Protection of Conscience Project Library
Service, not Servitude
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Real medical care and services always respect human
life. No one should be forced to collaborate in abortion (even when it is achieved through the prevention of implantation), lethal research on embryos, euthanasia, or assisted suicide.
Castro O, Lombardo FA, Gordeuk VR. (Correspondence) The Celestial Fire of Conscience. N Engl J Med. 2005 Sep 22;353(12):1301.
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To bring out what I see as the most plausible interpretation of Kukla’s article, I recast her main point as follows (though I am not optimistic that she would accept this restatement): The received view in bioethics is commonly interpreted so that autonomy occurs exclusively through discrete informed consents to medical procedures. However, this vision of autonomy is too narrow. Autonomy is also expressed through stable, enduring, and committed acceptance of medical practices. Kukla rightly points out that this account must be rounded by a rich understanding of medical practices together with a model of the virtue of conscientiousness in upholding the practices, principles, regimes, and values adopted.
Beauchamp TL. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent. Rep.. 2005;September-October):5-6.
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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.
Alexander JK. Promising, professional obligations, and the refusal to provide service. HEC Forum. 2005;17(3):178-195.
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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.
Afif MT. Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions? Pace Law Review. 2005;26(1):243-272.
Responding to: Charo RA. The Celestial Fire of Conscience – Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005
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It is especially noteworthy that, in an essay about the exercise of freedom of conscience by health care workers, Professor R. Alta Charo has virtually nothing to say about freedom or conscience (The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005). “Conscience clauses,” yes: conscientious objection, to be sure: and she mentions acts of conscience and the right of conscience. But nothing about freedom, and, on the subject of conscience itself, the most she can muster is, “Conscience is a tricky business.”
Murphy S. The Silence of Good People and Non-cooperation with Evil: A Response to Prof. R. Alta Charo [Internet]. Protection of Conscience Project; 2005 Aug 19.
Abstract
What has been lost in the media coverage of and political dialogue about this issue are the nuances and implications of conscientious objection. Like their physician and nurse colleagues, pharmacists routinely operate within both professional and personal ethical frameworks (3). On a personal level, pharmacists have the same rights as their fellow health-care colleagues. Like a surgeon who refuses to perform abortions because of a personal moral objection or a nurse who believes that turning off a patient’s respirator would contradict her beliefs on the sanctity of life, pharmacists must be allowed to be true to their own belief systems as they practice their profession. This does not mean that pharmacists should be allowed to impose their personal morals on patients under their care. As with physicians and nurses, it simply means that pharmacists must maintain the right to “step away” from the offending activity and should refer the patient in question to another pharmacist who can dispense the prescription.
Manasse Jr HR. Conscientious Objection and the Pharmacist. Science. 2005 Jul 10;308(5728):1558-1559.
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This essay examines (1) the underlying philosophical considerations when patients or decision makers request “inappropriate treatment”; (2) questions to consider in determining if the treatment sought would be ineffective, or, in the words of Weijer et al., effective toward a controversial end; and (3) practical ways to resolve such conflicts.
Suziedelis A. Requests for Inappropriate Treatment: Can A Doctors “Just Say ‘No'”? Health Care Ethics USA. 2005;13(1):E2
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Apparently heeding George Washington’s call to “labor to keep alive in your breast that little spark of celestial fire called conscience,” physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
Charo RA. The Celestial Fire of Conscience — Refusing to Deliver Medical Care. N Engl J Med.. 2005 Jun 16;352(24).
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Patient autonomy is the foundation of the ethical principles that guide a health professional’s actions. It can be defined as “the right of individuals to make decisions about what will happen to their bodies; what choice will be made among competing options; and what they choose to take or not take into their bodies. ” By being a barrier to the patient’s receipt of a legally available prescription product, the pharmacist is not only denying the patient her autonomy but potentially causing her emotional and/or physical harm.
Coons SJ. (Editorial) Pharmacists’ Rights of Conscience: Whose Autonomy Is It, Anyway?. Clin Ther. 2005 Jun;27(6):924-925
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The coalescence of involuntarily administered antipsychotic medications and competency for execution created a novel and controversial issue that became the basis of Singleton’s final appeal. The Arkansas Supreme Court stated the question succinctly: May the State ”mandatorily medicate [Singleton] with antipsychotic drugs in order to keep him from being a danger to himself and others when a collateral effect of that medication is to render him competent to understand the nature and reason for his execution[?]” Or, as Singleton put it, “Am I too sane to live, or too insane to die?” The cynical view of that question is that Singleton was clever and manipulative. Like most people, he would do just about anything to forestall his death. The more charitable view is that Singleton found an Achilles heel in the execution process and physicians’ involvement with it, one that created what some physicians consider to be an intolerable dilemma.
Cantor J. Of Pills and Needles: Involuntary Medicating the Psychotic Inmate When Execution Looms. Indiana Health L Rev. 2005;2(1):119-172.