Protection of Conscience Project Library

(Correspondence) Paternalism and the Physician’s Conscience

Julia E Connelly

Journal Extract
I read Dr. Thomasma’s article (1) with skepticism. All models for the doctor-patient relationship are shortsighted as they do not acknowledge systems of relationships beyond that of the physician and the patient. Despite this inherent shortcoming, Thomasma’s model contains two characteristics that distinguish it from other such models. Both the strength of his physician conscience model and its greatest limitations exist in these two characteristics. First, his model requires that physicians assess beliefs, attitudes, and emotions they recognize in response to their patients in an effort to determine how these factors influence the health care they provide. . .

Connelly JE. (Correspondence) Paternalism and the Physician’s Conscience. Ann Intern Med. 1983 Aug 01;99(22):276.

(Correspondence) An objective social reason to reconsider abortions

Carlos Del Campo

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
Therapeutic abortions have been extensively condemned for religious and moral reasons; these arguments have not been strong enough to prevent them. This objective statistical analysis poses an argument for all those who require a different approach to the problem. The child of the woman you persuade not to undergo an abortion today may be the person whose productivity will save your existence tomorrow.

Campo CD. (Correspondence) An objective social reason to reconsider abortions. Can Med Assoc J. 1983 Jul 01;129(1):12.

Beyond Medical Paternalism and Patient Autonomy: A Model of Physician Conscience for the Physician-Patient Relationship

David C Thomasma

Abstract
Medical paternalism lies at the heart of traditional medicine. In an effort to counteract the effects of this paternalism, medical ethicists and physicians have proposed a model of patient autonomy for the physician patient relationship. However, neither paternalism or autonomy are adequate characterizations of the physician patient relationship. Paternalism does not respect the rights of adults to self-determination, and autonomy does not respect the principle of beneficence that leads physicians to argue that acting on behalf of others is essential to their craft. A model of physician conscience is proposed that summarizes the best features of both models-paternalism and autonomy.

Thomasma DC. Beyond Medical Paternalism and Patient Autonomy: A Model of Physician Conscience for the Physician-Patient Relationship. Ann. Intern. Med.. 1983;98(2):243-248.

(Editorial) A Nurse’s Conscience

Leah L Curtin

(This lengthy editorial was repeated verbatim in 1993. It includes the following)
Extract
“No nurse should be required to give any drug if (a) she is not competent to give it or (b) she has problems of conscience with regard to its administration. If, for these reasons, a nurse refuses to give a drug, another nurse may do so. The original nurse should receive inservice and/or counseling. If she still has conscientious objections, she should not be coerced. The patient’s right to have/refuse a drug should be protected by meticulous adherence to the principles and procedures of informed consent. However, his right to the drug is not greater than another human being’s (the nurse’s) obligation to practice with integrity. Therefore, if one nurse will not give the drug – the head nurse, coordinator or supervisor should give the drug.” If none of these nurses can, in conscience, administer the drug, then the physician who ordered it must give It himself or find another physician who will do it for him..

Curtin LL. (Editorial) A Nurse’s Conscience. Nurs Manag. 1983 Feb;14(2):7-8

CMA reviews its position

Normand Da Sylva

Extract
Throughout the 1 970s and early 1 980s the issue of abortion was causing such concern that, at its 1981 meeting in Halifax, General Council directed the association “to review the situation with respect to therapeutic abortions in Canada”. As part of this review, the Board of Directors decided to go to the grassroots or the association and to ask individual physicians what their opinions were, not only on the procedural aspects of the current legislation, but also on the ethical and moral aspects of terminating a pregnancy. . . . With the help of an outside consultant, we then drew the names of 2000 physicians from the associations membership file to get a statistically valid sample, proportionally representative of our membership by province and by specialty.

Sylva ND. CMA reviews its position. Can Med Assoc J. 1983;128(1):57.

Conscientious objection

Pedro F Silva-Ruiz

Extract
The main purpose of this paper is to summarize the legal status of conscientious objectors in the United States. To accomplish it we would briefly state a background of the law of conscientious objection in the United States and then analyze the current factual situation. . . . The registration has been reinstated by the President of the United States recently and, although no draft has been called, it remains a very real possibility, especially since the volunteer army has not proven satisfactory.51 Should Congress abolish the exemption to bear arms, the important question the Court’s would face is whether or not conscientious objection to war, to a particular conflict or to all, is a right recognized and protected by the Constitution of the United States.

Silva-Ruiz PF. Conscientious objection. Am J Comp Law. 1982 Dec 1;30 Supp 1982:427-437.

(Correspondence) Abortion

MT Casey

Extract
The fetus in the uterus of a pregnant woman is not the body of the pregnant woman; it is the body of someone else. I ask Dr. Wilson: If a woman asked him to provide her with the means to end her own life and used the same logic, that it is her own body and she is entitled to do with it what she wants, would he readily agree?

Casey MT. (Correspondence) Abortion. Can Med Assoc J. 1982 May 01;126(9):1032.

(Correspondence) Abortion

Wendell W Watters, May Cohen

Extract
The statement on abortion sponsored by the Canadian Physicians for Life and Les Medecins du Quebec pour le Respect de la Vie (Can Med Assoc J 1981; 125: 922) is an insult to all physicians who support the position of the Canadian Medical Association (CMA) on abortion, including physicians who are members of the Canadian Abortions Rights Action League (CARAL). We categorically reject the charge that we “promote the destruction of the unborn”. The use of the epithet proabortion in reference to either the CMA or the prochoice position is one of many examples of deliberate misrepresentation of the facts surrounding abortion. “Proabortion” applies to those who promote abortion, who favour it as a population control measure; such people live chiefly in India and China. Antichoicers do not recognize this crucial distinction between proabortion and prochoice . . .Are antichoicers now prepared to guarantee that the emotional and physical needs of all unwanted children will be met; to ensure that each one is able to make a life out of the existence that antichoicers would force on it? Hardly. They are interested only in “protecting” the fetus until it is too late for an abortion. They feel no responsibility for the aftermath of compulsory pregnancy for either the mother or the offspring. Their interest is in quantity, not quality of life. . . .These prolife physicians endorse the “moral rights of hospital boards” to protect the “unborn” by depriving women of their legal right to terminate an unwanted pregnancy. History teaches us that whenever the rights of institutions are allowed to ride roughshod over the rights of individuals, humanity as a whole suffers. No publicly funded hospital in this country has any moral right to deprive the women it serves of their legal right to an induced abortion. . . .As long as our laws make it possible for antichoice groups to impose their notions of reproductive morality on other Canadians in this arbitrary fashion, we should all blush in referring to Canada as a democracy.

Watters WW, Cohen M. (Correspondence) Abortion. Can Med Assoc J. 1982 Mar 01;126(5):465. Available from:

(Correspondence) Abortion before “individuation”

Peter G Bolland

Extract
As president of the Toronto Catholic Doctors Guild I must point out a divergence from traditional Roman Catholic teaching alleged to have been promulgated by Father David Roy of the Centre for Bioethics of the Clinical Research Institute of Montreal (Can Med Assoc J 1981; 125: 507, 509). Dorothy Trainor, the author, reported that Father Roy believes that since physical characteristics of “individuation” have been shown by experimental evidence to take place 14 to 21 days after conception he would have no qualms about abortion before that time. Such a view is, of course, entirely contrary to the teaching of our church and would seem to presume that the infusion of soul by God must necessarily await physical “individuation”. . . our behavioural guidelines must not be compromised by the thesis expounded by Father Roy.

Bolland PG. (Correspondence) Abortion before “individuation”. Can Med Assoc J. 1982;126(3):231.

(Correspondence) Abortion

DR Wilson

Extract
Sex is a pleasurable human activity that should be encouraged, not made taboo by old-fashioned minds that seek to give young people guilty consciences they don’t need. If an unwanted fetus is conceived, there is no point in having an unwanted child in the world, so there should be no obstacle such as an abortion committee to delay the operation.

Wilson DR. (Correspondence) Abortion. Can Med Assoc J. 1982 Jan 01;126(1):21.