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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers


Irving DN, Shamoo AE. Which ethics for science and public policy? Account Res 1993;3(2-3): 77-100 PMID: 11652298

Dianne Nutwell Irving, Adil E. Shamoo

  • The problem of inaccurate, misapplied or fraudulent scientific data could be addressed by government regulations, or by self-regulation from within science itself. To many, self-regulation implies the grounding of research activities in some "neutral"; standard of "ethics"; acceptable in a "pluralistic"; society. Yet, there is no such thing as a "neutral ethics"; and many "contemporary"; theories contain such serious theoretical deficiencies and contradictions that they are practically inapplicable. As a viable alternative to these theoretical and practical problems, an objectively based realistic framework of ethics is considered, and used to ground both the individual scientific and the collective public policy decision making processes. This is an ethics of properly integrated relationships. It is then applied to an analysis of many of the causes of incorrect scientific data, as well as of many of the internal and external pressures and abuses often experienced by scientists today. This approach respects the integrity of each decision maker as a human being and a moral agent - which in turn better insures the integrity of the protocol, the data, and the public policy decisions which follow - and ultimately, the integrity of the scientific enterprise itself. The alternative is government regulations.

Irving DN. The impact of "scientific misinformation" on other fields: philosophy, theology, biomedical ethics, public policy. Account Res 1993;2(4):243-72   PMID: 11652144

Dianne Nutwell Irving

  • Abstract: "Scientific misinformation" or inaccuracies are problematic within the field of science itself. However, perhaps few scientists are aware of or concerned about the possible impact which scientific misinformation apparently has on several other seemingly unrelated fields - e.g., philosophy, theology, biomedical ethics, and public policy. To demonstrate such an influence, I will take only one issue currently debated in these other fields -i.e., the biological "marker events of human personhood" during human embryogenesis, and trace the impact that seemingly contradictory scientific claims have had on the theoretical structures and practical conclusions of the several interrelated fields. Concern is expressed about the serious need for more accurate scientific input into these discussions and issues, and for scientists to help sort out which scientific data and theories are actually the most accurate and scientifically acceptable.

Begley AM. Beneficent voluntary active euthanasia: a challenge to professionals caring for terminally ill patients. Nurs Ethics 1998 Jul;5(4):294-306 PMID: 9782915¤

Ann-Marie Begley

  • For the purposes of this article, the term 'beneficent voluntary active euthanasia' (BVAE) will be used: beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means 'good death'.

This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community.

The aims of this article are: to generate debate among professionals; to present a threeway discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths.

Crosby, JF. There Is No Moral Authority in Medicine: Response to Cowdin and Tuohey.  Christian Bioethics 1998, Vol. 4, No. 1, pp. 63-82.

John F. Crosby

  • Abstract:  Central to the Cowdin-Tuohey paper is the concept of a moral authority proper to medical practitioners. Much as I agree with the authors in refusing to degrade doctors to the status of mere technicians, I argue that one does not succeed in retrieving the moral dimension of medical practice by investing doctors with moral authority. I show that none of the cases brought forth by Cowdin-Tuohey really amounts to a case of moral authority. Then I try to explain why no such cases can be found. Developing an insight that is common to all the major moral thinkers in the philosophia perennis, I show that doctors are professionally competent with respect only to a part of the human good; morally wise persons are competent with respect to that which makes man good as man. I try to show why it follows that a) professional expertise has no natural tendency to pass over into moral understanding, and that b) doctor and non-doctor alike start from the same point in developing their understanding of medical morality. It follows that the authors fail in their attempt to de-center the moral magisterium of the Church by setting up centers of moral authority outside of the Church.

Maeder T. Kindling a conscience for the biotech industry. Lancet 1998 Jun 27;351(9120): 1942 (News)   PMID: 9654277

Thomas Maeder

  • The most widespread human health problem is malnutrition. The "Green Revolution" has dramatically increased food production through the introduction of fertilisers and high-yield grain cultivars. The revolution was crucial to staving off large-scale starvation, but now a second wave of innovation is needed to meet the needs of a population that will double again in the next 30 years.

Muramoto O, Permanente K.   Bioethics of the refusal of blood by Jehovah's Witnesses: Part 1. Should bioethical deliberation consider dissidents' views? J Med Ethics 1998 Aug;24(4): 223-30 (Review) Erratum in: J Med Ethics 1998 Dec;24(6):375 Comment in: J Med Ethics. 2000 Oct;26(5):375-80. PMID: 9752623

Osamu Muramoto

  • Jehovah's Witnesses' (JWs) refusal of blood transfusions has recently gained support in the medical community because of the growing popularity of "no-blood" treatment. Many physicians, particularly so-called "sympathetic doctors", are establishing a close relationship with this religious organization. On the other hand, it is little known that this blood doctrine is being strongly criticized by reform-minded current andformer_JWs who have expressed conscientious dissentfrom the organization. Their arguments reveal religious practices that conflict with many physicians' moral standards. They also suggest that a certain segment of "regular" or orthodox J7Ws may have different attitudes towards the blood doctrine. The author considers these viewpoints and argues that there are ethicalflaws in the blood doctrine, and that the medical community should reconsider its supportive position. The usual physician assumption that JWs are acting autonomously and uniformly in refusing blood is seriously questioned.

Rubia Vila FJ.[The unconscious conscience] An R Acad Nac Med (Madr) 1998;115(2):483-95 (Addresses)  [Article in Spanish]   PMID: 9882835


Self DJ, Skeel JD. The moral reasoning of HEC members. HEC Forum 1998 Mar;10(1):43-54. PMID: 10178382

Donnie J. Self, Joy D. Skeel

  • In contrast to the teaching of medical ethics in the classroom, considerable interest has developed in recent years concerning clinical medical ethics activity in general, and hospital ethics committees (HECs) in particular. The initial development of medical ethics as an academic discipline was mostly classroom urientoo with an emphasis on getting curriculum time, primarily in the first two years of medical education (1)(2). In recent years there has been much more emphasis on expanding medical ethics into the clinical years in both clerkship and residency training as well as in direct patient care through the establishment of HECs and clinical ethics consultation services (3)(4). The activities of HECs and clinical ethics consultation services should always be to improve patient care, although there are many ways to accomplish that task. Ultimately all of these ways, however, should at least promote the principles of autonomy, beneficence, and justice and not just attempt to provide legal protection and risk management.

Spencer EM. Physician's conscience and HECs: friends or foes?  HEC Forum 1998 Mar;10(1):34-42  PMID: 10178381

  • Abstract:  No matter the future of healthcare financing and management, physicians of conscience and integrity must still be an important force in the consideration of ethical issues. The traditional role for the conscientious physician--being the only or even the major determinant of the morality of specific clinical decisions--is, for better or worse, no longer in effect. Much of this authority now belongs to patients and HECs are the mechanism within HCOs to help maintain this authority and to observe, comment on, recommend, and occasionally "regulate" the ethics of the healthcare arena. It is natural that these mechanisms for addressing areas of moral uncertainty create a certain tension. This tension should be acknowledged by conscientious physicians and HEC members. Total agreement on all moral issues in the clinical setting is impossible and should not be a goal. However, the respectful recognition of the importance of each perspective by both HEC members and conscientious physicians, and cooperation in developing effective mechanisms to address real differences, are possible and desirable. All who are interested in the ethics of healthcare now and in the future should support these endeavors.

von Post I.  Perioperative nurses' encounter with value conflicts. A descriptive study. Scand J Caring Sci 1998;12(2):81-8  PMID: 9801628

Iréne von Post

  • The aim of the study was to gain a better insight into perioperative nurses' experience in a value conflict that has arisen in the perioperative caring environment and how they deal with it. In order to obtain as full and objective a picture as possible the critical incident technique was chosen. Perioperative nurses were asked to write down stories about value conflicts which they have experienced in the perioperative caring environment. When interpreting the textual content of the stories the aim has been to understand the meaning of nurses' experiences and how the nurses act in a value conflict situation. A value conflict is something that nurses have become part of against their own will. They are prevented from giving the good care they want to give, they are in conflict with themselves and have a bad conscience, and they feel guilt and shame for not having prevented the value conflict. The nurse who is involved in a value conflict aims, for the sake of the patient, to be a professional caring nurse. The nurse chooses to be the patient's neighbour, the one who suffers along with the patient and represents the patient's cry for help.

Webb SL, Marshall MF, Boettcher F, Perlmutter M. Refusal of treatment by an adolescent: the deliverances of different consciences. HEC Forum 1998 Mar;10(1):9-23  PMID: 10178387¤

Sally L. Webb, Mary Faith Marshall, Flint Boettcher, Marty Perlmutter

  • Introduction: This paper describes and analyzes a problematic fictionalized case in health care ethics. Inherent in the case is the complex interplay between adolescent decision-making, clinical uncertainty and religious beliefs that most health care providers find alien and that challenge their professional norms. The paper examines the way the case unfolded, paying special attention to the "consciences" of the health care providers involved in the case, and ends with a few reflections on some of the conflicts of conscience that emerged.

Zoloth-Dorfman L, Rubin SB.  Insider trading: conscience and critique in bioethics. HEC Forum 1998 Mar;10(1):24-33  PMID: 10178380

Laurie Zoloth-Dorfman, Susan B. Rubin

  • Introduction: Practicing what we preach - One of the most unsettling questions that can be asked of any professional who purports to give advice and help people for a living is whether she practices what she preaches. The practice of bioethics and of medicine have much in common, but one of the unsettling parallels may well surround the difficulty in following our own best advice. In the healthcare arena as every other, it is only too easy to locate the contradictions: the physician who speaks of regular exercise and healthy nutrition over an extravagantly catered dinner meeting; the surgeon who lectures on informed consent and routinely fails to adequately to disclose patients the actual risks of surgery; the nurse who emphasizes truth telling and hesitates when directly asked her opinion; the respiratory therapist who smokes a pack a day; the ethicist who speaks of duty and virtue and yet falters when the strength of her moral fiber is at stake, or who teaches the centrality of courage and character but will fail when the character that is tested is his own. In each instance, one could note the obvious: it is enormously challenging to struggle with desire, and it takes skill and experience successfully to navigate the distance between theory and practice. . .