0 - Protection of Conscience Project Library

Is there room for freedom of conscience in medical practice?

Daniel P Sulmasy, John Lane

Extract
I’m going to talk about conscience in general and about the principle of cooperation. Then you will hear from Dr. Lane about the current application of that in the current administration’s policies. . .

. . .What [conscience] really is, in some ways, is a commitment on our part. And there are two basic hinges, if you will, to the commitment that conscience is. The first is to have and to hold fundamental moral principles. That if you are to be a moral person to begin with, you have to commit yourself to having fundamental moral commitments. Then, secondly, once you have those, you commit yourself to acting in accordance with them. And that’s what in essence, conscience is.

Sulmasy DP, Lane J. ” Is there room for freedom of conscience in medical practice?” Paper presented at: That Nature that Urges Us to Care for Others Is the Heart. The American Association of Medicine and the Person Annual Meeting 2012 Oct 19-21; Florham Park NJ.

Death by request in Switzerland: Post-traumatic stress disorder and complicated grief after witnessing assisted suicide

B Wagner, J Müller, A Maercker

Abstract
Background: Despite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.
Methods: A cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss.
Results: Of the 85 participants, 13% met the criteria for full PTSD (cut-off 35), 6.5% met the criteria for subthreshold PTSD (cut-off 25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%.
Conclusion: A higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.

Wagner B, Müller J, Maercker A. Death by request in Switzerland: Post-traumatic stress disorder and complicated grief after witnessing assisted suicide. European Psychiatry. 2012; 27(7): 542-546.

Controversy, Contraception, and Conscience: Insurance Coverage Standards Under the Patient Protection and Affordable Care Act

Lara Cartwright-Smith, Sara Rosenbaum

Extract
In the end, although the ACA has made significant headway in expanding insurance coverage of contraception, the controversy surrounding religious and moral objections to contraception means that policy makers continue to struggle to ensure access to this important public health service while respecting religious freedom.

Cartwright-Smith L, Rosenbaum S. Controversy, Contraception, and Conscience: Insurance Coverage Standards Under the Patient Protection and Affordable Care Act. Pub Health Rep. 2012;127(September-October):541-545.

Recognizing conscience in abortion provision

Lisa Harris

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

Extract
The exercise of conscience in health care is generally considered synonymous with refusal to participate in contested medical services, especially abortion. This depiction neglects the fact that the provision of abortion care is also conscience-based. The persistent failure to recognize abortion provision as “conscientious” has resulted in laws that do not protect caregivers who are compelled by conscience to provide abortion services, contributes to the ongoing stigmatization of abortion providers, and leaves theoretical and practical blind spots in bioethics with respect to positive claims of conscience — that is, conscience-based claims for offering care, rather than for refusing to provide it.

Harris L. Recognizing conscience in abortion provision. N Engl J Med 2012; 367:981-983

Rawls and religious paternalism

David M Shaw, Jacob Busch

Abstract
MacDougall has argued that Rawls’s liberal social theory suggests that parents who hold certain religious convictions can legitimately refuse blood transfusion on their children’s behalf. This paper argues that this is wrong for at least five reasons. First, MacDougall neglects the possibility that true freedom of conscience entails the right to choose one’s own religion rather than have it dictated by one’s parents. Second, he conveniently ignores the fact that children in such situations are much more likely to die than to survive without blood. Third, he relies on an ambiguous understanding of what is “rational” and treats children as mere extensions of their parents. Fourth, he neglects the fact that those in the original position would seek to protect themselves from persecution and enslavement and thus would not allow groups of children to be killed because of their parents’ beliefs. Finally, Rawls makes it clear that we should choose for children as we would choose for ourselves in the original position, with no particular conception of the good (such as that held by Jehovah’s Witnesses).

Shaw DM, Busch J. Rawls and religious paternalism. J Med Phil 2012 Aug;37(4):373-386.

Redefining Physicians’ Role in Assisted Dying

Julian J.Z. Prokopetz, Lisa Soleymani Lehmann

Journal Summary
Data from places with legal assisted dying have allayed concerns about potential abuses and patient safety, but a lingering challenge comes from the medical establishment. Creating a centralized mechanism for prescribing lethal medication could overcome this hurdle.

Prokopetz JJZ, Lehmann LS. Redefining Physicians’ Role in Assisted Dying. N Engl J Med 2012; 367:97-99 July 12, 2012

Catholicism, Cooperation and Contraception

Patrick C Beeman

Abstract
Catholic physicians practice in a world that condones the use of contraception. In the effort to be morally consistent, questions arise regarding the extent to which one’s participation in the provision of contraceptives constitutes immoral cooperation in evil. Particular challenges face the resident physician, who practices under another physician and within the constraints of local and specialty-wide training requirements. We examine the nature of the moral act of “referring” for contraception and argue that, in limited cases,there is a moral distinction between a referral and an intra-residency patient transfer, and the latter may be morally licit according to the principle of material cooperation

Beeman PC. Catholicism, Cooperation and Contraception. National Catholic Bioethics Quarterly. 2012;Summer):1-27.

May Doctors Refuse Infertility Treatments t o Gay Patients?

Jacob M Appel

Extract
The controversy in Benitez vs NCWC stands at the nexus of two competing approaches to the issue of “conscience”exemptions. On the one hand, most states have statutes that shield medical students and physicians from having to perform procedures, such as abortion and sterilization, to which they object on religious or moral grounds.

Appel JM. May Doctors Refuse Infertility Treatments t o Gay Patients? Hastings Cent Rep. 2006;July-August:20-21.

Resisting Moral Residue

Alina Bennett, Sheena M Eagan Chamberlin

Abstract
This paper surveys contemporary scholarly conceptions of moral residue in order to demonstrate the fruitful inconsistencies contained in these various notions. Due to the fact that moral dilemmas are commonplace in the practice of medicine, patients and practitioners are uniquely situated to experience moral residue. The authors investigate two medical sites as case studies that demonstrate how a more capacious notion of moral residue can be useful for explaining ethical complexities: euthanasia on the battlefield and care of minors who are members of the Jehovah’s Witness faith community. These case studies will be of particular interest to chaplains, pastoral theologians, and other relevant practitioners and intellectuals. Fruitfully cast against the illuminations of interdisciplinary scholars including Donald Capps, Lorraine Hardingham, and others, these cases are used as instructive discursive devices, shedding greater light on ideas put forth within the literature on this engaging and complex topic.

Bennett A, Chamberlin SME. Resisting Moral Residue. Pastoral Psychol. 2013;62(2):151-162.

(Correspondence) Female feticide

Susan J Woolhouse

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Rajendra Kale. . .advocates for physician regulatory agencies to undertake a recommendation to ban the disclosure of the sex of a fetus before 30 weeks gestation. This advocacy is misguided at best and dangerous at worst. . . . Blaming women for the scourge of gender-based violence is also not a solution. This is why limiting access to abortion based on this specific reason is dangerous health policy. Does this mean that some women will decide to abort female fetuses preferentially? Sadly, yes.

Woolhouse SJ. (Correspondence) Female feticide. Can Med Assoc J. 2012 Jun 12;184(9):1064.