Ethics Archives - Page 27 of 81 - Protection of Conscience Project Library

When Doctors Break the Rules: On the Ethics of Physician Noncompliance

Jeffrey Blustein

Cambridge Quarterly of Healthcare Ethics

Abstract
Avoiding complicity in injustice is not limited to engaging in acts of noncompliance on behalf of one’s patients. The injustices from which one’s patients suffer may be rooted in morally suspect norms to which the profession of medicine, or some influential part of it, has lent its support or that it has not opposed and from which it and its practitioners have benefited. There may also be injustices that the profession has condemned but that remain. In general, avoiding complicity in wrongdoing involves, as a base- line, understanding that the norms and practices responsible for it have contributed to making noncompliance an option that at least deserves serious moral consideration, if not endorsement. A physician may then decide to engage in some form of rule breaking in order to act on this understanding and express her refusal to be complicit.. . .Complicity threatens the moral and professional integrity of the physician, and noncompliance may be warranted in part because it is the only way that a physician can meet the threat.

Blustein J. When Doctors Break the Rules: On the Ethics of Physician Noncompliance. Camb Q Healthc Ethics. 2012;21(02):249-259.

After-birth abortion: Why should the baby live?

Alberto Giubilini, Francesca Minerva

Abstract
Abortion is largely accepted even for reasons that do not have anything to do with the fetus’ health. By showing that (1) both fetuses and newborns do not have the same moral status as actual persons, (2) the fact that both are potential persons is morally irrelevant and (3) adoption is not always in the best interest of actual people, the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.

Giubilini A, Minerva F. After-birth abortion: Why should the baby live?. J Med Ethics. 2013;39(5):261-263.

Conscience Rules: Implications for Care

Ryan Blum

Extract
On February 18, the Department of Health and Human Services issued a rule, “Regulation for the Enforcement of Federal Health Care Provider Conscience Protection Laws,” that limits health care providers’ power to shape their practice by personal conviction. The rule narrows possible conscientious objection significantly, protecting patients’ rights and in the process eliminating public reinforcement of the harmful idea that religion and medicine are always destined to diverge.

Blum R. Conscience Rules: Implications for Care. Hastings Cent Rep 2011;41(3):c3.

What makes killing wrong?

Walter Sinnott-Armstrong, Franklin G Miller

Abstract
What makes an act of killing morally wrong is not that the act causes loss of life or consciousness but rather that the act causes loss of all remaining abilities. This account implies that it is not even pro tanto morally wrong to kill patients who are universally and irreversibly disabled, because they have no abilities to lose. Applied to vital organ transplantation, this account undermines the dead donor rule and shows how current practices are compatible with morality.

Sinnott-Armstrong W, Miller FG. What makes killing wrong? J Medical Ethics 2013;39:3-7.

(Correspondence) Should doctors feel able to practise according to their personal values and beliefs?

Murat Civaner

Extract
The moral problem related to defining a space for personal values in medical care is that they may conflict with professional values, legitimising discrimination. Then it would be nearly impossible to criticise doctors and institutions that refuse abortion, do not examine patients of the opposite sex on religious grounds, and refuse to operate on HIV-positive patients or to treat people with different political affiliations. It would be hard to call that kind of environment a “healthy diversity”.

Civaner M. (Correspondence) Should doctors feel able to practise according to their personal values and beliefs?. Med J Aust. 2012 Feb 06;196(2):109.

(Correspondence) Should doctors feel able to practise according to their personal values and beliefs?

William R Adam

Extract

Clinicians have to be prepared to go to court to put their case for the best interests of the child, and then accept the legal decision with good grace, however personally distressing. This is just another example in medicine of the need for all to work with less than desirable outcomes.

Adam WR. (Correspondence) Should doctors feel able to practise according to their personal values and beliefs? Med J Aust. 2012;196(2):109.

The Harmony Between Professional Conscience Rights and Patients’ Right of Access

Matthew S Bowman, Christopher P Schandevel

Abstract
“Access” is the new catchphrase for expanding privacy rights. This shift moves from seeking merely legalization, to demanding government assistance and the participation of private citizens. . . . This article will begin by examining the chief access arguments being used against conscience protections today: that the health professionals hold a monopoly so they are bound to offer abortion, that health professionals must defer their pro-life consciences to abortion’s legal status, and that health professionals must not impose their pro-life views. The article will conclude that, if access principles really flowed from a neutral concern for patient choices, they would require rather than strike down conscience protections. In many cases patients desire in their physicians the traditional Hippocratic values that unequivocally support human life and therefore oppose participating in activities such as abortion. The right of patients to access such physicians can only exist by guaranteeing the right of physicians to practice according to those values.

Bowman MS, Schandevel CP. The Harmony Between Professional Conscience Rights and Patients’ Right of Access. Social Science Research Network. 2012;1-39.

In Defense of Ectogenesis

Anna Smajdor

Extract
In his article ‘‘Research Priorities and the Future of Pregnancy’’ in this issue of CQ, Timothy Murphy evaluates some of the arguments I advanced in an earlier publication, ‘‘The Moral Imperative for Ectogenesis.’’ In this reply to Murphy’s article, I acknowledge some of his points and seek to show why some of his objections are not as powerful as he thinks. I start here by summarizing the argument put forward in my original article.

Smajdor A. In Defense of Ectogenesis. Camb Q Healthc Ethics (2012) 21 , pp 90-103

“It’s a girl!” could be a death sentence.

Rajenda Kale

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
When Asians migrated to Western countries they brought welcome recipes for curries and dim sum. Sadly, a few of them also imported their preference for having sons and aborting daughters. Female feticide happens in India and China by the millions, but it also happens in North America in numbers large enough to distort the male to female ratio in some ethnic groups.1^–4 Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups?

Kale R. “It’s a girl!” could be a death sentence. CMAJ January 16, 2012, doi: 10.1503/cmaj.120021

(Correspondence) Should doctors feel able to practise according to their personal values and beliefs?

Peter C Arnold

Extract
“Do doctors have the right to refuse certain treatments on the grounds of personal conscience?” Is the question asking about Conway’s point about what the doctor sincerely, on medical grounds, considers to be in the patient’s best interests, or is the question asking about a doctor’s refusal to attend to a patient on the basis of some irrational prejudice? Horses of quite different colours — racing in different races.

Arnold PC. (Correspondence) Should doctors feel able to practise according to their personal values and beliefs? Med J Aust. 2012;196(1):38. Available from: