Education Archives - Page 2 of 3 - Protection of Conscience Project Library

Conscience-based exemptions for medical students

Mark R Wicclair

Cambridge Quarterly of Healthcare Ethics

Journal’s Extract
Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association (AMA) introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might prompt requests for conscience-based exemptions (CBEs). In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety.

Wicclair MR. Conscience-based exemptions for medical students. Camb Q Healthc Ethics. 2010;19(1):38-50.

Russia: update on animal experiments and alternatives in education

Nick Jukes

Abstract
Progress continues in Russia with growing awareness and implementation of alternatives in education. Further outreach visits and negotiations for replacement have been made by InterNICHE campaigners. Russian language information resources have been complemented by the distribution of translated freeware physiology and pharmacology alternatives; and the InterNICHE Alternatives Loan Systems continue to provide valuable hands-on access to a range of learning tools. Donations of computers and alternatives have established exemplary multimedia laboratories, with software having directly replaced the annual use of several thousand animals. New agreements have been made with institutes to abandon animal experiments for teaching purposes. Work to consolidate the successes is being done, and Russian teachers have begun to present at conferences to share their experiences of implementation. Further development and implementation of alternatives is being achieved through grant funding from the InterNICHE Humane Education Award. Using a different approach, cases of determined conscientious objection have included a campaign against the use of stolen companion animals for surgery practice in the Russian Far East, and a continuing legal challenge to experiments at Moscow State University. This multi-pronged, decentralised and culturally appropriate campaigning strategy has proved to be an effective approach to achieving sustainable change in Russia..

Jukes N. Russia: update on animal experiments and alternatives in education. Alternatives to Animal Experimentation (ALTEX). 2008;25(1):56-62.

(Correspondence) Integrating Abortion Training Into FM Residency Programs

Gary W Clark, Kelly Latimer, Richard W Sams II, Gordon Zubrod

Extract
Abortion training for residents is not simply a “politically charged” issue, as the authors assert. It is a moral or ethical issue. As faculty physicians in family medicine residency programs, we oppose the introduction of abortion training on moral, not political grounds. German physicians “politicized” euthanasia and ultimately killed 200,000 mentally ill and disabled persons from 1939–1945.

Clark GW, Latimer K, Richard W Sams II, Zubrod G. (Correspondence) Integrating Abortion Training Into FM Residency Programs. Fam Med. 2008;40(1).

(Correspondence) More on Abortion Training Articles

Lucy M Candib

Extract
As we gear up to provide the basket of services important to our patients in the Future of< Family Medicine, residencies need the information in these articles to be able to best design and implement abortion training. Residents with a strong experience in reproductive health, including abortion, will be best suited to meet the needs of the women they will meet in their future practices.

Candib LM. (Correspondence) More on Abortion Training Articles. Fam Med. 2008 Jan;40(1):7.

Initiating Abortion Training in Residency Programs: Issues and Obstacles

Ian Bennett, Abigail Calkins Aguirre, Jean Burg, Madelon L Finkel, Elizabeth Wolff, Katherine Bowman, Joan Fleischman

Abstract
Objectives: Early abortion is a common outpatient procedure, but few family medicine residencies provide abortion training. We wished to assess experiences and obstacles among residency programs that have worked to establish early abortion services.
Methods: From 2001–2004, 14 faculty participated in a collaborative program to initiate abortion training at seven family medicine residencies. Ten focus groups with all trainees were followed by individual semi-structured interviews with a smaller group (n=9) that explored the progress and obstacles they experienced. Individual interviews were recorded and analyzed to identify major themes and sub-themes related to initiating abortion training.
Results: Five of seven sites established abortion training. Five major themes were identified: (1) establishing support, (2) administration, (3) finance, (4) legal matters,and (5) security/demonstrators. Faculty from sites where training was ultimately established rated the sub-themes of billing/reimbursement, obtaining staff support, and state/hospital regulations as most difficult. Gaining support from within the department and institution was most difficult for the two sites that could not establish training. None experienced difficulty with security/demonstrators.
Conclusions: Developing the clinical and administrative capacity to provide early abortion services in family medicine residency programs is feasible. Support from leadership within departments and from the wider institution is important for implementation.

Bennett I, Aguirre AC, Burg J, Finkel ML, Wolff E, Bowman K et al. Initiating Abortion Training in Residency Programs: Issues and Obstacles. Fam Med. 2006;38(5):330-335.

The scope and limits of conscientious objection

Bernard M Dickens, Rebecca J Cook

International Journal of Gynecology & Obstetrics

Abstract
Principles of religious freedom protect physicians, nurses and others who refuse participation in medical procedures to which they hold conscientious objections. However, they cannot decline participation in procedures to save life or continuing health. Physicians who refuse to perform procedures on religious grounds must refer their patients to non-objecting practitioners. When physicians refuse to accept applicants as patients for procedures to which they object, governmental healthcare administrators must ensure that non-objecting providers are reasonably accessible. Nurses’ conscientious objections to participate directly in procedures they find religiously offensive should be accommodated, but nurses cannot object to giving patients indirect aid. Medical and nursing students cannot object to be educated about procedures in which they would not participate, but may object to having to perform them under supervision. Hospitals cannot usually claim an institutional conscientious objection, nor discriminate against potential staff applicants who would not object to participation in particular procedures.

Dickens BM, Cook RJ. The scope and limits of conscientious objection. Int J Gyn Ob. 2000;71(1):71-77.

Training family practice residents in abortion and other reproductive health care: a national survey

JE Steinauer, T DePineres, AM Robert, J Westfall, P Darney

Abstract
The majority of residents responding to a 1995 survey of program directors and chief residents at 244 family medicine residency programs in the United States reported they had no clinical experience in cervical cap fitting, diaphragm fitting or IUD insertion and removal. For all family planning methods except oral contraceptives, no more than 24% of residents had experience with 10 or more patients. Although 29% of programs included first-trimester abortion training as either optional or routine, only 15% of chief residents had clinical experience providing first-trimester abortions. Five percent of residents stated they certainly or probably would provide abortions, while 65% of residents stated they certainly would not provide abortions. A majority (65%) of residents agreed that first-trimester abortion training should be optional within family practice residency programs. Residents were more likely to agree with inclusion of optional abortion training and with the appropriateness of providing abortions in family practice if their program offered the training.

Steinauer JE, DePineres T, Robert AM, Westfall J, Darney P. Training family practice residents in abortion and other reproductive health care: a national survey. Fam Plann Perspect. 1997;29(5):222-227.

(Editorial) A de-facto end to abortion in USA?

The Lancet

Extract
these Bills (one in the House of Representatives and a less wild version in the Senate) are unnecessary and deceptive. . . .The Bills would allow residents and programmes to abstain from abortions on any grounds, not just religious or moral. . . .So what is their objective? It is the de facto ending of abortion in the USA. By allowing more residents and more programmes to opt out of abortion training, safe termination of pregnancy in America will become even more difficult to obtain. Already, the number of competently trained graduates has fallen dramatically. Access to doctors and clinics has shrunk, and too many American women wanting an abortion already face a long and sometimes dangerous search for help. This is an attack on women’s choices and an interference in medical education. If it passes Congress, President Clinton should veto it immediately.

The Lancet. (Editorial) A de-facto end to abortion in USA? The Lancet. 1996;347(9008):1055.

(Editorial) Wilful exposure to unwanted pregnancy?

Carol A Cowell

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
The WEUP syndrome (otherwise known as “Wilful Exposure to Unwanted Pregnancy”) has been well documented in a number of psychiatric publications. . .

. . . Abortion is not an emergency procedure and the lowering of the legal age of consent has had virtually no effect on the availability of the operation to the adolescent patient. . . .

. . . .does the “open approach” and provision of effective contraception mean to young people that you personally endorse premarital sexual experimentation and does this influence their behaviour? My answer is an unequivocal “No”; they make their own choice with or without your approval, and whether or not they are “outfitted” beforehand with effective contraception.

. . To the question “What was your main reason for having an abortion?” the following answers were given: “too young” (55%), “wanted to finish school” (15%), “wanted a child but couldn’t keep it” (12%), “pressure advice from parents (7%), “don’t want the kid (child)” (7%), other (4%). From our follow-up data regarding the girls’ assessment of what for them was the best solution (i.e. term delivery or abortion), 93.3% said that abortion was the best solution, with some 4.3% saying that it was not and 2.4% providing no answer. . .

Cowell CA. (Editorial) Wilful exposure to unwanted pregnancy?. Can Med Assoc J. 1974 Nov 16;111(10):1045, 1047.

(Correspondence) Working of the Abortion Act

E Allan, Phyllis Taylor, Kirsten Walker, MS Fisher, John Nixon, GR Spencer

British Medical Journal, BMJ — British Medical Journal

Extract
It is reported that over 90,000 pregnancies in Britain are now terminated annually and this must place a considerable extra burden on the already overstretched resources of the N.H.S., resulting in even longer delays for those women needing other forms of gynaecological surgery. Some young hospital doctors and nurses who wish to gain experience in the field of obstetrics and gynaecology are discouraged from doing so by the pressures which would inevitably be put upon them to assist at, or perform, abortions.

Allan E, Taylor P, Walker K, Fisher M, Nixon J, Spencer G. (Correspondence) Working of the Abortion Act. Br Med J. 1971;305.