Journal Articles Archives - Page 54 of 67 - Protection of Conscience Project Library

A physician’s professional duty to inform despite personal ethical objections

Laura D Briley

Extract
This physician may feel ethically torn, but it is the physician’s duty to help enable this patient to make the best decision. By informing the patient about abortion, the physician is not endorsing the procedure, or swaying this mother in either direction, but simply providing information. This use of information will strengthen the relationship between patient and physician because it fosters autonomy and offers a sense of support during a time when it is needed most. Although it may not be a physician’s duty to perform an abortion when the physician feels ethically opposed, it is the duty of the physician to inform a woman about the procedure without allowing personal beliefs to influence her decision.

Briley LD. A physician’s professional duty to inform despite personal ethical objections. Curr Surg. 2003;60(6):594.

Access to emergency contraception

Rebecca J Cook, Bernard M Dickens

Journal of Obstetrics and Gynaecology Canada

Abstract
The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Cook RJ, Dickens BM. Access to emergency contraception. J Ob Gyn Canada. 2003 Nov;25(11):914-916.

Private Conscience: Public Duty

Graham Zellick

Extract
The premise of this lecture is that there are two different sets of ethical rules, the purely private and a special set arising in the workplace which will differ from occupation to occupation. . . .

• First, I hope it is axiomatic that ethics and morals must accompany individuals at all times no matter what they are doing.

• Secondly, that the moral or ethical position of the individual may in certain circumstances have to take on board other considerations which also have a moral and ethical dimension and that the ultimate decision, though different from one that would be reached in private life by the individual, is nevertheless justifiable and ethical.

• Thirdly, that to violate these precepts, even if it is done in order to give primacy to one’s own ethical code, is not ethical: the individual should resign or seek an alternative occupation. In other words, there are times when to listen to one’s private conscience while remaining deaf to the moral demands of one’s occupation can itself be seriously unethical.

• Fourthly, that weighing these considerations in the balance is no easy task and succumbs to no formula. It calls for the exercise of keen judgment informed by a developed moral framework.

Zellick G. Private Conscience: Public Duty. European Judaism. 2003 Autumn;36(2):118-131.

When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict

Brietta R Clark

Extract
Conclusion
Using this framework, I propose a more protective principle for free exercise protection than currently exists, one that requires a heightened scrutiny of all laws that burden religious liberty, even neutral laws of general applicability. This review should examine carefully the need for the government law and the possibility of an exemption or accommodation that will not undermine the purpose of the law. However, I would not go as far as some states in providing almost absolute free exercise protection from government laws serving important government interests. Rather, the principle I advocate requires a balancing of interests tipped to favor laws protecting third parties’ from harm over religious claimants’ objections. The Catholic hospital conflict demonstrates how even under this more protective free exercise principle, the rule of law and the self–limiting principle of the liberty of conscience and religious liberty operate as justifiable limits on the scope of free exercise protection. The hospitals’ free exercise interests must be balanced against the potential harm to patients who cannot access necessary reproductive health care and information, which means that in many cases exemptions for religious hospitals will be denied.

Clark BR. When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict. Oregon Law Review. 2003 Fall;82(3):625-694.

Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services

Karen E Adams

Journal of the American Women's Medical Association — Journal of the American Women’s Medical Association

Abstract
Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians’ moral values take on special significance, however, when considering services patients may request but that contradict that physician’s moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician’s freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient’s right to full disclosure of options and informed consent is not compromised by the physician’s personal moral stance.

Adams KE. Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services. J American Med Women’s Ass (1972). 2003;58(4):223-226.

The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses

Venke Sørlie, Lilian Jansson, Astrid Norberg

Abstract
Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the ‘uninteresting’ patients. This may be understood as ethics of memory where their conscience ‘set them a test’. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture.

Sørlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses. Scand. J. Caring Sci. 2003;17(285-292.

In Good Conscience: The Legal Trend to Include Prescription Contraceptives in Employer Insurance Plans and Catholic Charities’ “Conscience Clause” Objection

Kate Spota

Extract
This Note examines Petitioner’s constitutional argument in Catholic Charities v. Superior Court as applied to a California statute drafted with a narrowly drawn “conscience clause” exemption. First, this Note describes the background for Roman Catholic opposition to contraceptives, and contrasts the reasons behind women’s rights activists’ claim for equal access to contraception as a part of reproductive freedom. Second, this Note examines the preeminent cases decided by the U.S. Supreme Court, the U.S. Court of Appeals for the Ninth Circuit, and the California Supreme Court, as well as the relevant federal statutes and administrative decisions used by the California Court of Appeal in deciding Catholic Charities. Third, this Note describes in detail the arguments advanced by the Petitioner in Catholic Charities and the court’s resulting analysis. Concluding that the Court of Appeal of California correctly decided against the Petitioner in Catholic Charities, this Note examines the possible impacts of that decision on society’s view of women and on the Catholic health care system. Finally, this Note concludes that the California Supreme Court will affirm the appellate court’s decision and hold that the mandatory inclusion of prescription contraceptives in insurance plans, even for institutions whose religious beliefs are contrary to the mandate, does not violate the Free Exercise Clause or the Establishment Clause of the U.S. or California Constitutions.

Spota K. In Good Conscience: The Legal Trend to Include Prescription Contraceptives in Employer Insurance Plans and Catholic Charities’ “Conscience Clause” Objection. Cathol U Law Rev. 2003;52(4):1081-1113.

The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945

Michael Von Cranach

Israeli Journal of Psychiatry and Related Sciences

Abstract
Between 1939 and 1945, 180,000 psychiatric patients were killed in Nazi Germany. This paper opens with a brief discussion of the reasons for addressing this issue today; it is followed by the details of the so-called euthanasia program that entailed killing of patients by gas in special hospitals in the years 1939-1941, and in psychiatric hospitals in the years 1942-1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. The fate of the Jewish patients and forced laborers, as well as the experiments conducted on the patients, are mentioned. Finally, some thoughts are presented to answer the question of why this could have happened. To me, the giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul, including those of a psychiatrist.

Cranach MV. The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945. Israeli J Psych & Related Sciences. 2003;40(1):8-18

A presentation by the same title with a similar abstract was presented at a meeting of the Israel Psychiatric Association, Jerusalem, 6th of December 2001.

Overcoming obstacles in confronting torture

Derrick Silove

Abstract
Television images of torture chambers in Iraq and reports of the escalating use of torture in Zimbabwe remind us that this form of state-sponsored abuse continues unabated in many parts of the world. . . It is timely, therefore, to consider the reasons for the inadequate attention given to the topic by health professionals.

Silove D. Overcoming obstacles in confronting torture. The Lancet. 2003 May 3;361(9368):1555.

Nurse supervisors’ actions in relation to their decision-making style and ethical approach to clinical supervision

Ingela Berggren, Elisabeth Severinsson

Extract
Findings. The essence of the nurse supervisors’ decision-making style is deliberations and priorities. The nurse supervisors’ willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors’ ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors’ interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings.

Conclusion. Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees’ professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.

Berggren I, Severinsson E. Nurse supervisors’ actions in relation to their decision-making style and ethical approach to clinical supervision. J Adv Nurs. 2003;41(6):615-622.