Religious Freedom Archives - Page 8 of 9 - Protection of Conscience Project Library

The injustice of unsafe motherhood

Rebecca J Cook, Bernard M Dickens

Abstract
This paper presents an overview of the dimensions of unsafe motherhood, contrasting data from economically developed countries with some from developing countries. It addresses many common factors that shape unsafe motherhood, identifying medical, health system and societal causes, including women’s powerlessness over their reproductive lives in particular as a feature of their dependent status in general. Drawing on perceptions of Jonathan Mann, it focuses on public health dimensions of maternity risks, and equates the role of bioethics in conscientious medical care to that of human rights in public health care. The microethics of medical care translate into the macroethics of public health, but the transition compels some compromise of personal autonomy, a key feature of Western bioethics, in favour of societal analysis. Religiously-based morality is seen to have shaped laws that contribute to unsafe motherhood. Now reformed in former colonizing countries of Europe, many such laws remain in effect in countries that emerged from colonial domination. UN conferences have defined the concept of ‘reproductive health’ as one that supports women’s reproductive self-determination, but restrictive abortion laws and practices epitomize the unjust constraints to which many women remain subject, resulting in their unsafe motherhood. Pregnant women can be legally compelled to give the resources of their bodies to the support of others, while fathers are not legally compellable to provide, for instance, bone-marrow or blood donations for their children’s survival. Women’s unjust legal, political, economic and social powerlessness explains much unsafe motherhood and maternal mortality and morbidity.

Cook RJ, Dickens BM. The injustice of unsafe motherhood. Dev World Bioeth. 2002 May;2(1):64-81

Misperception and Misapplication of the First Amendment in the American Pluralistic System: Mergers between Catholic and Non-Catholic Healthcare Systems

Jason M Kellhofer

Extract
This note questions the wisdom of those who contend that Catholic health providers, to constitutionally qualify for government assistance or be permitted to merge with public entities, must be stripped of that which makes them most effective – their religious identity. The threat to sectarian healthcare has steadily been on the rise as can be seen in actions such as the American Public Health Association’s recent approval of a policy statement recommending more government oversight to preclude the dropping of reproductive services when Catholic and Non-Catholic hospitals merge. Section II explores why these mergers occur and why certain services are subsequently dropped. Section III applies a historical analysis to refute the argument that public and private are meant to remain separate. After establishing that pluralism has been and is presently the foundation of the American society and its healthcare, section IV evaluates whether the Establishment Clause or the Free Exercise Clause of the First Amendment is in danger of violation by mergers between Catholic and Non-Catholic hospitals. Finally, section V addresses the argument that Catholic healthcare mergers constructively deny women, most especially indigent women in rural areas, the right to reproductive services, namely abortion.

Kellhofer JM. Misperception and Misapplication of the First Amendment in the American Pluralistic System: Mergers between Catholic and Non-Catholic Healthcare Systems. J. Law Health. 2001-2002;16(1):103-104.

The High Cost of Merging With A Religiously-Controlled Hospital

Monica Sloboda

Berkeley Women's Law Journal — Berkeley Women’s Law Journal

Extract
Conclusion
The trend of hospital mergers between religious and non-religious hospitals may continue to threaten access to reproductive health services, especially for patients who already have limited access because they live in rural areas or have low incomes.l” However, as this essay suggests, there are several avenues that concerned citizens and activists can take to try to prevent the loss of these vital services.l ” The creativity and determination of those who commit themselves to ensuring that reproductive health services will continue to be available to all who desire them has resulted in several viable legal and practical methods of intervention. Although I believe it is important to respect the religious rights and beliefs of others. when the expression of these beliefs encroaches on patients’ rights to access basic health services, intervention is appropriate and necessary. I hope that public outcry, in the forms of legal and grassroots action, will persuade state actors, legislatures, hospital administrators, and clergy to properly acknowledge patients’ rights and participate in the creation of acceptable solutions to the financial problems that hospitals increasingly face. We need solutions that do not deny essential health services to any group of people.

Sloboda M. The High Cost of Merging With A Religiously-Controlled Hospital. Berkeley Women’s Law J. 2001 Sep;140-156.

Religious and philosophical exemptions from vaccination requirements and lessons learned from conscientious objectors from conscription

Daniel A Salmon, Andrew W Siegel

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.

Salmon DA, Siegel AW. Religious and philosophical exemptions from vaccination requirements and lessons learned from conscientious objectors from conscription. Pub Health Rep. 2001 Jul-Aug;116(4):289-295.

Private Religious Hospitals: Limitations Upon Autonomous Moral Choices in Reproductive Medicine

William W Bassett

Journal of Contemporary Health Law and Policy

Extract
“Conscience clauses,” protecting the free exercise of religion in ethical decision-making by religiously affiliated hospitals, I believe, should continue to be absolute in reproductive medicine where the hospitals are clearly and unmistakably religious and patient choices of providers are free and fully informed. This conclusion is compelled by the free exercise clause of the First Amendment, as well as by the national interest in preserving and promoting diversity in the voluntary health care sector.

Bassett WW. Private Religious Hospitals: Limitations Upon Autonomous Moral Choices in Reproductive Medicine. J Contemp Health Law Policy. 2001;17:455-583.

L’incidence du refus de traitement sur le droit à l’indemnisation de la victime d’un préjudice corporel: pour une interprétation conforme au respect des libertés de conscience et de religion

Marie-Ève Arbour

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.

Arbour M-È. L’incidence du refus de traitement sur le droit à l’indemnisation de la victime d’un préjudice corporel: pour une interprétation conforme au respect des libertés de conscience et de religion. Les Cahiers de Droit. 2000;41(4):627-655.

The scope and limits of conscientious objection

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

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.

Dickens BM, Cook RJ. The scope and limits of conscientious objection. Int J Gyn Ob. 2000;71(1):71-77.

Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims

Steven S Smugar, Bernadette J Spina, Jon F Merz

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.

Smugar SS, Bernadette J Spina BA, Jon F Merz JD. Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims. Am J Public Health. 2000 Sep;90(9):1372-1376.

(News) Matters of principle; AMA favors reproductive rights access but says providers can’t be forced to violate conscience

Deanna Bellandi,Elizabeth Thompson

Extract
After Roman Catholic leaders issued strong criticism about its trampling of religious freedom, the American Medical Association approved a watered-down measure supporting continued community access to a full range of reproductive services following hospital consolidations. The AMA’s amended resolution stopped short of saying Catholic hospitals should have to perform all reproductive health procedures. . . The AMA instead upheld its policy that physicians and hospitals not be forced to perform services that violate their moral principles. . .

Bellandi D, Thompson E. Matters of principle; AMA favors reproductive rights access but says providers can’t be forced to violate conscience. Mod Healthcare 2000 Jun 19; 30(25): 6,14.

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.