Bernard M Dickens Archives - Page 3 of 4 - Protection of Conscience Project Library

Reproductive Health Services and the Law and Ethics of Conscientious Objection

Bernard M Dickens

Abstract
Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation,in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians’ conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses’ claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health- related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.

Dickens BM. Reproductive Health Services and the Law and Ethics of Conscientious Objection. Med Law. 2001;20(2)283-293.

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.

The Continuing Conflict between
Sanctity of Life and Quality of Life

From Abortion to Medically Assisted Death

Bernard M Dickens

Annals of the New York Academy of Sciences

The purpose of this paper is to address how analysts and commentators approach the relationship between abortion law and law governing medically assisted death, discussion of which is here limited to assisted suicide and voluntary active euthanasia. The issue of involuntary euthanasia or “mercy killing” of non-consenting persons is beyond the present discussion. This paper is further limited to English language literature, and to legal experience and commentary primarily from the United States of America, Britain and Canada, although reactions to developments in the Netherlands are included. Attention will be directed initially to legal and related analysts and commentators who oppose legalization both of abortion and of medically assisted death, and who resist application of the reasoning that supported decriminalization of abortion to medically assisted death. They represent the socalled Pro-Life protagonists in the debate. Language is often employed instrumentally in the conduct of the disagreement, but the practice adopted here is to refer to protagonists by the titles they give themselves.

Second, attention will be given to adherents to the so-called pro-choice position, who favor both liberalized abortion laws and tolerance of medical means by which individuals may end their own lives when they find survival excessively painful, burdensome, or undignified. Consideration is then given to those who oppose liberal abortion laws, perhaps because of fetal vulnerability, but who consider that non-vulnerable, competent persons, such as terminal patients in unrelievable distress, should be legally entitled to assistance in dying. The reverse is then addressed, concerning those who favor women’s choice on abortion, but oppose medically assisted death because, for instance, it may be exploitive of disabled patients or violative of ethical duties that health care professionals owe patients. In conclusion, it will be proposed that reconciliation of opposing views may be approached through promotion of choice, both to continue unplanned pregnancy and burdensome life, through availability of options that individuals may be encouraged and supported, but not coerced, to adopt.

Dickens BM. The Continuing Conflict between Sanctity of Life and Quality of Life: From Abortion to Medically Assisted Death. Annals NY Acad Sciences 2000 Sep;913:88-104

Some ethical and legal issues in assisted reproductive technology

Bernard M Dickens, Rebecca J Cook

Abstract
The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients’ treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities..

Dickens BM, Cook RJ. Some ethical and legal issues in assisted reproductive technology. Int J Gynecol Obstet. 1999;66(1) 55-61.

Human rights and abortion laws

Rebecca J Cook, Bernard M Dickens

Abstract
Human rights protections have developed to resist governmental intrusion in private life and choices. Abortion laws have evolved in legal practice to protect not fetuses as such but state interests, particularly in prenatal life. National and international tribunals are increasingly called upon to resolve conflicts between state enforcement of continuation of pregnancy against women’s wishes and women’s reproductive choices. Legal recognition that human life begins at conception does not resolve conflicts between respect due to women’s reproductive self-determination and due to prenatal life. Human rights protect healthcare providers’ claims to conscientious objection, but not at the cost of women’s lives and enduring health.

Cook RJ, Dickens BM. Human rights and abortion laws. Int J Gynecol Obstet. 1999 Apr 22;65(81-87.

International Developments in Abortion Law from 1988 to 1998

Rebecca J Cook, Bernard M Dickens, Laura E Bliss

Abstract
Objectives
In 2 successive decades since 1967, legal accommodation of abortion has grown in many countries. The objective of this study was to assess whether liberalizing trends have been maintained in the last decade and whether increased protection of women’s human rights has influenced legal reform.

Methods
A worldwide review was conducted of legislation and judicial rulings affecting abortion, and legal reforms were measured against governmental commitments made under international human rights treaties and at United Nations conferences.

Results
Since 1987, 26 jurisdictions have extended grounds for lawful abortion, and 4 countries have restricted grounds. Additional limits on access to legal abortion services include restrictions on funding of services, mandatory counseling and reflection delay requirements, third party authorizations, and blockades of abortion clinics.

Conclusions
Progressive liberalization has moved abortion laws from a focus on punishment toward concern with women’s health and welfare and with their human rights. However, widespread maternal mortality and morbidity show that reform must be accompanied by accessible abortion services and improved contraceptive care and information.

Cook RJ, Dickens BM, Bliss LE. International Developments in Abortion Law from 1988 to 1998. Am J Public Health. 1999;89(4):579-586.

Artificial Reproduction and Child Custody

Bernard M Dickens

This article considers general principles of child custody law in regard to children born following artificial reproduction that employed donated sperm, ova
or embryos, and the law applicable when women give birth to children conceived in order to be surrendered to others (notably their biological fathers). Claims to parental rights raise the issue of who the legal parents are, and may conflict with the apparent best interests of such children and the state’s view of its responsibility. The article considers interests of the unconceived child, the embryo and fetus in utero, the embryo extra uterum and a child born of donation, and the status of sperm, ovum and embryo donors and of “surrogate” mothers. Particular attention is given to the Ontario Law Reform Commission’s Report on Human Artificial Reproduction and Related Matters (1985), which is the first Canadian report to make wide-ranging recommendations on these issues .

Dickens B. Artificial Reproduction and Child Custody. Can Bar Rev 1987 Mar; 66(1): 49-75.

Prenatal diagnosis and female abortion: a case study in medical law and ethics

Bernard M Dickens

Abstract
Alarm over the prospect that prenatal diagnostic techniques, which permit identification of fetal sex and facilitate abortion of healthy but unwanted female fetuses has led some to urge their outright prohibition. This article argues against that response. Prenatal diagnosis permits timely action to preserve and enhance the life and health of fetuses otherwise endangered, and, by offering assurance of fetal normality, may often encourage continuation of pregnancies otherwise vulnerable to termination. Further, conditions in some societies may sometimes render excusable the inclination to abort certain healthy female fetuses. In places where abortion for fetal sex alone is recognised as unethical, however, medical licensing authorities already possess the power to discipline, for professional misconduct, physicians who prescribe or perform prenatal diagnosis purely to identify fetal sex, or those who disclose fetal sex when that is unrelated to the fetus’s medical condition.

Dickens BM. Prenatal diagnosis and female abortion: a case study in medical law and ethics. J Med Ethics 1986 Sep; 12(3): 143-144.

Abortion laws in African Commonwealth countries

Rebecca J Cook, Bernard M Dickens

Journal Extract
The problem of abortion is not primarily a problem of law. The law clearly addresses the social practice of abortion, it influences the means of practice and may, at its best, resolve the social consequences of abortion, but the problem of abortion is located in social experience and prevailing social philosophies, rather than in statute books and judicial decisions. Abortion lies at the heart of a number of concerns of particular sensitivity, but it can also have a severe medical and personal impact.

Cook RJ, Dickens BM. Abortion laws in African Commonwealth countries. J Afr Law. 1981 Autumn;25(2):60-79.

Abortion: 3. Therapeutic abortion committees and third parties

Bernard M Dickens

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

Extract
The recent incident in Nova Scotia concerning Mr. Hulme, who tried to prevent his estranged wife from having an abortion (see part 2 of this series), resulted in only secondary and indeterminate litigation. . . Mr. Hulme had taken legal action against the Victoria General Hospital in Halifax, whose therapeutic abortion committee had approved the abortion. . . . A therapeutic abortion committee’s alleged liability to judicial reversal suggests it is making a judicial or quasi-judicial decision; however, this is doubtful. . . . Indeed, the only third parties whose interests the committees may have to consider are guardians of the mentally incompetent and parents of minors. . . . hospitals that permit pressure from a third party to interfere with treatment of their competent, consenting adult patients for whom there is a danger to life or health may incur legal and ethical liabilities to such patients. . . Physicians may also face disciplinary charges of professional misconduct. . . .The best solution may be to remove the legal requirement of committee approval and to trust the judgement and good faith of physicians. . .

Dickens BM. Abortion: 3. Therapeutic abortion committees and third parties. Can Med Assoc J. 1981;124(4):362-363. 384.