Ethics Archives - Page 50 of 81 - Protection of Conscience Project Library

Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection

Gamal I Serour, International Federation of Gynecology and Obstetrics (FIGO)

International Journal of Gynecology & Obstetrics

Abstract
The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health held a combined meeting with the Committee of Women’s Sexual and Reproductive rights to discuss ethical aspects of issues that impact the discipline of Obstetrics, Gynecology, and Women’s Health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Serour GI, FIGO. Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection. Int J Gyn Ob. 2006 Feb 03;92(3):333-334.

On Whose Conscience? Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care

Patricia L Selby

Extract
In 2004 the Michigan House passed a bill called the “Conscientious Objector Policy Act.”. . . The bill as passed reflected no balancing of or respect for patients’ rights to autonomy, or their other needs and interests.

This article traces brief histories of health care conscience clauses and the patient’s right to informed consent. It analyzes the bill in the context of patients’s rights, and proposes alternative approaches to restore balance to the patient-provider relationship, while maintaining providers’ right to conscience. The article’s final section evaluates a variety of potential legal challenges to protect patients if the bill is re-introduced unchanged.

Selby PL. Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care. U Detroit Mercy Law Rev. 2006;83(4):507-541.

(Op/Ed) Counter attack

Barbara W

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
The assignment: to buy the drug in a small, remote town where I was sojourning on business. If I could not get the pill in this straight-talking, hard- working place, who could? . . . approached a smiling pharmacy worker and asked for Plan B. . . . Kevin refused to hand it over. Only a pharmacist could give me the drug. He was a pharmacist’s assistant; the real pharmacist was on her break. . . . When I returned at 5:30, Kevin, the man of steely resolve, informed me that the pharmacist had left for the day. No pharmacist, no Plan B. [Pharmacist assistant seems to have answered questions evasively] . . . Was this not a nonprescription drug. Yes. Why could I not purchase the drug if no prescription was necessary? And then he said it: “Because, ethically, I don’t believe in it and I would not give it to you anyway. It is against my principles, and I don’t have to do anything I am uncomfortable with,” he said loudly and proudly. . . According to Kevin, there is nothing unprofessional about placing personal conviction ahead of a woman’s health care needs. . . a reasonably articulate curmudgeon like myself cannot obtain emergency contraception, what chance does a worried, upset teenage girl have?

Barbara W. Counter attack. Can Med Assoc. J. 2006;174(2):211-212.

Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives?

Susan C Winkler, John A Gans

Journal of the American Pharmacists Association

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.

Winkler SC, Gans JA. Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives? J Am Pharm Assoc. 2006 Jan;46(1):12-13.

Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada

Eike-Henner Kluge

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

Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses

Kelsey C Brodsho

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.

Brodsho KC. Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses. Minnesota Journal of Law, Science & Technology. 2005;7(1):327-336.

A new rejection of moral expertise

Christopher Cowley

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.

Cowley C. A new rejection of moral expertise. Med Health Care & Phil. 2005 Nov;8(3):273-279.

Defining the limits of conscientious objection in health care

J Andrew West

Extract
I will argue that we should prefer narrow conscience clauses because they (1) respect patients’ right to informed consent and (2) reduce risks to vulnerable populations. I will then propose and defend an example of what a narrow conscience clause might look like. The clause I propose allows: (1) any person (2) directly involved in providing (3) nonemergency medical treatment or service (4) to refuse to provide the treatment or service in question, so long as the person (5) objects on moral or religious grounds and (6) cooperates in the transfer or referral of the patient to a willing provider. Before I turn to these arguments, a brief overview of the genesis and evolution of conscience clauses in medicine is in order.

West JA. Defining the limits of conscientious objection in health care. Newsletter Phil Med. 2005 Fall;5(1):25-34.

(Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them

CH Browner

Extract
I was intrigued by her argument that an “autonomous” medical decision can sometimes involve simple deference to medical authority, but I’m still unclear what she means when she says that such decisions can be construed as conscientiously autonomous if derived from a patient’s “self trust.” This seems precisely the paradox at the heart of debates over the existence of free will, or in Kukla’s rubric, autonomous choice: is there a “space” outside of social life constituting individual desires where choices derive from what one “really” wants?

Browner C. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent Rep. 2005; September-October:4-5.

Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women

Holly Teliska

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.

Teliska H. Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women. Berkely J Gender, Law Justice. 2005;20(1):229-248.