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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers



Bassett WW. Private religious hospitals: limitations upon autonomous moral choices in reproductive medicine. J Contemp Health Law Policy. 2001 Summer;17(2):455-583. PMID: 11475568

William W. Basset

  • Abstract: Contemporary managed care imperatives have severely limited an individual's right to make free and informed choices regarding his or her own health care. The author posits that legislation allowing private, religiously affiliated hospitals to refuse patient requests for legitimate health care services - particularly reproductive medicine - must be reconsidered.

Ethical exemptions allowing religious hospitals to refuse sensitive and controversial medical services such as abortion, sterilization and prescription of contraceptive drugs, AIDS counseling, and fertilization are virtually unlimited. However, these institutional privileges cannot remain absolute. Private hospital exemptions should be re-written, with clear limitations conditioned upon newly evolving public policy imperatives for informed choice in comprehensive patient health care plans.

Daverschot M, van der Wal H. The position of nurses in the new Dutch euthanasia bill: a report of legal and political developments. Ethics Med. 2001 Summer;17(2):85-92. PubMed PMID: 15069982.

Marianne Daverschot, Hugo Van Der Wal

  • Introduction:  In the autumn of 2000, opposing views on euthanasia and physician-assisted suicide clearly came to light when members of the Second Chamber of the Dutch Parliament discussed the new euthanasia Bill, titled `Review Procedures For The Termination Of Life On Request And Assisted Suicide. . .

de Kantor IN. [Conscience objection]. Medicina (B Aires). 2001;61(1):115. Spanish. PubMed PMID: 11265614.


Dickens BM. Reproductive health services and the law and ethics of conscientious objection. Med Law. 2001;20(2):283-93. Review. PubMed PMID: 11495210.

Bernard M. Dickens

  • Abstract:  Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation, in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians' conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses' claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health-related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.

Gigli GL. The importance of the Catholic obstetrician-gynaecologist for the presence of the Church in the world of health and health care. Dolentium Hominum. 2001;16(3):78-80. PubMed PMID: 12577887.


Kahn JP, Mastroianni AC. Moving from compliance to conscience: why we can and should improve on the ethics of clinical research. Arch Intern Med. 2001 Apr 9;161(7):925-8. Review. PubMed PMID: 11295954.

Jeffrey P. Kahn, Anna C. Mastroianni

  • The ethics of clinical research are long-standing; researchers confronted ethical issues long before the implementation of federal oversight and regulations and continue to be challenged by the sometimes fuzzy distinctions between ethically acceptable and ethically unacceptable research. New technologies (gene therapy, stem cell transplants, and bioartificial organs, to name a few) raise new ethical issues, but at the same time, so many of the issues that researchers must deal with are recurring. This is a time not only of great opportunity and promise for the pursuit of biomedical research, but also of great responsibility.

Kissling F. The place for individual conscience. J Med Ethics. 2001 Oct;27 Suppl 2:ii24-7. PubMed PMID: 11574655; PubMed Central PMCID: PMC1765545.

Frances Kissling

  • Abstract: From a liberationist, feminist, and Catholic point of view, this article attempts to understand the decision of abortion. People are constantly testing their principles and values against the question of abortion. Advances in technology, the rise of communitarianism and the rejection of individualism, and the commodification of children are factors in the way in which the abortion debate is being constructed in society. The paper offers solutions to end the ugliness of the abortion debate by suggesting that we would be able to progress further on the issue of abortion if we looked for the good in the opposing viewpoint. The article continues with a discussion of Catholics For a Free Choice's position on abortion, and notes firstly that there is no firm position within the Catholic Church on when the fetus becomes a person; secondly that the principle of probablism in Roman Catholicism holds that where the church cannot speak definitively on a matter of fact (in this case, on the personhood of the fetus), the consciences of individual Catholics must be primary and respected, and thirdly that the absolute prohibition on abortion by the church is not infallible. In conclusion, only the woman herself can make the abortion decision.

Lejarraga H. [Conscience objection]. Medicina (B Aires). 2001;61(3):377-8. Spanish. PubMed PMID: 11474892.


May T. Rights of conscience in health care. Soc Theory Pract. 2001 Jan;27(1):111-28. PubMed PMID: 12564446.

Thomas May

  • Professional life in a liberal constitutional society involves a balancing of values between professional and client. While this is most commonly accomplished through negotiation, in some areas of life the values in question are so fundamental and important that negotiated compromise is difficult, if not impossible. This is especially true in health care, where the values at stake are attached to issues of life and death, and the fundamental capacities and abilities that give meaning to people's lives. Because health care touches upon profound issues of life, death and quality of life, the practice of health care can at times call for participation in activities that some health care professionals might find morally inappropriate. Requests for physician-assisted suicide, abortion, euthanasia, and the withdrawal or withholding of life support are just a few examples of controversial issues that leave little room for conqjromise. . .

Myers RS. On the need for a federal conscience clause. Natl Cathol Bioeth Q. 2001 Spring;1(1):23-6. PubMed PMID: 12862052.


Puntillo KA, Benner P, Drought T, Drew B, Stotts N, Stannard D, Rushton C, Scanlon C, White C. End-of-life issues in intensive care units: a national random survey of nurses' knowledge and beliefs. Am J Crit Care. 2001 Jul;10(4):216-29. PubMed PMID: 11432210.

K.A. Puntillo, P. Benner, T. Drought, B. Drew, N. Stotts, D. Stannard, C. Rushton, C. Scanlon, C. White

  • Objective: To investigate the knowledge, beliefs, and ethical concerns of nurses caring for patients dying in intensive care units.

Methods: A survey was mailed to 3000 members of the American Association of Critical-Care Nurses. The survey contained various scenarios depicting end-of-life actions for patients: pain management, withholding or withdrawing life support, assisted suicide, and voluntary and nonvoluntary euthanasia.

Results: Most of the respondents (N = 906) correctly identified the distinctions among the end-of-life actions depicted in the scenarios. Almost all (99%-100%) agreed with the actions of pain management and withholding or withdrawing life support. A total of 83% disagreed with assisted suicide, 95% disagreed with voluntary euthanasia, and 89% to 98% disagreed with nonvoluntary euthanasia. Most (78%) thought that dying patients frequently (31%) or sometimes (47%) received inadequate pain medicine, and almost all agreed with the double-effect principle. Communication between nurses and physicians was generally effective, but unit-level conferences that focused on grief counseling and debriefing staff rarely (38%) or never (49%) occurred. Among the respondents, 37% had been asked to assist in hastening a patient's death. Although 59% reported that they seldom acted against their consciences in caring for dying patients, 34% indicated that they sometimes had acted against their conscience, and 6% had done so to a great extent.

Conclusions: Intensive care unit nurses strongly support good pain management for dying patients and withholding or withdrawing life-sustaining therapies to allow unavoidable death. The vast majority oppose assisted suicide and euthanasia. Wider professional and public dialogue on end-of-life care in intensive care units is warranted.

Sloboda M. The high cost of merging with a religiously-controlled hospital. Berkeley Womens Law J. 2001;16:140-56. PubMed PMID: 15233116.

Monica Sloboda

  • Introduction:  Increasingly, public and privately-owned hospitals are merging with religious health care systems, which are often Catholic. Many hospitals experiencing financial troubles assert that merging with a religious health care system is the only way to stay in business.  However, the nonfinancial cost for saving a hospital in this manner may be severe. Such mergers may reduce or eliminate women's health services in the affected communities, especially abortion. contraception, sterilization, infertility services, and emergency contraception for rape survivors. The women most affected by these cutbacks are low-income and minority women, particularly those living in rural areas, because these women have fewer health care options.  This essay will provide a brief overview of the growing trend of these hospital mergers, the resulting loss of women's health services,' and the various legal and grass-roots methods that activists have employed to preserve full access to women's health services.

Spital A. Ethical issues in living organ donation: donor autonomy and beyond. Am J Kidney Dis. 2001 Jul;38(1):189-95. PubMed PMID: 11431202.

Aaron Spital

  • Abstract: Despite nearly 50 years of experience with living kidney donation, ethical questions about this practice continue to haunt us today. In this editorial I will address two of them: (1) Given the possibility of limited understanding and coercion, how can we be sure that a person who offers to donate an organ is acting autonomously? and (2) Do people have a right to donate? The universal requirement for informed consent is the traditional method for ensuring that a person is acting autonomously. But, while obtaining fully informed consent is desirable, it may not always be achievable or necessary. When the recipient is very dear to the potential donor, the donor may base his decision primarily on care and concern rather than on a careful weighing of risks and benefits. I will argue that consent that emanates from such deep affection should be considered just as valid as consent that is fully informed. But consent is not enough. There is no absolute right to donate an organ. If there were such a right, then some physician would be obligated to remove an offered organ upon request, regardless of the risks involved. I do not believe that physicians have such an obligation. Physicians are moral agents who are responsible for their actions and for the welfare of their patients. Therefore, while the values and goals of the potential donor should be given great weight during the decision-making process, physicians may justifiably refuse to participate in living organ donation when they believe that the risks for the donor outweigh the benefits.

Thompson WT, Cupples ME, Sibbett CH, Skan DI, Bradley T. Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study. BMJ. 2001 Sep 29;323(7315):728-31. PubMed PMID: 11576981; PubMed Central PMCID: PMC56892.

William T. Thompson, Margaret E. Cupples, Caryl H. Sibbett, Delia I. Skan, Terry Bradley

  • Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues.

Design: Qualitative study using focus groups and indepth interviews.

Setting: Primary care in Northern Ireland.

Participants: 27 general practitioners, including six recendy appointed principals and six who also practised occupational medicine part time.

Main outcome measures: Participants' views about their own and colleagues' health.

Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise.

Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

von Cranach M.  The Killing of Psychiatric Patients in Nazi-Germany between 1939 – 1945.  Paper presented at a meeting of the Israel Psychiatric Association, Jerusalem, 6th of December 2001. 

M. von Cranach

Abstract:  Between 1939 and 1945 180.000 psychiatric patients were killed in Nazi-Germany. After a brief introduction reflecting the ways of and reasons for addressing this issue today, the details of the so called euthanasia program are presented: The killing of patients by gas in special hospitals between 1939 and 1941 in its first phase and the continuation in the psychiatric hospitals until 1945. In this second phase patients were killed with lethal injections and through the introduction of a hunger diet. The fate of the Jewish patients and forced labourers as well as human experiments are mentioned. Finally some thoughts are presented to answer the question of why this could happen. The giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul.

Weber L, Bissel MG. Employee conscientious objection. Clin Leadersh Manag Rev. 2001 Mar-Apr;15(2):114-5. PubMed PMID: 11299902.


Zoloth L.  Limiting Access to Medical Treatment in an Age of Medical Progress: Developing a Catholic Consensus: A Response from Jewish Tradition. Christian Bioethics  2001, Vol. 7, No. 2, pp. 193-201

Laurie Zoloth

The efforts of Christian colleagues to articulate a clear framework of specific Christian moral values to assess clinical treatments are a necessary contribution to the debates about justice and resource allocation in health care. Such efforts not only make clear the way in which all such judgement is located, understood and interpreted from a particular social venue and from a particular ethical stance; finding one's moral location is the first task of critical theory and concomitant practice. The clinical epistemology required in medical resource allocation is framed by cultural and theological stance just as surely as any knowledge, and Christians must be fully responsible for making overt the often covert assumptions that undergird such work. It is only after such clarity and definition that it is possible to make the shared, civic negotiations for allocation, speaking in comprehensible moral sentences about justice and limits in a language held in common by a plurality of different religious traditions. . .