Extract Medicine depends on more than competence and expertise, essential as these are. It cannot function as an institution without good faith on the part of provider, patient and the public as a whole. The root of the public’s trust is the confidence that physicians will put patients’ welfare ahead of all other considerations, even the patients’ momentary wishes or the physicians’ monetary gain. It is the function of medicine as a profession to safeguard and promote this trust in the society at large. This point could be phrased as a maxim: “Medicine must always be treated as a public good, never as a commodity.” . . . medicine must take the lead in a public conversation about the profession’s contract with society. If it does not, that contract is likely to be redefined in terms, and in a language, quite antithetical to the core concerns of medicine.
Abstract This contribution deals with the issue of the professional autonomy of the medical doctor. Worldwide, the physician’s autonomy is guaranteed and limited, first of all, by Codes of Medical Ethics. In Italy, the latest version of the national Code of Medical Ethics (Code 1998) was published in 1998 by the Federation of provincial Medical Asso- ciations (FNOMCEO). The Code 1998 acknowledges the physician’s autonomy regarding the scheduling, the choice and application of diagnostic and therapeutic means, within the principles of professional responsibility. This responsibility has to make reference to the following fundamental ethical principles: (1) the protection of human life; (2) the protection of the physical and psychological health of the human being; (3) the relief from pain; (4) the respect for the freedom and the dignity of the human person, without discrimination; (5) an up-to-date scientific qualification (Art. 5). The authors underline that autonomy is an anthropological – and consequently ethical – characteristic of the human person. Different positions on autonomy in bioethics (individualistic, evolutionistic, utilitarian and personalistic models) are explained. The relation between the professional autonomy of the physician and the autonomy of the patient and of colleagues is discussed. In fact, the medical doctor is obliged: (1) to respect the fundamental rights of the person, first of all his/her life; (2) to ensure the continuity of the care, even if he can only relieve the patient’s suffering; (3) to maintain, except under certain circumstances, professional secrecy and confidentiality regarding patients and their medical records. Moreover, the physician cannot deny the patient correct and appropriate information. He/she should not perform any diagnostic or therapeutic activity without the informed consent of the patient and the medical doctor must give up medical treatment in case of documented refusal of the individual. Furthermore, the medical doctor has the right to raise conscientious objections if he/she is requested to perform medical actions that are contrary to his/her conscience or medical opinion, unless this attitude would seriously and immediately harm the patient. Regarding the relationships with colleagues, the physician is obliged to solidarity, mutual respect, and care of sick colleagues. Finally, the authors discuss the Italian legislation affecting the physician’s professional autonomy: (1) the SSN health care Acts; (2) the so- called Charter for Public Health Care Services; (3) the Acts on privacy; (4) Good Clinical Practice.
Extract Ask your pharmacist: It’s the ubiquitous slogan of the past decade, underscoring the campaigns of most national and provincial pharmacy organizations as they promote the value of pharmacy services. But what if the question is about RU-486, the abortion drug, or Preven, the morning-after-pill? What if the question is from a physician seeking information on terminal sedation or assisted suicide?
Such questions push, and often breach, an ethical boundary for some pharmacists, who find their desire to help the patient in conflict with their moral convictions. And the ethical quagmire is likely to get deeper as advocacy groups press the federal government to allow physician-assisted suicide and various health organizations promote greater access to emergency postcoital contraception.
If these practices compromise your moral convictions, could you be fired by your employer for refusing to fill a prescription? More specifically, is there a point at which your personal beliefs supersede your obligation to the patient? That’s the difficult question posed by an Alberta-based group called Concerned Pharmacists for Conscience, which has suggested a conscience clause to protect pharmacists in such situations.
Abstract The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients’ treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities..
Abstract In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.
Abstract Patients who refuse a specific medical treatment for religious reasons must often overcome strongly entrenched presumptions held by physicians and judges, presumptions frequently based on personal values. A case in point is the refusal of blood transfusion therapy by Jehovah’s Witnesses. This paper rests on the following theory: The sanctity of life principle is not necessarily violated by respecting the autonomous decision of a patient who, for religious or moral reasons, chooses one therapy over another that may be favored by the treating physician. Where a patient has decided for conscientious reasons against a certain treatment in any given medical situation, the need to be informed will shift from the patient to the physician. The physician must understand the nature of the religious or moral conviction as well as his own moral and legal obligation to respect the patient’s wishes by providing the best Medical care under the circumstances.
Extract More specifically, this article explores the question: Is it morally permissible for a lawyer to decline representation of a prospective client who seeks to obtain a legal but immoral objective, if the lawyer reasonably believes that the prospective client will be otherwise unable to obtain legal representation?
Extract Bruce Ackerman’s “We The People: Transformations” is elegantly conceived, theoretically clever, rhetorically inventive, and empirically convincing, but it remains ideologically inadequate. . . . In the absence of attention to how people in the United States have come to think about a higher law, Ackerman has fallen back on a Whiggish view where love of liberty and justice is assumed to be part of the human endowment, at least of American humans. Fused convictions about democratic governance and liberal aspirations motivate Ackerman’s We the People. . . . This Whiggish overlay upon the argument of Transformations appears most strikingly in the discussion of Reconstruction, in which all acts are optimized-whether those of intransigent Radical Republicans or white supremacist Southern Redeemers. Some higher force is orchestrating this partisan cacophony into a melodious resolution. . . . I will pose the proposition that two higher law concepts have polarized American politics from Alexander Hamilton through Ronald Reagan, and that they need to be put into the picture of Ackerman’s grand transformative moments.
Abstract Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.
Extract It appears that on many characteristics there are significant differences among members and non-members of HECs. Whether it be a self-selection bias or some other factor, whatever is at work on the composition of HECs seems to have a profound effect pulling toward homogeneity of the membership. This is not necessarily bad if it leads to the best ethical thinking in the institution. It does, however, give pause for thought considering the current widespread emphasis on cultural diversity in society. If diversity is thought to be desirable, is such homogeneity within HECs appropriate?
