Ethics Archives - Page 29 of 87 - Protection of Conscience Project Library

Conscientious objection, health care and Article 9 of the European Convention on Human Rights

Mark Campbell

Abstract
Article 9 of the European Convention on Human Rights provides protection for freedom of thought, conscience and religion. From one perspective, it may be said that Article 9 guarantees a right to conscientious objection in health care, whereas from another perspective, a Strasbourg case, such as Pichon and Sajous v France, effectively means that Article 9 provides little or no protection in that context. In this article it is argued that the matter is more complex than either of these two positions would suggest. Moreover, given the nature of the subject matter, national authorities should be afforded a significant margin of appreciation in the way that they protect and regulate conscientious objection. By way of illustration, there is a discussion of the ways in which Article 9 might affect conscientious objection in health care under English law. The final part of the article considers the conceptual limitations of Article 9 in thinking about conscientious objection in health care; in particular, the claim that the extent to which Article 9 of the Convention provides protection for a conscientious objection in the health care context is a different question from whether conscientious objection by doctors and other health care practitioners is justified in principle.

Campbell M. Conscientious objection, health care and Article 9 of the European Convention on Human Rights. Medical Law International. 2011 Dec 06;11(4):284-304.

(Debate) Should doctors feel able to practise according to their personal values and beliefs? No.

Julian Savulescu

Abstract
Conscientious objection by doctors, as is commonly practised, is discriminatory medicine. Only a fully justified and publicly accepted set of objective values results in ethical medicine as a proper public service with agreed and justified moral and legal standards to which doctors should be held.

Savulescu J. (Debate) Should doctors feel able to practise according to their personal values and beliefs? No. Med J Aust. 2011 Nov;195(9):497.

Applying ethical practice competencies to the prevention and management of unintended pregnancy

Joyce Cappiello, Margaret W Beal, Kim Gallogly-Hudson

Journal of Obstetric, Gynecologic & Neonatal Nursing

Abstract
Using a case study that incorporates patient, nurse practitioner, and student perspectives, we address ethical principles of respect for autonomy, beneficence, and fairness; professionals’ right of conscience; and a social justice model for the discussion of prevention and management of unintended pregnancy. Through an ongoing process of self-reflection and values clarification, nurses can prepare for the challenge of applying ethical principles to the reproductive health care of women.

Cappiello J, Beal MW, Gallogly-Hudson K. Applying ethical practice competencies to the prevention and management of unintended pregnancy. J Obstet Gyn Neonat Nurs. 2011 Nov;40(6):808-816.

(Debate) Should doctors feel able to practise according to their personal values and beliefs? Yes.

Brian V Conway

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.

Obstetrician-gynecologists’ objections to and willingness to help patients obtain an abortion

Lisa H Harris, Alexandra Cooper, Kenneth A Rasinski, Farr A Curlin, Anne Drapkin Lyerly

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.

Managing ethically questionable parental requests: growth suppression and manipulation of puberty

David Isaacs, Bernadette Tobin, Julie Hamblin, Emma Slaytor, Kim C Donaghue, Craig Munns, Henry A Kilham

Abstract
Doctors sometimes struggle with ethically challenging requests for treatment from children’s parents. For instance, we have recently had two requests by parents of children, a girl and a boy, each with a severe developmental disability, for hormonal therapy to suppress growth and puberty: the girl’s parents requested, in addition, hysterectomy and mastectomy. We propose a reliable approach to assessing the ethical and legal aspects of these and other requests for ‘non-therapeutic’ treatment of a minor who lacks the capacity to give informed consent. We argue that a doctor should first assess whether the request is one that he or she can, in conscience, accede to, and then, if it is, seek the authorisation of a court. We outline considerations relevant to the doctor’s assessment of both the ethical issues and to the need for court authorisation.

Isaacs D, Tobin B, Hamblin J, Slaytor E, Donaghue KC, Munns C, Kilham HA. Managing ethically questionable parental requests: growth suppression and manipulation of puberty. J Paed Child Health. 2011 Sep 27;47(9):581-584.

Adolescents, contraception, and confidentiality: a national survey of obstetrician-gynecologists

RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin

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.

Conscientious objection in medical students: A questionnaire survey

Sophie LM Strickland

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.

Abortion: At the still point of the turning conscientious objection debate

Elliott Louis Bedford

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.