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Protection of Conscience Project

Service, not Servitude
Periodicals & Papers


Adams KE. Ethical issues in gynecology: adolescent confidentiality, provider conscience and abortion, and patient choice of provider gender. Curr Womens Health Rep. 2002 Dec;2(6):423-8. PubMed PMID: 12429075.

  • Abstract: All medical specialists struggle with problems that cannot be solved with medical knowledge alone. The field of gynecology is not unique in medicine for the presence of ethical dilemmas, but the nature of the dilemmas are unique. Gynecologists commonly confront complex ethical questions in their practices that can be answered only through thoughtful consideration of the values, interests, rights, goals, and obligations of those involved. In this paper, three ethical issues that commonly arise in the practice of gynecology are presented: adolescent confidentiality regarding reproductive health services, physician conscience and provision of abortion services, and the question of accommodating patient choice of provider gender. Each topic is introduced with a case vignette followed by an analysis of the issues involved and recommendations for resolution.

Bagaric M, Amarasekara K. Euthanasia: why it doesn't matter (much) what the doctor thinks and why there is no suggestion that doctors should have a duty to kill. J Law Med. 2002 Nov;10(2):221-31. PubMed PMID: 12497736.

  • Abstract:  A major reason that The Netherlands has taken a different approach to the rest of the world on such a fundamental moral issue is that the courts and legislature in that country have accorded the interests of doctors a cardinal role in the euthanasia debate. This article argues that the interests of doctors are of only incidental and peripheral relevance in relation to the moral status of euthanasia. The moral status of euthanasia has little to do with the preparedness of doctors to administer the lethal injection or their general attitude towards the practice. Euthanasia is principally about the interests of the patient and the impact that the practice may have on the community in general, not preserving the conscience or improving the working life of doctors.

Bleich JD. The physician as a conscientious objector. Fordham Urban Law J. 2002 Nov;30(1):245-65. PubMed PMID: 15868672.

J. David Bleich

  • Rabbinic lore relates an anecdote, probably apocryphal, portraying a lively student who flits from person to person in the study hall. To each one he says, I have an answer. Ask me a question! I do not claim to have a resolution to the dilemma posed when a conflict arises between a patient's rights and a physician's conscience, certainly not a facile one. My real task is to convince those in a position to implement a solution that a problem exists and that it merits serious consideration. Patient autonomy certainly deserves both moral respect and legal protection, but to demand of a physician that she act in a manner she deems to be morally unpalatable not only compromises the physician's ethical integrity, but is also likely to have a corrosive effect upon the dedication and zeal with which she ministers to patients. . .

Charles J. Mandatory overtime: conflicts of conscience? JONAS Health Law Ethics Regul. 2002 Mar;4(1):10-2. PubMed PMID: 11924250.

Jennell Charles

  • A press release dated July 12, 2001, was titled Ohio Nurses Association: Going to the Hospital? Nurses Warn: Don't Count on Safe Care. In that press release, Joyce Shaffer, RN, writes that "patients are at risk in our hospitals because there aren't enough registered nurses on staff or on duty, hospital cost-cutting has put nurses at risk, too, assigning responsibility for more patients than we can safely care for and forcing mandatory overtime that's stressful, increases errors, and jeopardizes our own health." . . .

Chervenak FA, McCullough L. A group practice disagrees about offering contraception. Am Fam Physician. 2002 Mar 15;65(6):1230, 1233. PubMed PMID: 11925099.

Frank A. Chervenak, Laurence McCullough

  • Case Scenario: At one of our group-practice meetings, we agreed that we could not require partners to perform services to which they had moral objections. For example, some of us had wanted to offer our patients medical abortion, but we had agreed that none of us would offer this service so we could accommodate the views of our other partners. The discussion led to some soul searching, during which time some of our physicians said that they were morally opposed to prescribing birth control. We therefore agreed that, in keeping with our effort to present a unified policy, we also could not offer prescription birth control. However, this conclusion created an uncomfortable situation because it meant that to accommodate the religious views of some of our physicians, we would have to deny important medical services to thousands of patients who did not have many health care options. In addition, the moral issues became economic issues because so many of our patients come to us seeking contraceptive management. Many patients became angry and left our practice when they were told that their physician would no longer prescribe birth control. The issue threatened to break up our group. . .

Gambino G, Spagnolo AG. Ethical and juridical foundations of conscientious objection for health care workers. Med Etika Bioet. 2002 Spring-Summer;9(1-2):3-5. PubMed PMID: 16276661.

  • Abstract: In front of the evolution of medicine and biotechnology, health care workers are called upon to take part within new biomedical practices, that may overcome the limit of acceptability, as it is perceived by their moral conscience. Issues as abortion, euthanasia, assisted suicide, artificial fertilisation, experimentation on human embryos and prescription of contraceptives and abortifacients call into play the right to conscientious objection of health care personnel, and in some cases, perhaps of physicians and pharmacists too. This recall--already present in many codes of professional conduct and medical ethics--sounds today as a necessity, which asks for a serious deepening of the content, the applicability and the new hypothesis of conscientious objection, in the light of bioethics and law. In particular, the self-determination and often exasperated autonomy of the patient within these practices makes a new principle of professional integrity arise, to protect the physician's conscientious convictions, if the request of the patient or society seem to violate some fundamental human values.

Harte C. Inconsistent papal approaches towards problems of conscience? Natl Cathol Bioeth Q. 2002 Spring;2(1):99-122. PubMed PMID: 12854570.


Harvey  MT, What does a 'right' to physician-assisted suicide (PAS) legally entail? Theoretical Medicine 23: 271–286, 2002.

M.T. Harvey

  • Abstract. "What Does a Right to Physician-Assisted Suicide (PAS) Legally entail?" Much of the bioethics literature focuses on the morality of PAS but ignores the legal implications of the conclusions thereby wrought. Specifically, what does a legal right to PAS entail both on the part of the physician and the patient? I argue that we must begin by distinguishing a right to PAS qua "external" to a particular physician-patient relationship from a right to PAS qua "internal" to a particular physician-patient relationship. The former constitutes a negative claim right in rem that prohibits outside interference with the exercise of a right to PAS while the latter can provide the patient with a positive claim right in personam to obligatory assistance from his physician. Importantly, I argue that the creation of such a patient right, however, originates with the physician who may exercise an unqualified right of first refusal prior to promising to help her patient commit suicide. In doing so, I hope to establish that explicit physician promises of assistance in dying should become legally binding. As such, current PAS law in both the Netherlands and Oregon is in need of substantive modification.

Hosay CK.  Compliance with patients' end-of-life wishes by nursing homes in New york City with conscience policies. OMEGA, Vol. 44(1) 57-76, 2001-2002

Cynthia K. Hosay

  • Abstract: Nursing home patients have a constitutional right to refuse treatment. The Patient Self-Determination Act confirmed that right. State laws address the obligations of health care providers and facilities to honor that right. The New York State law is more specific than those of many other states. It allows exemptions for "reasons of conscience" and imposes a number of requirements on nursing homes claiming such an exemption, including the transfer of a patient to a home that will honor an end-of-life wish. This study, conducted by FRIA,1 investigated the refusal of some nursing homes in New York City to carry out patients' end-of-life wishes because of consciencebased objections. The study also investigated the willingness of homes which did not have such policies to accept patients transferring from a home with a policy so that the patient's end-of-life wishes would be honored. Implications for administrators, policy makers, and regulators are discussed.

Kahlenborn C, Stanford JB, Larimore WL. Postfertilization effect of hormonal emergency contraception. Ann Pharmacother. 2002 Mar;36(3):465-70. Review. PubMed PMID: 11895061.

C. Kahlenborn, J.B. Stanford, W.L. Larimore

  • Objective: To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency contraception (EC) used in the US and to explore the ethical impact of this possibility.

Data sources and study selection: A MEDLINE search (1966-November 2001) was done to identify all pertinent English-language journal articles. A review of reference sections of the major review articles was performed to identify additional articles. Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel, mechanism of action, Plan B. DATA

Synthesis: The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect). The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory, or postovulatory phase of the menstrual cycle.

Conclusions: Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.

McQueen MM, Walsh JL. Pragmatism and conscience: a religious perspective on competing values in embryo experimentation. Linacre Q. 2002 May;69(2):120-32.
PubMed PMID: 12731523.


Pellegrino ED. The physician's conscience, conscience clauses, and religious belief: a Catholic perspective. Fordham Urban Law J. 2002 Nov;30(1):221-44. PubMed PMID: 15868671.

Edmund D. Pellegrino

  • Conscientious persons strive to preserve moral integrity. This requires that their external behavior be congruent with their conscience's internal dictates about what they take to be morally right and feel compelled to do. In our morally diverse world, conscientious persons may come into conflict with each other and with society's moral values. Except for the amoral sociopath, conflicts of conscience are a regular feature of the moral life. Even for extreme relativists, resolving these conflicts is a constant challenge. . .

van Bogaert LJ. The limits of conscientious objection to abortion in the developing world. Dev World Bioeth. 2002 Dec;2(2):131-43. PubMed PMID: 12870481.

Louis-Jacques van Bogaert

  • Abstract: The South African Choice on Termination of Pregnancy Act 92 of 1996 gives women the right to voluntary abortion on request. The reality factor, however, is that five years later there are still more 'technically illegal' abortions than legal ones. Amongst other factors, one of the main obstacles to access to this constitutionally enshrined human right is the right to conscientious objection/refusal. Although the right to conscientious objection is also a basic human right, the case of refusal to provide abortion services on conscientious objection grounds should not be seen as absolute and inalienable, at least in the developing world. In the developed world, where referral to another service provider is for the most part accessible, a conscientious objector to abortion does not really put the abortion seeker's life at risk. The same cannot be said in developing countries even when abortion is decriminalised. This is because referral procedures are fraught with major obstacles. Therefore, it is argued that the right to conscientious objection to abortion should be limited by the circumstances in which the request for abortion arises.