Journal Articles Archives - Page 50 of 64 - Protection of Conscience Project Library

Pharmacist Refusals: Dispensing (With) Religious Accommodation Under Title VII

Amy Berquist

Abstract
Conclusion
. . . The pharmaceutical industry will continue to create drugs to which some pharmacists object on religious grounds. Employers must anticipate that some pharmacists will object not only to birth control, but also to Ritalin, 226 Viagra for unmarried men, or drugs to treat AIDS; some pharmacists may even object on religious grounds to serving particular customers. The religious discrimination provisions of the Civil Rights Act allow most employers to dispense with the majority of possible religious accommodations for pharmacists who refuse to fill prescriptions on religious grounds. Those provisions are meaningless, however, if employers are reluctant to assert Title VII’s protections against accommodations imposing an undue hardship on the pharmacy’s business operations. As pharmacies negotiate the tensions between consumers demanding prompt access to prescription drugs, a tight labor market for pharmacists, pressure from certain religious groups to discourage the use of birth control, vocal national groups advocating expanded access to contraception, and their own economic bottom line, Title VII can serve either as an answer or as an excuse. Employers may use Title VII as a pretense to justify unnecessary accommodations for objecting pharmacists; pharmacies may attempt to use federal law to shield themselves from customer and activist criticism by asserting that they have no choice but to accommodate. On the other hand, pharmacies can utilize Title VII as a tool to define the outer limits of their pharmacist accommodation policies. A clear understanding of the parameters of Title VII’s religious accommodation requirements will help guide and monitor the behavior and legal justifications presented by employers, employees, and customers when pharmacists refuse to dispense certain drugs on religious grounds.

Berquist A. Pharmacist Refusals: Dispensing (With) Religious Accommodation Under Title VII. Minn Law Rev. 2006;90(4):1073-1106.

When an adult female seeks ritual genital alteration: Ethics, law, and the parameters of participation

Julie D Cantor

Abstract
Ritual genital cutting for women, a common practice in Africa and elsewhere around the world, remains dangerous and controversial. In recent years, a 14-year-old girl living in Sierra Leone exsanguinated and died following a ritualistic genital cutting. Hoping to avoid that fate, women with backgrounds that accept ritual genital cutting may, when they reach majority age, ask plastic surgeons to perform genital alterations for cultural reasons. Although plastic surgeons routinely perform cosmetic procedures, unique ethical and legal concerns arise when an adult female patient asks a surgeon to spare her the tribal elder’s knife and alter her genitalia according to tradition and custom. Misinformation and confusion about this issue exist. This article explores the ethical and legal issues relevant to this situation and explains how the thoughtful surgeon should proceed.

Cantor JD. When an adult female seeks ritual genital alteration: Ethics, law, and the parameters of participation. Plast Reconstr Surg. 2006 Apr 01;117(4):1158-1164.

Physician Participation in Executions: Care Giver or Executioner?

Peter A Clark

Abstract
The fear of many is that some physicians have been co-opted by the penal authorities and state legislatures in this country to believe that physician participation is a civic duty and one that is in the prisoner’s best interest. In reality, these physicians are being used as a means to an end. They are being used by certain states to medicalize executions in order to make them more palatable to the American public and to prevent capital punishment from being declared unconstitutional because it is “cruel and unusual punishment.” A basic tenet of the principle of respect for persons is that one may never use another person as a means to an end. Legislating that physicians must be present at executions uses these physicians as pawns, or means, in order to legitimize capital punishment. This not only violates the rights of these physicians but violates the basic ethical principles of the medical profession and distorts the physicians’ role in society.

Clark PA. Physician Participation in Executions: Care Giver or Executioner?. J Law Med Ethics. 2006 Spring;34(1)95-104.

Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept

Anita Catlin, Deborah Volat, Mary Ann Hadley, Ranginah Bassir, Christine Armigo, Elnora Valle, Wendy Gong, Kelly Anderson

Abstract
This article is an exploratory effort meant to solicit and provoke dialog. Conscientious objection is proposed as a potential response to the moral distress experienced by neonatal nurses. The most commonly reported cause of distress for all nurses is following orders to support patients at the end of their lives with advanced technology when palliative or comfort care would be more humane. Nurses report that they feel they are harming patients or causing suffering when they could be comforting instead. We examined the literature on moral distress, fi.itility, and the concept of conscientious objection from the perspective of the nurse’s potential response to performing advanced technologic interventions for the dying patient. We created a small pilot study to engage in clinical verification of the use of our concept of conscientious objection. Data from 66 neonatal intensive care and pediatric intensive care unit nurses who responded in a one-month period are reported here. Interest in conscientious objection to care that causes harm or suffering was very high. This article reports the analysis of conscientious objection use in neonatal care.

Catlin A, Volat D, Hadley MA, Bassir R, Armigo C, Valle E et al. Conscientious Objection: A Potential Neonatal Nursing Response to Care Orders That Cause Suffering at the End of Life? Study of a Concept. Neonatal Netw. 2008 Mar;27(2):101-108. Available from:

An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary

Brian P Knestout

Journal of Contemporary Health Law and Policy

Extract
Conclusion
. . . The only solution to this dilemma may be the solution that the APhA suggested, namely, to endorse a conscience clause, but simultaneously require pharmacists to refer a valid prescription to another service provider. Those members of the profession who bear the burden of this course of action are those who believe that a referral is equivalent to the act itself. However, such a view safeguards most of the ethical goals of pharmacists while simultaneously serving the public need for effective provision of legally prescribed drugs.

Knestout BP. An Essential Prescription: Why Pharmacist-Inclusive Conscience Clauses are Necessary. J Contemp Health Law Pol. 2006 Spring;22(2):349-382.

Conscientious objection in medicine

Julian Savulescu

British Medical Journal, BMJ — British Medical Journal

Extract
Shakespeare wrote that “Conscience is but a word cowards use, devised at first to keep the strong in awe” (Richard III V.iv.1.7). Conscience, indeed, can be an excuse for vice or invoked to avoid doing one’s duty. When the duty is a true duty, conscientious objection is wrong and immoral. When there is a grave duty, it should be illegal. A doctors’ conscience has little place in the delivery of modern medical care. What should be provided to patients is defined by the law and consideration of the just distribution of finite medical resources, which requires a reasonable conception of the patient’s good and the patient’s informed desires (box). If people are not prepared to offer legally permitted, efficient, and beneficial care to a patient because it conflicts with their values, they should not be doctors. Doctors should not offer partial medical services or partially discharge their obligations to care for their patients.

Savulescu J. Conscientious objection in medicine. BMJ. 2006 February 4; 332(7536): 294–297. doi: 10.1136/bmj.332.7536.294

Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection

Gamal I Serour, International Federation of Gynecology and Obstetrics (FIGO)

International Journal of Gynecology & Obstetrics

Abstract
The FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health held a combined meeting with the Committee of Women’s Sexual and Reproductive rights to discuss ethical aspects of issues that impact the discipline of Obstetrics, Gynecology, and Women’s Health. The following document represents the result of that carefully researched and considered discussion. This material is not intended to reflect an official position of FIGO, but to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.

Serour GI, FIGO. Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Ethical guidelines on conscientious objection. Int J Gyn Ob. 2006 Feb 03;92(3):333-334.

On Whose Conscience? Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care

Patricia L Selby

Extract
In 2004 the Michigan House passed a bill called the “Conscientious Objector Policy Act.”. . . The bill as passed reflected no balancing of or respect for patients’ rights to autonomy, or their other needs and interests.

This article traces brief histories of health care conscience clauses and the patient’s right to informed consent. It analyzes the bill in the context of patients’s rights, and proposes alternative approaches to restore balance to the patient-provider relationship, while maintaining providers’ right to conscience. The article’s final section evaluates a variety of potential legal challenges to protect patients if the bill is re-introduced unchanged.

Selby PL. Patient Rights Disappear Under Broad Protective Measures for Conscientious Objectors in Health Care. U Detroit Mercy Law Rev. 2006;83(4):507-541.

Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives?

Susan C Winkler, John A Gans

Journal of the American Pharmacists Association

Extract
Expanding collaborative practice navigates the issue well, providing a seamless way for women to access emergency contraception without compromising the pharmacist’s ability to opt out. Such legislative initiatives are far more effective in expanding access to emergency contraception than misguided regulations that require pharmacists or pharmacies to assure dispensing of contraceptives “without delay.” In addition to blatantly insulting the professionals who are required to check their beliefs at the door, duty-to-dispense laws can have the opposite effect by limiting access to contraceptives when pharmacy practices simply choose not to carry the products rather than face sanctions if workable solutions for accommodating the patient and the pharmacist are disrupted by misguided regulations. Conscience and collaborative practice can complement each other, but only if both are available.

Winkler SC, Gans JA. Conscientious Objection and Collaborative Practice: Conflicting or Complementary Initiatives? J Am Pharm Assoc. 2006 Jan;46(1):12-13.

Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada

Eike-Henner Kluge

Extract
There are other flaws with Bill C-407, but this is not the place to present them in detail. However, there is one serious flaw that is appropriately considered in this forum, and that is the fact that the Bill is a partial measure at best. It deals only with assisted suicide, not euthanasia. It would not help those who, although competent, could not perform the final act themselves because they are disabled. . . .As well, the Bill ignores those who have never been competent and never will be. Their rights would still be less than those of other persons: they would be condemned to suffer when a competent person would not. An appropriately crafted suicide and euthanasia Bill would change that situation.

Kluge E-H. Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada. Humanist Perspectives Online Supplement. 2005;38(4):1-5