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Abstract Treatment refusal, when resulting from a choice based on certain religious principles requires a study of the effect of the Charters of human rights and freedoms into the obligation to reduce the harm that is imposed on any victim. To lay down the parameters of such an obligation, the author analyzes the effects of various cases of refusal to afford treatment in light of rules from private and public law. Owing to the rather small number of precedents dealing with this issue, she seeks inspiration from foreign jurisdictions so as to forge a proposed method for interpreting provisions adapted to the specifics of Québec and Canadian law. The author does reach the conclusion that resorting to constitutional exemption is sometimes a necessity in order to respect freedoms of conscience and religion.
Abstract Many of the assumptions implicit in a Western autonomy-based approach to bioethical deliberation may not be shared by Chinese Canadians. In traditional Chinese culture, greater social and moral meaning rests in the interdependence of family and community, which overrides self-determination. Consequently, many Chinese may vest in family members the right to receive and disclose information, to make decisions and to organize patient care. Furthermore, interactions between Chinese patients and health care workers may be affected by important differences in values and goals and in the perception of the nature and meaning of illness. Acknowledging and negotiating these differences can lead to considerable improvement in communication and in the quality of care.
Abstract Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses’ conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.
Abstract At the dawn of the 20th century, postmodern academics stressed the cultural differences among human beings. Philosophers predicated differing value systems based on these cultural differences, and conflicts have arisen among those who hold distinctly different religious traditions. Many people believe there can be no universal system to explain reality and thus form the basis for norms in human behavior. However, at the close of the 20th century scientists and philosophers had come full circle: physics quite literally became metaphysics, and ethical systems made sense. Rush Kidder interviewed two dozen “men and women of good conscience” from around the world and asked them if there is a single set of values that wise people use to make decisions. They answered with a resounding YES! Thus, in addition to the customary principles of beneficence, nonmalfeasance, honesty, and so forth, the author proposes a set of ethical principles based on those universal values, adapted to fit nursing administrators’ dual responsibilities. Ethical decision making and behavior, the author contends, help to reconcile perspectives and interests and to keep values and mission uppermost in one’s mind. In the process, ethical behavior establishes long-term relations of trust and cooperation, which in turn promote consistency and stability in an unstable world..
Abstract There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 5K large urban hospitals, including 28 Catholic hospitals from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim’s right to information about her treatment options and jeopardize physicians’ fiduciary responsibility to act in their patients’ best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requirng hospitals to meet the standard of care for treatment of rape victims is appropriate.
Extract Mifepristone, the controversial “abortion pill,” may soon be available in the US, but the distribution rules may be so strict that they “hurt access.”. . . Mifepristone has been available to women in many European countries for more than a decade. More than 500 000 women worldwide have used it, with few complications reported. When taken with misoprostol, which has already been approved in Canada, mifepristone causes abortion – in essence a miscarriage – in 95% of women who are no more than 49 days pregnant.
The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.
Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.
Abstract Recognition of conscientious objection seems reasonable in relation to controversial and contentious issues, such as physician assisted suicide and abortion. However, physicians also advance conscience-based objections to actions and practices that are sanctioned by established norms of medical ethics, and an account of their moral force can be more elusive in such contexts. Several possible ethical justifications for recognizing appeals to conscience in medicine are examined, and it is argued that the most promising one is respect for moral integrity. It is also argued that an appeal to conscience has significant moral weight only if the core ethical values on which it is based correspond to one or more core values in medicine. Finally, several guidelines pertaining to appeals to conscience and their ethical evaluation are presented.
Extract After Roman Catholic leaders issued strong criticism about its trampling of religious freedom, the American Medical Association approved a watered-down measure supporting continued community access to a full range of reproductive services following hospital consolidations. The AMA’s amended resolution stopped short of saying Catholic hospitals should have to perform all reproductive health procedures. . . The AMA instead upheld its policy that physicians and hospitals not be forced to perform services that violate their moral principles. . .
Journal Extract “The question is whether we will ever be able to learn from history,” Alexander Mitscherlich said in 1947. He was a member of the German Medical Commission, who by order of the German General Medical Council witnessed the Nuremberg Trial. “I believe,” Mitscherlich continued, “that we won’t master it by just keeping our distance morally. This is doubtless easy to achieve. However, it is useless for us as soon as we think of the dark future of this century, in which situations might occur leading to a similar coldness and ignorance towards the right to live of people more defenseless and disregarded” [1]. 1
Over the ensuing decades, neither physicians nor the public faced the tiring process of reviewing and questioning history. Even the reports of the German Medical Commission met with a growing disinterest and disapproval from the physicians in post-war Germany. 2 Almost 50 percent of the German physicians were members of the NSDAP (Nazi Party), and they resumed their work after 1945 after only a brief interruption.
Thus it is understandable that it was not the physicians’ organizations nor the medical historical departments of the universities that turned towards history at the beginning of the1980s. Rather, it was their children [End Page 373] and grandchildren, who were working in the hospitals, the psychiatric institutions, and homes for persons with disabilities. They began to ask what happened 40 or 50 years ago where they were working. They were not involved personally, nor did they blame their fathers and mothers. This is the generation to which I also belong. 3
After Auschwitz and Hadamar, particularly in Germany, discussion about medical ethics and about the future of medicine are nowadays impossible without reference to history. 4 This consideration was the basis of the program entitled “Medicine and Conscience” in the German Section of International Congress of Physicians for the Prevention of Nuclear War, held in Nuremberg in October 1996. 5 As a result of this congress, on the 50th anniversary of the pronouncement of judgment in the Nuremberg Trial, 20 August 1997, the Nuremberg Code 1997 was presented. Based on the historical experiences and the fundamental ideas of the 1947 Code, the 1997 Code is designed to answer current medical questions about the application of biosciences to human beings. It discusses 10 topics, including medical experiments, reproductive medicine, genetic diagnostics and therapy, transplantation, euthanasia, and distribution of resources. (Due to the time limit and the theme of this symposium, I will focus only on the topic of medical research.) The Nuremberg Code 1997 follows the widespread practice of considering informed consent to be a prerequisite in all fields of public health care service.
The critical-historical link to the Nuremberg Code 1947 that we attempted to make with Code 1997 had to confront two fundamental issues. First, we had to determine whether the Code’s significance was only historical or universally valid. To put it differently: was the 1947 Code only to be understood from the historical context? Did it only aim at the judgment of the practices of the Nazi physicians? Or did it imply a universal validity for medical research and medicine in a civilized world?
Historical evidence, as well as a look at the text of the Code, clearly speaks for a universal validity. Telford Taylor, the chief prosecutor of Nuremberg, stated in his introduction that the trial was no mere murder trial, since the defendants were physicians who had sworn the Hippocratic oath and thus had become murderers in the execution of their profession. Logically, the judges created with the Nuremberg Code a basis for the judgment of crimes which became possible within the bounds of medicine. 6[End Page 374]
