Journal Articles Archives - Page 39 of 67 - Protection of Conscience Project Library

First and second things, and the operations of conscience in science

Bruce G. Charlton

Author Summary
Why is modern science less efficient than it used to be, why has revolutionary science declined, and why has science become so dishonest? One plausible explanation behind these observations comes from an essay First and second things published by CS Lewis. First Things are the goals that are given priority as the primary and ultimate aim in life. Second Things are subordinate goals or aims – which are justified in terms of the extent to which they assist in pursuing First Things. The classic First Thing in human society is some kind of religious or philosophical world view. Lewis regarded it as a ‘universal law’ that the pursuit of a Second Thing as if it was a First Thing led inevitably to the loss of that Second Thing: ‘You can’t get second things by putting them first; you can get second things only by putting first things first’. I would argue that the pursuit of science as a primary value will lead to the loss of science, because science is properly a Second Thing. Because when science is conceptualized as a First Thing the bottom-line or operational definition of ‘correct behaviour’ is approval and high status within the scientific community. However, this does nothing whatsoever to prevent science drifting-away from its proper function; and once science has drifted then the prevailing peer consensus will tend to maintain this state of corruption. I am saying that science is a Second Thing, and ought to be subordinate to the First Thing of transcendental truth. Truth impinges on scientific practice in the form of individual conscience (noting that, of course, the strength and validity of conscience varies between scientists). When the senior scientists, whose role is to uphold standards, fail to posses or respond-to informed conscience, science will inevitably go rotten from the head downwards. What, then, motivates a scientist to act upon conscience? I believe it requires a fundamental conviction of the reality and importance of truth as an essential part of the basic purpose and meaning of life. Without some such bedrock moral underpinning, there is little possibility that individual scientific conscience would ever have a chance of holding-out against an insidious drift toward corruption enforced by peer consensus.

Charlton BG. First and second things, and the operations of conscience in science. Med Hypotheses. 2010 Jan;74(1):1-3. Epub 2009 Sep 5.

Conscience-based exemptions for medical students

Mark R Wicclair

Cambridge Quarterly of Healthcare Ethics

Journal’s Extract
Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association (AMA) introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might prompt requests for conscience-based exemptions (CBEs). In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety.

Wicclair MR. Conscience-based exemptions for medical students. Camb Q Healthc Ethics. 2010;19(1):38-50.

Cooperation with Securities Fraud

Ronald J Colombo

Abstract
Although “proximity” is itself an indefinite concept, we are not without tools in deciphering it. For we have at our disposal a well-developed, longtested method of analyzing proximity with an eye toward the just imposition of culpability: moral philosophy’s “principles of cooperation.” By turning to these principles, we have at our fingertips a ready-made set of factors to consider in assessing whether one’s conduct should be deemed proximate versus remote to another’s fraud. The principles of cooperation also provide a framework around which we can organize securities fraud jurisprudence in general. For the insights gleaned from the principles regarding moral culpability in many respects parallel the conclusions reached by courts and commentators construing liability under the securities laws. Perhaps, in addition to the assistance it provides us in resolving the difficult issue of proximity, this framework could serve as a useful aid in resolving other, and future, securities fraud questions..

Colombo RJ. Cooperation with Securities Fraud. Alabama University Law Review. 2009 Dec;61(1)-66.

An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician’s role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience.

Chervenak FA, McCullough LB. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide. Am J Obstet Gynecol. 2009 Dec;201(6):560.e1-560.e6.

Where conscience meets desire: refusal of health care providers to honor health care proxies for sexual minorities

Shawna S Baker

Women's Rights Law Reporter — Women’s Rights Law Reporter

Baker SS. Where conscience meets desire: refusal of health care providers to honor health care proxies for sexual minorities. Women’s Rights Law Reporter. 2009-2010;31(1):1-41.

When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience

Suzanne Davis, Paul Lansing

Extract
Conclusion
In conclusion, we think that the marketplace of ideas should be allowed to function on this issue. So long as consumers have access to distribution channels for emergency contraception and to information regarding where the drug is available, there is no reason why the market would fail to reconcile this dilemma. However, if Wilson is correct that governments will not be able to fight the urge to take an active role in this dispute, then freedom of conscience should be the paramount fundamental right. This determination is necessary to provide the proper balance of rights because placing an affirmative duty on pharmacists to dispense a drug negates the basic premises on which our nation is built and only avoids a slight inconvenience to consumers who desire emergency contraception. Finally, it is important for governments to recognize that there are sound arguments on both sides of this legal debate and that an in depth analysis of the ethical and public policy ramifications of regulation on this issue is absolutely necessary.

Davis S, Lansing P. When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience. 12 Depaul J. Health Care L. 67, 89-91 (2009)

Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile

Lidia Casas

Abstract
As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women’s rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women’s health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women’s rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.

Keywords:

Casas L. Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile. Reprod Health Matter. 2009 Nov;17(34):78-87.

Reporting of euthanasia and physician-assisted suicide in the Netherlands: Descriptive study

Hilde Buiting, Johannes Van Delden, Bregje D Onwuteaka-Philipsen, Judith Rietjens, Mette Rurup, Donald Van Tol, Joseph Gevers,Paul Van Der Maas,Agnes Van Der Heide

Abstract
Background: An important principle underlying the Dutch Euthanasia Act is physicians’ responsibility to alleviate patients’ suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee. We studied which arguments Dutch physicians use to substantiate their adherence to the criteria and which aspects attract review committees’ attention. . . .

Conclusion: Dutch physicians substantiate their adherence to the criteria in a variable way with an emphasis on physical symptoms. The information they provide is in most cases sufficient to enable adequate review. Review committees’ control seems to focus on (unbearable) suffering and on procedural issues.

Buiting H, Delden JV, Onwuteaka-Philipsen BD, Rietjens J, Rurup M, Tol DV et al. Reporting of euthanasia and physician-assisted suicide in the Netherlands: Descriptive study. BMC Medical Ethics. 2009;10(1).

The prisoner as model organism: malaria research at Stateville Penitentiary

Nathaniel Comfort

Studies in History and Philosophy of Biological and Biomedical Sciences

Abstract

In a military-sponsored research project begun during the Second World War, inmates of the Stateville Penitentiary in Illinois were infected with malaria and treated with experimental drugs that sometimes had vicious side effects. They were made into reservoirs for the disease and they provided a food supply for the mosquito cultures. They acted as secretaries and technicians, recording data on one another, administering malarious mosquito bites and experimental drugs to one another, and helping decide who was admitted to the project and who became eligible for early parole as a result of his participation. Thus, the prisoners were not simply research subjects; they were deeply constitutive of the research project. Because a prisoner’s time on the project was counted as part of his sentence, and because serving on the project could shorten one’s sentence, the project must be seen as simultaneously serving the functions of research and punishment. Michel Foucault wrote about such ‘mixed mechanisms’ in his Discipline and punish. His shining example of such a ‘transparent’ and subtle style of punishment was the panopticon, Jeremy Bentham’s architectural invention of prison cellblocks arrayed around a central guard tower. Stateville prison was designed on Bentham’s model; Foucault featured it in his own discussion. This paper, then, explores the power relations in this highly idiosyncratic experimental system, in which the various roles of model organism, reagent, and technician are all occupied by sentient beings who move among them fluidly. This, I argue, created an environment in the Stateville hospital wing more panoptic than that in the cellblocks. Research and punishment were completely interpenetrating, and mutually reinforcing.

Comfort N. The prisoner as model organism: malaria research at Stateville Penitentiary. Stud Hist Philos Biol Biomed Sci. 2009;40(3):190-203. doi:10.1016/j.shpsc.2009.06.007

Conscientious objection to termination of pregnancy: The competing rights of patients and nurses

Roslyn Kane

Abstract
Aims: To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses.

Background: Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection.

Methods: A review of the academic literature.

Results: The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services.

Conclusions: This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion.

Implications for Nursing Management: Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.

Kane R. Conscientious objection to termination of pregnancy: The competing rights of patients and nurses. J Nurs Manag. 2009 Sep 24;17(7):907-912.