Protection of Conscience Project Library

Civil disobedience, conscientious objection, and evasive noncompliance: a framework for the analysis and assessment of illegal actions in health care

James F Childress

Abstract
This essay explores some of the conceptual and moral issues raised by illegal actions in health care. The author first identifies several types of illegal action, concentrating on civil disobedience, conscientious objection or refusal, and evasive noncompliance. Then he sketches a framework for the moral justification of these types of illegal action. Finally, he applies the conceptual and normative frameworks to several major cases of illegal action in health care, such as “mercy killing” and some decisions not to treat incompetent patients.

Childress JF. Civil disobedience, conscientious objection, and evasive noncompliance: a framework for the analysis and assessment of illegal actions in health care. J Med Philos. 1985 Feb 01;10(1):63-83.

(Correspondence) The tragedy of abortion

Luis Huaypaya

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Cook and Howe (Can Med Assoc J 1984; 131: 539) state that “a possible tragedy was avoided” by recommending an abortion to a pregnant woman with schizophrenia. What constitutes a tragedy may be considered from different perspectives, and I would like to suggest an alternative view. It can be considered a tragedy that many well-intentioned health professionals believe that suppressing a life is an appropriate way of preventing human suffering. . . that many childless couples have to wait years to adopt while thousands of potentially adoptable children . . . are prevented from being born . . .

Huaypaya L. (Correspondence) The tragedy of abortion. Can Med Assoc J. 1985 Jan 15;132(2):93-96.

(Editorial) Conscience, virtue, integrity and medical ethics

Journal of Medical Ethics

Extract
. . . Conscience, for example, turns out to be an ambiguous concept. On the one hand is the concept of an unthinking but morally controlling force within us telling us what we should do and not do. . . The second concept of conscience corresponds to the . . . corresponds to many analyses of conscience in the theological and philosophical literature in which conscience is an essentially rational faculty . . . Thus it is immediately clear that claims for the adequacy of a good conscience for medical ethics must make clear which of these two concepts of conscience is intended. . . .

JME. (Editorial) Conscience, virtue, integrity and medical ethics. J Med Ethics. 1984 Dec;10(4):171-172.

(Correspondence) Abortion denied – outcome of mothers and babies

Carlos Del Campo

Extract
The Aberdeen study examined the cases of 300 women applying for abortions, of which 60% were approved; approximately 120 women were denied abortion. This number would constitute only 1.9% of the 6323 cases in my survey. Furthermore, if they had been included the results would remain statistically unchanged. . . Dr. Watters states that I was “very selective in examining the work done in Czechoslovakia” and cites the work of Matejcek and colleagues.3 I direct Dr. Watters’ attention to reference 11 in my survey, in which this work is cited. This was Dr. Matejcek and colleagues’ original publication on the same group of patients; furthermore, they published a more recent follow-up study, in which their original findings remained basically unchanged. To base a therapeutic approach toward women with unwanted pregnancies on the evidence quoted by Dr. Watters and to ignore the massive evidence presented in my survey would be unacceptable.

Campo CD. (Correspondence) Abortion denied – outcome of mothers and babies. Can Med Assoc J. 1984 Sep 15;131(6):546-548.

(Correspondence) Abortion denied – outcome of mothers and babies

Wendell W Watters

Extract
Apparently Dr. Carlos Del Campo (Can Med Assoc J 1984; 130: 361, 362, 366) consulted only a small portion of the literature in concluding that it shows “no evidence that a continued unwanted pregnancy will endanger the mother’s mental health”. He ignored the Aberdeen study, . . .Dr. Del Campo was very selective in examining the work done in Czechoslovakia. . . the conclusion to be drawn from these studies is that termination of an unwanted pregnancy is likely to be beneficial to a woman’s mental health if it is her choice to exercise this option, whereas mandatory motherhood is likely to be harmful to her mental health. This conclusion is consistent with my clinical experience of 20 years in working with couples and families, as it is with that of many other family psychiatrists.

Watters WW. (Correspondence) Abortion denied – outcome of mothers and babies. Can Med Assoc J. 1984 May 15;130(10):1264, 1266.

(Editorial) Abortion denied – outcome of mothers and babies

Carlos Del Campo

Extract
The children of women who have been denied an abortion are at risk of certain disadvantages, but such problems could be alleviated by better adoption and social programs. Since well educated women have the most “liberal” attitudes towards abortion’4 and are the least likely to have economic reasons for wanting an abortion, programs to prevent abortion should be directed towards changing their attitudes. Also, women who have been denied abortion should be followed up, both for the child’s sake and to prevent further requests for abortion.

Campo CD. (Editorial) Abortion denied – outcome of mothers and babies. Can Med Assoc J. 1984 Feb 15;130(4):361-362, 366.

(Correspondence) The CMA abortion survey

PG Coffey

Extract
The CMA should have asked prolife physicians “Do you believe that the threat to a woman’s life should be the only indication for abortion?” In my experience most pro-life advocates believe not that there is absolutely no indication for abortion, but that abortion is indicated only in serious circumstances.

Coffey PG. (Correspondence) The CMA abortion survey. Can Med Assoc J. 1983 Dec 15;129(12):1260.

(Correspondence) The CMA abortion survey

Donovan Brown

Extract
I am saddened and a little shocked to find that nearly 50% of the medical profession in Canada would terminate pregnancy at the wishes of the patient. We are supposed to be a profession, but what do we profess to do?

Brown D. (Correspondence) The CMA abortion survey. Can Med Assoc J. 1983;129(12):1260.

(Correspondence) The CMA abortion survey

Paul de Bellefeuille

Extract
I find the CMA abortion survey disturbing and completely unsatisfying. Without exception, all the questions assume that abortion is acceptable and can therefore be neatly compartmentalized to facilitate its performance. Nothing could be further who initially did not want their babies did want them once they were born,’ some individuals may ignore this normal evolution of maternal feelings. . . . slightly more than half of the respondents would refuse to terminate a pregnancy solely at the “woman’s request”. . . . Everyone knows that few, if any, terminations of pregnancy are therapeutic, although many are pathogenic. . .

de Bellefeuille P. (Correspondence) The CMA abortion survey. Can Med Assoc J. 1983;129(12):1259-1260.

(Correspondence) Abortion

WJ Kazun

Extract
I disagree with Dr. Morton S. Rapp on a number of the points he made in his letter . . . Dr. Rapp must realize that no one compels any woman or man to become a parent. He must also realize that there is no ethical choice when an innocent life is destroyed. . . Abortion is a violent act and the ultimate in child abuse. Dr. Rapp must agree that child abuse has increased markedly with the increase in abortions and presumably the birth of only wanted children. A study done by Dr. Philip Ney, a well known children’s psychiatrist, proved that the increase in abortions has led to an increase in child abuse and frequently to abuse of wanted children.

Kazun W. (Correspondence) Abortion. Can Med Assoc J. 1983 Aug 15;129(4):320.