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Abstract Conscience, like most words that describe human experience and recommend human action, has changed its meanings over time and takes on subtly different meanings in different contexts. Since the time of Thomas Aquinas, when conscience referred to moral judgments about action, and our founding era, when “freedom of conscience” dominantly referred to individual religious liberty, our understanding has evolved. In this paper, I concentrate on present usage. My aims are partially descriptive and mainly normative. My hope is that by clarifying various ways the notion of conscience is conceived, I can contribute to a thoughtful elaboration of normative issues concerning responses to assertions of conscience and to near relatives of such assertions.
Abstract Is there a moral right to freedom of conscience? Should a legal right to freedom of conscience be established in each country on Earth? This essay argues for negative answers to both questions.
Extract The term freedom of conscience might refer to freedom of thought and the freedom of expression that sustains freedom of thought. In this sense we might affirm the right of each person to form individual opinions about the right and the good, about what we owe one another by way of due consideration of others, and about what is worthy of pursuit in life, on the basis of free discussion of these matters. In the present discussion, these freedoms, important as they might be, are not under consideration. Let us assume freedom of thought and expression are secured. The status of freedom of conscience in the sense that is our concern in this discussion is still wide open.
Eduardo Díaz Amado, Maria Cristina Calderón García, Katherine Romero Cristancho, Elena Prada Salas, Eliane Barreto Hauzeur
Reproductive Health Matters
Abstract During a highly contested process, abortion was partially decriminalised in Colombia in 2006 by the Constitutional Court: when the pregnancy threatens a woman’s life or health, in cases of severe fetal malformations incompatible with life, and in cases of rape, incest or unwanted insemination. However, Colombian women still face obstacles to accessing abortion services. This is illustrated by 36 cases of women who in 2006-08 were denied the right to a lawful termination of pregnancy, or had unjustified obstacles put in their path which delayed the termination, which are analysed in this article. We argue that the obstacles resulted from fundamental disagreements about abortion and misunderstandings regarding the ethical, legal and medical requirements arising from the Court’s decision. In order to avoid obstacles such as demands for a judge’s authorisation, institutional claims of conscientious objection, rejection of a claim of rape, or refusal of health insurance coverage for a legal termination, which constitute discrimination against women, three main strategies are suggested: public ownership of the Court’s decision by all Colombian citizens, a professional approach by those involved in the provision of services in line with the law, and monitoring of its implementation by governmental and non-governmental organisations.
Statement of conscience in trisomy 21 screening: Pregnant women’s free will jeopardized
E. Azria
Journal de Gynécologie Obstétrique et biologie de la reproduction
Extract [Paragraph de conclusion] C’est précisément parce qu’« il ne peut y avoir d’anesthésie des consciences » qu’il faut s’opposer fermement à toute mesure qui restreindraient davantage encore la liberté décisionnelle des femmes en matière de dépistage prénatal. L’idée de clause de conscience soutenue par Leblanc et Ardouin en fait partie.
[Concluding paragraph] It is precisely because “there can be no anesthesia of conscience” that we must strongly oppose any measures that would further restrict women’s decision-making freedom in prenatal screening. The idea of a conscience clause supported by Leblanc and Ardouin is one of them.
Abstract In Stormans, Inc. v. Selecky, a group of Washington pharmacists contended their religious beliefs precluded them from dispensing the drug Plan B, a post-coital emergency contraceptive. They based their argument on rights conferred by the Free Exercise Clause of the First Amendment to the United States Constitution. A United States District Court found in the pharmacists’ favor and enjoined enforcement of rules issued by the Washington State Board of Pharmacy requiring pharmacies to deliver medications. The Ninth Circuit reversed, finding that the district court erroneously applied a heightened level of scrutiny to a neutral law of general applicability. Interestingly, the pharmacists did not bring a claim under the Washington State Constitution, a document that has been interpreted to confer greater protection for free exercise rights than the U.S. Constitution. This Comment argues that even under the Washington State Constitution’s heightened protection of free exercise, the pharmacists’ position in Stormans would ultimately fail. The Board’s rules protect public health and accommodate individual religious objections, thereby satisfying the Washington State Supreme Court’s strict scrutiny test.
Karen B. Farris, Daniel Ashwood, Jennifer McIntosh, Natalie A. DiPietro, Nicole Monastersky Maderas, Sharon Cohen Landau, John Swegle, Orod Solemani
Journal of the American Pharmacists Association
Abstract Objectives: To review the literature regarding pharmacists’ roles in preventing unintended pregnancy, review the relevant laws and policies in the United States to describe pharmacists’ and/or pharmacy’s role in policy development related to unintended pregnancy, and identify partners who pharmacists can work with in this public health area.
Data sources: A systematic review was conducted focusing on the role of pharmacists in unintended pregnancy. For practice, articles were identified in Medline through July 1, 2009, using MeSH and keywords. For policy, two authors examined the current status of access issues related to over-the-counter (OTC) status and collaborative practice agreements. Partners were identified in the reviews and authors’ experiences.
Data extraction: English-language, U.S.-based articles that contained either qualitative or quantitative data or were review articles addressing pharmacist interventions, pharmacists’ knowledge and attitudes regarding contraception, and pharmacists’ comfort and ability to counsel on preventing unintended pregnancy were included.
Data synthesis: Some improvements to emergency contraception (EC) access in pharmacies have occurred during the previous decade. Studies focused on counseling, pharmacist provision of depot reinjection, and pharmacist initiation of oral contraceptives were positive. No studies linked increased contraceptive access in pharmacies to lower pregnancy rates. In terms of policy, the literature described three access-related areas, including (1) EC and conscience clauses, (2) collaborative practice agreements, and (3) changes in prescription to OTC status. Pharmacists’ partnerships may include physicians/clinicians, local health departments, family planning organizations, nongovernmental organizations, and colleges of pharmacy.
Conclusion: Currently, pharmacists may increase access to contraceptives primarily via EC and use of collaborative practice agreements to initiate and/or continue hormonal contraceptives. New practice models should be implemented in community or clinic practices as allowed by collaborative practice regulations in each state. We encourage researchers and practitioners to consider a community approach in their endeavors by working with numerous types of primary care providers and organizations to explore ways to increase contraceptive access.
European Archive of Psychiatry & Clinical Neuroscience
Abstract Under the Euthanasia Program of Nazi Germany, more than 200,000 psychiatric patients were killed by doctors in psychiatric institutions. After summarising the historical facts and the slow and still going-on process of illuminating and understanding what happened, some ethical consequences are drawn. What can we learn from history? The following aspects are addressed: the special situation of psychiatry in times of war, bioethics and biopolitics, the responsibility of the psychiatrist for the individual patient, the effects of hierarchy on personal conscience and responsibility, the unethical “curable- uncurable” distinction and the atrocious concept that persons differ in their value.
RE Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
Human Reproduction
Abstract Background Tubal ligation can be a controversial method of birth control, depending on the patient’s circumstances and the physician’s beliefs.
Methods In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients’ and physicians’ characteristics influence Ob/Gyns’ advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient’s age, gravida/parity and her husband’s agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery.
Results The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9–70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians’ sex had no significant effect on advice about tubal ligation.
Conclusions Regarding patients who seek surgical sterilization, physicians’ advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.
Ryan E Lawrence, Kenneth A Rasinski, John D Yoon, Farr A Curlin
Contraception
Abstract Background: Although emergency contraception (EC) is available without a prescription, women still rely on doctors’ advice about its safety and effectiveness. Yet little is known about doctors’ beliefs and practices in this area.
Study design: We surveyed 1800 US obstetrician-gynecologists. Criterion variables were doctors’ beliefs about EC’s effects on pregnancy rates, and patients’ sexual practices. We also asked which women are offered EC. Predictors were demographic, clinical and religious characteristics.
Results: Response rate was 66% (1154/1760). Most (89%) believe EC access lowers unintended pregnancy rates. Some believe women use other contraceptives less (27%), initiate sex at younger ages (12%) and have more sexual partners (15%). Half of physicians offer EC to all women (51%), while others offer it never (6%) or only after sexual assault (6%). Physicians critical of EC, males and religious physicians were more likely to offer it never or only after sexual assault (odds ratios 2.1-12).
Conclusion: Gender, religion and divergent beliefs about EC’s effects shape physicians’ beliefs and practices.
Best Practice and Research Clinical Obstetrics & Gynaecology
Abstract Abortion has been a reality in women’s lives since the beginning of recorded history, typically with a high risk of fatal consequences, until the last century when evolutions in the field of medicine, including techniques of safe abortion and effective methods of family planning, could have ended the need to seek unsafe abortion. The context of women’s lives globally is an important but often ignored variable, increasingly recognised in evolving human rights especially related to gender and reproduction. International and regional human rights instruments are being invoked where national laws result in violations of human rights such as health and life. The individual right to conscientious objection must be respected and better understood, and is not absolute. Health professional organisations have a role to play in clarifying responsibilities consistent with national laws and respecting reproductive rights. Seeking common ground using evidence rather than polarised opinion can assist the future focus.
