Abstract Rather than putting the onus on women to have children at times that suit societal rather than women’s individual interests, we could provide technical alternatives to gestation and childbirth so that women are no longer unjustly obliged to be the sole risk takers in reproductive enterprises. In short, what is required is ectogenesis: the development of artificial wombs that can sustain fetuses to term without the need for women’s bodies. Only by thus remedying the natural or physical injustices involved in the unequal gender roles of reproduction can we alleviate the social injustices that arise from them.
Christina Juthberg, Sture Eriksson, Astrid Norberg, Karin Sundin
Nursing Ethics
Abstract Every day situations arising in health care contain ethical issues influencing care providers’ conscience. How and to what extent conscience is influenced may differ according to how conscience is perceived. This study aimed to explore the relationship between perceptions of conscience and stress of conscience among care providers working in municipal housing for elderly people. A total of 166 care providers were approached, of which 146 (50 registered nurses and 96 nurses’ aides/enrolled nurses) completed a questionnaire containing the Perceptions of Conscience Questionnaire and the Stress of Conscience Questionnaire. A multivariate canonical correlation analysis was conducted. The first two functions emerging from the analysis themselves explained a noteworthy amount of the shared variance (25.6% and 17.8%). These two dimensions of the relationship were interpreted either as having to deaden one’s conscience relating to external demands in order to be able to collaborate with coworkers, or as having to deaden one’s conscience relating to internal demands in order to uphold one’s identity as a ‘good’ health care professional.
Rebecca J. Cook, Joanna N. Erdman, Bernard M. Dickens
International Journal of Gynecology & Obstetrics
Abstract National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states’ explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors’ scrutiny.
Extract Conscience is a tricky business. Some interpret its personal beacon as the guide to universal truth and undoubtedly many of the health care providers who refuse to treat or refer or inform their patients do so in the sincere belief that it is in the patients’ own interests, regardless of how those patients might view the matter themselves. But the assumption that one’s own conscience is the conscience of the world is fraught with dangers. As C.S. Lewis wrote, “of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron’s cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.”
Extract Conclusion Medical ethics and the practice of medicine as an act of conscience have become integral to this scientifically unsettled debate. Before medication is prescribed or dispensed, a prudent practitioner weighs carefully the risks of the medication with the potential benefits. 70 Laws that require a medical professional to perform an act against his or her best judgment violate the code of ethics of that profession to do no harm in the professional’s highest and best medical judgment. It ought to be alarming that a patient’s expectations may become the standard for professional action. Ought medical professionals prescribe and dispense what the patient wants even if it harms him or her, just because the patient’s autonomy allows a patient to live a risky life? 71 Family planning deserves a principled approach carried out with integrity that protects the parties, and that approach should be reflected in legal policy and lawmaking.
Should doctors and pharmacists be able to refuse to give out emergency contraceptives based on conscientious objections? Sexual freedom that was protected by the Supreme Court’s emancipation of sexuality from reproduction has allowed emergency contraceptives to be used for any purpose an individual desires, rather than for the best and most responsible medical purposes. Therefore, when a medical professional has concerns that an emergency contraceptive may harm the health of his or her patients or customers or their offspring, a conscientious objection provided by law seems more appropriate than a legal requirement to dispense despite objections, at least until a medical and legal consensus can be reached.
Extract Conclusion Conscience clauses raise many difficult issues in a pluralistic society. Health care providers have special obligations to patients that are not replicated in many other professional endeavors. Duties prescribed by law and professional codes of conduct expect health care providers to act out of respect for the patient’s welfare and dignity. While no one suggests that health professionals should abandon their religious or moral principles, patients should not suffer harm or potential harm because of a belief they do not share. It is often appropriate to accommodate individuals who wish to exercise their principles in the care of patients, but conscience clauses that promote blanket immunity for refusals to provide health care services resolve the tension between patient needs and provider autonomy in a onesided manner.
When health care providers deviate from standards of care, engage in unprofessional conduct, or unduly burden their colleagues and employers through refusals to perform services, exemptions from malpractice, disciplinary, or employment actions are not appropriate. . .Accordingly, legislators should not tie the hands of disciplinary boards in addressing such conduct.
The clamor for absolute immunity from employment actions for health care workers asserting moral refusals to treat demonstrates a myopic view of the burdens imposed by such objections on patients, employers, and coworkers. . . . Although legislators may choose to heighten the de minimis accommodation standard under Title VII, abrogation of the undue hardship test is not warranted from either a policy or legal prospective.
. . . the overriding purpose of our health care system is to protect the health and safety of patients. The expansion of refusal legislation to create immunity for health care providers who refuse any service for almost any reason is cause for alarm. Conscience clauses fail to achieve a reasonable balance when they confer a special benefit on those whose religious, moral, or ethical beliefs compel them to deny health care while absolving them of the potentially harmful consequences of their choices. . .
Abstract The issue of pharmacists refusing to dispense birth control or emergency contraception recently has become a major debate in the battle over reproductive rights. Several states have enacted legislation to protect refusing pharmacists, and many more are considering such laws. I explore these new laws against the backdrop of the existing legal landscape governing the actions of pharmacists, including tort law, Title VII of the Civil Rights Act of 1964, and free exercise jurisprudence. I then consider how courts might interpret refusal clauses upon which pharmacists may rely. I argue that courts should read pharmacist refusal statutes narrowly by limiting the protected act of conscience to the actual refusal to dispense medication, and not extending protection to behavior that could violate the pharmacist’s duty of care to patients. Such an approach will not only minimize the impact of refusals on the interests of patients and employers, but will meld these new statutes with the existing legal framework addressing religious objectors, which has consistently shown concern for third-party rights.
Farr A Curlin, Ryan E Lawrence, Marshall H Chin, John D Lantos
New England Journal of Medicine
Abstract Background There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice.
Methods We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians’ judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval.
Results A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5).
Conclusions Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests.
Extract This Article will demonstrate that a pharmacist’s refusal to fill a valid prescription for emergency contraception constitutes sex discrimination and violates the WLAD. Part I explains the nature and function of emergency contraceptive pills (ECPs) as well as their role in basic health care for women and the importance of their accessibility. Part II addresses federal civil rights protections and the failure of these protections to provide relief for women facing refusals. Focusing on the WLAD, Part II also explains how state public accommodation statutes protect women from discrimination in places of public accommodation. It further sets forth the prima facie case of such a claim where a woman is refused access to emergency contraception. Part III presents arguments likely to be submitted by a pharmacist facing litigation under the WLAD. Finally, Part IV illustrates how Washington public policy supports women and the protection of reproductive freedom. The Article concludes with suggestions for judicial interpretation..
