0 - Page 3 of 5 - Protection of Conscience Project Library

Moral Courage Through a Collective Voice

(Ethics and Rural Healthcare)

Julie Aultman

Extract
In posing the question of whether it is morally right for the only pharmacist in town to refuse healthcare services based on his or the community’s religious convictions, I could not help but think of “the conscience clause.” While many states across the United States support the conscience clause, which protects healthcare professionals from discrimination when refusing to dispense birth control pills or performing abortions and sterilizations, such clauses have different implications in the rural setting.When a physician or pharmacist refuses to prescribe or dispense birth control pills, the urban patient is able to acquire birth control from another healthcare provider with less difficulty than the rural patient. The rural patient may have to drive a great distance to acquire birth control even if it is needed for a medical condition rather than to prevent pregnancy.

Aultman J. Moral Courage Through a Collective Voice (Ethics and Rural Healthcare). Am J Bioeth. 2008;8(4):67-69.

Physicians need freedom of conscience

Joseph Askin

Abstract
Medically trained English philosopher Dr. John Locke (1632-1704) held that freedom of conscience is the basis of individual rights, thereby limiting intrusion by the state into the lives of its citizens.

Askin J. Physicians need freedom of conscience. Medical Post. 2008;11-12

Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people

Christina Juthberg, Sture Eriksson, Astrid Norberg, Karin Sundin

Abstract
Aims. The aim was to study the relationship between conscience and burnout among care-providers in older care, exploring the relationship between stress of conscience and burnout, and between perceptions of conscience and burnout.

Background. Everyday work in healthcare presents situations that influence care-providers’ conscience. How care-providers perceive conscience has been shown to be related to stress of conscience (stress related to troubled conscience), and in county council care, an association between stress of conscience and burnout has been found.

Method. A questionnaire study was conducted in municipal housing for older people. A total of 166 care-providers were approached, of which 146 (50 registered nurses and 96 nurses’ aides/enrolled nurses) completed a questionnaire folder containing the stress of conscience questionnaire, the perceptions of conscience questionnaire and the maslach burnout inventory. Multivariate canonical correlation analysis was used to explore relationships.

Result. The relationship between stress of conscience and burnout indicates that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout (primarily to emotional exhaustion). The relationship between perceptions of conscience and burnout indicates that a deadened conscience is strongly related to burnout.

Conclusion. Conscience seems to be of importance in relation to burnout, and suppressing conscience may result in a profound loss of wholeness, integrity and harmony in the self.

Relevance to clinical practice. The results from our study could be used to raise awareness of the importance of conscience in care.

Juthberg C, Eriksson S, Norberg A, Sundin K. Stress of conscience and perceptions of conscience in relation to burnout among care-providers in older people. J Clin Nurs. 2008 Jun 10;17(14):1897-1906.

Russia: update on animal experiments and alternatives in education

Nick Jukes

Abstract
Progress continues in Russia with growing awareness and implementation of alternatives in education. Further outreach visits and negotiations for replacement have been made by InterNICHE campaigners. Russian language information resources have been complemented by the distribution of translated freeware physiology and pharmacology alternatives; and the InterNICHE Alternatives Loan Systems continue to provide valuable hands-on access to a range of learning tools. Donations of computers and alternatives have established exemplary multimedia laboratories, with software having directly replaced the annual use of several thousand animals. New agreements have been made with institutes to abandon animal experiments for teaching purposes. Work to consolidate the successes is being done, and Russian teachers have begun to present at conferences to share their experiences of implementation. Further development and implementation of alternatives is being achieved through grant funding from the InterNICHE Humane Education Award. Using a different approach, cases of determined conscientious objection have included a campaign against the use of stolen companion animals for surgery practice in the Russian Far East, and a continuing legal challenge to experiments at Moscow State University. This multi-pronged, decentralised and culturally appropriate campaigning strategy has proved to be an effective approach to achieving sustainable change in Russia..

Jukes N. Russia: update on animal experiments and alternatives in education. Alternatives to Animal Experimentation (ALTEX). 2008;25(1):56-62.

Anesthetizing the public conscience: lethal injection and animal euthanasia

(The Lethal Injection Debate: Law and Science)

Ty Alper

Extract
People are never executed using the anesthetic-only procedure that veterinarians and shelter workers use on animals. And animals are never euthanized by the three-drug formula prison officials use on human beings. As detailed in this Article, the veterinary and animal welfare communities widely condemn the use of neuromuscular blocking agents such as pancuronium. Particularly given the popular assumption that execution of humans by lethal injection is no different than “putting an animal to sleep,” the condemnation of the use of curariform drugs in the euthanasia context should give courts pause when assessing the risks of the three-drug formula under the Eighth Amendment. . . The Humane Society mandates a method of euthanasia the primary benefit of which is that it is actually humane. At a time when the public’s trust in the administration of capital punishment in this country appears to be eroding, the states, on the other hand, have clung to a method whose primary benefit is that it looks humane- but that in reality risks the unnecessary infliction of excruciating pain and suffering.

Alper T. Anesthetizing the public conscience: lethal injection and animal euthanasia (The Lethal Injection Debate: Law and Science). Fordham Urban Law J. 2008;35(4):817-856.

Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives

Jennifer E. Spreng

Extract
Conclusion
Pharmacists are already involved in litigation over conscience clauses; it is probably only a matter of time before a woman sues a pharmacist for wrongful conception. Changes in the pharmacy profession and correlative tort duties mean a common law or statutory duty to dispense or sell emergency or daily oral contraceptives is not outside the realm of possibility. Many religious pharmacists have compelling reasons to refuse to sell, but federal Free Exercise protections are currently uncertain. State statutory conscience clauses offer some protection and do not violate the Establishment Clause. Therefore, more states should not hesitate to provide
this protection to all healthcare providers.

Spreng JE. Conscientious Objectors Behind the Counter: Statutory Defenses to Tort Liability for Failure to Dispense Contraceptives. 1 St. Louis U. J. Health L. & Pol’y 337, 337-40 (2008)

(Correspondence) LVADs and the Limits of Autonomy

Jeremy Simon, Ruth Fischbach

Extract
Jeremy Simon’s commentary argues that physicians may decline to deactivate an LVAD even at the request of a capable patient. . . . No doctor may be forced to act against her conscience to end a patient’s life. A physician moved by Simon’s argument would be covered by this doctrine. As for legal precedents, if there have been any cases regarding the removal of destination LVADs, there certainly have not been enough for the case law in this matter to be considered settled. . .

Simon J, Fischbach R. (Correspondence) LVADs and the Limits of Autonomy. Hast Cent Rep. 2008 May-June;5.

(Correspondence) Responses to Abortion Training

Hugh Silk

Extract
While a fetus dies during an abortion, women also die when they don’t have access to proper reproductive services. People died in concentration camps and during civil rights protests. However, I would never compare reproductive issues to those historical events. . . . Regardless of which side we stand on in this debate, let’s not do an injustice to those who endured so much in WWII and in the United States during the 1950s and 1960s to allow us to have the freedom to have this debate. . . . Doing no harm may be impossible. Doing the lesser of harms is more achievable.

Silk H. (Correspondence) Responses to Abortion Training. Fam Med. 2008 May;40(5):311.

(Correspondence) GMC guidance on beliefs: Denies conscientious objection

Eugene G Breen

British Medical Journal, BMJ — British Medical Journal

Extract
The recent ethical guideline of the General Medical Council puts doctors in an impossible position. The giving of information or aiding someone to obtain a service the doctor considers immoral contravenes the essence of conscientious objection. The doctor’s right to have his moral code respected, provided that it isn’t spurious or lacking a credible evidence base, is a basic human right.

Breen EG. (Correspondence) GMC guidance on beliefs: Denies conscientious objection. Br Med J. 2008;336(7648):790.

Conscientious commitment

Bernard M. Dickens

Extract
In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?

Dickens BM. Conscientious commitment. Lancet [Internet]. 2008 Apr 12; 371(9620): 1240 – 1241