Protection of Conscience Project Library

Conscientious objections in pharmacy practice in Great Britain

Zuzana Deans

Abstract
Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article.

I propose that the pharmacy profession’s policy on conscientious objections should be altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere.

Deans Z. Conscientious objections in pharmacy practice in Great Britain. Bioethics. 2013 Jan;27(1):48-57. doi: 10.1111/j.1467-8519.2011.01918.x. Epub
2011 Jul 29. PubMed PMID: 21797914.

Professional QOL of Japanese nurses/midwives providing abortion/childbirth care

M. Mizuno, E. Kinefuchi, R. Kimura

Abstract
This study explored the relationship between professional quality of life and emotion work and the major stress factors related to abortion care in Japanese obstetric and gynecological nurses and midwives. . . . Multiple regression analysis revealed that of all the evaluated variables, the Japanese version of the Frankfurt Emotional Work Scale score for negative emotions display was the most significant positive predictor of compassion fatigue and burnout. The stress factors “thinking that the aborted fetus deserved to live” and “difficulty in controlling emotions during abortion care” were associated with compassion fatigue. These findings indicate that providing abortion services is a highly distressing experience for nurses and midwives.

Mizuno M, Kinefuchi E, Kimura R. Professional QOL of Japanese nurses/midwives providing abortion/childbirth care. Nurs Ethics January 17, 2013 0969733012463723

Beyond abortion: Why the Personhood Movement Implicates Reproductive Choice

Jonathon F Will

Abstract
This paper describes the background of the Personhood Movement and its attempt to achieve legal protection of the preborn from the earliest moments of biological development. Following the late 2011 failure of the personhood measure in Mississippi, the language used within the Movement was dramatically changed in an attempt to address some of the concerns raised regarding implications for reproductive choice. Putting abortion to one side, this paper identifies why the personhood framework that is contemplated by the proposed changes does not eliminate the potential for restrictions on contraception and in vitro fertilization (IVF) that put the lives of these newly recognized persons at risk; nor should it if proponents intend to remain consistent with their position. The paper goes on to suggest what those restrictions might look like based on recent efforts being proposed at the state level and frameworks that have already been adopted in other countries.

Will JF. Beyond abortion: Why the Personhood Movement Implicates Reproductive Choice. Am J Law Med. 2013;39(573-616.

Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care

Paul Vanden Berghe, Arsène Mullie, Marc Desmet, Gert Huysmans

Journal Summary
In Flanders (the Dutch-speaking, northern part of Belgium), in the course of the last ten years, physician-assisted dying and euthanasia have become embedded in palliative care. Paul Vanden Berghe, Arsène Mullie, Marc Desmet and Gert Huysmans, from the Federation of Palliative Care Flanders, describe how this major change happened and what issues it raises.

Berghe PV, Mullie A, Desmet M, Huysmans G. Assisted dying – the current situation in Flanders: euthanasia embedded in palliative care. European J Palliative Care. 2013;20(6):266-272.

The spread of conscience clause legislation

Claire Marshall

Summary
The article presents information on a proliferation in conscience clause legislation to federal and state laws in the U.S. The move is stated to be pitting individual religious autonomy against the public interest, mainly in the areas of education and health care.

Marshall C. The spread of conscience clause legislation. Human Rights [Internet]. 2013 Jan; 39(2), 15-16.

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.