Protection of Conscience Project Library
Service, not Servitude
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Asserting that we should encourage dialogue is one thing; showing that such dialogue is possible is another. My commentary has in no way argued against having beliefs that result from religious conscience; rather, I have argued only that religious conscience, regardless of the religion from which it develops, has no place in medical decision-making.
Adams MP. Conscience and Conflict (Conscience in Medicine). Am J Bioeth. 2007;7(12):28-29.
Abstract
Conclusion
“[H]uman law does not prohibit everything that is forbidden by the natural law. Perhaps this aphorism from Saint Thomas Aquinas says it best. In fact, the very reality of conscientious objection concedes as much given that, with the rare exception of a worker being asked to commit a crime, it always involves an objection to an otherwise legal act. Of course, it is likely no coincidence that those who support or oppose laws conferring a right to object to a particular act seem to also oppose or support, respectively, the act in general. Perhaps, as in the case of the abortion based laws, this is simply the result of political compromise. However, such reflexive logic can grow suspect when it extends in a more general manner, whether that be in providing a global right to refuse in the private workplace or, to the contrary, in barring any refusals at all. As noted from the start, this article provides no panacea. Rather, it simply suggests that the trend of open-ended conscience protection that is presently sweeping the nation in the health care arena insufficiently considers the interests of affected employers in at-will authority. The trend is inconsistent with treatments of conscience in law and culture generally, and ignores the fundamental prejudice and public policy bases that otherwise operate in the limited exceptions to the at-will rule that have been developed to this point. Finally, by removing the issue from the deliberative process between employers and their employees, the trend threatens to balkanize both sides in a manner that is good neither for them nor the communities they serve. Conscience is an important and vigorous principle in our common life. For it to remain so on the job, it must act like any other value in an otherwise free and fair system-submit itself to the marketplace of both work and ideas.
Sonne JA. Firing Thoreau: Conscience and At-Will Employment. Pennsylvania Journal of Labor & Employment Law. 2007 Winter;9(2):235-291.
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Conclusion
In conclusion, states may provide pharmacists and pharmacies with rights of conscience without infringing upon the constitutional rights of patients. Pharmacists’ beliefs should be respected and accommodated, especially when there are ways to do so without depriving patients of validly prescribed medications. Specific conscience clause legislation is the best method for protecting pharmacists’ consciences, and such legislation also provides the most clarity and certainty when well- drafted. Conscience clause legislation should address who is covered, whether a religious objection is required, the medications involved, the scope of the protection, any requirements for compliance, and whether a private cause of action is created. Such legislation provides adequate protection to pharmacists and clarifies the rights of both pharmacists and patients. If such legislation operates in tandem with policies such as pharmacist prescribing, doctor dispensing, and doctor referrals to pharmacies known to handle the prescription, which have shown promise in some states, then patients should have adequate access to medications without forcing pharmacists to compromise their beliefs.
Yoder JD. Pharmacists’ Right of Conscience: Strategies for Showing Respect for Pharmacists’ Beliefs While Maintaining Adequate Care for Patients. Valparaiso U Law Rev. 2007 Winter;41(2):975-1025.
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This discussion leaves us with a very practical question: what do I do if my informed conscience says not to participate in, say, an abortion or some other intervention, while the patient, law, and hospital policy allow it? The only answer I have is the answer common to other human encounters — speak truthfully, quickly and transparently. But do not abandon conscience, which, though certainly fallible, is far better than the alternative of having a person with immense power such as a physician acting without it. Conscience is the imperfect means by which we tether medicine and morality.
Barfield R. Conscience is the means by which we engage the moral dimension of medicine. American Journal Of Bioethics. 2007 Dec;7(12):26-7; discussion W1-2.
Abstract
This article compares the ethical pivot points in debates over nonprescription access to emergency contraceptive pills in Canada and the United States. These include women’s right to be informed about the contraceptive method and its mechanism of action, pharmacists’ conscientious objection concerning the dispensing of emergency contraceptive pills, and rights and equality of access to the method, especially for poor women and minorities. In both countries, arguments in support of expanding access to the pills were shaped by two competing orientations toward health and sexuality. The first, “harm reduction,” promotes emergency contraception as attenuating the public health risks entailed in sex. The second orientation regards access to pills as a question of women’s right to engage in nonprocreative sex and to choose from among all reproductive health-care options. The authors contend that arguments for expanding access to emergency contraceptive pills that frame issues in terms of health and science are insufficient bases for drug regulation; ultimately, women’s health is also a matter of women’s rights.
Wynn LL, Erdman JN, Foster AM, Trussell J. Harm reduction or women’s rights? Debating access to emergency contraceptive pills in Canada and the United States. Stud Fam Plann. 2007 Dec 07;38(4):253-257.
Abstract
Health care providers occasionally may find that providing indicated, even standard, care would present for them a personal moral problem-a conflict of conscience particularly in the field of reproductive medicine. Although respect for conscience is important, conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient’s health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequalities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled. All health care providers must provide accurate and unbiased information so that patients can make informed decisions. Where conscience implores physicians to deviate from standard practices, they must provide potential patients with accurate and prior notice of their personal moral commitments. Physicians and other health care providers have the duty to refer patients in a timely manner to other providers if they do not feel that they can in conscience provide the standard reproductive services that patients request. In resource-poor areas, access to safe and legal reproductive services should be maintained. Providers with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place. In an emergency in which referral is not possible or might negatively have an impact on a patient’s physical or mental health, providers have an obligation to provide medically indicated and requested care.
ACOG. The Limits of Conscientious Refusal in Reproductive Medicine. ACOG Committee on Ethics. 2007;385):1-6.
Abstract
National and international courts and tribunals are increasingly ruling that although states may aim to deter unlawful abortion by criminal penalties, they bear a parallel duty to inform physicians and patients of when abortion is lawful. The fear is that women are unjustly denied safe medical procedures to which they are legally entitled, because without such information physicians are deterred from involvement. With particular attention to the European Court of Human Rights, the UN Human Rights Committee, the Constitutional Court of Colombia, the Northern Ireland Court of Appeal, and the US Supreme Court, decisions are explained that show the responsibility of states to make rights to legal abortion transparent. Litigants are persuading judges to apply rights to reproductive health and human rights to require states’ explanations of when abortion is lawful, and governments are increasingly inspired to publicize regulations or guidelines on when abortion will attract neither police nor prosecutors’ scrutiny.
Cook RJ, Erdman J, Dickens BM. Achieving Transparency In Implementing Abortion Laws. Int J Gyn Ob. 2007 Nov;99(2):157-161.
Abstract
OBJECTIVES: The aim of this paper is to thoroughly examine the involvement and experiences of nurses in the care of mentally competent, adult patients requesting euthanasia (i.e. administration of lethal drugs by someone other than the person concerned with the explicit intention of ending a patient’s life, at the latter’s explicit request) by means of a literature review. . .
CONCLUSIONS: Nurses can make a significant contribution to the quality of care by assisting and counseling patients and their families, physicians, and their nursing colleagues in a professional manner, even in countries where euthanasia is not legal. However, research on nurses’ involvement in euthanasia has methodological and terminological problems,leading to our recommendation for more carefully designed qualitative studies that explore in-depth the experiences of nurses in caring for patients requesting euthanasia.
Bal ND, Gastmans C, de Casterlé BD. Nurses’ involvement in the care of patients requesting euthanasia: a review of the literature. Int J Nurs Studies. 2008;45(4):626-644.
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I thank the thoughtful commentators on my essay. Their contributions have deepened my grasp of the relevant issues. Unfortunately I cannot discuss each selection in turn, but will instead focus on several commentaries that purport to offer the most serious objections to my argument. . . I was inspired to write this article in order to examine some possible moral justifications for conscientious objection with respect to EC, given that objecting providers seemed to be under no obligation to even state their reasons for refusal. To the extent that this paper spurs further elaboration and evaluation of these reasons, I will consider it a success. (Responds to Farr Curlin, Carson Strong).
Card RF. Response to Commentators on “Conscientious Objection and Emergency Contraception”: Sex, Drugs and the Rocky Role of Levonorgestrel. Am J Bioeth. 2007;7(10):W4-W6.
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Doctors and other healthcare staff who take any part in executions by lethal injection should be punished by their professional bodies, says the human rights organisation, Amnesty International.
White C. Doctors who give lethal injections should be punished, says Amnesty. Br Med J. 2007 Oct 6;335(7622):690.