Protection of Conscience Project Library
Service, not Servitude
Extract
In formulating a response to the abortion issue, the nursing profession needs to be careful not to lose sight of its moral obligation to ensure that women receive the care they require. Nurses also need to be wary of the politicisation of conscience and the corrupting influence this can have on authentic debate about complex moral issues.
Johnstone M-J. Abortion and the politicisation of conscience. Aust Nurs J. 2008 Dec;16(6):21.
Abstract
The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers, hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’ duties to refer patients to non-objecting providers, and that hospitals, clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.
Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gyn Ob. 2009 Nov 29;104(3):249-252.
(Article compares approach to freedom of conscience in health care in the US and Canada)
Extract
Advocates of compulsory referral claim that doctors who discriminate against certain practices are, whether they know it or not, also discriminating against certain people — namely, the poor, the uneducated and those in remote areas. These people already have limited access to medical services, a problem that, all sides agree, is exacerbated when their doctors refuse to present them with all their options.
Collier R. Morals, medicine and geography. Can Med Assoc J. 2008 Nov 04;179(10):996-997.
Journal Extract
This Educational Bulletin outlines delivery systems and contraceptive formulations, summarizes advances in emergency contraception and reviews the effects of hormonal contraception on cancer risks, cardiovascular disease, and bone.
ASRM. Hormonal contraception: recent advances and controversies (ASRM Practice Commitee). Fertil Steril. 2008;90(3 SUPPL.):s103-s113.
Abstract
BACKGROUND: For over 30 years, pharmacists have exercised the right to dispense medications in accordance with moral convictions based upon a Judeo-Christian ethic. What many of these practitioners see as an apparent shift away from this time-honored ethic has resulted in a challenge to this right.
OBJECTIVE: To review and analyze pharmacy practice standards, legal proceedings, and ethical principles behind conflicts of conscientious objection in dispensing drugs used for emergency contraception.
DATA SOURCES: We first searched the terms conscience and clause and Plan B and contraception and abortion using Google, Yahoo, and Microsoft Networks (2006-September 26, 2008). Second, we used Medscape to search professional pharmacy and other medical journals, restricting our terms to conscience, Plan B, contraceptives, and abortifacients. Finally, we employed Loislaw, an online legal archiving service, and did a global search on the phrase conscience clause to determine the status of the legal discussion.
DATA SYNTHESIS: To date, conflicts in conscientious objection have arisen when a pharmacist believes that dispensing an oral contraceptive violates his or her moral understanding for the promotion of human life. Up to this time, cases in pharmacy have involved only practitioners from orthodox Christian faith communities, primarily devout Roman Catholics. A pharmacist’s right to refuse the dispensing of abortifacients for birth control according to moral conscience over against a woman’s right to reproductive birth control has created a conflict that has yet to be reconciled by licensing agents, professional standards, or courts of law.
CONCLUSIONS: Our analysis of prominent conflicts suggests that the underlying worldviews between factions make compromise improbable. Risks and liabilities are dependent upon compliance with evolving state laws, specific disclosure of a pharmacist’s moral objections, and professionalism in the handling of volatile situations. Objecting pharmacists and their employers should have clear policies and procedures in place to minimize workplace conflicts and maximize patient care.
Keywords:
Wernow JR, Grant DG. Dispensing with conscience: A legal and ethical assessment. Ann. Pharmacother. 2008;42(11):1669-1678. Available from:
Abstract
Objective: The aim of this study was to focus on barriers, controversy and perceived risk associated with use of emergency contraception (EC) after unprotected sexual intercourse.
Design and method: Data were extracted from the literature of the MEDLINE database service. Original articles, surveys, clinical trials and investigations are considered for this review.
Results: After the introduction of over-the-counter and advance prescription provisions for easy access to EC, the rural–urban disparity in availability of EC poses a barrier to use of EC for rural dwellers. The socio-economically weaker section of the population is unable to purchase EC because of low or no income, although there is mounting pressure by the State for prevention of unintended pregnancy by use of EC. Some healthcare providers have objected to provide EC to the patient on the grounds of their conscience and morality. Some providers and users have also expressed concerns about the possibility of increase in irresponsible sexual behaviour because of easy access to EC. There may be some truth in their apprehension because nearly 3.2 million unintended pregnancies occur annually despite various contraceptive options available in USA and the extensive use of EC is directly proportional to the volume of unprotected sexual intercourse, which is too directly proportional to the quantum of risk for contacting sexually transmitted infections (STIs)/AIDS.
Conclusions: Emergency contraception is a one-off postcoital procedure and not to be opted after every sexual intercourse. Controversy about EC may be resolved if it is used within this limit. Extensive use of EC may increase risk for contacting STIs/AIDS.
Sarkar NN. Barriers to emergency contraception (EC): Does promoting EC increase risk for contacting sexually transmitted infections, HIV/AIDS? Int J Clin Pract. 2008 Oct 15;62(11):1769-1775.
Extract
Physicians should not lend their medical expertise to the state to make executions more palatable to the public, even by advising on drug protocols, doses, and routes of administration. Even physicians who support the death penalty should stay out of its execution, because the problem that the state seeks to solve by using physicians is one of the state’s own making by its refusal to abolish capital punishment and its insistence on execution by lethal injection.
Annas GJ. Toxic Tinkering – Lethal Injection Execution and the Constitution. N Engl J Med. 2008;359(14):1512-1518.
Abstract
The analysis of a dispute can focus on either interests, rights, or power. Commentators often frame the conflict over conscience in clinical practice as a dispute between a patient’s right to legally available medical treatment and a clinician’s right to refuse to provide interventions the clinician finds morally objectionable. Multiple sources of unresolvable moral disagreement make resolution in these terms unlikely. One should instead focus on the parties’ interests and the different ways in which the health care delivery system can accommodate them. In the specific case of pharmacists refusing to dispense emergency contraception, alternative systems such as advanced prescription, pharmacist provision, and over-the-counter sales may better reconcile the client’s interest in preventing unintended pregnancy and the pharmacist’s interest in not contravening his or her conscience. Within such an analysis, the ethicist’s role becomes identifying and clarifying the parties’ morally relevant interests.
Antommaria AHM. Adjudicating rights or analyzing interests: ethicists’ role in the debate over conscience in clinical practice. Theor Med Bioeth. 2008;29(3):201-212.
Abstract
This article introduces the life of Shomatsu Yokoyama ( 1913-1992), a physiologist and military doctor, to the reader. During the Sino-Japanese war, Yokoyama disobeyed orders given by his superior officer to conduct inhumane medical experiments on humans. Not only in Unit 731, but also in other units, many military doctors were involved in medical crimes against residents of the areas invaded by the Japanese Army. In human living-body experiments and vivisections were widely conducted at that time. There were, however, a small number of researchers who did not follow the orders to perform human body experiments. Highlighting the life of such a rare researcher for the purpose of ascertaining the reason for his noncompliance with the order will provide us with insights on medical ethics.
Suenaga K. Shomatsu Yokoyama, a Physiologist Who Refused to Conduct Experments on Living Human Bodies. Journal of Japanese History of Medicine (Nihon Ishigaku Zasshi). 2008;54(3):239-248.
Extract
The chair of the President’s Council on Bioethics, Edmund Pellegrino, has insisted that medical ethics are and must be the same for civilian and military physicians, “except in the most extreme contingencies.” There is no special medical ethics for active-duty military physicians any more than there is for Veterans Affairs physicians, National Guard physicians, public health physicians, prison physicians, or managed care physicians. The only question is whether there are “extreme contingencies” that justify physicians’ suspension of their medical–ethical obligations.
Annas GJ. Military Medical Ethics – Physician First, Last, Always. N Engl J Med. 2008;1087-1090.