0 - Protection of Conscience Project Library

Emergency Contraception for Women Who Have Been Raped: Must Catholics Test for Ovulation, or Is Testing for Pregnancy Morally Sufficient?

Daniel P Sulmasy

Abstract
On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion.

Sulmasy DP. Emergency Contraception for Women Who Have Been Raped: Must Catholics Test for Ovulation, or Is Testing for Pregnancy Morally Sufficient? Kennedy Inst Ethics J. 2006;16(4):305-331.

Conscience Clauses and Oral Contraceptives: Conscientious Objection or Calculated Obstruction?

Mary K Collins

Abstract
The ideal conscience statutes will balance the interests on both sides. Conscientious objectors should be free to practice in accordance with their beliefs, but should have to give employers and patients reasonably advanced notice that they may not be reliable in certain situations.173 The individual objector should avoid knowingly entering into employment situations guaranteed to create conflict. While health care providers have a duty to ensure informed decision making, women seeking unbiased clinical care should not be subjected to lectures on personally held views of morality. Places of worship are a more appropriate arena for proselytizing. Institutional and individual objectors should develop appropriate accommodations through referral and notice to avoid inconvenience, delay, and possible injury to the patients who depend on them.

Collins MK. Conscience Clauses and Oral Contraceptives: Conscientious Objection or Calculated Obstruction?. Ann Health Law. 2006 Winter;15(37-60.

Rx for Drugstore Discrimination: Challenging Pharmacy Refusals to Dispense Prescription Contraceptives under State Public Accommodation Laws

Charu A Chandrasekhar

Extract
The problem of refusals to dispense prescription contraceptives in pharmacies is real and urgent. State public accommodations statutes offer an excellent vehicle in many states for challenging these discriminatory practices. State public accommodations lawsuits should ideally be brought solely against the pharmacy, not against the individual pharmacist who refuses to dispense a prescription. Pharmacies are best positioned to make institutional adjustments that ensure the filling of prescription contraceptives while accommodating the views and legal rights of their pharmacist employees. Moreover, a state public accommodations lawsuit will likely have a greater remedial and public relations impact if brought against a pharmacy as opposed to against an individual
pharmacist and will result in broader systemic change.

Chandrasekhar CA. Rx for Drugstore Discrimination: Challenging Pharmacy Refusals to Dispense Prescription Contraceptives under State Public Accommodation Laws. Albany Law Rev. 2006;70:55-115.

(Correspondence) Revisiting Pharmacists’ Refusals to Dispense Emergency Contraception (Author’s Response)

Ralph Baergen, Christopher Owens

Extract
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.

Scope Note 46: Pharmacists and Conscientious Objection

Richard M Anderson, Laura Jane Bishop, Martina Darragh, Harriet Hutson Gray, Anita Nolen,Susan Cartier Poland

Extract
The literature and online resources cited below include (1) policy statements and codes by professional organizations; (2) review essays on conscientious objection in health care and articles on the current debate regarding the field of pharmacy; and (3) legal perspectives and cases.

Anderson RM, Bishop LJ, Darragh M, Gray HH, Nolen A, Poland SC. Scope Note 46: Pharmacists and Conscientious Objection. Kennedy Inst Ethics J. 2006;16(4):379-396.

Equality, Justice, and Paternalism: Recentreing Debate about Physician-Assisted Suicide

Andrew Sneddon

Abstract
Debate about physician-assisted suicide has typically focused on the values of autonomy and patient well-being. This is understandable, even reasonable, given the importance of these values in bioethics. However, these are not the only moral values there are. The purpose of this paper is to examine physician-assisted suicide on the basis of the values of equality and justice. In particular, I will evaluate two arguments that invoke equality, one in favour of physician-assisted suicide, one against it, and I will eventually argue that a convincing equality-based argument in support of physician-assisted suicide is available. I will conclude by showing how an equality-based perspective transforms some secondary features of debate about this issue.

Sneddon A. Equality, Justice, and Paternalism: Recentreing Debate about Physician-Assisted Suicide. J Applied Phil. 2006 Nov;23(4):387-404.

Two Cheers for Conscience Exceptions

Adrienne Asch

Abstract
The pharmacist who wants her integrity and self-conception to be respected must accord respect to the woman whose views about sex, life processes, and parenthood differ from her own by courteously offering her own rationale and a referral.

Asch A. Two Cheers for Conscience Exceptions. Hastings Cent Rep. 2006;November-December):11-12.

Ethical misconduct by abuse of conscientious objection laws

Bernard M Dickens

Abstract
This paper addresses laws and practices urged by conservative religious organizations that invoke conscientious objection in order to deny patients access to lawful procedures. Many are reproductive health services, such as contraception, sterilization and abortion, on which women’s health depends. Religious institutions that historically served a mission to provide healthcare are now perverting this commitment in order to deny care. Physicians who followed their calling honourably in a spirit of self-sacrifice are being urged to sacrifice patients’ interests to promote their own, compromising their professional ethics by conflict of interest. The shield tolerant societies allowed to protect religious conscience is abused by religiously-influenced agencies that beat it into a sword to compel patients, particularly women, to comply with religious values they do not share. This is unethical unless accompanied by objectors’ duty of referral to non-objecting practitioners, and governmental responsibility to ensure supply of and patients’ access to such practitioners.

Dickens BM. Ethical misconduct by abuse of conscientious objection laws. Med Law. 2006 Sep;25(3):513-522.

The Oral Contraceptive as Abortifacient: An Analysis of the Evidence

Dennis M Sullivan

Abstract
Pro-life Christian ethicists and medical practitioners have been united in their opposition to abortion, but have sometimes been divided in their ethical approach to hormonal contraception. Even though many Christians believe that birth control may be a moral option, some claim that the “Pill” acts, at least some of the time, as an abortifacient. If true, Christians who hold that human personhood begins at conception would be morally opposed to the use of combined oral contraceptives. This article examines the scientific evidence for an abortifacient effect of such contraceptive agents, and concludes that such an effect is yet unproven. Some of the ethical arguments are also examined, and the author suggests that further research on early pregnancy factor (EPF) may help to resolve this controversial issue.

Sullivan DM. The Oral Contraceptive as Abortifacient: An Analysis of the Evidence. Perspectives on Science and Christian Faith. 2006;58(3):189-195. Available from:

Does Mission Matter?

Lawrence E Singer

Extract
It is apparent that Catholic health care is suffused with a religious purpose. Its creation is based upon Church interpretation of a duty to Jesus, and its facilities are required to adhere to formal prescriptions of appropriate canonical, ethical and moral behavior. As recently as twenty years ago, questions regarding a facility’s Catholicity and the implications of this calling would rarely have been asked. In part this was because of the highly visible presence of Sisters or Brothers in the facility, making the religious nature of the institution readily apparent to even the casual observer. Too, few Catholic institutions were part of health care systems, and those systems that existed were of a local or regional nature, likely well- known by the communities served.

Today, many Catholic health care facilities have joined together into larger (often multi-state) health care systems with less visible Sister presence and the development of sophisticated corporate management teams distant from day-to-day operations and local community involvement. Many of these systems enjoy significant market power. As discussed below, the heightened visibility of these organizations has led to very public questioning of institutional adherence to religious teaching (especially in the area of sterilizations and, to a lesser extent, abortion), posing a significant challenge to the Catholic mission. Other significant challenges to the mission have also arisen, as the law, the competitive environment, and even changes within the Church present their own hurdles to Catholic facilities. Section III discusses these issues, setting the stage in Part IV for a discussion of whether a religious mission is sustainable in a pluralistic society.

Singer LE. Does Mission Matter? Houston J Health Law Pol. 2006 Sep;6(2):347-377.