Protection of Conscience Project Library
Service, not Servitude
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It is unrealistic and unfair to expect patients to anticipate all conditions that may befall them, identify which ones might be problematic for their physicians, and agree either to reach a compromise or to seek care elsewhere.
Stotland NL. (Correspondence) Religion, Conscience and Controversial Clinical Practices. N Engl J Med.. 2007;356(18):1889-1890.
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A health care system must establish clear criteria to allow the right balance between paternalism and the autonomy of patients in the case of medical issues that are controversial among health care professionals.
Zarate V. (Correspondence) Religion, Conscience and Controversial Clinical Practices. N Engl J Med. 2007 May 03;356(18):1890-1891.
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Those who act conscientiously do not “disavow responsibility” and “substitute their personal values for the fundamental rights of their patients.” Rather, they are engaging in the struggle to know and do the right thing and to understand and fulfill their moral obligations in a particular situation. This task cannot be externalized or delegated. Indeed, acting conscientiously is the heart of the ethical life, and to the extent that physicians give it up, they are no longer acting as moral agents.
Curlin FA, Lawrence RE, Lantos JD. (Correspondence) Religion, Conscience and Controversial Clinical Practices (Authors respond). N. Engl. J. Med.. 2007;356(18):1891-1892.
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Discussion:
CMA policy states that “a physician should not be compelled to participate in the termination of a pregnancy.” In addition, “a physician whose moral or religious beliefs prevent him or her from recommending or performing an abortion should inform the patient of this so that she may consult another physician.” You should therefore advise the patient that you do not provide abortion services. You should also indicate that because of your moral beliefs, you will not initiate a referral to another physician who is willing to provide this service (unless there is an emergency). However, you should not interfere in any way with this patient’s right to obtain the abortion. At the patient’s request, you should also indicate alternative sources where she might obtain a referral. This is in keeping with the obligation spelled out in the CMA policy: “There should be no delay in the provision of abortion services.”.
Blackmer J. (Correspondence) Clarification of the CMA’s position concerning induced abortion. Can Med Assoc J. 2007;176(9):1310.
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I am deeply disturbed by the negative responses (posted as e-letters) to the guest editorial by Sanda Rogers and Jocelyn Downie. Most of the authors articulate an uncompromising ideological position in favour of the right to life of a fetus, while ignoring the basic human rights of women who, presumably, are their patients. . . . Why should an individual doctor’s personal beliefs trump the legal definition of “person” and of “human being,” violate the constitutionally entrenched rights of women to sexual and reproductive autonomy, and violate international human rights?
Côté A. (Correspondence) Access to abortion. Can Med Assoc J. 2007 Feb 13;176(4):493-494.
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Given that abortion and its regulation and restriction continue to be hotly debated in Canada, it is not simply “like any other medical procedure.” It is also inaccurate to portray a physician who exercises a right of conscientious objection to participating in abortion as violating CMA policy. The 1988 CMA Policy on Induced Abortion specifically allows for such a right of conscientious objection.
Buckingham JE. (Correspondence) Access to abortion. Can Med Assoc J. 2007;176(4):492.
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pharmacists are autonomous, moral agents who are accountable for their choices and entitled—within limits— to decide in which activities they will participate. Pharmacists’ professionalism is defended, their responsibilities in the provision of drug therapy are set forth in the context of pharmaceutical care, and these lead to the conclusion that pharmacists’ refusals may be ethically justified. There are important limits on how are being asked to participate in actions they find morally objectionable. Notably, they must ensure that these prescriptions are filled by someone else in a timely manner and must refrain from any abusive or demeaning treatment of patients, as summed up in our Principle of Conscientious Refusal to Dispense.
Baergen R, Owens C. Revisiting Pharmacists’ Refusals to Dispense Emergency Contraception. Obstetrics & Gynecology. 2006;108(5):1277-1282.
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an egalitarian justice argument, he mentions only briefly as more promising than the former: refusing to provide reproductive assistance to homosexual parents while making it available to heterosexual parents constitutes unjust discrimination against the former. Appel does not develop this suggestion at all, but I want to say a word about an issue on which it hinges, namely, the moral standing that reproductive assistance has in a just health care system.
Blustein J. (Correspondence) Infertility Treatments for Gay Patients? Hastings Cent Rep. 2006;36(5):6.
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If a pharmacist’s beliefs or personal convictions prevent him or her from providing a particular service, the pharmacist must disclose this fact before accepting employment to allow procedures to be put in place to enable patients to access the services they require. In such circumstances the Code of Ethics and Standards requires that a pharmacist must not condemn or criticise the patient and that either the pharmacist or a member of staff must advise the patient of an alternative source for the service requested.
Balmer L. (Correspondence) Royal Pharmaceutical Society and conscientious objectors. The Lancet. 2006;367(9527):1980.
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I have, however, a question about the implication that the pharmacy assistant was being unprofessional because he let his personal conviction affect the provision of care. I would like to assume for the sake of argument that his personal conviction was that Plan B is unethical because it induces abortion and he is of the opinion that abortion ends a person’s life. By providing Plan B he would be doing something that he genuinely believes is in the best interest of neither his adult client nor her embryo. Wouldn’t it be unprofessional to ignore this conviction and provide the drug anyway? What should a professional do when he is asked to do something by a client that he genuinely believes is not in the client’s best interest? What would a lawyer do?
Brickell SE. (Correspondence) Personal conviction: what role should it play. Can Med Assoc J. 2006;174(8):1134.