Journal Articles Archives - Page 51 of 64 - Protection of Conscience Project Library

Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses

Kelsey C Brodsho

Extract
The medical community agrees that while health professionals may be given statutory rights to refuse health services for moral reasons, refusal cannot prevent patients from receiving “the information, services, and dignity to which they are entitled.” In theory, laws and institutional policies that allow pharmacists to transfer prescriptions to another pharmacist do not interfere with established treatment plans. However, in practice these laws may delay health care services and harm patients. . . . In many foreseeable situations, a pharmacist’s moral objection may delay or prevent the receipt of prescription mediation. Pharmacists who refuse to provide services or transfer prescriptions to colleagues act contrary to professional objectives. Unnecessary delays or obstructions by pharmacists jeopardize treatment plans established by physicians and patients. . . . Conscience clause legislation that does not assure patient access to contraceptive services likely conflicts with reproductive liberty interests. . . states may require pharmacists to fill all prescriptions. Alternately, states may pass conscience clause legislation that assures patient access to health care services by prescription transfer or other similar procedure. . . . Conscience clause debate should not be clothed in abortion politics. Rather, its focus should be on whether a pharmacist has a right to interfere with a treatment plan established by a patient and his or her primary health care provider.

Brodsho KC. Patient expectations and access to prescription medication are threatened by pharmacist conscience clauses. Minnesota Journal of Law, Science & Technology. 2005;7(1):327-336.

A new rejection of moral expertise

Christopher Cowley

Abstract
There seem to be two clearly-defined camps in the debate over the problem of moral expertise. On the one hand are the “Professionals”, who reject the possibility entirely, usually because of the intractable diversity of ethical beliefs. On the other hand are the “Ethicists”, who criticise the Professionals for merely stipulating science as the most appropriate paradigm for discussions of expertise. While the subject matter and methodology of good ethical thinking is certainly different from that of good clinical thinking, they argue, this is no reason for rejecting the possibility of a distinctive kind of expertise in ethics, usually based on the idea of good justification. I want to argue that both are incorrect, partly because of the reasons given by one group against the other, but more importantly because both neglect what is most distinctive about ethics: that it is personal in a very specific way, without collapsing into relativism.

Cowley C. A new rejection of moral expertise. Med Health Care & Phil. 2005 Nov;8(3):273-279.

Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women

Holly Teliska

Extract
If pharmacists object to particular prescriptions, they should only be allowed to refuse to fill the prescription if meaningful and logistically feasible alternatives are in place. As an alternative, either another pharmacist must be on duty with the refusing pharmacist, or alternative ways of providing service must be in place. A woman should not have to travel to other pharmacies in search of a pharmacist that serves all patients, nor should she have to wait an unreasonable amount of time to have her prescription filled.

Teliska H. Obstacles to Access: How Pharmacist Refusal Clauses Undermine the Basic Health Care Needs of Rural and Low-Income Women. Berkely J Gender, Law Justice. 2005;20(1):229-248.

Promising, professional obligations, and the refusal to provide service

John K Alexander

Extract
Someone might want to argue that this strict adherence to promise keeping justifies a person being forced, coerced, compelled, into performing actions that are unjust or morally impermissible if they are members of an organization/profession that begins to engage in performing unjust, or morally unjustifiable actions. . . .By utilizing our moral beliefs at the appropriate time when first we make our promise to provide competent professional service to our clients, we can avoid placing ourselves in situations that compromise our deeply held moral beliefs later on. If later on we are confronted by a change in the professional setting that did not exist in the original decision making situation, then we are rationally compelled to reassess our professional position relative to the requirements of our moral beliefs and perform the appropriate action, either comply, persuade others that they are wrong or leave the professional setting.

Alexander JK. Promising, professional obligations, and the refusal to provide service. HEC Forum. 2005;17(3):178-195.

Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions?

Maryam T Afif

Extract
Conclusion
Offering legal protection to pharmacists comes at too great a cost to women’s health and legal rights. The pill is a viable and effective method of birth control for many women and, as Congress has noted, it can be used to prevent other social, economic, and medical problems. The Supreme Court has clearly established that a state cannot interfere with a woman’s right to access contraceptives, including the pill. While pharmacists should be free to practice their religion, that practice cannot interfere with their professional duty to dispense valid prescriptions free of moral judgment. Furthermore, the vague wording in most conscience clause statutes does not restrict objections to those of a religious nature. A pharmacist can use any personal moral objection as an excuse not to dispense a prescription. The result of a pharmacist’s objection can be quite severe for the patient (an unintended pregnancy or health problems), and the duties imposed under tort law should apply. A pharmacist should not be able to escape the legal consequences of his or her actions. States that allow pharmacists to do so are clearly protecting the rights of a small segment of their citizens at the expense of others. If these statutes are challenged in court, it is likely that the statutes will be found to be unconstitutional. While this is a serious consequence, it is appropriate given the rights at stake.

Afif MT. Prescription Ethics: Can States Protect Pharmacists Who Refuse to Dispense Contraceptive Prescriptions? Pace Law Review. 2005;26(1):243-272.

Conscientious Objection and the Pharmacist

Henri R Manasse Jr

Abstract
What has been lost in the media coverage of and political dialogue about this issue are the nuances and implications of conscientious objection. Like their physician and nurse colleagues, pharmacists routinely operate within both professional and personal ethical frameworks (3). On a personal level, pharmacists have the same rights as their fellow health-care colleagues. Like a surgeon who refuses to perform abortions because of a personal moral objection or a nurse who believes that turning off a patient’s respirator would contradict her beliefs on the sanctity of life, pharmacists must be allowed to be true to their own belief systems as they practice their profession. This does not mean that pharmacists should be allowed to impose their personal morals on patients under their care. As with physicians and nurses, it simply means that pharmacists must maintain the right to “step away” from the offending activity and should refer the patient in question to another pharmacist who can dispense the prescription.

Manasse Jr HR. Conscientious Objection and the Pharmacist. Science. 2005 Jul 10;308(5728):1558-1559.

Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions

Matthew White

Abstract
Conclusion
. . .The patchwork of current conscience protection for pharmacists indisputably fails its purpose-in almost all cases the current legislation is severely one-sided and out of date. Although such conscience protection admirably attempts to embody the purposes of the First Amendment, most of the actual and proposed legislation suffers from severe partisan myopia. Statutes purporting to offer absolute protection to patients, to employers, or to health care providers rather than striking a balance tend to prolong and enlarge conflict rather than resolve it. . .

Patients, pharmacists, and employers all have civil rights implicated in the delicate interactions that surround the use of oral contraception, and decisive action should be taken to enact statutes that protect the rights of each, rather than statutes that protect one group exclusively. Legislators should make a painstaking effort to craft new conscience legislation that protects the conscience rights of pharmacists without inserting the pharmacist between the patient and her doctor. Such legislation should also make some provision for employers that would be substantially burdened by an inability to conduct their business in the event of a bona fide conscience claim.

White M. Conscience Clauses for Pharmacists: The Struggle to Balance Conscience Rights with the Rights of Patients and Institutions. Wisc Law Rev. 2005;6(1611-1648.

Of Pills and Needles: Involuntary Medicating the Psychotic Inmate When Execution Looms

Julie Cantor

Extract
The coalescence of involuntarily administered antipsychotic medications and competency for execution created a novel and controversial issue that became the basis of Singleton’s final appeal. The Arkansas Supreme Court stated the question succinctly: May the State ”mandatorily medicate [Singleton] with antipsychotic drugs in order to keep him from being a danger to himself and others when a collateral effect of that medication is to render him competent to understand the nature and reason for his execution[?]” Or, as Singleton put it, “Am I too sane to live, or too insane to die?” The cynical view of that question is that Singleton was clever and manipulative. Like most people, he would do just about anything to forestall his death. The more charitable view is that Singleton found an Achilles heel in the execution process and physicians’ involvement with it, one that created what some physicians consider to be an intolerable dilemma.

Cantor J. Of Pills and Needles: Involuntary Medicating the Psychotic Inmate When Execution Looms. Indiana Health L Rev. 2005;2(1):119-172.

Unspeakably Cruel-Torture, Medical Ethics, and the Law

George J Annas

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
The Nazi doctors defended themselves primarily by arguing that they were engaged in necessary wartime medical research and were following the orders of their superiors. These defenses were rejected because they are at odds with the Nuremberg Principles, articulated a year earlier, at the conclusion of the multinational war crimes trial in 1946, that there are crimes against humanity (such as torture), that individuals can be held to be criminally responsible for committing them, and that obeying orders is no defense.

Annas GJ. Unspeakably Cruel-Torture, Medical Ethics, and the Law. N. Engl. J. Med.. 2005;352(20):2127-2132.

Un aspect crucial mais délicat des libertés de conscience et de religion des articles 2 et 3 des Chartes canadienne et québécoise: l’objection de conscience

Henri Brun

Abstract
The Supreme Court of Canada, obiter, in the Big M Drug Mart Case, has spoken of the “Constitutional Exemption”. It is the possibility not to be bound to obey the neutral laws that conflict with one’s conscience or religion. It is what we call in French l’objection de conscience. The institution exists in Canadian and Québec Law as a part of the right to freedom of conscience or religion expressed in 2a) and 3 of the Canadian and Québec Charters of Rights. And it goes well beyond the right not to fight within the armed forces. The Supreme Court of Canada has actually delivered six judgments touching on the subject in 1985 and 1986. The conditions under which l’objection de conscience come into play are not so well known however. Does it cover matters of worship or only rules of morals ? Secular or only religious principles ? Personal or only group beliefs ? Do the existence of the rule, the sincerity of the objector and the reasonableness of the exemption have to be proved? Above all, what is the difference between a creed and an opinion ? The following article tries to formulate answers to these questions, with the help of current case-law.

Brun H. Un aspect crucial mais délicat des libertés de conscience et de religion des articles 2 et 3 des Chartes canadienne et québécoise: l’objection de conscience. Les Cahiers de Droit. 1987;28(1):185-205.