The place for individual conscience

Frances Kissling

Journal of Medical Ethics
Journal of Medical Ethics

Abstract
From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. . . . The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice’s position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.


Kissling F. The place for individual conscience. J Med Ethics. 2001 Oct;27(suppl II):ii24-ii27.

The High Cost of Merging With A Religiously-Controlled Hospital

Monica Sloboda

Berkeley Women's Law Journal
Berkeley Women’s Law Journal

Extract
Conclusion

The trend of hospital mergers between religious and non-religious hospitals may continue to threaten access to reproductive health services, especially for patients who already have limited access because they live in rural areas or have low incomes.l” However, as this essay suggests, there are several avenues that concerned citizens and activists can take to try to prevent the loss of these vital services.l ” The creativity and determination of those who commit themselves to ensuring that reproductive health services will continue to be available to all who desire them has resulted in several viable legal and practical methods of intervention. Although I believe it is important to respect the religious rights and beliefs of others. when the expression of these beliefs encroaches on patients’ rights to access basic health services, intervention is appropriate and necessary. I hope that public outcry, in the forms of legal and grassroots action, will persuade state actors, legislatures, hospital administrators, and clergy to properly acknowledge patients’ rights and participate in the creation of acceptable solutions to the financial problems that hospitals increasingly face. We need solutions that do not deny essential health services to any group of people.


Sloboda M. The High Cost of Merging With A Religiously-Controlled Hospital. Berkeley Women’s Law J. 2001 Sep;140-156.

Limiting Access to Medical Treatment in an Age of Medical Progress: Developing a Catholic Consensus: A Response from Jewish Tradition

Laurie Zoloth

Christian Bioethics
Christian Bioethics

Extract
The efforts of Christian colleagues to articulate a clear framework of specific Christian moral values to assess clinical treatments are a necessary contribution to the debates about justice and resource allocation in health care. Such efforts not only make clear the way in which all such judgement is located, understood and interpreted from a particular social venue and from a particular ethical stance; finding one’s moral location is the first task of critical theory and concomitant practice. The clinical epistemology required in medical resource allocation is framed by cultural and theological stance just as surely as any knowledge, and Christians must be fully responsible for making overt the often covert assumptions that undergird such work. I have been asked to respond to the Consensus Statement by Catholics as a Jewish ethicist.


Zoloth L. Limiting Access to Medical Treatment in an Age of Medical Progress: Developing a Catholic Consensus: A Response from Jewish Tradition. Christ Bioet. 2001 Jan 01;7(2):193-201.

Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims

Steven S Smugar, Bernadette J Spina, Jon F Merz

American Journal of Public Health
American Journal of Public Health

Abstract
There is growing concern that rape victims are not provided with emergency contraceptives in many hospital emergency rooms, particularly in Catholic hospitals. In a small pilot study, we examined policies and practices relating to providing information, prescriptions, and pregnancy prophylaxis in emergency rooms. We held structured telephone interviews with emergency department personnel in 5K large urban hospitals, including 28 Catholic hospitals from across the United States. Our results showed that some Catholic hospitals have policies that prohibit the discussion of emergency contraceptives with rape victims, and in some of these hospitals, a victim would learn about the treatment only by asking. Such policies and practices are contrary to Catholic teaching. More seriously, they undermine a victim’s right to information about her treatment options and jeopardize physicians’ fiduciary responsibility to act in their patients’ best interests. We suggest that institutions must reevaluate their restrictive policies. If they fail to do so, we believe that state legislation requirng hospitals to meet the standard of care for treatment of rape victims is appropriate.


Smugar SS, Bernadette J Spina BA, Jon F Merz JD. Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims. Am J Public Health. 2000 Sep;90(9):1372-1376.

Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights

Katherine A White

Stanford Law Review
Stanford Law Review

Abstract
In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to “sensitive” services like abortion, family planning , HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers’ right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White’s analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients’ right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal “bypass” legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.


White KA. Crisis of Conscience: Reconciling Religious Health Care Providers’ Beliefs and Patients’ Rights. Stanford Law Rev. 1999 Jul;51(6)1703-1749.

There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey

John F Crosby

Christian Bioethics
Christian Bioethics

Abstract
Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.


Crosby JF. There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey. Christ Bioet. 1998 Jan 01;4(1):63-82.

Who is worse? Fanatics or their followers?

Douglas Waugh

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
When Dr. Garson Romalis was shot in Vancouver in November – police have suggested there is a link between the shooting and his performance of abortions – I realized there are certain aspects of human behaviour that I will never figure out. What could give rise to such hatred? What mysterious willingness causes people to let themselves be led into destructive and pointless violence? . . . Although the motives in these cases are undoubtedly complex, it seems clear that each of the fanatic snipers intended to kill, maim or scare the daylights out of these physicians and others like them. And although society as a whole reacted to the events with revulsion, there were without doubt people who said of each case: “Right on! That’s the proper treatment for those baby killers.” . . . Even if we must accept the occasional appearance of a misguided or mad killer among us, must we also accept the frightening cluster of approving supporters who almost inevitably turn up to endorse the madman and his ideas?


Waugh D. Who is worse? Fanatics or their followers?. Can Med Assoc J. 1995 Jan 01;152(1):90.

Moral and Religious Objections by Hospitals to Withholding and Withdrawing Life-Sustaining Treatment

Anna Maria Cugliari, Tracy E Miller

Journal of Community Health
Journal of Community Health

Abstract
A patient’s right to decide about life-sustaining treatment may conflict with the policies of health care facilities that refuse on the basis or religious or moral convictions to honor certain decisions to forgo treatment. The New York State Task Force on Life and the Law examined the prevalence and nature of facility conscience objections to the refusal of life-sustaining treatment by conducting a survey of New York hospitals. Written questionnaires were distributed to hospitals in New York State. Fifty-eight percent of the New York State hospitals responded. Twenty-nine percent of the respondents indicated that their hospital would object on grounds of conscience either to withholding or to withdrawing life-sustaining treatment in at least one of the twelve hypothetical cases presented. Hospitals were more likely to have “no policy” for withdrawing than for withholding treatment. Only 10% of the hospitals that would object to decisions to forgo treatment on religious or moral grounds had stated the objections in writing. The patient’s medical condition and the type of life-sustaining treatment to be withdrawn or withheld are important factors in determining whether a hospital will object on grounds of conscience. The imminence of death appeared more decisive than the degree of debilitation or disability as a factor in the willingness to accept decisions to forgo life-sustaining treatment. Hospitals should establish clear, written policies about their objections to forgoing treatment so that patients and their families can evaluate whether the facility meets their needs.


Cugliari AM, Miller TE. Moral and Religious Objections by Hospitals to Withholding and Withdrawing Life-Sustaining Treatment. J. Community Health. 1994 Apr 01;19(2):87-100.

(Correspondence) Abortion debate continues

Linda Spano, Michael Brennan

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
. . . we all – including Reynolds – operate from a biased set of basic assumptions. Is it really antireligious to suggest that the antiabortion forces are largely motivated by fundamental religious views that represent fixed basic assumptions? We think not. . . . Medical intervention includes helping people achieve their potential according to their own objectives as well as many other “appropriate” activities, such as the therapeutic termination of pregnancy. . . .The abortion debate is not entirely about abortion or religion, nor is it even a debate. . . the argument is about the freedom of choice and the access of all Canadian women to safe, competent medical care and about the refusal of most Canadians to submit to the irrational demands of a vociferous minority. . .


Spano L, Brennan M. (Correspondence) Abortion debate continues. Can Med Assoc J. 1993 Jun 15;148(12):2112-2113.

Religious Ethics and Active Euthanasia in a Pluralistic Society

Courtney S Campbell

Kennedy Institute of Ethics Journal
Kennedy Institute of Ethics Journal

Abstract
This article sets out a descriptive typology of religious perspectives on legalized euthanasia — political advocacy, individual conscience, silence, embedded opposition, and formal public opposition — and then examines the normative basis for these perspectives through the themes of sovereignty, stewardship, and the self. It also explores the public relevance of these religious perspectives for debates over legalized euthanasia, particularly in the realm of public policy. Ironically, the moral discourse of religious traditions on euthanasia may gain public relevance at the expense of its religious content. Nonetheless, religious traditions can provide a context of ultimacy and meaning to this debate, which is a condition for genuine pluralism.


Campbell CS. Religious Ethics and Active Euthanasia in a Pluralistic Society. Kennedy Inst Ethics J. 1992;2(3):253-277.