“It’s a girl!” could be a death sentence.

Rajenda Kale

Canadian Medical Association Journal

When Asians migrated to Western countries they brought welcome recipes for curries and dim sum. Sadly, a few of them also imported their preference for having sons and aborting daughters. Female feticide happens in India and China by the millions, but it also happens in North America in numbers large enough to distort the male to female ratio in some ethnic groups.14 Should female feticide in Canada be ignored because it is a small problem localized to minority ethnic groups? No. Small numbers cannot be ignored when the issue is about discrimination against women in its most extreme form. This evil devalues women. How can it be curbed? The solution is to postpone the disclosure of medically irrelevant information to women until after about 30 weeks of pregnancy. . .

Kale R. “It’s a girl!” could be a death sentence. CMAJ January 16, 2012, doi: 10.1503/cmaj.120021

Sex selection migrates to Canada

Lauren Vogel

Canadian Medical Association Journal

Easy access to abortion and advances in prenatal sex determination have combined to make Canada a haven for parents who would terminate female fetuses in favour of having sons, despite overwhelming censure of the practice, economists and bioethics experts say.

Arguing that Canadian lawmakers’ silence on the issue is undermining the status of women, they’re calling for federal legislation to uphold societal and professional values opposing sex-selective abortion, either through a direct ban or restrictions on the disclosure of fetal gender. They also contend that sex-selective abortion is forcing physicians to compromise between their ethical obligations to discourage sex selection and legal obligations to respect their patients’ autonomy. . .

Vogel L. Sex Selection Migrates to Canada CMAJ January 16, 2012 cmaj.109-4091

Alternative Burdens on Freedom of Conscience

Adam J. Kolber

San Diego Law Review

Abstract: Suppose a pharmacist refuses to dispense pills that induce abortion claiming that dispensing such pills runs counter to principles he holds dear. Indeed, the pharmacist claims that forcing him to dispense the pills would violate his freedom of conscience. He even claims that he would not have become a pharmacist had he foreseen an obligation to dispense such pills at the time he entered his profession. Should the pharmacist’s job be protected if he is making a bona fide claim of conscience? And does it matter whether the pharmacist’s objection to dispensing the pills is rooted in religious or nonreligious reasons?

Kolber AJ. Alternative Burdens on Freedom of Conscience, 47 San Diego L. Rev. 919 (2010).

Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications

Laura A.Davidson, Clare T.Pettis, Amber J.Joiner, Daniel M.Cook, Craig M.Klugmand

Social Science & Medicine

Abstract: Some US states allow pharmacists to refuse to dispense medications to which they have moral objections, and federal rules for all health care providers are in development. This study examines whether demographics such as age, religion, gender influence 668 Nevada pharmacists’ willingness to dispense or transfer five potentially controversial medications to patients 18 years and older: emergency contraception, medical abortifacients, erectile dysfunction medications, oral contraceptives, and infertility medications. Almost 6% of pharmacists indicated that they would refuse to dispense and refuse to transfer at least one of these medications.  Religious affiliation significantly predicted pharmacists’ willingness to dispense emergency contraception and medical abortifacients, while age significantly predicted pharmacists’ willingness to distribute infertility medications.  Evangelical Protestants, Catholics and other-religious pharmacists were significantly more likely to refuse to dispense at least one medication in comparison to non-religious pharmacists in multinomial logistic regression analyses.  Awareness of the influence of religion in the provision of pharmacy services should inform health care policies that appropriately balance the rights of patients, physicians, and pharmacists alike.  The results from Nevada pharmacists may suggest similar tendencies among other health care workers, who may be given latitude to consider morality and value systems when making clinical decisions about care.

Davidson LA, Pettis CT, Joiner AJ, Cook DM, Klugman CM. Religion and conscientious objection: a survey of pharmacists’ willingness to dispense medications. Soc Sci Med. 2010 Jul;71(1):161-5. Epub 2010 Apr 13. PubMed PMID: 20447746

Freedom of conscience. Biojuridical conflicts at multicultural societies

Marta Albert Márquez

Cuadernos de Boetica

Abstract: The paper [in Spanish] analyzes the right of healthcare professionals to conscientious objection in multicultural societies. The ethical relativism characteristic of these societies abides with an apparently paradoxical reduction of the exercise of freedom of conscience. “Apparently” because, in the end, ethical relativism tends to adopt dogmatic attitudes. Special attention is paid to the situation of Spanish healthcare in relation to euthanasia and abortion. With regard to euthanasia, the “death with dignity” draft bill of Andalucía is considered. With regard to abortion, we will pay attention to the reform of the Penal Code in the context of a new regulation about “reproductive health” of women, which means the adoption of a system of time limits, and the characterization of abortion as a women’s right. It is concluded that freedom of conscience of healthcare professionals will probably be at risk if proposed legal policies don’t change.

Albert Márquez M. [Freedom of conscience. Biojuridical conflicts at multicultural societies]. Cuadernos de Bioetica : Revista Oficial de la Asociacion Espanola de Bioetica y Etica Medica. 2010 Jan-Apr;21(71):61-77. Spanish

Conscientious objection in developing countries

Debora Dinez

Developing World Bioethics

The administration of former President George W. Bush and the subsequent revival of the abortion disputes in the United States have put the ethical challenges of conscientious objection in the spotlight in many international journals on bioethics in the last decade. Bioethical analyses cover a wide range of perspectives: from bedside ethics between women and physicians, to constitutional analyses of how to protect fundamental needs in the context of pluralist societies.  In the last few years some clear administrative guidelines have been drawn up, considering the institutional realities of developed countries, most of them with private healthcare systems. These include rules that the objection or refusal is an individual right and not an institutional right and healthcare providers have a duty to refer a woman to a similar health care service provider.

I would suggest that this is not the reality for many developing countries . . .

Diniz D. Conscientious objection in developing countries. Dev World Bioeth. 2010 Apr;10(1):ii. PubMed PMID: 20433463.

Healthcare responsibilities and conscientious objection

Rebecca J. Cook, Monica Arango Olaya, Bernard M. Dickens

International Journal of Gynecology & Obstetrics

Abstract: The Constitutional Court of Colombia has issued a decision of international significance clarifying legal duties of providers,hospitals, and healthcare systems when conscientious objection is made to conducting lawful abortion. The decision establishes objecting providers’duties to refer patients to non-objecting providers, and that hospitals,clinics, and other institutions have no rights of conscientious objection. Their professional and legal duties are to ensure that patients receive timely services. Hospitals and other administrators cannot object, because they do not participate in the procedures they are obliged to arrange. Objecting providers, and hospitals, must maintain knowledge of non-objecting providers to whom their patients must be referred. Accordingly, medical schools must adequately train, and licensing authorities approve, non-objecting providers. Where they are unavailable, midwives and perhaps nurse practitioners may be trained, equipped, and approved for appropriate service delivery. The Court’s decision has widespread implications for how healthcare systems must accommodate conscientious objection and patients’ legal rights.

Cook RJ, Olaya MA, Dickens BM. Healthcare responsibilities and conscientious objection. Int J Gynaecol Obstet. 2009 Mar;104(3):249-52. Epub 2008 Nov 29.

Legal protection and limits of conscientious objection: when conscientious objection is unethical

Bernard M. Dickens

Medicine and Law

Abstract: The right to conscientious objection is founded on human rights to act according to individuals’ religious and other conscience. Domestic and international human rights laws recognize such entitlements. Healthcare providers cannot be discriminated against, for instance in employment, on the basis of their beliefs. They are required, however, to be equally respectful of rights to conscience of patients and potential patients. They cannot invoke their human rights to violate the human rights of others. There are legal limits to conscientious objection. Laws in some jurisdictions unethically abuse religious conscience by granting excessive rights to refuse care. In general, healthcare providers owe duties of care to patients that may conflict with their refusal of care on grounds of conscience. The reconciliation of patients’ rights to care and providers’ rights of conscientious objection is in the duty of objectors in good faith to refer their patients to reasonably accessible providers who are known not to object. Conscientious objection is unethical when healthcare practitioners treat patients only as means to their own spiritual ends. Practitioners who would place their own spiritual or other interests above their patients’ healthcare interests have a conflict of interest, which is unethical if not appropriately declared. [Full Text]

Dickens BM. Legal protection and limits of conscientious objection: when conscientious objection is unethical. Med Law. 2009 Mar;28(2):337-47. PubMed PMID: 19705646.

Conscientious commitment

Bernard M. Dickens

The Lancet

In some regions of the world, hospital policy, negotiated with the health ministry and police, requires that a doctor who finds evidence of an unskilled abortion or abortion attempt should immediately inform police authorities and preserve the evidence. Elsewhere, religious leaders forbid male doctors from examining any part of a female patient’s body other than that being directly complained about. Can a doctor invoke a conscientious commitment to medically appropriate and timely diagnosis or care and refuse to comply with such directives?

Dickens BM. Conscientious commitment. Lancet [Internet]. 2008 Apr 12; 371(9620): 1240 – 1241

Achieving transparency in implementing abortion laws

Rebecca J. Cook, Joanna N. Erdman, Bernard M. Dickens

International Journal of Gynecology & Obstetrics

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 JN, Dickens BM. Achieving transparency in implementing abortion laws. Int J Gynaecol Obstet. (2007) 99, 157-161