Abstract Apparently heeding George Washington’s call to “labor to keep alive in your breast that little spark of celestial fire called conscience,” physicians, nurses, and pharmacists are increasingly claiming a right to the autonomy not only to refuse to provide services they find objectionable, but even to refuse to refer patients to another provider and, more recently, to inform them of the existence of legal options for care.
Extract . . . In medical and legal opinion, Terri Schiavo’s cognizance of her self and her life ended in 1990, when she suffered a cardiac arrhythmia and massive cerebral cortical encephalopathy that left her in a persistent vegetative state. Her facial expressions, along with a seemingly “normal” sleep–wake cycle, constituted but one dimension of the cruelty of this condition. . .
. . .More than one commentator has viewed the “right- to-life” fight to prolong Schiavo’s pitiable existence as an anti-abortion campaign “by other means.” . . .
. . . there seems little doubt that, in North America, ideology and religion have begun to seriously distort the type of consensus-building that is the proper business of democratic politics . . .
Where do physicians find themselves in such debates? Medicine is a secular and scientific profession that, for all that, must still contend with the sacred matters of birth, life and death. In practice, physicians must set aside their own beliefs in deference to the moral autonomy of each patient — or else transfer that patient’s care to someone who can meet this secular ethic. . .
. . .The emotionalism and rancour that swirled around the Schiavo case underscores a wider societal duty borne by the medical and scientific community. This is to remain alert to political and legislative tendencies that impose imprecise moral generalizations on the majority, at the expense of reason, scientific understanding and, not infrequently, compassion.
Extract Women in some parts of England have to wait up to two months from first seeking advice about an abortion to having the procedure, says a survey. The delays in referral mean that many women are presenting to services later than nine weeks pregnant and cannot be considered for early medical termination using the abortion pill, mifepristone, despite this being a popular option among women. . .The survey, which was conducted by Voice for Choice—an alliance of national pro-choice organisations including British Pregnancy Advisory Service, Marie Stopes International, and the Family Planning Association—reviewed the abortion services of 243 primary care trusts.
Extract The CMA Code of Ethics begins with the principle that an ethical physician will consider first the well-being of the patient. Physicians who feel entitled to subordinate their patients’ desire for well-being to the service of their own personal morality or conscience should not practise clinical medicine.
Abstract The merits of non-prescription distribution of levonorgestrel as emergency contraception (EC), which is effective within 72 hours of unprotected intercourse, are contentious. The advantage of promptness and convenience of access may be offset by the absence of medical counselling. Opposition to EC based on the possibility of the drug acting after fertilization but before implantation departs from standard medical criteria of pregnancy. Physicians who propose to apply non-medical criteria, and use religious objections to abortion to deny prescription of EC, must publicize their opposition in advance, so that women may seek assistance elsewhere. When objecting practitioners, or facilities, become responsible for women for whom EC is indicated, such as rape victims, they are bound ethically and legally to refer them to reasonably accessible non-objecting sources of care.
Abstract The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more ‘technically illegal’ abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker’s life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.
Extract Conclusion Physicians’ appeals to conscience, understood as fear of loss of integrity, should not be taken lightly. Integrity provides the basis for a unified, whole, and unalienated life, and its moral value, while dependent on the presence of other good traits in the agent, is not reducible to them. . . a physician can consistently be concerned about his or her own integrity without claiming to know better than the patient what is in the patient’s best interests. . . . The conception of integrity I have proposed . . . allows for the possibility of integrity-preserving compromise. . . . I have also considered the common practice of patient referral from the standpoint of physician integrity, and asked whether a physician who refuses to treat a patient as a matter of conscience can consistently refer the patient to another physician for the same treatment. . . in a dispute between physicians and their patients, there may be other values and principles at stake than the ones expressed in their conflicting positions, and a physician might well decide that referral in such a case is an appropriate response to a morally complex situation.
Extract A nurse practitioner’s personal position on this issue is irrelevant in tem1s of the provision of patient care. Our responsibility as nurse practitioners is to provide our patients with information that helps them to make their own decisions based on the constructs of their own beliefs and needs. This does not mean that nurse practitioners who find a patient’s reproductive-health decisions to be in conflict with their own morals and beliefs should be forced to counsel on those choices. Instead, they have a responsibility to ensure that the patient has her needs met with another provider.
Wysocki S. (Correspondence) Readers Advocate Pro-conscience, Not Pro-Choice (Invited response). Nurse Pract. 1992 Oct;17(10):8-9
Paul Cameron, May Cohen, Linda Rapson, Wendell W Watters (Doctors for the Repeal of the Abortion Law)
Canadian Medical Association Journal
Extract Mr. Geekie explains that the ethics committee changed the code to prevent patients from being “abandoned – a result that was not in keeping with the tenets of the profession.” . . . If the profession follows Mr. Geekie’s guidelines the new code will result in a lower level of care for Canadian women faced with unwanted pregnancies. Antiabortion physicians now have an ethical green light to send such women on an endless round of pointless, time-consuming referrals until it may be too late to interrupt the pregnancy. . . .If ambiguity exists in the present code of ethics it should be eliminated, if necessary by return to the old code, which allowed women to find their own way to help without this form of “assistance”.
Extract The CMA has the audacity to “place responsibility” on the physician who acts in accordance with his intelligence and informed conscientious judgement in the matter. It is not true to state that a physician abandons a patient if he informs her that his moral principles preclude his becoming involved in referring her for an abortion. No patient has the right to anything other than what a physician can in his conscience do. To ask for more is to ask for his cooperation in performing an act that he deems an act of killing an innocent human being. The CMA, in supporting this type of request, is bringing pressure to bear on the physician to cooperate. By including it in the code of ethics the CMA has also put the physician who does not publicly object in the position of appearing to agree with the CMA. His intellectual and moral integrity are challenged by this action. . . .If the government were to make abortion on demand legal, I have no doubt the CMA would make another change in the code that would “place responsibility” on the physician to cooperate in this also. I find it intolerable that the CMA is telling me I may not follow my conscience in this most serious matter.
