0 - Protection of Conscience Project Library

Freedom of conscience, professional responsibility, and access to abortion

Rebecca S. Dresser

Extract
Access to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scar city has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion. Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?

Dresser RS. Freedom of conscience, professional responsibility, and access to abortion. J Law Med Ethics 1994 Fall;22(3):280-5.

Abortion: the limits of moral repugnance

Leah L Curtin

Abstract
A 28-year-old married woman, gravida 3 para 2002, was transferred to a tertiary care hospital at 27 2/7 weeks gestation for verification of gross fetal anomalies. Ultra-sonography studies showed the child she carried had a dramatic gastroschises, an enlarged heart, and small limb buds for arms. The patient was informed of her fetus’ condition and, after she discussed the situation with her husband, both parents asked that the pregnancy be terminated.

Using prostaglandin, the physician induced labor prematurely in a labor and delivery room suite. Both parents held the child until shortly before its death.

A voluntary abortion this late in pregnancy for nonlethal birth defects caused considerable concern and even distress among the nursing staff on this unit. As a matter of conscience, almost half of the nursing staff refused to care for any patients having elective abortions, and this case raised even more moral questions than usual. Moreover, this couple—and even their family members—received threatening phone calls and letters while the woman was still in the hospital, and the couple reported receiving even more after she returned home.

Curtin LL. Abortion: the limits of moral repugnance. Nurs Manag. 1994 Oct;25(10):22-25.

(Correspondence) Methotrexate and misoprostol used in abortions (Author responds)

Ellen R Wiebe

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Of course methotrexate is contraindicated for a wanted pregnancy: it causes abortion in approximately 95% of pregnancies of less than 7 weeks’ gestation. This is why we are using it as an abortifacient. . . . if abortion failed in a women given methotrexate and she refused to undergo surgical abortion, there would be a risk to the fetus. From the experience with RU 486 in Europe we know that women rarely change their minds about abortion in such cases.

Wiebe ER. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994;151(5):518.

(Correspondence) Methotrexate and misoprostol used in abortions

Anthony T Kerigan

Extract
. . . methotrexate is contraindicated during pregnancy. If Wiebe and the University of British Columbia Ethics Committee have information on the safety of this drug during pregnancy perhaps they could share it with readers.

Kerigan AT. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994 Sep 01;151(5):518.

Consequences for patients of health care professionals’ conscientious actions: the ban on abortions in South Australia

Leslie Cannold

Abstract
The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs’ claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action ‘… invades a patient’s autonomy, puts a patient at serious risk … [and] treats a patient unjustly’ (1) Secondly, because the consequences of such refusals turn them into political acts-acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.

Cannold L. Consequences for patients of health care professionals’ conscientious actions: the ban on abortions in South Australia. J Med Ethics. 1994 Jun;20(2):80-86.

Bioethics: Private Choice and Common Good

Daniel Callahan

Extract
There is a peculiar and disturbing feature of our times. On the one hand, biomedicine unceasingly extends its power to shape our lives and our culture. . . On the other hand, our protean selves and malleable culture are themselves more wary than ever about responding to that challenge with what might be the only means at our disposal: the search for some coherent, plausible view of what constitutes the good of human beings and their societies. In the absence of such a view, all the real power is in the hands of science, which can decisively bring about fundamental changes even without aiming deliberately to do so. Only an understanding of the self that has substance and direction can fight back, setting its own counteragenda. Choice alone cannot do that. For its part also, a society that itself lacks a compass, devoted only to fostering a minimalist civic accord, is in no less vulnerable a position. If there is no common picture of what biomedicine can do to foster a good human life-if the very question of what constitutes such a life has been banished in the name of pluralism-then that life will be pushed about in ways it is helpless to control, a frail ship that has lost its direction on a stormy, confused sea.

Callahan D. Bioethics: Private Choice and Common Good. Hastings Cent Rep. 1994 May-Jun;24(3):28-31.

(Correspondence) Methotrexate and misoprostol used in abortions

Ellen R Wiebe

Extract
Medically induced abortion rather than surgical abortion has many advantages and could improve access to abortion in Canada . . . In December 1993 I received permission from the University of British Columbia Ethics Committee to start a pilot study of abortion induced with methotrexate and misoprostol; the study is under way. I would like to hear from other physicians who may be interested in this method.

Wiebe ER. (Correspondence) Methotrexate and misoprostol used in abortions. Can Med Assoc J. 1994 May 01;150(9):1381-1382.

Toleration of moral diversity and the conscientious refusal by physicians to withdraw life-sustaining treatment

S Wear,S Lagaipa,G Louge

Abstract
The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and “step aside”. This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated.

Wear S, Lagaipa S, Louge G. Toleration of moral diversity and the conscientious refusal by physicians to withdraw life-sustaining treatment. J Med Phil. 1994 Apr;19(2):147-159.

Moral and Religious Objections by Hospitals to Withholding and Withdrawing Life-Sustaining Treatment

Anna Maria Cugliari, Tracy E Miller

Abstract
A patient’s right to decide about life-sustaining treatment may conflict with the policies of health care facilities that refuse on the basis or religious or moral convictions to honor certain decisions to forgo treatment. The New York State Task Force on Life and the Law examined the prevalence and nature of facility conscience objections to the refusal of life-sustaining treatment by conducting a survey of New York hospitals. Written questionnaires were distributed to hospitals in New York State. Fifty-eight percent of the New York State hospitals responded. Twenty-nine percent of the respondents indicated that their hospital would object on grounds of conscience either to withholding or to withdrawing life-sustaining treatment in at least one of the twelve hypothetical cases presented. Hospitals were more likely to have “no policy” for withdrawing than for withholding treatment. Only 10% of the hospitals that would object to decisions to forgo treatment on religious or moral grounds had stated the objections in writing. The patient’s medical condition and the type of life-sustaining treatment to be withdrawn or withheld are important factors in determining whether a hospital will object on grounds of conscience. The imminence of death appeared more decisive than the degree of debilitation or disability as a factor in the willingness to accept decisions to forgo life-sustaining treatment. Hospitals should establish clear, written policies about their objections to forgoing treatment so that patients and their families can evaluate whether the facility meets their needs.

Cugliari AM, Miller TE. Moral and Religious Objections by Hospitals to Withholding and Withdrawing Life-Sustaining Treatment. J. Community Health. 1994 Apr 01;19(2):87-100.