Gary W Clark, Kelly Latimer, Richard W Sams II, Gordon Zubrod
Family Medicine
Extract Abortion training for residents is not simply a “politically charged” issue, as the authors assert. It is a moral or ethical issue. As faculty physicians in family medicine residency programs, we oppose the introduction of abortion training on moral, not political grounds. German physicians “politicized” euthanasia and ultimately killed 200,000 mentally ill and disabled persons from 1939–1945.
Extract As we gear up to provide the basket of services important to our patients in the Future of< Family Medicine, residencies need the information in these articles to be able to best design and implement abortion training. Residents with a strong experience in reproductive health, including abortion, will be best suited to meet the needs of the women they will meet in their future practices.
Journal of Family Planning and Reproductive Health Care
Abstract Background and methodology Community pharmacists’ role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists’ expertise but little is known about pharmacists’ attendant ethical concerns. Semi-structured qualitative interviews were undertaken with 23 UK pharmacists to explore their views and ethical concerns about EHC.
Results Dispensing EHC was ethically acceptable for almost all pharmacists but beliefs about selling EHC revealed three categories: pharmacists who sold EHC, respected women’s autonomy and peers’ conscientious objection but feared the consequences of limited EHC availability; contingently selling pharmacists who believed doctors should be first choice for EHC supply but who occasionally supplied and were influenced by women’s ages, affluence and genuineness; non-selling pharmacists who believed EHC was abortion and who found selling EHC distressing and ethically problematic. Terminological/factual misunderstandings about EHC were common and discussing ethical issues was difficult for most pharmacists. Religion informed non-selling pharmacists’ ethical decisions but other pharmacists prioritised professional responsibilities over their religion.
Discussion and conclusions Pharmacists’ ethical views on EHC and the influence of religion varied and, together with some pharmacists’ reliance upon non-clinical factors, led to a potentially variable supply, which may threaten the prompt availability of EHC. Misunderstandings about EHC perpetuated lay beliefs and potentially threatened correct advice. The influence of subordination and non-selling pharmacists’ dispensing EHC may also lead to variable supply and confusion amongst women. Training is needed to address both factual/terminological misunderstandings about EHC and to develop pharmacists’ ethical understanding and responsibility.
Extract Physicians who fail to act in their patient’s interests breach the fundamental duty of care of a physician. It is negligent to deny a person who would benefit a blood transfusion, a vaccination, an abortion, intensive care or sedation at the end of their life. Physicians should not play God. If they morally disagree with some medical treatment, they can give their reasons to their patients and they can take that debate to the level of law and professional bodies. But in a liberal society they should not inflict their judgments on their patients. Physicians can disagree, but they should not dictate.
Extract Conscience and conscientious objection or moral justification are social activities not just Individualistic, “do-it-yourself” moralities. This requires education, training and intentional moral development and active input and encouragement. It is not just a matter of our moral biases but of awareness of the different applications of such principles and perspectives to particular situations and cases and of how to respond to moral critique and alternative conscientious grounds and beliefs.
Extract Contrary to what Lawrence and Curlin (2007) suggest, it is not primarily disagreement about the nature of “the conscience” that underlies the controversy about whether and when health professionals should be allowed to refuse to provide services that violate their ethical beliefs. Rather, the primary source of disagreement is over the professional obligations of physicians, pharmacists and other healthcare providers and how to resolve conflicts between those obligations and healthcare professionals’ interest in maintaining their moral integrity.
Extract The strength of the nondualistic-approach is that it will contribute to “meaningful dialogue about the role of the conscience” which depends on “shared definitions of the relevant terms” (Lawrence and Curlin 2007, 10). This approach of “shared definitions” can also be termed commensurability— when two people who hold incommensurable values can create common ground when one or both changes their values, empathize or agree to disagree and work towards a common goal (Glenn 2003). . . The alternative to seeking commensurability is the enforcement of a law, which is a solution that does not always resolve the underlying issues. The legal system devotes many resources to the resolving of problems, but the result is often “winner-take-all”—without regard to the long-term consequences and impact on the relationship of the parties.
Abstract In a perfect world, acting conscientiously would always be compatible with acting in conformity with the conscience. But ours is not a perfect world; in the context of healthcare, acting conscientiously may require acting against the conscience. For the conscience is sometimes unreliable and cannot serve as a guiding principle where public health is at stake. Defining the conscience does not change that, nor does it offer a justification for conscientious objection. To deliver responsible healthcare, physicians must act conscientiously.
Extract Lawrence and Curlin (2007) correctly note that not all disputants agree about what conscience is. However, I doubt that their distinction is as important as they think. I believe that understanding the distinctions just discussed is far more likely to lead to a satisfactory conclusion. If advocates of conscientious objection for medical professionals attended to these distinctions, they would see that what they want cannot be justified, at least not in the unqualified form most of them advocate.
Extract The first way to avoid the problems that conscience raises is. . . that physicians and others be required to tell patients what areas of practice would be against their conscience. A second way is not to license physicians, pharmacists or others who will refuse to involve themselves in certain areas of medicine because of conscience. Because the practice of medicine (and pharmacy, etc.) is a social role and society already exercises some control over who may legally perform these roles, adding requirements is not such a radical idea.
