Extract We question Savulescu’s statement that a specialist valuing her own life more than her duty to her patients during a bird flu epidemic would be demonstrating values “incompatible with being a doctor.” . . . recklessly to treat a highly contagious individual without taking adequate precautions would be imprudent and irresponsible. Equity and fairness requires a professional to judiciously balance the needs of one patient with the needs of others, including those of his or her own family.
Extract Shakespeare wrote that “Conscience is but a word cowards use, devised at first to keep the strong in awe” (Richard III V.iv.1.7). Conscience, indeed, can be an excuse for vice or invoked to avoid doing one’s duty. When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient’s good and the patient’s informed desires (box). If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.
Gamal I Serour, International Federation of Gynecology and Obstetrics (FIGO)
International Journal of Gynecology & Obstetrics
Abstract The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health held a combined meeting with the Committee of Women’s Sexual and Reproductive rights to discuss ethical aspects of issues that impact the discipline of Obstetrics, Gynecology, and Women’s Health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.
Extract In 2004 the Michigan House passed a bill called the “Conscientious Objector Policy Act.”. . . The bill as passed reflected no balancing of or respect for patients’ rights to autonomy, or their other needs and interests.
This article traces brief histories of health care conscience clauses and the patient’s right to informed consent. It analyzes the bill in the context of patients’s rights, and proposes alternative approaches to restore balance to the patient-provider relationship, while maintaining providers’ right to conscience. The article’s final section evaluates a variety of potential legal challenges to protect patients if the bill is re-introduced unchanged.
Extract The assignment: to buy the drug in a small, remote town where I was sojourning on business. If I could not get the pill in this straight-talking, hard- working place, who could? . . . approached a smiling pharmacy worker and asked for Plan B. . . . Kevin refused to hand it over. Only a pharmacist could give me the drug. He was a pharmacist’s assistant; the real pharmacist was on her break. . . . When I returned at 5:30, Kevin, the man of steely resolve, informed me that the pharmacist had left for the day. No pharmacist, no Plan B. [Pharmacist assistant seems to have answered questions evasively] . . . Was this not a nonprescription drug. Yes. Why could I not purchase the drug if no prescription was necessary? And then he said it: “Because, ethically, I don’t believe in it and I would not give it to you anyway. It is against my principles, and I don’t have to do anything I am uncomfortable with,” he said loudly and proudly. . . According to Kevin, there is nothing unprofessional about placing personal conviction ahead of a woman’s health care needs. . . a reasonably articulate curmudgeon like myself cannot obtain emergency contraception, what chance does a worried, upset teenage girl have?
Barbara W. Counter attack. Can Med Assoc. J. 2006;174(2):211-212.
Extract Expanding collaborative practice navigates the issue well, providing a seamless way for women to access emergency contraception without compromising the pharmacist’s ability to opt out. Such legislative initiatives are far more effective in expanding access to emergency contraception than misguided regulations that require pharmacists or pharmacies to assure dispensing of contraceptives “without delay.” In addition to blatantly insulting the professionals who are required to check their beliefs at the door, duty-to-dispense laws can have the opposite effect by limiting access to contraceptives when pharmacy practices simply choose not to carry the products rather than face sanctions if workable solutions for accommodating the patient and the pharmacist are disrupted by misguided regulations. Conscience and collaborative practice can complement each other, but only if both are available.
Extract There is concern that conscience clauses for pharmacists will lead to pharmacists refusing to fill prescriptions outside the area of contraception. For example, pharmacists who believe AIDS is a punishment from God may not fill a patient’s prescription for AIDS medication. Doctors who think children should only be born to heterosexual, married couples may not provide adequate fertility treatment or may not encourage their patients to explore their options fully. The current trend of pharmacists refusing to fill prescriptions because of personal beliefs violates a woman’s constitutional rights, a pharmacist’s duty of care, and a woman’s right to confidentiality. Forcing pharmacists to fill prescriptions that conflict with their religious beliefs also violates their constitutional right to free exercise of religion. Allowing individual pharmacists to decline to fill prescriptions while mandating that pharmacies have a policy to ensure that customers’ needs are met will help alleviate the concerns of both parties to the conflict. Thus, any legislation that is enacted should balance the needs of both pharmacists and patients.
Abstract Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.
Extract There are other flaws with Bill C-407, but this is not the place to present them in detail. However, there is one serious flaw that is appropriately considered in this forum, and that is the fact that the Bill is a partial measure at best. It deals only with assisted suicide, not euthanasia. It would not help those who, although competent, could not perform the final act themselves because they are disabled. . . .As well, the Bill ignores those who have never been competent and never will be. Their rights would still be less than those of other persons: they would be condemned to suffer when a competent person would not. An appropriately crafted suicide and euthanasia Bill would change that situation.
Kluge E-H. Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada. Humanist Perspectives Online Supplement. 2005;38(4):1-5
Extract The medical community agrees that while health professionals may be given statutory rights to refuse health services for moral reasons, refusal cannot prevent patients from receiving “the information, services, and dignity to which they are entitled.” In theory, laws and institutional policies that allow pharmacists to transfer prescriptions to another pharmacist do not interfere with established treatment plans. However, in practice these laws may delay health care services and harm patients. . . . In many foreseeable situations, a pharmacist’s moral objection may delay or prevent the receipt of prescription mediation. Pharmacists who refuse to provide services or transfer prescriptions to colleagues act contrary to professional objectives. Unnecessary delays or obstructions by pharmacists jeopardize treatment plans established by physicians and patients. . . . Conscience clause legislation that does not assure patient access to contraceptive services likely conflicts with reproductive liberty interests. . . states may require pharmacists to fill all prescriptions. Alternately, states may pass conscience clause legislation that assures patient access to health care services by prescription transfer or other similar procedure. . . . Conscience clause debate should not be clothed in abortion politics. Rather, its focus should be on whether a pharmacist has a right to interfere with a treatment plan established by a patient and his or her primary health care provider.
