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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers


Allen WL, Brushwood DB.  Pharmaceutically assisted death and the pharmacist's right of conscience. J Pharm Law. 1996;5(1):1-18. PMID: 11657421

William L. Allen, David B. Brushwood

  • Pharmacists are health care providers who accept responsibility for the outcomes of drug therapy by accurately processing medication orders, detecting and rectifying potential problems with drug therapy, counseling patients concerning the anticipated effects of drugs, and monitoring the results of drug use. Once thought of as mere retail dealers in a product, pharmacists have expanded their activities as service providers to patients, and have adopted a mission for themselves referred to as "pharmaceutical care".' The commitment to pharmaceutical care signifies that pharmacists are responsible providers of drug therapy, for the purpose of achieving definite outcomes, intended to improve patients' quality of life. Pharmacists see themselves as drug therapy managers whose duty it is to assure that patients' best interests are being promoted. This means, necessarily, that any controversial use of medications, such as execution by lethal injection, abortion by pharmacotherapy, or pharmaceutically assisted death through prescription of drugs, is a critical issue for pharmacists. . .

Baker TP. Descriptive and normative ethics: conscientious objection. Nurs Manage 1996 Oct;27(10):32D-32FF  PMID: 8932104

Tina P.H. Baker

  • Abstract: Conscientious objection preserves the personal integrity and wholeness of a health care professional's character and personality. Professionals are obligated not only to codes of ethics and standards of care that guide their practices, but also to personal values. When professional and perstmal values conflict with health care delivery, nurses are compelled to object on moral grounds on behalf of themselves and the public they serve.

Brown JM.  Conscience: the professional and the personal.   PMID: 8705077 J Nurs Manag 1996 May;4(3):171-7 (Review)

J.M. Brown

  • Abstract:  Conscience is sometimes thought of as private, personal, individual, possibly religious, and not to be questioned. This paper seeks to present and make plausible an account of conscience as social, possibly secular, and fallible (and hence corrigible). In the light of this an account of professional conscience is offered and conclusions are drawn about the questions that should be answered in the event of a nurse making an appeal to conscience.

Kluge EH.  Clinical practice guidelines and the law.  CMAJ Sept. 1996; 155 (5)

Eike-Henner Kluge

  • With physicians in Canada under increasing threat of malpractice litigation, it has been suggested that adopting clinical practice guidelines (CPGs) as standards of care would free doctors from the fear of litigation initiated by dissatisfied patients.  However, ethicist Eike-Henner Kluge argues that CPGs can only be considered general indicators of standards of care.

Meyers C, Woods RD. An obligation to provide abortion services: what happens when physicians refuse? J Med Ethics 1996 Apr;22(2):115-20  PMID: 8731539

Christopher Meyers, Robert D. Woods

  • Access to abortion services in the United States continues to decline. It does so not because of significant changes in legislation or court rulings but because fewer andfewer physicians wish to perform abortions and because most states now have "conscientious objection" legislation that makes it easy for physicians to refuse to do so. We argue in this paper that physicians have an obligation to perform all socially sanctioned medical services, including abortions, and thus that the burden ofjustification lies upon those who wish to be excused from that obligation. That is, such persons should have to show how requiring them to perform abortions would represent a serious threat to theirfundamental moral or religious beliefs. We use current California law as an example of legislation that does not take physicians' obligations into account and thus allows them too easily to declare conscientious objection.

Mullan K, Allen WL, Brushwood DB.  Conscientious objection to assisted death: can pharmacy address this in a systematic fashion? Ann Pharmacother 1996 Oct;30(10):1185-91  PMID: 8893130

K. Mullan, William L. Allen, David B. Brushwood

  • Objective: To describe a legal structure for the accommodation of pharmacists' rights of conscience in the dispensing of drugs for pharmaceutically assisted death.

Background: Pharmacists have indicated that there is disagreement in the profession regarding the appropriateness of a practice known as "pharmaceutically assisted death," in which lethal medications are prescribed for terminally ill patients who want to end their lives. Pharmacists who object to pharmaceutically assisted death may be asserting a conscientious objection that threatens to create a conflict with their employers. In addition, pharmacists who support pharmaceutically assisted death, but whose employers forbid the dispensing of medications for this purpose, may face a similar conflict. Current laws and principles of professional ethics fail to adequately address the resolution of either of these conflicts.

Discussion: We propose a system within which the pharmacy profession could accommodate the right to conscientious objection without sacrificing the quality of patient care. At the heart of our proposal is the understanding that employers must respect an employee's right to beliefs that differ from those of the employer and, correspondingly, the understanding that employees must respect the employer's duty to provide products and services to those who seek them from the employer.

Conclusions: Pharmacy associations can adopt policies for conscientious objection and have those policies become law through action of the state legislature or the state board of pharmacy. This approach could lead to the development of a clear policy and procedure for resolving the issue of conscientious objection within the pharmacy community, making it far less likely that institutions outside pharmacy would be required to develop a solution for pharmacy.

Oak JC. A conflict of loyalties: nursing, conscientious objection, and JCAHO HR.5. Mak Rounds Health Faith Ethics 1996 Feb 26;1(12):1, 3-5, 8  PMID: 11656572

Jeffrey C. Oak

  • In one of the many vigorous moral debates at the height of the Vietnam War, Hubert Humphrey argued against selective conscientious objection, saying it would give a person "God-like powers." A noted Chicago columnist made the same point less elegantly when he said it would be "a helluva way to run a railroad" (Finn 1988:x). A new standard from the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO), which mandates that hospitals have formal policies for dealing with conscientious objection, is likely to be greeted with the same response. The standard requires that accredited institutions "address any request by a staff member not to participate in an aspect of patient care, including treatment . . . where there is perceived conflict with the staff member's cultural values or religious beliefs" (JCAHO 1995: HR.5 and HR. 5.1, my emphasis). It requires little effort to imagine supervisors, administrators, and members of governing boards complaining that to meet such a standard would be a helluva way to run a hospital. . .