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0 - Page 2 of 3 - Protection of Conscience Project Library
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Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions?

Maryam T Afif

Pace Law Review
Pace Law Review

Extract
Conclusion

Offering legal protection to pharmacists comes at too great a cost to women’s health and legal rights. The pill is a viable and effective method of birth control for many women and, as Congress has noted, it can be used to prevent other social, economic, and medical problems. The Supreme Court has clearly established that a state cannot interfere with a woman’s right to access contraceptives, including the pill. While pharmacists should be free to practice their religion, that practice cannot interfere with their professional duty to dispense valid prescriptions free of moral judgment. Furthermore, the vague wording in most conscience clause statutes does not restrict objections to those of a religious nature. A pharmacist can use any personal moral objection as an excuse not to dispense a prescription. The result of a pharmacist’s objection can be quite severe for the patient (an unintended pregnancy or health problems), and the duties imposed under tort law should apply. A pharmacist should not be able to escape the legal consequences of his or her actions. States that allow pharmacists to do so are clearly protecting the rights of a small segment of their citizens at the expense of others. If these statutes are challenged in court, it is likely that the statutes will be found to be unconstitutional. While this is a serious consequence, it is appropriate given the rights at stake.


Afif MT. Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions? Pace Law Review. 2005;26(1):243-272.

(Corrrespondence) Psychological aftermath of abortion (Two of the authors respond)

Sukhbir S Singh, William A Fisher

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
L.L. deVeber and Ian Gentles imply that termination of pregnancy causes psychological problems. However, pre-existing differences between women who seek abortion and those who carry pregnancies to term are considerable and may account for differences in psychological status after abortion or delivery. A relevant comparison would assess psychological distress experienced by women seeking and obtaining an abortion and those seeking but denied pregnancy termination. . . The research cited by deVeber and Gentles, however, fails to meet this standard. . . . There is no causal evidence that abortion alone elevates the risk of psychiatric admission. Observational evidence of such an association may be readily interpreted as resulting from confounding pre-existing factors.


Singh SS, Fisher WA. (Corrrespondence) Psychological aftermath of abortion (Two of the authors respond). Can Med Assoc J. 2005 Aug 30;173(5):467.

The Silence of Good People and Non-cooperation with Evil: A Response to Prof. R. Alta Charo

Sean Murphy

Protection of Conscience Project
Protection of Conscience Project

Responding to: Charo RA. The Celestial Fire of Conscience – Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005

Extract
It is especially noteworthy that, in an essay about the exercise of freedom of conscience by health care workers, Professor R. Alta Charo has virtually nothing to say about freedom or conscience (The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005). “Conscience clauses,” yes: conscientious objection, to be sure: and she mentions acts of conscience and the right of conscience. But nothing about freedom, and, on the subject of conscience itself, the most she can muster is, “Conscience is a tricky business.”


Murphy S. The Silence of Good People and Non-cooperation with Evil: A Response to Prof. R. Alta Charo [Internet]. Protection of Conscience Project; 2005 Aug 19.

Conscientious Objection and the Pharmacist

Henri R Manasse Jr

Science
Science

Abstract
What has been lost in the media coverage of and political dialogue about this issue are the nuances and implications of conscientious objection. Like their physician and nurse colleagues, pharmacists routinely operate within both professional and personal ethical frameworks (3). On a personal level, pharmacists have the same rights as their fellow health-care colleagues. Like a surgeon who refuses to perform abortions because of a personal moral objection or a nurse who believes that turning off a patient’s respirator would contradict her beliefs on the sanctity of life, pharmacists must be allowed to be true to their own belief systems as they practice their profession. This does not mean that pharmacists should be allowed to impose their personal morals on patients under their care. As with physicians and nurses, it simply means that pharmacists must maintain the right to “step away” from the offending activity and should refer the patient in question to another pharmacist who can dispense the prescription.


Manasse Jr HR. Conscientious Objection and the Pharmacist. Science. 2005 Jul 10;308(5728):1558-1559.

Requests for Inappropriate Treatment: Can A Doctors “Just Say ‘No'”?

Ann Suziedelis

Health Care Ethics USA
Health Care Ethics USA

Abstract
This essay examines (1) the underlying philosophical considerations when patients or decision makers request “inappropriate treatment”; (2) questions to consider in determining if the treatment sought would be ineffective, or, in the words of Weijer et al., effective toward a controversial end; and (3) practical ways to resolve such conflicts.


Suziedelis A. Requests for Inappropriate Treatment: Can A Doctors “Just Say ‘No'”? Health Care Ethics USA. 2005;13(1):E2

The Celestial Fire of Conscience — Refusing to Deliver Medical Care

R Alta Charo

New England Journal of Medicine, NEJM
New England Journal of Medicine

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.


Charo RA. The Celestial Fire of Conscience — Refusing to Deliver Medical Care. N Engl J Med.. 2005 Jun 16;352(24).

Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions

Matthew White

Wisconsin Law Review
Wisconsin Law Review

Abstract
Conclusion

. . .The patchwork of current conscience protection for pharmacists indisputably fails its purpose-in almost all cases the current legislation is severely one-sided and out of date. Although such conscience protection admirably attempts to embody the purposes of the First Amendment, most of the actual and proposed legislation suffers from severe partisan myopia. Statutes purporting to offer absolute protection to patients, to employers, or to health care providers rather than striking a balance tend to prolong and enlarge conflict rather than resolve it. . .

Patients, pharmacists, and employers all have civil rights implicated in the delicate interactions that surround the use of oral contraception, and decisive action should be taken to enact statutes that protect the rights of each, rather than statutes that protect one group exclusively. Legislators should make a painstaking effort to craft new conscience legislation that protects the conscience rights of pharmacists without inserting the pharmacist between the patient and her doctor. Such legislation should also make some provision for employers that would be substantially burdened by an inability to conduct their business in the event of a bona fide conscience claim.


White M. Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions. Wisc Law Rev. 2005;6(1611-1648.

(Editorial) Pharmacists’ Rights of Conscience: Whose Autonomy Is It, Anyway?

Stephen Joel Coons

Clinical Therapeutics
Clinical Therapeutics

Extract
Patient autonomy is the foundation of the ethical principles that guide a health professional’s actions. It can be defined as “the right of individuals to make decisions about what will happen to their bodies; what choice will be made among competing options; and what they choose to take or not take into their bodies. ” By being a barrier to the patient’s receipt of a legally available prescription product, the pharmacist is not only denying the patient her autonomy but potentially causing her emotional and/or physical harm.


Coons SJ. (Editorial) Pharmacists’ Rights of Conscience: Whose Autonomy Is It, Anyway?. Clin Ther. 2005 Jun;27(6):924-925

Of Pills and Needles: Involuntary Medicating the Psychotic Inmate When Execution Looms

Julie Cantor

Indiana Health Law Review
Indiana Health Law Review

Extract
The coalescence of involuntarily administered antipsychotic medications and competency for execution created a novel and controversial issue that became the basis of Singleton’s final appeal. The Arkansas Supreme Court stated the question succinctly: May the State ”mandatorily medicate [Singleton] with antipsychotic drugs in order to keep him from being a danger to himself and others when a collateral effect of that medication is to render him competent to understand the nature and reason for his execution[?]” Or, as Singleton put it, “Am I too sane to live, or too insane to die?” The cynical view of that question is that Singleton was clever and manipulative. Like most people, he would do just about anything to forestall his death. The more charitable view is that Singleton found an Achilles heel in the execution process and physicians’ involvement with it, one that created what some physicians consider to be an intolerable dilemma.


Cantor J. Of Pills and Needles: Involuntary Medicating the Psychotic Inmate When Execution Looms. Indiana Health L Rev. 2005;2(1):119-172.

Unspeakably Cruel-Torture, Medical Ethics, and the Law

George J Annas

New England Journal of Medicine, NEJM
New England Journal of Medicine

Extract
The Nazi doctors defended themselves primarily by arguing that they were engaged in necessary wartime medical research and were following the orders of their superiors. These defenses were rejected because they are at odds with the Nuremberg Principles, articulated a year earlier, at the conclusion of the multinational war crimes trial in 1946, that there are crimes against humanity (such as torture), that individuals can be held to be criminally responsible for committing them, and that obeying orders is no defense.


Annas GJ. Unspeakably Cruel-Torture, Medical Ethics, and the Law. N. Engl. J. Med.. 2005;352(20):2127-2132.