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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers


Benedict S, Kuhla J. West J.  Nurses' participation in the euthanasia programs of Nazi Germany. Nurs Res 1999 Apr;21(2):246-63 (Historical Article)  College of Nursing, Medical University of South Carolina, USA.PMID: 11512180

Susan Benedict, Jochen Kuhla

  • During the Nazi era, so-called euthanasia programs were established for handicapped and mentally ill children and adults. Organized killings of an estimated 70,000 German citizens took place at killing centers and in psychiatric institutions. Nurses were active participants; they intentionally killed more than 10,000 people in these involuntary euthanasia programs. After the war was over, most of the nurses were never punished for these crimes against humanity -  although some nurses were tried along with the physicians they assisted. One such trial was of 14 nurses and was held in Munich in 1965. Although some of these nurses reported that they struggled with a guilty conscience, others did not see anything wrong with their actions, and they believed that they were releasing these patients from their suffering.

Collett T S.  The Common Good and the Duty to Represent: Must the Last Lawyer in Town Take Any Case?  40 S. Tex. L. Rev. 137 (1999)

Teresa Stanton Collett

  • Ask any American lawyer whether there is a duty to represent any particular person or cause, and I suspect you will get a swift and emphatic "no."' Give the lawyer a little time for reflection, and he or she might modify the answer to "well... not unless the court appoints the lawyer to represent the client."  Ask if there are any other circumstances in which a lawyer may have a moral duty to undertake representation, and some lawyers will maintain that there is a duty to represent prospective clients who are too poor to have any other real options in obtaining legal services. Probe further still, and those well versed in the literature of professional responsibility may amend their answers to suggest a duty to represent prospective clients in those cases where the' lawyer is "the last lawyer in town," and the prospective client has no other reasonable expectation of obtaining legal representation.

Dickens BM, Cook RJ.  Some legal and ethical issues in assisted reproductive technology.  Int J Gynaecol Obstet. 66 (1999) 55-61

  • Abstract:  The potential and actual applications of reproductive technologies have been reviewed by many governmental committees, and laws have been enacted in several countries to accommodate, limit and regulate their use. Regulatory systems have nevertheless left some legal and ethical issues unresolved, and have caused other issues to arise. Issues that regulatory systems leave unresolved, or that systems have created, include disposal of embryos that remain after patients' treatments are concluded, and multiple implantation and pregnancy. This may result in risks to maternal, embryonic and neonatal life and health, and the contentious relief that may be achieved by selective reduction of multiple pregnancies. A further concern arises when clinics must or choose to publicize their success rates, and they compete for favorable statistics by questionable patient selection criteria and treatment priorities.

Freeman JW. Collective conscience: the ethics committee and community.  S D J Med 1999 Jun;52(6):185-8 (Editorial)PMID: 10388342


Harvey SE, Lu EL, Rivas O, Rodgers J.  Do pharmacists have the right to refuse to dispense a prescription based on personal beliefs?  New Mexico Pharmacy Association¤

Stephanie E. Harvey,  Ei-Lun Lu, Oscar Rivas, Julie Rodgers

  • Introduction:  The purpose of this article is to discuss legal and ethical issues regarding the pharmacist's right to refuse to dispense based on personal beliefs. Five ethical principles - nonmaleficence, beneficence, autonomy, loyalty, and justice are used to deliberate the issue. Legal facts are used to clarify the position that pharmacists may find themselves in should the decision to refuse to dispense be made. It is imperative that pharmacists assume responsibility for reducing the severity of the implications of this issue by taking a proactive approach in considering the impact of these and other moral dilemmas before they are presented in the workplace. The recommendation is made that each state, employer, pharmaceutical organization, and individual pharmacist develop, communicate, and implement a conscience clause that protects the pharmacist's rights without denying the patient access to treatment. A conscience clause is a declaration of conscientious objection to an issue. It explains the position a person, organization, or entity takes on a specific moral issue. The conscience clause can be used as an opening for discussion between all relevant parties. These measures are intended to limit problems that may arise by minimizing conflict in the workplace and preventing legal battles in the courtroom while providing outstanding patient care. . .

Monsanto HA, Fabregas SM, Velez AE. Adoption of a pharmacist conscience clause by Professional Associations and Boards of Pharmacy in the United States. P R Health Sci J 1999 Dec;18(4):401-4  PMID: 10730309

H.A. Monsanto, S.M. Fabregas, A.E. Velez

  • Objective: To determine the number of professional associations and boards of pharmacy in the United States that have adopted or are considering to adopt a conscience clause as part of their codes of ethics, rules, laws or regulations.

Background: Pharmacists are often exposed to ethical dilemmas in their day-to-day practice and their response depends on a number of factors, including the personal beliefs and values of those involved. This has lead some professional associations to address whether their members have the right to refuse to participate in procedures which are contrary to their conscience or moral convictions. The outcome of these discussions is usually the development and adoption of a conscience clause.

Methods: A one-page self-administered questionnaire was sent by Fax to the highest ranking officer of 108 pharmacy organizations in the United States.

Results: Thirty-five completed questionnaires were received for a 32.4% response rate. In general, it was found that there is a lack of knowledge as to what a conscience clause is. Only two state associations and one board of pharmacy responded that they have a conscience clause as part of their code of ethics or regulations. Reasons given for not having a conscience clause included lack of interest and low priority. Nevertheless, four state associations, one national association and one board of pharmacy responded that they are considering developing a pharmacist conscience clause. More professional associations than boards of pharmacy expressed interest to obtain information about conscience clauses.

Conclusion: Although many state associations and boards of pharmacy that responded do not have a conscience clause as part of their codes of ethics, laws or regulations, this survey shows an increasing interest to learn about it. This is expected as the pharmacist assumes increasing responsibility in patient care.

Ridley DT  Jehovah's Witnesses' refusal of blood: obedience to scripture and religious conscience. Med Ethics 1999 Dec;25(6):469-72 [Comment in: J Med Ethics. 1999 Dec;25(6):463-8; J Med Ethics. 2000 Oct;26(5):375-80; J Med Ethics. 2000 Oct;26(5):381-6]  PMID: 10635500

Donald T. Ridley

  • Jehovah's Witnesses are students of the Bible. They refuse transfusions out of obedience to the scriptural directive to abstain and keep from blood. Dr Muramoto disagrees with the Witnesses' religious beliefs in this regard. Despite this basic disagreement over the meaning of Biblical texts, Muramoto flouts the religious basis for the Witnesses'position. His proposed policy change about accepting transfusions in private not only conflicts with the Witnesses' fundamental beliefs but it promotes hypocrisy. In addition, Muramoto's arguments about pressure to conform and coerced disclosure of private information misrepresent the beliefs and practices ofJehovah's Witnesses and ignore the element of individual conscience. In short, Muramoto resorts to distortion and uncorroborated assertions in his effort to portray a matter of religious faith as a matter of medical ethical debate.

Thatcher C.  Conscience clause: moral compromise.  CPJ. Canadian Pharmaceutical Journal 132.7 (Sep 1999): 10-11

Chris Thatcher

  • Abstract: Conscience clauses are not new, but the idea gained prominence in California in 1996 when the state pharmacy association passed a policy to recognize pharmacists' rights of conscience and guaranteed that the association would protect those who objected to the performance of any act on ethical, moral or religious grounds. In a 1997 article for The California Pharmacist, Richard Abood and David Brushwood, both pharmacy law and ethics professors, made the case that conscientious objection does have its limits. "The patient's right to receive medication is worthy of as much respect as is the pharmacist's rights of conscience...It is improper to assert conscientious objection to deny therapy to a patient. Conscientious objection is not a 'trump card' that automatically defeats all other interests." When the morning-after-pill came on market, the Washington State Pharmacists Association avoided a conscience clause by conducting an exhaustive education campaign. In over 50 training sessions, it spelled out what the pill actually does and what the pharmacist's responsibilities are; "that resulted in virtually no opposition to providing the service and no organized movement to impose a conscience clause," said Don Downing, pharmaceutical care coordinator. Pharmacists may refuse, he said, but they must refer the patient. Downing also raised the always present issue of legal liability. "If you deny the only option available to that woman, and it's a recognized standard of care, you have some risk exposure that you'll have to live with and it may not be very nice."

White KA. Crisis of conscience: reconciling religious health care providers' beliefs and patients' rights. Stanford Law Rev 1999 Jul;51(6):1703-49. PMID: 10558539

Katherine A. White

  • In this note, Katherine A. White explores the conflict between religious health care providers who provide care in accordance with their religious beliefs and the patients who want access to medical care that these religious providers find objectionable. Specifically, she examines Roman Catholic health care institutions and HMOs that follow the Ethical and Religious Directives for Catholic Health Care Services and considers other religious providers with similar beliefs. In accordance with the Directives, these institutions maintain policies that restrict access to "sensitive" services like abortion, family plan- ning, HIV counseling, infertility treatment, and termination of life-support. White explains how most state laws protecting providers' right to refuse treatments in conflict with religious principles do not cover this wide range of services. Furthermore, many state and federal laws and some court decisions guarantee patients the right to receive this care. The constitutional complication inherent in this provider-patient conflict emerges in White's analysis of the interaction of the Free Exercise and Establishment Clauses of the First Amendment and patients' right to privacy. White concludes her note by exploring the success of both provider-initiated and legislatively mandated compromise strategies. She first describes the strategies adopted by four different religious HMOs which vary in how they increase or restrict access to sensitive services. She then turns her focus to state and federal "bypass" legislation, ultimately concluding that increased state supervision might help these laws become more viable solutions to provider-patient conflicts.