- Abstract: Purpose: This research used a descriptive and
explorative design to determine the levels of nurses' organizational
trust and organizational citizenship and to investigate relationships
between the levels of organizational trust and organizational citizenship
Design and Methods: Nurses who had completed their orientation from a
total of 11 hospitals with bed capacities of 100 and located in the European
district of Istanbul were included in the sample for this study. Formal,
written applications and approval of the ethical committee were obtained
from concerned institutions before proceeding with the data collection step.
The Organizational Trust Inventory and the Organizational Citizenship Level
Scale, a questionnaire form including five questions regarding nurses'
personal characteristics, were used in data collection. Data collection
tools were distributed to 900 nurses in total, and usable data were obtained
from 482 nurses. Number and percentage calculations and Pearson correlation
analysis were used to assess research data.
Findings: The results of the present research showed that nurses had a
higher than average level of trust in their managers and coworkers and they
trusted more in their managers and coworkers than their institutions. The
Organizational Citizenship Level Scale indicated that the behavior most
frequently demonstrated by the nurses was conscientiousness, followed by
courtesy and civic virtue, whereas sportsmanship was displayed to an average
extent. An analysis of relationships between nurses' level of
organizational trust and their organizational citizenship behaviors revealed
that nurses who trust in their managers, institutions, and coworkers
demonstrated the organizational citizenship behaviors of conscientiousness,
civic virtue, courtesy, and altruism more frequently.
Conclusions: The findings attained in this study indicated that the
organizational trust the staff had in their institutions, managers, and
coworkers influenced the organizational citizenship behaviors of
conscientiousness, civic virtue, altruism, and courtesy, whereas it had no
effect on sportsmanship behavior. Nurse managers should introduce studies to
improve their subordinates' organizational trust to ensure that they develop
organizational citizenship behaviors, and they should support them in
Clinical Relevance: These topics for nursing services will provide
guidance to managers, particularly to managers of nursing services, in
establishing processes to predict nurses' organizational commitment, job
satisfaction, performance, intention to leave, and other relevant issues.
- Introduction: Is there a moral right to freedom of conscience? Should a
legal right to freedom of conscience be established in each country on
Earth? This essay argues for negative answers to both questions.
The term freedom of conscience might refer to freedom of thought and the
freedom of expression that sustains freedom of thought. In this sense we
might affirm the right of each person to form individual opinions about
the right and the good, about what we owe one another by way of due
consideration of others, and about what is worthy of pursuit in life, on
the basis of free discussion of these matters. In the present discussion,
these freedoms, important as they might be, are not under consideration.
Let us assume freedom of thought and expression are secured. The status
of freedom of conscience in the sense that is our concern in this
discussion is still wide open. . .
Colloquium paper: the difference of being human: morality.
Natl Acad Sci U S A. 2010 May 11;107 Suppl 2:9015-22. Epub 2010 May 5.
PMID: 20445091; PubMed Central PMCID: PMC3024030.
- In The Descent of Man, and Selection in Relation to Sex, published in
1871, Charles Darwin wrote: "I fully . . . subscribe to the judgment of
those writers who maintain that of all the differences between man and the
lower animals the moral sense or conscience is by far the most important." I
raise the question of whether morality is biologically or culturally
determined. The question of whether the moral sense is biologically
determined may refer either to the capacity for ethics (i.e., the proclivity
to judge human actions as either right or wrong), or to the moral norms
accepted by human beings for guiding their actions. I propose that the
capacity for ethics is a necessary attribute of human nature, whereas moral
codes are products of cultural evolution. Humans have a moral sense because
their biological makeup determines the presence of three necessary
conditions for ethical behavior: (i) the ability to anticipate the
consequences of one's own actions; (ii) the ability to make value judgments;
and (iii) the ability to choose between alternative courses of action.
Ethical behavior came about in evolution not because it is adaptive in
itself but as a necessary consequence of man's eminent intellectual
abilities, which are an attribute directly promoted by natural selection.
That is, morality evolved as an exaptation, not as an adaptation. Moral
codes, however, are outcomes of cultural evolution, which accounts for the
diversity of cultural norms among populations and for their evolution
- Why is modern science less efficient than it used to be, why has
revolutionary science declined, and why has science become so dishonest? One
plausible explanation behind these observations comes from an essay First
and second things published by CS Lewis. First Things are the goals that are
given priority as the primary and ultimate aim in life. Second Things are
subordinate goals or aims â€“ which are justified in terms of the extent to
which they assist in pursuing First Things. The classic First Thing in human
society is some kind of religious or philosophical world view. Lewis
regarded it as a 'universal law' that the pursuit of a Second Thing as if it
was a First Thing led inevitably to the loss of that Second Thing: 'You
can't get second things by putting them first; you can get second things
only by putting first things first'.
I would argue that the pursuit of science as a
primary value will lead to the loss of science, because science is properly
a Second Thing. Because when science is conceptualized as a First Thing the
bottom-line or operational definition of 'correct behaviour' is approval and
high status within the scientific community. However, this does nothing
whatsoever to prevent science drifting-away from its proper function; and
once science has drifted then the prevailing peer consensus will tend to
maintain this state of corruption.
I am saying that science is a Second Thing, and ought
to be subordinate to the First Thing of transcendental truth. Truth impinges
on scientific practice in the form of individual conscience (noting that, of
course, the strength and validity of conscience varies between scientists).
When the senior scientists, whose
role is to uphold standards, fail to posses or respond-to informed
conscience, science will inevitably go rotten from the head downwards. What,
then, motivates a scientist to act upon conscience? I believe it requires a
fundamental conviction of the reality and importance of truth as an
essential part of the basic purpose and meaning of life. Without some such
bedrock moral underpinning, there is little possibility that individual
scientific conscience would ever have a chance of holding-out against an
insidious drift toward corruption enforced by peer consensus.
- This paper considers how far a legal-cultural perspective may help
to explain contrasts in approaches, in different jurisdictions, to a
particular legal issue addressed by five national reports on which the
paper comments. The issue is: how should law respond to employees'
objections, on grounds of conscience, to being required to perform
particular work tasks assigned by their employers, or to being required
to perform them in particular ways? The national reports discussed
relate to Japan, the United States, Germany, Israel and Spain. The paper
argues that cultural factors can influence not only law's response but
also the ways in which the issue of conscience is understood,
contextualised and legally presented.
- Abstract: Some US states allow pharmacists to refuse to
dispense medications to which they have moral objections, and federal rules
for all health care providers are in development. This study examines whether
demographics such as age, religion, gender influence 668 Nevada pharmacists'
willingness to dispense or transfer five potentially controversial
medications to patients 18 years and older: emergency contraception, medical
abortifacients, erectile dysfunction medications, oral contraceptives, and
infertilitymedications. Almost 6% of pharmacists indicated that they would
refuse to dispense and refuse to transfer at least one of these medications.
Religious affiliation significantly predicted pharmacists' willingness to
dispense emergency contraception and medical abortifacients, while age
significantly predicted pharmacists' willingness to distribute infertility
medications. Evangelical Protestants, Catholics and other-religious
pharmacists were significantly more likely to refuse to dispense at least
one medication in comparison to non-religious pharmacists in multinomial
logistic regression analyses. Awareness of the influence of religion
in the provision of pharmacy services should inform health care policies
that appropriately balance the rights of patients, physicians,
and pharmacists alike. The results from Nevada pharmacists may suggest
similar tendencies among other health care workers, who may be given latitude
to consider morality and value systems when making clinical decisions about
- Abstract: The provisions of the andalusian Law on rights and guarantees of the dignity
in the process of death, also
known asÂ«act ofdignified
The right to the
the patient, supported,
centers to give
satisfaction, to the
their potential and respecting
those demands. The core
to find the
implementation of the
palliative care, there
questionable proposals, affecting
the rights of doctors: a lack
of understanding of freedom
and professional responsibility,
objection of conscience and
As expressed by the law,
substantial rights of doctors
- The administration of former President George W. Bush and the subsequent
revival of the abortion disputes in the United States have put the ethical
challenges of conscientious objection in the spotlight in many
international journals on bioethics in the last decade. Bioethical analyses
cover a wide range of perspectives: from bedside ethics between women and
physicians, to constitutional analyses of how to protect fundamental needs
in the context of pluralist societies. In the last few years some
clear administrative guidelines have been drawn up, considering the
institutional realities of developed countries, most of them with private
healthcare systems. These include rules that the objection or refusal is an
individual right and not an institutional right and healthcare providers
have a duty to refer a woman to a similar health care service provider.
I would suggest that this is not the reality for many developing
countries . . .
- Abstract: Objectives: To review the literature
regarding pharmacists' roles in preventing unintended pregnancy, review the
relevant laws and policies in the United States to describe pharmacists'
and/or pharmacy's role in policy development related to unintended
pregnancy, and identify partners who pharmacists can work with in this
public health area.
Data sources: A systematic review was conducted focusing on the role of
pharmacists in unintended pregnancy. For practice, articles were
identified in Medline through July 1, 2009, using MeSH and keywords. For
policy, two authors examined the current status of access issues related to
over-the-counter (OTC) status and collaborative practice agreements.
Partners were identified in the reviews and authors' experiences.
Data extraction: English-language, U.S.-based articles that contained
either qualitative or quantitative data or were review articles addressing
pharmacist interventions, pharmacists' knowledge and attitudes regarding
contraception, and pharmacists' comfort and ability to counsel on preventing
unintended pregnancy were included.
Data synthesis: Some improvements to emergency contraception (EC) access
in pharmacies have occurred during the previous decade. Studies focused on
counseling, pharmacist provision of depot reinjection, and pharmacist
initiation of oral contraceptives were positive. No studies linked increased
contraceptive access in pharmacies to lower pregnancy rates. In terms of
policy, the literature described three access-related areas, including (1)
EC and conscience clauses, (2) collaborative practice agreements, and (3)
changes in prescription to OTC status. Pharmacists' partnerships may include
physicians/clinicians, local health departments, family planning
organizations, nongovernmental organizations, and colleges of pharmacy.
Conclusion: Currently, pharmacists may increase access to contraceptives
primarily via EC and use of collaborative practice agreements to initiate
and/or continue hormonal contraceptives. New practice models should be
implemented in community or clinic practices as allowed by collaborative
practice regulations in each state. We encourage researchers and
practitioners to consider a community approach in their endeavors by working
with numerous types of primary care providers and organizations to explore
ways to increase contraceptive access.
- Abstract: Due to the growing number of medical treatments,
physicians - who are also human beings with their own conscience and beliefs
- are increasingly confronted with treatments that may conflict with their
principles and convictions. Although several human rights documents recognize
the freedom of conscience and belief, we could not locate the recognition of
an explicit right to conscientious objection. Furthermore, a direct
application of the right to freedom of thought, conscience and religion, as
recognized by article 9 of the ECHR, does not include such a right due to the
narrow interpretation of this right by the European Court of Human Rights.
However, the Court seems to have taken steps away from this narrow
interpretation in Pichón and Sajous v. France. Notwithstanding these steps,
no general right to conscientious objection exists. Physicians therefore are
dependent on a judgment if they refuse a certain treatment because of
- Introduction: Recently, the discussion regarding the
physicians' "Right of Conscience" (ROC) has been on the rise. This issue is
often confined to the "reproductive health" arena (abortions, birth control,
morning-after pills, fertility treatments, etc.) within the political
context. The recent dispute of the Bush-Obama administrations regarding the
legal protections of health workers who refuse to provide care that violates
their personal beliefs is an example of the political aspects of this
dispute. . .
- Abstract: Although organizational and situational
factors have been found to predict burnout, not everyone employed at the
same workplace develops it, suggesting that becoming burnt out is a complex,
multifaceted phenomenon. The aim of this study was to elucidate perceptions
of conscience, stress of conscience, moral sensitivity, social support and
resilience among two groups of health care personnel from the same
workplaces, one group on sick leave owing to medically assessed burnout (n Â¼
20) and one group who showed no indications of burnout (n Â¼ 20). The results
showed that higher levels of stress of conscience, a perception of
conscience as a burden, having to deaden one's conscience in order to keep
working in health care and perceiving a lack of support characterized the
burnout group. Lower levels of stress of conscience, looking on life with
forbearance, a perception of conscience as an asset and perceiving support
from organizations and those around them (social support) characterized the
- The History: After the Second World War, Japan's
national flag ("Hinomaru," meaning "rising sun") and national anthem ("Kimigayo") have
been two of the most controversial issues in Japanese politics. Leftist
groups have attacked both as symbols of the militarism that resulted in
the invasion of Japan during the war. Throughout the entire history of
post-war Japan, such groups have taken advantage of every opportunity to
protest singing the anthem or paying respect to the flag. The Japan
Teachers Union, which organizes public school teachers, once was
dominated by the Japan Communist Party and, as it has been for a long
time and continues today, is still heavily influenced by leftist
ideology. The union has been organizing protests at school events such as
entrance, graduation, and other ceremonies and union members have further
refused to pay respect to the flag or sing the national anthem. . .
- Abstract: Two areas of ethical conflict in
intercultural nursing â€“ who needs single rooms more, and how far should
nurses go to comply with ethnic minority patients' wishes? â€“ are discussed
from a utilitarian and commonsense morality point of view. These theories
may mirror nurses' way of thinking better than principled ethics, and both
philosophies play a significant role in shaping nurses' decision making.
Questions concerning room allocation, noisy behaviour, and demands that
nurses are unprepared or unequipped for may be hard to cope with owing to
physical restrictions and other patients' needs. Unsolvable problems may
cause stress and a bad conscience as no solution is 'right' for all the
patients concerned. Nurses experience a moral state of disequilibrium, which
occurs when they feel responsible for the outcomes of their actions in
situations that have no clear-cut solution.
- Abstract: Aim. This paper is a report of a study
of patterns of perceptions of conscience, stress of conscience and burnout
in relation to occupational belonging among Registered Nurses and nursing
assistants in municipal residential care of older people.
Background. Stress and burnout among healthcare personnel and experiences
of ethical difficulties are associated with troubled conscience. In elder
care the experience of a troubled conscience seems to be connected to
occupational role, but little is known about how Registered Nurses and
nursing assistants perceive their conscience, stress of conscience and
Method. Results of previous analyses of data collected in 2003, where 50
Registered Nurses and 96 nursing assistants completed the Perceptions of
Conscience Questionnaire, Stress of Conscience Questionnaire and Maslach
Burnout Inventory, led to a request for further analysis. In this study
Partial Least Square Regression was used to detect statistical predictive
Result. Perceptions of conscience and stress of conscience explained
41Ã†9% of the variance in occupational belonging. A statistical predictive
pattern for Registered Nurses was stress of conscience in relation to
falling short of expectations and demands and to perception of conscience as
demanding sensitivity. A statistical predictive pattern for nursing
assistants was perceptions that conscience is an authority and an asset in
their work. Burnout did not contribute to the explained variance in
Conclusion. Both occupational groups viewed conscience as an asset and
not a burden. Registered Nurses seemed to exhibit sensitivity to
expectations and demands and nursing assistants used their conscience as a
source of guidance in their work. Structured group supervision with
personnel from different occupations is needed so that staff can gain better
understanding about their own occupational situation as well as the
situation of other occupational groups.
- Abstract: Background: In elderly care registered nurses (RNs) and nurse
assistants (NAs) face ethical challenges which may trouble their conscience.
Objective: This study aimed to illuminate meanings of RNs' and NAs' lived
experience of troubled conscience in their work in municipal residential
Design: Interviews with six RNs and six NAs were interpreted separately
using a phenomenological hermeneutic method.
Settings: Data was collected in 2005 among RNs and NAs working in special
types of housings for the elderly in a municipality in Sweden.
Participants: The RNs and NAs were selected for participation had
previously participated in a questionnaire study and their ratings in the
questionnaire study constituted the selection criteria for the interview
Results: The RNs' lived experience of troubled conscience was formulated
in two themes. The first theme is 'being trapped in powerlessness' which
includes three sub-themes: being restrained by others' omission, being
trapped in ethically demanding situations and failing to live up to others'
expectations. The second theme is 'being inadequate' which includes two
sub-themes: lacking courage to maintain one's opinion and feeling
incompetent. The NAs' lived experience of troubled conscience was formulated
in the two themes. The first is 'being hindered by pre-determined
conditions' which includes two sub-themes: suffering from lack of focus in
one's work and being restrained by the organisation. The second theme is
'being inadequate' which includes two sub-themes: lacking the courage to
object and being negligent.
Conclusions: The RNs' lived experience of troubled conscience were
feelings of being trapped in a state of powerlessness, caught in a struggle
between responsibility and authority and a sense of inadequacy fuelled by
feelings of incompetence, a lack of courage and a fear of revealing
themselves and endangering residents' well-being. The NAs' lived experience
of troubled conscience was feelings of being hindered by pre-determined
conditions, facing a fragmented work situation hovering between norms and
rules and convictions of their conscience. To not endangering the atmosphere
in the work-team they are submissive to the norms of their co-workers. They
felt inadequate as they should be model care providers. The findings were
interpreted in the light of Fromm's authoritarian and humanistic conscience.
- Abstract: The purpose of this paper is to present the theoretical
and philosophical assumptions of the Nursing Manifesto, written by three
activist scholars whose objective was to promote emancipatory nursing
research, practice, and education within the dialogue and praxis of
social justice. Inspired by discussions with a number of nurse
philosophers at the 2008 Knowledge Conference in Boston, two of the
original Manifesto authors and two colleagues discussed the need to
explicate emancipatory knowing as it emerged from the Manifesto. Our
analysis yielded an epistemological framework based on liberation
principles to advance praxis in the discipline of nursing. This paper
adds to what is already known on this topic, as there is not an explicit
contribution to the literature of this specific Manifesto, its
significance, and utility for the discipline.While each of us have
written on emancipatory knowing and social justice in a variety of works,
it is in this article that we identify, as a unit of knowledge production
and as a direction towards praxis, a set of critical values that arose
from the emancipatory conscience-ness and intention seen in the framework
of the Nursing Manifesto.
- Introduction: Suppose a pharmacist refuses to
dispense pills that induce abortion claiming that dispensing such pills
runs counter to principles he holds dear. Indeed, the pharmacist claims
that forcing him to dispense the pills would violate his freedom of
conscience. He even claims that he would not have become a pharmacist
had he foreseen an obligation to dispense such pills at the time he
entered the profession. Should the pharmacist's job be protected if he
is making a bona fide claim of conscience? And does it matter whether
the pharmacist's objection to dispensing the pills is rooted in
religious or nonreligious reasons?
- One of the most intriguing questions in medical ethics is whether
individual physicians ought to be able to refuse conscientiously to provide
services that patients seek. The issue requires us to delve into difficult
problems, such as the extent to which physicians must subordinate their
interests to those of their current or prospective patients, and how
essential the services physicians object to are as new medical technologies
develop. Despite the difficulty that surrounds this issue, many
bioethicists - like Dan Brock and Mark Wicclair - have tried to address it in a
single journal article. But Holly Fernandez Lynch is an exception. She gives
conscientious objection in medicine (hereafter, "conscientious objection")
the book-length treatment that it deserves. . .
- Introduction: Even in the dire circumstances of rape, incest, or
medical emergency, certain federal and state provisions allow health care
professionals to ignore the needs of women on the basis of ethical and
moral qualms, also known as conscientious refusal. Conscience has been
defined as the private, constant, ethically attuned part of the human
character. It operates as an internal sanction that comes into play through
critical reflection about a certain action or inaction.' With the protection
of certain federal and state regulations, doctors, who vow under the
Hippocratic Oath to do no harm, may turn their patients away
withoutreferrals to other doctors willing to perform abortions. This legal
protection of conscience extends beyond doctors, and also exculpates
pharmacists from liability when they refuse to fill prescriptions for birth
control pills or Plan B emergency contraceptives. This paper seeks to
analyze the basis of the laws protecting conscientious objection in
healthcare and to examine how the legal protection of this behavior
conflicts with the rights and welfare of women. . .
- Abstract: Healthcare professionals often face
complex ethical dilemmas in the workplace. Some professionals confront
the ethical issues directly while others turn away. Moral courage helps
individuals to address ethical issues and take action when doing the
right thing is not easy. In this article the author defines moral
courage, describes ongoing discussions related to moral courage,
explains how to recognize moral courage, and offers strategies for
developing and demonstrating moral courage when faced
with ethical challenges.
- Abstract: This issue's "Legal Briefing" column covers legal
developments pertaining to conscience clauses and conscientious refusal.
Not only has this topic been the subject of recent articles in this journal,
but it has also been the subject of numerous public and professional
discussions. Over the past several months, conscientious refusal disputes
have had an unusually high profile not only in courthouses, but also in
legislative and regulatory halls across the United States. Healthcare
providers' own moral beliefs have been obstructing and are expected to
increasingly obstruct patients' access to medical services. For example,
some providers, on ethical or moral grounds, have denied: (1) sterilization
procedures to pregnant patients, (2) pain medications in end-of-life
situations, and (3) information about emergency contraception to rape
victims. On the other hand, many healthcare providers have been forced to
provide medical treatment that is inconsistent with their moral beliefs. There are two fundamental types of conscientious objection laws. First,
there are laws that permit healthcare workers to refuse providing - on
ethical, moral, or religious grounds healthcare services that they might
otherwise have a legal or employer-mandated obligation to provide.
Second, there are laws directed at forcing healthcare workers to provide
services to which they might have ethical, moral, or religious objections.
Both types of laws are rarely comprehensive, but instead target: (1)
certain types of healthcare providers, (2) specific categories of healthcare
services, (3) specific patient circumstances, and (4) certain conditions
under which a right or obligation is triggered. For the sake of clarity, I
have grouped recent legal developments concerning conscientious refusal into
1. Abortion: right to refuse
2. Abortion: duty to provide
Contraception: right to refuse
4. Contraception: duty to provide
Sterilization: right to refuse
6. Fertility, HIV, vaccines, counseling
7. End-of-life measures: right to refuse
8. Comprehensive laws: right to
- Abstract: Their nursing experience and/or training
may lead students preparing for the nursing profession to have less moral distress and more
favorable attitudes towards a hastened death compared with those preparing
for other fields of study. To ascertain if this was true, 66
undergraduates (54 women, 9 men, 3 not stated) in southeastern USA
completed measures of moral distress and attitudes towards hastening death.
Unexpectedly, the results from nursing and non-nursing majors were not
significantly different. All the present students reported moderate moral
distress and strong resistance to any efforts to hasten death but these
factors were not significantly correlated. However, in the small sample of
nurses in training, the results suggest that hastened death situations
may not be a prime reason for moral distress.
- Abstract: This research was conducted to examine
experiences of nursing students in administering medication in the clinical
setting. Grounded theory was utilized, involving in-depth interviews with 28
final-year students. In this article, we examine the importance participants
attached to conforming to the prevailing culture, and their responses when
offered what they considered inadequate supervision. Three main categories
emerged: norming for the survival of self, conforming and adapting for
benefit of self and others; and performing with absolute conscience.
Subsequently, the model of contingent reasoning was developed to explain the
actions of students. Contingent reasoning was influenced by the relationship
with the registered nurse and individual characteristics of the students.
Contingent reasoning was validated by participants and is discussed in
relation to Kohlberg's theory of moral reasoning and other relevant nursing
literature. This model has the potential to enhance understanding of how
students make decisions, and ultimately to positively influence this
legal analysis of conscientious objections in health care. LL.M.
Short Thesis. Course: Patient's Rights in the Twenty First Century.
Professor: Judit Marcella Sándor. Central European University,
Budapest, Hungary. 29 March, 2010
- The purpose of this thesis is
to demonstrate what would be an appropriate model of the regulation of
conscientious objections in health care. These objections are regulated in many
countries' national legislations, however, some of them fail to provide
safeguards which would secure proper balance between the two conflicting
interests - the health care professional's right to act in accordance with his
conscience and individual's right to access health care.
Therefore, this thesis analyzes regulation of the conscientious objection in the
legal systems of the USA, the UK and the Slovak Republic with respect to the
appropriateness of such regulation and major differences which they include. The
thesis suggests that the protection of conscientious objection in the USA can go
too far and be too excessive, while the UK presents much more appropriate model
of regulation of conscientious objection with certain limitations. Furthermore,
it submits that regulation of conscientious objection in Slovakia consists in
general but vague clause creating the possibilities for future controversies.
The thesis also analyses different opinions on the acceptability of
conscientious objection in health care and finally, it suggests conditions and
limitations of conscientious objection that should be met in the regulation of
national legislations in order to find appropriate balance between the competing
interests of health care professionals and patient.
Sutton EJ, Upshur RE.
Are there different spheres of conscience?
J Eval Clin
Pract. 2010 Apr;16(2): 338-43. PubMed PMID: 20367861.
- Abstract: Interest in understanding the meaning of
conscience and conscientious objection in medicine has recently emerged in
the academic literature. We would like to contribute to this debate in
four ways: (1) to underscore and challenge the existing hierarchy of
conscientious objection in health care; (2) to highlight the importance
of considering the lay public when discussing the role of conscientious
objection in medicine; (3) to critique the numerous proposals put forth
in favour of implementing review boards to assess whether appeals to
conscience are justifiable, reasonable and sincere; and (4) to introduce the
Universal Declaration of Human Rights and the Siracusa Principles into
the dialogue around conscience and suggest that perhaps conscientious
objection is a human right.
Practice against our beliefs. J Christ Nurs. 2010
Apr-Jun;27(2):106-9. PubMed PMID: 20364524.
- Hans's descent started gradually. Shortly after joining the Army, his
superior gave him the task of registering a group of people."For their
protection,"the sergeant told him. A few months later, the sergeant ordered
him to gather the people together and deliver them to a certain walled-in
section of the city."For their protection," he said again. Later, Hans was
part of a detail that escorted those people to waiting trains. They were
traveling to another city for work. Rumors of extermination surfaced, and
people described Jews as "vermin." By the time Hans was transferred a
concentration camp, he was hardened to the fate of the Jews. As Hans
descended into his killer role, the people in authority rewarded him for
obedience and threatened to shoot him if he protested. The soldiers who got
promoted were the most brutal and ruthless in carrying out orders. . .
von Cranach M.
Ethics in psychiatry: the lessons we learn from Nazi
psychiatry. Eur Arch Psychiatry Clin Neurosci. 2010 Nov;260 Suppl
2010 Oct 20. Review. PubMed PMID: 20960004.
- Abstract: Under the Euthanasia Program of Nazi Germany, more than 200,000
psychiatric patients were killed by doctors in psychiatric institutions.
After summarising the historical facts and the slow and still going-on
process of illuminating and understanding what happened, some ethical
consequences are drawn. What can we learn from history? The following
aspects are addressed: the special situation of psychiatry in times of war,
bioethics and biopolitics, the responsibility of the psychiatrist for the
individual patient, the effects of hierarchy on personal conscience and
responsibility, the unethical "curableuncurable" distinction and the
atrocious concept that persons differ in their value.
- Bertha Alvarez Manninen's (2010) exploration of how a bodily integrity
argument might defend the abortion right even if the Supreme Court
assigned fetuses to the category of persons for purposes of
constitutional law has many strengths. As a bioethicist and a legal
scholar, I share both her desire to bridge philosophical and legal
conversations and her conclusion that the abortion right should be
preserved. In this brief commentary, I offer alternate responses to the
two factors driving her project (legislative challenges to Roe and
perceptions of the pro-choice position as "callous") and raise two
unanswered questions in her bodily integrity argument.
- Just as physicians can object to providing services due to their ethical
and/or religious beliefs, medical students can have conscience-based
objections to participating in educational activities. In 1996, the Medical
Student Section of the American Medical Association (AMA) introduced a
resolution calling on the AMA to adopt a policy in support of exemptions for
students with ethical or religious objections. In that report,
students identified abortion, sterilization, and procedures performed on
animals as examples of activities that might prompt requests for
conscience-based exemptions (CBEs). In response to the student initiative,
the Council on Medical Education recommended the adoption of seven
"principles to guide exemption of medical students from activities based on
conscience." The House of Delegates adopted these principles in their