Ethics Archives - Page 50 of 87 - Protection of Conscience Project Library

When an adult female seeks ritual genital alteration: Ethics, law, and the parameters of participation

Julie D Cantor

Abstract
Ritual genital cutting for women, a common practice in Africa and elsewhere around the world, remains dangerous and controversial. In recent years, a 14-year-old girl living in Sierra Leone exsanguinated and died following a ritualistic genital cutting. Hoping to avoid that fate, women with backgrounds that accept ritual genital cutting may, when they reach majority age, ask plastic surgeons to perform genital alterations for cultural reasons. Although plastic surgeons routinely perform cosmetic procedures, unique ethical and legal concerns arise when an adult female patient asks a surgeon to spare her the tribal elder’s knife and alter her genitalia according to tradition and custom. Misinformation and confusion about this issue exist. This article explores the ethical and legal issues relevant to this situation and explains how the thoughtful surgeon should proceed.

Cantor JD. When an adult female seeks ritual genital alteration: Ethics, law, and the parameters of participation. Plast Reconstr Surg. 2006 Apr 01;117(4):1158-1164.

Physician Participation in Executions: Care Giver or Executioner?

Peter A Clark

Abstract
The fear of many is that some physicians have been co-opted by the penal authorities and state legislatures in this country to believe that physician participation is a civic duty and one that is in the prisoner’s best interest. In reality, these physicians are being used as a means to an end. They are being used by certain states to medicalize executions in order to make them more palatable to the American public and to prevent capital punishment from being declared unconstitutional because it is “cruel and unusual punishment.” A basic tenet of the principle of respect for persons is that one may never use another person as a means to an end. Legislating that physicians must be present at executions uses these physicians as pawns, or means, in order to legitimize capital punishment. This not only violates the rights of these physicians but violates the basic ethical principles of the medical profession and distorts the physicians’ role in society.

Clark PA. Physician Participation in Executions: Care Giver or Executioner?. J Law Med Ethics. 2006 Spring;34(1)95-104.

Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept

Anita Catlin, Deborah Volat, Mary Ann Hadley, Ranginah Bassir, Christine Armigo, Elnora Valle, Wendy Gong, Kelly Anderson

Abstract
This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, fi.itility, and the concept of conscientious objection from the perspective of the nurse’s potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.

Catlin A, Volat D, Hadley MA, Bassir R, Armigo C, Valle E et al. Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept. Neonatal Netw. 2008 Mar;27(2):101-108. Available from:

An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary

Brian P Knestout

Journal of Contemporary Health Law and Policy

Extract
Conclusion
. . . The only solution to this dilemma may be the solution that the APhA suggested, namely, to endorse a conscience clause, but simultaneously require pharmacists to refer a valid prescription to another service provider. Those members of the profession who bear the burden of this course of action are those who believe that a referral is equivalent to the act itself. However, such a view safeguards most of the ethical goals of pharmacists while simultaneously serving the public need for effective provision of legally prescribed drugs.

Knestout BP. An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary. J Contemp Health Law Pol. 2006 Spring;22(2):349-382.

(Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics

Frank A Chervenak, Laurence B McCullough

British Medical Journal, BMJ — British Medical Journal

Extract
Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.

Chervenak FA, McCullough LB. (Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics. Br Med J. 2006 Feb 18;332(7538):425.

(Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience

Vaughn P Smith

Extract
Since visiting Auschwitz, I have grappled with the question of how I would have behaved as a doctor in Nazi Germany or Stalinist Russia. I hope I would have had the moral courage to refuse to participate in the various perversions of medicine that these regimes demanded — for example, respectively, eugenic “research” and psychiatric “treatment” of dissidents. . . . My chances of behaving honourably would have been
greatest if I had felt part of an independent medical profession with allegiance to something higher and more enduring than the regime of the day. They would have been least if Savulescu’s opinions had prevailed . . .After 30 years of reading the BMJ, Sava-
lescu’s article was the first one to make me feel physically sick.

Smith VP. (Correspondence) Conscientious objection in medicine: Doctors’ freedom of conscience. Br Med J. 2006 Feb 18;332(425)

(Correspondence) Conscientious objection in medicine: the ethics of responding to bird flu

E Murray, P de Zulueta

Extract
We question Savulescu’s statement that a specialist valuing her own life more than her duty to her patients during a bird flu epidemic would be demonstrating values “incompatible with being a doctor.” . . . recklessly to treat a highly contagious individual without taking adequate precautions would be imprudent and irresponsible. Equity and fairness requires a professional to judiciously balance the needs of one patient with the needs of others, including those of his or her own family.

Murray E, de_Zulueta P. Conscientious objection in medicine: the ethics of responding to bird flu. Br Med J. 2006;332(7538):425.

Conscientious objection in medicine

Julian Savulescu

Extract
Shakespeare wrote that “Conscience is but a word cowards use, devised at first to keep the strong in awe” (Richard III V.iv.1.7). Conscience, indeed, can be an excuse for vice or invoked to avoid doing one’s duty. When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient’s good and the patient’s informed desires (box). If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.

Savulescu J. Conscientious objection in medicine. BMJ. 2006 February 4; 332(7536): 294–297. doi: 10.1136/bmj.332.7536.294

Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection

Gamal I Serour, International Federation of Gynecology and Obstetrics (FIGO)

International Journal of Gynecology & Obstetrics

Abstract
The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health held a combined meeting with the Committee of Women’s Sexual and Reproductive rights to discuss ethical aspects of issues that impact the discipline of Obstetrics, Gynecology, and Women’s Health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Serour GI, FIGO. Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection. Int J Gyn Ob. 2006 Feb 03;92(3):333-334.

On Whose Conscience? Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care

Patricia L Selby

Extract
In 2004 the Michigan House passed a bill called the “Conscientious Objector Policy Act.”. . . The bill as passed reflected no balancing of or respect for patients’ rights to autonomy, or their other needs and interests.

This article traces brief histories of health care conscience clauses and the patient’s right to informed consent. It analyzes the bill in the context of patients’s rights, and proposes alternative approaches to restore balance to the patient-provider relationship, while maintaining providers’ right to conscience. The article’s final section evaluates a variety of potential legal challenges to protect patients if the bill is re-introduced unchanged.

Selby PL. Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care. U Detroit Mercy Law Rev. 2006;83(4):507-541.