Extract While a fetus dies during an abortion, women also die when they don’t have access to proper reproductive services. People died in concentration camps and during civil rights protests. However, I would never compare reproductive issues to those historical events. . . . Regardless of which side we stand on in this debate, let’s not do an injustice to those who endured so much in WWII and in the United States during the 1950s and 1960s to allow us to have the freedom to have this debate. . . . Doing no harm may be impossible. Doing the lesser of harms is more achievable.
Extract The recent ethical guideline of the General Medical Council puts doctors in an impossible position. The giving of information or aiding someone to obtain a service the doctor considers immoral contravenes the essence of conscientious objection. The doctor’s right to have his moral code respected, provided that it isn’t spurious or lacking a credible evidence base, is a basic human right.
Extract In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?
Farr A Curlin, Chinyere Nwodim, Jennifer L Vance, Marshall H Chin, John D Lantos
American Journal of Hospice and Palliative Care
Abstract This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients.
Extract Religion has no monopoly on conscience, however. History, both distant and recent, shows how health-care providers and others, driven by conscientious concerns, can defy laws and religious opposition to provide care to vulnerable, dependent populations. They might also defy the medical establishment. Pioneers of the birth control movement were not doctors, and were opposed by medical, state, and religious establishments. As long ago as 1797, Jeremy Bentham advocated means of birth control, and in the following century, John Stuart Mill was briefly imprisoned for distributing birth control handbills. Charles Bradlaugh and Annie Besant were similarly prosecuted, in 1877, for selling pamphlets about birth control.
Extract In this work the institutionalisation of Hospital Ethics Committees in the USA and in Germany will be analysed by focussing on nurses’ participation and the representation of caring issues. Therefore, questions about the design of Hospital Ethics Committees and how their practices really look like, will be raised. The central question is, how the traditional care ethos of the helping professions in medicine and nursing can find its place in discussions of these committees while hospitals have increasingly been organised along economic criteria.
. . . .My observations and interviews in the field work show that care practices in the tradition of Hippocratic Medicine are no longer self-evident for the helping professions. Physicians and nurses do rather struggle for a care ethos especially with regard to end-of- life questions and regulations of tube-feeding. The “cases” for ethics consultation brought into the committees by physicians and nurses did not rarely emerge as social problems and as a lack of professional competence. The problems appeared to be solvable by translating them into a language of principles and making the process manageable. These principle-based discussions in the practical arena of the hospital resemble discourse practices embedded within the larger bioethical debates in the political arena. Technical procedures given by management and administration do fit into the use of abstract principles and contribute to a language that limits the possibilities to think – what is at stake for patients – in terms of caring relations rather than thinking in terms of rules, regulations and control.
Abstract Stories abound of both women with prescriptions turned away at the pharmacy door and members of the most trusted health care profession losing jobs and running afoul of ethics rules. Scholars have spilt much intellectual ink divining whether a pharmacist must dispense Plan B, the primary emergency contraceptive. Now, many are calling for a common law “duty to dispense” that could serve as a foundation for a wrongful pregnancy action against a dissenting pharmacist. Such a duty simply does not arise from established tort principles or pharmacist-specific precedents. Only in rare circumstances will a pharmacist and customer have the type and quality of relationship giving rise to a duty to dispense. Nevertheless, law changes over time and makes allowances for unique circumstances. Pharmacists are taking on more responsibility for drug therapy. They have an awkward role in the distribution of Plan B. Moreover, while the law may protect pharmacists’ consciences, it may not be so receptive to pharmacists-as-activists. Dissenting pharmacists can take practical steps to protect themselves today, but tomorrow is another day.
Extract Conclusion The constitutional jurisprudence surrounding assisted conception is only beginning to take shape . . . . When conception occurs naturally, both positive and negative rights surrounding procreation are fairly clear, but grow murky as the reproductive process invites third parties to assist. As methods of assisted conception show increasing technological promise for those whose physical characteristics, social status, or both require they look to ART for family formation, worrisome trends suggest that third party actors are quietly mounting status-based barriers to fertility treatment. Barriers to ART are taking shape on the basis of patient characteristics including wealth, race, ethnicity, sexual orientation, and marital status, all under the guise of preventing harm to offspring and society at large. However, judgments by ART providers and public lawmakers that certain individuals will be unfit parents, veer dangerously close to the coercive eugenics practices of early twentieth century America, practices whose only positive legacy is the extreme caution with which we now approach state-sponsored limitations on reproduction.
Like a pentimento, ART barriers are only beginning to come into view from the experiences of an increasingly diverse and nontraditional reproductive medicine patient population. As each barrier emerges-whether it be a provider refusing treatment to a single or gay or lesbian prospective parent, or a lawmaker attempting to limit the availability of a reproductive technology for reasons unrelated to human health-it is essential to evaluate these actions by the same standards we would evaluate barriers to natural conception. . . . State-sponsored or state-approved limitations on any individual’s right to procreate simply cannot stand in a society that acknowledges the preeminence of reproductive freedom. Justice Douglas’ selfevident observation that reproduction is a basic human right is as durable and universal as the human race-it simply must be nurtured in order to continue to thrive.
Extract The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.
Extract Refusals by individual pharmacies and pharmacists to fill prescriptions for emergency contraceptives (“EC”) have dominated news headlines. . .These refusals. . .reflect moral and religious concerns about facilitating an act that would cut-off a potential human life.
Recently, conscience-based refusals have ballooned far beyond EC. Pharmacists are refusing to fill prescriptions for birth control, and other ancillary care professionals are asserting their own conscience concerns.
Conclusion Ultimately we must decide as a community whether we prize access more highly than religious freedom. The older healthcare conscience clauses offer us a range of methods to manage the clash between competing moral interests. If urgency for the service cannot be achieved through better information, state legislatures could make a number of choices. They could choose not to burden the professional’s choice at all—prizing religious liberty more highly than access. They could force providers to provide every service legally requested—prizing patient access more highly than moral or religious freedom. Or they could choose to allow individuals of conscience to exempt themselves up to the point that it creates a hardship for the patient or employer. In a pluralistic society, a live-and-let-live regime like this may be the most we can hope for.
