Ethical Distinction Between Direct and Indirect Referral for Abortion

Frank A Chervenak, Laurence B McCullough

The Female Patient
The Female Patient

Extract
Conclusion

The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.


Chervenak FA, McCullough LB. Ethical Distinction Between Direct and Indirect Referral for Abortion. The Female Patient. 2009 Dec;34:46-48

Where conscience meets desire: refusal of health care providers to honor health care proxies for sexual minorities

Shawna S Baker

Women's Rights Law Reporter
Women’s Rights Law Reporter

Baker SS. Where conscience meets desire: refusal of health care providers to honor health care proxies for sexual minorities. Women’s Rights Law Reporter. 2009-2010;31(1):1-41.

Islamic Biomedical Ethics: Principles and Application

Islamic Biomedical Ethics: Principles and Application

Abdulaziz Sachedina A. Islamic Biomedical Ethics: Principles and Application. Oxford: University Press, 2009, 296 pp. Print ISBN-13: 9780195378504. DOI:10.1093/acprof:oso/9780195378504.001.0001

Author’s Abstract
This book undertakes to correlate practical ethical decisions in modern medical practice to principles and rules derived from Islamic juridical praxis and theological doctrines. This study links these rulings to the moral principles extracted from the normative religious texts and historically documented precedents. Western scholars of Islamic law have pointed out the importance of the historical approach in determining the rules and the juristic practices that were applied to the cases under consideration before the judicial opinions were issued within a specific social, economic, and political context. These decisions reflected aspects of intellectual as well as social history of the Muslim community engaged in making everyday life conform to the religious values. Ethical decisions are an important part of interpersonal relations in Islamic law. Practical guidance affecting all facets of individual and collective human life, have been provided under the general rules of “Public good” and “No harm, no harassment.” However, no judicial decision that claims to further public good is regarded authoritative without supporting documentation from the foundational sources, like the Qur‘an and the Sunna (the exemplary tradition of the Prophet). Hence, Muslim jurists, in order to infer fresh rulings about matters that were not covered by the existing precedents in the Qur‘an and the Sunna, undertook to develop rational stratagems to enable them to solve problems faced by the community. This intellectual activity led to the systematic formulation of the principles of Islamic jurisprudence, which has assumed unprecedented importance in connection with the distinct field of medical ethics in the Islamic world that shares the modern medical technology with the West. The book argues that there are distinct Islamic principles that can serve as sources for Muslim biomedical ethics that can engage in dialogue with both secular and other religiously oriented bioethics in the context of universal medical practice and research.


“Abdulaziz Sachedina is the leading Islamic thinker writing in Engish today.  Thus, his Islamic Biomedical Ethics is a welcome addition to the already extensive literature in the field because of his great knowledge of the classical and modern Islamic legal and ethical sources, his authentic religious commitment to the truth of Islam, and his willingness to engage perspectives from other traditions in what is becoming a genuinely multicultural field of moral discourse.”  David Novak, author of Jewish Social Ethics


Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile

Lidia Casas

Reproductive Health Matters
Reproductive Health Matters

Abstract
As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women’s rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women’s health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women’s rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.

Keywords:

Casas L. Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile. Reprod Health Matter. 2009 Nov;17(34):78-87.

(Debate) Do FPs agree on what professionalism is? Yes

Michael Yeo

Canadian Family Physician
Canadian Family Physician

Extract
Closing Arguments

• Professionalism is in vogue today, as evidenced by the proliferation of discussion in the academic literature and in policy and guidance issued by various medical organizations.

• There is general agreement in the literature that, essentially, to be a medical professional is to profess competence in medicine and to use it primarily for the benefit of patients and communities.

• Although there has been no formal study of whether FPs agree on what professionalism is, there is reason to suppose that they agree on the general concept as it is generally elaborated in the literature and on the moral norms associated with the professional ideal.

• Family physicians might disagree about particular applications of the moral norms that make up the professional ideal, but such disagreement is perfectly compatible with the idea of professional judgment and is indeed a part of it.


Yeo M. (Debate) Do FPs agree on what professionalism is? Yes. Can Fam Physician. 2009 Oct;55:968-971.

The prisoner as model organism: malaria research at Stateville Penitentiary

Nathaniel Comfort

Studies in History and Philosophy of Biological and Biomedical Sciences
Studies in History and Philosophy of Biological and Biomedical Sciences

Abstract

In a military-sponsored research project begun during the Second World War, inmates of the Stateville Penitentiary in Illinois were infected with malaria and treated with experimental drugs that sometimes had vicious side effects. They were made into reservoirs for the disease and they provided a food supply for the mosquito cultures. They acted as secretaries and technicians, recording data on one another, administering malarious mosquito bites and experimental drugs to one another, and helping decide who was admitted to the project and who became eligible for early parole as a result of his participation. Thus, the prisoners were not simply research subjects; they were deeply constitutive of the research project. Because a prisoner’s time on the project was counted as part of his sentence, and because serving on the project could shorten one’s sentence, the project must be seen as simultaneously serving the functions of research and punishment. Michel Foucault wrote about such ‘mixed mechanisms’ in his Discipline and punish. His shining example of such a ‘transparent’ and subtle style of punishment was the panopticon, Jeremy Bentham’s architectural invention of prison cellblocks arrayed around a central guard tower. Stateville prison was designed on Bentham’s model; Foucault featured it in his own discussion. This paper, then, explores the power relations in this highly idiosyncratic experimental system, in which the various roles of model organism, reagent, and technician are all occupied by sentient beings who move among them fluidly. This, I argue, created an environment in the Stateville hospital wing more panoptic than that in the cellblocks. Research and punishment were completely interpenetrating, and mutually reinforcing.


Comfort N. The prisoner as model organism: malaria research at Stateville Penitentiary. Stud Hist Philos Biol Biomed Sci. 2009;40(3):190-203. doi:10.1016/j.shpsc.2009.06.007

Conscientious objection to termination of pregnancy: The competing rights of patients and nurses

Roslyn Kane

Nursing Management
Nursing Management

Abstract
Aims:
To highlight the potential difficulties in the management of staff with a conscientious objection to abortion, in light of expanding role of nurses.

Background: Recent years have seen changes in the provision of abortion services. Medical procedures are now gaining popularity and some areas are seeing the integration of outpatient clinics into ward settings. This may involve nurses being required to provide care to women undergoing termination of pregnancy, which may not have previously been within their remit. This has implications for staff with a conscientious objection.

Methods: A review of the academic literature.

Results: The advent of medical abortion has led to changes in the way in which abortion services are provided which in turn has re-ignited the debate of the competing rights of nurses with a conscientious objection and those of the patient accessing abortion services.

Conclusions: This extended role of nurses creates challenges for staff working in clinical areas offering termination of pregnancy and these are further compounded when staff have expressed a conscientious objection to abortion.

Implications for Nursing Management: Managers face new challenges in achieving the fine balance between the rights of staff with a conscientious objection to abortion and women accessing abortion services.


Kane R. Conscientious objection to termination of pregnancy: The competing rights of patients and nurses. J Nurs Manag. 2009 Sep 24;17(7):907-912.

Unethical Protection of Conscience: Defending the Powerful against the Weak

Bernard M Dickens

American Medical Association Journal of Ethics
American Medical Association Journal of Ethics

Extract
In protecting and privileging health care professionals who withhold information that their patients depend upon, the provisions reduce health care professionals to the status of self-serving traders in an unequal market who may take advantage of those obliged or unwise enough to trust them and rely on their integrity. The provisions underscore the challenge that conscientious objection poses to health care professionalism [8]. To allow physicians to deny or frustrate a patient’s rights of conscience by enforcing their own through nonreferral, as the new regulations do, is unethical. It is ethically justifiable to be intolerant of religious or other fundamentalist intolerance.


Dickens BM. Unethical Protection of Conscience: Defending the Powerful against the Weak. Am Med Ass J Ethics. 2009;11(9):725-729.

Physicians’ beliefs about conscience in medicine: a national survey

Ryan E Lawrence, Farr A Curlin

Academic Medicine
Academic Medicine

Abstract
PURPOSE
: To explore physicians’ beliefs about whether physicians sometimes have a professional obligation to provide medical services even if doing so goes against their conscience, and to examine associations between physicians’ opinions and their religious and ethical commitments.

METHOD: A survey was mailed in 2007 to a stratified random sample of 1,000 U.S. primary care physicians, selected from the American Medical Association Physician Masterfile. . . .

RESULTS: The response rate was 51% (446/879 delivered questionnaires). Forty-two percent and 22% believed they are never and sometimes, respectively, obligated to do what they personally believe is wrong, and 36% agreed with both statements. Physicians who are more religious are more likely to believe that physicians are never obligated to do what they believe is wrong (58% and 31% of those with high and low intrinsic religiosity, respectively; multivariate odds ratio, 2.9; 95% CI, 1.2-7.2). Those with moral objections to any of three controversial practices were more likely to hold that physicians should never do what they believe is wrong.

CONCLUSION: A substantial minority of physicians do not believe there is ever a professional obligation to do something they personally believe is wrong.


Lawrence RE, Curlin FA. Physicians’ beliefs about conscience in medicine: a national survey.. Acad Med. 2009;84(9):1276-1282.

The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide

Bert Broeckaert, Joris Gielen, Trudie Van Iersel, Stef Van Den Branden

Ethical Perspectives
Ethical Perspectives

Abstract
Surveys carried out among palliative care physicians have shown that most participants do not support euthanasia and assisted suicide. Belgium, however, is one of the few countries in the world in which voluntary euthanasia is allowed by law. The potential influence of this legal dimension thus warranted a study of the attitudes of Belgian palliative care physicians toward euthanasia and assisted suicide. . . .The majority of the physicians favour legalisation on assisted suicide. There is no significant association between the euthanasia clusters and attitudes toward assisted suicide. We conclude that although most Flemish palliative care physicians agree that there may be circumstances in which a euthanasia request is justified, they also strongly believe in the effects of good palliative care and want the ‘palliative filter’ to be included in the law on euthanasia. Religion and worldview are an important factor determining attitudes towards euthanasia.


Broeckaert B, Gielen J, Iersel TV, Branden SVD. The Attitude of Flemish Palliative Care Physicians to Euthanasia and Assisted Suicide. Ethical Perspectives. 2009;16(3):311-335.