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Abstract As a science and practice transcending metaphysical and ethical disagreements, ‘secular’ medicine should not exist. ‘Secularity’ should be understood in an Augustinian sense, not a secularist one: not as a space that is universally rational because it is religion-free, but as a forum for the negotiation of rival reasonings. Religion deserves a place here, because it is not simply or uniquely irrational. However, in assuming his rightful place, the religious believer commits himself to eschewing sheer appeals to religious authorities, and to adopting reasonable means of persuasion. This can come quite naturally. For example, Christianity (theo)logically obliges liberal manners in negotiating ethical controversies in medicine. It also offers reasoned views of human being and ethics that bear upon medicine and are not universally held – for example, a humanist view of human dignity, the bounding of individual autonomy by social obligation, and a special concern for the weak.
Abstract “Emergency contraception” case law from the state of Washington is reviewed and analyzed. Important legal, social policy, and professional ethical questions are considered with focus on professional and institutional conscientious objection to participating in this therapy.
Abstract There is surprising confusion surrounding the concept of biological totipotency, both within the scientific community and in society at large. Increasingly, ethical objections to scientific research have both practical and political implications. Ethical controversy surrounding an area of research can have a chilling effect on investors and industry, which in turn slows the development of novel medical therapies. In this context, clarifying precisely what is meant by “totipotency” and how it is experimentally determined will both avoid unnecessary controversy and potentially reduce inappropriate barriers to research. Here, the concept of totipotency is discussed, and the confusions surrounding this term in the scientific and nonscientific literature are considered. A new term, “plenipotent,” is proposed to resolve this confusion. The requirement for specific, oocyte-derived cytoplasm as a component of totipotency is outlined. Finally, the implications of twinning for our understanding of totipotency are discussed.
Highlights
Inaccurate use of the term “totipotent” by scientists creates unnecessary ethical controversy.
Public concern over producing embryos by reprogramming reflects confusion over totipotency.
Twinning by blastocyst splitting does not provide scientific evidence for totipotency.
Abstract [ES] La proliferación de los conflictos por motivos de conciencia en el contexto sanitario ha conducido con frecuencia a un tratamiento inadecuado de los mismos. En el caso de los profesionales sanitarios, es posible observar un uso inapropiado de conceptos como el de objeción de conciencia, banalizándolo o sacralizándolo, sin considerar el alcance que la negativa a prestar un tratamiento pueda tener para el resto de personas implicadas; en el caso de los usuarios, es frecuente que sus convicciones tengan un reconocimiento limitado a la hora de tomar decisiones que atañen a su bienestar. A partir de estas premisas, se pretende analizar las tensiones entre intereses, derechos y deberes de las partes implicadas, así como las relaciones de poder que se establecen entre quienes ostentan el conocimiento experto y quienes se encuentran en situación de mayor vulnerabilidad. Este análisis persigue identificar los problemas en los distintos niveles discursivos ¿de intereses, de derechos y deberes y de relaciones de poder- para establecer posteriormente una serie de límites que condicionen el ejercicio de la libertad de conciencia tanto para los profesionales como para los usuarios. Con ello se aspira a ofrecer un marco ético-normativo que pudiera servir como referencia para la resolución de conflictos, basado en una noción de conciencia menos individualista y más relacional-feminista.
[Translation] The proliferation of conflicts for reasons of conscience in the health context has frequently led to their inadequate treatment. In the case of health professionals, it is possible to observe an inappropriate use of concepts such as conscientious objection, trivializing or sacralizing it, without considering the scope that the refusal to provide treatment may have for the rest of the people involved; In the case of users, it is common for their convictions to have limited recognition when making decisions that concern their well-being. Based on these premises, it is intended to analyze the tensions between interests, rights and duties of the parties involved, as well as the power relations that are established between those who hold expert knowledge and those who are in a situation of greater vulnerability. This analysis seeks to identify the problems at the different discursive levels – interests, rights and duties and power relations – to subsequently establish a series of limits that condition the exercise of freedom of conscience for both professionals and users. With this, it aspires to offer an ethical-regulatory framework that could serve as a reference for conflict resolution, based on a less individualist and more relational-feminist notion of conscience.
Abstract Many countries, Sweden among them, lack professional guidelines and established procedures for responding to young females requesting virginity certificates or hymen restoration due to honour-related threats. The purpose of the present survey study was to further examine the attitudes of the Swedish healthcare professionals concerned towards young females requesting virginity certificates or hymen restorations. The study indicates that a small majority of Swedish general practitioners and gynaecologists would accommodate these patients, at least given certain circumstances. But a large minority of physicians would under no circumstances help the young females, regardless of speciality, years of practice within medicine, gender, or experience of the phenomenon. Their responses are similar to other areas where it has been claimed that society should adopt a zero tolerance policy against certain phenomena, for instance drug policy, where it has also been argued that society should never act in ways that express support for the practice in question. However, this argument is questionable. A more pragmatic approach would also allow for follow-ups and evaluation of virginity certificates and hymen restorations, as is demonstrated by the Dutch policy. Hence, there are some obvious advantages to this pragmatic approach compared to the restrictive one espoused by a large minority of Swedish physicians and Swedish policy-makers in this area.
Howard Brody, Sarah E. Leonard, Jing-Bao Nie, Paul Weindling
Cambridge Quarterly of Healthcare Ethics
Abstract In 1945–46, representatives of the U.S. government made similar discoveries in both Germany and Japan, unearthing evidence of unethical experiments on human beings that could be viewed as war crimes. The outcomes in the two defeated nations, however, were strikingly different. In Germany, the United States, influenced by the Canadian physician John Thompson, played a key role in bringing Nazi physicians to trial and publicizing their misdeeds. In Japan, the United States played an equally key role in concealing information about the biological warfare experiments and in securing immunity from prosecution for the perpetrators. The greater force of appeals to national security and wartime exigency help to explain these different outcomes.
Abstract This paper aims to demonstrate how public disclosure can be used to balance physicians’ conscientious objections with their professional obligations to patients – specifically respect for patient autonomy and informed consent. It is argued here that physicians should be permitted to exercise conscientious objections, but that they have a professional obligation to provide advance notification to patients about those objections. It is further argued here that public disclosure is an appropriate and ethically justifiable limit to the principle of advance notification. The argument for publicly disclosing physicians’ conscientious objections is made in this paper by discussing three practical benefits of public disclosure in medicine, and then addressing how publicly disclosing physicians’ conscientious objections is not an undue invasion of privacy. Three additional concerns with public disclosure of physicians’ conscientious objections are briefly addressed – potential harassment of physicians, workplace discrimination, and mischaracterising physicians’ professional aptitude – concluding that each of these concerns requires further deliberation in the realm of business ethics.
Abstract Laboratory classes in which animals are seriously harmed or killed, or which use cadavers or body parts from ethically debatable sources, are controversial within veterinary and other biomedical curricula. Along with the development of more humane teaching methods, this has increasingly led to objections to participation in harmful animal use. Such cases raise a host of issues of importance to universities, including those pertaining to curricular design and course accreditation, and compliance with applicable animal welfare and antidiscrimination legislation. Accordingly, after detailed investigation, some universities have implemented formal policies to guide faculty responses to such cases, and to ensure that decisions are consistent and defensible from legal and other policy perspectives. However, many other institutions have not yet done so, instead dealing with such cases on an ad hoc basis as they arise. Among other undesirable outcomes this can lead to insufficient student and faculty preparation, suboptimal and inconsistent responses, and greater likelihood of legal challenge. Accordingly, this paper provides pertinent information about the evolution of conscientious objection policies within Australian veterinary schools, and about the jurisprudential bases for conscientious objection within Australia and the USA. It concludes with recommendations for the development and implementation of policy within this arena.
Abstract Reproductive justice will exist in the Philippines when the lowest-income Filipino women have access to contraception. As long as women express a desire to use modern contraception but cannot access it, the Philippine government has not met its obligations. As the right to health is self-executing, Filipinos do not depend on the interest or goodwill of their government, but rather have enforceable claims to health care, including contraception. The government of Philippines should adhere to the Constitution, national laws, and ratified international agreements and fulfill the RH Act’s objectives to advance reproductive justice for all Filipinos.
Abstract The legalization of physician-assisted death in states such as Washington and Oregon has presented defining ethical issues for hospice programs because up to 90% of terminally ill patients who use the state-regulated procedure to end their lives are enrolled in hospice care. The authors recently partnered with the Washington State Hospice and Palliative Care Organization to examine the policies developed by individual hospice programs on program and staff participation in the Washington Death with Dignity Act. This article sets a national and local context for the discussion of hospice involvement in physician-assisted death, summarizes the content of hospice policies in Washington State, and presents an analysis of these findings. The study reveals meaningful differences among hospice programs about the integrity and identity of hospice and hospice care, leading to different policies, values, understandings of the medical procedure, and caregiving practices. In particular, the authors found differences 1) in the language used by hospices to refer to the Washington statute that reflect differences among national organizations, 2) the values that hospice programs draw on to support their policies, 3) dilemmas created by requests by patients for hospice staff to be present at a patient’s death, and 4) five primary levels of noninvolvement and participation by hospice programs in requests from patients for physician-assisted death. This analysis concludes with a framework of questions for developing a comprehensive hospice policy on involvement in physician-assisted death and to assist national, state, local, and personal reflection.
