Protection of Conscience Project Library
Service, not Servitude
Extract
Respect for doctors’ right to conscientiously object is the ultimate safeguard against abuses of power, error and exploitation in medicine. It is the key safeguard of the doctor–patient relationship.
Conway BV. (Debate) Should doctors feel able to practise according to their personal values and beliefs? Yes. Med J Aust. 2011 Nov 07;195(9):496-497.
Abstract
Objective: To describe obstetrician-gynecologists’ (ob-gyns’) views and willingness to help women seeking abortion in a variety of clinical scenarios.
Methods: We conducted a mailed survey of 1,800 U.S. ob-gyns. We presented seven scenarios in which patients sought abortions. For each, respondents indicated if they morally objected to abortion and if they would help patients obtain an abortion. We analyzed predictors of objection and assistance.
Results: The response rate was 66%. Objection to abortion ranged from 16% (cardiopulmonary disease) to 82% (sex selection); willingness to assist ranged from 64% (sex selection) to 93% (cardiopulmonary disease). Excluding sex selection, objection was less likely among ob-gyns who were female (odds ratio [OR] 0.5, 95% confidence interval [CI] 0.4-0.8), urban (OR 0.3, 95% CI 0.1-0.7), or Jewish (OR 0.3, 95% CI 0.1-0.7) compared with male, rural, or religiously unaffiliated ob-gyns. Objection was more likely among ob-gyns from the South (OR 1.9, 95% CI 1.2-3.0) or Midwest (OR 1.9, 95% CI 1.2-3.1), and among Catholic, Evangelical Protestant, or Muslim ob-gyns, or those for whom religion was most important, compared with reference. Among ob-gyns who objected to abortion in a given case, approximately two-thirds would help patients obtain an abortion. Excluding sex selection, assistance despite objection was more likely among female (OR 1.8, 95% CI 1.1-2.9) and United States-born ob-gyns (OR 2.2, 95% CI 1.1-4.7) and less likely among southern ob-gyns (OR 0.3, 95% CI 0.2-0.6) or those for whom religion was most important (OR 0.3, 95% CI 0.1-0.7).
Conclusion: Most ob-gyns help patients obtain an abortion even when they morally object to abortion in that case. Willingness to assist varies by clinical context and physician characteristics.
Harris LH, Cooper A, Rasinski KA, Curlin FA, Lyerly AD. Obstetrician-gynecologists’ objections to and willingness to help patients obtain an abortion. Obstet Gynecol. 2011;118(4):905-912.
Abstract
This paper reports on a national study that explored the complexity surrounding ethical conflicts related to conscientious objection in social work. Specific focus was on the extent to which practitioners have a right to remove themselves from professional services and situations that conflict with a religious or moral worldview.
Sweifach J. Conscientious Objection in Social Work: Rights vs. Responsibilities. J Social Work Values & Ethics, Fall. 2011;8(2).
Abstract
Background
Given recent legislative efforts to require parental notification for the provision of reproductive health care to minors, we sought to assess how ob/gyns respond to requests for confidential contraceptive services.
Study Design
Mailed survey of 1800 U.S. Obstetrician-Gynecologists, utilizing a vignette where a 17-year-old college freshman requests birth control pills and does not want her parents to know. Criterion variables were the likelihood of: encouraging her to abstain from sexual activity until she is older; persuading her to involve her parents in this decision; and prescribing contraceptives without notifying her parents. Covariates included physicians’ religious, demographic, and clinical characteristics.
Results
Response rate 66%. Most (94%) would provide contraceptives without notifying her parents. Half (47%) would encourage her to involve a parent, and half (54%) would advise abstinence until she is older. Physicians who frequently attend religious services were more likely to encourage her to involve her parents (OR 1.9), and to abstain from sex until she is older (OR 4.4), but equally likely to provide the contraceptives.
Conclusions
Most obstetrician-gynecologists will provide adolescents with contraceptives without notifying their parents.
Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Adolescents, contraception, and confidentiality: a national survey of obstetrician-gynecologists. Contraception. 2011;84(3):259-265.
Abstract
Objective: To explore attitudes towards conscientious objections among medical students in the UK.
Methods: Medical students at St George’s University of London, Cardiff University, King’s College London and Leeds University were emailed a link to an anonymous online questionnaire, hosted by an online survey company. The questionnaire contained nine questions. A total of 733 medical students responded.
Results: Nearly half of the students in this survey stated that they believed in the right of doctors to conscientiously object to any procedure. Demand for the right to conscientiously object is greater in Muslim medical students when compared with other groups of religious medical students.
Discussion: Abortion continues to be a contentious issue among medical students and this may contribute to the looming crisis in abortion services over the coming years. This project sheds some light on how future doctors view some of their ethical rights and obligations. Using empirical evidence, it reveals that conscientious objection is an issue in the UK medical student body today. These data could help anticipate problems that may arise when these medical students qualify and practise medicine in the community.
Conclusion: Clearer guidance is needed for medical students about the issue of conscientious objection at medical school.
Strickland SL. Conscientious objection in medical students: A questionnaire survey. J Med Ethics. 2012;38(1):22-25.
Abstract
Abortion is the central issue in the conscientious objection debate. In this article I demonstrate why this is so for two philosophical viewpoints prominent in American culture. One, represented by Patrick Lee and Robert P. George, holds that the fundamental moral value of being human can be found in bare life and the other, represented by Tom Beauchamp and James Childress, holds that this fundamental value is found in the life that can choose and determine itself. First, I articulate Lee and George’s philosophical theory and demonstrate how the fundamental moral value of their theory, personhood, is represented in the issue of abortion. Second, I examine Beauchamp and Childress’ theoretical vision and demonstrate how their fundamental moral value, the right to autonomous selfdetermination, is represented in abortion. Third, I sketch the theoretical and practical dynamics of the conscientious objection debate as well as each author’s understanding of conscience. Fourth, I demonstrate how abortion, which represents their respective fundamental value, shapes each perspectives’ approach to the conscientious objection debate. I conclude that because each theory finds its fundamental value represented in the issue of abortion, each perspective is bound to engage the conscientious objection debate in a way that centers on the issue of abortion.
Bedford EL. Abortion: At the still point of the turning conscientious objection debate. HEC Forum. 2012;24(2):63-82.
Journal Extract
The Council of Europe’s Parliamentary Assembly has adopted a resolution on conscientious objection in medicine, ‘The Right to Conscientious Objection in Lawful Medical Care’.1 In general terms, this resolution (‘the Resolution’) affirms the place of conscientious objection in the medical context while inviting member states to provide appropriate regulation of the practice of conscientious objection. In particular, it provides the following: first, there is a recognition that ‘[n]o person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason’.2 Secondly, the right of conscientious objection is affirmed together with the state’s responsibility ‘to ensure that patients are able to access lawful medical care in a timely manner’.3 Thirdly, it is acknowledged that ‘[i]n the vast majority of Council of Europe member states, the practice of conscientious objection is adequately regulated’.4 Fourthly, the Resolution invites member states ‘to develop comprehensive and clear regulations that define and regulate conscientious objection with regard to health and medical services’.5 Given that the Resolution sets out broad principles in this area and is not binding on member states—the Parliamentary Assembly has the role of a consultative body within the Council of Europe that seeks through its adopted texts to influence legislation and practice at a domestic level—the purpose of this short article is not to provide a line-by-line analysis of the text. It is rather to ‘read between the lines’ of the Resolution by examining its background and significance.
Campbell M. Conscientious objection and the Council of Europe: The right to conscientious objection in lawful medical care. Resolution 1763 (2010). Resolution adopted by the Council of Europe’s Parliamentary Assembly. Med Law Rev. 2011 Summer;19(3):467-475.
Extract
Beware of arguments that appear to accept that CO is just about our ‘personal values’; it isn’t. Beware of relying on our fallen consciences rather than on God’s Word. Beware of resorting to the safety of guidelines and laws which may be changed. By God’s grace, we have the right to CO made explicit in our professional guidance, given concrete examples in the law, supported by a European assembly. We can argue from history or personal example in favour of it. But in the end, we need to be prepared to stand for Christ, and the experience of those before us suggests that this will be costly.
Cattermole G. Conscientious Objection. Nucleus. 2011 Summer; 24-27.
Abstract
Objective
To examine obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling.
Methods
Between October 2008 and January 2009, a survey was mailed to a national randomized sample of 1800 practicing US obstetrician–gynecologists. Study variables were agreement with 2 statements. (1) “If physicians counsel patients about safe-sex practices, the patients will be less likely to engage in risky sexual behaviors”. (2) “If physicians counsel patients about abstinence, the patients will be much less likely to engage in sexual activity”. Covariates included demographic, clinical, and religious characteristics of the physician.
Results
The response rate was 66% (1154/1760 eligible physicians). Most respondents somewhat (62%) or strongly (25%) agreed that counseling patients about safe-sex practices makes patients less likely to engage in risky sexual behaviors. Fewer agreed strongly (3%) or somewhat (28%) that counseling patients about abstinence makes patients less likely to engage in sexual activity. The belief that safe-sex counseling reduces risky behaviors was less common among males (odds ratio [OR] 0.6) and more common among immigrants (OR 2.0). Religious physicians were more likely to believe that abstinence counseling reduces sexual activity (OR 2.2–5.3).
Conclusions
Most obstetrician–gynecologists believed that counseling about safe sex is effective, and a significant minority endorsed abstinence counseling.
Lawrence RE, Rasinski KA, Yoon JD, Curlin FA. Obstetrician–gynecologists’ beliefs about safe-sex and abstinence counseling. Int J Gyn Obst 2011; 114(3):281-285.
Abstract
Background and objectives: Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners’ opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists’ (OB/GYN) support for the recommendations.
Design: A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee–whether the doctor referred and whether the doctor disclosed their objection to the abortion.
Participants and setting: 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases.
Measurement: Physicians indicated their approval for the vignette doctor’s decision.
Main results: Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure.
Conclusion: OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor-patient relationship.
Rasinski KA, Yoon JD, Kalad YG, Curlin FA. Obstetrician-gynecologists’ opinions about conscientious refusal of a request for abortion: results from a national vignette experiment. J Med Ethics. 2011;37(12):711-714.