Referral Archives - Page 4 of 8 - Protection of Conscience Project Library

An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
We provide comprehensive, practical guidance for physicians on when to offer, recommend, perform, and refer patients for induced abortion and feticide. We precisely define terminology and articulate an ethical framework based on respecting the autonomy of the pregnant woman, the fetus as a patient, and the individual conscience of the physician. We elucidate autonomy-based and beneficence-based obligations and distinguish professional conscience from individual conscience. The obstetrician’s role should be based primarily on professional conscience, which is shaped by autonomy-based and beneficence-based obligations of the obstetrician to the pregnant and fetal patients, with important but limited constraints originating in individual conscience.

Chervenak FA, McCullough LB. An ethically justified practical approach to offering, recommending, performing, and referring for induced abortion and feticide. Am J Obstet Gynecol. 2009 Dec;201(6):560.e1-560.e6.

Ethical Distinction Between Direct and Indirect Referral for Abortion

Frank A Chervenak, Laurence B McCullough

Extract
Conclusion
The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.

Chervenak FA, McCullough LB. Ethical Distinction Between Direct and Indirect Referral for Abortion. The Female Patient. 2009 Dec;34:46-48

Unethical Protection of Conscience: Defending the Powerful against the Weak

Bernard M Dickens

American Medical Association Journal of Ethics

Extract
In protecting and privileging health care professionals who withhold information that their patients depend upon, the provisions reduce health care professionals to the status of self-serving traders in an unequal market who may take advantage of those obliged or unwise enough to trust them and rely on their integrity. The provisions underscore the challenge that conscientious objection poses to health care professionalism [8]. To allow physicians to deny or frustrate a patient’s rights of conscience by enforcing their own through nonreferral, as the new regulations do, is unethical. It is ethically justifiable to be intolerant of religious or other fundamentalist intolerance.

Dickens BM. Unethical Protection of Conscience: Defending the Powerful against the Weak. Am Med Ass J Ethics. 2009;11(9):725-729.

From reproductive choice to reproductive justice

Rebecca J Cook, Bernard M Dickens

International Journal of Gynecology & Obstetrics

Abstract
Since the 1994 Cairo Conference on Population and Development, the human rights movement has embraced the concept of reproductive rights. These are often pursued, however, by means to which objection is taken. Some conservative political and religious forces continue to resist implementation of several means of protecting and advancing reproductive rights. Individuals’ rights to grant and to deny consent to medical procedures affecting their reproductive health and confidentiality have been progressively advanced. However, access to contraceptive services, while not necessarily opposed, is unjustifiably obstructed in some settings. Rights to lawful abortion have been considerably liberalized by legislative and judicial decisions, although resistance remains. Courts are increasingly requiring that lawful services be accommodated under transparent conditions of access and of legal protection. The conflict between rights of resort to lawful reproductive health services and to conscientious objection to participation is resolved by legal duties to refer patients to non-objecting providers.

Cook RJ, Dickens BM. From reproductive choice to reproductive justice. Int J Gyn Ob. 2009 Aug;106(2):106-109.

(Editorial) Conscience and the Unconscionable

Robert Baker

Extract
The challenge is thus to accommodate conscience- based treatment refusals without jeopardizing the foundations of pluralistic medical professionalism. I believe that medical professionals functioning in pluralistic healthcare settings may be excused from providing certain information or services if they apologize to those in need of this aid, and if those in need of aid can be assured equitable access to the information or services in question. Note carefully, I am proposing conditions for excusing professionals who fail to maintain moral neutrality; I am not defending a right to conscience-based denials of healthcare, or ‘civil rights’ protections for refusers. . .Refusals to refer to other professionals or to transfer prescriptions are inexcusable.

Baker R. (Editorial) Conscience and the Unconscionable. Bioethics. 2009;23(5):350-352.

Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical

Bernard M Dickens

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.

Dickens BM. Legal Protection and Limits of Conscientious Objection: When Conscientious Objection is Unethical. Med Law. 2009;28(2)337-347.

Conscientious Objection: Resisting Ethical Aggression in Medicine

Sean Murphy

Responding to Cantor, Julie D., Conscientious Objection Gone Awry – Restoring Selfless Professionalism in Medicine. N Eng J Med 360;15, 9 April, 2009

Extract
Judging from the title of her article, Professor Julie D. Cantor believes that “selfless professionalism” in medicine is being destroyed by health care workers who will not do what they believe to be wrong.

She also implies that Americans have access to health care only because health care workers are compelled to provide services that they find morally repugnant. At least, that is the inference to be drawn from her warning that health care “could grind to a halt” if a federal protection of conscience regulation were “[t]aken to its logical extreme.”

Such anxiety is inconsistent with the fact that religious believers and organizations have been providing health care in the United States for generations. If anything, this demonstrates that health care is provided to many Americans – and many of the poorest Americans – because of the commitment of health care workers to their moral convictions, not in spite of them.

Murphy S. Conscientious Objection: Resisting Ethical Aggression in Medicine [Internet]. Protection of Conscience Project (2009 Apr 17).

Healthcare responsibilities and conscientious objection

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

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.

Healthcare responsibilities and conscientious objection

Rebecca J Cook, Mónica Arango Olaya, Bernard M Dickens

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 Gyn Ob. 2009 Nov 29;104(3):249-252.

(News) Morals, medicine and geography

Roger Collier

Canadian Medical Association Journal, CMAJ — Canadian Medical Association Journal

(Article compares approach to freedom of conscience in health care in the US and Canada)
Extract
Advocates of compulsory referral claim that doctors who discriminate against certain practices are, whether they know it or not, also discriminating against certain people — namely, the poor, the uneducated and those in remote areas. These people already have limited access to medical services, a problem that, all sides agree, is exacerbated when their doctors refuse to present them with all their options.

Collier R. Morals, medicine and geography. Can Med Assoc J. 2008 Nov 04;179(10):996-997.