Service, not Servitude
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Remember the many thousands who have served and are serving honorably, caring for American soldiers and Iraqis, and not the few who might have greatly disappointed us with their lack of proper ethical judgment.
Kiley KC. (Correspondence) Military medicine and human rights. The Lancet. 2004 Nov 20;364(9448):1851-1852.
Abstract
From its emergence, preimplantation genetic diagnosis (PGD) has been opposed by religious, feminist, and disability-rights advocates. PGD has developed, however, to extend beyond genetic diagnosis of embryos to diagnose chromosomal abnormalities. Evidence shows that PGD is safe, children born after in vitro fertilization (IVF) and PGD having no higher rate of birth defects than children of normal pregnancies. Laws may accommodate PGD directly or indirectly, but some prohibit PGD totally or except to identify sex-linked genetic disorders. When children suffer severe genetic disorders and require stem-cell transplantation, compatible donors may be unavailable. Then, IVF and PGD of resulting embryos may identify some whose gestation and birth would produce unaffected newborns, and placental and cord blood from which stem-cells compatible for implantation in sick siblings can be derived. Ethical issues concern conscientious objection to direct participation, discarding of healthy but unsuitable embryos, and valuing savior siblings in themselves, not just as means to others’ ends.
Keywords:
Dickens BM. Pre-implantation genetic diagnosis and ‘savior siblings’. Int J Gynaec Obstet. 2005;88(1):91-96.
Abstract
Several reports have detailed cases in which pharmacists have refused to fill prescriptions for emergency contraception. Should pharmacists have the right to refuse access to these medications? This Sounding Board article discusses arguments for and against the right to refuse and proposes a balanced solution to the problem.
Cantor JD, Baum K. The Limits of Conscientious Objection-May Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?. N Engl J Med. 2004 Nov 04;351(19):2008-212.
Abstract
The fact that certain vaccines are grown in cell strains derived decades ago from an aborted fetus is a concern for some. To understand such concerns, a standardized search identified internet sites discussing vaccines and abortion. Ethical concerns raised include autonomy, conscience, coherence, and immoral material complicity. Two strategies to analyse moral complicity show that vaccination is ethical: the abortions were past events separated in time, agency, and purpose from vaccine production. Rubella disease during pregnancy results in many miscarriages and malformations. Altruism, the burden of rubella disease, and protection by herd immunity argue for widespread vaccination although autonomous decisions and personal conscience should be respected.
Zimmerman RK. Ethical analyses of vaccines grown in human cell strains derived from abortion: Arguments and Internet search. Vaccine. 2004 Oct 2004;22(31-32):4238-4244.
Extract
Religious fundamentalism and a lack of resources are the chief barriers to achieving sexual and reproductive rights for all by 2015, concluded the 2004 International Conference on Population and Development (ICPD) . . . Katherine McDonald, president of Action Canada for Population and Development, said that advocates of the Cairo consensus have been overly distracted by their efforts to isolate and shame US and conservative backlash and must reinvest in a commitment to human rights. “In-depth policy analyses of sexual, reproductive, and abortion rights are lacking,” she said.
Clark J. Slow progress to reproductive rights. Can Med Assoc J. 2004;171(8):841.
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Three years after the US government approved mifepristone (Mifeprex or RU-486), use of the so-called “abortion pill” has increased 70%. . . . Mifepristone, a progesterone blocker, induces abortion in women who are up to 8 weeks pregnant.
Sibbald B. “Abortion pill” use. Can Med Assoc J. 2004 Sep 28;171(7):718.
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“Refusal clauses” and “conscience exceptions,” which allow US doctors, nurses, and healthcare workers to refuse to provide certain types of health care to patients, are being extended to hospitals, insurance companies, pharmacies, and managed care companies.
Tanne JH. “Conscience” clauses allow US corporate providers to refuse care. Br Med J. 2004;329(7464):476.
Abstract
A competent person can avoid the onset of dementia by refusing life-sustaining medical care and by voluntarily stopping eating and drinking, bringing life to an end well before any health crisis. A competent person can also try to limit the duration of dementia by drafting an advance directive that sets bounds on the life-sustaining care, including artificial nutrition and hydration, that medical caregivers can provide when the person no longer has the capacity to make her own medical decisions. But between these two strategies there can lie a significant gap. A person could live with moderate to severe dementia for a considerable time, no longer able to voluntarily stop eating and drinking yet also not yet requiring the life-sustaining care forbidden by advance directive. This gap has been much discussed in recent years in the Hastings Center Report. Several years ago (in the May-June 2014 issue), Paul Menzel and M. Colette Chandler-Cramer argued for what they described as a moderate correction to the dominant view that food and water should always be offered to a patient with dementia if the patient expresses a desire to eat and drink. The problem is taken up again by the legal scholar Norman L. Cantor in this issue (July-August 2018), and Cantor, too, tries to find a moderate alternative.
Kaebnick GE. Advance Directives and Dementia. Hastings Cent Rep. 2018 Aug 16;48(4):2.
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A series of attention-grabbing lawsuits and a crop of new legislation have spotlighted a long-gathering movement to vastly expand the scope of policies allowing health care providers, institutions and payers to refuse to participate in sexual and reproductive health services by claiming a moral or religious objection. In some cases, these radical new policies are intentionally designed to undermine, if not actually eliminate, the ability of governments at all levels, and even private businesses, to balance providers’ “conscience” rights with the ability of patients to exercise their own conscience and gain access to health care services that they want and need.
Sonfield A. New Refusal Clauses Shatter Balance Between Provider ‘Conscience’, Patient Needs. Guttmacher Rep Public Pol. 2004 August:1-3.
Extract
As neither our original Commentary on access to emergency contraception nor our letter response was suitable for fully referenced legal or ethical reasoning, we appreciate this opportunity to expand a little on the substance of both, addressing the points Mr Murphy raises.
Dickens BM, Cook RJ. (Correspondence) In Response. 2004 Aug; 26(8): 706-707.