When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience

Suzanne Davis, Paul Lansing

DePaul Journal of Health Care Law
DePaul Journal of Health Care Law

Extract
Conclusion

In conclusion, we think that the marketplace of ideas should be allowed to function on this issue. So long as consumers have access to distribution channels for emergency contraception and to information regarding where the drug is available, there is no reason why the market would fail to reconcile this dilemma. However, if Wilson is correct that governments will not be able to fight the urge to take an active role in this dispute, then freedom of conscience should be the paramount fundamental right. This determination is necessary to provide the proper balance of rights because placing an affirmative duty on pharmacists to dispense a drug negates the basic premises on which our nation is built and only avoids a slight inconvenience to consumers who desire emergency contraception. Finally, it is important for governments to recognize that there are sound arguments on both sides of this legal debate and that an in depth analysis of the ethical and public policy ramifications of regulation on this issue is absolutely necessary.


Davis S, Lansing P. When Two Fundamental Rights Collide at the Pharmacy: The Struggle to Balance the Consumer’s Right to Access Contraception and the Pharmacist’s Right of Conscience. 12 Depaul J. Health Care L. 67, 89-91 (2009)

Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile

Lidia Casas

Reproductive Health Matters
Reproductive Health Matters

Abstract
As Latin American countries seek to guarantee sexual and reproductive health and rights, opponents of women’s rights and reproductive choice have become more strident in their opposition, and are increasingly claiming conscientious objection to providing these services. Conscientious objection must be seen in the context of the rights and interests at stake, including women’s health needs and right to self-determination. An analysis of law and policy on conscientious objection in Peru, Mexico and Chile shows that it is being used to erode women’s rights, especially where it is construed to have no limits, as in Peru. Conscientious objection must be distinguished from politically-motivated attempts to undermine the law; otherwise, the still fragile re-democratisation processes underway in Latin America may be placed at risk. True conscientious objection requires that a balance be struck between the rights of the objector and the health rights of patients, in this case women. Health care providers are entitled to their beliefs and to have those beliefs accommodated, but it is neither viable nor ethically acceptable for conscientious objectors to exercise this right without regard for the right to health care of others, or for policy and services to be rendered ineffectual because of individual objectors.

Keywords:

Casas L. Invoking conscientious objection in reproductive health care: evolving issues in Peru, Mexico and Chile. Reprod Health Matter. 2009 Nov;17(34):78-87.

Unethical Protection of Conscience: Defending the Powerful against the Weak

Bernard M Dickens

American Medical Association Journal of Ethics
American Medical Association Journal of Ethics

Extract
In protecting and privileging health care professionals who withhold information that their patients depend upon, the provisions reduce health care professionals to the status of self-serving traders in an unequal market who may take advantage of those obliged or unwise enough to trust them and rely on their integrity. The provisions underscore the challenge that conscientious objection poses to health care professionalism [8]. To allow physicians to deny or frustrate a patient’s rights of conscience by enforcing their own through nonreferral, as the new regulations do, is unethical. It is ethically justifiable to be intolerant of religious or other fundamentalist intolerance.


Dickens BM. Unethical Protection of Conscience: Defending the Powerful against the Weak. Am Med Ass J Ethics. 2009;11(9):725-729.

From reproductive choice to reproductive justice

Rebecca J Cook, Bernard M Dickens

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.


Cook RJ, Dickens BM. From reproductive choice to reproductive justice. Int J Gyn Ob. 2009 Aug;106(2):106-109.

Federal provider conscience regulation: Unconscionable

Robert F Card

Journal of Medical Ethics
Journal of Medical Ethics

Abstract
This paper argues that the provider conscience regulation recently put into place in the USA is misguided. The rule is too broad in the scope of protection it affords, and its conception of what constitutes assistance in the performance of an objectionable procedure reveals that it is unworkable in practice. Furthermore, the regulation wrongly treats refusal of other reproductive services as on a par with conscientious objection to participation in abortion. Finally, the rule allows providers to refuse even to discuss “objectionable” options with patients and serves to protect discriminatory refusals of medical care. For all of these reasons, this regulation is unwise.


Card RF. Federal provider conscience regulation: Unconscionable. J Med Ethics. 2009;35(8):471-472.

Conscience in the Workplace

C W Von Bergen

Employee Relations Law Journal
Employee Relations Law Journal

Abstract
Most definitions of conscience in the US legal context are broadly defined as including religious, moral, or ethical principles. The wave of state and federal laws and bills supporting conscience protection for medical personnel are increasingly covering all health care services, and this has created counterclaims challenging the idea that health-related professionals may deny legally and medically permitted therapeutic interventions, particularly if their objections are personal and religious. The question is whether Americans deem it proper to put a person in the position of leaving his or her job or violating his or her conscience. Although such laws make reference to “conscience,” most define that term in a virtually boundless fashion to include religion, moral, or ethical principles and convictions. Such a broad definition may bring the freedom of conscience debate clearly within the protection of Title VII and its prohibition of religious discrimination.


Von Bergen CW. Conscience in the Workplace. Employee Relat Law J. 2009;35(1):3-24.

Belgian euthanasia law: a critical analysis

Raphael Cohen-Almagor

Journal of Medical Ethics
Journal of Medical Ethics

Abstract
Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse.


Cohen-Almagor R. Belgian euthanasia law: a critical analysis. J Med Ethics. 2009;35(7):436-439.

Rights to emergency contraception

Edith Weisberg, Ian S Fraser

International Journal of Gynecology & Obstetrics
International Journal of Gynecology & Obstetrics

Abstract
Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.


Weisberg E, Fraser IS. Rights to emergency contraception. Int J Gynec Obstet. 2009 Jun 18;106(2):160-163.

What Physicians Need to Know About the Legal Status of Abortion in the United States

Tracy A Weitz

Clinical Obstetrics and Gynecology
Clinical Obstetrics and Gynecology

Abstract
Abortion is the most politically contested social issue in the United States, a debate that manifests itself in extensive regulation of abortion as a health care service. This study provides a brief history of the judicial acceptance of abortion regulation and an overview of the most common forms of abortion regulation affecting physicians in the United States. The article concludes with a discussion of pending threats to the legal right to abortion in the United States and recommended resources where physicians can find assistance to comply with existing laws.


Weitz TA. What Physicians Need to Know About the Legal Status of Abortion in the United States. Clin Obstet Gynecol. 2009 Jun;52(2):130-139.

(Working Paper) Conscientious Oppression: Conscientious Objection in the Sphere of Sexual and Reproductive Health

Marcelo Alegre

Yale Law School Lillian Goldman Law Library
Yale Law School Lillian Goldman Law Library

Abstract
Although for centuries conscientious objection was primarily claimed by those who for religious or ethical reasons refused to join the ranks of the military (whether out of a general principle or in response to a particular violent conflict), in recent decades a significant broadening of the concept can be seen. In Thailand, for example, doctors recently refused medical attention to injured policemen suspected of having violently repressed a demonstration. In Argentina a few public defenders have rejected for conscientious reasons to represent individuals accused of massive human rights violations. In different countries all over the world there are doctors who refuse to perform euthanasia, schoolteachers who reject to teach the theory of evolution, and students who refuse to attend biology classes where frogs are dissected.


Alegre M. (Working Paper) Conscientious Oppression: Conscientious Objection in the Sphere of Sexual and Reproductive Health. 2009;1-34.