Journals Archives - Page 62 of 108 - Protection of Conscience Project Library

Advance Directives and Dementia

Gregory E Kaebnick

Abstract
A competent person can avoid the onset of dementia by refusing life-sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life-sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But between these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life-sustaining care forbidden by advance directive. This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May-June 2014 issue), Paul Menzel and M. Colette Chandler-Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July-August 2018), and Cantor, too, tries to find a moderate alternative.

Kaebnick GE. Advance Directives and Dementia. Hastings Cent Rep. 2018 Aug 16;48(4):2.

(Correspondence) In Response

Bernard M. Dickens, Rebecca J. Cook

Journal of Obstetrics and Gynaecology Canada

Extract

As neither our original Commentary on access to emergency contraception nor our letter response was suitable for fully referenced legal or ethical reasoning, we appreciate this opportunity to expand a little on the substance of both, addressing the points Mr Murphy raises.

Dickens BM, Cook RJ. (Correspondence) In Response. 2004 Aug; 26(8): 706-707.

(Correspondence) Access to Emergency Contraception

Sean Murphy

Extract

In a letter in the February issue of JOGC, Rebecca J. Cook and Bernard M. Dickens state, “Physicians who feel entitled to subordinate their patient’s desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine” (emphasis added).
The statement is unsupported by their own legal references, and it has little to recommend it as an ordering principle in the practice of medicine.

Murphy S. (Correspondence) Access to Emergency Contraception. JOGC. 2004 Aug; 26(8): 705-706.

(News) Delays in abortion referrals limit women’s choices, says report

Debashis Singh

British Medical Journal, BMJ — British Medical Journal

Extract
Women in some parts of England have to wait up to two months from first seeking advice about an abortion to having the procedure, says a survey. The delays in referral mean that many women are presenting to services later than nine weeks pregnant and cannot be considered for early medical termination using the abortion pill, mifepristone, despite this being a popular option among women. . .The survey, which was conducted by Voice for Choice—an alliance of national pro-choice organisations including British Pregnancy Advisory Service, Marie Stopes International, and the Family Planning Association—reviewed the abortion services of 243 primary care trusts.

Singh D. Delays in abortion referrals limit women’s choices, says report. Br Med J. 2004;328(7455):1518e.

(News) Emergency contraception could lower abortion rate

Barbara Sibbald

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Anti-abortion groups should welcome proposed new regulation allowing patients to access emergency contraception without a prescription, says the Society of Obstetricians and Gynaecologists of Canada. . . . Emergency contraception, or the “morning after pill,” is sold in Canada as levonorgestrel (Plan B). If taken within 72 hours of unprotected intercourse, it can prevent ovulation, or interfere with fertilization, or implantation. . .The Catholic Organization for Life and Family and other anti-abortion groups believe pregnancy begins with conception, not implantation. In a letter to Health Canada, the organization called levonorgestrel an “abortifacient.”.

Sibbald B. Emergency contraception could lower abortion rate. Can Med Assoc J. 2004 Jun 22;170(13):1903.

Speciesism as a precondition to justice

Y Michael Barilan

Abstract
Over and above fairness, the concept of justice presupposes that in any community no one member’s wellbeing or life plan is inexorably dependent on the consumption or exploitation of other members. Renunciation of such use of others constitutes moral sociability, without which moral considerability is useless and possibly meaningless. To know if a creature is morally sociable, we must know it in its community; we must know its ecological profile, its species. Justice can be blind to species no more than to circumstance. Speciesism, the recognition of rights on the basis of group membership rather than solely on the basis of moral considerations at the level of the individual creature, embodies this assertion but is often described as a variant of Nazi racism. I consider this description and find it unwarranted, most obviously because Nazi racism extolled the stronger and the abuser and condemned the weaker and the abused, be they species or individuals, humans or animals. To the contrary, I present an argument for speciesism as a precondition to justice.

Barilan YM. Speciesism as a precondition to justice. Politics and the Life Sciences. 2005;23(1):22-33.

(Correspondence) Access to Emergency Contraception – In Response

Rebecca J Cook, Bernard M Dickens

Extract
The CMA Code of Ethics begins with the principle that an ethical physician will consider first the well-being of the patient. Physicians who feel entitled to subordinate their patients’ desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine.

Cook RJ, Dickens BM. (Correspondence) Access to Emergency Contraception – In Response. J. Obstet Gynaecol Can. 2004 Feb;112.

War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments

Michael Salter, Suzanne Ost

Extract
There is a considerable amount of academic and popular literature on Nazi medical experimentation within concentration camps, however, the existing research largely focuses on the doctors and the details of their experiments and has neglected two interesting themes. The first neglected theme is the potential legal liabilities and defense strategies of those among the SS leadership, such as SS General Karl Wolff. Wolff facilitated these experiments in a purely administrative capacity, but without his contribution this type of war crime would not have been possible. Secondly, the research has neglected the extent to which Wolff was able to avoid legal accountability for these and other war crimes, as a result of his wartime cooperation with a U.S. intelligence agency and his post-war assistance to interrogators within the Allied Military Intelligence as well as the Nuremberg prosecutors. [2] The present article, which is the first in a series of related studies, focuses largely on the first theme. This article gives particular attention to Wolff’s attempts to avoid prosecution by insisting that the experiments were of a voluntary nature, based on the consent of the research subject, and were, therefore, not criminal acts. Additionally, the article focuses on Wolff’s claim that he did not possess the requisite mens rea or intent necessary to secure a criminal conviction.

Salter M, Ost S. War Crimes and Legal Immunities: The Complicities of Waffen-SS General Karl Wolff in Nazi medical experiments. Rutgers J Law Rel. 2004(1);1-69.

A physician’s professional duty to inform despite personal ethical objections

Laura D Briley

Extract
This physician may feel ethically torn, but it is the physician’s duty to help enable this patient to make the best decision. By informing the patient about abortion, the physician is not endorsing the procedure, or swaying this mother in either direction, but simply providing information. This use of information will strengthen the relationship between patient and physician because it fosters autonomy and offers a sense of support during a time when it is needed most. Although it may not be a physician’s duty to perform an abortion when the physician feels ethically opposed, it is the duty of the physician to inform a woman about the procedure without allowing personal beliefs to influence her decision.

Briley LD. A physician’s professional duty to inform despite personal ethical objections. Curr Surg. 2003;60(6):594.

Access to emergency contraception

Rebecca J Cook, Bernard M Dickens

Abstract
The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.

Cook RJ, Dickens BM. Access to emergency contraception. J Ob Gyn Canada. 2003 Nov;25(11):914-916.