Law Archives - Page 9 of 43 - Protection of Conscience Project Library

Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death

Courtney S Campbell, Margaret A Black

Abstract
The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient’s death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.

Campbell CS, Black MA. Dignity, death, and dilemmas: A study of Washington hospices and physician-assisted death. J Pain Symptom Manage. 2014 Jan;47(1):137-153.

Conscientious Objection and Professionalism

Bernard M Dickens

Expert Review of Obstetrics & Gynecology

Abstract
The duty of referral that objecting physicians owe their patients, and that hospitals owe members of the communities they serve, requires identification of and patients’ reasonable access to physicians (or other qualified health service providers) able and willing to undertake the lawful procedures that objectors find offensive. Referral must be made in good faith, since objecting physicians cannot ethically or lawfully practise deception or evasion to compel their patients’ involuntary compliance with objectors’ own religious or moral beliefs.

Dickens BM. Conscientious Objection and Professionalism. Expert Rev Obstet Gynec. 2009;4(2):97-100.

Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings

Christina Zampas

International Journal of Gynecology & Obstetrics

Abstract
The practice of conscientious objection by healthcare workers is growing across the globe. It is most common in reproductive healthcare settings because of the religious or moral values placed on beliefs as to when life begins. It is often invoked in the context of abortion and contraceptive services, including the provision of information related to such services. Few states adequately regulate the practice, leading to denial of access to lawful reproductive healthcare services and violations of fundamental human rights. International ethical, health, and human rights standards have recently attempted to address these challenges by harmonizing the practice of conscientious objection with women’s right to sexual and reproductive health services. FIGO ethical standards have had an important role in influencing human rights development in this area. They consider regulation of the unfettered use of conscientious objection essential to the realization of sexual and reproductive rights. Under international human rights law, states have a positive obligation to act in this regard. While ethical and human rights standards regarding this issue are growing, they do not yet exhaustively cover all the situations in which women’s health and human rights are in jeopardy because of the practice. The present article sets forth existing ethical and human rights standards on the issue and illustrates the need for further development and clarity on balancing these rights and interests.

Zampas C. Legal and ethical standards for protecting women’s human rights and the practice of conscientious objection in reproductive healthcare settings. Int J Gyn Ob. 2013 Dec 10;123:S63-S65.

(Editorial) Conscientious objection to the provision of reproductive healthcare

Wendy Chavkin

Extract
Healthcare providers who cite conscientious objection as grounds for refusing to provide components of legal reproductive care highlight the tension between their right to exercise their conscience and women’s rights to receive needed care. There are also societal obligations and ramifications at stake, including the responsibility for negotiating balance between all of these competing interests. . .

. . . There are too many barriers to access to reproductive health- care. Conscience-based refusal of care may be one that we can successfully address.

Chavkin W. (Editorial) Conscientious objection to the provision of reproductive healthcare. Int J Gynec Obstet. 2013 Dec;123(SUPPL.3):s39-s40.

Conscientious objection and refusal to provide reproductive healthcare: A White Paper examining prevalence, health consequences, and policy responses

Wendy Chavkin, Liddy Leitman, Kate Polin, Global Doctors for Choice

Abstract
Background
Global Doctors for Choice—a transnational network of physician advocates for reproductive health and rights—began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity.

Objectives and search strategy
The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice.

Conclusions
Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients’ health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women’s lives.

Chavkin W, Leitman L, Polin K, for Choice GD. Conscientious objection and refusal to provide reproductive healthcare: A White Paper examining prevalence, health consequences, and policy responses. Int J Gynec Obstet. 2013 Dec 10;123(S41-S56.

Conscientious objection to the provision of legal abortion care

Brooke R Johnson, Eszter Kismödi, Monica V Dragoman, Marleen Temmerman

Abstract
Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when referral is not possible. In addition, states should take all necessary measures to ensure that all women and adolescents have the means to prevent unintended pregnancies and to obtain safe abortion..

Johnson BR, Kismödi E, Dragoman MV, Temmerman M. Conscientious objection to the provision of legal abortion care. Int J Gyn Obstet. 2013;123(S60-S62).

Seeing through the secular illusion

Iain T Benson

Dutch Reformed Theological Journal (NGTT)

Abstract
Only when it is recognized that not all ‘faiths’ are religious and that all citizens operate out of some sort of faith commitments can we be properly in a position to evaluate nonreligious faiths alongside religiously informed ones. This re-adjustment of the usual way of examining matters then should lead, Professor Benson argues, to a more accurate way of viewing current education and politics (and their areas of avoidance) as well as such things as fair access to the public square by religious believers and their communities. The long dominance of atheistic and agnostic forms of social ordering (including funding for such things as education and health care) is based, in part, on a belief that stripping religious frameworks from public sector projects is ‘neutral’ when it is not.

In addition, the focus on a rights based jurisprudence has a tendency to view rights such as the freedom of religion in individualist ways that ignore the communal importance of religion. The paper will suggest that moves to put pressure on the associational dimension of religions ignore the communal nature of certain forms of belief to the detriment of a more co-operative society and far from encouraging human freedom, actually reduce it.

In the long run, the importance of religions and their communities to the public sphere – which has been recognized by the Constitutional Court of South Africa – will be encouraged by this fresh and more accurate way of viewing belief systems and the communities that form around them. The more accurate way of understanding both the reality of and the need for more articulate public beliefs, will, Benson argues, provide a richer ground for such things as public school curriculum which often drift in the face of fears of moral imperialism and metaphobia (fear of metaphysics).

Benson IT. Seeing through the secular illusion. Nederduitse Gereformeerde Teologiese Tydskrif. 2013;54(Supplement 4)

The attack on Western religions by Western law

Re-framing pluralism, liberalism and diversity

Iain T. Benson

International Journal for Religious Freedom

Abstract
This paper discusses how law is increasingly being used to attack religious associations under the guise of “equality” advancement and “non-discrimination” restrictions. I explore two important insights: first that the concept of “transformation” has been distorted, to shelter approaches to law that fail to respect properly associational diversity. When misused, “transformation” seeks to change the moral viewpoints or religious beliefs of religious associations by force of law. Second, the paper discusses the expansion of law so that it becomes a threat to associations. The “goods of religion” and the “limits of law” need to be more widely recognized and understood both by religious communities and by those involved in law, politics and the media. These insights demonstrate how “equality activists” employ a rhetoric of “equality” to produce inequality, “diversity” to produce homogeneity and “non-discrimination” to discriminate against religious communities and religious beliefs. Several solutions for identifying these errors and resisting them are outlined in brief.

Benson IT. The attack on Western religions by Western law: Re-framing pluralism, liberalism and diversity. International Journal for Religious Freedom, Volume 6, Issue 1/2, 2013

Conscience Legislation, the Personhood Movement, and Access to Emergency Contraception

Jonathon F. Will

Abstract
In the medical setting, conscience legislation serves to protect health care professionals who refuse to provide certain procedures or services that would violate their consciences. The “Personhood Movement,” on the other hand, is characterized by advocates’ attempts to adopt legislation or constitutional amendments at the state and/or federal level that would extend the legal and moral protection associated with personhood to members of the human species at the earliest stages of biological development. The relationship between conscience legislation and the Personhood Movement may not be self-evident, but the connection becomes apparent when considering trends in conscience legislation. This is particularly true in the context of expanding legal protection to health care professionals who object to certain forms of birth control, such as emergency contraception (EC).

In a recent paper Professor Elizabeth Sepper noted that instead of protecting a health care provider’s conscience, a possible purpose behind broad conscience legislation is to “make abortions, family planning, and end-of-life care more difficult to obtain,” and that the true goal of such legislation is “hostility to reproductive health and patients’ interests.” Indeed, this essay will suggest that the adoption of a personhood framework could represent majoritarian approval of the very principles that cause certain people to conscientiously object to EC. While some have raised concerns that conscience legislation itself could lead to problems with access to EC (especially in rural communities), adoption of a personhood framework seems to pose a much greater risk. This essay describes the expansion of conscience legislation in the medical setting, which reflects a trend toward authorizing the refusal of a broader range of procedures and services by a broader range of health care professionals. It then draws a connection between Mississippi’s very expansive conscience legislation and the decision by a national organization, Personhood USA, to propose a personhood amendment to the Mississippi Constitution. A brief discussion of the relevant biology reveals the relationship between concepts of personhood and EC. This essay suggests that even if a personhood framework is not officially adopted, legislatures that favor the movement and the broad protection of conscience-based refusals may be less inclined to enact measures that protect a woman’s ability to obtain EC. This should be viewed as problematic given that many people, including physicians and pharmacists, may not have an accurate understanding of the reproductive biology associated with early human development and the operation of EC, which may lead such professionals to make conscientious objections based on clinically false information.

Will JF. Conscience Legislation, the Personhood Movement, and Access to Emergency Contraception. 4 Faulkner Law Review 411 (2013)

The Invention of a Human Right: Conscientious Objection at the United Nations, 1947-2-11

Jeremy K Kessler

Abstract
The right of conscientious objection to military service is the most startling of human rights. While human rights generally seek to protect individuals from state power, the right of conscientious objection radically alters the citizen-state relationship, subordinating a state’s decisions about national security to the beliefs of the individual citizen. In a world of nation-states jealous of their sovereignty, how did the human right of conscientious objection become an international legal doctrine? By answering that question, this Article both clarifies the legal pedigree of the human right of conscientious objection and sheds new light on the relationship between international human rights law and national sovereignty.

Kessler JK. The Invention of a Human Right: Conscientious Objection at the United Nations, 1947-2-11. Columbia Hum R Law R. 2013;44(753-791.