Abstract Most definitions of conscience in the US legal context are broadly defined as including religious, moral, or ethical principles. The wave of state and federal laws and bills supporting conscience protection for medical personnel are increasingly covering all health care services, and this has created counterclaims challenging the idea that health-related professionals may deny legally and medically permitted therapeutic interventions, particularly if their objections are personal and religious. The question is whether Americans deem it proper to put a person in the position of leaving his or her job or violating his or her conscience. Although such laws make reference to “conscience,” most define that term in a virtually boundless fashion to include religion, moral, or ethical principles and convictions. Such a broad definition may bring the freedom of conscience debate clearly within the protection of Title VII and its prohibition of religious discrimination.
Journal Extract It has been 40 years since the seminal papers on pharmacy’s status as a profession sparked debate about the pharmacist’s role in health care, yet the questions they raised are just as poignant today as they were then. The issue of pharmacy’s status as a profession and its role in health care has again been brought into question, albeit in a roundabout manner, through discussions over the pharmacist’s right to refrain from dispensing emergency contraception. The key to understanding the contemporary pharmacist’s role as part of the health care team, as well as the pharmacist’s alleged right to refrain from dispensing emergency contraception, is to examine a situation that almost every contemporary pharmacist experiences.
Abstract Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse.
Abstract Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.
Abstract Abortion is the most politically contested social issue in the United States, a debate that manifests itself in extensive regulation of abortion as a health care service. This study provides a brief history of the judicial acceptance of abortion regulation and an overview of the most common forms of abortion regulation affecting physicians in the United States. The article concludes with a discussion of pending threats to the legal right to abortion in the United States and recommended resources where physicians can find assistance to comply with existing laws.
Abstract Pharmacy, like other health care professions, is both a knowledge-based and a value-based profession. However, the values that inform practice activities are rarely made explicit. We sought to identify the values drawn on by UK pharmacists through qualitative interviews on day-to-day practice activities focused around practitioners’ conceptions of ‘the good pharmacist’, good practice and their experiences of ethical issues and dilemmas. The study was based upon loosely structured, one-to-one interviews of 38 selected practitioners reflecting a range of practice roles and settings. The interviews were recorded, transcribed and analysed following the principles of grounded theory. The accounts of practice (of self and colleagues) in the data showed pharmacists to be very dedicated and conscientious. Practice was predominantly discussed and presented by practitioners drawing upon a scientific mode of rationality. Value and ethical judgements were typically presented within this mode, with more open-ended and complex discussion of values and ethics appearing quite rarely. Two core values generally drawn on in reported practice emerged from the analysis – these were, ‘the patient’s best interests’ and a value we labelled ‘respect for medicines’. Common dilemmas arose from conflicting values, for example competing obligations to different parties, sometimes brought to a head by the conflicting demands of ‘rules’ of various sorts. Reported dilemmas related to rule breaking, resource allocation, patient communication and teamwork. There was a tendency for practitioners to ‘fall back’, often unreflectively, on their own personal value judgements when addressing these dilemmas. However, in the main, the values and dilemmas reported clearly show the socially embedded nature of professional ethics and, thereby, contribute to the social science re-theorisations of professional ethics needed if work on ethics development is to be realistic.
Extract The correct measure of the public health burden of a discrete event is its incidence: the annual per capita rate of occurrence of the event of interest in the relevant population group. As we reported, the incidence of induced abortion in Peru is as high as, or higher than, the incidence in Britain and the United States, but in Peru this practice is illegal, performed clandestinely and potentially unsafe. . . .he is probably correct in his assertion that the legal restrictions in Peru result in relatively fewer pregnancies being terminated in that country than in Britain or the United States; that is, there are more unwanted births in Peru. . . The high incidence of induced abortion clearly indicates a high incidence of unwanted pregnancy.
Extract The challenge is thus to accommodate conscience- based treatment refusals without jeopardizing the foundations of pluralistic medical professionalism. I believe that medical professionals functioning in pluralistic healthcare settings may be excused from providing certain information or services if they apologize to those in need of this aid, and if those in need of aid can be assured equitable access to the information or services in question. Note carefully, I am proposing conditions for excusing professionals who fail to maintain moral neutrality; I am not defending a right to conscience-based denials of healthcare, or ‘civil rights’ protections for refusers. . .Refusals to refer to other professionals or to transfer prescriptions are inexcusable.
Abstract Recent legislation in Wisconsin mandating provision of emergency contraception to victims of sexual assault may create a conflict of conscience for some health care professionals. Although disputes exist over the exact mechanism of action of emergency contraception, those professionals who espouse a particularly strict stance may be reluctant to dispense the medication for fear that it could prevent a fertilized embryo from implanting in the uterus. While no objection of conscience clause was written into the new law, Wisconsin law has a long tradition of recognizing rights of conscience in matters of religious conflict. This legal tradition both at statutory and common law levels is summarized with application to the recent emergency contraception mandate. A case is made for a potential legal defense should a health care professional abstain from dispensing emergency contraception.
Bradley CT. Emergency Contraception and Physicians’ Rights of Conscience: A Review of Current Legal Standards in Wisconsin. Wis Med J. 2009 May; 108(3):156-160
Abstract The right to conscientious objection is founded on human rights to act according to individuals’ religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. They are required, however, to be equally respectful of rights to conscience of patients and potential patients. They cannot invoke their human rights to violate the human rights of others. There are legal limits to conscientious objection. Laws in some jurisdictions unethically abuse religious conscience by granting excessive rights to refuse care. In general, healthcare providers owe duties of care to patients that may conflict with their refusal of care on grounds of conscience. The reconciliation of patients’ rights to care and providers’ rights of conscientious objection is in the duty of objectors in good faith to refer their patients to reasonably accessible providers who are known not to object. Conscientious objection is unethical when healthcare practitioners treat patients only as means to their own spiritual ends. Practitioners who would place their own spiritual or other interests above their patients’ healthcare interests have a conflict of interest, which is unethical if not appropriately declared.
