Law Archives - Page 17 of 43 - Protection of Conscience Project Library

(Book Review) Conflicts of conscience in health care an institutional compromise

Dhrubajyoti Bhattacharya

Holly Fernandez Lynch. Conflicts of Conscience in Health Care: An Institutional Compromise. Boston: The MIT Press; 2008, 368 pp. ISBN: 9780262123051

Extract
Lynch demystifies the practice of medicine as a value-neutral panacea to remedy social ills with physicians as unwavering obligors to provide service on demand. . . . As far as the provision of services goes, protecting patient and physician interests are, as Lynch argues, not mutually exclusive propositions. In practice, physicians who check their moral apprehensions at the hospital doors may even compromise patient safety. An enlightened approach, as proposed here, encourages health professionals to embrace moral plurality to inform, rather than stymie, the provision of services in the best interests of patients—while respecting physician individuality.

Conflicts of Conscience in Health Care: An Institutional Compromise will serve as an excellent resource for educators and policymakers eager to parse the complex issues of patient wants, physician duties, and institutional prerogatives to secure individual and population health and well-being.

Bhattacharya D. (Book Review) Conflicts of conscience in health care an institutional compromise. J Leg Med. 2009;30(2):289-298.

Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin

Ciaran T Bradley

Abstract
Recent legislation in Wisconsin mandating provision of emergency contraception to victims of sexual assault may create a conflict of conscience for some health care professionals. Although disputes exist over the exact mechanism of action of emergency contraception, those professionals who espouse a particularly strict stance may be reluctant to dispense the medication for fear that it could prevent a fertilized embryo from implanting in the uterus. While no objection of conscience clause was written into the new law, Wisconsin law has a long tradition of recognizing rights of conscience in matters of religious conflict. This legal tradition both at statutory and common law levels is summarized with application to the recent emergency contraception mandate. A case is made for a potential legal defense should a health care professional abstain from dispensing emergency contraception.

Bradley CT. Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin. Wis Med J. 2009 May; 108(3):156-160

Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical

Bernard M Dickens

Abstract
The right to conscientious objection is founded on human rights to act according to individuals’ religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. They are required, however, to be equally respectful of rights to conscience of patients and potential patients. They cannot invoke their human rights to violate the human rights of others. There are legal limits to conscientious objection. Laws in some jurisdictions unethically abuse religious conscience by granting excessive rights to refuse care. In general, healthcare providers owe duties of care to patients that may conflict with their refusal of care on grounds of conscience. The reconciliation of patients’ rights to care and providers’ rights of conscientious objection is in the duty of objectors in good faith to refer their patients to reasonably accessible providers who are known not to object. Conscientious objection is unethical when healthcare practitioners treat patients only as means to their own spiritual ends. Practitioners who would place their own spiritual or other interests above their patients’ healthcare interests have a conflict of interest, which is unethical if not appropriately declared.

Dickens BM. Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical. Med Law. 2009;28(2)337-347.

Conscientious Objection: Resisting Ethical Aggression in Medicine

Sean Murphy

Responding to Cantor, Julie D., Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine. N Eng J Med 360;15, 9 April, 2009

Extract
Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong.

She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant. At least, that is the inference to be drawn from her warning that health care “could grind to a halt” if a federal protection of conscience regulation were “[t]aken to its logical extreme.”

Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. If anything, this demonstrates that health care is provided to many Americans – and many of the poorest Americans – because of the commitment of health care workers to their moral convictions, not in spite of them.

Murphy S. Conscientious Objection: Resisting Ethical Aggression in Medicine [Internet]. Protection of Conscience Project (2009 Apr 17).

Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine

Julie D Cantor

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. . . .Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.

Cantor JD. Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine. N Engl J Med. 2009 Apr 09;360(15):1484-1485.

Healthcare responsibilities and conscientious objection

Rebecca J. Cook, Monica Arango Olaya, Bernard M. Dickens

International Journal of Gynecology & Obstetrics

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers,hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’duties to refer patients to non-objecting providers, and that hospitals,clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gynaecol Obstet. 2009 Mar;104(3):249-52. Epub 2008 Nov 29.

Euthanasia policy and practice in Belgium: Critical observations and suggestions for improvement

Raphael Cohen-Almagor

Abstract
The essay opens with some background information about the context of euthanasia in Belgium. It proceeds by discussing the Belgian law on euthanasia and concerns about the law, its interpretations and implementation. Finally, the major developments and controversies since the law came into effect are discussed. Suggestions as to how to improve the Belgian law and circumscribe the practice of euthanasia are made, urging Belgian legislators and the medical establishment to reflect and study so as to prevent potential abuse of vulnerable patients.

The article’s methodology is based on critical review of the literature supplemented by interviews I conducted in Belgium with leading scholars and practitioners in February 2003 and February 2005. The interviews were conducted in English, usually in the interviewees’ offices. The interviews were semi-structured. I began with a list of twenty-four questions but did not insist on answers to all of them if I saw that the interviewee preferred to speak about subjects that were not included in the original questionnaire. The length of interviews varied from one to two and a half hours. After completing the first draft I sent the manuscript to my interviewees as well as to some leading experts for critical review and comments. The comments received were integrated into this final version of the essay. In 2008, while writing the final draft, I approached my interviewees and some other well-known experts and invited their comments and updates. Responses received by mid-January 2009 were integrated into the article.

Cohen-Almagor R. Euthanasia policy and practice in Belgium: Critical observations and suggestions for improvement. Issues Law Med. 2009 Spring;24(3):187-218.

Transparency in the delivery of lawful abortion services

Rebecca J Cook

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Abstract
• Laws limiting access to abortion services do not reduce the number of abortions, only their safety.

• Governments of countries are obligated to collect official statistics on the number of abortions and their health effects.

• Where statistics show deficiencies in the delivery of abortion services, governments are obligated to remedy the problem.

• Governments are obligated to ensure that women, irrespective of age or other socio-demographic factors, have transparent access to abortion counselling and services where they are legal.

Cook RJ. Transparency in the delivery of lawful abortion services. Can Med Assoc J. 2009 Feb 03;180(3):272-273.

Healthcare responsibilities and conscientious objection

Rebecca J Cook, Mónica Arango Olaya, Bernard M Dickens

Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’ duties to refer patients to non-objecting providers, and that hospitals, clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gyn Ob. 2009 Nov 29;104(3):249-252.

(Book Review) Conflicts of Conscience in Health Care: An Institutional Compromise

Sean Murphy

Holly Fernandez Lynch. Conflicts of Conscience in Health Care: An Institutional Compromise. Boston: The MIT Press, 2008. 368 pp. ISBN: 9780262123051

Extract
Conflicts of Conscience in Health Care was published in 2008 as the 24th volume in the Basic Bioethics series from the Massachusetts Institute of Technology. It is an American book dealing with the American political and legal controversies over freedom of conscience in health care. However, the discussion of the American experience by Holly Fernandez Lynch is relevant elsewhere, since the United States has the most extensive and varied network of protection of conscience legislation in the world.

While acknowledging that freedom of conscience is of concern to all health care workers and institutions, Fernandez Lynch focuses exclusively on physicians. This carefully and deliberately restricted focus is one of the strengths of the book.

After a preface and introduction, discussion and argument occupy about 260 pages, supplemented by 53 pages of end notes, many of which offer expanded comment on the text. A good 12 page index has been included, as well as four pages of cited statutes and cases. The earliest source found in a list of 300 references is from 1951; the rest date from 1972 to 2007. . .

. . . . As the subtitle of the book indicates, she is seeking a compromise that will provide “maximal liberty for all parties.” She believes that freedom of conscience for physicians and the provision of legal medical services are both important social goals, and that they are not incompatible. Thus, she rejects “all-or-nothing” strategies that seek “total victory.” Ultimately, quoting the Protection of Conscience Project, she affirms that all legitimate concerns can be met by “dialogue, prudent planning, and the exercise of tolerance, imagination and political will.”

Murphy S. Book Review: Conflicts of Conscience in Health Care: An Institutional Compromise. Protection of Conscience Project; 2009 Dec 17.