Laurence B McCullough Archives - Protection of Conscience Project Library

Ethical Distinction Between Direct and Indirect Referral for Abortion

Frank A Chervenak, Laurence B McCullough

Extract
Conclusion
The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.

Chervenak FA, McCullough LB. Ethical Distinction Between Direct and Indirect Referral for Abortion. The Female Patient. 2009 Dec;34:46-48

The ethics of direct and indirect referral for termination of pregnancy

Frank A Chervenak, Laurence B McCullough

American Journal of Obstetrics & Gynecology

Abstract
Referral of pregnant patients for termination of pregnancy by physicians morally opposed to the procedure is ethically controversial, with polarized positions taken by physician organizations. Based on the ethical principles of beneficence and respect for autonomy, we establish the distinction between direct and indirect referral. Direct referral is beneficence based and requires the referring physician to ensure that the referral occurs. Indirect referral is autonomy based, with a beneficence-based component that requires that the physician provide information to the patient about health care organizations that will provide competent medical care. We show that only indirect referral is ethically required in healthy women for termination of an unwanted pregnancy or a pregnancy complicated by fetal anomalies because the indications for this procedure are solely autonomy based. Direct referral for termination of pregnancy is not ethically required but is permissible. Conscience-based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral do not.

Chervenak FA, McCullough LB. The ethics of direct and indirect referral for termination of pregnancy. Am J Obstet Gynecol. 2008 Jul 30;199(3):232.e1-232.e3.

Professional Responsibility and Individual Conscience: Protecting the Informed Consent Process from Impermissible Bias

Frank A Chervenak, Laurence B McCullough

Extract
The ethics of referral for abortion is autonomy based with a beneficence-based component, the clinician’s obligation to protect the woman’s health and life, similar to referral for cosmetic procedures. At a minimum, indirect referral— providing referral information but not ensuring that referral occurs—should be the clinical ethical standard of care. Direct referral for abortion is a matter of individual clinician discretion, not the clinical ethical standard of care. Conscience based objections to direct referral for termination of pregnancy have merit; conscience-based objections to indirect referral for termination of pregnancy do not.

Chervenak FA, McCullough LB. Professional Responsibility and Individual Conscience: Protecting the Informed Consent Process from Impermissible Bias. J Clin Ethics. 2008 Spring;19(1):24-25.

(Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics

Frank A Chervenak, Laurence B McCullough

British Medical Journal, BMJ — British Medical Journal

Extract
Savulescu’s account of conscientious objection in medicine is a bold statement that requires all obstetricians to perform abortions, regardless of any moral convictions that they may have to the contrary. Unfortunately, he violates the standards of argument based ethics.

Chervenak FA, McCullough LB. (Correspondence) Conscientious Objection in Medicine: Author did not meet standards of argument based ethics. Br Med J. 2006 Feb 18;332(7538):425.