Extract I have, however, a question about the implication that the pharmacy assistant was being unprofessional because he let his personal conviction affect the provision of care. I would like to assume for the sake of argument that his personal conviction was that Plan B is unethical because it induces abortion and he is of the opinion that abortion ends a person’s life. By providing Plan B he would be doing something that he genuinely believes is in the best interest of neither his adult client nor her embryo. Wouldn’t it be unprofessional to ignore this conviction and provide the drug anyway? What should a professional do when he is asked to do something by a client that he genuinely believes is not in the client’s best interest? What would a lawyer do?
Abstract Conclusion . . . The pharmaceutical industry will continue to create drugs to which some pharmacists object on religious grounds. Employers must anticipate that some pharmacists will object not only to birth control, but also to Ritalin, 226 Viagra for unmarried men, or drugs to treat AIDS; some pharmacists may even object on religious grounds to serving particular customers. The religious discrimination provisions of the Civil Rights Act allow most employers to dispense with the majority of possible religious accommodations for pharmacists who refuse to fill prescriptions on religious grounds. Those provisions are meaningless, however, if employers are reluctant to assert Title VII’s protections against accommodations imposing an undue hardship on the pharmacy’s business operations. As pharmacies negotiate the tensions between consumers demanding prompt access to prescription drugs, a tight labor market for pharmacists, pressure from certain religious groups to discourage the use of birth control, vocal national groups advocating expanded access to contraception, and their own economic bottom line, Title VII can serve either as an answer or as an excuse. Employers may use Title VII as a pretense to justify unnecessary accommodations for objecting pharmacists; pharmacies may attempt to use federal law to shield themselves from customer and activist criticism by asserting that they have no choice but to accommodate. On the other hand, pharmacies can utilize Title VII as a tool to define the outer limits of their pharmacist accommodation policies. A clear understanding of the parameters of Title VII’s religious accommodation requirements will help guide and monitor the behavior and legal justifications presented by employers, employees, and customers when pharmacists refuse to dispense certain drugs on religious grounds.
Abstract Ritual genital cutting for women, a common practice in Africa and elsewhere around the world, remains dangerous and controversial. In recent years, a 14-year-old girl living in Sierra Leone exsanguinated and died following a ritualistic genital cutting. Hoping to avoid that fate, women with backgrounds that accept ritual genital cutting may, when they reach majority age, ask plastic surgeons to perform genital alterations for cultural reasons. Although plastic surgeons routinely perform cosmetic procedures, unique ethical and legal concerns arise when an adult female patient asks a surgeon to spare her the tribal elder’s knife and alter her genitalia according to tradition and custom. Misinformation and confusion about this issue exist. This article explores the ethical and legal issues relevant to this situation and explains how the thoughtful surgeon should proceed.
Abstract The fear of many is that some physicians have been co-opted by the penal authorities and state legislatures in this country to believe that physician participation is a civic duty and one that is in the prisoner’s best interest. In reality, these physicians are being used as a means to an end. They are being used by certain states to medicalize executions in order to make them more palatable to the American public and to prevent capital punishment from being declared unconstitutional because it is “cruel and unusual punishment.” A basic tenet of the principle of respect for persons is that one may never use another person as a means to an end. Legislating that physicians must be present at executions uses these physicians as pawns, or means, in order to legitimize capital punishment. This not only violates the rights of these physicians but violates the basic ethical principles of the medical profession and distorts the physicians’ role in society.
Anita Catlin, Deborah Volat, Mary Ann Hadley, Ranginah Bassir, Christine Armigo, Elnora Valle, Wendy Gong, Kelly Anderson
Neonatal Network
Abstract This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, fi.itility, and the concept of conscientious objection from the perspective of the nurse’s potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.
Extract Conclusion . . . The only solution to this dilemma may be the solution that the APhA suggested, namely, to endorse a conscience clause, but simultaneously require pharmacists to refer a valid prescription to another service provider. Those members of the profession who bear the burden of this course of action are those who believe that a referral is equivalent to the act itself. However, such a view safeguards most of the ethical goals of pharmacists while simultaneously serving the public need for effective provision of legally prescribed drugs.
Extract Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.
Extract Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded — for example, respectively, eugenic “research” and psychiatric “treatment” of dissidents. . . . My chances of behaving honourably would have been greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day. They would have been least if Savulescu’s opinions had prevailed . . .After 30 years of reading the BMJ, Sava- lescu’s article was the first one to make me feel physically sick.
Extract We question Savulescu’s statement that a specialist valuing her own life more than her duty to her patients during a bird flu epidemic would be demonstrating values “incompatible with being a doctor.” . . . recklessly to treat a highly contagious individual without taking adequate precautions would be imprudent and irresponsible. Equity and fairness requires a professional to judiciously balance the needs of one patient with the needs of others, including those of his or her own family.
Extract Shakespeare wrote that “Conscience is but a word cowards use, devised at first to keep the strong in awe” (Richard III V.iv.1.7). Conscience, indeed, can be an excuse for vice or invoked to avoid doing one’s duty. When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient’s good and the patient’s informed desires (box). If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.
