Journal Articles Archives - Page 13 of 67 - Protection of Conscience Project Library

Aid-in-dying laws and the physician’s duty to inform

Mara Buchbinder

Abstract
On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient–provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID.

Buchbinder M. Aid-in-dying laws and the physician’s duty to inform. J Med Ethics. 2016;43(10):1-4.

Conscientious objection to vaccination

Steve Clarke, Alberto Giubilini, Mary Jean Walker

Abstract
Vaccine refusal occurs for a variety of reasons. In this article we examine vaccine refusals that are made on conscientious grounds that is, for religious, moral, or philosophical reasons. We focus on two questions: first, whether people should be entitled to conscientiously object to vaccination against contagious diseases (either for themselves or for their children) second, if so, to what constraints or requirements should conscientious objection (CO) to vaccination be subject. To address these questions, we consider an analogy between CO to vaccination and CO to military service. We argue that conscientious objectors to vaccination should make an appropriate contribution to society in lieu of being vaccinated. The contribution to be made will depend on the severity of the relevant disease(s), its morbidity, and also the likelihood that vaccine refusal will lead to harm. In particular, the contribution required will depend on whether the rate of CO in a given population threatens herd immunity to the disease in question: for severe or highly contagious diseases, if the population rate of CO becomes high enough to threaten herd immunity, the requirements for CO could become so onerous that CO, though in principle permissible, would be de facto impermissible.

Clarke S, Giubilini A, Walker MJ. Conscientious objection to vaccination. Bioethics. 2017 Mar;31(3):155-161.

The corporately produced conscience: Emergency contraception and the politics of workplace accommodations

Isaac Weiner

Journal of the American Academy of Religion

Abstract
This article uses a chance encounter with a supermarket checkout clerk as an occasion for reframing contemporary debates about workplace accommodations and the religious politics of contraception. Scholarship on workplace religion has tended to assume a rigid distinction between the religious spaces in which conscience is formed and the secular spaces to which claims of conscience are brought. In contrast, I argue that we might productively redescribe employee claims of conscience as corporately produced, rather than emanating from the realm of the private or personal. I reimagine the workplace as an important site of ethical subject formation, as a space in and through which moral claims are constituted, rather than to which they are brought, and I explore how accommodations can produce the very differences they are meant to protect. In this way, my discussion reveals how legal mandates and corporate policies join together to produce new moral subjects.

Weiner I. The corporately produced conscience: Emergency contraception and the politics of workplace accommodations. J Am Acad Religion. 2017 Mar;85(1):31-63.

Cosmetic surgery and conscientious objection

Francesca Minerva

Abstract
In this paper, I analyse the issue of conscientious objection in relation to cosmetic surgery. I consider cases of doctors who might refuse to perform a cosmetic treatment because: (1) the treatment aims at achieving a goal which is not in the traditional scope of cosmetic surgery; (2) the motivation of the patient to undergo the surgery is considered trivial; (3) the patient wants to use the surgery to promote moral or political values that conflict with the doctor’s ones; (4) the patient requires an intervention that would benefit himself/herself, but could damage society at large.

Minerva F. Cosmetic surgery and conscientious objection. Journal of Medical Ethics. Published Online First: 02 March 2017. doi:10.1136/medethics-2016-103804

Conscientious objection in healthcare and the duty to refer

Christopher Cowley

Abstract
Although some healthcare professionals have the legal right to conscientiously object to authorise or perform certain lawful medical services, they have an associated duty to provide the patient with enough information to seek out another professional willing to authorise or provide the service (the ‘duty to refer’). Does the duty to refer morally undermine the professional’s conscientious objection (CO)? I narrow my discussion to the National Health Service in Britain, and the case of a general practitioner (GP) being asked by a pregnant woman to authorise an abortion. I will be careful not to enter the debate about whether abortion should be legalised, or the debate about whether CO should be permitted—I will take both as given. I defend the objecting GP’s duty to refer against those I call the ‘conscience absolutists’, who would claim that if a state is serious enough in permitting the GP’s objection in the first place (as is the UK), then it has to recognise the right to withhold any information about abortion.

Cowley C. Conscientious objection in healthcare and the duty to refer. J Med Ethics 2017;43:207-212.

Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers

PG Brindley, JP Kerrie

Canadian Journal of General Internal Medicine

Abstract
“Conscientious objection” typically implies refusal to participate in an action based on strongly held ethical beliefs. It is historically associated with refusing to fight on the grounds of personal conscience or religion.2 Like other military allusions such as collateral damage or life in the trenches, its usage has spread into wider societal use. Conscientious objection is now used in regards to opposing euthanasia in Canada. Euthanasia, in turn, is now referred to by the less emotive term, Medical Assistance in Dying (MAID). Most medical practitioners and hospitals that object do so in part because of their disagreement or discomfort with the act of killing. As such, the analogy is not wholly unjustified. What is less clear is how this construct, and this terminology, will ultimately affect patients, practitioners, administrators and politicians.

Brindley PG, Kerrie JP. Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers. Canadian Journal of General Internal Medicine. 2016;11(4):7-10.

The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine

Robert F Card

Cambridge Quarterly of Healthcare Ethics

Abstract
This article first critically reviews the major philosophical positions in the literature on conscientious objection and finds that they possess significant flaws. A substantial number of these problems stem from the fact that these views fail to assess the reasons offered by medical professionals in support of their objections. This observation is used to motivate the reasonability view , one part of which states: A practitioner who lodges a conscientious refusal must publicly state his or her objection as well as the reasoned basis for the objection and have these subjected to critical evaluation before a conscientious exemption can be granted (the reason-giving requirement). It is then argued that when defenders of the other philosophical views attempt to avoid granting an accommodation to spurious objections based on discrimination, empirically mistaken beliefs, or other unjustified biases, they are implicitly committed to the reason-giving requirement. This article concludes that based on these considerations, a reason-giving position such as the reasonability view possesses a decisive advantage in this debate.

Card RF. The Inevitability of Assessing Reasons in Debates about Conscientious Objection in Medicine. Camb Q Healthc Ethics 2017 Jan;26(1):82-96. doi: 10.1017/S0963180116000669

“She’s on her own”: a thematic analysis of clinicians’ comments on abortion referral

Nazeneen Homaifar, Lori Freedman,Valerie French

Abstract
Objective: The objective was to understand the motivations around and practices of abortion referral among women’s health providers.

Methods: We analyzed the written comments from a survey of Nebraska physicians and advanced-practice clinicians in family medicine and obstetrics-gynecology about their referral practices and opinions for a woman seeking an abortion. We analyzed clinician’s responses to open-ended questions on abortion referral thematically.

Results: Of the 496 completed surveys, 431 had comments available for analysis. We found four approaches to abortion referral: (a) facilitating a transfer of care, (b) providing the abortion clinic name or phone number, (c) no referral and (4) misleading referrals to clinicians or facilities that do not provide abortion care. Clinicians described many motivations for their manner of referral, including a fiduciary obligation to refer, empathy for the patient, respect for patient autonomy and the lack of need for referral. We found that abortion stigma impacts referral as clinicians explained that patients often desire additional privacy and clinicians themselves seek to avoid tension among their staff. Other clinicians would not provide an abortion referral, citing moral or religious objections or stating they did not know where to refer women seeking abortion. Some respondents would refer women to other providers for additional evaluation or counseling before an abortion, while others sought to dissuade the woman from obtaining an abortion.

Conclusions: While practices and motivations varied, few clinicians facilitated referral for abortion beyond verbally naming a clinic if an abortion referral was made at all.

Implications: Interprofessional leadership, enhanced clinician training and public policy that addresses conscientious refusal of abortion referral are needed to reduce abortion stigma and ensure that women can access safe care.

Homaifar N, Freedman L,French V. “She’s on her own”: a thematic analysis of clinicians’ comments on abortion referral. Contraception. 2017 May;95(5):470-476. doi: 10.1016/j.contraception.2017.01.007. Epub 2017 Jan 25.

Tolerance, Professional Judgment, and the Discretionary Space of the Physician

Daneil P. Sulmasy

Abstract
Arguments against physicians’ claims of a right to refuse to provide tests or treatments to patients based on conscientious objection often depend on two premises that are rarely made explicit. The first is that the protection of religious liberty (broadly construed) should be limited to freedom of worship, assembly, and belief. The second is that because professions are licensed by the state, any citizen who practices a licensed profession is required to provide all the goods and services determined by the profession to fall within the scope of practice of that professional specialty and permitted by the state, regardless of any personal religious, philosophical, or moral objection. In this article, I argue that these premises ought to be rejected, and therefore the arguments that depend on them ought also to be rejected. The first premise is incompatible with Locke’s conception of tolerance, which recognizes that fundamental, self-identifying beliefs affect public as well as private acts and deserve a broad measure of tolerance. The second premise unduly (and unrealistically) narrows the discretionary space of professional practice to an extent that undermines the contributions professions ought to be permitted to make to the common good. Tolerance for conscientious objection in the public sphere of professional practice should not be unlimited, however, and the article proposes several commonsense, Lockean limits to tolerance for physician claims of conscientious objection.

Sulmasy DP. Tolerance, Professional Judgment, and the Discretionary Space of the Physician. Camb Q Healthc Ethics. 2017 Jan;26(1):18-31.

Conscientious non-objection in intensive care

Dominic Wilkinson

Abstract
Discussions of conscientious objection (CO) in healthcare often concentrate on objections to interventions that relate to reproduction, such as termination of pregnancy or contraception. Nevertheless, questions of conscience can arise in other areas of medicine. For example, the intensive care unit is a locus of ethically complex and contested decisions. Ethical debate about CO usually concentrates on the issue of whether physicians should be permitted to object to particular courses of treatment; whether CO should be accommodated. In this article, I focus on the question of how clinicians ought to act: should they provide or support a course of action that is contrary to their deeply held moral beliefs? I discuss two secular examples of potential CO in intensive care, and propose that clinicians should adopt a norm of conscientious non-objection (CNO). In the face of divergent values and practice, physicians should set aside their personal moral beliefs and not object to treatment that is legally and professionally accepted and provided by their peers. Although there may be reason to permit conscientious objections in healthcare, conscientious non-objection should be encouraged, taught, and supported.

Wilkinson D. Conscientious non-objection in intensive care. Camb. Q. Healthc. Ethics. 2017;26(1):132-142.