Extract Expanding collaborative practice navigates the issue well, providing a seamless way for women to access emergency contraception without compromising the pharmacist’s ability to opt out. Such legislative initiatives are far more effective in expanding access to emergency contraception than misguided regulations that require pharmacists or pharmacies to assure dispensing of contraceptives “without delay.” In addition to blatantly insulting the professionals who are required to check their beliefs at the door, duty-to-dispense laws can have the opposite effect by limiting access to contraceptives when pharmacy practices simply choose not to carry the products rather than face sanctions if workable solutions for accommodating the patient and the pharmacist are disrupted by misguided regulations. Conscience and collaborative practice can complement each other, but only if both are available.
Extract There is concern that conscience clauses for pharmacists will lead to pharmacists refusing to fill prescriptions outside the area of contraception. For example, pharmacists who believe AIDS is a punishment from God may not fill a patient’s prescription for AIDS medication. Doctors who think children should only be born to heterosexual, married couples may not provide adequate fertility treatment or may not encourage their patients to explore their options fully. The current trend of pharmacists refusing to fill prescriptions because of personal beliefs violates a woman’s constitutional rights, a pharmacist’s duty of care, and a woman’s right to confidentiality. Forcing pharmacists to fill prescriptions that conflict with their religious beliefs also violates their constitutional right to free exercise of religion. Allowing individual pharmacists to decline to fill prescriptions while mandating that pharmacies have a policy to ensure that customers’ needs are met will help alleviate the concerns of both parties to the conflict. Thus, any legislation that is enacted should balance the needs of both pharmacists and patients.
Abstract Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.
Extract There are other flaws with Bill C-407, but this is not the place to present them in detail. However, there is one serious flaw that is appropriately considered in this forum, and that is the fact that the Bill is a partial measure at best. It deals only with assisted suicide, not euthanasia. It would not help those who, although competent, could not perform the final act themselves because they are disabled. . . .As well, the Bill ignores those who have never been competent and never will be. Their rights would still be less than those of other persons: they would be condemned to suffer when a competent person would not. An appropriately crafted suicide and euthanasia Bill would change that situation.
Kluge E-H. Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada. Humanist Perspectives Online Supplement. 2005;38(4):1-5
Extract The medical community agrees that while health professionals may be given statutory rights to refuse health services for moral reasons, refusal cannot prevent patients from receiving “the information, services, and dignity to which they are entitled.” In theory, laws and institutional policies that allow pharmacists to transfer prescriptions to another pharmacist do not interfere with established treatment plans. However, in practice these laws may delay health care services and harm patients. . . . In many foreseeable situations, a pharmacist’s moral objection may delay or prevent the receipt of prescription mediation. Pharmacists who refuse to provide services or transfer prescriptions to colleagues act contrary to professional objectives. Unnecessary delays or obstructions by pharmacists jeopardize treatment plans established by physicians and patients. . . . Conscience clause legislation that does not assure patient access to contraceptive services likely conflicts with reproductive liberty interests. . . states may require pharmacists to fill all prescriptions. Alternately, states may pass conscience clause legislation that assures patient access to health care services by prescription transfer or other similar procedure. . . . Conscience clause debate should not be clothed in abortion politics. Rather, its focus should be on whether a pharmacist has a right to interfere with a treatment plan established by a patient and his or her primary health care provider.
Abstract There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.
Abstract Background: Physicians face ethical difficulties daily, yet they seek ethics consultation infrequently. To date, no systematic data have been collected on the strategies they use to resolve such difficulties when they do so without the help of ethics consultation. Thus, our understanding of ethical decision making in day to day medical practice is poor. We report findings from the qualitative analysis of 310 ethically difficult situations described to us by physicians who encountered them in their practice. When facing such situations, the physicians sought to avoid conflict, obtain assistance, and protect the integrity of their conscience and reputation, as well as the integrity of the group of people who participated in the decisions. These goals could conflict with each other, or with ethical goals, in problematic ways. Being aware of these potentially conflicting goals may help physicians to resolve ethical difficulties more effectively. This awareness should also contribute to informing the practice of ethics consultation. . . .
Results: When faced with ethical difficulties, the physicians avoided conflict and looked for assistance, which contributed to protecting, or attempting to protect, the integrity of their conscience and reputation, as well as be integrity of the group of people who participated in the decisions. These efforts sometimes reinforced ethical goals, such as following patients’ wishes or their best interests, but they sometimes competed with them. The goals of avoiding conflict, obtaining assistance, and protecting the respondent’s integrity and that of the group of decision makers could also compete with each other.
Conclusion: In resolving ethical difficulties in medical practice, internists entertained competing goals that they did not always successfully achieve. Additionally, the means employed were not always the most likely to achieve those aims. Understanding these aspects of ethical decision making in medical practice is important both for physicians themselves as they struggle with ethical difficulties and for the ethics consultants who wish to help them in this process.
Extract If pharmacists object to particular prescriptions, they should only be allowed to refuse to fill the prescription if meaningful and logistically feasible alternatives are in place. As an alternative, either another pharmacist must be on duty with the refusing pharmacist, or alternative ways of providing service must be in place. A woman should not have to travel to other pharmacies in search of a pharmacist that serves all patients, nor should she have to wait an unreasonable amount of time to have her prescription filled.
Extract Someone might want to argue that this strict adherence to promise keeping justifies a person being forced, coerced, compelled, into performing actions that are unjust or morally impermissible if they are members of an organization/profession that begins to engage in performing unjust, or morally unjustifiable actions. . . .By utilizing our moral beliefs at the appropriate time when first we make our promise to provide competent professional service to our clients, we can avoid placing ourselves in situations that compromise our deeply held moral beliefs later on. If later on we are confronted by a change in the professional setting that did not exist in the original decision making situation, then we are rationally compelled to reassess our professional position relative to the requirements of our moral beliefs and perform the appropriate action, either comply, persuade others that they are wrong or leave the professional setting.
Extract Conclusion Offering legal protection to pharmacists comes at too great a cost to women’s health and legal rights. The pill is a viable and effective method of birth control for many women and, as Congress has noted, it can be used to prevent other social, economic, and medical problems. The Supreme Court has clearly established that a state cannot interfere with a woman’s right to access contraceptives, including the pill. While pharmacists should be free to practice their religion, that practice cannot interfere with their professional duty to dispense valid prescriptions free of moral judgment. Furthermore, the vague wording in most conscience clause statutes does not restrict objections to those of a religious nature. A pharmacist can use any personal moral objection as an excuse not to dispense a prescription. The result of a pharmacist’s objection can be quite severe for the patient (an unintended pregnancy or health problems), and the duties imposed under tort law should apply. A pharmacist should not be able to escape the legal consequences of his or her actions. States that allow pharmacists to do so are clearly protecting the rights of a small segment of their citizens at the expense of others. If these statutes are challenged in court, it is likely that the statutes will be found to be unconstitutional. While this is a serious consequence, it is appropriate given the rights at stake.
