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Protection of Conscience Project

www.consciencelaws.org

Service, not Servitude
Ethics

GENERAL

The Hippocratic "oath"
(Some further reasonable hypotheses)

  • Sergio Musitelli*, Ilaria Bossi* | Although 65 treatises - either preserved or lost, but quoted by ancient authors like Bacchius (3rd century B.C.), Erotian (1st century A.D.) and Galen (c. 129-199 A.D.) - are ascribed to Hippocrates (c. 469-c. 399 B.C.) and consist of nearly 83 books, nonetheless there is no doubt that none of them was written by Hippocrates himself. This being the fact, we cannot help agreeing with Ulrich von Wilamowitz Möllendorf (1848-1931), who maintained that Hippocrates is a name without writings! . . .
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Medicine's Intrinsic Good

  • Teresa Iglesias* | What is good medicine? Who counts as a good doctor? These are very large questions that cannot be fully addressed here. I want to focus on a basic aspect of these two questions and on the ethical idea of "the good.". . .
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Why Medical Ethics?

  • Daniel Eisenberg* | When I lecture to audiences about the Jewish approach to medical ethics, one issue always lurks below the surface: Why medical ethics? And why particularly Jewish medical ethics? Isn't it sufficient to allow the medical field to police itself? Aren't physicians moral people?
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Is Bioethics Ethical?

  • Wesley J. Smith* | The author argues that control over public policy decisions in health care has been ceded to [secular] bioethicists, "an elite group of academics, philosophers, lawyers, and physicians, many of whom are openly hostile to the sanctity of life and the Hippocratic traditions that most people still take for granted." The result is that law and public policy are increasingly shaped by beliefs that are not shared by the people whom they affect. . .
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The Bioethics Mess

  • Dianne N. Irving* | "Bioethics" -- the word sounds like old-fashioned medical ethics applied to new medical technology. It's the application of traditional philosophical or theological principles to the moral dilemmas created by, say, cloning or experimenting with new AIDS drugs, right? Not really. . .
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Which Medical Ethics for the 21st Century?

  • Dianne N. Irving* | . . . Abstracting from all the possible academic ethical theories . . . I will focus narrowly instead on two theories of medical ethics - secular bioethics and Roman Catholic medical ethics, pointing out briefly what they are, comparing their conclusions about what is right or wrong, and indicating where they have already lead us. . .
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'Bioethics' -- What It Really Means for Prolife Nurses

  • Dianne N. Irving* | . . .When you find yourself in a situation where you and your deepest gut instincts are so pitted against some "theory" - any "theory" - then perhaps it is time to stop and to question this "theory"? The specific "theory" in question here is not really "ethics", but, I would suggest -- "bioethics".
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Is American Bioethics Lost in the Woods?

  • Michael Cook* | The debate between a libertarian bioethicist and a communitarian bioethicist illustrates why American bioethics is becoming increasingly marginalised and irrelevant to the democratic society that it intends to serve . . .
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Establishment Bioethics

  • Sean Murphy* | Ethical differences between one theory of bioethics and another may be quite as dramatic as doctrinal differences between religions, though, like religions, there are also similarities. Problems for ethical minorities arise when one version of bioethics becomes predominant, and its practitioners attain positions of influence and power in government, academic and professional circles. . .
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The Impact of International Bioethics on the Sanctity of Life Ethics and the Ability of Ob Gyn's to Practise According to Conscience

  • Dianne N. Irving* | . . . the key to understanding any philosophical or theological ethical theory is to identify its philosophical or theological "anthropology"-- or definition of "a human being" or "person". . . Bioethics tries to claim that its theory really has no "anthropology", i.e., the "personhood" issue. . . However, almost all bioethics arguments do incorporate a "delayed personhood" claim, whether or not they know or admit it --
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Suggestions for the Future of Bioethics

  • Daniel P. Sulmasy* | I suggest that bioethics has evolved through three phases: a religious phase in the 1950s and '60s, a philosophical phase in the '70s and '80s, and a political-empirical phase from the '90s to the present. . . Where should bioethics go next? I will make six suggestions. I am sure they will not be uniformly popular, but I'd like to think they might provoke some interesting discussion. . .
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The Costs of Taking Conscience

  • Michael A Fragoso* | . . .There is already a growing physician shortage . . . The shortage will increase without any of the supply reductions that are likely to occur as a result of decertifying practicing obstetricians who refuse to perform abortions and deterring future obstetricians who will choose a different career or specialty rather than violate their consciences. . .
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Observing Bioethics
Renee C. Fox, Judith P. Swazey
Oxford: University Press, 2008

  • Sally Satel*  |. . . Whether bioethics has achieved its goal is the urgent question at the core of this useful book . . .Through enjoyable interviews with major figures in the field and a rich trove of personal observations, the book perceptively, if densely, chronicles the growth of bioethics as a profession. . .Fox and Swazey portray bioethics as a field in turmoil. . . [Their] own prescription-to expand the bioethics' franchise into global justice and activism-will not help. Bioethics would become politicized, thereby undermining the already shaky credibility of the field. . . .
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MEDICAL PRACTICE AND CONSCIENCE

 

Patients' Rights - A World View
The Patients' Rights Act 20 years on – Achievements and Challenges

  • Dr. Otmar Kloiber*  |  . . .  to understand patient rights and the relation of health professionals to them it is important to be clear what patients are. Towards the end of the last century, particularly during the 1990s, the notion came into being that patients are "customers". Now some prefer the word "clients", which sounds much more elaborate and elegant, however it is merely the French word for "customer". It is undeniable that in any relationship where one pays money for a service there is an aspect or an expectation that classifies one party as a "customer" and the other as a "provider" or "vendor". But transferring this paradigm as the description for the patient/physician relationship falls dangerously short of reality. . .
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Six questions about physician-assisted death, from a conscientious objector

  • Ewan C. Goligher* | Canadian policy makers have recently proposed to require all doctors to provide an effective referral for physician-assisted death (PAD) upon the patient's request. Forcing doctors to knowingly send their patient to another doctor willing to cause the patient's death will seriously compromise the moral integrity of conscientiously objecting doctors and risks undermining the quality of patient care. To understand the position of conscientiously objecting doctors, consider the following questions. . .
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The Hidden Professions of Conscientious Objection

  • Bob Parke* | . . . While interpreters and clinical informatics team members may be asked to participate in euthanasia their right to conscientious objection is not recognized as it is for doctors, nurses, pharmacists and other frontline staff. As such, they need to be considered and supported in organizational policies addressing [euthanasia/assisted suicide]
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Are tribunals the solution to disruptive conscientious objectors?

  • Michael Cook* | While some bioethicists believe that conscientious objection has no place in modern medicine, others feel that they could be accommodated by setting up tribunals. Here are three proposed this year in the Journal of Medical Ethics. . .
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There's no "mushy middle" on euthanasia

  • Margaret Somerville* | Many know the saying "You have to fish or cut bait". Many fewer know the law's equivalent, "You can't approbate and reprobate". But the Canadian Medical Association's recent dealing with their 2007 Policy on Euthanasia and Assisted Suicide makes it seem they are unaware of the warning and wisdom these axioms communicate. . .
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Entrenching a 'duty to do wrong' in medicine
Canadian government funds project to suppress freedom of conscience and religion

  • Sean Murphy* |A 25 year old woman who went to an Ottawa walk-in clinic for a birth control prescription was told that the physician offered only Natural Family Planning and did not prescribe or refer for contraceptives or related services. She was given a letter explaining that his practice reflected his "medical judgment" and "professional ethical concerns and religious values." She obtained her prescription at another clinic about two minutes away and posted the physician's letter on Facebook. The resulting crusade against the physician and two like-minded colleagues spilled into mainstream media and earned a blog posting by Professor Carolyn McLeod on Impact Ethics. . .
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Conscience in the Practice of the Health Professions

 

Freedom of Conscience and the Needs of the Patient

  • Sean Murphy* | . . . I am going to focus on the terms in the title of this presentation - freedom, conscience, and needs - touching, in one place, upon ethics, and concluding with a reflection upon faith and the notion of moral neutrality. . . I have not attempted an apology for freedom of conscience, so you will not leave here with slogans to brandish, a handy list of pros and cons or practical advice on how to avoid being sued. Instead, I have offered a number of observations and reflections on words that we too often take for granted, and cause us to stumble: needs, ethics, freedom, conscience, and faith. . .
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The Role of Conscience in Medical Decisions

  • Daniel P. Sulmasy* | In this lecture, Dr. Daniel Sulmasy will discuss how medical professionals can strive to preserve their moral integrity while also respecting and serving patients with whom they might have deep moral disagreements.
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Presentation to President's Council on Bioethics

  • Christian Medical Association | . . . Because the way things are going, some would actually force out of the profession those physicians who have moral objections to procedures such as abortion. And that loss of physicians--especially Obstetricians and Gynecologists who are already leaving because of malpractice insurance costs--would have a severe impact on the delivery of healthcare. . .
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Liberty of conscience is critical for individual doctors

  • Dr. Lachlan Dunjey | "Liberty of conscience is critical for individual doctors as it lies at the very heart of our integrity," he said. "It is conscience that must compel doctors to refuse to participate in treatments they believe to be un-ethical. It is not enough for doctors to simply be providers of medical services on demand from consumers or third parties, providing all that is legal whether or not it is consistent with their ethical base. To sacrifice conscience and be concerned only with service provision is to destroy the heart and soul of medicine." . . .
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Considerations on the Future of Obstetrics and Gynaecology: The Fundamental Human Right to Practise and be Trained According to Conscience

  • Mons. Tarcisio Bertone, SDB* | . . .When there is a conflict between the moral norm and the law, i.e. between natural law and positive law, the only instrument to overcome the dilemma or the clash is conscientious objection. Conscientious objection represents a founded and legitimate dissent in relation to the constituted order, due to its dissonance towards a higher law. . .
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Medicine, Strasbourg, and conscientious objection
European Court of Human Rights decision

  • Julian Sheather* | . . .Conscientious objection is a live issue in medicine. . . Given the prevailing political pluralism-given the co-existence in our culture of different value systems-to what extent should medicine accommodate such objections? Should those whose consciences differ be treated differently? What forms of conscientious objection should be tolerated and on the basis of what criteria?
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Confronting Conscientious Objection

  • Maggie Little* | Conscientious objection. . . is not something lightly invoked. Its legitimate exercise brings with it strong obligations. Objecting providers must disclose their limitations early and often to minimize patient burdens. And they must convey those restrictions with compassion and respect. . . . The very premise of protecting conscientious refusal, after all, is that deeply good and reasonable people disagree on the issue.
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SPECIFIC ISSUES

Abortion

Abortion: Where do we draw the line?

  • Margaret Somerville* | The conferral of an honorary degree on Dr. Henry Morgentaler provided a flashpoint for yet another explosion in the long-standing, deeply acrimonious war as to the values that should govern abortion. The two polar positions are well defined, but I want to speak for those, like me, who regard all abortion as raising serious ethical issues, but who would not legally prohibit early abortion . . .
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Abortion, Conscience and Health Care Provider Rights

  • E. Christian Brugger* | In this essay, I will elaborate the ACOG account, juxtapose it to what I call the "classical account" as defended in Western philosophy, and finally answer the question whether healthcare providers have a right to refuse to treat some patients.
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A Tough Call: Does conscience protection excuse a health professional from providing after-abortion care?

  • Cristina Alarcon* | Last November a Planned Parenthood nurse in Idaho rang a local pharmacist and asked for methergine -- a drug used to prevent bleeding after childbirth or an abortion. Considering the source of the request it is quite likely to have been the latter, and the pharmacist, who has a conscientious objection to abortion, asked whether that was the case. The caller refused to say, citing federal privacy law, and the pharmacist refused to fill the prescription. The caller then asked for a referral to another pharmacy and the pharmacist hung up on her. . .
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Artificial reproduction
  • Michael Cook* |  "Gender disappointment" is not a recognised medical condition. But many women in Australia – where gender selection is illegal -- attribute their depression to it. Speaking to Australia's ABC network, a woman using the pseudonym Kate described it as as "a guilt-ridden, debilitating depression". She has two boys and she desperately wants a daughter.. . .
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Assisted nutrition and hydration

Tube Feeding: Medical Treatment or Basic Care?

  • Adrian Treloar*, Philip Howard* | The authors argue that feeding tube placement is a medical procedure and as such requires consideration of the benefits and risks as for any other medical treatment. However, the day-to-day use of feeding tubes, to provide hydration and nutrition, constitutes ordinary care that does not require medical supervision. Withdrawal of tube feeding raises major ethical and legal questions.
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Birth Control

Clearing Rhetorical Minefields

  • Sean Murphy* | Progress towards understanding the importance of freedom of conscience for health care workers is not infrequently hindered by rhetorical minefields . . .What follows is an attempt to clarify some of the points of dispute and identify key issues. It introduces the term "embryocide" and specifies the meaning of "abortifacient" and "contraceptive" based upon what is common to parties who hold contrary views about abortion and contraception. . .
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Contraception for the Unmarried

  • Christian Medical Fellowship [United Kingdom] | . . .I came to the conclusion that I could only provide contraception to married couples, and that my contraceptive advice to unmarried couples would be limited to that of advising them not to have intercourse. I would advise them that if they rejected my advice they should go elsewhere and obtain their contraception from another doctor. I was not forcing my opinion on them, because they were perfectly free to reject my advice and obtain their contraception elsewhere. . .
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Over the counter conscience vote

  • Beth Doherty* | Every now and again, stories hit the media about pharmacists who refuse to stock condoms, dispense the contraceptive pill and, more recently, the morning-after pill. Contrary to what we are led to believe, this is not an irregular occurrence, nor is it a particularly surprising stance for a Christian pharmacist. . .
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Idaho Case of Pharmacist Refusal

  • Wesley J. Smith* | . . .based on the reporting of the story, this isn't even a close call. This is not a proper conscience clause (from my criteria) case and in Wesley World, the pharmacist would not be protected.
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Criteria for determining death

Report Prompts Protocols for Diagnosis of Brain Death

  • MY Wang P Wallace JP Gruen | After reviewing the 78 brain deaths documented at the hospital in 1999, J. Peter Gruen, MD, and colleagues at the Keck School of Medicine of the University of Southern California in Los Angeles, discovered that the diagnosis was highly variable and concluded that standards for practice and documentation were sorely needed.
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Eugenics

New Genetics Functions as Eugenics

  • Margaret Somerville* | One effect of intense individualism in the context of reprogenetics is that the accumulation of individual decisions are resulting in an overall outcome that would never be acceptable as public policy. In short, the new genetics is functioning as eugenics, but that fact is not identified. . .
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Euthanasia, assisted suicide

Canadian Medical Association plans for physician assisted suicide, euthanasia
Commentary on draft framework (June/July, 2015)

  • Sean Murphy* | On 6 February, 2015, the Supreme Court of Canada ordered the legalization of physician-assisted suicide and euthanasia in Canada, effective in February, 2016. . . The Canadian Medical Association (CMA) had been preparing for legalization of physician assisted suicide and euthanasia since 2014.  In the months following the ruling, CMA officials and the Board of Directors finalized draft guidelines ("draft framework") on the subject and published them in June.  An internal CMA on-line consulation concerning the draft framework ran from 8 June to 20 July, 2015. . .
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Assisted Suicide: What Role for Nurses?

  • Carrie Farella* | Initially, when [Oregon's assisted suicide law] was designed, the assumption was that physicians would be the first ones to explore PAS with patients," . . . "but in reality, nurses are usually the ones in the line of fire. Patients often feel nurses understand their wishes for good quality of life and good quality of death, too."
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'Pulling the plug' isn't euthanasia

  • Margaret Somerville* | . . .The ongoing transformation in the methods and ethics of medicine raises profound moral questions for doctors, nurses, pharmacists, and others who believe in the traditional virtues of Hippocratic medicine that proscribe abortion and assisted suicide and compel physicians to "do no harm.". . . Tolerance toward dissenters of what might be called the "new medicine" is quickly eroding. . .
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Execution
  • Michael Cook* | The American state of Arkansas executed four prisoners in April. They were given a lethal injection with a three-drug cocktail, a procedure which requires some medical skills. Should doctors take part in such executions? . . . In an unusual intervention in the bitter debate, cardiologist Sandeep Jauhar has written an op-ed . . .arguing that the presence of doctors is ethical. . .
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Harm reduction

Give them sterile razors: controversial self-harm strategy

  • Michael Cook* |  Some people who self-harm should be provided with sterile razors, says a mental health expert in the Journal of Medical Ethics. Patrick Sullivan, of the University of Manchester, argues that this approach may be more respectful of patients' autononomy. He suggests that a harm-minimisation strategy for self-harming individuals could include provision of sterile cutting implements, education on how to self-injure more safely to avoid blood poisoning and infection, as well as therapy and alternative coping strategies. . . .
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Research

Complicity after the fact: moral blindness becomes a virtue and necessity
US scientists were "accomplices after the fact" in Japanese doctors' war crimes

  • Michael Cook* | . . .hundreds of Japanese medical personnel . . . experimented on Chinese civilians and prisoners of war  . . .They killed an estimated 3,000 people in the infamous Unit 731 in Harbin, in northeastern China before and during World War II – plus tens of thousands of civilians when they field-tested germ warfare. . . the Americans struck a deal with the doctors. They traded immunity from prosecution for access to scientific information from the ghastly Japanese experiments – many of which are too grim to detail here.
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Sedation

Consensus Guidelines on Analgesia and Sedation in Dying Intensive Care Unit Patients

  • Laura A Hawryluck* William RC Harvey* Louise Lemieux-Charles* Peter A Singer* | (Research Paper) Intensivists must provide enough analgesia and sedation to ensure dying patients receive good palliative care. However, if it is perceived that too much is given, they risk prosecution for committing euthanasia. The goal of this study is to develop consensus guidelines on analgesia and sedation in dying intensive care unit patients that help distinguish palliative care from euthanasia. . .
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Surgery

Is it ethical to refuse a patient surgery for body art?

  • Michael Cook* | The "bioartist" Stelarc has an ear surgically implanted on his forearm. Like him, a number of other people have hacked their own bodies with implants and prostheses. With growing interest in transhumanism, more and more people are likely to request enhancements to turn them into cyborgs. . .
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If sex reassignment surgery is the answer, what is the question?

  • Michael Cook* | Sex reassignment surgery requires the intervention of doctors. But what kind of treatment is it? Is it a therapy for a disease which should be offered only after psychiatric authorization? Or is it a biomedical enhancement which anyone can freely choose?. . .
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Conscientious objection to "patriarchal norms"
Hymen restoration and 'virginity certificates' in Sweden

  • Michael Cook*  |  Informed consent and conscientious objection are easy to fulminate about, but tricky to discuss with consistency. Take, for instance, the delicate topic of requests for hymen restorations and virginity certificates. Worldwide, an estimated 5,000 women were victims of honour killings in 2000. If a young woman from a culture which sanctions honour killing approaches a doctor, what should he or she do?
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Torture and interrogation

Doctors launch online pledge against torture

  • Michael Cook* | Physicians for Human Rights (PHR) has launched an online pledge for health professionals across the United States to reject torture as an absolute wrong which can never be sanctioned.
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Torture: sometimes a man's gotta do what a man's gotta do, say bioethicists

  • Michael Cook* | Torture is an issue on which the public might expect bioethicists to be moral absolutists. Never again! Never ever! It was somewhat surprising, then, to read in the New York Times that one of the world's leading animal rights theorists, Oxford's Jeff McMahan, support torture.
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Psychologists and Abusive Interrogations: Acting on Conscience

  • Dr. Mary Pipher* | . . . For the past few years, I have been troubled by various media and Department of Defense reports that psychologists have designed protocols and trained and supervised interrogators in the use of sophisticated methods for breaking the human spirit and destroying mental functioning . . .
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American Psychological Association removes infamous "Nuremberg Defense" from ethics code

  • Stephen Soldz* | . . . like every change in APA's policies on psychologists providing interrogation support, this change is too little too late. APA leadership waited till over a year after the end of the Bush regime and its "enhanced interrogation" torture program before changing this clause which provided protection for psychologists aiding the torturers. . .
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Vaccination

Compulsory Vaccination

  • Dave Stevens* | I spent a lot of time learning about immunization practices while a missionary in Africa. I had an isolation ward full of children with measles complications and a quarter of them died in the hospital. . . It is clear to me that Steve LeBlanc's, the author of this article, comments are less about immunizations and more about right of conscience. . .
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