Protection of Conscience Project Library
Service, not Servitude
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This article attempts to engage only in a discussion of the ethical dimensions of mandatory overtime; the economic and empirical discussions are left for others to explore. Using the framework of “conscience,” we can begin to see some of the dynamics underlying the almost visceral reaction of some nurses to the issue of mandatory overtime.
Charles J. Mandatory Overtime: Conflicts of Conscience. JONA’s Healthcare Law, Ethics Reg. 2002;4(1):10-12.
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In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise
Broeckaert B, Janssens R. Palliative Care and Euthanasia: Belgian and Dutch Perspectives. Ethical Perspectives 9(2-3); 2002 Feb 01, 156-175
Abstract
Objectives: To determine emergency department (ED) practitioner willingness to offer emergency contraception (EC) following sexual assault and consensual sex, and to compare responses of practitioners from states whose laws permit the refusal, discussion, counseling, and referral of patients for abortions (often called “opt-out” or “abortion-related conscience clauses”) with those of practitioners from states without these laws.
Methods: Using a structured questionnaire, a convenience sample of ED practitioners attending a national emergency medicine meeting was surveyed.
Results: The 600 respondents were: 71% male, 29% female; 34% academic, 26% community, and 33% resident physicians; and 7% nurse practitioners and physician assistants. Many respondents (88%) were inclined to offer EC to those sexually assaulted by unknown assailants. More practitioners said they were willing to offer EC if the assailant was known to be HIV-infected rather than if the assailant had low HIV risk factors (90% vs. 79%, p < 0.01). More respondents would prescribe EC after sexual assault than consensual sex (88% vs. 73%, p < 0.01). The rates of willingness to offer EC were the same for practitioners in states with “abortion-related conscience clauses” and those from other states.
Conclusions: Most ED practitioners said they were willing to offer EC. Although the risk of pregnancy exists after consensual sex, practitioners were less willing to prescribe EC after those exposures than for sexual assault. “Abortion-related conscience clauses” did not seem to influence willingness to offer EC.
Keshavarz R, Merchant RC, McGreal J. Emergency contraception provision: a survey of emergency department practitioners. Acad Emerg Med. 2002 Jan;9(1):69-74.
Abstract
From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. . . . The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice’s position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.
Kissling F. The place for individual conscience. J Med Ethics. 2001 Oct;27(suppl II):ii24-ii27.
Abstract
Op 20 maart 2001 werd het euthanasiewetsvoorstel van de meerderheidspartijen, samen met een wetsvoorstel over palliatieve zorg, goedgekeurd door de Verenigde Commissies voor Justitie en Sociale Aangelegenheden. Op initiatief van de Senaatsvoorzitter werd het euthanasiewetsvoorstel intussen doorgestuurd naar de Raad Van State, voor een spoedadvies. In zijn advies (2 juli 2001) stelt de Raad Van State uitdrukkelijk dat het euthanasiewetsvoorstel niet in strijd is met artikel 2 van het Europees Verdrag over de Rechten van de Mens (EVRM) en artikel 6 van het Internationaal Verdrag inzake Burgerlijke en Politieke Rechten (IVBPR), artikels die handelen over het door de wet beschermde recht op leven. Wat betreft het euthanasievoorstel beperkt de Raad van State zich tot detailkritiek.
In de bespreking van het wetsvoorstel over palliatieve zorg is de toon heel anders: hier toont de Raad Van State zich bijzonder kritisch. Vragen worden onder meer gesteld bij de vaagheid van de term palliatieve zorg, bij gecontroleerde sedatie en bij de federale bevoegdheid wat betreft de palliatieve zorg. Na het zomerreces is het nu (van 23 tot 25 oktober 2001) aan de plenaire vergadering van de Senaat om zich over het euthanasiewetsvoorstel uit te spreken.
Met de onderstaande tekst (26 september 2001) wil de Federatie Palliatieve Zorg Vlaanderen haar voorstel om in de euthanasieprocedure een palliatieve filter in te bouwen nogmaals onder de aandacht van de Senatoren brengen.
[Translation] On March 20, 2001, the euthanasia bill proposed by the majority parties, along with a bill on palliative care, was approved by the United Committees on Justice and Social Affairs. At the initiative of the Senate President, the euthanasia bill has now been forwarded to the Council of State for urgent advice. In its advice (July 2, 2001), the Council of State expressly states that the euthanasia bill does not conflict with Article 2 of the European Convention on Human Rights (ECHR) and Article 6 of the International Covenant on Civil and Political Rights ( ICCPR), articles dealing with the right to life protected by law. With regard to the euthanasia proposal, the Council of State restricts itself to detailed criticism.
In the discussion of the bill on palliative care, the tone is very different: the Council of State is particularly critical here. Questions are asked about the vagueness of the term palliative care, about controlled sedation and about the federal competence with regard to palliative care. After the summer recess, it is now (from 23 to 25 October 2001) up to the plenary session of the Senate to pronounce on the euthanasia bill.
With the text below (September 26, 2001), the Federation Palliative Care Flanders wants to bring its proposal to include a palliative filter in the euthanasia procedure once again to the attention of the Senators.
Broeckaert B. Federatie Palliatieve Zorg Vlaanderen Pleit Voor Een Palliatieve Filter in de Euhanasie Procedure (Flanders Palliative Care Federation Advocates A Palliative Filter in the Euthanasia Procedure). Ethische perspectieven. 2001;11(3):171-176.
Abstract
Despite nearly 50 years of experience with living kidney donation, ethical questions about this practice continue to haunt us today. In this editorial I will address two of them: (1) Given the possibility of limited understanding and coercion, how can we be sure that a person who offers to donate an organ is acting autonomously? and (2) Do people have a right to donate? The universal requirement for informed consent is the traditional method for ensuring that a person is acting autonomously. But, while obtaining fully informed consent is desirable, it may not always be achievable or necessary. When the recipient is very dear to the potential donor, the donor may base his decision primarily on care and concern rather than on a careful weighing of risks and benefits. I will argue that consent that emanates from such deep affection should be considered just as valid as consent that is fully informed. But consent is not enough. There is no absolute right to donate an organ. If there were such a right, then some physician would be obligated to remove an offered organ upon request, regardless of the risks involved. I do not believe that physicians have such an obligation. Physicians are moral agents who are responsible for their actions and for the welfare of their patients. Therefore, while the values and goals of the potential donor should be given great weight during the decision-making process, physicians may justifiably refuse to participate in living organ donation when they believe that the risks for the donor outweigh the benefits..
Spital A. Ethical issues in living organ donation: donor autonomy and beyond. Am J Kidney Dis. 2001 Jul;38(1):189-195.
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Having read the well-written article by Laura Eggertson, I feel that her thrust (and that of Planned Parenthood, the Canadian Abortion Rights Action League, Health Minister Allan Rock, etc.) is that it is a scandal and surprise that a “medically necessary” operation — abortion — is not universally accepted like other procedures You do not hear most of the old debating arguments about abortion any more, but the one that will not go away concerns whether abortion is a medically necessary operation. . . .Abortion is both a moral and a medical issue, and we should not be surprised if people do not regard it as a necessary procedure in the same way they view other operations.
Coffey PG. (Correspondence) The abortion issue. Can Med Assoc J. 2001 Jul 10;165(1):14-15.
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Your homey analogy of abortion as a patchwork quilt — a warm, comforting and maternal object if ever there was one — furthers the dishonourable tradition of euphemizing the medicalized killing of small human beings. . . CMA members remain deeply divided on these issues. An even-handed editorial and reporting style would show respect for this diversity of opinion.
Johnston W. (Correspondence) The abortion issue. Can Med Assoc J. 2001 Jul 10;165(1):15.
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“Conscience clauses,” protecting the free exercise of religion in ethical decision-making by religiously affiliated hospitals, I believe, should continue to be absolute in reproductive medicine where the hospitals are clearly and unmistakably religious and patient choices of providers are free and fully informed. This conclusion is compelled by the free exercise clause of the First Amendment, as well as by the national interest in preserving and promoting diversity in the voluntary health care sector.
Bassett WW. Private Religious Hospitals: Limitations Upon Autonomous Moral Choices in Reproductive Medicine. J Contemp Health Law Policy. 2001;17:455-583.
Abstract
. . . an emphasis on oversight and compliance misses the point. By overly focusing on making sure that rules are followed, we push researchers away from a real appreciation for issues and into doing whatever it takes to expedite the oversight process. This approach can cause researchers to quickly lose sight of the point of research protections – the rights and interests of the subjects themselves.
Kahn JP. Moving From Compliance to Conscience: Why We Can and Should Improve on the Ethics of Clinical Research. Arch Intern Med. 2001 Apr 09;161(7) 925-928.