Journals Archives - Page 48 of 108 - Protection of Conscience Project Library

Anesthetizing the public conscience: lethal injection and animal euthanasia

(The Lethal Injection Debate: Law and Science)

Ty Alper

Extract
People are never executed using the anesthetic-only procedure that veterinarians and shelter workers use on animals. And animals are never euthanized by the three-drug formula prison officials use on human beings. As detailed in this Article, the veterinary and animal welfare communities widely condemn the use of neuromuscular blocking agents such as pancuronium. Particularly given the popular assumption that execution of humans by lethal injection is no different than “putting an animal to sleep,” the condemnation of the use of curariform drugs in the euthanasia context should give courts pause when assessing the risks of the three-drug formula under the Eighth Amendment. . . The Humane Society mandates a method of euthanasia the primary benefit of which is that it is actually humane. At a time when the public’s trust in the administration of capital punishment in this country appears to be eroding, the states, on the other hand, have clung to a method whose primary benefit is that it looks humane- but that in reality risks the unnecessary infliction of excruciating pain and suffering.

Alper T. Anesthetizing the public conscience: lethal injection and animal euthanasia (The Lethal Injection Debate: Law and Science). Fordham Urban Law J. 2008;35(4):817-856.

Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives

Jennifer E. Spreng

Extract
Conclusion
Pharmacists are already involved in litigation over conscience clauses; it is probably only a matter of time before a woman sues a pharmacist for wrongful conception. Changes in the pharmacy profession and correlative tort duties mean a common law or statutory duty to dispense or sell emergency or daily oral contraceptives is not outside the realm of possibility. Many religious pharmacists have compelling reasons to refuse to sell, but federal Free Exercise protections are currently uncertain. State statutory conscience clauses offer some protection and do not violate the Establishment Clause. Therefore, more states should not hesitate to provide
this protection to all healthcare providers.

Spreng JE. Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives. 1 St. Louis U. J. Health L. & Pol’y 337, 337-40 (2008)

(Correspondence) LVADs and the Limits of Autonomy

Jeremy Simon, Ruth Fischbach

Extract
Jeremy Simon’s commentary argues that physicians may decline to deactivate an LVAD even at the request of a capable patient. . . . No doctor may be forced to act against her conscience to end a patient’s life. A physician moved by Simon’s argument would be covered by this doctrine. As for legal precedents, if there have been any cases regarding the removal of destination LVADs, there certainly have not been enough for the case law in this matter to be considered settled. . .

Simon J, Fischbach R. (Correspondence) LVADs and the Limits of Autonomy. Hast Cent Rep. 2008 May-June;5.

(Correspondence) Responses to Abortion Training

Hugh Silk

Extract
While a fetus dies during an abortion, women also die when they don’t have access to proper reproductive services. People died in concentration camps and during civil rights protests. However, I would never compare reproductive issues to those historical events. . . . Regardless of which side we stand on in this debate, let’s not do an injustice to those who endured so much in WWII and in the United States during the 1950s and 1960s to allow us to have the freedom to have this debate. . . . Doing no harm may be impossible. Doing the lesser of harms is more achievable.

Silk H. (Correspondence) Responses to Abortion Training. Fam Med. 2008 May;40(5):311.

(Correspondence) GMC guidance on beliefs: Denies conscientious objection

Eugene G Breen

British Medical Journal, BMJ — British Medical Journal

Extract
The recent ethical guideline of the General Medical Council puts doctors in an impossible position. The giving of information or aiding someone to obtain a service the doctor considers immoral contravenes the essence of conscientious objection. The doctor’s right to have his moral code respected, provided that it isn’t spurious or lacking a credible evidence base, is a basic human right.

Breen EG. (Correspondence) GMC guidance on beliefs: Denies conscientious objection. Br Med J. 2008;336(7648):790.

Conscientious commitment

Bernard M. Dickens

Extract
In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?

Dickens BM. Conscientious commitment. Lancet [Internet]. 2008 Apr 12; 371(9620): 1240 – 1241

Access to abortion: what women want from abortion services

Ellen R Wiebe, S Sandhu

Journal of Obstetrics and Gynaecology Canada

Abstract
Objective: Whether Canadian physicians can refuse to refer women for abortion and whether private clinics can charge for abortions are matters of controversy. We sought to identify barriers to access for women seeking therapeutic abortion and to have them identify what they considered to be most important about access to abortion services.

Methods: Women presenting for abortion over a two-month period at two free-standing abortion clinics, one publicly funded and the other private, were invited to participate in the study. Phase I of the study involved administration of a questionnaire seeking information about demographics, perceived barriers to access to abortion, and what the women wanted from abortion services. Phase II involved semi-structured interviews of a convenience sample of women to record their responses to questions about access. Responses from Phase I questionnaires were compared between the two clinics, and qualitative analysis was performed on the interview responses.

Results: Of 423 eligible women, 402 completed questionnaires, and of 45 women approached, 39 completed interviews satisfactorily. Women received information about abortion services from their physicians (60.0%), the Internet (14.8%), a telephone directory (7.8%), friends or family (5.3%), or other sources (12.3%). Many had negative experiences in gaining access. The most important issue regarding access was the long wait time; the second most important issue was difficulty in making appointments. In the private clinic, 85% of the women said they were willing to pay for shorter wait times, compared with 43.5% in the public clinic.

Conclusion: Physicians who failed to refer patients for abortion or provide information about obtaining an abortion caused distress and impeded access for a significant minority of women requesting an abortion. Management of abortion services should be prioritized to reflect what women want: particularly decreased wait times for abortion and greater ease and convenience in booking appointments. Since many women are willing to pay for services in order to have an abortion within one week, this option should be considered by policy makers.

Wiebe ER, Sandhu S. Access to abortion: what women want from abortion services. J Obstet Gynaecol Can. 2008 Apr;30(4):327-331.

To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

Farr A Curlin, Chinyere Nwodim, Jennifer L Vance, Marshall H Chin, John D Lantos

American Journal of Hospice and Palliative Care

Abstract
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients.

Curlin FA, Nwodim C, Vance JL, Chin MH, Lantos JD. To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support. American J Hospice & Pall Care. 2008;25(12):112-120.

Conscientious Commitment

Bernard M Dickens

Extract
Religion has no monopoly on conscience, however. History, both distant and recent, shows how health-care providers and others, driven by conscientious concerns, can defy laws and religious opposition to provide care to vulnerable, dependent populations. They might also defy the medical establishment. Pioneers of the birth control movement were not doctors, and were opposed by medical, state, and religious establishments. As long ago as 1797, Jeremy Bentham advocated means of birth control, and in the following century, John Stuart Mill was briefly imprisoned for distributing birth control handbills. Charles Bradlaugh and Annie Besant were similarly prosecuted, in 1877, for selling pamphlets about birth control.

Dickens BM. Conscientious Commitment. The Lancet. 2008;371(1240-1241.

Pharmacists and the “Duty” To Dispense Emergency Contraceptives

Jennifer E Spreng

Abstract
Stories abound of both women with prescriptions turned away at the pharmacy door and members of the most trusted health care profession losing jobs and running afoul of ethics rules. Scholars have spilt much intellectual ink divining whether a pharmacist must dispense Plan B, the primary emergency contraceptive. Now, many are calling for a common law “duty to dispense” that could serve as a foundation for a wrongful pregnancy action against a dissenting pharmacist. Such a duty simply does not arise from established tort principles or pharmacist-specific precedents. Only in rare circumstances will a pharmacist and customer have the type and quality of relationship giving rise to a duty to dispense. Nevertheless, law changes over time and makes allowances for unique circumstances. Pharmacists are taking on more responsibility for drug therapy. They have an awkward role in the distribution of Plan B. Moreover, while the law may protect pharmacists’ consciences, it may not be so receptive to pharmacists-as-activists. Dissenting pharmacists can take practical steps to protect themselves today, but tomorrow is another day.

Spreng JE. Pharmacists and the “Duty” To Dispense Emergency Contraceptives. Issues Law Med. 2008 Spring;23(3):215-277.