Journal Articles Archives - Page 40 of 67 - Protection of Conscience Project Library

Unethical Protection of Conscience: Defending the Powerful against the Weak

Bernard M Dickens

American Medical Association Journal of Ethics

Extract
In protecting and privileging health care professionals who withhold information that their patients depend upon, the provisions reduce health care professionals to the status of self-serving traders in an unequal market who may take advantage of those obliged or unwise enough to trust them and rely on their integrity. The provisions underscore the challenge that conscientious objection poses to health care professionalism [8]. To allow physicians to deny or frustrate a patient’s rights of conscience by enforcing their own through nonreferral, as the new regulations do, is unethical. It is ethically justifiable to be intolerant of religious or other fundamentalist intolerance.

Dickens BM. Unethical Protection of Conscience: Defending the Powerful against the Weak. Am Med Ass J Ethics. 2009;11(9):725-729.

Physicians’ beliefs about conscience in medicine: a national survey

Ryan E Lawrence, Farr A Curlin

Abstract
PURPOSE: To explore physicians’ beliefs about whether physicians sometimes have a professional obligation to provide medical services even if doing so goes against their conscience, and to examine associations between physicians’ opinions and their religious and ethical commitments.

METHOD: A survey was mailed in 2007 to a stratified random sample of 1,000 U.S. primary care physicians, selected from the American Medical Association Physician Masterfile. . . .

RESULTS: The response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians who are more religious are more likely to believe that physicians are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely to hold that physicians should never do what they believe is wrong.

CONCLUSION: A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.

Lawrence RE, Curlin FA. Physicians’ beliefs about conscience in medicine: a national survey.. Acad Med. 2009;84(9):1276-1282.

The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide

Bert Broeckaert, Joris Gielen, Trudie Van Iersel, Stef Van Den Branden

Abstract
Surveys carried out among palliative care physicians have shown that most participants do not support euthanasia and assisted suicide. Belgium, however, is one of the few countries in the world in which voluntary euthanasia is allowed by law. The potential influence of this legal dimension thus warranted a study of the attitudes of Belgian palliative care physicians toward euthanasia and assisted suicide. . . .The majority of the physicians favour legalisation on assisted suicide. There is no significant association between the euthanasia clusters and attitudes toward assisted suicide. We conclude that although most Flemish palliative care physicians agree that there may be circumstances in which a euthanasia request is justified, they also strongly believe in the effects of good palliative care and want the ‘palliative filter’ to be included in the law on euthanasia. Religion and worldview are an important factor determining attitudes towards euthanasia.

Broeckaert B, Gielen J, Iersel TV, Branden SVD. The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide. Ethical Perspectives. 2009;16(3):311-335.

The Australian Childhood Immunisation Register-A model for universal immunisation registers?

Brynley P Hull, Shelly L Deeks, Peter B McIntyre

Abstract
The Australian Childhood Immunisation Register (ACIR) was established in 1996 as an opt-out register built on the platform of Medicare, the universal national health insurance scheme. Introduction of financial incentives for providers and parents, linked to the ACIR, followed from 1998. Over the subsequent decade, national levels for receipt of all vaccines by 12, 24 and 72 months of age have risen to 91%, 93%, and 88%, respectively. Conscientious objection to immunisation can be registered, with retention of eligibility for incentives. The ACIR has been important in implementation of a range of measures to improve childhood immunisation coverage in Australia. Linkage of a universal childhood immunisation register to national health insurance schemes has potential applicability in a variety of settings internationally.

Hull BP, Deeks SL, McIntyre PB. The Australian Childhood Immunisation Register-A model for universal immunisation registers? Vaccine. 2009 Aug 13;27(37):5054-5060.

From reproductive choice to reproductive justice

Rebecca J Cook, Bernard M Dickens

International Journal of Gynecology & Obstetrics

Abstract
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.

Cook RJ, Dickens BM. From reproductive choice to reproductive justice. Int J Gyn Ob. 2009 Aug;106(2):106-109.

Federal provider conscience regulation: Unconscionable

Robert F Card

Abstract
This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss “objectionable” options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise.

Card RF. Federal provider conscience regulation: Unconscionable. J Med Ethics. 2009;35(8):471-472.

Conscience in the Workplace

C W Von Bergen

Abstract
Most definitions of conscience in the US legal context are broadly defined as including religious, moral, or ethical principles. The wave of state and federal laws and bills supporting conscience protection for medical personnel are increasingly covering all health care services, and this has created counterclaims challenging the idea that health-related professionals may deny legally and medically permitted therapeutic interventions, particularly if their objections are personal and religious. The question is whether Americans deem it proper to put a person in the position of leaving his or her job or violating his or her conscience. Although such laws make reference to “conscience,” most define that term in a virtually boundless fashion to include religion, moral, or ethical principles and convictions. Such a broad definition may bring the freedom of conscience debate clearly within the protection of Title VII and its prohibition of religious discrimination.

Von Bergen CW. Conscience in the Workplace. Employee Relat Law J. 2009;35(1):3-24.

The Pharmacist’s Obligations to Patients: Dependent or Independent of the Physician’s Obligations?

Jason V Altilio

Journal Extract
It has been 40 years since the seminal papers on pharmacy’s status as a profession sparked debate about the pharmacist’s role in health care, yet the questions they raised are just as poignant today as they were then. The issue of pharmacy’s status as a profession and its role in health care has again been brought into question, albeit in a roundabout manner, through discussions over the pharmacist’s right to refrain from dispensing emergency contraception. The key to understanding the contemporary pharmacist’s role as part of the health care team, as well as the pharmacist’s alleged right to refrain from dispensing emergency contraception, is to examine a situation that almost every contemporary pharmacist experiences.

Altilio JV. The Pharmacist’s Obligations to Patients: Dependent or Independent of the Physician’s Obligations? J Law Med Ethics. 2009;37(2):358-368.

Belgian euthanasia law: a critical analysis

Raphael Cohen-Almagor

Abstract
Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse.

Cohen-Almagor R. Belgian euthanasia law: a critical analysis. J Med Ethics. 2009;35(7):436-439.

Rights to emergency contraception

Edith Weisberg, Ian S Fraser

Abstract
Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.

Weisberg E, Fraser IS. Rights to emergency contraception. Int J Gynec Obstet. 2009 Jun 18;106(2):160-163.