Journal Synopsis All jurisdictions in the US require proof of vaccination for school entrance. Most states permit non-medical exemptions. Public health officials must balance the rights of individuals to choose whether or not to vaccinate their children with the individual and societal risks associated with choosing not to vaccinate (i.e., claiming an exemption). To assist the public health community in optimally reaching this balance, this analysis examines the constitutional basis of nonmedical exemptions and examines policies governing conscientious objection to conscription as a possible model. The jurisprudence that the US Supreme Court has developed in cases in which religious beliefs conflict with public or state interests suggests that mandatory immunization against dangerous diseases does not violate the First Amendment right to free exercise of religion. Accordingly, states do not have a constitutional obligation to enact religious exemptions. Applying the model of conscientious objectors to conscription suggests that if states choose to offer nonmedical exemptions, they may be able to optimally balance individual freedoms with public good by considering the sincerity of beliefs and requiring parents considering exemptions to attend individual educational counseling.
Michigan State University DCL Journal of International Law
Abstract The aim of this paper is to outline the legal framework of euthanasia in the Netherlands and to analyze the leading court cases involving adults. I will first explain the legal ambiguity that existed in the Netherlands until the enacting of the euthanasia law on April 10, 2001 which is supposed to come into effect in early 2002 and then discuss how did the courts treat cases of mercy killings.
Abstract . . . an emphasis on oversight and compliance misses the point. By overly focusing on making sure that rules are followed, we push researchers away from a real appreciation for issues and into doing whatever it takes to expedite the oversight process. This approach can cause researchers to quickly lose sight of the point of research protections – the rights and interests of the subjects themselves.
Abstract Nursing home patients have a constitutional right to refuse treatment. The Patient Self-Determination Act confirmed that right. State laws address the obligations of health care providers and facilities to honor that right. The New York State law is more specific than those of many other states. It allows exemptions for “reasons of conscience” and imposes a number of requirements on nursing homes claiming such an exemption, including the transfer of a patient to a home that will honor an end-of-life wish. This study, conducted by FRIA, 1 investigated the refusal of some nursing homes in New York City to carry out patients’ end-of-life wishes because of conscience-based objections. The study also investigated the willingness of homes which did not have such policies to accept patients transferring from a home with a policy so that the patient’s end-of-life wishes would be honored. Implications for administrators, policy makers, and regulators are discussed.
Abstract Treatment refusal, when resulting from a choice based on certain religious principles requires a study of the effect of the Charters of human rights and freedoms into the obligation to reduce the harm that is imposed on any victim. To lay down the parameters of such an obligation, the author analyzes the effects of various cases of refusal to afford treatment in light of rules from private and public law. Owing to the rather small number of precedents dealing with this issue, she seeks inspiration from foreign jurisdictions so as to forge a proposed method for interpreting provisions adapted to the specifics of Québec and Canadian law. The author does reach the conclusion that resorting to constitutional exemption is sometimes a necessity in order to respect freedoms of conscience and religion.
Abstract Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses’ conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.
Abstract There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 5K large urban hospitals, including 28 Catholic hospitals from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim’s right to information about her treatment options and jeopardize physicians’ fiduciary responsibility to act in their patients’ best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requirng hospitals to meet the standard of care for treatment of rape victims is appropriate.
The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.
Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.
Journal Extract “The question is whether we will ever be able to learn from history,” Alexander Mitscherlich said in 1947. He was a member of the German Medical Commission, who by order of the German General Medical Council witnessed the Nuremberg Trial. “I believe,” Mitscherlich continued, “that we won’t master it by just keeping our distance morally. This is doubtless easy to achieve. However, it is useless for us as soon as we think of the dark future of this century, in which situations might occur leading to a similar coldness and ignorance towards the right to live of people more defenseless and disregarded” [1]. 1
Over the ensuing decades, neither physicians nor the public faced the tiring process of reviewing and questioning history. Even the reports of the German Medical Commission met with a growing disinterest and disapproval from the physicians in post-war Germany. 2 Almost 50 percent of the German physicians were members of the NSDAP (Nazi Party), and they resumed their work after 1945 after only a brief interruption.
Thus it is understandable that it was not the physicians’ organizations nor the medical historical departments of the universities that turned towards history at the beginning of the1980s. Rather, it was their children [End Page 373] and grandchildren, who were working in the hospitals, the psychiatric institutions, and homes for persons with disabilities. They began to ask what happened 40 or 50 years ago where they were working. They were not involved personally, nor did they blame their fathers and mothers. This is the generation to which I also belong. 3
After Auschwitz and Hadamar, particularly in Germany, discussion about medical ethics and about the future of medicine are nowadays impossible without reference to history. 4 This consideration was the basis of the program entitled “Medicine and Conscience” in the German Section of International Congress of Physicians for the Prevention of Nuclear War, held in Nuremberg in October 1996. 5 As a result of this congress, on the 50th anniversary of the pronouncement of judgment in the Nuremberg Trial, 20 August 1997, the Nuremberg Code 1997 was presented. Based on the historical experiences and the fundamental ideas of the 1947 Code, the 1997 Code is designed to answer current medical questions about the application of biosciences to human beings. It discusses 10 topics, including medical experiments, reproductive medicine, genetic diagnostics and therapy, transplantation, euthanasia, and distribution of resources. (Due to the time limit and the theme of this symposium, I will focus only on the topic of medical research.) The Nuremberg Code 1997 follows the widespread practice of considering informed consent to be a prerequisite in all fields of public health care service.
The critical-historical link to the Nuremberg Code 1947 that we attempted to make with Code 1997 had to confront two fundamental issues. First, we had to determine whether the Code’s significance was only historical or universally valid. To put it differently: was the 1947 Code only to be understood from the historical context? Did it only aim at the judgment of the practices of the Nazi physicians? Or did it imply a universal validity for medical research and medicine in a civilized world?
Historical evidence, as well as a look at the text of the Code, clearly speaks for a universal validity. Telford Taylor, the chief prosecutor of Nuremberg, stated in his introduction that the trial was no mere murder trial, since the defendants were physicians who had sworn the Hippocratic oath and thus had become murderers in the execution of their profession. Logically, the judges created with the Nuremberg Code a basis for the judgment of crimes which became possible within the bounds of medicine. 6[End Page 374]
Extract Ask your pharmacist: It’s the ubiquitous slogan of the past decade, underscoring the campaigns of most national and provincial pharmacy organizations as they promote the value of pharmacy services. But what if the question is about RU-486, the abortion drug, or Preven, the morning-after-pill? What if the question is from a physician seeking information on terminal sedation or assisted suicide?
Such questions push, and often breach, an ethical boundary for some pharmacists, who find their desire to help the patient in conflict with their moral convictions. And the ethical quagmire is likely to get deeper as advocacy groups press the federal government to allow physician-assisted suicide and various health organizations promote greater access to emergency postcoital contraception.
If these practices compromise your moral convictions, could you be fired by your employer for refusing to fill a prescription? More specifically, is there a point at which your personal beliefs supersede your obligation to the patient? That’s the difficult question posed by an Alberta-based group called Concerned Pharmacists for Conscience, which has suggested a conscience clause to protect pharmacists in such situations.
