Science Archives - Page 2 of 3 - Protection of Conscience Project Library

Politics, Parents, and Prophylaxis — Mandating HPV Vaccination in the United States

R Alta Charo

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

Extract
Public health officials may have legitimate questions about the merits of HPV vaccine mandates, in light of the financial and logistic burdens these may impose on families and schools, and also may be uncertain about adverse-event rates in mass-scale programs. But given that the moral objections to requiring HPV vaccination are largely emotional, this source of resistance to mandates is difficult to justify.

Charo RA. Politics, Parents, and Prophylaxis — Mandating HPV Vaccination in the United States. N Engl J Med. 2007 May 10;356(19):1905-1908.

From Eisenstadt to Plan B: A Discussion of Conscientious Objections to Emergency Contraception

Lynne Marie Kohm

Extract
Conclusion
Medical ethics and the practice of medicine as an act of conscience have become integral to this scientifically unsettled debate. Before medication is prescribed or dispensed, a prudent practitioner weighs carefully the risks of the medication with the potential benefits. 70 Laws that require a medical professional to perform an act against his or her best judgment violate the code of ethics of that profession to do no harm in the professional’s highest and best medical judgment. It ought to be alarming that a patient’s expectations may become the standard for professional action. Ought medical professionals prescribe and dispense what the patient wants even if it harms him or her, just because the patient’s autonomy allows a patient to live a risky life? 71 Family planning deserves a principled approach carried out with integrity that protects the parties, and that approach should be reflected in legal policy and lawmaking.

Should doctors and pharmacists be able to refuse to give out emergency contraceptives based on conscientious objections? Sexual freedom that was protected by the Supreme Court’s emancipation of sexuality from reproduction has allowed emergency contraceptives to be used for any purpose an individual desires, rather than for the best and most responsible medical purposes. Therefore, when a medical professional has concerns that an emergency contraceptive may harm the health of his or her patients or customers or their offspring, a conscientious objection provided by law seems more appropriate than a legal requirement to dispense despite objections, at least until a medical and legal consensus can be reached.

Kohm LM. From Eisenstadt to Plan B: A Discussion of Conscientious Objections to Emergency Contraception. William Mitchell Law Rev. 2007 Mar;33(3):787-805.

The Oral Contraceptive as Abortifacient: An Analysis of the Evidence

Dennis M Sullivan

Abstract
Pro-life Christian ethicists and medical practitioners have been united in their opposition to abortion, but have sometimes been divided in their ethical approach to hormonal contraception. Even though many Christians believe that birth control may be a moral option, some claim that the “Pill” acts, at least some of the time, as an abortifacient. If true, Christians who hold that human personhood begins at conception would be morally opposed to the use of combined oral contraceptives. This article examines the scientific evidence for an abortifacient effect of such contraceptive agents, and concludes that such an effect is yet unproven. Some of the ethical arguments are also examined, and the author suggests that further research on early pregnancy factor (EPF) may help to resolve this controversial issue.

Sullivan DM. The Oral Contraceptive as Abortifacient: An Analysis of the Evidence. Perspectives on Science and Christian Faith. 2006;58(3):189-195. Available from:

A new rejection of moral expertise

Christopher Cowley

Abstract
There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Cowley C. A new rejection of moral expertise. Med Health Care & Phil. 2005 Nov;8(3):273-279.

(Thesis) Morality as Natural History: An adaptationist account of ethics

Oliver Scott Curry

Abstract
What are moral values and where do they come from? David Hume argued that moral values were the product of a range of passions,inherent to human nature, that aim at the common good of society. Recent developments in game theory, evolutionary biology, animal behaviour, psychology and neuroscience suggest that Hume was right to suppose that humans have such passions. This dissertation reviews these developments, and considers their implications for moral philosophy. I first explain what Darwinian adaptations are, and how they generate behaviour. I then explain that, contrary to the Hobbesian caricature of life in the state of nature, evolutionary theory leads us to expect that organisms will be social, cooperative and even altruistic under certain circumstances. I introduce four main types of cooperation – kin altruism,coordination to mutual advantage, reciprocity and conflict resolution –and provide examples of ‘adaptations for cooperation’ from nonhuman species. I then review the evidence for equivalent adaptations for cooperation in humans. Next, I show how this Humean-Darwinian account of the moral sentiments can be used to make sense of traditional positions in meta-ethics; how it provides a rich deductive framework in which to locate and make sense of a wide variety of apparently contradictory positions in traditional normative ethics; and how it clearly demarcates the problems of applied ethics. I defend this version of ethical naturalism against the charge that it commits ‘the naturalistic fallacy’. I conclude that evolutionary theory provides the best account yet of the origins and status of moral values, and that moral philosophy should be thought of as a branch of natural history.

Curry OS. (Thesis) Morality as Natural History: An adaptationist account of ethics. London School of Economics and Political Science. 2004.

(Editorial) Unwanted results: the ethics of controversial research

CMAJ

Extract
. . . We are chided for publishing flawed research and told that we should be ashamed of publishing the “opinions” of self-evidently biased researchers. We are accused of doing a disservice to women, medicine and the Journal, of failing to conduct proper peer review, and of not adequately scrutinizing the credentials of the authors.

The abortion debate is so highly charged that a state of
respectful listening on either side is almost impossible to achieve. This debate is conducted publicly in religious, ideological and political terms: forms of discourse in which detachment is rare. But we do seem to have the idea in medicine that science offers us a more dispassionate means of analysis. To consider abortion as a health issue, indeed as a medical “procedure,” is to remove it from metaphysical and moral argument and to place it in a pragmatic realm where one deals in terms such as safety, equity of access, outcomes and risk–benefit ratios, and where the prevailing ethical discourse, when it is evoked, uses secular words like autonomy and patient choice. . .

CMAJ. (Editorial) Unwanted results: the ethics of controversial research. Can. Med. Assoc. J.. 2003 Jul 22;169(2):93.

Effect of mifepristone and levonorgestrel on expression of steroid receptors in the human Fallopian tube

A Christow, X Sun, K Gemzell-Danielsson

Abstract
It is likely that mifepristone or levonorgestrel in the future will find extended use for contraceptive purposes. It is therefore essential to characterize the modes of action of these compounds. To assess the effect on the human Fallopian tube, 24 women with regular menstrual cycles and proven fertility, admitted to the hospital for voluntary sterilization by laparoscopic technique, were randomly allocated to a control or one of two treatment groups. Treatments were given with either a single dose of 200 mg mifepristone or 0.75 mg levonorgestrel in two doses 12 h apart, on day LH2. Surgery was performed on day LH4 to LH6. Steroid receptor expression was analysed by immunohistochemistry, Western blot and RT-PCR. In the controls, there was a higher concentration of progesterone receptors in the stromal cells in the isthmic region than in those in the ampullar region. Treatment with mifepristone increased the progesterone receptor concentration in epithelial and stromal cells and increased the estrogen receptor concentration in epithelial cells. No effect on steroid receptor concentration was found following levonorgestrel. The contraceptive effect of post-ovulatory mifepristone has previously been considered to be dependent on an effect on the endometrium. However an effect on the Fallopian tube could contribute to alter the peri-implantation milieu influencing fertilization and embryo development.

Christow A, Sun X, Gemzell-Danielsson K. Effect of mifepristone and levonorgestrel on expression of steroid receptors in the human Fallopian tube. Mol Hum Reprod. 2002 April 01;8(4):333-340.

Exploring the Biological Contributions to Human Health: Does Sex Matter?

Institute of Medicine

Institute of Medicine (US) Committee on Understanding the Biology of Sex and Gender Differences, Theresa M. Wizemann, Mary-Lou Pardue, eds. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington, DC: The National Academies Press.
https://doi.org/10.17226/10028.

Abstract
One of the most compelling reasons for looking at what is known about the biology of sex differences is that there are striking differences in human disease that are not explained at this time.

Being male or female is an important basic human variable that affects health and illness throughout the life span. Differences in health and illness are influenced by individual genetic and physiological constitutions, as well as by an individual’s interaction with environmental and experiential factors. The incidence and severity of diseases vary between the sexes and may be related to differences in exposures, routes of entry and the processing of a foreign agent, and cellular responses. Although in many cases these sex differences can be traced to the direct or indirect effects of hormones associated with reproduction, differences cannot be solely attributed to hormones.

Therefore, sex should be considered when designing and analyzing studies in all areas and at all levels of biomedical and health-related research. The study of sex differences is evolving into a mature science. There is now sufficient knowledge of the biological basis of sex differences to validate the scientific study of sex differences and to allow the generation of hypotheses with regard to health. The next step is to move from the descriptive to the experimental phase and establish the conditions that must be in place to facilitate and encourage the scientific study of the mechanisms and origins of sex differences. Naturally occurring variations in sex differentiation can provide unique opportunities to obtain a better understanding of basic differences and similarities between and within the sexes.

Barriers to the advancement of knowledge about sex differences in health and illness exist and must be eliminated. Scientists conducting research on sex differences are confronted with an array of barriers to progress, including ethical, financial, sociological, and scientific factors.

The committee provides scientific evidence in support of the conclusions presented above and makes recommendations to advance the understanding of sex differences and their effects on health and illness.

Bioethics: Private Choice and Common Good

Daniel Callahan

Extract
There is a peculiar and disturbing feature of our times. On the one hand, biomedicine unceasingly extends its power to shape our lives and our culture. . . On the other hand, our protean selves and malleable culture are themselves more wary than ever about responding to that challenge with what might be the only means at our disposal: the search for some coherent, plausible view of what constitutes the good of human beings and their societies. In the absence of such a view, all the real power is in the hands of science, which can decisively bring about fundamental changes even without aiming deliberately to do so. Only an understanding of the self that has substance and direction can fight back, setting its own counteragenda. Choice alone cannot do that. For its part also, a society that itself lacks a compass, devoted only to fostering a minimalist civic accord, is in no less vulnerable a position. If there is no common picture of what biomedicine can do to foster a good human life-if the very question of what constitutes such a life has been banished in the name of pluralism-then that life will be pushed about in ways it is helpless to control, a frail ship that has lost its direction on a stormy, confused sea.

Callahan D. Bioethics: Private Choice and Common Good. Hastings Cent Rep. 1994 May-Jun;24(3):28-31.

(Correspondence) Code of ethics

Hugh M Scott

Extract
various well-meaning groups believe that something as basic as a code of ethics should be subject to the whim of members of a general meeting acting on an amendment from the floor. . . . I am sceptical of the value of hypnosis therapy for cigarette smoking and obesity, of transcendental meditation for angina pectoris and of acupuncture for all sorts of disorders. Is this because of my beliefs or because of my scientific training? If the latter, is not dedication to the scientific method a “belief”? Therefore, should we be expected to post signs in our offices declaring all our beliefs or scepticisms, and, if confronted with a patient with any of these problems, suggest consultation with a colleague who is more “liberal”? Surely we will never do better than to depend on the good sense and dedication of our colleagues. The use of a code of ethics as an issue in a current political debate is a dangerous precedent and one that I, for one, would wish abandoned forthwith.

Scott HM. (Correspondence) Code of ethics. Can Med Assoc J. 1978 Oct 07;119(7):692. Available from: