Religion Archives - Page 7 of 12 - Protection of Conscience Project Library

Rights to emergency contraception

Edith Weisberg, Ian S Fraser

International Journal of Gynecology & Obstetrics

Abstract
Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.

Weisberg E, Fraser IS. Rights to emergency contraception. Int J Gynec Obstet. 2009 Jun 18;106(2):160-163.

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 Gone Awry-Restoring Selfless Professionalism in Medicine

Julie D Cantor

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

Extract
Health care providers already enjoy broad rights — perhaps too broad — to follow their guiding moral or religious tenets when it comes to sterilization and abortion. An expansion of those rights is unwarranted. . . .Physicians should support an ethic that allows for all legal options, even those they would not choose. Federal laws may make room for the rights of conscience, but health care providers — and all those whose jobs affect patient care — should cast off the cloak of conscience when patients’ needs demand it.

Cantor JD. Conscientious Objection Gone Awry-Restoring Selfless Professionalism in Medicine. N Engl J Med. 2009 Apr 09;360(15):1484-1485.

Autonomy, religion and clinical decisions: findings from a national physician survey

RE Lawrence, Farr A Curlin

Abstract
Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined.

Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions.

Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8).

Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature.

Lawrence RE, Curlin FA. Autonomy, religion and clinical decisions: findings from a national physician survey. J Med Ethics. 2009;35, 214-218.

To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support

Farr A Curlin, Chinyere Nwodim, Jennifer L Vance, Marshall H Chin, John D Lantos

American Journal of Hospice and Palliative Care

Abstract
This study analyzes data from a national survey to estimate the proportion of physicians who currently object to physician-assisted suicide (PAS), terminal sedation (TS), and withdrawal of artificial life support (WLS), and to examine associations between such objections and physician ethnicity, religious characteristics, and experience caring for dying patients. Overall, 69% of the US physicians object to PAS, 18% to TS, and 5% to WLS. Highly religious physicians are more likely than those with low religiosity to object to both PAS (84% vs 55%, P < .001) and TS (25% vs 12%, P < .001). Objection to PAS or TS is also associated with being of Asian ethnicity, of Hindu religious affiliation, and having more experience caring for dying patients. These findings suggest that, with respect to morally contested interventions at the end of life, the medical care patients receive will vary based on their physicians’ religious characteristics, ethnicity, and experience caring for dying patients.

Curlin FA, Nwodim C, Vance JL, Chin MH, Lantos JD. To Die, to Sleep: US Physicians’ Religious and Other Objections to Physician-Assisted Suicide, Terminal Sedation, and Withdrawal of Life Support. American J Hospice & Pall Care. 2008;25(12):112-120.

Conscientious Commitment

Bernard M Dickens

Extract
Religion has no monopoly on conscience, however. History, both distant and recent, shows how health-care providers and others, driven by conscientious concerns, can defy laws and religious opposition to provide care to vulnerable, dependent populations. They might also defy the medical establishment. Pioneers of the birth control movement were not doctors, and were opposed by medical, state, and religious establishments. As long ago as 1797, Jeremy Bentham advocated means of birth control, and in the following century, John Stuart Mill was briefly imprisoned for distributing birth control handbills. Charles Bradlaugh and Annie Besant were similarly prosecuted, in 1877, for selling pamphlets about birth control.

Dickens BM. Conscientious Commitment. The Lancet. 2008;371(1240-1241.

The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine)

Robert D Orr

Extract
At what point is an individual accountable for involvement in an action that he or she believes to be immoral? This subquestion is, I believe, important to both the religious and the non-religious individual in dealing with matters of personal or professional conscience. . . Lawrence and Curlin (2007) have stated it is important to have a basic understanding of what an individual means when he or she invokes this right of conscience. I believe it is equally important for those individuals, and for the public at large, to understand that there is a spectrum of belief about one’s moral complicity. Thus two people of faith may arrive at different conclusions about when it is appropriate to invoke this right. Such variation is fundamental to the concept of an individual’s conscience.

Orr RD. The Role of Moral Complicity in Issues of Conscience (Conscience in Medicine). Am J Bioeth. 2007;7(12).

Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine)

Ryan E Lawrence, Farr A Curlin

Abstract
What role should the physician’s conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one’s conscience. Importantly, these basic disagreements underlie current controversies regarding the role of the clinician’s conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine.

Lawrence RE, Curlin FA. Clash of definitions: Controversies about conscience in medicine (Conscience in Medicine). Am J Bioeth. 2007;7(12):10-14.

Conscience and Conflict (Conscience in Medicine)

Marcus P Adams

Extract
Asserting that we should encourage dialogue is one thing; showing that such dialogue is possible is another. My commentary has in no way argued against having beliefs that result from religious conscience; rather, I have argued only that religious conscience, regardless of the religion from which it develops, has no place in medical decision-making.

Adams MP. Conscience and Conflict (Conscience in Medicine). Am J Bioeth. 2007;7(12):28-29.

Caution: Conscience is the Limb on Which Medical Ethics Sits (Conscientious Objection and Emergency Contraception)

Farr A Curlin

Extract
Card (2007) does not merely claim that practitioners are obligated to provide EC; he argues that they are obligated to do so even if they have a conscientious objection. This last clause may seem harmless on the surface, but a closer look reveals that it effectively saws off the limb on which the first clause and all medical ethics sit. . . . A genuine conscientious objection, even if misinformed, is an expression of a commitment to acting morally, and . . . judgments of conscience need not be informed by explicitly religious ideas. Moreover, all ethical arguments are appeals to conscience. As such, acting conscientiously is the most fundamental of all moral obligations.

Curlin FA. Caution: Conscience is the Limb on Which Medical Ethics Sits (Conscientious Objection and Emergency Contraception). Am J Bioeth. 2007;7(6):30-31.