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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers



Boyle J. Radical moral disagreement in contemporary health care: a Roman Catholic perspective. J Med Philos 1994 Apr;19(2):183-200 PMID: 8051516 

J. Boyle

  • Abstract: This paper addresses the moral challenges presented by the existence of radical moral disagreement in contemporary health care. I argue that there is no neutral moral perspective for understanding and resolving these challenges, but that they must be formulated and resolved from within the various perspectives that generate the disagreement. I then explore the natural law tradition's approach to these issues as a test case for my thesis.

Callahan D.  Bioethics:  Private choice and common good. Hastings Cent Rep 1994 May-June; 24(3):31.

Daniel Callahan

  • Almost from its start bioethics has been a child of its time, and a child of good fortune at that. In his 1954 book Medicine and Morals, Joseph Fletcher ventured the idea of personal choice as the highest moral value and the struggle against nature as medicine's most liberating mission. That was a bold combination at the time, but it turned out to have been prophetically popular, and by the late 1960s its force was becoming apparent not only in medicine but in the fledgling field of bioethics. Fletcher's grand themes needed only to be complemented by another great theme of the times, justice and equality, to catch fully that era in midflight. . .

Cannold L. J Med Ethics 1994 Jun;20(2):80-6 Consequences for patients of health care professionals' conscientious actions: the ban on abortions in South Australia.  PMID: 8083879

Leslie Cannold

  • The legitimacy of the refusal of South Australian nurses to care for second trimester abortion patients on grounds of conscience is examined as a test case for a theory of permissible limits on the autonomy of health care professionals. In cases of health care professional (HCP) conscientious refusal, it is argued that a balance be struck between the HCPs' claims to autonomous action and the consequences to them of having their autonomous action restricted, and the entitlement of patients to care and the consequences for them of being refused such care. Conscientious action that results in the disruption or termination of health care services, however, is always impermissible on two grounds. Firstly, because it is at this point that the action '... invades a patient's autonomy, puts a patient at serious risk ... [and] treats a patient unjustly' (1) Secondly, because the consequences of such refusals turn them into political acts - acts of civil disobedience. It is arguable that in order for acts of civil disobedience to be legitimate, certain obligations are required of the dissenter by the community. It is concluded that the actions of the South Australian nurses, which have over the last few years both terminated and disrupted second trimester services, are morally impermissible.

Cugliari AM, Miller TE. Moral and religious objections by hospitals to withholding and withdrawing life-sustaining treatment. J Community Health 1994 Apr;19(2):87-100 PMID: 8006212

Anna Maria Cugliari, Tracy E. Miller

  • Abstract: A patient's right to decide about life-sustaining treatment may conflict with the policies of health care facilities that refuse on the basis or religious or moral convictions to honor certain decisions to forgo treatment. The New York State Task Force on Life and the Law examined the prevalence and nature of facility conscience objections to the refusal of life-sustaining treatment by conducting a survey of New York hospitals. Written questionnaires were distributed to hospitals in New York State. Fifty-eight percent of the New York State hospitals responded. Twenty-nine percent of the respondents indicated that their hospital would object on grounds of conscience either to withholding or to withdrawing life-sustaining treatment in at least one of the twelve hypothetical cases presented. Hospitals were more likely to have "no policy" for withdrawing than tbr withholding treatment. Only 10% of the hospitals that would object to decisions to forgo treatment on religious or moral grounds had stated the objections in writing. The patient's medical condition and the type of life-sustaining treatment to be withdrawn or withheld are important factors in determining whether a hospital will object on grounds of conscience. The imminence of death appeared more decisive than the degree of debilitation or disability as a factor in the willingness to accept decisions to forgo life-sustaining treatment. Hospitals should establish clear, written policies about their objections to forgoing treatment so that patients and their families can evaluate whether the facility meets their needs.

Denstedt-Stigzelius I. [The right to have a conscience] Lakartidningen 1994 Jun 22;91(25):2491 (Letter)  [Article in Swedish]  PMID: 8046956

I. Denstedt-Stigzelius


Dooley D. Conscientious refusal to assist with abortion. BMJ 1994 Sep 10;309(6955):622-3 (Editorial) [Comment in: BMJ. 1994 Dec 10;309(6968):1582.]  PMID: 8086982

Dolores Dooley

  • Claims of conscience by doctors and nurses almost always relate to substantial moral issues that touch closely on their identity and integrity. Abortion is such an issue. Agreement among reasonable and sincere individuals often seems beyond reach. Ethical reasoning promises no conclusive resolution but might constructively help us to understand the sources of disagreement and search for shared principles in the differences. . .

Dresser RS.  Freedom of conscience, professional responsibility, and access to abortion. J Law Med Ethics 1994 Fall;22(3):280-5PMID: 7749485 

Rebecca S. Dresser

  • Acess to abortion is becoming increasingly restricted for many women in the United States. Besides the longstanding financial barriers facing low-income women in most states, a newer source of scar­ city has emerged. The relatively small number of physicians willing to perform the procedure is compromising the ability of women in certain parts of the country to obtain an abortion. Do physicians have a duty to respond to this situation? Do they have a professional responsibility to ensure that abortions are reasonably available to the women who want to terminate their pregnancies? Or, is abortion so morally and socially controversial as to remove any professional obligation to provide reasonable access?

Eisgruber CL, and Sager,LG. The Vulnerability of Conscience: The Constitutional Basis for Protecting Religious Conduct.  he University of Chicago Law Review  Vol. 61, No. 4 (Autumn, 1994), pp. 1245-1315.  

Christopher L. Eisgruber, Lawrence G. Sager

  • In Employment Division, Department of Human Resources of Oregon v Smith, the Supreme Court held that members of the Native American Church were not constitutionally entitled to ingest peyote as part of their religion's sacrament in the face of an Oregon law outlawing the use of peyote. Many aspects of the Smith decision have been sharply criticized, but none so much as the general view of religious exemptions announced by Justice Scalia's opinion for the Court. Justice Scalia distinguished freedom of religious belief from behavior driven by religious belief, and further distinguished laws directed at religion from general laws that merely collide with behavior driven by religious belief. That work done, Justice Scalia had a simple and flat response to the constitutional claimants in Smith: religious believers have no constitutional license to disregard otherwise-valid general laws that conflict with the dictates of their religion. . .

Enheten NT. [Clauses of conscience in education. A conflict between students and patients] Lakartidningen 1994 Nov 16;91(46):4289-90 [Article in Swedish]  PMID: 7808134

N.T. Enheten


Hafferty FW, Franks R. The hidden curriculum, ethics teaching, and the structure of medical education. Acad Med  1994 Nov;69(11):861-71 (Review) PMID: 7945681

Frederick W. Hafferty, Ronald Franks

  • Abstract: The authors raise questions regarding the wide-spread calls emanating from lay and medical audiences alike to intensify the formal teaching of ethics within the medical school curriculum. In particular, they challenge a prevailing belief within the culture of medicine that while it may be possible to teach information about ethics (e.g., skills in recognizing the presence of common ethical problems, skills in ethical reasoning, or improved understanding of the language and concepts of ethics), course material or even an entire curriculum can in no way decisively influence a student's personality or ensure ethical conduct. To this end, several issues are explored, including whether medical ethics is best framed as a body of knowledge and skills or as part of one's professional identity. The authors argue that most of the critical determinants of physician identity operate not within the formal curriculum but in a more subtle, less officially recognized "hidden curriculum." The overall process of medical education is presented as a form of moral training of which formal instruction in ethics constitutes only one small piece. Finally, the authors maintain that any attempt to develop a comprehensive ethics curriculum must acknowledge the broader cultural milieu within which that curriculum must function. In conclusion, they offer recommendations on how an ethics curriculum might be more fruitfully structured to become a seamless part of the training process.

Law SA. Silent no more: physicians' legal and ethical obligations to patients seeking abortions. Rev Law Soc Change 1994-1995;21(2):279-321 PMID: 11660619

Sylvia A. Law

  • Introduction: More than half of the pregnancies among American women are unintended, and half of these are terminated by abortions; in 1988, 1.6 million abortions were performed in the United States. Often, a woman is informed by a physician or other health care provider that she is pregnant. This Article explores the ethical and medical principles that should guide physicians and other health care providers in conversations that follow the confirmation of pregnancy. It argues that physicians should not automatically assume that a pregnant woman wants to continue or end the pregnancy. Rather, the doctor should ask the woman what her reaction is to the news that she is pregnant, and provide medical information informing the patient of her choices. The physician should then refer her to those appropriate medical services that he or she does not personally provide. . .

Nyman K. [Parliament says no to conscience clause]Vardfacket 1994 Jun 2;18(10):11 [Article in Swedish]  PMID: 7801680

K. Nyman


Pellegrino ED. Patient and physician autonomy: conflicting rights and obligations in the physician patient relationship. 10 J. Contemp. Health L. & Pol'y 47 1994

Edmund D. Pellegrino

  • For centuries, physician beneficence went unchallenged as the first principle of medical ethics. To be sure, some physicians had, at times, violated this principle. But no creditable ethical opposition was mounted until a quarter of a century ago when patient autonomy was asserted as a prima facie moral principle of equal or greater weight than beneficence.' Progressively since then, patient autonomy has become the dominant principle shaping physician-patient relationships.

Three serious moral conflicts have emerged as a result: first, beneficence and autonomy have been polarized against each other when they should be complementary; second, the physician's moral claim to autonomy has received little attention; and third, the "autonomy" of medical ethics, itself, has come under a serious threat. This essay will examine each of these three consequences resulting from the rise of patient autonomy. . .

Wear S, Lagaipa S, Logue G. Toleration of moral diversity and the conscientious refusal by physicians to withdraw life-sustaining treatment. J Med Philos 1994 Apr;19(2):147-59   PMID: 8051514 

S. Wear, S. Lagaipa, G. Logue

  • Abstract: The removal of life-sustaining treatment often brings physicians into conflict with patients. Because of their moral beliefs physicians often respond slowly to the request of patients or their families. People in bioethics have been quick to recommend that in cases of conflict the physician should simply sign off the case and "step aside". This is not easily done psychologically or morally. Such a resolution also masks a number of more subtle, quite trouble some problems that conflict with the commitment to toleration and moral diversity that it is intended to support. These conflicts are detailed and evaluated.