Ethics Archives - Page 39 of 81 - Protection of Conscience Project Library

Is conscientious objection incompatible with a physician’s professional obligations?

Mark R Wicclair

Abstract
In response to physicians who refuse to provide medical services that are contrary to their ethical and/or religious beliefs, it is sometimes asserted that anyone who is not willing to provide legally and professionally permitted medical services should choose another profession. This article critically examines the underlying assumption that conscientious objection is incompatible with a physician’s professional obligations (the “incompatibility thesis”). Several accounts of the professional obligations of physicians are explored: general ethical theories (consequentialism, contractarianism, and rights-based theories), internal morality (essentialist and non-essentialist conceptions), reciprocal justice, social contract, and promising. It is argued that none of these accounts of a physician’s professional obligations unequivocally supports the incompatibility thesis.

Wicclair MR. Is conscientious objection incompatible with a physician’s professional obligations? Theor Med Bioeth. 2008;29(3):171-185.

Conscience and clinical practice: Medical ethics in the face of moral controversy

Farr A Curlin

Abstract
Physicians sometimes refuse to provide legally permitted medical services on the grounds that they cannot do so in good conscience. Such conscientious refusals are at least as old as the Hippocratic movement. Yet new events, such as the refusal by health care professionals to prescribe or dispense post-coital (‘‘emergency’’) contraception, have kindled new debates about what physicians are obligated to do when patients request legal medical interventions to which their physicians have moral objections. In a recent national survey, we found that a large majority of physicians believe they are obligated in such circumstances to present all possible options to the patient, including information about obtaining the requested intervention, and to refer the patient to a clinician who does not object to the requested intervention. Yet a substantial minority of physicians—particularly those who are more religious and/or who themselves object to common controversial practices—disagree with these majority opinions.

Curlin FA. Conscience and clinical practice: Medical ethics in the face of moral controversy. Theor Med Bioeth. 2008;29(3):129-133.

Medically Assisted Death: Nancy B. v. Hotel-Dieu de Quebec

Bernard M Dickens

Abstract
In Nancy B. v. Hotel-Dieu de Quebec, the Quebec Superior Court held that a patient was legally entitled to discontinue and decline medical treatment when she found it unacceptable. The author discusses how this case is consistent with several other, decisions, yet distinguishable from certain Canadian decisions which contributed to its outcome. Through an analysis of Criminal Code provisions against homicide and on the duty to preserve life, the doctrine of informed consent, and related jurisprudence, the author argues that the Nancy B. decision narrows the gap between allowing a patient to suffer natural death and medically assisting death. The author also raises issues associated with the notion of medical futility. He concludes that “the Nancy B. case moves the discourse in medical ethics and law towards the feminist “carebased” paradigm and suggests that the carefully- circumscribed judicial response was an appropriate legal answer to the question of how best to care for Nancy B..

Dickens BM. Medically Assisted Death: Nancy B. v. Hotel-Dieu de Quebec. McGill Law Journal. 1993;38(1053-1070.

The ethics of direct and indirect referral for termination of pregnancy

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
Referral of pregnant patients for termination of pregnancy by physicians morally opposed to the procedure is ethically controversial, with polarized positions taken by physician organizations. Based on the ethical principles of beneficence and respect for autonomy, we establish the distinction between direct and indirect referral. Direct referral is beneficence based and requires the referring physician to ensure that the referral occurs. Indirect referral is autonomy based, with a beneficence-based component that requires that the physician provide information to the patient about health care organizations that will provide competent medical care. We show that only indirect referral is ethically required in healthy women for termination of an unwanted pregnancy or a pregnancy complicated by fetal anomalies because the indications for this procedure are solely autonomy based. Direct referral for termination of pregnancy is not ethically required but is permissible. Conscience-based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral do not.

Chervenak FA, McCullough LB. The ethics of direct and indirect referral for termination of pregnancy. Am J Obstet Gynecol. 2008 Jul 30;199(3):232.e1-232.e3.

Moral Courage Through a Collective Voice

(Ethics and Rural Healthcare)

Julie Aultman

Extract
In posing the question of whether it is morally right for the only pharmacist in town to refuse healthcare services based on his or the community’s religious convictions, I could not help but think of “the conscience clause.” While many states across the United States support the conscience clause, which protects healthcare professionals from discrimination when refusing to dispense birth control pills or performing abortions and sterilizations, such clauses have different implications in the rural setting.When a physician or pharmacist refuses to prescribe or dispense birth control pills, the urban patient is able to acquire birth control from another healthcare provider with less difficulty than the rural patient. The rural patient may have to drive a great distance to acquire birth control even if it is needed for a medical condition rather than to prevent pregnancy.

Aultman J. Moral Courage Through a Collective Voice (Ethics and Rural Healthcare). Am J Bioeth. 2008;8(4):67-69.

Physicians need freedom of conscience

Joseph Askin

Abstract
Medically trained English philosopher Dr. John Locke (1632-1704) held that freedom of conscience is the basis of individual rights, thereby limiting intrusion by the state into the lives of its citizens.

Askin J. Physicians need freedom of conscience. Medical Post. 2008;11-12

Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people

Christina Juthberg, Sture Eriksson, Astrid Norberg, Karin Sundin

Abstract
Aims. The aim was to study the relationship between conscience and burnout among care-providers in older care, exploring the relationship between stress of conscience and burnout, and between perceptions of conscience and burnout.

Background. Everyday work in healthcare presents situations that influence care-providers’ conscience. How care-providers perceive conscience has been shown to be related to stress of conscience (stress related to troubled conscience), and in county council care, an association between stress of conscience and burnout has been found.

Method. A questionnaire study was conducted in municipal housing for older people. A total of 166 care-providers were approached, of which 146 (50 registered nurses and 96 nurses’ aides/enrolled nurses) completed a questionnaire folder containing the stress of conscience questionnaire, the perceptions of conscience questionnaire and the maslach burnout inventory. Multivariate canonical correlation analysis was used to explore relationships.

Result. The relationship between stress of conscience and burnout indicates that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout (primarily to emotional exhaustion). The relationship between perceptions of conscience and burnout indicates that a deadened conscience is strongly related to burnout.

Conclusion. Conscience seems to be of importance in relation to burnout, and suppressing conscience may result in a profound loss of wholeness, integrity and harmony in the self.

Relevance to clinical practice. The results from our study could be used to raise awareness of the importance of conscience in care.

Juthberg C, Eriksson S, Norberg A, Sundin K. Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people. J Clin Nurs. 2008 Jun 10;17(14):1897-1906.

Russia: update on animal experiments and alternatives in education

Nick Jukes

Abstract
Progress continues in Russia with growing awareness and implementation of alternatives in education. Further outreach visits and negotiations for replacement have been made by InterNICHE campaigners. Russian language information resources have been complemented by the distribution of translated freeware physiology and pharmacology alternatives; and the InterNICHE Alternatives Loan Systems continue to provide valuable hands-on access to a range of learning tools. Donations of computers and alternatives have established exemplary multimedia laboratories, with software having directly replaced the annual use of several thousand animals. New agreements have been made with institutes to abandon animal experiments for teaching purposes. Work to consolidate the successes is being done, and Russian teachers have begun to present at conferences to share their experiences of implementation. Further development and implementation of alternatives is being achieved through grant funding from the InterNICHE Humane Education Award. Using a different approach, cases of determined conscientious objection have included a campaign against the use of stolen companion animals for surgery practice in the Russian Far East, and a continuing legal challenge to experiments at Moscow State University. This multi-pronged, decentralised and culturally appropriate campaigning strategy has proved to be an effective approach to achieving sustainable change in Russia..

Jukes N. Russia: update on animal experiments and alternatives in education. Alternatives to Animal Experimentation (ALTEX). 2008;25(1):56-62.

Anesthetizing the public conscience: lethal injection and animal euthanasia

(The Lethal Injection Debate: Law and Science)

Ty Alper

Extract
People are never executed using the anesthetic-only procedure that veterinarians and shelter workers use on animals. And animals are never euthanized by the three-drug formula prison officials use on human beings. As detailed in this Article, the veterinary and animal welfare communities widely condemn the use of neuromuscular blocking agents such as pancuronium. Particularly given the popular assumption that execution of humans by lethal injection is no different than “putting an animal to sleep,” the condemnation of the use of curariform drugs in the euthanasia context should give courts pause when assessing the risks of the three-drug formula under the Eighth Amendment. . . The Humane Society mandates a method of euthanasia the primary benefit of which is that it is actually humane. At a time when the public’s trust in the administration of capital punishment in this country appears to be eroding, the states, on the other hand, have clung to a method whose primary benefit is that it looks humane- but that in reality risks the unnecessary infliction of excruciating pain and suffering.

Alper T. Anesthetizing the public conscience: lethal injection and animal euthanasia (The Lethal Injection Debate: Law and Science). Fordham Urban Law J. 2008;35(4):817-856.

(Correspondence) LVADs and the Limits of Autonomy

Jeremy Simon, Ruth Fischbach

Extract
Jeremy Simon’s commentary argues that physicians may decline to deactivate an LVAD even at the request of a capable patient. . . . No doctor may be forced to act against her conscience to end a patient’s life. A physician moved by Simon’s argument would be covered by this doctrine. As for legal precedents, if there have been any cases regarding the removal of destination LVADs, there certainly have not been enough for the case law in this matter to be considered settled. . .

Simon J, Fischbach R. (Correspondence) LVADs and the Limits of Autonomy. Hast Cent Rep. 2008 May-June;5.