Ethics Archives - Page 33 of 81 - Protection of Conscience Project Library

Professional Conscientious Objection in Medicine with Attention to Referral

Thomas A Cavanaugh

Extract
What duties accompany conscientious objection? To sum up what follows: The obligations to the patient remain unchanged, but for the denial of the contested request.

Specifically, what do these obligations entail? First, following from the very meaning of professing—and to develop a point previously mooted—full disclosure imposes the obligation to promulgate to the relevant parties one’s conscientious objection. This includes one’s prospective and current patients, colleagues, employers, and relevant institutions, for example hospitals and insurance companies. . . .

Second, conscientious objector status obliges the relevant professional to explain her reasons for her objection to those patients who request further information. . . . the patient is due the offer of an explanation. This does not, however, amount to the professional’s having a right to pontificate concerning the relevant matter. Rather, the interested patient ought to receive some answer to the question as to why the professional objects. Certainly, not all patients will be interested to know why. Those who are not interested ought not to be treated as captive audiences; those who do want to know ought to receive a considerate and considered answer. . .

Third, conscientious objector status bears exclusively on the patient’s contested request; it does not relate to the other care the physician, nurse, or pharmacist provides for the patient. If a relationship exists with the patient . . . the physician, nurse, or pharmacist must provide care to which she does not object. . .

Fourth, conscientious objector status requires the continued maintenance of confidentiality, particularly with respect to the fact that the professional objects to something the patient requests. . . .the professional must strenuously and scrupulously protect the patient’s privacy specifically concerning the patient’s request and the practitioner’s conscientious objection.

Finally, as earlier noted, while conscientious objection does not require referral to a third party who will abide by the patient’s request, it does require transfer of relevant documents, returning a prescription, and, more generally, acts which, while they may result in the act to which one objects, do not require one to aim at that act.

Cavanaugh T. Professional Conscientious Objection in Medicine with Attention to Referral. Ave Maria Law Rev. 2011;9(1):190-206.

The physician’s right to conscientious objection: an evolving recognition in Europe

Tom Goffin

Abstract
Due to the growing number of medical treatments, physicians–who are also human beings with their own conscience and beliefs–are increasingly confronted with treatments that may conflict with their principles and convictions. Although several human rights documents recognize the freedom of conscience and belief, we could not locate the recognition of an explicit right to conscientious objection. Furthermore, a direct application of the right to freedom of thought, conscience and religion, as recognized by article 9 of the ECHR, does not include such a right due to the narrow interpretation of this right by the European Court of Human Rights. However, the Court seems to have taken steps away from this narrow interpretation in Pichon and Sajous v. France. Notwithstanding these steps, no general right to conscientious objection exists. Physicians therefore are dependent on a judgment if they refuse a certain treatment because of conscientious objections.

Goffin T. The physician’s right to conscientious objection: an evolving recognition in Europe. Med Law. 2010 Jun;29(2):227-37.

Crisis of Conscience: Pharmacist Refusal to Provide Health Care Services on Moral Grounds

Eileen P Kelly, Aimee Dars Ellis, Susan PS Rosenthal

Employee Responsibility and Rights Journal

Abstract
Advances in technology have resulted in medical procedures and practices that were unthought-of in previous generations. Embryonic stem cell research, abortifacients, birth control, and artificial insemination are just a few examples of these technological advances. While many individuals readily embrace such medical advances, others find them morally objectionable. A contentious national debate is now occurring over whether employee pharmacists have the right to refuse to fill legal prescriptions for emergency contraception because of conscientious objections. In the United States, existing public policy is somewhat muddled in both protecting and encroaching on the employee pharmacist’s right of refusal. This article discusses the legal and ethical nature of that controversy, as well as the clash of interests, rights and responsibilities between employers, employee pharmacists and customers from a U.S. perspective.

Kelly EP, Ellis AD, Rosenthal SP. Crisis of Conscience: Pharmacist Refusal to Provide Health Care Services on Moral Grounds. Employee Responsibilities and Rights J. 2011 May 22;23(1):37-54.

Conscience, Contraception, and Catholic Health-Care Professionals

Janet E Smith

Abstract
The Church’s teachings are often very challenging. Those who are involved in the health-care professions and who conduct their practices in accord with Church teaching can expect misunderstanding and even rejection from their colleagues and patients. One of the most difficult teachings of the Church is its condemnation of contraception. In 1968 Pope Paul VI issued the encyclical Humanae vitae, which hit the world like a bomb. In it he affirmed the Church’s long-standing teaching on human sexuality and condemned contraception in particular. Today scientific advances such as in vitro fertilization and embryonic stem-cell research, as well as the challenges in making moral decisions about end-of-life care, make it increasingly difficult for health-care professionals to practice in accord with their deeply held moral convictions. Developing a properly formed conscience, which is the voice of God, is essential in dealing with these contemporary issues and making right choices. This essay outlines the process for properly forming the conscience. It also explains why prescribing contraception is morally wrong.

Smith JE. Conscience, Contraception, and Catholic Health-Care Professionals. Linacre Quarterly. 2010 May;77(2):204-228. Edited transcript of a talk given at the first annual symposium for health-care professionals, “Conscience and Ethical Dilemmas in Catholic Healthcare,” hosted by the Archdiocese of Baltimore Respect Life Office and Baltimore Guild of the Catholic Medical Association, Baltimore, MD, May 9, 2009. The text is more conversational than a written paper and not as closely documented as a professional piece. Much of the material was accompanied by PowerPoint slides.

The difference of being human: Morality

Francisco J Ayala

Proceedings of the National Academy of Sciences (USA)

Abstract
In The Descent of Man, and Selection in Relation to Sex, published in 1871, Charles Darwin wrote: “I fully . . . subscribe to the judgment of those writers who maintain that of all the differences between man and the lower animals the moral sense or conscience is by far the most important.” I raise the question of whether morality is biologically or culturally determined. The question of whether the moral sense is biologically determined may refer either to the capacity for ethics (i.e., the proclivity to judge human actions as either right or wrong), or to the moral norms accepted by human beings for guiding their actions. I propose that the capacity for ethics is a necessary attribute of human nature, whereas moral codes are products of cultural evolution. Humans have a moral sense because their biological makeup determines the presence of three necessary conditions for ethical behavior: (i) the ability to anticipate the consequences of one’s own actions; (ii) the ability to make value judgments; and (iii) the ability to choose between alternative courses of action. Ethical behavior came about in evolution not because it is adaptive in itself but as a necessary consequence of man’s eminent intellectual abilities, which are an attribute directly promoted by natural selection. That is, morality evolved as an exaptation, not as an adaptation. Moral codes, however, are outcomes of cultural evolution, which accounts for the diversity of cultural norms among populations and for their evolution through time.

Ayala FJ. The difference of being human: Morality. Proc Natl Acad Sci U S A. 2010 May 11;107 Suppl 2:9015-22. Epub 2010 May 5.

Practice against our beliefs

Colly A Tettelbach

Extract
The United States has embarked on a dangerous course. When the right of healthcare workers to refuse participation in certain procedures based on conscience is denied, we have started down the path of preparing rightminded, conscience-driven people to abandon ethical practice and in some situations to become killers. Anytime people are forced to act against what they believe to be right and coerced to do what they consider to be wrong, a very treacherous gulf has been crossed. When the right of conscience is removed from healthcare workers, we will have healthcare workers without conscience.

Tettelbach CA. Practice against our beliefs. J Christ Nurs. 2010;27(2):106-109.

Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care

Debra B Stulberg, Ryan E Lawrence, Jason Shattuck, Farr A Curlin

Abstract
BACKGROUND
Religiously affiliated hospitals provide nearly 20% of US beds, and many prohibit certain end-of-life and reproductive health treatments. Little is known about physician experiences in religious institutions.
OBJECTIVE
Assess primary care physicians’ experiences and beliefs regarding conflict with religious hospital policies for patient care.
DESIGN
Cross-sectional survey.
PARTICIPANTS
General internists, family physicians, and general practitioners from the AMA Masterfile.
MAIN MEASURES
In a questionnaire mailed in 2007, we asked physicians whether they had worked in a religiously affiliated hospital or practice, whether they had experienced conflict with the institution over religiously based patient care policies and how they believed physicians should respond to such conflicts. We used chi-square and multivariate logistic regression to examine associations between physicians’ demographic and religious characteristics and their responses.
KEY RESULTS
Of 879 eligible physicians, 446 (51%) responded. In analyses adjusting for survey design, 43% had worked in a religiously affiliated institution. Among these, 19% had experienced conflict over religiously based policies. Most physicians (86%) believed when clinical judgment conflicts with religious hospital policy, physicians should refer patients to another institution. Compared with physicians ages 26–29 years, older physicians were less likely to have experienced conflict with religiously based policies [odds ratio (95% confidence interval) compared with 30–34 years: 0.02 (0.00–0.11); 35–46 years: 0.07 (0.01–0.72); 47–60 years: 0.02 (0.00–0.10)]. Compared with those who never attend religious services, those who do attend were less likely to have experienced conflict [attend once a month or less: odds ratio 0.06 (0.01–0.29); attend twice a month or more: 0.22 (0.05–0.98)]. Respondents with no religious affiliation were more likely than others to believe doctors should disregard religiously based policies that conflict with clinical judgment (13% vs. 3%; p = 0.005).
Conclusions
Hospitals and policy-makers may need to balance the competing claims of physician autonomy and religiously based institutional policies.

Stulberg DB, Lawrence RE, Shattuck J, Curlin FA. Religious Hospitals and Primary Care Physicians: Conflicts over Policies for Patient Care. J Gen Intern Med. 2010;25(7):725-730. Available from:

Freedom of conscience. Biojuridical conflicts at multicultural societies

Marta Albert Márquez

Pub Med Abstract
The paper [in Spanish] analyzes the right of healthcare professionals to conscientious objection in multicultural societies. The ethical relativism characteristic of these societies abides with an apparently paradoxical reduction of the exercise of freedom of conscience. “Apparently” because, in the end, ethical relativism tends to adopt dogmatic attitudes. Special attention is paid to the situation of Spanish healthcare in relation to euthanasia and abortion. With regard to euthanasia, the “death with dignity” draft bill of Andalucía is considered. With regard to abortion, we will pay attention to the reform of the Penal Code in the context of a new regulation about “reproductive health” of women, which means the adoption of a system of time limits, and the characterization of abortion as a women’s right. It is concluded that freedom of conscience of healthcare professionals will probably be at risk if proposed legal policies don’t change.

Albert Márquez M. [Freedom of conscience. Biojuridical conflicts at multicultural societies]. Cuadernos de Bioetica : Revista Oficial de la Asociacion Espanola de Bioetica y Etica Medica. 2010 Jan-Apr;21(71):61-77. Spanish

Are there different spheres of conscience?

Erica J Sutton, Ross EG Upshur

Journal of Evaluation in Clinical Practice

Abstract
Interest in understanding the meaning of conscience and conscientious objection in medicine has recently emerged in the academic literature. We would like to contribute to this debate in four ways: (1) to underscore and challenge the existing hierarchy of conscientious objection in health care; (2) to highlight the importance of considering the lay public when discussing the role of conscientious objection in medicine; (3) to critique the numerous proposals put forth in favour of implementing review boards to assess whether appeals to conscience are justifiable, reasonable and sincere; and (4) to introduce the Universal Declaration of Human Rights and the Siracusa Principles into the dialogue around conscience and suggest that perhaps conscientious objection is a human right.

Sutton EJ, Upshur RE. Are there different spheres of conscience? J Eval Clin Pract. 2010;16(2):338-343.

(Thesis) Comparative Legal Analysis of Conscientious Objection in Health Care

Slavomíra Slovinská

Abstract
The purpose of this thesis is to demonstrate what would be an appropriate model of the regulation of conscientious objections in health care. These objections are regulated in many countries’ national legislation, however, some of them fail to provide safeguards which would secure proper balance between the two conflicting interests – the health care professional’s right to act in accordance with his conscience and individual’s right to access health care. Therefore, this thesis analyzes regulation of the conscientious objection in the legal systems of the USA, the UK and the Slovak Republic with respect to the appropriateness of such regulation and major differences which they include. The thesis suggests that the protection of conscientious objection in the USA can go too far and be too excessive, while the UK presents much more appropriate model of regulation of conscientious objection with certain limitations. Furthermore, it submits that regulation of conscientious objection in Slovakia consists in general but vague clause creating the possibilities for future controversies.The thesis also analyses different opinions on the acceptability of conscientious objection in health care and finally, it suggests conditions and limitations of conscientious objection that should be met in the regulation of national legislation in order to find appropriate balance between the competing interests of health care professionals and patient.

Slovinská S. (Thesis) Comparative Legal Analysis of Conscientious Objection in Health Care. Central European University, Budapest, Hungary. 2010 Mar 29.