Referral Archives - Page 6 of 8 - Protection of Conscience Project Library

Religion, Conscience, and Controversial Clinical Practices

Farr A Curlin, Ryan E Lawrence, Marshall H Chin, John D Lantos

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

Abstract
Background
There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice.

Methods
We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians’ judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval.

Results
A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5).

Conclusions
Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests.

Curlin FA, Lawrence RE, Chin MH, Lantos JD. Religion, Conscience, and Controversial Clinical Practices. N. Engl. J. Med.. 2007;356(6):593-600.

Conscience Clauses and Oral Contraceptives: Conscientious Objection or Calculated Obstruction?

Mary K Collins

Abstract
The ideal conscience statutes will balance the interests on both sides. Conscientious objectors should be free to practice in accordance with their beliefs, but should have to give employers and patients reasonably advanced notice that they may not be reliable in certain situations.173 The individual objector should avoid knowingly entering into employment situations guaranteed to create conflict. While health care providers have a duty to ensure informed decision making, women seeking unbiased clinical care should not be subjected to lectures on personally held views of morality. Places of worship are a more appropriate arena for proselytizing. Institutional and individual objectors should develop appropriate accommodations through referral and notice to avoid inconvenience, delay, and possible injury to the patients who depend on them.

Collins MK. Conscience Clauses and Oral Contraceptives: Conscientious Objection or Calculated Obstruction?. Ann Health Law. 2006 Winter;15(37-60.

(Correspondence) Revisiting Pharmacists’ Refusals to Dispense Emergency Contraception (Author’s Response)

Ralph Baergen, Christopher Owens

Extract
pharmacists are autonomous, moral agents who are accountable for their choices and entitled—within limits— to decide in which activities they will participate. Pharmacists’ professionalism is defended, their responsibilities in the provision of drug therapy are set forth in the context of pharmaceutical care, and these lead to the conclusion that pharmacists’ refusals may be ethically justified. There are important limits on how are being asked to participate in actions they find morally objectionable. Notably, they must ensure that these prescriptions are filled by someone else in a timely manner and must refrain from any abusive or demeaning treatment of patients, as summed up in our Principle of Conscientious Refusal to Dispense.

Baergen R, Owens C. Revisiting Pharmacists’ Refusals to Dispense Emergency Contraception. Obstetrics & Gynecology. 2006;108(5):1277-1282.

Two Cheers for Conscience Exceptions

Adrienne Asch

Abstract
The pharmacist who wants her integrity and self-conception to be respected must accord respect to the woman whose views about sex, life processes, and parenthood differ from her own by courteously offering her own rationale and a referral.

Asch A. Two Cheers for Conscience Exceptions. Hastings Cent Rep. 2006;November-December):11-12.

Conscientious objection and emergency contraception

Robert F Card

Abstract
This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested.

Card RF. Conscientious objection and emergency contraception. Am. J. Bioeth. 2007;7(6):8-14.

The Growing Abuse of Conscientious Objection

Rebecca J Cook, Bernard M Dickens

American Medical Association Journal of Ethics

Extract
Religious initiatives to propose, legislate, and enforce laws that protect denial of care or assistance to patients, (almost invariably women in need), and bar their right of access to lawful health services, are abuses of conscientious objection clauses that aggravate public divisiveness and bring unjustified criticism toward more mainstream religious beliefs. Physicians who abuse the right to conscientious objection and fail to refer patients to nonobjecting colleagues are not fulfilling their profession’s covenant with society.

Cook RJ, Dickens BM. The Growing Abuse of Conscientious Objection. Am Med Ass J Ethics. 2006 May;8(5):337-340.

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.

(Correspondence) The Celestial Fire of Conscience: Prof. Charo Replies

R Alta Charo

Extract
With regard to Dr. Lee’s comment that the proposed Wisconsin legislation does not eliminate a health care provider’s duty to provide a referral after refusing to perform a service, I would note that Assembly Bill 207 . . . specifically permits health care providers’ refusals to “participate in” services they find personally objectionable, with “participate in” specifically defined . . . as “to perform; practice; engage in; assist in; recommend; counsel in favor of; make referrals for; prescribe, dispense or administer drugs”.

Charo RA. (Correspondence) The Celestial Fire of Conscience: Prof. Charo Replies. N Engl J Med. 2005 Sep 22;353(12):1302.

The Silence of Good People and Non-cooperation with Evil: A Response to Prof. R. Alta Charo

Sean Murphy

Responding to: Charo RA. The Celestial Fire of Conscience – Refusing to Deliver Medical Care N Eng J Med 352:24, June 16, 2005

Extract
It is especially noteworthy that, in an essay about the exercise of freedom of conscience by health care workers, Professor R. Alta Charo has virtually nothing to say about freedom or conscience (The Celestial Fire of Conscience- Refusing to Deliver Medical Care. N Eng J Med 352:24, June 16, 2005). “Conscience clauses,” yes: conscientious objection, to be sure: and she mentions acts of conscience and the right of conscience. But nothing about freedom, and, on the subject of conscience itself, the most she can muster is, “Conscience is a tricky business.”

Murphy S. The Silence of Good People and Non-cooperation with Evil: A Response to Prof. R. Alta Charo [Internet]. Protection of Conscience Project; 2005 Aug 19.

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.