Extract The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.
Extract Refusals by individual pharmacies and pharmacists to fill prescriptions for emergency contraceptives (“EC”) have dominated news headlines. . .These refusals. . .reflect moral and religious concerns about facilitating an act that would cut-off a potential human life.
Recently, conscience-based refusals have ballooned far beyond EC. Pharmacists are refusing to fill prescriptions for birth control, and other ancillary care professionals are asserting their own conscience concerns.
Conclusion Ultimately we must decide as a community whether we prize access more highly than religious freedom. The older healthcare conscience clauses offer us a range of methods to manage the clash between competing moral interests. If urgency for the service cannot be achieved through better information, state legislatures could make a number of choices. They could choose not to burden the professional’s choice at all—prizing religious liberty more highly than access. They could force providers to provide every service legally requested—prizing patient access more highly than moral or religious freedom. Or they could choose to allow individuals of conscience to exempt themselves up to the point that it creates a hardship for the patient or employer. In a pluralistic society, a live-and-let-live regime like this may be the most we can hope for.
Extract However, as long as medicine is practiced in a pluralistic democracy where some people find moral guidance in religions and others do not, situations will arise in which two paediatricians, both acting deliberately and conscientiously, will choose different responses to a given clinical decision. The policy challenge becomes one of specifying the situations for which conscience claims ought to be tolerated. . . For situations in which disagreement is consistent with good medical practice, practitioners must be free to follow the dictates of conscience. The risks of disallowing conscientious practice to the profession are greater than that of allowing grounded and well-articulated zones of moral pluralism.
Extract If members of legislative assemblies are meant to be our representatives for the purposes of deliberating about whether legislative measures are the right measures in terms of the general good of the community, conscience votes are an essential element of the legislative process. Australian political institutions are a less than perfect embodiment of the deliberative view of the legislative process. The competing mandate view is deeply entrenched in the attitudes of the political class. Accordingly, the explicit designation of a vote as a conscience vote remains a rare event in Australian politics. In so far as members of legislative assemblies are free to vote according to their consciences, it is important for them to understand what a conscience vote ought not to be. . . .
Gregory D Curfman, Stephen Morrissey, Jeffrey M Drazen
New England Journal of Medicine
Extract Physicians and other health care providers should not be involved in capital punishment, even in an advisory capacity. A profession dedicated to healing the sick has no place in the process of execution.
Curfman GD, Morrissey S, Drazen JM. Physicians and Execution. N Engl J Med. 2008 Jan 24;358(4):403-404.
Gary W Clark, Kelly Latimer, Richard W Sams II, Gordon Zubrod
Family Medicine
Extract Abortion training for residents is not simply a “politically charged” issue, as the authors assert. It is a moral or ethical issue. As faculty physicians in family medicine residency programs, we oppose the introduction of abortion training on moral, not political grounds. German physicians “politicized” euthanasia and ultimately killed 200,000 mentally ill and disabled persons from 1939–1945.
Extract As we gear up to provide the basket of services important to our patients in the Future of< Family Medicine, residencies need the information in these articles to be able to best design and implement abortion training. Residents with a strong experience in reproductive health, including abortion, will be best suited to meet the needs of the women they will meet in their future practices.
Journal of Family Planning and Reproductive Health Care
Abstract Background and methodology Community pharmacists’ role in the sale and supply of emergency hormonal contraception (EHC) represents an opportunity to increase EHC availability and utilise pharmacists’ expertise but little is known about pharmacists’ attendant ethical concerns. Semi-structured qualitative interviews were undertaken with 23 UK pharmacists to explore their views and ethical concerns about EHC.
Results Dispensing EHC was ethically acceptable for almost all pharmacists but beliefs about selling EHC revealed three categories: pharmacists who sold EHC, respected women’s autonomy and peers’ conscientious objection but feared the consequences of limited EHC availability; contingently selling pharmacists who believed doctors should be first choice for EHC supply but who occasionally supplied and were influenced by women’s ages, affluence and genuineness; non-selling pharmacists who believed EHC was abortion and who found selling EHC distressing and ethically problematic. Terminological/factual misunderstandings about EHC were common and discussing ethical issues was difficult for most pharmacists. Religion informed non-selling pharmacists’ ethical decisions but other pharmacists prioritised professional responsibilities over their religion.
Discussion and conclusions Pharmacists’ ethical views on EHC and the influence of religion varied and, together with some pharmacists’ reliance upon non-clinical factors, led to a potentially variable supply, which may threaten the prompt availability of EHC. Misunderstandings about EHC perpetuated lay beliefs and potentially threatened correct advice. The influence of subordination and non-selling pharmacists’ dispensing EHC may also lead to variable supply and confusion amongst women. Training is needed to address both factual/terminological misunderstandings about EHC and to develop pharmacists’ ethical understanding and responsibility.
Extract Physicians who fail to act in their patient’s interests breach the fundamental duty of care of a physician. It is negligent to deny a person who would benefit a blood transfusion, a vaccination, an abortion, intensive care or sedation at the end of their life. Physicians should not play God. If they morally disagree with some medical treatment, they can give their reasons to their patients and they can take that debate to the level of law and professional bodies. But in a liberal society they should not inflict their judgments on their patients. Physicians can disagree, but they should not dictate.
Extract Conscience and conscientious objection or moral justification are social activities not just Individualistic, “do-it-yourself” moralities. This requires education, training and intentional moral development and active input and encouragement. It is not just a matter of our moral biases but of awareness of the different applications of such principles and perspectives to particular situations and cases and of how to respond to moral critique and alternative conscientious grounds and beliefs.
