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Protection of Conscience Project

Service, not Servitude


Childress JF.  Conscience and conscientious actions in the context of MCOs. Kennedy Inst Ethics J 1997 Dec;7(4):403-11 PMID: 11655373

James F. Childress

  • Abstract:  Managed care organizations can produce conflicts of obligation and conflicts of interest that may lead to problems of conscience for health care professionals. This paper provides a basis for understanding the notions of conscience and conscientious objection and offers a framework for clinicians to stake out positions grounded in personal conscience as a way for them to respond to unacceptable pressures from managers to limit services.

Collett TS. Professional versus Moral Duty: Accepting Appointments in Unjust Civil Cases.  32 Wake Forest L. Rev. 635 Fall, 1997.

Teresa Stanton Collett

  • Introduction:  American lawyers have long claimed the right to select clients in accordance with their conscience. From the first formulation of an American code of legal ethics to its current incarnations, members of the legal profession have recognized the tension arising fromthe duty to assure the availability of legal services to all who need representation and the right of lawyers to determine whom they represent. In its earliest formulation this tension was stated as a matter of conscience. Current lawyer regulations state the problem in terms of personal integrity. The Preamble to the Model Rules of Professional Conduct describes the tension in these terms: 'Virtually all difficult ethical problems arise from conflict between a lawyer's responsibilities to clients, to the legal system, and to the lawyer's own interest in remaining an upright person while earning a satisfactory living." . . .

Daly BJ, Berry D, Fitzpatrick JJ, Drew B, Montgomery K.  Assisted suicide: implications for nurses and nursing. Nurs Outlook 1997 Sep-Oct;45(5):209-14  PMID: 9364530

Barbara J. Daly, Devon Berry, Joyce J. Fitzpatrick, Barbara Drew, Kathleen Montgomery,

  • The ANA, as well as the AMA and the National Hospice Association, have issued position statements expressly declaring opposition to nurse or physician participation in assisted suicide. Nonetheless, the literature includes numerous reports of the participation of nurses and physicians in assisted suicide. What are the implications of this issue for nurses and nursing?

Grisez G. Difficult moral questions: may a physician remain in a group that provides immoral services? Linacre Q 1997 May;64(2):21-5  PMID: 11654999


Lazarus ES. Politicizing abortion: personal morality and professional responsibility of residents training in the United States. Soc Sci Med 1997 May;44(9):1417-25 PMID: 9141173

Ellen S. Lazarus

  • Abstract:  --Ever-increasing technological innovations surrounding birth are creating new challenges in biomedical ethics in U.S. obstetrics. The politicization of abortion has augmented these challenges and led to increased conflict between physicians' personal morality and professional responsibility. This paper focuses on some of the problems generated by abortion policies and procedures in an obstetric/ gynecology residency program. Examples of conflicts among residents are presented to demonstrate the effect of pluralistic moral perspectives. A system is described where some residents will do abortions and some will not. Patients seeking abortion are often treated in an unprofessional manner when it appears that a conflict exists between the values of patients and those of residents. Unless the socialization of residents includes ethical training, defined educational policy and institutional direction, ethical dilemmas will lead to increased resident stress, an inadequate doctor-patient relationship and a continued shortage of physicians willing to perform abortions despite new policies called for in graduate medical education.

Wildes KW. Institutional identity, integrity, and conscience.  Kennedy Inst Ethics J 1997 Dec;7(4):413-9  PMID: 11655374

Kevin William Wildes

Abstract: Bioethics has focused on the areas of individual ethical choices--patient care--or public policy and law. There are, however, important arenas for ethical choices that have been overlooked. Health care is populated with intermediate arenas such as hospitals, nursing homes, hospices, and health care systems. This essay argues that bioethics needs to develop a language and concepts for institutional ethics. A first step in this direction is to think about institutional conscience.