Protection of Conscience Project Library
Service, not Servitude
Extract
I referred to a 2010 study in which Asians were defined, for the purposes of that study, as “people from India, China, Korea, Vietnam and Philippines.”3 I did not intend to suggest that . . . evidence of sex selection, disparity of infant sex. . . applied to all those groups; indeed, the results were varied. I apologize for the ambiguity.
Kale R. (Correspondence) Female feticide (Dr. Kale responds). Can Med Assoc J. 2012 Jun 12;184(9):1065.
Extract
Forces worldwide are leading to greater intermingling of cultures with different perspectives on status of women, and it is unlikely that sex-selective abortions can be reduced without conscious efforts to raise awareness of gender equality at all levels of society.
Auger N, Kang HS. (Correspondence) Female feticide. Can Med Assoc J. 2012;184(9):1064.
Abstract
Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor’s death, this approach satisfies the dead donor rule. The donor family’s wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.
Morrisey PE. The Case for Kidney Donation Before End-of-Life Care. American J Bioethics Vol. 12, Iss. 6, 2012
Abstract
Background
The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use.
Methods
We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older).
Results
Among the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age.
Conclusions
The effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.)
Brooke Winner, M.D., et al, Effectiveness of Long-Acting Reversible Contraception. N Engl J Med 2012; 366:1998-2007
Abstract
Recent survey data gathered from British medical students reveal widespread acceptance of conscientious objection in medicine, despite the existence of strict policies in the UK that discourage conscientious refusals by students to aspects of their medical training. This disconnect demonstrates a pressing need to thoughtfully examine policies that allow conscience objections by medical students; as it so happens, the USA is one country that has examples of such policies. After presenting some background on promulgated US conscience protections and reflecting on their significance for conscience objections by medical students, this paper observes that the dominant approach (following the American Medical Association’s conscience clause) is to allow exempted students to instead be evaluated on the basis of alternative curricular activities to learn the associated underlying content. This paper then introduces and discusses an example in which male Muslim students who believe it is wrong to touch members of the opposite sex object to performing physical examinations on female subjects in their medical training. This sort of case, it is argued, causes difficulty for a conscience clause that resolves the dilemma by granting reasonable exemptions in the form of participation in alternative curricular activities: there are cases where one must perform the ‘objectionable’ activity itself in order to learn the necessary content and underlying principles.
Card RF. Is there no alternative? Conscientious objection by medical students. Med Ethics doi:10.1136/medethics-2011-100190
Abstract
A physician’s long-established right to refuse to provide a requested service based on his or her moral beliefs is being challenged. Some authors suggest that physicians should not be licensed if they are unwilling to provide all legal services. Others would grant them the right to refuse, but require them to refer to a willing professional. What are the limits of a physician’s right to refuse? When such a right is claimed on moral grounds, what residual obligations does the physician have to the patient? How should the profession (or society) decide when a moral claim to a right to refuse is justified?
Orr RD. The physician’s right of refusal: What are the limits? Christ Bioet. 2012;18(1):30-40.
Abstract
Bernard Dickens seeks to undermine the legal and ethical protections accorded to health care workers and hospitals conscientiously objecting to abortion. First, he appeals to the rationale of antidiscrimination laws as a basis for arguing against conscientious objection. Second, he argues that conscientious objection undermines the rights of patients and their autonomy. Third, he holds that conscientiously objecting doctors have a duty to refer patients for abortion. Fourth, he believes that Kant’s principle of respect for humanity as an end in itself is violated by conscientious objection to abortion. Fifth, Dickens quotes remarks by Pope John Paul II as support for the idea that physicians should not conscientiously object to abortion. Finally, he posits that institutions, such as Catholic hospitals, have a responsibility to provide abortions. I argue that all of the arguments offered by Dickens against conscientious objection are unsound.
Kaczor C. Conscientious objection and health care: A reply to Bernard Dickens. Christ Bioet. 2012 Apr 02;18(1):59-71.
Abstract
Two hundred years ago, Thomas Jefferson asserted that no law “ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority.” Since then, freedom of conscience has continued to be heralded as a fundamental principle of American society. Indeed, many current policy debates–most notably in the medical and military contexts–are predicated on the theory that claims of conscience are worthy of legal respect. This Article, which offers a comprehensive account of the contemporary treatment of conscience, challenges established assumptions and seeks to reframe the debate about the normative value of conscience in American society. This Article first clarifies contemporary understandings of conscience by systematically analyzing its treatment in positive law. It looks beyond the traditional medical, military, and religious contexts, giving a descriptive account of law’s treatment of conscience across various substantive realms, including tax evasion, civil disobedience, discrimination, and even violent terrorism. It demonstrates that legal accommodations are typically granted on an ad hoc basis, without a guiding doctrinal principle. If there is a consistent and coherent justification for treating cases differently, our legal system has thus far failed to provide it. This Article concludes that, in order for American law to reflect the kind of robust, autonomy-based respect for conscience to which every pluralistic society aspires, we must agree on a content-neutral guiding principle for negotiating future claims for legal accommodation. The alternative, the Article posits, is to concede that American society has abandoned the fundamental purpose of conscientious accommodation–namely, protecting the individual from oppressive majoritarian understandings of morality.
Sawicki NN. The Hollow Promise of Freedom of Conscience. 33 Cardozo L. Rev. 1389, 1413-16 (2012)
Extract
Jürgen Habermas’s recent observations regarding the increasing gulf between traditional religions and contemporary secularism is correct (2002, 2008). The dominant bioethical and political ideologies of the contemporary Western world have come to be not merely secular but often passionately atheistic. Throughout Western Europe and North America, for example, there is a growing movement to undermine the salience of religious discourse, to undue its influence in the public forum, and to erase religion from the public space. Attempts to frame all of medicine within a completely secular morality, relegating religious belief and practice to the realm of private personal choice, have become ever more prominent. Here, one need only consider the current clash between the US Roman Catholic bishops and President Obama’s administration over whether Catholic employers, such as Catholic hospital systems, ought to be legally required to provide insurance coverage for artificial contraception, including abortifacients, in their employer sponsored health care plan.1 In law and public policy, there has been a profound rupture from Traditional Christianity, which secular proponents aggressively seek to place in the distant past, as if Christianity had been an unfortunate, perhaps immoral, accident of history. Habermas’s acknowledgment of the vast divide between traditional religions that approach the world and moral analysis with knowledge of a God Who commands, and secular worldviews that begin all epistemic and normative analysis with the prior assumption that God does not exist, elucidates the fundamental debates of contemporary bioethics.
Cherry MJ. Conscience clauses, the refusal to treat, and civil disobedience-practicing medicine as a Christian in a hostile secular moral space. Christ Bioet. 2012 Apr 01;18(1):1-14.
Abstract
Health care begins as an act of conscience, which urges a response to the sick and holds caregivers accountable to moral standards that public authorities ultimately do not define. Conscience nonetheless expresses itself as a type of dialogue within oneself that is influenced by dialogue with others, especially with society in the form of civil law and professional standards. A well-formed conscience for health care relates the foundations of morality to health care practices and contributes sound moral judgment about them to the common good. Some current health care policies and medical education presume a distorted view of conscience as personal sentiment. These policies circumvent serious discussion and possible resolution of society’s most vexing bioethics controversies.
Brown GT. Discovery and revelation: The consciences of Christians, public policy, and bioethics debate. Christ Bioet. 2012;18(1):41-58.