lethal medication provisions are in a precarious state. Over the past decade, pharmaceutical companies have attempted to stamp out the use of their drugs in executions, creating several economic and regulatory hurdles for access to these medications. As a result, patients seeking physician-assisted suicide (PAS) as well as death penalty states aiming to execute their capital offenders have been forced to turn to unregulated and dangerous alternatives for these drugs. This note attempts to unpack the quality, safety, and access issues emerging from these recent changes and to explore the implications for the future of these practices.

In order to fully grasp the exact mechanisms at work, this note will first offer a brief pharmacological description of the lethal medications and detail many technical aspects of their use. The next section provides a historical account of the past decade, illustrating the emergent quality, safety, and access issues. This note then evaluates the competing notions of ‘botched’ executions and ‘complications’ in PAS while analysing the standards set forward to measure safety and efficacy for each. Finally, this note closes by exploring the future of each practice in light of our discussion.

Riley S. Navigating the new era of assisted suicide and execution drugs. Journal of Law and the Biosciences. Volume 4, Issue 2, 1 August 2017, Pages 424–434, https://doi.org/10.1093/jlb/lsx028

There is no defence for ‘Conscientious objection’ in reproductive health care

Christian Fiala, Joyce H. Arthur

European Journal of Obstetrics and Gynecology

Abstract
A widespread assumption has taken hold in the field of medicine that we must allow health care professionals the right to refuse treatment under the guise of ‘conscientious objection’ (CO), in particular for women seeking abortions. At the same time, it is widely recognized that the refusal to treat creates harm and barriers for patients receiving reproductive health care. In response, many recommendations have been put forward as solutions to limit those harms. Further, some researchers make a distinction between true CO and ‘obstructionist CO’, based on the motivations or actions of various objectors. This paper argues that ‘CO’ in reproductive health care should not be considered a right, but an unethical refusal to treat. Supporters of CO have no real defence of their stance, other than the mistaken assumption that CO in reproductive health care is the same as CO in the military, when the two have nothing in common (for example, objecting doctors are rarely disciplined, while the patient pays the price). Refusals to treat are based on non-verifiable personal beliefs, usually religious beliefs, but introducing religion into medicine undermines best practices that depend on scientific evidence and medical ethics. CO therefore represents an abandonment of professional obligations to patients. Countries should strive to reduce the number of objectors in reproductive health care as much as possible until CO can feasibly be prohibited. Several Scandinavian countries already have a successful ban on CO.

Fiala C, Arthur JH. Eur J Obstet Gynecol Reprod Biol. 2017 Jul 23. pii: S0301-2115(17)30357-3. doi: 10.1016/j.ejogrb.2017.07.023. [Epub ahead of print]

Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement

Fabian Stahle

Abstract
The international movement that promotes the legalisation of euthanasia/physician-assisted suicide (PAS) is propelled by highly potent psychological mechanisms to overcome the resistance to its agenda. It is all about cognitive restructuring to justify inhumane actions. These are always in use when normal, well-socialised persons are coerced into accepting and participating in the killing of fellow human beings. Various scientific studies, pioneered by Albert Bandura, have shown that participators are able to endure their deeds by activating these powerful mechanisms of moral disengagement. However, those who make use of such mechanisms pay a high price. These mechanisms have a personality-changing power that dehumanizes the perpetrators. For the society that has allowed itself to be manipulated by such mechanisms for the purpose of systematizing “death on demand”, there are also serious consequences. These consequences can be described in terms of dehumanization and brutalization of that society as a whole.

Stahle F. Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement. J Ethics Ment Health. 2017;10 (1-15)

The history of autonomy in medicine from antiquity to principlism

Toni C Saad

Abstract
Respect for Autonomy (RFA) has been a mainstay of medical ethics since its enshrinement as one of the four principles of biomedical ethics by Beauchamp and Childress’ in the late 1970s. This paper traces the development of this modern concept from Antiquity to the present day, paying attention to its Enlightenment origins in Kant and Rousseau. The rapid C20th developments of bioethics and RFA are then considered in the context of the post-war period and American socio-political thought. The validity and utility of the RFA are discussed in light of this philosophical-historical account. It is concluded that it is not necessary to embrace an ethic of autonomy in order to guard patients from coercion or paternalism, and that, on the contrary, the dominance of autonomy threatens to undermine those very things which have helped doctors come to view and respect their patients as persons.

Saad TC. The history of autonomy in medicine from antiquity to principlism. Med Health Care Phil. 2018;21(1):125-137.

Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

Madeline Li, Sarah Watt, Marnie Escaf, Michael Gardam, Ann Heesters, Gerald O’Leary, and Gary Rodin

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
After Canada legalized medical assistance in dying (MAiD), the University Health Network in Toronto implemented a hospital-based MAiD program. UHN offers a framework for assessing patients for and providing MAiD while respecting the rights of patients and staff.

Li M, Watt S, Escaf M, Gardam M, Heesters A, O’Leary G, M.B., Rodin G. Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada. N Engl J Med 2017; 376:2082-2088 May 25, 2017 DOI: 10.1056/NEJMms1700606

Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection

Toni C Saad

Abstract
In her paper Cosmetic surgery and conscientious objection’, Minerva rightly identifies cosmetic surgery as an interesting test case for the question of conscientious objection in medicine. Her treatment of this important subject, however, seems problematic. It is argued that Minerva’s suggestion that a doctor has a prima facie duty to satisfy patient preferences even against his better clinical judgment, which we call Patient Preference Absolutism, must be regarded with scepticism. This is because (1) it overlooks an important distinction regarding autonomy’s meaning and place in clinical practice, and (2) it makes obsolete the important concepts of expert clinical judgment and beneficence. Finally, we discuss two ideas which emerge from consideration of cosmetic surgery in relation to conscientious objection. These are the possible analogy between clinical judgment and conscientious objection, and the possible role the goals of medicine can play in defining the scope of conscientious objection.

Saad TC. Mistakes and missed opportunities regarding cosmetic surgery and conscientious objection. J Med Ethics. 2018;44(9):649-650.

Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription

Morten Magelssen

Abstract
By way of a case story, two common presuppositions in the academic debate on conscientious objection in healthcare are challenged. First, the debate typically presupposes a sharp division between conscience-based refusals based on personal core moral beliefs and refusals based on professional (eg, medical) reasons. Only the former might involve the moral gravity to warrant accommodation. The case story challenges this division, and it is argued that just as much might sometimes be at stake morally in refusals based on professional reasons. The objector’s moral integrity might be equally threatened in objections based on professional reasons as in objections based on personal beliefs. Second, the literature on conscientious objection typically presupposes that conflicts of conscience pertain to well-circumscribed and typical situations which can be identified as controversial without attention to individualising features of the concrete situation. However, the case shows that conflicts of conscience can sometimes be more particular, born from concrete features of the actual situation, and difficult, if not impossible, to predict before they arise. Guidelines should be updated to address such ‘situation-based’ conscientious refusals explicitly.

Magelssen M. Professional and conscience-based refusals: the case of the psychiatrist’s harmful prescription. Journal of Medical Ethics Published Online First: 24 April 2017. doi: 10.1136/medethics-2017-104162

Reasons, reasonability and establishing conscientious objector status in medicine

Robert F Card

Abstract
This paper builds upon previous work in which I argue that we should assess a provider’s reasons for his or her objection before granting a conscientious exemption. For instance, if the medical professional’s reasoned basis involves an empirical mistake, an accommodation is not warranted. This article poses and begins to address several deep questions about the workings of what I call a reason-giving view: What standard should we use to assess reasons? What policy should we adopt in order to evaluate the reasons offered by medical practitioners in support of their objections? I argue for a reasonability standard to perform the essential function of assessing reasons, and I offer considerations in support of a policy establishing conscientious objector status in medicine.

Card RF. Reasons, reasonability and establishing conscientious objector status in medicine. J Med Ethics 2017 Apr;43(4):222-225. doi: 10.1136/medethics-2016-103792

Physicians, Not Conscripts — Conscientious Objection in Health Care

Ronit Y. Stahl, Ezekiel J. Emanuel

Journal Summary
Conscientious objection laws give health care professionals the legal right to refuse, on the basis of personal beliefs, to perform certain procedures or care for particular patients. The authors argue that professional societies should declare conscientious objection unethical.

Stahl RY, Emanuel EJ. Physicians, Not Conscripts – Conscientious Objection in Health Care. N Engl J Med 2017; 376:1380-1385 April 6, 2017 DOI: 10.1056/NEJMsb1612472

Abortion decriminalisation and statutory rights of conscience

Mary Neal

Extract
On 13 March 2017, the House of Commons voted by 172 to 142 in favour of a second reading for the Reproductive Health (Access to Terminations) Bill. The bill, introduced by Diana Johnson MP, would decriminalise abortion until the end of the 24th week of pregnancy, meaning that abortion could be performed until the end of the 24th week of pregnancy without the need to satisfy any statutory grounds, or to obtain two doctors’ authorisation. Many campaigners see this bill as a first step toward the longer-term goal of fully decriminalising abortion. [1]

The prospect of decriminalisation raises a number of interesting and important issues, including an issue which has been neglected in the debates over decriminalisation so far, namely what any change in the law might mean for the right of health professionals to withdraw from participation in abortion on grounds of conscience, under section 4 of the Abortion Act 1967. . . .

Neal M. Abortion decriminalisation and statutory rights of conscience. the bmjopinion [Internet]. 2017 Mar 24.