Ethics Archives - Page 55 of 81 - Protection of Conscience Project Library

Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection

Peter Bartmann

Abstract
In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to ‘‘organize” a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. . .I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.

Bartmann P. Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection. Christ Bioet. 2003;9(3):203-225.

The Limits of Conscientious Objection to Abortion in the Developing World

Louis-Jacques Van Bogaert

Abstract
The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more ‘technically illegal’ abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker’s life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.

Bogaert L-JV. The Limits of Conscientious Objection to Abortion in the Developing World. Dev World Bioeth. 2002;2(2):131-143.

The Physician as a Conscientious Objector

J David Bleich

Extract
Patient autonomy certainly deserves both moral respect and legal protection, but to demand of a physician that she act in a manner she deems to be morally unpalatable not only compromises the physician’s ethical integrity, but is also likely to have a corrosive effect upon the dedication and zeal with which she ministers to patients.

Bleich JD. The Physician as a Conscientious Objector. Fordham Urban Law J. 2002;30(1): 245-265 .

(Thesis) Samvete och samvetsfrihet: En analys av samvetskonflikter i det svenska samhället och av begreppen samvete och samvetsfrihet

(Conscience and freedom of conscience: An analysis of conflicts of conscience in Swedish society and of the concepts of conscience)

Mats Alden

Abstract
This thesis has several aims which are related in various ways. The first task is to study conflicts of conscience in Swedish society. In this type of conflict, the terms conscience and freedom of conscience are central terms. Thus it is vital that they are understood and related to when analyzing the conflicts themselves. The second task is therefore to study and come to grips with the term conscience, suggest a definition, and then apply the various ways of understanding conscience to the conflicts of conscience in order to answer the question of whether or not an individual should follow his or her conscience. The third task is to study the term freedom of conscience and provide a definition. In addition, a typology is provided and applied to the conflicts of conscience studied in order to answer the question of whether or not there is ample freedom to follow one’s conscience. Finally, I take a stand for one of the types in the typology. The first task is undertaken in Chapter 2, the second task comprises Chapter 3 and the third task, Chapter 4.

Alden M. (Thesis) Samvete och samvetsfrihet: En analys av samvetskonflikter i det svenska samhället och av begreppen samvete och samvetsfrihet (Conscience and freedom of conscience: An analysis of conflicts of conscience in Swedish society and of the concepts of conscience. Lund University, Sweden. 2002;5-215.

Christian churches and euthanasia in the Low Countries: background, argumentation and commentary

Jans Jans

Extract
In this article, I will first describe the argumentative way in which the major Christian churches in the Netherlands and Belgium have dealt with what they considered the challenge of the demand to legalize euthanasia in their respective countries. Given the important differences between the courses of events in both countries, the part on the interventions in the Netherlands will be considerably longer than the one on Belgium. No doubt, the most important reason for this difference is the fact that the public discussion on euthanasia together with efforts to change the penal law prohibiting it, took shape in the Netherlands already from 1968 on. Next to this, the fact that the major Christian churches in the Netherlands were not in agreement on the proper approach also contributes to a more differentiated picture. In the third part of this article, I will present some comments and a moral theological evaluation of the core of the argumentation forwarded by the Christian churches.

Jans Jans. Christian churches and euthanasia in the Low Countries: background, argumentation and commentary. Ethical Perspect 2002;9(2-3) 119-33.

The injustice of unsafe motherhood

Rebecca J Cook, Bernard M Dickens

Abstract
This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women’s powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women’s reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children’s survival. Women’s unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.

Cook RJ, Dickens BM. The injustice of unsafe motherhood. Dev World Bioeth. 2002 May;2(1):64-81

A Group Practice Disagrees About Offering Contraception

Frank A Chervenak, Laurence McCullough

Extract
This case concerns the justification of moral constraints that a physician group decides to apply to itself in the provision of patient services. Family physicians confront this issue with regard to reproductive medical services and state laws such as those in Oregon regarding physician-assisted suicide. Whether such constraints are ethically justified depends on the distinction between professional medical ethics and individual conscience.

Chervenak FA, McCullough L. A Group Practice Disagrees About Offering Contraception. Am Fam Physician. 2002 Mar 15;65(6):1230-1233.

Mandatory Overtime: Conflicts of Conscience

Jennell Charles

JONA's Healthcare Law, Ethics and Regulation — JONA’s Healthcare Law, Ethics and Regulation

Extract
This article attempts to engage only in a discussion of the ethical dimensions of mandatory overtime; the economic and empirical discussions are left for others to explore. Using the framework of “conscience,” we can begin to see some of the dynamics underlying the almost visceral reaction of some nurses to the issue of mandatory overtime.

Charles J. Mandatory Overtime: Conflicts of Conscience. JONA’s Healthcare Law, Ethics Reg. 2002;4(1):10-12.

Palliative Care and Euthanasia: Belgian and Dutch Perspectives

Bert Broeckaert, Rien Janssens

Extract
In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise

Broeckaert B, Janssens R. Palliative Care and Euthanasia: Belgian and Dutch Perspectives. Ethical Perspectives 9(2-3); 2002 Feb 01, 156-175

Emergency contraception provision: a survey of emergency department practitioners

Reza Keshavarz, Roland C Merchant, John McGreal

Abstract
Objectives: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called “opt-out” or “abortion-related conscience clauses”) with those of practitioners from states without these laws.

Methods: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed.

Results: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with “abortion-related conscience clauses” and those from other states.

Conclusions: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. “Abortion-related conscience clauses” did not seem to influence willingness to offer EC.

Keshavarz R, Merchant RC, McGreal J. Emergency contraception provision: a survey of emergency department practitioners. Acad Emerg Med. 2002 Jan;9(1):69-74.