The conscience of the physician. Ethics Medics.
2004 Jan;29(1):2-3. PubMed PMID: 15828146.
Greg F. Burke
Cantor J, Baum K. The Limits of Conscientious Objection - May
Pharmacists Refuse to Fill Prescriptions for Emergency Contraception?
N Engl J Med. 2004 Nov 4;351(19):2008-12. PMID: 15525728 [Project
Julie D. Cantor, Ken Baum
- Health policy decisions are often controversial, and the recent
determination by the Food and Drug Administration (FDA) not to grant
over-the-counter status to the emergency contraceptive Plan B was
no exception. Some physicians decried the decision as a troubling
clash of science, politics, and morality. Other practitioners,
citing safety, heralded the agency's prudence. Public sentiment
mirrored both views. Regardless, the decision preserved a major
barrier to the acquisition of emergency contraception - the need to
obtain and fill a prescription within a narrow window of efficacy.
- Animosity between doctors and medical malpractice lawyers has
reached such a pitch in the United States that the American
Medical Association last week debated a motion proposing that
doctors should refuse medical treatment to such lawyers, their
families, and employees except in emergencies. Although the
motion, brought by Dr Chris Hawk, a surgeon from South Carolina,
was lost, some doctors felt the fact that it was proposed at all
shows how bad relations between the professions have become.
Doctors are angry, among other things, at the effect that
malpractice awards are having on their insurance premiums. . .
John K. Davis
- Patients sometimes request procedures their doctors find morally
objectionable. Do doctors have a right of conscientious refusal? I
argue that conscientious refusal is justified only if the doctor's
refusal does not make the patient worse off than she would have been had
she gone to another doctor in the first place. From this approach I
derive conclusions about the duty to refer and facilitate transfer,
whether doctors may provide 'moral counseling,' whether doctors are
obligated to provide objectionable procedures when no other doctor is
available, why the moral consensus among doctors seems relevant even
though it does not determine whether something is morally acceptable,
and whether doctors should stay out of fields whose standard procedures
they find morally unacceptable.
Denise M. Dudzinski
Delese Wear and Mark G. Kuczewski's criticisms (2004) of the
professionalism movement could be recast as the "potential dangers of
renam(ing) what has been called medical ethics as professionalism." I
discuss two dangers of categorizing medical ethics as a subset of
professionalism, both of which are congruous with Wear and
Kuczewski's arguments. First, ethical principles and ideals may be
concretized to meet dominant goals and interests of a privileged
profession. Without more critical reflection on the implicit values
of medicine, the profession risks marginalizing vulnerable patients,
minority and underrepresented students and physicians, and women.
Second, complex virtues such as integrity might be oversimpliÂªed in
the attempt to better measure outcomes.
T Faunce, S Bolsin, W-P Chan
- Conflicts between the ethical values of an organisation and the
ethical values of the employees of that organisation can often lead
to conflict. When the ethical values of the employee are considerably
higher than those of the organisation the potential for catastrophic
results is enormous. In recent years several high profile cases have
exposed organisations with ethical weaknesses. Academic medical
institutions have exhibited such weaknesses and when exposed their
employees have almost invariably been vindicated by objective
inquiry. The mechanisms that work to produce such low ethical
standards in what should be exemplary organisations are well
documented and have been highlighted recently. The contribution of
elements of medical training in eroding ethical standards of medical
students have also been emphasised recently and strategies proposed
to reduce or reverse this process. The ability to rapidly change the
ethical and professional culture of graduate medical trainees may
help to deal with some of the perceived problems of declining ethical
standards in academic medicine.
Susan Berke Fogel, Lourdes A. Riveray
- This article advocates for legislative action against the "religious
exemptions" or "conscience clauses" used by religiously-affiliated
healthcare facilities, particular in the context of refusing
abortion, sterilization, and other reproductive health services. Among
other recommendations, the authors call for religious exemptions on
the individual rather than institutional level; that the religious
exemption be disallowed in rural areas or situations where reasonable
alternatives are unavailable; and a requirement that complete,
medically accurate information be made available regardless of a
Vaccines and the right of conscience.
Bioeth Q. 2004 Spring;4(1):53-62. PubMed PMID: 15192850.
Edward J. Furton
- As a father of five, I have been confronted with the question of
whether to vaccinate my children against rubella ("German measles").
As many now know, this vaccine is currently produced from a cell line
that had its origin in abortion.1 Two other vaccines are similarly
implicated in the tragedy of abortion: the hepatitis A and the new
varicella ("chicken pox") vaccines. As unfortunate as these facts are,
an analysis of the problem, using traditional Catholic moral
principles, does not seem to indicate that there is any obligation on
the part of parents to avoid the use of these products. For my own
part, therefore, I have not hesitated to have my children protected
against these diseases. . .
- Abstract: A growing concern exists about the
tensions that may be found between medical professionalism and the
concept of conscientious objection, on the part of physicians and other
healthcare professionals, regarding healthcare decisions made by
patients or their surrogates. This tension reflects the concept of what
it means to be a healthcare professional in contrast to one's strongly
held personal or religious ethical convictions. The major concerns
revolve around issues at the beginning or at the end of life. These
issues must be addressed to avoid serious conflicts with those for whom
healthcare professionals have a duty to serve.
- David Steinberg (2004) makes a strong case for an "optin" system
to increase the supply of transplantable organs. The incentive to
receive preference in organ allocation by agreeing to be a donor
oneself would surely motivate more people to donate. While the
requirement to donate may be perceived as mildly coercive, it seems
more like a little nudge to go ahead and do what one clearly ought to
do. . .
- For more than thirty years, supporters of legalized abortion have
publicly advocated for the practice as a matter of "choice."' Initially,
these advocates argued for a "right to choose" to be free from
governmental interference in the decision to abort. In 1971, Sarah
Weddington, who represented Jane Roe2 in the case of Roe v. Wade,3
argued before the United States Supreme Court for a "liberty from
being forced to continue the unwanted pregnancy ' She argued before
the Court for a negative right, for a restraint on governmental
interference in the abortion decision, not for a positive right of
access or governmental entitlement to abortion. But today, advocates
of legalized abortion argue for governmental facilitation of abortion
and are attempting to shift the debate in the public forum from "choice"
to "access," a state of affairs that implies "coercion" of those
health care providers who disagree. . .
Marla J. Marek
- Objective: To examine nurses' attitudes toward pregnancy
termination in the labor and delivery setting and the frequency of
nurse refusal to care for patients undergoing pregnancy termination.
Design: Nonexperimental, descriptive study. Setting: Six central
and northern California hospitals, including Level 1, 2, and 3
facilities. Participants: Seventy-five labor and delivery
Method: Anonymous survey with visual analog scales.
Results: Ninety-five percent of the nurses indicated they would
agree to care for patients terminating a pregnancy because of fetal
demise, 77% would care for patients terminating a fetus with
anomalies that were incompatible with life, and 37% would care for
patients terminating for serious but nonlethal anomalies, with a
significant drop in agreement as gestation advanced. Few nurses would
agree to care for patients undergoing termination for sex selection,
selective reduction, or personal reasons. Nurses both accepting and
refusing patient care assignments were criticized by coworkers.
Conclusion: Clear guidelines should be established on how to
handle nurse refusal to care for patients terminating pregnancy in
advance. Open discussions should be encouraged between staff and
management to minimize criticism.
Laurence B. McCullough
- The nature and limits of the physician's professional
responsibilities constitute core topics in clinical ethics. These
responsibilities originate in the physician's professional role, which
was first examined in the modern English-language literature of
medical ethics by two eighteenthcentury British physician-ethicists,
John Gregory and Thomas Percival. The papers in this annual clinical
ethics number of the Journal explore the physician's professional
responsibilities in the areas of surgical ethics, matters of
conscience, and managed care.
Murphy S. Access to emergency contraception. J Obstet
Gynaecol Can. 2004 Aug;26(8):705-6; author reply 706-7. PubMed PMID:
- Rebecca J. Cook and Bernard M. Dickens state, "Physicians who feel
entitled to subordinate their patient's desire for well-being to
the service of their own personal morality or conscience should not
practise clinical medicine. " (Emphasis added).
The statement is unsupported by their own legal references, and it has
little to recommend it as an ordering principle in the practice of
medicine. . .
Nikolas T. Nikas
- A series of attention-grabbing lawsuits and a crop of new
legislation have spotlighted a long-gathering movement to vastly
expand the scope of policies allowing health care providers,
institutions and payers to refuse to participate in sexual and
reproductive health services by claiming a moral or religious
objection. In some cases, these radical new policies are
intentionally designed to undermine, if not actually eliminate, the
ability of governments at all levels, and even private businesses,
to balance providers' "conscience" rights with the
ability of patients to exercise their own conscience and gain
access to health care services that they want and need. . .
Venke Sørlie, Annica Larsson Kihlgren, Mona Kihlgren
- Five enrolled nures (ENs) were interviewed as part of a comprehensive
investigation into the narratives of registered nuress, ENs and
patients about their experiences in an acute care ward. The ward
opened in 1997 and provides patient care for a period of up to three
days, during which time a decision has to be made regarding further care
ebewhere or a return home. The ENs were interviewed concerning their
experience of being in ethically difficult care situations and of
acute care work. The method of phenomenological - hermeneutic
interpretation inspired by the French philosopher Paul Ricoeur was
used. The most prominent feature was the focus on relationships, as
expressed in concern for society's and administrators' responsibility
for health care and the care of older people Other themes focus on
how nurse managers respond to the ENs' work as well as their
relationship with fellow EN s, in both work situations and shared social
and sports activities. Their reflections seem to show an expectation of
care as expressed in their lived experiences and their desire for a
particular level and qualitv of care for their own family members. A
lack of time could lead to a bad conscience over the 'little bit extra'
being omitted. This lack of time could also lead to tiredness and
even burnout, but the system did not allow for more time.
Janice Hopkins Tanne
- "Refusal clauses" and "conscience exceptions," which allow US doctors, nurses,
and healthcare workers to refuse to provide certain types of health care to
patients, are being extended to hospitals, insurance companies, pharmacies, and
managed care companies. New legislation may upset the balance between providers who refuse to provide
care to which they have ethical objections and patients' ability to get the care
they want and need. . .
Robert M. Veatch
- Abstract: Research by Siminoff and colleagues
reveals that many lay people in Ohio classify legally living persons
in irreversible coma or persistent vegetative state (PVS) as dead and
that additional respondents, although classifying such patients as
living, would be willing to procure organs from them. This paper
analyzes possible implications of these findings for public policy. A
majority would procure organs from those in irreversible coma or in
PVS. Two strategies for legitimizing such procurement are suggested.
One strategy would be to make exceptions to the dead donor rule
permitting procurement from those in PVS or at least those who are in
irreversible coma while continuing to classify them as living.
Another strategy would be to further amend the definition of death to
classify one or both groups as deceased, thus permitting procurement
without violation of the dead donor rule. Permitting exceptions to
the dead donor rule would require substantial changes in law - such as
authorizing procuring surgeons to end the lives of patients by means
of organ procurement - and would weaken societal prohibitions on
killing. The paper suggests that it would be easier and less
controversial to further amend the definition of death to classify those
in irreversible coma and PVS as dead. Incorporation of a conscience
clause to permit those whose religious or philosophical convictions
support whole-brain or cardiac-based death pronouncement would avoid
violating their beliefs while causing no more than minimal social
problems. The paper questions whether those who would support an
exception to the dead donor rule in these cases and those would
support a further amendment to the definition of death could reach
agreement to adopt a public policy permitting organ procurement of those
in irreversible coma or PVS when proper consent is obtained.
Pro-life nurses and abortion. Natl Cathol
Bioeth Q. 2004 Winter;4(4):665-7. PubMed PMID: 15658023.
- Abstract: The fact that certain vaccines are grown in cell strains
derived decades ago from an aborted fetus is a concern for some. To
understand such concerns, a standardized search identified internet
sites discussing vaccines and abortion. Ethical concerns raised include
autonomy, conscience, coherence, and immoral material complicity. Two
strategies to analyse moral complicity show that vaccination is ethical:
the abortions were past events separated in time, agency, and purpose
from vaccine production. Rubella disease during pregnancy results in
many miscarriages and malformations. Altruism, the burden of rubella
disease, and protection by herd immunity argue for widespread
vaccination although autonomous decisions and personal conscience
should be respected.