Abstract Defense attorneys at the Nuremberg Medical Trial argued that no ethical difference existed between experiments in Nazi Concentration camps and research in U.S. prisons. Investigations that had taken place in an Illinois prison became an early focus of this argument. Andrew C. Ivy, MD, whom the American Medical Association had selected as a consultant to the Nuremeberg prosecutors, responded to courtroom crticisim of research in his home state by encouraging the Illinois governor to establish a committee to evaluate prison research. The governor names a committee and accepted Ivy’s offer to chair the panel. Late in the trial, Ivy testified – drawing on the authority of this committee – that research on Us prisoners was ethically ideal. However, the governor’s committee had never met. After the trial’s conclusion, the report was published in JAMA, where it became a source of support for experimentation on prisoners.
Abstract Conscientious objection preserves the personal integrity and wholeness of a health care professional’s character and personality. Professionals are obligated not only to codes of ethics and standards of care that guide their practices, but also to personal values. When professional and personal values conflict with health care delivery, nurses are compelled to object on moral grounds on behalf of themselves and the public they serve.
Abstract The powers of medicine, as well as the faith put into it, endows the doctor a particular place within our social organisation. Possessor of its knowledge on the actions on the bodies, its power interferes with that of the society elites which imposes limits as well as obligations to profit the search of individual and collective well being. The doctor, magician or therapist, incites fear from the moment he attributes his powers only on the basis of his knowledge. We therefore have to consider him on the same level as the rest of society and while recognizing the special role of his profession, make sure that he is aware that he is not above the law, that he is linked to each of his patients due to the trust that they place in him. But this contract between two individuals is as well, and increasingly a social contract which places the medical practice in the complex game of social relations, even if at times it is seen on a more economic level. And that is why it is important to insert another social limit that would remind the doctor that his interventions affect the human body, and therefore the respect of a person and her identity and integrity. A medical science that is too proud or paternalistic, cannot keep to itself the mastery of new biomedical technology. It must be shared with his patients who now have a new role in healthcare, as holders of subjective rights. Should not the new “drama” of medical science, rather than imposing limits on some promoters of “promethenne” médecine, be that of reinforcing the obligations doctors have in general to serve their purpose towards social, collective and individual means that so often don’t inspire the trust that should be linked to conscience? Slave of a collective healthcare system, the doctor should still feel useful if his freedom to serve those that he helps is preserved. This does not necessarily mean that his participation in establishing certain social norms is impossible, however, it requires a definition of those issues that are relevant to the medical function. This search towards equilibrium, however ambiguous, and some even say impossible, appears to be even more acute in the sphere of biomedical practices. The monopoly conserved—and even reinforced—of the physician to protect the individuals at the beginning or at the end of their life, is added to a doctor’s burden, to a certain extent, of the weight of all the individual’s desires, of contradictory interests, and desire to do all that is possible in a world with real limitation. We therefore have to admit that his conscience can allow him to decline care to the patients that require it when he cannot or does not want to change their wishes. But even by acting this way, and that is why the clause of conscience distinguishes itself from contractual liberty, the doctor who refuses the administration of care must continue to have compassion towards his patients. So we can now wager, based on what we have just stated, that the medical practice will be a contributing factor in making law conform to the role that Aguesseau wanted for justice: “Juger humainement des choses humaines”.
Extract This article considers the problem of line-drawing between autonomy-preserving and autonomy-negating influence in clinical relationships. The author’s purpose is not to propose particular boundaries, either with respect to reproductive decisions by HIV-infected women or for other clinical choices. Rather, he attempts to shed some light on what drives our disputes about whether one or another influence method is compatible with autonomous choice. The author argues that such disagreements reflect underlying conflicts between normative commitments, and that resolving these conflicts is essential to settling controversies over whether particular influences unduly interfere with autonomous choice.
Abstract I propose that a woman who becomes pregnant with the intent to abort will be treated as an initial aggressor, and as such she will be denied the “abortion exception” that will be granted to the woman who aborts an accidental, unwanted pregnancy. Moreover, I shall argue that a woman should not be allowed to designate the donee of the fetal tissue from her abortion, even though her pregnancy was accidental. Without this restriction, a woman who intends to become pregnant and abort may simply claim her pregnancy was accidental, and thereby claim the exception. Central to this study is the question of fetal worth, and the value to be ascribed to beings not like us, that is, not like human beings who have been born. Although I argue for a moral justification of elective abortions, I intend to show that such a justification should be a narrowly drawn exception to the prima facie duties neither to harm nor to instrumentalize others. I shall also argue that prohibiting a woman from becoming pregnant in order to abort is necessary because such a situation does not fall within the narrow exception for elective abortions, and that such a restriction is crucial to preserving our respect for those with no voice. Finally, I shall argue that the prohibition against becoming pregnant with the intent to abort does not vitiate a woman’s right to terminate an unwanted pregnancy. Rather, this restriction is a necessary condition of the prima facie duties of nonmaleficence and non-insturmentalization.
Extract It is this author’s position that the concerns of the selective conscientious objector ought to be legally recognized, not because an exemption is granted to the pacifist, but because it is the right thing to do in a democratic society that is respectful of its members’ religious commitments. This is not proposed as yet another right to add to the ever-growing list of individual rights in our society. The point of this essay is not to argue implicitly in defense of liberalism by arguing explicitly for a right deriving therefrom. Rather, it is proposed that the recognition of selective conscientious objection is necessary due to the presence of two existent legal concepts: the free exercise of religion, already extended to pacifists, and the right to confessional neutrality. “Compelling state interests” simply do not, in point of fact, override confessional neutrality. The government’s arguments about the feasibility of determining sincere selective objectors, about the drain of manpower that it claims would occur, and that the selective objector is merely a “political” dissenter and as such should not be granted this privilege, are not convincing.
Abstract Objective: To determine the outcome and side effects of a new drug protocol to induce abortion.
Design: Case series.
Setting: An urban primary care practice.
Patients: One hundred consecutive patients who requested elective termination of pregnancies of less than 8 weeks’ gestation.
Intervention: Subjects received methotrexate (50 mg/m2 body surface area, administered intramuscularly) and, 3 days afterward, misoprostol (800 pg, given vaginally).
Outcome measures: Number of abortions induced within 24 hours and within 10 days of misoprostol administration, number of surgical aspirations conducted because of incomplete abortion, mean amount of bleeding and pain and the number of women who, if faced with the same situation, said they would again choose a drug-induced abortion over a surgical one.
Results: Abortion occurred within 24 hours of misoprostol administration among 48 women and within 10 days among 69 women. In total, 89 women had an abortion without surgical aspiration. Of these women, 71 said they would choose a drug-induced abortion if faced with the choice again.
Conclusion: Abortion induced with methotrexate and misoprostol appears to be a feasible alternative to surgical abortion and deserves further study.
Extract In this article, we describe the pharmacist’s potential involvement in what has been referred to as “physician assisted suicide”. We suggest that when a physician prescribes a medication for the purpose of terminating a patient’s life, and when that prescription is presented to a pharmacist for filling, a moral dilemma may exist. The basis of the dilemma is the choice a pharmacist may be required to make between the duty to fill a legal prescription for a medication that is deemed appropriate by both the prescriber and the patient, and the duty to adhere to one’s own belief that medication should not be used to end life. We contend that in filling a prescription, especially given the recent advances in pharmacy practice, a pharmacist is no mere bystander in drug therapy. Rather, the pharmacist is an active participant whose values, attitudes, and beliefs should be given consideration.
Abstract Debates regarding the development of new reproductive technologies (NRTs), funding for infertility treatments, and non-medical criteria for access to infertility treatments frequently invoke “rights to reproduce” or “procreative rights”. The claim of this right – literally the right to have children – is not the same thing as many other “reproductive rights” that are invoked in contraception, abortion, and pregnancy management discussions.
The author argues that the claim of a right to bear or beget children, which may in turn support research into NRTs and then funding and access claims, is not justified. Framing procreative decisions in terms of rights claims is a problematic ethical project, which in turn creates difficulties for the establishment of legal procreative rights. There are two critical problems: first, the distinction between positive (entitlement) and negative (liberty) rights claims leaves those requiring reproductive assistance in need of a different justification for their claims than those who need no help; second, a procreative right is generally claimed to be limited by the rights or interests of the future children, but a right of non-conception is an intemally contradictory concept.
The author then discusses variations of procreative rights claims, including claims of rights to enter reproductive contracts or to seek assistance, and other conceptual foundations for reproductive decisions. Thus, while reproductive rights are often helpful in protecting individuals and families from undue governmental intrusion, rights are shown to be a problematic, inadequate, and inappropriate framework to describe both the legal and moral status of claims for assisted procreation.
