Ethics Archives - Page 37 of 87 - Protection of Conscience Project Library

(Working Paper) Conscientious Oppression: Conscientious Objection in the Sphere of Sexual and Reproductive Health

Marcelo Alegre

Yale Law School Lillian Goldman Law Library

Abstract
Although for centuries conscientious objection was primarily claimed by those who for religious or ethical reasons refused to join the ranks of the military (whether out of a general principle or in response to a particular violent conflict), in recent decades a significant broadening of the concept can be seen. In Thailand, for example, doctors recently refused medical attention to injured policemen suspected of having violently repressed a demonstration. In Argentina a few public defenders have rejected for conscientious reasons to represent individuals accused of massive human rights violations. In different countries all over the world there are doctors who refuse to perform euthanasia, schoolteachers who reject to teach the theory of evolution, and students who refuse to attend biology classes where frogs are dissected.

Alegre M. (Working Paper) Conscientious Oppression: Conscientious Objection in the Sphere of Sexual and Reproductive Health. 2009;1-34.

Understanding pharmacists’ values: A qualitative study of ideals and dilemmas in UK pharmacy practice

Ailsa Benson, Alan Cribb, Nick Barber

Abstract
Pharmacy, like other health care professions, is both a knowledge-based and a value-based profession. However, the values that inform practice activities are rarely made explicit. We sought to identify the values drawn on by UK pharmacists through qualitative interviews on day-to-day practice activities focused around practitioners’ conceptions of ‘the good pharmacist’, good practice and their experiences of ethical issues and dilemmas. The study was based upon loosely structured, one-to-one interviews of 38 selected practitioners reflecting a range of practice roles and settings. The interviews were recorded, transcribed and analysed following the principles of grounded theory. The accounts of practice (of self and colleagues) in the data showed pharmacists to be very dedicated and conscientious. Practice was predominantly discussed and presented by practitioners drawing upon a scientific mode of rationality. Value and ethical judgements were typically presented within this mode, with more open-ended and complex discussion of values and ethics appearing quite rarely. Two core values generally drawn on in reported practice emerged from the analysis – these were, ‘the patient’s best interests’ and a value we labelled ‘respect for medicines’. Common dilemmas arose from conflicting values, for example competing obligations to different parties, sometimes brought to a head by the conflicting demands of ‘rules’ of various sorts. Reported dilemmas related to rule breaking, resource allocation, patient communication and teamwork. There was a tendency for practitioners to ‘fall back’, often unreflectively, on their own personal value judgements when addressing these dilemmas. However, in the main, the values and dilemmas reported clearly show the socially embedded nature of professional ethics and, thereby, contribute to the social science re-theorisations of professional ethics needed if work on ethics development is to be realistic.

Benson A, Cribb A, Barber N. Understanding pharmacists’ values: A qualitative study of ideals and dilemmas in UK pharmacy practice. Soc Sci Med. 2009;68(12):2223-2230.

(Book Review) Conflicts of conscience in health care an institutional compromise

Dhrubajyoti Bhattacharya

Holly Fernandez Lynch. Conflicts of Conscience in Health Care: An Institutional Compromise. Boston: The MIT Press; 2008, 368 pp. ISBN: 9780262123051

Extract
Lynch demystifies the practice of medicine as a value-neutral panacea to remedy social ills with physicians as unwavering obligors to provide service on demand. . . . As far as the provision of services goes, protecting patient and physician interests are, as Lynch argues, not mutually exclusive propositions. In practice, physicians who check their moral apprehensions at the hospital doors may even compromise patient safety. An enlightened approach, as proposed here, encourages health professionals to embrace moral plurality to inform, rather than stymie, the provision of services in the best interests of patients—while respecting physician individuality.

Conflicts of Conscience in Health Care: An Institutional Compromise will serve as an excellent resource for educators and policymakers eager to parse the complex issues of patient wants, physician duties, and institutional prerogatives to secure individual and population health and well-being.

Bhattacharya D. (Book Review) Conflicts of conscience in health care an institutional compromise. J Leg Med. 2009;30(2):289-298.

(Editorial) Conscience and the Unconscionable

Robert Baker

Extract
The challenge is thus to accommodate conscience- based treatment refusals without jeopardizing the foundations of pluralistic medical professionalism. I believe that medical professionals functioning in pluralistic healthcare settings may be excused from providing certain information or services if they apologize to those in need of this aid, and if those in need of aid can be assured equitable access to the information or services in question. Note carefully, I am proposing conditions for excusing professionals who fail to maintain moral neutrality; I am not defending a right to conscience-based denials of healthcare, or ‘civil rights’ protections for refusers. . .Refusals to refer to other professionals or to transfer prescriptions are inexcusable.

Baker R. (Editorial) Conscience and the Unconscionable. Bioethics. 2009;23(5):350-352.

Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin

Ciaran T Bradley

Abstract
Recent legislation in Wisconsin mandating provision of emergency contraception to victims of sexual assault may create a conflict of conscience for some health care professionals. Although disputes exist over the exact mechanism of action of emergency contraception, those professionals who espouse a particularly strict stance may be reluctant to dispense the medication for fear that it could prevent a fertilized embryo from implanting in the uterus. While no objection of conscience clause was written into the new law, Wisconsin law has a long tradition of recognizing rights of conscience in matters of religious conflict. This legal tradition both at statutory and common law levels is summarized with application to the recent emergency contraception mandate. A case is made for a potential legal defense should a health care professional abstain from dispensing emergency contraception.

Bradley CT. Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin. Wis Med J. 2009 May; 108(3):156-160

Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical

Bernard M Dickens

Abstract
The right to conscientious objection is founded on human rights to act according to individuals’ religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. They are required, however, to be equally respectful of rights to conscience of patients and potential patients. They cannot invoke their human rights to violate the human rights of others. There are legal limits to conscientious objection. Laws in some jurisdictions unethically abuse religious conscience by granting excessive rights to refuse care. In general, healthcare providers owe duties of care to patients that may conflict with their refusal of care on grounds of conscience. The reconciliation of patients’ rights to care and providers’ rights of conscientious objection is in the duty of objectors in good faith to refer their patients to reasonably accessible providers who are known not to object. Conscientious objection is unethical when healthcare practitioners treat patients only as means to their own spiritual ends. Practitioners who would place their own spiritual or other interests above their patients’ healthcare interests have a conflict of interest, which is unethical if not appropriately declared.

Dickens BM. Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical. Med Law. 2009;28(2)337-347.

Conscientious Objection: Resisting Ethical Aggression in Medicine

Sean Murphy

Responding to Cantor, Julie D., Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine. N Eng J Med 360;15, 9 April, 2009

Extract
Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong.

She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant. At least, that is the inference to be drawn from her warning that health care “could grind to a halt” if a federal protection of conscience regulation were “[t]aken to its logical extreme.”

Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. If anything, this demonstrates that health care is provided to many Americans – and many of the poorest Americans – because of the commitment of health care workers to their moral convictions, not in spite of them.

Murphy S. Conscientious Objection: Resisting Ethical Aggression in Medicine [Internet]. Protection of Conscience Project (2009 Apr 17).

Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine

Julie D Cantor

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. . . .Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.

Cantor JD. Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine. N Engl J Med. 2009 Apr 09;360(15):1484-1485.

Autonomy, religion and clinical decisions: findings from a national physician survey

RE Lawrence, Farr A Curlin

Abstract
Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined.

Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions.

Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8).

Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature.

Lawrence RE, Curlin FA. Autonomy, religion and clinical decisions: findings from a national physician survey. J Med Ethics. 2009;35, 214-218.

Euthanasia policy and practice in Belgium: Critical observations and suggestions for improvement

Raphael Cohen-Almagor

Abstract
The essay opens with some background information about the context of euthanasia in Belgium. It proceeds by discussing the Belgian law on euthanasia and concerns about the law, its interpretations and implementation. Finally, the major developments and controversies since the law came into effect are discussed. Suggestions as to how to improve the Belgian law and circumscribe the practice of euthanasia are made, urging Belgian legislators and the medical establishment to reflect and study so as to prevent potential abuse of vulnerable patients.

The article’s methodology is based on critical review of the literature supplemented by interviews I conducted in Belgium with leading scholars and practitioners in February 2003 and February 2005. The interviews were conducted in English, usually in the interviewees’ offices. The interviews were semi-structured. I began with a list of twenty-four questions but did not insist on answers to all of them if I saw that the interviewee preferred to speak about subjects that were not included in the original questionnaire. The length of interviews varied from one to two and a half hours. After completing the first draft I sent the manuscript to my interviewees as well as to some leading experts for critical review and comments. The comments received were integrated into this final version of the essay. In 2008, while writing the final draft, I approached my interviewees and some other well-known experts and invited their comments and updates. Responses received by mid-January 2009 were integrated into the article.

Cohen-Almagor R. Euthanasia policy and practice in Belgium: Critical observations and suggestions for improvement. Issues Law Med. 2009 Spring;24(3):187-218.