0 - Protection of Conscience Project Library

Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada

Eike-Henner Kluge

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

Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses

Kelsey C Brodsho

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.

Brodsho KC. Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses. Minnesota Journal of Law, Science & Technology. 2005;7(1):327-336.

A new rejection of moral expertise

Christopher Cowley

Abstract
There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Cowley C. A new rejection of moral expertise. Med Health Care & Phil. 2005 Nov;8(3):273-279.

Defining the limits of conscientious objection in health care

J Andrew West

Extract
I will argue that we should prefer narrow conscience clauses because they (1) respect patients’ right to informed consent and (2) reduce risks to vulnerable populations. I will then propose and defend an example of what a narrow conscience clause might look like. The clause I propose allows: (1) any person (2) directly involved in providing (3) nonemergency medical treatment or service (4) to refuse to provide the treatment or service in question, so long as the person (5) objects on moral or religious grounds and (6) cooperates in the transfer or referral of the patient to a willing provider. Before I turn to these arguments, a brief overview of the genesis and evolution of conscience clauses in medicine is in order.

West JA. Defining the limits of conscientious objection in health care. Newsletter Phil Med. 2005 Fall;5(1):25-34.

(Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them

CH Browner

Extract
I was intrigued by her argument that an “autonomous” medical decision can sometimes involve simple deference to medical authority, but I’m still unclear what she means when she says that such decisions can be construed as conscientiously autonomous if derived from a patient’s “self trust.” This seems precisely the paradox at the heart of debates over the existence of free will, or in Kukla’s rubric, autonomous choice: is there a “space” outside of social life constituting individual desires where choices derive from what one “really” wants?

Browner C. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent Rep. 2005; September-October:4-5.

(Correspondence) The Celestial Fire of Conscience: Prof. Charo Replies

R Alta Charo

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
With regard to Dr. Lee’s comment that the proposed Wisconsin legislation does not eliminate a health care provider’s duty to provide a referral after refusing to perform a service, I would note that Assembly Bill 207 . . . specifically permits health care providers’ refusals to “participate in” services they find personally objectionable, with “participate in” specifically defined . . . as “to perform; practice; engage in; assist in; recommend; counsel in favor of; make referrals for; prescribe, dispense or administer drugs”.

Charo RA. (Correspondence) The Celestial Fire of Conscience: Prof. Charo Replies. N Engl J Med. 2005 Sep 22;353(12):1302.

Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women

Holly Teliska

Extract
If pharmacists object to particular prescriptions, they should only be allowed to refuse to fill the prescription if meaningful and logistically feasible alternatives are in place. As an alternative, either another pharmacist must be on duty with the refusing pharmacist, or alternative ways of providing service must be in place. A woman should not have to travel to other pharmacies in search of a pharmacist that serves all patients, nor should she have to wait an unreasonable amount of time to have her prescription filled.

Teliska H. Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women. Berkely J Gender, Law Justice. 2005;20(1):229-248.

(Correspondence) The Celestial Fire of Conscience

Oswaldo Castro, Frederic A Lombardo, Victor R Gordeuk

Extract
Real medical care and services always respect human
life. No one should be forced to collaborate in abortion (even when it is achieved through the prevention of implantation), lethal research on embryos, euthanasia, or assisted suicide.

Castro O, Lombardo FA, Gordeuk VR. (Correspondence) The Celestial Fire of Conscience. N Engl J Med. 2005 Sep 22;353(12):1301.

(Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them

Tom L Beauchamp

Extract
To bring out what I see as the most plausible interpretation of Kukla’s article, I recast her main point as follows (though I am not optimistic that she would accept this restatement): The received view in bioethics is commonly interpreted so that autonomy occurs exclusively through discrete informed consents to medical procedures. However, this vision of autonomy is too narrow. Autonomy is also expressed through stable, enduring, and committed acceptance of medical practices. Kukla rightly points out that this account must be rounded by a rich understanding of medical practices together with a model of the virtue of conscientiousness in upholding the practices, principles, regimes, and values adopted.

Beauchamp TL. (Correspondence) Conscientious Autonomy: What Patients Do vs. What Is Done to Them. Hastings Cent. Rep.. 2005;September-October):5-6.

Promising, professional obligations, and the refusal to provide service

John K Alexander

Extract
Someone might want to argue that this strict adherence to promise keeping justifies a person being forced, coerced, compelled, into performing actions that are unjust or morally impermissible if they are members of an organization/profession that begins to engage in performing unjust, or morally unjustifiable actions. . . .By utilizing our moral beliefs at the appropriate time when first we make our promise to provide competent professional service to our clients, we can avoid placing ourselves in situations that compromise our deeply held moral beliefs later on. If later on we are confronted by a change in the professional setting that did not exist in the original decision making situation, then we are rationally compelled to reassess our professional position relative to the requirements of our moral beliefs and perform the appropriate action, either comply, persuade others that they are wrong or leave the professional setting.

Alexander JK. Promising, professional obligations, and the refusal to provide service. HEC Forum. 2005;17(3):178-195.