0 - Protection of Conscience Project Library

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

Journal of Obstetrics and Gynaecology Canada

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.

Private Conscience: Public Duty

Graham Zellick

Extract
The premise of this lecture is that there are two different sets of ethical rules, the purely private and a special set arising in the workplace which will differ from occupation to occupation. . . .

• First, I hope it is axiomatic that ethics and morals must accompany individuals at all times no matter what they are doing.

• Secondly, that the moral or ethical position of the individual may in certain circumstances have to take on board other considerations which also have a moral and ethical dimension and that the ultimate decision, though different from one that would be reached in private life by the individual, is nevertheless justifiable and ethical.

• Thirdly, that to violate these precepts, even if it is done in order to give primacy to one’s own ethical code, is not ethical: the individual should resign or seek an alternative occupation. In other words, there are times when to listen to one’s private conscience while remaining deaf to the moral demands of one’s occupation can itself be seriously unethical.

• Fourthly, that weighing these considerations in the balance is no easy task and succumbs to no formula. It calls for the exercise of keen judgment informed by a developed moral framework.

Zellick G. Private Conscience: Public Duty. European Judaism. 2003 Autumn;36(2):118-131.

When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict

Brietta R Clark

Extract
Conclusion
Using this framework, I propose a more protective principle for free exercise protection than currently exists, one that requires a heightened scrutiny of all laws that burden religious liberty, even neutral laws of general applicability. This review should examine carefully the need for the government law and the possibility of an exemption or accommodation that will not undermine the purpose of the law. However, I would not go as far as some states in providing almost absolute free exercise protection from government laws serving important government interests. Rather, the principle I advocate requires a balancing of interests tipped to favor laws protecting third parties’ from harm over religious claimants’ objections. The Catholic hospital conflict demonstrates how even under this more protective free exercise principle, the rule of law and the self–limiting principle of the liberty of conscience and religious liberty operate as justifiable limits on the scope of free exercise protection. The hospitals’ free exercise interests must be balanced against the potential harm to patients who cannot access necessary reproductive health care and information, which means that in many cases exemptions for religious hospitals will be denied.

Clark BR. When Free Exercise Exemptions Undermine Religious Liberty and the Liberty of Conscience: A Case Study of the Catholic Hospital Conflict. Oregon Law Review. 2003 Fall;82(3):625-694.

Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services

Karen E Adams

Journal of the American Women's Medical Association — Journal of the American Women’s Medical Association

Abstract
Physicians are independent moral agents whose values, like those of nonphysicians, are shaped by personal experience, religious beliefs, family, and lifetime mentors. Most individuals are free to exercise their moral values in the ways that they see fit within the boundaries of legality. Physicians’ moral values take on special significance, however, when considering services patients may request but that contradict that physician’s moral beliefs, such as termination of pregnancy. In this article I analyze the competing obligations to self and to patient that a conscientiously objecting physician must consider when his or her personal morality affects his or her relationship with the patient. Despite each physician’s freedom to choose his or her mode of practice and which services to provide, a physician with a moral viewpoint that would prevent even counseling on certain options should consider practicing in an area of medicine in which the patient’s right to full disclosure of options and informed consent is not compromised by the physician’s personal moral stance.

Adams KE. Moral Diversity Among Physicians and Conscientious Refusal of Care in the Provision of Abortion Services. J American Med Women’s Ass (1972). 2003;58(4):223-226.

(News) “Abortion pill” use doubles

Barbara Sibbald

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Two years after the US government approved the use of mifepristone (RU-486), the “abortion pill’s” popularity has nearly doubled. . . . Mifepristone, a progesterone blocker, induces abortion in women who are up to 8 weeks’ pregnant.

Sibbald B. News@a glance: “Abortion pill” use doubles. Can Med Assoc J. 2003 Aug 19;169(4):330.

The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses

Venke Sørlie, Lilian Jansson, Astrid Norberg

Abstract
Twenty female Registered Nurses who had experienced being in ethically difficult care situations in paediatric care were interviewed as part of a comprehensive investigation into the narratives of male and female nurses and physicians about being in such situations. The transcribed interview texts were subjected to phenomenological-hermeneutic interpretation. The results showed that nurses appreciated social confirmation from their colleagues, patients and parents very much. This was a conditioned confirmation that was given when they performed the tasks expected from them. The nurses, however, felt that something was missing. They missed self-confirmation from their conscience. This gave them an identity problem. They were regarded as good care providers but at the same time, their conscience reminded them of not taking care of all the ‘uninteresting’ patients. This may be understood as ethics of memory where their conscience ‘set them a test’. The emotional pain nurses felt was about remembering the children they overlooked, about bad conscience and lack of self-confirmation. Nurses felt lonely because of the lack of open dialogue about ethically difficulties, for example, between colleagues and about their feeling that the wrong things were prioritized in the clinics. In this study, problems arose when nurses complied with the unspoken rules and routines without discussing the ethical challenges in their caring culture.

Sørlie V, Jansson L, Norberg A. The meaning of being in ethically difficult care situations in paediatric care as narrated by female Registered Nurses. Scand. J. Caring Sci. 2003;17(285-292.

In Good Conscience: The Legal Trend to Include Prescription Contraceptives in Employer Insurance Plans and Catholic Charities’ “Conscience Clause” Objection

Kate Spota

Extract
This Note examines Petitioner’s constitutional argument in Catholic Charities v. Superior Court as applied to a California statute drafted with a narrowly drawn “conscience clause” exemption. First, this Note describes the background for Roman Catholic opposition to contraceptives, and contrasts the reasons behind women’s rights activists’ claim for equal access to contraception as a part of reproductive freedom. Second, this Note examines the preeminent cases decided by the U.S. Supreme Court, the U.S. Court of Appeals for the Ninth Circuit, and the California Supreme Court, as well as the relevant federal statutes and administrative decisions used by the California Court of Appeal in deciding Catholic Charities. Third, this Note describes in detail the arguments advanced by the Petitioner in Catholic Charities and the court’s resulting analysis. Concluding that the Court of Appeal of California correctly decided against the Petitioner in Catholic Charities, this Note examines the possible impacts of that decision on society’s view of women and on the Catholic health care system. Finally, this Note concludes that the California Supreme Court will affirm the appellate court’s decision and hold that the mandatory inclusion of prescription contraceptives in insurance plans, even for institutions whose religious beliefs are contrary to the mandate, does not violate the Free Exercise Clause or the Establishment Clause of the U.S. or California Constitutions.

Spota K. In Good Conscience: The Legal Trend to Include Prescription Contraceptives in Employer Insurance Plans and Catholic Charities’ “Conscience Clause” Objection. Cathol U Law Rev. 2003;52(4):1081-1113.

(Correspondence) Abortion perils debated

Linda Capperauld

Extract
Not only is the article by David Reardon and associates1 flawed . . . but the authors, particularly the lead author, have a specific and known political bias against abortion rights. . . By publishing an article that does not adhere to high standards, we feel that CMAJ has done a disservice to our field, not to mention women and their families across the nation.

Capperauld L. (Correspondence) Abortion perils debated. Can Med Assoc J. 2003 Jul 22;169(2):101.

(Editorial) Unwanted results: the ethics of controversial research

CMAJ

Extract
. . . We are chided for publishing flawed research and told that we should be ashamed of publishing the “opinions” of self-evidently biased researchers. We are accused of doing a disservice to women, medicine and the Journal, of failing to conduct proper peer review, and of not adequately scrutinizing the credentials of the authors.

The abortion debate is so highly charged that a state of
respectful listening on either side is almost impossible to achieve. This debate is conducted publicly in religious, ideological and political terms: forms of discourse in which detachment is rare. But we do seem to have the idea in medicine that science offers us a more dispassionate means of analysis. To consider abortion as a health issue, indeed as a medical “procedure,” is to remove it from metaphysical and moral argument and to place it in a pragmatic realm where one deals in terms such as safety, equity of access, outcomes and risk–benefit ratios, and where the prevailing ethical discourse, when it is evoked, uses secular words like autonomy and patient choice. . .

CMAJ. (Editorial) Unwanted results: the ethics of controversial research. Can. Med. Assoc. J.. 2003 Jul 22;169(2):93.