Extract Public health officials may have legitimate questions about the merits of HPV vaccine mandates, in light of the financial and logistic burdens these may impose on families and schools, and also may be uncertain about adverse-event rates in mass-scale programs. But given that the moral objections to requiring HPV vaccination are largely emotional, this source of resistance to mandates is difficult to justify.
Extract Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with society.
Extract The assignment: to buy the drug in a small, remote town where I was sojourning on business. If I could not get the pill in this straight-talking, hard- working place, who could? . . . approached a smiling pharmacy worker and asked for Plan B. . . . Kevin refused to hand it over. Only a pharmacist could give me the drug. He was a pharmacist’s assistant; the real pharmacist was on her break. . . . When I returned at 5:30, Kevin, the man of steely resolve, informed me that the pharmacist had left for the day. No pharmacist, no Plan B. [Pharmacist assistant seems to have answered questions evasively] . . . Was this not a nonprescription drug. Yes. Why could I not purchase the drug if no prescription was necessary? And then he said it: “Because, ethically, I don’t believe in it and I would not give it to you anyway. It is against my principles, and I don’t have to do anything I am uncomfortable with,” he said loudly and proudly. . . According to Kevin, there is nothing unprofessional about placing personal conviction ahead of a woman’s health care needs. . . a reasonably articulate curmudgeon like myself cannot obtain emergency contraception, what chance does a worried, upset teenage girl have?
Barbara W. Counter attack. Can Med Assoc. J. 2006;174(2):211-212.
Abstract Apparently heeding George Washington’s call to “labor to keep alive in your breast that little spark of celestial fire called conscience,” physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
Extract Inspired by Nazi ideology and implemented by its apostles, eugenics and euthanasia in the late 1930s and early 1940s served no social necessity and had no scientific justification. Like a poison, they ultimately contaminated all intellectual activity in Germany. But the doctors were the precursors. How can we explain their betrayal? What made them forget or eclipse the Hippocratic Oath? What gagged their conscience? What happened to their humanity?
Wiesel E. Without Conscience. N Engl J Med.. 2005 Apr 14;352(15):1511-1513.
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.
Abstract . . . an emphasis on oversight and compliance misses the point. By overly focusing on making sure that rules are followed, we push researchers away from a real appreciation for issues and into doing whatever it takes to expedite the oversight process. This approach can cause researchers to quickly lose sight of the point of research protections – the rights and interests of the subjects themselves.
Extract Medicine depends on more than competence and expertise, essential as these are. It cannot function as an institution without good faith on the part of provider, patient and the public as a whole. The root of the public’s trust is the confidence that physicians will put patients’ welfare ahead of all other considerations, even the patients’ momentary wishes or the physicians’ monetary gain. It is the function of medicine as a profession to safeguard and promote this trust in the society at large. This point could be phrased as a maxim: “Medicine must always be treated as a public good, never as a commodity.” . . . medicine must take the lead in a public conversation about the profession’s contract with society. If it does not, that contract is likely to be redefined in terms, and in a language, quite antithetical to the core concerns of medicine.
Extract When I was a medical student in the early ‘40s, and for a considerable time after that, the artificial termination of pregnancy was considered an unspeakable crime. . . . No one knew for certain how widespread the practice was, but enough patients turned up in emergency departments or in the morgue for us to know it was going on, and to arouse the ire and indignation of society’s moralists. . . . The credit for bringing the revolution about certainly belongs to Dr. Henry Morgentaler, but it is clear that Canada’s social climate had been changing slowly for several years before he defied the law by opening his first abortion clinic in Montreal . . . True, the anti-abortion campaign is not yet dead, but its force has become so attenuated the impact is limited.
Journal summary With physicians in Canada under increasing threat of malpractice litigation, it has been suggested that adopting clinical practice guidelines (CPGs) as standards of care would free doctors from the fear of litigation initiated by dissatisfied patients. However, ethicist Eike-Henner Kluge argues that CPGs can only be considered general indicators of standards of care.
Kluge E-H. Clinical Practice Guidelines and the Law. Can Med Assoc J. 1996;155(5):574-576.
