Abstract Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples.
Journal’s Extract Hospitals sometimes refuse to provide goods and services or honor patients’ decisions to forgo life-sustaining treatment for reasons that appear to resemble appeals to conscience. For example, based on the Ethical and Religious Directives for Catholic Health Care Services (ERD), Catholic hospitals have refused to forgo medically provided nutrition and hydration (MPNH), and Catholic hospitals have refused to provide emergency contraception (EC) and perform abortions or sterilization procedures. I consider whether it is justified to refuse to offer EC to victims of sexual assault who present at the emergency department (ED). A preliminary question, however, is whether a hospital’s refusal to provide services can be conceptualized as conscience based.
Karen B. Farris, Daniel Ashwood, Jennifer McIntosh, Natalie A. DiPietro, Nicole Monastersky Maderas, Sharon Cohen Landau, John Swegle, Orod Solemani
Journal of the American Pharmacists Association
Abstract Objectives: To review the literature regarding pharmacists’ roles in preventing unintended pregnancy, review the relevant laws and policies in the United States to describe pharmacists’ and/or pharmacy’s role in policy development related to unintended pregnancy, and identify partners who pharmacists can work with in this public health area.
Data sources: A systematic review was conducted focusing on the role of pharmacists in unintended pregnancy. For practice, articles were identified in Medline through July 1, 2009, using MeSH and keywords. For policy, two authors examined the current status of access issues related to over-the-counter (OTC) status and collaborative practice agreements. Partners were identified in the reviews and authors’ experiences.
Data extraction: English-language, U.S.-based articles that contained either qualitative or quantitative data or were review articles addressing pharmacist interventions, pharmacists’ knowledge and attitudes regarding contraception, and pharmacists’ comfort and ability to counsel on preventing unintended pregnancy were included.
Data synthesis: Some improvements to emergency contraception (EC) access in pharmacies have occurred during the previous decade. Studies focused on counseling, pharmacist provision of depot reinjection, and pharmacist initiation of oral contraceptives were positive. No studies linked increased contraceptive access in pharmacies to lower pregnancy rates. In terms of policy, the literature described three access-related areas, including (1) EC and conscience clauses, (2) collaborative practice agreements, and (3) changes in prescription to OTC status. Pharmacists’ partnerships may include physicians/clinicians, local health departments, family planning organizations, nongovernmental organizations, and colleges of pharmacy.
Conclusion: Currently, pharmacists may increase access to contraceptives primarily via EC and use of collaborative practice agreements to initiate and/or continue hormonal contraceptives. New practice models should be implemented in community or clinic practices as allowed by collaborative practice regulations in each state. We encourage researchers and practitioners to consider a community approach in their endeavors by working with numerous types of primary care providers and organizations to explore ways to increase contraceptive access.
Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
Contraception
Abstract Background: Although emergency contraception (EC) is available without a prescription, women still rely on doctors’ advice about its safety and effectiveness. Yet little is known about doctors’ beliefs and practices in this area.
Study design: We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors’ beliefs about EC’s effects on pregnancy rates, and patients’ sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics.
Results: Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12).
Conclusion: Gender, religion and divergent beliefs about EC’s effects shape physicians’ beliefs and practices.
Extract Conclusion This Comment analyzes the PCR, which is currently under review by the Obama Administration. As currently written, the PCR promises to have devastating effects on the healthcare system. . .
Commenters have predicted that the PCR will be used to discriminate against patients based on their sexual orientation. 196 And because reproductive healthcare remains so controversial in this country, women will be disproportionately disadvantaged by the PCR, which now allows almost all employees-not only the doctor, but potentially the nurse, the pharmacist, the pharmacist’s assistant, the receptionist, the ambulance driver, and the janitor-to have a say in whether she can access her chosen healthcare without interference.
The PCR brought the ongoing debate over conscience clauses into the national spotlight. . . .this Comment argues that any analysis of conscience clauses must recognize that what is at stake is access to healthcare services, and that reduction of healthcare access can be accomplished not only explicitly, for example through the explicit redefining of the term “abortion,” but also through “strategic ambiguity.” . . .
Extract Conclusion . . . Currently, ambiguities in the Maryland statute allow too much flexibility for providers in emergency rooms to refuse to provide or even inform patients about emergency contraception. This kind of state sanctioned refusal serves as the kind of government obstacle the Supreme Court has forbidden in upholding a woman’s right to bodily privacy. The Maryland legislature should act to eliminate the ambiguities in Maryland’s conscience legislation and explicitly protect a woman’s right to access emergency contraception in Maryland emergency rooms. In order to do so, the Maryland legislature should adopt the medical community’s definition for abortion that excludes emergency contraception. The new Maryland conscience statute should also provide explicit protections to patients receiving emergency room care. Physicians should be required to inform patients of emergency contraception if treatment in each particular case is medically indicated. Finally, physicians should be required to treat patients that request access to emergency contraception or to refer them to another provider who is willing to administer treatment within the effective time period of emergency contraception. . .
Extract Introduction: Recently, the discussion regarding the physicians’ “Right of Conscience” (ROC) has been on the rise. This issue is often confined to the “reproductive health” arena (abortions, birth control, morning-after pills, fertility treatments, etc.) within the political context. The recent dispute of the Bush-Obama administrations regarding the legal protections of health workers who refuse to provide care that violates their personal beliefs is an example of the political aspects of this dispute.
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.
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.
Extract An appeal to the doctrine of double effect supposes that the end aimed at is morally good. I claim that women who use emergency contraception need only intend the contraceptive effect of the medication, and not any possible abortifacient effect it may have. If one denies that even the former is a permissible end, then the doctrine of double effect makes no difference.
