Abstract A physician’s long-established right to refuse to provide a requested service based on his or her moral beliefs is being challenged. Some authors suggest that physicians should not be licensed if they are unwilling to provide all legal services. Others would grant them the right to refuse, but require them to refer to a willing professional. What are the limits of a physician’s right to refuse? When such a right is claimed on moral grounds, what residual obligations does the physician have to the patient? How should the profession (or society) decide when a moral claim to a right to refuse is justified?
Abstract Bernard Dickens seeks to undermine the legal and ethical protections accorded to health care workers and hospitals conscientiously objecting to abortion. First, he appeals to the rationale of antidiscrimination laws as a basis for arguing against conscientious objection. Second, he argues that conscientious objection undermines the rights of patients and their autonomy. Third, he holds that conscientiously objecting doctors have a duty to refer patients for abortion. Fourth, he believes that Kant’s principle of respect for humanity as an end in itself is violated by conscientious objection to abortion. Fifth, Dickens quotes remarks by Pope John Paul II as support for the idea that physicians should not conscientiously object to abortion. Finally, he posits that institutions, such as Catholic hospitals, have a responsibility to provide abortions. I argue that all of the arguments offered by Dickens against conscientious objection are unsound.
Abstract Two hundred years ago, Thomas Jefferson asserted that no law “ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority.” Since then, freedom of conscience has continued to be heralded as a fundamental principle of American society. Indeed, many current policy debates–most notably in the medical and military contexts–are predicated on the theory that claims of conscience are worthy of legal respect. This Article, which offers a comprehensive account of the contemporary treatment of conscience, challenges established assumptions and seeks to reframe the debate about the normative value of conscience in American society. This Article first clarifies contemporary understandings of conscience by systematically analyzing its treatment in positive law. It looks beyond the traditional medical, military, and religious contexts, giving a descriptive account of law’s treatment of conscience across various substantive realms, including tax evasion, civil disobedience, discrimination, and even violent terrorism. It demonstrates that legal accommodations are typically granted on an ad hoc basis, without a guiding doctrinal principle. If there is a consistent and coherent justification for treating cases differently, our legal system has thus far failed to provide it. This Article concludes that, in order for American law to reflect the kind of robust, autonomy-based respect for conscience to which every pluralistic society aspires, we must agree on a content-neutral guiding principle for negotiating future claims for legal accommodation. The alternative, the Article posits, is to concede that American society has abandoned the fundamental purpose of conscientious accommodation–namely, protecting the individual from oppressive majoritarian understandings of morality.
Extract Jürgen Habermas’s recent observations regarding the increasing gulf between traditional religions and contemporary secularism is correct (2002, 2008). The dominant bioethical and political ideologies of the contemporary Western world have come to be not merely secular but often passionately atheistic. Throughout Western Europe and North America, for example, there is a growing movement to undermine the salience of religious discourse, to undue its influence in the public forum, and to erase religion from the public space. Attempts to frame all of medicine within a completely secular morality, relegating religious belief and practice to the realm of private personal choice, have become ever more prominent. Here, one need only consider the current clash between the US Roman Catholic bishops and President Obama’s administration over whether Catholic employers, such as Catholic hospital systems, ought to be legally required to provide insurance coverage for artificial contraception, including abortifacients, in their employer sponsored health care plan.1 In law and public policy, there has been a profound rupture from Traditional Christianity, which secular proponents aggressively seek to place in the distant past, as if Christianity had been an unfortunate, perhaps immoral, accident of history. Habermas’s acknowledgment of the vast divide between traditional religions that approach the world and moral analysis with knowledge of a God Who commands, and secular worldviews that begin all epistemic and normative analysis with the prior assumption that God does not exist, elucidates the fundamental debates of contemporary bioethics.
Abstract Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society’s most vexing bioethics controversies.
Janelle N Sobecki, Farr A Curlin, Kenneth A Rasinski, Stacy Tessler Lindau
Journal of Sexual Medicine
Abstract Introduction Sexuality is a key aspect of women’s physical and psychological health. Research shows both patients and physicians face barriers to communication about sexuality. Given their expertise and training in addressing conditions of the female genital tract across the female life course, obstetrician/gynecologists (ob/gyns) are well-positioned among all physicians to address sexuality issues with female patients. New practice guidelines for management of female sexual dysfunction and the importance of female sexual behavior and function to virtually all aspects of ob/gyn care, and to women’s health more broadly, warrant up-to-date information regarding ob/gyns’ sexual history-taking routine.
Aims To determine obstetrician/gynecologists’ practices of communication with patients about sexuality, and to examine the individual and practice-level correlates of such communication.
Methods A population-based sample of 1154 practicing U.S. obstetrician/gynecologists (53% male; mean age 48 years) was surveyed regarding their practices of communication with patients about sex.
Main Outcome Measures Self-reported frequency measures of ob/gyns’ communication practices with patients including whether or not ob/gyns discuss patients’ sexual activities, sexual orientation, satisfaction with sexual life, pleasure with sexual activity, and sexual problems or dysfunction, as well as whether or not one ever expresses disapproval of or disagreement with patients’ sexual practices. Multivariable analysis was used to correlate physicians’ personal and practice characteristics with these communication practices.
Results Survey response rate was 65.6%. Sixty-three percent of ob/gyns reported routinely assessing patients’ sexual activities; 40% routinely asked about sexual problems. Fewer asked about sexual satisfaction (28.5%), sexual orientation/identity (27.7%), or pleasure with sexual activity (13.8%). A quarter of ob/gyns reported they had expressed disapproval of patients’ sexual practices. Ob/gyns practicing predominately gynecology were significantly more likely than other ob/gyns to routinely ask about each of the five outcomes investigated.
Conclusion The majority of U.S. ob/gyns report routinely asking patients about their sexual activities, but most other areas of patients’ sexuality are not routinely discussed.
Abstract In the United States, the decision of whether to withdraw or continue to provide artificial nutrition and hydration (ANH) for patients in a permanent vegetative state (PVS) is placed largely in the hands of surrogate decision‐makers, such as spouses and immediate family members. This practice would seem to be consistent with a strong national emphasis on autonomy and patient‐centered healthcare. When there is ambiguity as to the patient’s advanced wishes, the presumption has been that decisions should weigh in favor of maintaining life, and therefore, that it is the withdrawal rather than the continuation of ANH that requires particular justification. I will argue that this default position should be reversed. Instead, I will argue that the burden of justification lies with those who would continue artificial nutrition and hydration (ANH), and in the absence of knowledge as to the patient’s advanced wishes, it is better to discontinue ANH. In particular, I will argue that among patients in PVS, there is not a compelling interest in being kept alive; that in general, we commit a worse violation of autonomy by continuing ANH when the patient’s wishes are unknown; and that more likely than not, the maintenance of ANH as a bridge to a theoretical future time of recovery goes against the best interests of the patient.
Washington and Lee Journal of Civil Rights and Social Justice
Extract As is now known, from 1946–48, the Venereal Disease Research Laboratory of the U.S. Public Health Service (PHS), the Pan American Sanitary Bureau (PASB), and the Guatemalan government spearheaded a study4 that intentionally infected and tested Guatemalan prisoners, asylum inmates, soldiers, and orphaned children.5 The research team, led by Dr. John C. Cutler, exposed Guatemalans to syphilis “through the use of infectious prostitutes or directly through [an] inoculum made from tissue of human and animal syphilitic gummas and chancres,”6 and then treated the Guatemalans with penicillin.7 Although the researchers acknowledged they could not use such methods in the United States,8 they experimented in secrecy and did not seek consent from human subjects.9 . . .
The Guatemala study was horrendous, and the legal standards and guidelines of its day failed to protect Guatemalans who were infected with syphilis. Similar studies are being conducted by U.S. researchers in developing nations around the world, whether through grants from the U.S. government or by private U.S. companies. These problems must be remedied, and the Research Participants Protection Modernization Act of 2011 provides the impetus for the U.S. to do so. As Amy Gutmann, Chair of the Presidential Commission for the Study of Bioethical Issues stated, “a civilization can be judged by the way that it treats its most vulnerable individuals. There is no position of vulnerability that is greater than to be the subject of a medical experiment.”.
Abstract Avoiding complicity in injustice is not limited to engaging in acts of noncompliance on behalf of one’s patients. The injustices from which one’s patients suffer may be rooted in morally suspect norms to which the profession of medicine, or some influential part of it, has lent its support or that it has not opposed and from which it and its practitioners have benefited. There may also be injustices that the profession has condemned but that remain. In general, avoiding complicity in wrongdoing involves, as a base- line, understanding that the norms and practices responsible for it have contributed to making noncompliance an option that at least deserves serious moral consideration, if not endorsement. A physician may then decide to engage in some form of rule breaking in order to act on this understanding and express her refusal to be complicit.. . .Complicity threatens the moral and professional integrity of the physician, and noncompliance may be warranted in part because it is the only way that a physician can meet the threat.
Roger Trigg. Equality, Freedom & Religion. Oxford: University Press; 2012 Jan 13, 224 pp. ISBN- 9780199576852.
Publisher’s Description Is religious freedom being curtailed in pursuit of equality, and the outlawing of discrimination? Is enough effort made to accommodate those motivated by a religious conscience? All rights matter but at times the right to put religious beliefs into practice increasingly takes second place in the law of different countries to the pursuit of other social priorities. The right to freedom of belief and to manifest belief is written into all human rights charters. In the United States religious freedom is sometimes seen as ‘the first freedom’. Yet increasingly in many jurisdictions in Europe and North America, religious freedom can all too easily be ‘trumped’ by other rights.
Roger Trigg looks at the assumptions that lie behind the subordination of religious liberty to other social concerns, especially the pursuit of equality. He gives examples from different Western countries of a steady erosion of freedom of religion. The protection of freedom of worship is often seen as sufficient, and religious practices are separated from the beliefs which inspire them. So far from religion in general, and Christianity in particular, providing a foundation for our beliefs in human dignity and human rights, religion is all too often seen as threat and a source of conflict, to be controlled at all costs. The challenge is whether any freedom can preserved for long, if the basic human right to freedom of religious belief and practice is dismissed as of little account, with no attempt to provide any reasonable accommodation. Given the central role of religion in human life, unnecessary limitations on its expression are attacks on human freedom itself.
