Law Archives - Page 26 of 39 - Protection of Conscience Project Library

Some ethical and legal issues in assisted reproductive technology

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

Abstract
The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients’ treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities..

Dickens BM, Cook RJ. Some ethical and legal issues in assisted reproductive technology. Int J Gynecol Obstet. 1999;66(1) 55-61.

Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights

Katherine A White

Abstract
In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.

White KA. Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights. Stanford Law Rev. 1999 Jul;51(6)1703-1749.

(Thesis) Conscientious objectors to a medical treatment: What are the rules?

Andre Carebonneau

Abstract
Patients who refuse a specific medical treatment for religious reasons must often overcome strongly entrenched presumptions held by physicians and judges, presumptions frequently based on personal values. A case in point is the refusal of blood transfusion therapy by Jehovah’s Witnesses. This paper rests on the following theory: The sanctity of life principle is not necessarily violated by respecting the autonomous decision of a patient who, for religious or moral reasons, chooses one therapy over another that may be favored by the treating physician. Where a patient has decided for conscientious reasons against a certain treatment in any given medical situation, the need to be informed will shift from the patient to the physician. The physician must understand the nature of the religious or moral conviction as well as his own moral and legal obligation to respect the patient’s wishes by providing the best Medical care under the circumstances.

Carebonneau A. (Thesis) Conscientious objectors to a medical treatment: What are the rules [masters thesis]. [Montreal, PQ]: McGill Univesity; 1999 Jul. 122 p.

The Common Good and the Duty to Represent: Must the Last Lawyer in Town Take Any Case?

Teresa Stanton Collett

Extract
More specifically, this article explores the question: Is it morally permissible for a lawyer to decline representation of a prospective client who seeks to obtain a legal but immoral objective, if the lawyer reasonably believes that the prospective client will be otherwise unable to obtain legal representation?

Collett TS. The Common Good and the Duty to Represent: Must the Last Lawyer in Town Take Any Case? South Texas Law Review. 1999;40(137-179)

The Americans’ higher-law thinking behind higher lawmaking

Joyce Appleby

Extract
Bruce Ackerman’s “We The People: Transformations” is elegantly conceived, theoretically clever, rhetorically inventive, and empirically convincing, but it remains ideologically inadequate. . . . In the absence of attention to how people in the United States have come to think about a higher law, Ackerman has fallen back on a Whiggish view where love of liberty and justice is assumed to be part of the human endowment, at least of American humans. Fused convictions about democratic governance and liberal aspirations motivate Ackerman’s We the People. . . . This Whiggish overlay upon the argument of Transformations appears most strikingly in the discussion of Reconstruction, in which all acts are optimized-whether those of intransigent Radical Republicans or white supremacist Southern Redeemers. Some higher force is orchestrating this partisan cacophony into a melodious resolution. . . . I will pose the proposition that two higher law concepts have polarized American politics from Alexander Hamilton through Ronald Reagan, and that they need to be put into the picture of Ackerman’s grand transformative moments.

Appleby J. The Americans’ higher-law thinking behind higher lawmaking. Yale Law J. 1999;108(8):1995-2001.

Human rights and abortion laws

Rebecca J Cook, Bernard M Dickens

Abstract
Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.

Cook RJ, Dickens BM. Human rights and abortion laws. Int J Gynecol Obstet. 1999 Apr 22;65(81-87.

International Developments in Abortion Law from 1988 to 1998

Rebecca J Cook, Bernard M Dickens, Laura E Bliss

Abstract
Objectives
In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women’s human rights has influenced legal reform.

Methods
A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences.

Results
Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third party authorizations, and blockades of abortion clinics.

Conclusions
Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women’s health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.

Cook RJ, Dickens BM, Bliss LE. International Developments in Abortion Law from 1988 to 1998. Am J Public Health. 1999;89(4):579-586.

(Editorial) Physician assisted suicide, euthanasia, or withdrawal of treatment: Distinguishing between them clarifies moral, legal, and practical positions

Larry R Churchill, Nancy MP King

British Medical Journal, BMJ — British Medical Journal

Extract
. . . In unanimous rulings last month, [United States] Chief Justice Rehnquist, writing for the court, held that there is no fundamental right to assistance in committing suicide1 and that, legally, distinguishing between refusing life saving medical treatment and requesting assistance in suicide “comports with fundamental legal principles of causation and intent.”

. . . Attempts to decriminalise assisted suicide in Britain have so far fallen well short of legislation.. . . Pressure groups in favour of voluntary euthanasia seem to accept that it will be difficult to achieve euthanasia legislation in one step but consider that assisted suicide represents a more attainable goal. From an opinion survey of Scottish doctors, the medical profession seems less resistant to assisting suicide than to practising euthanasia. . .

. . . it remains to be seen whether societal acceptance of physician assisted suicide will increase and how it will affect both social support for vulnerable and dying citizens and trust between patients and their doctors.

Churchill LR, King NMP. (Editorial) Physician assisted suicide, euthanasia, or withdrawal of treatment: Distinguishing between them clarifies moral, legal, and practical positions. Br Med J. 1997 Jul 19;315(7101):137-138.

Professional Versus Moral Duty: Accepting Appointments in Unjust Civil Cases

Teresa Stanton Collett

Extract
Conclusion
Tennessee Formal Ethics Opinion 96-F-140 attempts to disconnect morality from the lawyer’s work. The Board’s disregard of the lawyer’s moral and religious objections to accepting the appointment suggests either a hostility to the particular religious beliefs asserted by the inquiring lawyer or a willingness to demand lawyers accept being treated as mere means to clients’ and courts’ ends. Hostility to religious beliefs is deeply troubling when exhibited by those who are charged with providing lawyers’ guidance in discerning their professional obligations, but the second possible interpretation of the opinion is equally chilling. To the extent that the Board’s opinion represents the members’ considered judgment that lawyers are obligated to act as amoral facilitators of any action not proscribed by positive law, the power of the state is dramatically enlarged and the power of the individual and other social institutions dangerously diminished. This result cannot be tolerated under the terms of the First Amendment, nor can it be reconciled with the lawyer’s basic human rights.

Collett TS. Professional Versus Moral Duty: Accepting Appointments in Unjust Civil Cases. Wake Forest Law Review. 1997;32: 635-670.

Abortion and our changing society

Douglas Waugh

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
When I was a medical student in the early ‘40s, and for a considerable time after that, the artificial termination of pregnancy was considered an unspeakable crime. . . . No one knew for certain how widespread the practice was, but enough patients turned up in emergency departments or in the morgue for us to know it was going on, and to arouse the ire and indignation of society’s moralists. . . . The credit for bringing the revolution about certainly belongs to Dr. Henry Morgentaler, but it is clear that Canada’s social climate had been changing slowly for several years before he defied the law by opening his first abortion clinic in Montreal . . . True, the anti-abortion campaign is not yet dead, but its force has become so attenuated the impact is limited.

Waugh D. Abortion and our changing society. Can Med Assoc J. 1997 Feb 01;156(3):408.