Service, not Servitude
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
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.
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.
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.
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.
Extract
I referred to a 2010 study in which Asians were defined, for the purposes of that study, as “people from India, China, Korea, Vietnam and Philippines.”3 I did not intend to suggest that . . . evidence of sex selection, disparity of infant sex. . . applied to all those groups; indeed, the results were varied. I apologize for the ambiguity.
Kale R. (Correspondence) Female feticide (Dr. Kale responds). Can Med Assoc J. 2012 Jun 12;184(9):1065.
Extract
Forces worldwide are leading to greater intermingling of cultures with different perspectives on status of women, and it is unlikely that sex-selective abortions can be reduced without conscious efforts to raise awareness of gender equality at all levels of society.
Auger N, Kang HS. (Correspondence) Female feticide. Can Med Assoc J. 2012;184(9):1064.
Abstract
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor’s death, this approach satisfies the dead donor rule. The donor family’s wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
Morrisey PE. The Case for Kidney Donation Before End-of-Life Care. American J Bioethics Vol. 12, Iss. 6, 2012
Abstract
Background
The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.
Methods
We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).
Results
Among the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.
Conclusions
The effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.)
Brooke Winner, M.D., et al, Effectiveness of Long-Acting Reversible Contraception. N Engl J Med 2012; 366:1998-2007
Abstract
Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association’s conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the ‘objectionable’ activity itself in order to learn the necessary content and underlying principles.
Card RF. Is there no alternative? Conscientious objection by medical students. Med Ethics doi:10.1136/medethics-2011-100190