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.
- 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.
- 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
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
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
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. . .