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Gatekeeping and Personal Values: Misuses of Professional Roles (Conscientious Objection and Emergency Contraception)

D Micah Hester, Toby Schonfeld, Jean Amoura

Extract
. . .pharmacists and physicians who deny EC to women misuse their role as gatekeepers. This is because EC is safer than many over-the-counter (OTC) medications; therefore, its distribution does not require providers to exercise a particular skill or apply special knowledge. As a result,healthcare providers may appropriately act as advisors to women seeking EC, but may not use their role as gatekeepers as away of imposing their values on the women in their care. . . physicians and pharmacists who bar women from access to EC do so without professional cause. They misuse their role as gatekeeper, imposing personal values where professional ones should prevail.

Hester DM, Schonfeld T, Amoura J. Gatekeeping and Personal Values: Misuses of Professional Roles (Conscientious Objection and Emergency Contraception). Am J Med Ethics. 2007 Jun;7(6):27-8. doi: 10.1080/15265160701347361

Conscientious Objection? Yes, but make sure it’s genuine. (Conscientious Objection and Emergency Contraception)

Christopher Meyers, Robert D Woods

Extract
In our earlier essay (Meyers and Woods 1996, 118–119), and in alignment with Card’s (2007) analogy, we recommended a system similar to that used for exemption from military service, one that incorporates a review board for evaluating claims of genuine conscientious objection. Because different groups have different means for communicating that a belief is profoundly held, the review board should be structured to represent a diversity of racial, ethnic and religious beliefs and academic training. Furthermore, to reduce the potential power asymmetry between the review board and petitioners, it should also include a range of disciplines—medicine, nursing, mental health, social services, chaplaincy—and representatives from the community.

Meyers C, Woods RD. Conscientious Objection? Yes, but make sure it’s genuine. (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):. Available from:

Should Professional Associations Sanction Conscientious Refusals? (Conscientious Objection and Emergency Contraception)

Inmaculada de Melo-Martin

Extract
Notice that I am not defending the argument that pharmacists have no right to exercise conscientious refusals. My point is that a professional organization’s policy allowing such refusals cannot be squared with a code of ethics that calls for pharmacists to put concern for the well-being of patients at the center of their professional practice. In fact, such a policy establishes the appropriateness of ignoring the code’s principles anytime a pharmacist has a problem of conscience.

de Melo-Martin I. Should Professional Associations Sanction Conscientious Refusals? (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):23-24.

Conscientious Objection: Does the Zero-Probability Argument Work? (Conscientious Objection and Emergency Contraception)

Greg Loeben, Michelle A Chui

Extract
It seems clear from these observations that Card (2007) uses the zero probability argument as a bit of a straw man. The conscientious objector does not rely on such a simplistic claim. In fact, conscientious objection can and should be evaluated in light of a variety of components, rather than the mere possibility that one’s actions will contribute to an unethical result. Specifically, conscientious objection appears to be made more plausible by a variety of factors, including the likelihood, intentionality, causal directness, degree of consensus, and not least, the severity of the unethical action.

Loeben G, Chui MA. Conscientious Objection: Does the Zero-Probability Argument Work? (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007 Jun;7(6):28-30.

When to Grant Conscientious Objector Status (Conscientious Objection and Emergency Contraception)

Ronald A Lindsay

Extract
Provided the physician notifies the patient as soon as possible of any limitations on services and promptly assists the patient with referrals to other physicians, physicians should be allowed to refuse to provide some services. However, once the patient and physician have decided on a course of action, they should be able to rely on the cooperation of other healthcare workers. The last thing we need is to complicate our healthcare system even further by allowing pharmacists, nurses, and others to obstruct a person’s healthcare decisions based on their sectarian beliefs.

Lindsay RA. When to Grant Conscientious Objector Status (Conscientious Objection and Emergency Contraception). Am J Bioethcs. 2007 Jun 01 ;7(6):25-26. Available from:

The Necessity of Conscience and the Unspoken Ends of Medicine (Conscientious Objection and Emergency Contraception)

John J Hardt

Extract
The difficulties lie in those cases in which there is disagreement about the ends of medicine and the obligations they impose on its practitioners. It may very well be the case that in focusing our attention on particular acts of conscientious objection, we will fail to attend to the underlying and more pressing need to engage once again in a conversation on the nature of medicine and its proper ends. . . . It is here, I would suggest, that one will find the root cause of much of our current, heated debate about conscience and, perhaps, some possible resolution.

Hardt JJ. The Necessity of Conscience and the Unspoken Ends of Medicine (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):18-19.

The Pharmacist’s Personal and Professional Integrity (Conscientious Objection and Emergency Contraception)

(Conscientious Objection and Emergency Contraception)

Howard Brody, Susan S Night

Extract
We conclude that, although a “duty to refer” may not describe very well an actual, working policy that effectively balances the duties of personal and professional integrity for the objecting pharmacist, Card’s (2007) mandatory-service policy fails at a basic level to respect the dual dictates of personal and professional integrity. A policy that attempts to maximize the extent to which both duties can be fulfilled might be denounced by Card as a “moderate” policy in the sense that he finds objectionable. Nonetheless, it is ethically the soundest option.

Brody H, Night SS. The Pharmacist’s Personal and Professional Integrity (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):16-17.

Moral Disagreement and Providing Emergency Contraception: A Pluralistic Alternative (Conscientious Objection and Emergency Contraception)

Noam Zohar

Extract
Thus my conclusion is not very far from Card’s, but it rests on very different grounds. A pluralistic framework leads to an expectation that the pharmacist provide EC, even while acknowledging the legitimacy of his view that using it is wrong. The pharmacist should in this kind of case respect and yield to the differing view of the client. Yet in other kinds of situations—such as when what is required is direct action, as distinct from mere assistance—conscientious objection should sometimes be allowed.

Zohar N. Moral Disagreement and Providing Emergency Contraception: A Pluralistic Alternative (Conscientious Objection and Emergency Contraception). Am. J. Bioeth.. 2007;7(6):35-36.

Politics, Parents, and Prophylaxis — Mandating HPV Vaccination in the United States

R Alta Charo

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

Extract
Public health officials may have legitimate questions about the merits of HPV vaccine mandates, in light of the financial and logistic burdens these may impose on families and schools, and also may be uncertain about adverse-event rates in mass-scale programs. But given that the moral objections to requiring HPV vaccination are largely emotional, this source of resistance to mandates is difficult to justify.

Charo RA. Politics, Parents, and Prophylaxis — Mandating HPV Vaccination in the United States. N Engl J Med. 2007 May 10;356(19):1905-1908.

The moral imperative for ectogenesis

Anna Smajdor

Cambridge Quarterly of Healthcare Ethics

Abstract
Rather than putting the onus on women to have children at times that suit societal rather than women’s individual interests, we could provide technical alternatives to gestation and childbirth so that women are no longer unjustly obliged to be the sole risk takers in reproductive enterprises. In short, what is required is ectogenesis: the development of artificial wombs that can sustain fetuses to term without the need for women’s bodies. Only by thus remedying the natural or physical injustices involved in the unequal gender roles of reproduction can we alleviate the social injustices that arise from them.

Keywords:

Smajdor A. The moral imperative for ectogenesis. Camb Q. Healthc Ethics. 2007 May 09;16(3):336-345.